EPI STAKEHOLDERS IDENTIFICATIONpeople.musc.edu/~selassie/EpiDivision/Compiled... · What role do you see Epidemiology playing to address those national trends/priorities? (Probe:

EPI STAKEHOLDERS IDENTIFICATION Stakeholders are those Departments, Colleges, and/or other leaders that you will support on a day to day basis (or wish to support). Complete the following steps for your Stakeholder Analysis:

Stakeholder Need to Interview Method of Interview

1. Ray Greenberg Completed TA face-to-face (08-31-09) 2. Jack Feussner Completed TA face-to-face (09-02-09) 3. Yuko Palesch Completed TA face-to-face (08-27-09) 4. Gail Stewart (Nursing Dean) Completed E. Pickelsimer (09-01-09) 5. Sunil Patel Completed K. Hunt (TBD) 6. Peter Kalivas Completed K. Hunt (TBD) 7. Mark Sothmann Completed JZ face to face (09-01-09) 8. John Raymond Completed AS face-to-face (08-24-09) 9. Perry Halushka Completed AS face-to-face (08-24-09)

10. Arnold Karig (Pharmacy Dean) Completed J. Korte (09-02-09) 11. Bill Hueston Completed E. Pickelsimer (TBD) 12. Tom Uhde Unable to do JN face-to-face (TBD) 13. Steve Lanier (Associate Provost) Unable to do JN face-to-face (TBD) 14. Kathleen Brady Not Assigned 15. Michael Kilby Completed AS face-to-face (08-25-09) 16. Dave Cole Not Assigned 17. Pat Cawley Pending JZ face to face (09-04-09)

1

selassie

Inserted Text

Completed

selassie

Typewritten Text

Completed

Respondent: Dr. John Raymond, Provost Interview summary by: Anbesaw Selassie Date: August 24, 2009 at 11 a.m.

STAKEHOLDER INTERVIEW QUESTIONS 1. Considering what you know about the field of Epidemiology, where do you see the role of Epi at

MUSC? (Probe to find out how they define epidemiology. If time allows ask the first question proposed by the Biostat division so that you can asses if there is awareness about the distinction of the two disciplines)

JR: He sees the role of epidemiology at MUSC from different perspective—education, research, and service. In his opinion, epidemiology has important roles that complement clinical practice and translational research. His understanding of the science of epidemiology includes describing the frequency of diseases, exploring risk factors, and finding solutions to the problems of diseases. Particularly, he highlighted the role of epidemiology in educating future cadres of healthcare workers and providing support in competitive research. In this regard, the placement of DBE in DoM may open some door to work in collaborative projects like “Project Sugar” and “Project Stay”.

B.1. From your experience, how does Biostatistics differ from Epidemiology?

JR: He sees some distinction between the two. Biostat deals with analysis of data and providing methodological approaches to conduct the analysis using mathematical skills. It provides the tools needed to make the best use of data before and after collecting the data. Some clear examples of the former are sample size and power estimation, for the latter will be specific tests for the hypothesis postulated, correcting pitfalls in the data (e.g. missing information). However, he sees significant overlap between the two disciplines and feels epidemiology has more to do with the understanding of the biological processes that could be identified for intervention. Good research has to rely in epidemiology to translate the findings into some action.

2. Currently, how would you evaluate the Epidemiology Program in the following areas at MUSC? (the examples below may need some explanation, especially collaboration and service)

Current Services/Programs High Value

Some Value

No Value Don’t Know

Clinical Epidemiology Collaborative Research (consult on methods design, particular content area e.g. cancer, CVD)

Independent Research (i.e., behavioral, social, health sciences)? Independent and collaborative apply to all the topics

Education Service (e.g., fee-for-service type activities with no intellectual input on design and methods. E.g., CRO)

Health services research Quality improvement studies Social/behavioral epidemiology

1


2. Going forward, which services are “need to have” versus “nice to have?” Inventory of Potential Services/Programs Need to

Have Nice to

Have Don’t need

No Idea

Training in Applied Epidemiology Short Courses in Epidemiology Study design expertise Survey Design and tool development Qualitative Research

3. What national trends do you see that will impact research on this campus (what do we need to be organizing to deliver against or capitalize on, (?) e.g. comparative effectiveness, personalized medicine, Health Disparities, FDA’s Sentinel Initiative—(the 100 million observation relational database underdevelopment by FDA to track outcomes and adverse effects of products and drugs)?

