Building Successful Infrastructures: Lessons Learned in Achieving and Measuring Success

Slide Presentation from the AHRQ 2008 Annual Conference

On September 10, 2008, Kimberly A. Galt, Pharm.D., Ph.D.(c), made this presentation at the 2008 Annual Conference. Select to access the PowerPoint® presentation (2 MB; Plugin Software Help).

Slide 1

Building Successful Infrastructures: Lessons Learned in Achieving and Measuring Success

• Building Research Infrastructure Capacity (BRIC) Program Case Study: Creighton Health Services Research Program
• Kimberly A. Galt, Pharm.D., Ph.D.(c)
  Professor of Pharmacy Practice
  Associate Dean for Research
  Director, Creighton Health Services Research Program (CHRP)
  School of Pharmacy and Health Professions

Slide 2

Creighton University: Building on tradition. Changing lives.

• Shows a picture of the campus of Creighton University
• Location: Omaha, Nebraska on a 120-acre campus adjacent to the downtown business district
• Affiliation: Jesuit Catholic University
• Founded: 1878
• Enrollment: 6,700 from the U.S. and other countries
• Distinctions: Ranked 1st U.S. News and World Report as a Masters level private university 11 years

Slide 3

Objectives of Our BRIC Grant

• Develop both faculty and infrastructure to achieve and maintain a long-term, sustainable health services research effort.
• Implement our Institutional Research Infrastructure Development Plan and a nationally competitive and timely research project.

Slide 4

Institutional Research Infrastructure Development Plan

• Develop the skills and abilities of faculty.
• Develop the infrastructure and provide resources for CHRP research faculty.
• Develop the processes that support forming and maintaining an interdisciplinary health services research team.
• Develop the processes that support timely dissemination of products.
• Prepare a nationally competitive application.

Slide 5

Research Project Aims

• Develop a model to explain technology acceptance in primary care in the clinical decision support context.
• Describe the use and acceptance of technology by Nebraska and South Dakota primary care physicians.
• Predict the likelihood of voluntary implementation of technology and clinical decision support.
• Explore how the findings may be used with Medical Expenditure Panel Survey (MEPS) data to predict the potential impact on prescribing safety.
• Translate the findings back to practitioners for consideration in practice improvement decisions.
• Develop an external research grant proposal (R01).

Slide 6

Faculty Research Scientist Development

Shows four pictures of indiviuals and a group shot of nine people at a conference table.

• Skills
• Performance
• Focus
• Direction

Slide 7

CU In Kind Sources of Infrastructure and Development Support

• Health Futures Foundation (HHF)—launch monies
• School of Pharmacy and Health Professions:
  • CHRP Administrator—10 percent
  • CHRP Administrative Assistant—10 percent
  • Data Management/Analyst Position—75 percent
  • In kind salary/time for 2 faculty (Galt, Paschal)
• School of Nursing:
  • In kind salary/time for 1 faculty (Abbott)
  • Development expenses shared with CHRP

Slide 8

Strategic Development Plan

Phase I

• Creighton Health Services Research Program (CHRP)
• Health Futures Foundation Funding

Phase II

• Build Research Infrastructure Capacity (BRIC) Funding
• Development efforts:
  • CHRP Research Fellow Mentees
  • CHRP Leadership
  • Community Partnerships
  • University Relationships to build sustainable health services research

Phase III

• University contribution to sustain CHRP infrastructure
• BRIC 2 to expand and advance development

Phase IV

• To infinity and beyond!

Slide 9

Strategic Development Plan

Table with these column headings: Blank—Phase I, subheadings HFF and CU—Phase II, subheadings HFF, CU, and BRIC—Phase III (now), subheadings CU Bridge and BRIC 2 ?

Slide 10

Challenges

Within our university:

• Educate academic community to "know health services research" when they see it
• Create an institutional vision of health services research
• Establish "relationships without walls"
• Secure funding to support sustainability

Slide 11

Challenges

Among BRIC scientists:

• Develop clear concept for career trajectory
• Early need for team formation realized
• Additional time needed to form team work
• Engage in simultaneous training and ambitious research product
• Rapidly disseminate research as findings are generated in the research process
• Integration of emerging opportunities onto the project roadmap... revised deadlines
• Success breeds opportunities

Slide 12

Successes

• Shows pictures of two copies of Health Information Security and Privacy Collaborative (HISPC), and logos of the American Pharmacists Association, AHRQ, American Physical Therapy Association (APTA), and the Nebraska Medical Association

Engagement and Dissemination

• Scientific Leadership
• Relationship Leadership
• Translating Research to Service

This project is being supported in part by the grant "Enhancing Clinical Practices through the Adoption of Health Information Technology in Nebraska" through the Nebraska Medical Association and the Creighton Health Services Research Program grant no. 1P20 HS015816 Building Research Infrastructure Capacity from the Agency for Healthcare Research and Quality (AHRQ).

