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Implementing System Interventions to Close the Discovery-Delivery Gap

Bryan J. Weiner, PhD
Gillings School of Global Public Health
University of North Carolina at Chapel Hill

What's the problem?

In 2003, the NIH launched a fundamental restructuring of the clinical research enterprise. The goal was to advance the science of discovery and accelerate the translation of research findings into clinical care by conducting research in community-based settings -- the settings in which most people get their care.

The NIH has used several mechanisms, including provider-based research networks (PBRNs), to increase the participation of community-based providers in research and to enhance dissemination and implementation of evidence-based clinical services PBRNs are collaborative partnerships between community-based providers and academic institutions that are formed to conduct clinical research on an ongoing basis.

Some evidence suggests that PBRNs are challenging to implement and sustain. Also, little is known about how well PBRNs actually promote the use of evidence-based clinical services in community-based practice settings. An important component of this lack of knowledge is the dearth of information about the organizational factors that facilitate or hinder the implementation of PBRNs. This lack of knowledge about organizational factors is especially relevant in this era of health care reform, when the efficiency and effectiveness with which health care services are delivered is of key importance.

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How has this research addressed the problem?

Dr. Weiner, a professor in the Department of Health Policy and Management at UNC, Chapel Hill, is an organizational behavior expert who has focused his research on the adoption, implementation, and sustainability of innovations in health care organizations. He and his research team are completing a multi-year study that has examined the implementation, impact, sustainability, and business case of NCI's Community Clinical Oncology Program (CCOP), a federally funded national PBRN that the NIH sees as a model for PBRNs in other disease areas. Under the overall study, the team has conducted a number of case studies and analyses that have examined specific facets of this issue.

In one project, Dr. Weiner and his team conducted in-depth case studies of three newly funded CCOP organizations to investigate the implementation of the CCOP in community-based practice settings. The analysis found that the three CCOP organizations and their physicians varied in the extent to which they were able to consistently achieve the aims of community-based participation in research. This was due to a number of factors, including their varying levels of organizational readiness for change, limited hospital management support and available resources, and weak implementation policies and practices.

The study also used SEER-Medicare data to examine the impact of the CCOP on clinical practice through a longitudinal analysis of adoption rates of evidence-based cancer therapies (in this case, oxaliplatin therapy for colorectal cancer) by CCOP-affiliated and non-CCOP-affiliated providers. Results indicated that participation in the PBRN was associated with a greater probability of receiving the treatment innovation and high-quality cancer care.

Another longitudinal analysis, conducted among all the CCOP organizations active from 1991 through 2003, helped Dr. Weiner and his team assess the factors that affect sustainability of the CCOP in community-based practice settings. Finally, the team conducted an in-depth case study of five CCOP sites to explore whether community-based providers believe there is a business case for participating in a PBRN and what factors may support such a business case. The study found that a business case may exist if both direct and indirect financial benefits are included and if the time horizon is long enough to allow the benefits to be realized. Communicating these benefits to potential PBRN participants may help them see the business advantages of participating and may help to foster sustained participation.

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Significance of the research & results

This innovative study is a departure from much of the research traditionally conducted by NCI but it is making an important contribution to a priority articulated in NIH's Roadmap for Medical Research. Dr. Weiner's work is filling a major gap in our understanding of the organizational context for cancer care delivery in community settings and it is contributing to the development of theory and research methods in this area. Its findings have provided important insights into how community-based oncology practices function and what factors foster or hinder their ability to provide high-quality cancer care. The results also are giving NCI much-needed information about what it takes to implement and sustain PBRNs and what it can expect from PBRNs as a model for disseminating and implementing evidence-based cancer services in community-based practice settings. The results also will help the NIH apply these findings to PBRNs in other disease areas.

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Recent related publications of interest

Jacobs SR, Weiner BJ, Minasian LM, Good MJ. Achieving high cancer control trial enrollment in the community setting: an analysis of the Community Clinical Oncology Program. Contemp Clin Trials 2013 Mar;34(2):320-5. [View Abstract]

Song PH, Reiter KL, Weiner BJ, Minasian L, McAlearney AS. The business case for provider participation in clinical trials research: An application to the National Cancer Institute's community clinical oncology program. Health Care Manage Rev 2012 Oct 5. [Epub ahead of print] [View Abstract]

Teal R, Bergmire DM, Johnston M, Weiner BJ. Implementing community-based provider participation in research: an empirical study. Implement Sci 2012 May 8;7:41. doi: 10.1186/1748-5908-7-41. [View Abstract]

Carpenter WR, Meyer AM, Wu Y, Qaqish B, Sanoff HK, Goldberg RM, Weiner BJ. Translating research into practice: the role of provider-based research networks in the diffusion of an evidence-based colon cancer treatment innovation. Med Care 2012 Aug;50(8):737-48. doi: 10.1097/MLR.0b013e31824ebe13. [View Abstract]

Carpenter WR, Fortune-Greeley AK, Zullig LL, Lee SY, Weiner BJ. Sustainability and performance of the National Cancer Institute's Community Clinical Oncology Program. Contemp Clin Trials 2012 Jan;33(1):46-54. [View Abstract]

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Last Modified: 17 Oct 2014