JR: The future of health science research in general relies on maximizing health informatics. Epidemiology and Biostat faculty need to harness their efforts to integrate informatics science to conduct cutting edge research. Health disparities research is expected to remain important to better understand differences in population groups. Especially the science of genomics can provide the key to many of the factors that remained elusive for many years, such as why hypertension is refractory among AA even when treatment adherence is well managed. He resented the loss of some faculty such as Eberhard Voit and Jonas Almedia from DBBE.

4. What role do you see Epidemiology playing to address those national trends/priorities? (Probe: You may want to explain this by indicating the back-seat role epidemiology received in CTSA)

JR: He resented the notion that epidemiology is placed in the back-seat of CTSA. He feels epidemiology has big role in addressing national trends and priorities, from H1N1 flu to cancer. He also feels the exponential increase in healthcare cost is likely to open the door for preventive health services that can provide better opportunity for epidemiologists to be actively involved in preventive health services. In his opinion, good epidemiological studies are essential to address the healthcare crisis in the US and he feels more roles may unfold for epidemiologists at MUSC.

************************************************************************************************************

These two questions are optional (I asked them and they are helpful to compare the perceptions and understanding of the interviewees in the two disciplines.

Biostatistics (Slate and Biostat faculty)


(Please see page 2 for the response)

2


3

B.2. In what ways must Biostatistics evolve to maintain relevance for modern medical research and education? (Probe by asking if statistical services and collaborative work is what is expected from biostatistics)

JR: He feels strong clinical and translational research cannot be attained without having a good cadre of biostatisticians. He values the relevance of Biostat if it meshes well with informatics science (“Bioinformatics”). He expressed concern on the detachment of bioinformatics from DBE and encourages Biostat faculty to capture the opportunity to do informatics research by getting grants that allow “re-birth” of informatics type science to get national prominence.

Respondent: Dr. Perry Halushka, Dean CGS Interview summary by: Anbesaw Selassie Date: August 24, 2009 at 2 p.m.



PH: The key role he sees for epidemiology is in training the next generation of—mainly PhD level—epidemiologists since MUSC is primarily an educational institution. He regrets the diversion of the priorities of the mission of MUSC from education to research because of the need to get funding. While he has no objection to emphasizing research over education, he sees the need for training and educating epidemiologists that are needed to better understand the local health problems quintessential to the practice of epidemiology at MUSC and elsewhere for that matter. In his opinion, epidemiology is the science base for understanding the causes of diseases and the differences in population groups and seeks to understand why such differences exist. If one looks at epidemiology from these perspectives, its role at MUSC for education and research remains important.

B.1. From your experience, how does Biostatistics differ from Epidemiology? PH: He feels Biostat mainly focuses on methods and approaches to better understand the study findings. Epidemiologists mainly conduct investigative work based on what is observed in a population or group of patients, for example stroke among AA. Biostat also differs from epidemiology in that its tool is primarily statistical methods or numerical approaches (e.g., ANOVA, Linear Models, etc.) to test hypotheses. In epidemiology, the tool is mainly biological/pathological and environmental understanding on the occurrence of diseases and what factors increase the occurrence of these diseases. However, he feels the two are close in many aspects.



Some Value






1

Respondent: Dr. Perry Halushka, Dean CGS Interview summary by: Anbesaw Selassie Date: August 24, 2009 at 2 p.m. 2. Going forward, which services are “need to have” versus “nice to have?”

