Published September 1, 2016
The UB Primary Care Research Fellowship Training Program has been established through a five-year, $2 million federal grant from the Health Resources and Services Administration.
The program’s aim is to provide rigorous research training leading to successful primary care research career progression at the postdoctoral level. Candidates are recruited by the general clinical units and primary care-related disciplines across UB and nationally. Applications are accepted on a rolling basis with an emphasis on minority and disadvantaged candidates.
“Our intent is to increase the number of health services researchers, which involves taking what has been proved in clinical trials and translating it into either clinical practice or in a community setting,” says John S. Taylor, executive director of development for UB’s Primary Care Research Institute (PCRI), and a co-author of the grant.
“Clinical trials and basic science are all about proving cause-effect relationships,” Taylor says. “But in order to do so, you eliminate confounding variables in your design and thus create an unreal environment.”
“It is difficult to take clinical trial evidence and apply it to the real world because these ideal settings do not exist in a doctor’s office or a low-income community,” he says.
For example, real patients may be illiterate, obese or have other comorbidities that may be confounders excluded in the clinical trials, according to Linda S. Kahn, PhD, research professor of family medicine and the project director who co-wrote the grant application.
Because of these factors, Kahn says that, for instance, a heavily-resourced intervention program developed by the National Institutes of Health (NIH) may not always be able to be implemented in the real word.
“What we would look to do is to adapt some aspects of the NIH protocols,” she says. “We would take a study that has been proved efficacious by NIH and then look to how we can make it work at a safety net primary care practice in a low-income community.”
Taylor says what is often neglected in traditional clinical trials is that often those who are recruited to participate are of higher socioeconomic status.
“We are trying to bridge the reality of the health systems and the existing policy and procedures,” he says. “Typical research topics have a lot to do with how to overcome system failures or system barriers to treatment.”
“Hopefully, the work we all do together will inform medical care in a very practical way,” Kahn says. “As a medical anthropologist, I don’t embark on a study unless I feel it can help physicians, nurses, clinicians and patients — or inform health policy.”
Ranjit Singh, MB BChir, MBA, associate professor of family medicine, vice chair of research and director of the PCRI, says the NIH spends about $30 billion per year on research.
“There is a huge amount of knowledge that is being developed through all of that investment at the NIH that can be used to help patients, but in order to get it to those patients, we have to do this health services research or late stage translational research to take the last steps to get over the finish line.”
The grant supports six postdoctoral fellowship slots per cycle. Taylor says the talent pool for the fellowship training program includes people with both clinical and basic science backgrounds who all share the desire to translate evidence into practice.
Christine Verni, FNP, is a board-certified nurse practitioner who focuses much of her time on emergency medicine. She is the first fellow to be accepted into the training program.
Having been an emergency department nurse for 20 years, she says she sees a lot of patients who do not have health insurance, who cannot get in to see their primary care physicians or who don’t have the resources to adhere to the regimens their primary care providers prescribe.
“One area I see as an opportunity for research is educating emergency department patients in regard to their own health in order to prevent revisits for issues they can manage themselves,” Verni says.
“This is a really great opportunity for me to be able to participate in improving health care delivery to patients,” she says. “I am very excited to be getting guidance on developing research studies that can translate into improved patient outcomes.”
Another aim in the recruitment process is focusing on reaching out to members of underserved groups. “Not only because there is a shortage of people qualified to do this type of translational research, but also because we need underrepresented minorities to be doing that work since they bring a perspective that helps inform the work,” Singh says.
The training program is focused on preparing scholars to conduct and disseminate primary care research related to four health services research training tracks.
The four tracks are directly tied to federal “Triple Aim” research agenda (better health, better care and better value) and will be led by nationally recognized faculty from the PCRI and collaborators who specialize in these areas:
Led by Laurene M. Tumiel-Berhalter, PhD, associate professor of family medicine, this track focuses on all aspects of fostering and supporting patient self-management, especially chronic complex patients and population groups with health disparities.
Chester H. Fox, MD, professor of family medicine, leads this track, which focuses on changing care team workflows, practice improvement science and implementing evidence into practice.
Led by Richard D. Blondell, MD, professor of family medicine, this track focuses on all aspects of medical management of addiction recovery integrated with behavioral health services, screening and brief intervention and referral to treatment.
Singh leads this track, which can focus on any other topic related to primary care or “Triple Aims,” such as obesity, trauma-informed care, patient safety, geriatric end-of-life choice or patient-provider communication.
“By the end of this fellowship, the trainees will be qualified to write and submit an NIH career development award or other NIH grant,” Kahn says. “Some of them will go on to become faculty here at UB or at other institutions.”
Kahn says the early success of the training program reflects the support it has received through the Jacobs School of Medicine and Biomedical Sciences and the primary care-related disciplines in the UB Clinical and Translational Science Institute.
The program represents a partnership consisting of:
Taylor says the infrastructure of the Clinical and Translational Science Award (CTSA) that funds the CTRC allowed them to identify across all disciplines all faculty willing to be mentors, as well as identify fellowship candidates who were able to be documented in the grant application.
“It showed we were ready to ramp up immediately with an array of competent mentorships,” he says. “And it enabled us to win a very competitive grant. Most of the other institutions that were funded were Johns Hopkins University and the like.”