Slide 13

Status of Health Information Technology (Health IT) in Nebraska: Focus on Electronic Health Records in Physician Offices

• Shows photos of files, pills, a woman at a computer monitor, two people looking at a computer, and someone using a handheld device in addition to the logos of the Nebraska Medical association, Creighton University, and CHRP
• Andjela Drincic, M.D.; Mark V. Siracuse, Pharm.D., Ph.D.; Kimberly A. Galt, Pharm.D., Ph.D. (c); James D. Bramble, Ph.D.; Karen A. Paschal, DPT, MS; Amy A. Abbott,Ph.D., RN; Kevin T. Fuji, Pharm.D.; Ted A. Kasha, BS June 5, 2008
• Acknowledgement of sponsors: This project is sponsored by the grant "Enhancing Clinical Practices through the Adoption of Health Information Technology in Nebraska" from the Nebraska Medical Association/Foundation, and in part by grant no. 1P20 HS015816 Building Research Infrastructure Capacity from the Agency for Healthcare Research and Quality (AHRQ). Thanks to Ms. Jamie Barbee for assistance with this manuscript

Slide 14

Successes

• Financial performance: effort to success; cumulative grant application:
  • Line graphs compare grant submission effort with grant submission success over 3 years; numbers are approximate
  • Scale on left reads "Cumulative Dollars (Millions)"
  • Effort starts at about 0.05 and ends at about 1.5
  • Success starts at about 0.05 and ends at about 0.8

Slide 15

Successes

• CHRP cumulative financial performance: 2004 through 2007:
  • Line graphs show external grant dollars awarded, HFF dollars spent, and HFF dollars awarded; numbers are approximate
  • Scale on left reads "Cumulative Dollars (Millions)"
  • External grant dollars awarded starts at about 0.03 and ends at about 0.8
  • HFF dollars spent starts at about 0.03 and ends at about 0.19
  • HFF dollars awarded starts at about 0.12 and ends at about 0.33

Slide 16

"Name Brand" Recognition-Community and Government Relationships

Balloon chart shows Creighton Health Services Research Program surrounded by:

• Systems Engineering Initiative for Patient Safety—University of Wisconsin School of Engineering
• State of Nebraska E-Health Council Office of Rural Health Medicaid
• Quality Improvement Organization (QIO)—CIMRO of Nebraska
• University of Nebraska—Lincoln (UNL)-Qualitative and Mixed Methods Department
• UNL-Buros Institute
• University of Nebraska Medical Center (UNMC)-School of Allied Health
• Professional Associations: Nebraska Medical Association (NMA), Nebraska Pharmacists Association (NPA), Nebraska Health Information Management Association (NHIMA), Nebraska Rural Health Association (NRHA)
• Nebraska Center for Bioterrorism Preparedness
• Consumer Board
• Creighton Center for Health Policy and Ethics
• Veterans Affairs Medical Center (VAMC) Office of Research
• Creighton Health Sciences Center School of Pharmacy and Health Professions; School of Dentistry; School of Medicine; School of Nursing; Health Sciences Library

Slide 17

Growth and Accomplishments of Individuals

Table with these column headings: Health Services Researcher Team—Published abstracts/ manuscript—Federal Grant Reviews—Grants/Contract Submits—Grants/Contract Awards—Presentations—Appointments—Others

Slide 18

Lessons Learned

• Relationships are key to sustainability and success.
• Development and growth requires an organizational champion.
• Scientist faculty must share the vision.
• Funding for infrastructure support is key to success.
• Two years of external funding is an underinvestment to secure sustainability—"too lean and mean."
• Our two years prior to receiving BRIC was an essential "head start."
• Our early successes were important to garner bridge funding (HFF) while we are hopeful for BRIC 2.

Slide 19

How the grant has impacted research activities in the short term

• Obtained external funding to augment the BRIC research project (Nebraska and South Dakota).
• Obtained external funding to extend the research beyond the original BRIC project; related research questions are being asked by State government and BRIC faculty are actively engaged in formulation and conduct of this research.
• Driven faculty to rapidly engage with translation and dissemination opportunities directly related to the research.
• Facilitated interdisciplinary team formation and productivity in health services research.
• BRIC faculty have been sought to mentor other faculty who know of their advancing skills and abilities.
• Employed additional infrastructure staff to support these additional efforts.

Slide 20

How the grant has impacted research activities in the long term

• A higher level of excellence in research is sustainable through the talents of the faculty.
• Expectations within the university now include applying for federal funding in the health services research area.
• A snowball effect is observed as the BRIC faculty are sought as research experts to teach and participate in other projects that faculty need expert mentoring in.
• The university had little experience with AHRQ; the management of this grant resulted in the university research support staff becoming informed and experienced with the agency.
• Health services translational research is now identified with Creighton University by various stakeholders in the State.

Slide 21

Future Plans

• Continue Research Scientist Advancement:
  • Identifying Research Streams for Individuals
  • Identifying Research Platform for Research Team
  • Support grant application development
• Respond to Expanded Interest:
  • New faculty have requested support
  • Expand our external partner engagement
  • Engage scientists outside our university
• Further Develop Sustainability Plan:
  • Extend vision across campus
  • Include others not yet involved

Slide 22

Future Plans-Post Award efforts to Establish Funded Support

Table with these column headings: Participant—External Funding Application Type—Agency or Source—1st Target Date to Apply—2nd Target Date to Apply

Slide 23

How do we sustain what we have developed?

Slide 24

Our rapid success facilitated by federal funding... and now interrupted... forces us to ask...where will we land?

Picture of white 1958 Ford Thunderbird in mid-air heading toward what looks like the Grand Canyon

Slide 25

Contact Information

• Kimberly A. Galt, Pharm.D., Ph.D.(c)
• Professor of Pharmacy Practice
• Associate Dean for Research
• Director, Creighton Health Services Research Program (CHRP)
• School of Pharmacy and Health Professions
• Creighton University
• 2500 California Plaza - Boyne 143C
• Omaha, NE 68178
• kgalt@creighton.edu
• 402-280-4259

• Go to http://chrp.creighton.edu to view CHRP activities and opportunities.