Inventory of Potential Services/Programs Need to Have

Nice to Have

Don’t need

No Idea



PH: He feels research at MUSC can be competitive when there are educationally promoted research. Programs like MSTP can produce well trained clinicians equipped with clinical science and basic science tools. Epidemiology is the science base for decision making in health science. In this regard, he thinks the future of epidemiology is closely linked with unraveling the causes of diseases using current methods of genomics, proteomics, etc. He feels more than the pattern of the trend of diseases; the winners will be those who have the know-how in applying these tools.


PH: In his opinion, the prescription for epidemiology to play major role in competitive research should include the following actions. a) Conducting interdependent and independent research that relies on current knowledge of biomarkers. These suggests the need to work closely with researchers at the bench; b) Getting a training grant in epidemiology to attract talented and competent PhD students and post-doctoral fellows. He states that he has data-based evidence to support this point; c) Informing the MUSC community what epidemiology offers that is different from Biostat. He feels traditional epidemiology may not bode well in this setting (MUSC). He encourages all epidemiologists to go to the NIH website and read Dr. Francis Collins’ vision for NIH. Epidemiologists would be happy to know that the two winners are “Big Science” and “Large Population” studies.

************************************************************************************************************





2

Respondent: Dr. Perry Halushka, Dean CGS Interview summary by: Anbesaw Selassie Date: August 24, 2009 at 2 p.m.

3


PH: He points out that all the comments he stated on the relevance of epidemiology also applies for Biostat. Generally, Biostatistics has done well and is better recognized than Epidemiology, at least in MUSC, because of the two training grants they have. They have attracted 5-7 PhD pre-doctoral candidates yearly which gave them some advantage to publish and compete for more research. Epidemiology needs to emulate the success of Biostat to retain relevance and take the “front-seat” in collaborative research. Nationally, he feels Biostat is well recognized as a necessary tool for research. From his experience, he has not seen a study section that has not included at least one biostatistician and he is not sure about epidemiology. He feels the role of epidemiologists is at times usurped by others, like MDs. He thinks it is threatening to claim to be a statistician because it is a mathematical science but not so with epidemiology.

Respondent: Dr. Michael Kilby, Director Division of ID Interview summary by: Anbesaw Selassie Date: August 25, 2009 at 10 a.m.



MK: He defines epidemiology as the science of the determinants of diseases in population groups to identify how they can be prevented. In MUSC, especially in ID Division, epidemiology has a major role. In the activities of infectious disease division, epidemiology is the first thing assessed to identify patterns and sources of infection. From nosocomial infection control to global investigation of HIV/AIDS, epidemiology is critical to the practice of ID. Particularly, the advent of H1N1 and other potential outbreaks of emerging infectious diseases is a constant reminder about the importance of epidemiology. As he is recently recruited to MUSC, he looks forward to collaborate with epidemiologists at DBE to promote research.

B.1. From your experience, how does Biostatistics differ from Epidemiology? MK: He thinks Biostat has to do more with application of formulae and “cut-and-dry” methods of calculation to test hypotheses and estimate probabilities of risks from a dataset collected to study some health condition. He also feels Biostat and epidemiology are “interdigitated” or intertwined that it is hard to have one without the other. He feels epidemiology is broad in scope allowing the study of social and behavioral determinants of illnesses.



Some Value






1


2. Going forward, which services are “need to have” versus “nice to have?”


Nice to Have

Don’t need

No Idea



MK: He thinks emerging infectious diseases are likely to be major concern in the US with the changes in climate and the contraction of the global boundaries due to modern transportation. Readiness to respond to these infectious agents might require competencies in biomarkers and molecular techniques such as faster methods in DNA finger printing, phage typing, and PCR. Epidemiological research needs to focus in these areas and he wishes to see stronger capacity at MUSC in these biomarker researches.


