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Establishing a Pre-Award Office to Support Research at Intermountain Healthcare“Thank you for your heroic efforts getting us to the finish line, or starting line.”
Brad M. Isaacson, PhD, MBA, MSFResearch Initiatives ManagerOffice of Research
“THE ONLY REAL MISTAKE IS THE ONE FROM WHICH WE LEARN NOTHING.” – HENRY FORD
IDENTIFYING OUR WEAKNESS
BUILDING THE PATH FOR SUCCESSFUL RESEARCH
MINI-ATP
ADJUSTING THE PRE-AWARD WORKFLOW
No oversight
No knowledge
No followup meeting
PROBLEM:Grants were not being submitted on time
ManagementEnvironmentEquipment
“island” not team based
Opinionnot valued
No legacy information
PeopleProcess
No redundancy
One personw/knowledge
No formal process
No history of “prime”
No forms
No intake/kick offNo scientific
expertise
Metrics
No dashboardor tracking
No software for sharing documents
Materials
Computers not adequate for work load
Shauna got a notification
Shauna would see what’s
needed
Subaward
Prime
Admin. Review only
Subaward
Prime
Sent to sponsor
Shaunawould submit
OLD PROCESS
Timelines
Folders (electronic)
Forms
Package for AVP
Direct to team
members
Team plans a “kick off”
NEW PROCESS
OoR receives an email
Team discusses deadline
understands expectations
Project intake planned
Weekly calls planned
Application Submitted
Project manager assigned
15 min. huddles for
updates
When package is complete the
manager reviews
AVP proofs
No mgr. support No PM support No metrics/tracking No Backup or redundancy
No scientific support No “kick off” No package for AVP to proof No Awareness of issues
Issues Corrected
AVP asked to sign
55
85
0
20
40
60
80
100
2015 2016
# of Grants
55% increase in grants submitted since forming the Pre-Award Office
Prior to the Pre-Award Office : 14 +/- 6
After the Pre-Award Office: 21 +/- 2
14
21
7
13
22
19
2321
0
5
10
15
20
25
Q1 2015 Q2 2015 Q3 2015 Q4 2015 Q1 2016 Q2 2016 Q3 2016 Q4 2016
# of Grants for the Pre-Award Office
THE RESULTS
15
35
9
4
10 10
13
16
4
8
13
15
1311
0
5
10
15
20
25
Q1 2015 Q2 2015 Q3 2015 Q4 2015 Q1 2016 Q2 2016 Q3 2016 Q4 2016
Prime vs. Subawards for the Pre-Award Office
Prime Subcontracts
10
15
610
1916
19
14
4
6
1
3
3
3
4
7
0
5
10
15
20
25
Q1 2015 Q2 2015 Q3 2015 Q4 2015 Q1 2016 Q2 2016 Q3 2016 Q4 2016
Federal vs. Private Grants for the Pre-Award Office
Federal Private
A SHIFT TO PRIMESUBMISSIONS
WHO DID WE TARGET?
N=38N=6 N=4
N=8 N=1 N=3
$25,499,185
$7,649,800
$33,148,985
$66,776,041
$24,845,471
$91,621,511
$0
$20,000,000
$40,000,000
$60,000,000
$80,000,000
$100,000,000
Direct Indirect Total
Submissions on Annualized Basis
2015 2016
PRIVATE AND FEDERAL FUNDING WE APPLIED FOR BEFORE AND AFTER THE PRE-AWARD OFFICE ESTABLISHMENT
RESEARCH IS ALIGNING WITH INTERMOUNTAIN’S MISSION AND POPULATION HEALTH
Characterizing and Quantifying Challenges and Opportunities in Outpatient Care that Lead to an Emergency Department (ED) or InstaCare Visit
U.S. emergency departments treat
approximately 136 million patients
annually at a cost of $48.3 billion
Study Aim• Understand the predominant causes and effects
of the challenges and opportunities of outpatient care
• Improve education/training for patients and their providers
• Reduce cost• Decrease unnecessary healthcare utilization• Enhance patient safety and safety initiatives
National Child Traumatic Stress Initiative —Category II Treatment and Service Adaptation (TSA) Centers
Each year in the state of Utah over 50,000 children receive medical care after potentially
traumatic experiences and over 5,000 are evaluated in children’s advocacy centers.
Study Aim• Develop an Evidence-Based Care Process Model (EB-
CPM) and decision support tools for pediatric traumatic stress
• Implement and assess pediatric traumatic stress EB-CPM for frontline healthcare providers in primary care and children’s advocacy centers
• Provide national leadership on the use of care process models in trauma exposed children
ePneumonia: Development of an Electronic Clinical Decision Support System for Community-Onset Pneumonia
Pneumonia acquired in the community is the
eighth leading cause of death in the U.S.,
and accounts for over six million cases and
1.1 million annual hospitalizations.
Study Aim• Develop an electronic clinical decision support
systems (ePneumonia) for portability to the >500 hospitals and healthcare networks (iCentra)
• Evaluate the usability of ePneumonia and impact on clinical, patient-centered, and healthcare resource utilization outcomes
• Develop ePneumonia in a Standards-Based Services platform with interoperability across most EHR and widespread potential scalability
13771515 1471
1583 1589OPEN STUDIES 2012-2016
1 2 3
PI: Julie BradshawTotal Funded: $509,070
PI: Brandon Webb, MDPending: $2,245,581
PI: Todd Allen, MDTotal Funded: $287,000
RESEARCH IMPACT — Study shows that integrating mental and physical health through primary care teams results in better clinical outcomes and lower costs.