MK: Epidemiology can gain relevance here or anywhere when it applies the state-of-the-art knowledge on disease detection and evaluation. In his opinion, the relevance of a healthcare discipline is often defined by the size of the problem, new discoveries in disease mechanisms, and the potential for intervention. For epidemiology to have the front-row, integration of molecular and genetic information in epidemiological investigations is critical

************************************************************************************************************





2


3


MK: He feels the emphasis in methods and investigator-initiated research is more relevant to modern medical research than working in CRO type service activities. However, the latter may be important for “bread and butter” of institutional sustenance. In other words, he thinks the decision to put emphasis on one over the other should always be taken in the context of the financial resources available at the institution one serves. This he believes is also true for clinical practice—Doctors don’t want to chase the dollar but it comes out of necessity for survival.

Interviewee: Dr Gail Stuart, Dean CON (9/1/09) Interviewer: Elisabeth Pickelsimer

Stakeholders are those Departments, Colleges, and/or other leaders that you will support on a day to day basis (or wish to support). Complete the following steps for your Stakeholder Analysis:



Response: Epidemiology is essential in a health services center. We require an epi course in our Doctor of Nursing Practice curriculum and PhD program. We would love for someone from your division to teach these online courses for us, in particular in the area of social and applied epi. They could a lot of community participatory research in applied and social epi would be appropriate for that. (Note1: The stipend for teaching these courses would vary from $3500 to $4500 per 3-hour course. She gave me the course description for the epi course. Please come by EP’s office to get a copy if you’re interested.)

(Note 2: I asked about providing %effort for teaching. She provided me with a sheet with the per hourly effort her faculty receive for teaching, which is based on contact hours. She hired Martina Mueller as the CON statistician because she could not get someone from our dept to teach their stat course.) She defined epi as, “the study of health and disease and their social contexts in populations.” Dr Stuart understands epi quite well from a public health perspective and will be an advocate for us.)



Some Value


Clinical Epidemiology X Collaborative Research (consult on methods design, particular content area e.g. cancer, CVD)

X


X

Education X Service (e.g., fee-for-service type activities with no intellectual input on design and methods. E.g., CRO)

X

Health services research X Quality improvement studies X Social/behavioral epidemiology X 2. Going forward, which services are “need to have” versus “nice to have?” Inventory of Potential Services/Programs Need to

Have Nice to

Have Don’t need

No Idea

1


Training in Applied Epidemiology X Short Courses in Epidemiology x Study design expertise X Survey Design and tool development X Qualitative Research (said that CON is only college with a course in QR but need university wide course)

X

3. What national trends do you see that will impact research on this campus (what do we need to be

organizing to deliver against or capitalize on, (?) e.g. comparative effectiveness, personalized medicine, Health Disparities, FDA’s Sentinel Initiative—(the 100 million observation relational database underdevelopment by FDA to track outcomes and adverse effects of products and drugs)?

Response: The CTSA offers a unique opportunity.


Response: Epi should be highly involved in the CTSA. (She was shocked that we are not involved.) Epi needs to determine how to keep afloat. You need students and you should be reimbursed for teaching. (FYI: CON receives 25% of tuition dollars from Graduate Studies. She also stated that they need 20 students per class to break even.)

She suggested that epi determine our mission. (Is it both teaching and research?) What valve do we bring to MUSC. Who are the persons to make this happen?

************************************************************************************************************




Response: They are totally different but it would be good for your students to be exposed to both curricula. (FYI: Leon Gordis was Dr Stuart’s prof at JHU.)

B.2. In what ways must Biostatistics evolve to maintain relevance for modern medical

research and education? (Probe by asking if statistical services and collaborative work is

what is expected from biostatistics)

2


3

Response: Need to be involved in translational research and need to learn more about community based participatory research, an understanding that will be vital to research in the future.

Interviewee: Bill Hueston, MD, Chair, Dept of Family Medicine Interviewer: Elisabeth Pickelsimer

Date: September 4, 2009 FYI: In 2007 Dr Hueston approached the DBBE Leadership Council about merging DFM and DBBE. He would have been chair. He told Dr Tilley that she could be co-chair for one year. After that, she was to step down or retire. (EP: not sure if he told Dr T he wanted her to retire after one year.) Stakeholders are those Departments, Colleges, and/or other leaders that you will support on a day to day basis (or wish to support). Complete the following steps for your Stakeholder Analysis:



“I don’t see a value of epi to the Dept of Family Medicine (DFM). It’s invisible to DFM. Tony Alberg at HCC is the only epidemiologist that FM faculty works with. Have very little knowledge about what the epi group does. DFM does its own epidemiology and Health Services Research in areas such as risk factors for heart disease and peri-natal.”

Note1: For 10 years, Dr Hueston taught an epi course to MUSC medical students.

Note2: He has had bad experiences hiring “analysts” from our department to work with his faculty. The “analysts” were always saying that they had work to do over in our building and could not spend time on what DFM was paying them to do. These faculty are no longer in our dept. He currently employs one “PhD analyst” and is hiring two additional ones with new grant monies coming in soon. Due to having a bad experience with faculty in our dept, he wants to hire “fresh” people and not collaborate with DBE faculty.

Currently, how would you evaluate the Epidemiology Program in the following areas at MUSC? (the examples below may need some explanation, especially collaboration and service)


Some Value


Clinical Epidemiology x Collaborative Research (consult on methods design, particular content area e.g. cancer, CVD)

x


x

Education (Response applies only to medical school and MSCR program.)

x

Service (e.g., fee-for-service type activities with no intellectual input on design and methods. e.g., CRO)

x

Health services research x Quality improvement studies x Social/behavioral epidemiology x

1


Date: September 4, 2009 2. Going forward, which services are “need to have” versus “nice to have?” Inventory of Potential Services/Programs Need to

Have Nice to

Have Don’t need

No Idea

Training in Applied Epidemiology X Short Courses in Epidemiology X Study design expertise X Survey Design and tool development X Qualitative Research (DFM currently collaborates with CON faculty on this.)

X


“Translational research would stretch us. MUSC does not have people who are knowledgeable to carry this out. We are not prepared. We are not prepared to design and set up clinical research. Faculty think that if they pull in an industry-sponsored study that they are researchers. They are not. They need to design their own studies and submit for external funding. However, most just want to follow the easy money.”


“Need more people who can setup clinical trials. Valerie Durkalski is the only person in your dept whom we have worked with who knew how to do this.”

************************************************************************************************************




“Epi is more on the front end of developing a clinical trial (ie, developing the protocol and methods). Biostats is much more involved with the back in (ie, analysis).”

2


Date: September 4, 2009

3




“The DCU is what DFM needs. Paul Nietert has worked with us for awhile. Biostats should

decide who their customers (EP: MD PIs) are. Biostat customers are like patients to MDs.

Biostats should go for the wealthier customers (EP: depts.) to pay the bills. As an example,

the radiologists need to serve the patients first; independent research would come second.”

EP: Dr Hueston thinks that DBE faculty should assist MUSC clinicians with establishing their

clinical research. I asked him who would pay for this service. He responded that he does

stuff without compensation all the time. I have worked with Dr Hueston on the COM

Employee Perspective Task Force Committee for the past two years. He is a very capable

chair of that committee and he does a lot of work for it. I think he was being completely

serious when responding to these questions.

EP: I told Dr Hueston that if he presented his ideas at one of our faculty mtgs that the

faculty would probably “boo” him. He said that’s okay. Perhaps we should invite him to

attend.

Respondent: Dr. Sunil Patel, Co-Chair of Neuroscience Interview summary by: Kelly Hunt



Response: It is very important. We need to have two epidemiologists for every biostatistician. Please see subsequent responses. Difference between Epidemiology and Biostatistics: He used a very nice analogy. He said that epi and biostat had a relationship similar to math and physics. Math is a tool required for physics, but knowing math does not make you a physicist. He even went on to use the example of Einstein who was definitely a physicists as well as a mathematician. He said no matter how good of a mathematician Einstein was, if he had also not been a physicist he would not have come up with the theory of relativity. The role of epidemiologists is to identify the questions to be asked. Because of our training in substantive areas and our understanding of populations, we are able to develop research hypotheses. If you ask the wrong question, it does not matter how well the study is conducted or what type of analyses are completed. We use biostatistics as a tool to answer our questions. At a medical university it is very important to identify the correct questions. He also said that epidemiologist were important because we defined disease in terms of its impact on the population. This is an important perspective that physicians often do not have – disease in the context of public health.