Brenda Reiss-Brennan, PhD, APRN, et al. 2016
10-YEAR STUDY 2003-2013
113,452 Unique patients
113 Primary care providers
27 Team-based care (TBC) medical practices
75 Traditional practice management (TPM)medical practices
SCREENED FOR DEPRESSION
TBC TPM
46.1%
24.1%
DOCUMENTEDSELF-CARE PLAN
TBC TPM
48.4%
8.7%
ADHERED TODIABETES PROTOCOL
TBC TPM
24.6%19.5
EMERGENCY ROOM VISITS
Reduced
23%
HOSPITAL ADMISSIONS
Reduced
10.6%
PRIMARY CARE ENCOUNTERS
Reduced
7%
PAYMENTS TO PROVIDERS
Reduced
3.3%
($3,401 for TBC vs. $3,516 for TPM)
Savings of $115.00 Per patient per year (PPYR)
Savings of over $13 Million per year
$
CUSTOMER SERVICE“One good experience is shared with 1-3 people, but a negative experience is typically shared with 10-15.” – Brent James
CUSTOMER SERVICE
Use the Pre-Award Office Again Recommend a Friend
“One good experience is shared with 1-3 people, but a negative experience is typically shared with 10-15.” – Brent James
* Over the past 6 months, our mean customer service scores > 95% and respondents have given us a perfect score > 80% of the time
WHAT IS THE FUTURE OF THE PRE-AWARD OFFICE?
• “Research on a Napkin”
• Subject matter expertise and Research Director support
• Mock study sections
• Targeted solicitations and developing an investigator registry
• Supporting types I-IV research
SPECIAL THANKS TO
• Pre-Award Team
• Research Operational Leadership Team
• Office of Research, Homer Warner Center, Clinical Programs
• Mini-ATP Administration
• And many more….
QUESTIONS?
“Thank you for your heroic efforts getting us to the finish line, or starting line.”
BACKUP SLIDES
Time Period of Engagement with Customers
n=26
Roles of the Customers and Services Utilized in the of Office of Research
(n=5)
(n=2)
(n=11)
(n=8)
(n=12)
(n=5)
(n=19)
(n=12)
Customer Service Data for Mini-ATP (Pre and Post Intervention)
• A two-tailed paired sample’s t-test with an α = 0.05 indicated that all changes pre and post were statistical significant for those that have worked with the Office of Research.
Assessing Statistical Significance with Repeat Customers
Mean N
Std.
Deviation
Std. Error
Mean
Sig. (2
tailed)
PM_Pre 36.7 18 37.9 8.9
PM_Post 79.8 18 21.7 5.1
Transparency_Pre37.4 18 35.2 8.3
Transparency_Post76.0 18 21.9 5.2
Admin_Pre37.2 18 32.1 7.6
Admin_Post76.2 18 24.3 5.7
Editorial_Pre30.2 17 37.9 9.2
Editorial_Post 64.6 17 29.7 7.2
Science_Pre 19.8 17 28.1 6.8
Science_Post 48.6 17 35.2 8.5
Trust_Office_Pre 34.1 18 35.3 8.3
Trust_Office_Post 72.7 18 28.2 6.6
Pair 5
Pair 6
0.000
0.000
0.000
0.001
0.004
0.000
Paired Samples Statistics
Pair 1
Pair 2
Pair 3
Pair 4
Evaluating the Impact of our Change on Roles and Grants Submitted
Dedicated Project
Manager
Transparent Process
General Administrative
Support
Reviewer/Editing Expertise
Staffed Scientist
Trust in the
Process
Trust in the Leadership
Operations/Administrators (n=5) + 49% + 49% + 41% + 42% + 28% + 50% + 61%
Physician Investigators (n=7) + 54% + 40% + 56% + 46% + 29% + 45% + 43%
Non-physician Investigators (n=6) + 31% + 31% + 21% + 12% + 6% + 25% + 34%
The Intermountain Healthcare Customer Service data was further segmented into roles to determine how these groups were effected.
Dedicated Project
Manager
Transparent Process
General Administrative
Support
Reviewer/Editing Expertise
Staffed Scientist
Trust in the
Process
Trust in the Leadership
None, 0 Grants per Year (n=3) + 24% + 24% + 19% + 6% + 7% + 2% + 15%
Low, 1-2 Grants per Year (n=6) + 53% + 42% + 58% + 40% + 42% + 41% + 40%
High, 3-5 Grants per Year (n=6) + 34% + 28% + 28% + 41% + 28% + 45% + 51%
Super, 6-8 Grants per Year (n=1) + 42% + 77% + 76% + 27% + 16% + 57% + 62%
Examining the Profile of the DataTrust in the Office of Research (Prior to the Pre-Award Office)
Trust in the Office of Research (After the Pre-Award Office)
Trust in the Office of Research Leadership (Prior to the Pre-Award Office) Trust in the Office of Research Leadership (After the Pre-Award Office)
Trust in the Process
Trust in the Leadership
Understanding the Impact to Quality
Pearson Correlation Coefficients: Highlighting the Direct Relationships
Trajectory Charts: Going from a 50,000 to a 1,000 Foot View
Increased trajectory for 89% of cases