Some Value



X


X


X

Health services research X Quality improvement studies X Social/behavioral epidemiology X

1


2. Going forward, which services are “need to have” versus “nice to have?” Inventory of Potential Services/Programs Need to

Have Nice to

Have Don’t need

No Idea

Training in Applied Epidemiology X Short Courses in Epidemiology X Study design expertise X Survey Design and tool development X Qualitative Research X


He thought that given our population, health disparities was a key area that our research should capitalize on. He mentioned that if we were going to be a leader in South Carolina then focusing on Health Disparities was critical. He said that he believed epidemiologist were critical to the study of health disparities. We are the ones capable of asking the correct questions with respect to health disparities.


He was very surprised and concerned to hear that we were not highly involved in the CTSA. He thought that Epidemiology should play a critical role on this campus and had not realized that we took a backseat to biostatistics in our department.

************************************************************************************************************




2


3




Respondent: Dr. Peter Kalivas, Co-Chair of Neuroscience Interview summary by: Kelly Hunt



He thought that it was very important to have epidemiologist, but he did not really know what we do. He said that many of his colleagues valued epidemiologist and he was convinced that we were definitely required to have on campus. He knew that there were definite differences between epidemiologist and biostatisticians and saw us as more involved in the research form the beginning whereas the biostatisticians just want the data.



Some Value



X


X


X

Health services research X Quality improvement studies X Social/behavioral epidemiology X 2. Going forward, which services are “need to have” versus “nice to have?” Inventory of Potential Services/Programs Need to

Have Nice to

Have Don’t need

No Idea

Training in Applied Epidemiology X Short Courses in Epidemiology X Study design expertise X Survey Design and tool development X Qualitative Research X

1

Respondent: Dr. Peter Kalivas, Co-Chair of Neuroscience Interview summary by: Kelly Hunt

2



He said that he believed that epidemiology was important to have at MUSC and that he would do what ever he could to help us.

************************************************************************************************************







selassie

Typewritten Text

selassie

Typewritten Text

Interview Compiled by Tony Alberg Interviewees: Ray Greenberg, John Feussner, Yuko Palesch

Respondent: Dr. Arnold Karig, Dean of Pharmacy Interview summary by: Jeff Korte



(Please see narrative at the bottom of page 3)



Some Value





Health services research Quality improvement studies Social/behavioral epidemiology 2. Going forward, which services are “need to have” versus “nice to have?” Inventory of Potential Services/Programs Need to

Have Nice to

Have Don’t need

No Idea



1

Respondent: Dr. Arnold Karig, Dean of Pharmacy Interview summary by: Jeff Korte

2


************************************************************************************************************





**********************************************************************

September 4, 2009 Today I met with Arnold Karig, MUSC Dean of the College of Pharmacy, and John Bosso, chair of the Dept of Clinical Pharmacy and Outcomes Sciences. Dr. Karig said he was only vaguely aware of the biostatisticians on campus, and had not previously known that there were epidemiologists on campus. Accordingly he said his answers to the questionnaire would be “don’t know” all the way down. He had heard of epidemiologists, though, and when I asked, he offered that he conceptualized biostat as dealing with data, and epi as dealing with populations. Dr. Bosso was a little more aware of us, through his collaborations with Patrick Mauldin in his department, and in turn through Dr. Mauldin’s relationship (married) with Val Durkalski. Bosso listed several areas where he thought it would be very helpful to have an epidemiologist at the table: notably the outcomes research going on in his department, and the Center for Medication Safety housed in the other department (Rick Schnellmann, chair, Pharmaceutical and Biomedical Sciences). Bosso said that he thought being in the dept of Medicine might be a strong environment for us, with lots of potential for collaborative research. Karig and Bosso both thought that we would do well to offer both short courses in epidemiology methods, for which they thought there would be lots of interest; and semester-long courses, which they expected a variety of programs around campus would want to have available to their students. On the topic of collaborative roles versus conducting research as a principal investigator, Bosso offered his opinion that being an independent investigator was becoming an antiquated notion, and that the future lay in collaborative working groups. He said that a researcher proves his worth in these types of situations by demonstrating the unique strengths that she or he brings to the group, and the unique contributions that she or he has made. Karig volunteered that we need a marketing plan for ourselves, to increase our visibility etc.

MARK SOTHMANN, PHD 9-1-09 ( INTERVIEWED BY ZAPKA* OBSERVATION)



When asked about familiarity with Epi activities on campus MS replied he had chaired a committee (dealing with funds flow/tuition issues) and worked with Barbara Tilley. Given his background he noted he was more familiar with medical informatics and bioinformatics issues. Emphasized his hiring of Lee Saunders, one of our Epi PhD graduate students –an example of familiarity of epi work and some of faculty involved in traumatic brain injury. Referred also to the work of Kit Simpson’s expertise in health services research who ‘worked extensively” with our Department. (He seemed interested to learn that I had mentored one of his faculty as part of RCMAR and a PhD nursing student who works extensively with Dr. Kraus—and inquired about my research interests)

2. Currently, how would you evaluate the Epidemiology Program in the following areas at MUSC? (the examples below may need some explanation, especially collaboration and service) See notes


Some Value



x


Education x Service (e.g., fee-for-service type activities with no intellectual input on design and methods. E.g., CRO) ???

Health services research x Quality improvement studies x Social/behavioral epidemiology x When introducing the subject of degree programs and course work, MS described his on-going efforts to work with the School of Public Health in Columbia to get an MPH satellite program in the low country. He acknowledged the delicate nature of the discussions and the need not to compete with Arnold SPH. But he is convinced a “generic” MPH is of great interest for clinicians (? translate applied studies). Mentioned the MSCR needed more health services applied focus.

1

2. Going forward, which services are “need to have” versus “nice to have?” See notes above. MS noted that we (CHP and Epi faculty) should have more discussion about mutual interests in courses. This led to a discussion of difficulty of faculty support teaching. He offered comments on the tuition debates and lack of clarity about funds flow—relating his own difficulty in keeping degree programs. He queried about the moral of faculty, and offered encouragement that weathering the storm was important as he very much valued the work we do—we need to appreciate the change is to “structural issues” and the Provost has limited control . “There is no fundamental logic to the tuition matrix. “ “Are faculty open to teaching in other Colleges/departments?” Inventory of Potential Services/Programs Need to

Have Nice to

Have Don’t need

No Idea

Training in Applied Epidemiology x Short Courses in Epidemiology Study design expertise x Survey Design and tool development x Qualitative Research

What national trends do you see that will impact research on this campus (what do we need to be organizing to deliver against or capitalize on, (?) e.g. comparative effectiveness, personalized medicine, Health Disparities, FDA’s Sentinel Initiative—(the 100 million observation relational database underdevelopment by FDA to track outcomes and adverse effects of products and


MS referred to IOM reports dealing with disability and rehabilitative sciences and quality of care. These note the importance of health services research to improving outcomes..including disparities. He opined that there is a delicate balance of applied vs theoretical focus. Comparative efffectivness studies are an important oportunity

MS noted the difficulty in promoting epi education – “have to start with the premise no one makes money on it”..needs leadership support.

MS volunteered to bring faculties together to promote networking and foster collaborations “Conversation with CHP faculty could well be mutually advantageous”… seemed interested in the topics we are working on currently.

************************************************************************************************************





2

3

PATRICK CAWLEY MD, MBA 9-4-09 ( INTERVIEWED BY ZAPKA* OBSERVATION)

STAKEHOLDER INTERVIEW QUESTIONS

1. Considering what you know about the field of Epidemiology, where do you see the role of Epi at MUSC? (Probe to find out how they define epidemiology. If time allows ask the first question proposed by the Biostat division so that you can asses if there is awareness about the distinction of the two disciplines)

When asked about familiarity with Epi activities on campus PC replied he didn’t know that much, although several years ago he had done some guest lectures for Barbara Tilley. He jumped into description of John Hefner’s work (his predecessor) forming a Center for Patient Safety and Clinical Effectiveness (? correct name)—a natural for collaborations but the collaborations never fully developed. (* without prompt, PC comments clearly indicated the health services research arena was the connection to Epi for him)

When asked about “what it would take to foster those collaborations”, PC said # 1 “someone has to work it”, and dedicated time is needed. This needs vision because the “potential is massive”…but it will take resources. He stressed the growth in interest in quality improvement studies in the last 10 years. He noted the recent push for residents in General Medicine to do projects is further indication of the interest and emphasis. He noted that Bill Moran and Jack Fuessner “get it”…also acknowledged Kathy Wood and Kit Simpson. Internal Medicine’s effort should be a role model for the specialties. Got into an exchange about how challenging it was to overcome the knee jerk reactions to “research” (he stresses “innovation”). He noted it is hard to move projects from “before-after” review of records, do definition of research questions and studies which “test innovation”.

He stress strategic plans aim at 3 priorities—Change management, innovation, Team science training (Sic Sigma?) These provide opportunities for research collaboration. Little interest in formal courses. He mentioned interesting in “carving out time” for innovation research. Little work in clinical epi; but ideally should be. There is a need to “step back” from hospital and look at broader issues such as disparities (Dartmouth work?) Enthusiastically told story (New Yorker about McAllen Texas (one of highest health care districts in country) –not an issue of unhealthy habits, but a quantity driven health care system. Health reform needs to focus on accountable care organizations. (*Ed. This system change policy piece prompted by a query about clinical epi—I found and printed the article if anyone is interested))



Some Value

No Value

Don’t Know


x


Education Service (e.g., fee-for-service type activities with no intellectual input on design and methods. E.g., CRO) ???

Health services research x Quality improvement studies x Social/behavioral epidemiology 2. Going forward, which services are “need to have” versus “nice to have?” See notes

1

2


Nice to Have

Don’t need

No Idea



PC comments inferred several national efforts are important to what he viewed as applied epidemiology (health services research). He commented on “tangible big bets”. …”comparative effectiveness” does cause some defensiveness with physicians—as they want to “treat the Individual”…hard to change paradigm to “populations of patients”, rather then “individual patients.” Regulatory challenges also provide opportunities…Falls, medication management, transitions and catheter infections were discussed as current examples of non-sexy but critical issues for innovation and improvement. E.g. push for video-monitoring to prevent falls—doesn’t make sense..too late. ..need to test innovative approaches.


PC clearly focuses on the “hospital side”.. he interestingly understands the “research focus of MUSC, but see the role on the hospital side as applied research.

I asked directly how do we make collaborations happen. He responded “start right here”..i.e. with him. He mentioned staff were very interested, e.g. Director of Quality (Chris, Mike??) He noted that one of “nice things about being in (Dept ) medicine” is opportunities for us to work with residents.

************************************************************************************************************




PC clearly indicated he new the difference even though this question was not explicitly asked. He gave several

examples of design needs. Formulation of innovative questions, and study design methods is Epidemiology’s

strength. Stats are the analysts once design decisions have been made.

B.2. In what ways must Biostatistics evolve to maintain relevance for modern medical research and education?

(Probe by asking if statistical services and collaborative work is what is expected from biostatistics)

Documents

EPI STAKEHOLDERS IDENTIFICATIONpeople.musc.edu/~selassie/EpiDivision/Compiled... · What role do you see Epidemiology playing to address those national trends/priorities? (Probe: