Matthew Hudson, PhD, MPH, is the Cancer Care Delivery Research (CCDR) Director, and Comparative Effectiveness Research (CER) Director for the Greenville Health System. He is also a Clinical Assistant Professor of Biomedical Sciences at the University of South Carolina School of Medicine Greenville, and adjunct faculty member at the Arnold School of Public Health. In this month’s Member Spotlight, he shares his perspective on The Importance of Community and Vitality Promotion to Population Health. Download Dr. Hudson's ROCCStar Profile.
In your article "Achieving Effective Health Service Research Partnerships," you discuss the necessity of researchers and clinical practitioners recognizing their unique perspectives as mutually beneficial and valuable. What steps should be taken to successfully establish these relationships? What key elements help to sustain these relationship?
If researchers and clinical practitioners cling to “their” perspective, care teams will be challenged to recognize mutual benefit-optimal patient care and evidence-based practice efficiency. An inaugural step to advancing partnerships is transitioning from multidisciplinary teams to transdisciplinary teams. Multidisciplinary approaches, though appropriate in some instances, allow stakeholders to retain discipline-specific perspectives. Researchers may advise or direct clinicians to adopt scholarly approaches that fail to model the “real world’ clinical practice. Similarly, clinicians, invested in expeditious quality improvement, may eschew methodological rigor, thereby compromising tenable inferences about intervention impact. The transdisciplinary approach encourages stakeholders (e.g., researchers and clinicians) to jointly develop a shared conceptual framework transcending discipline-specific theories or assumptions. For the health service researcher, this may mean being amenable to pragmatic studies sacrificing a modicum of methodological rigor, yet informing practice-sustainable care modifications. I think researchers struggle with this, as we are well-versed on the perils of confounding, bias, and ecological fallacies. Typically, our zeal to address these concerns mandate warping the clinical care process to such a degree that studies, no matter how internally valid, fail to inform care as it “actually” occurs. So, the first step is to meet the stakeholders in the clinical environment, consider their assumptions, and develop a shared understanding and acceptance of inquiry approaches. While this is the first step, I won’t argue it’s an “easy” step.
Now, sustaining these relationships mandates familiarity and trust: there’s no magic bullet. All stakeholders need to be equally engaged and committed to the partnership. Stakeholders should expect to arrive at loggerheads over some issues. However, if stakeholders feel that each party is, at least, attempting to consider the clinical questions beyond their native conceptual lens, stakeholders will eventually become assured there is a shared aspiration (as opposed to a hidden or conflicting agenda). I think the key is to simply commit to the shared scholarship, especially when it is difficult to do so. My colleagues provided the foundation for this perspective in a series of editorials (including the one I co-authored with Drs. Horner, Russ-Sellers, and Youkey).
Describe why patient-centeredness should emerge as the logic linchpin that connects the distinct aims of clinical providers, health system leadership, payers, and researchers.
Patient-Centeredness (i.e., predicating medical decisions upon patients’ informed values and preferences) is essential. Care teams concede that the patient ultimately reaps the benefits and harms of any potential care strategy. So, providers need to educate patients on treatment risks and benefits and encourage patients to consider this information in the context of their values and ambitions. Care teams also need to hardwire patient input opportunities into care planning. If we assume patent centeredness begets patient satisfaction, patient-centeredness will benefit health care systems via favorable HCHAPS ratings on communication, and other metrics. Researchers are frequently forgotten ambassadors of patient-centeredness. Comparative effectiveness researchers (CER) particularly consider which intervention works best for which patient, under which circumstance. So, CER affirms investment in patient-centeredness by matching the appropriate treatment options to the appropriate patient groups. Care team, researcher, and administrator investment in patient-centeredness may increase treatment adherence and reduced need for subsequent care. The favorable financial impact may convince payers patient-centeredness is a sound and favorable fiscal policy, in addition its moral and ethical premise.
By engaging all stakeholders and creating a multidimensional research team, the likelihood of sustainable change in health care delivery increases. The Research on Care Community strives to foster these relationships as a means of speeding up the translation of knowledge. Please reflect on how your current projects engage multidisciplinary partners and is best positioned for translation.
First, I’d challenge the premise that multidimensional research teams, ipso facto, increase the likelihood of sustained care delivery change (per my response to your first question). I do agree with the spirit of your assertion if I assume the research team addresses clinical challenges informed by the realities of actual clinical practice. To that point, traditional Academic Medical Centers establish the academy as the core enterprise and lynchpin, connecting care systems and health-related programs as ancillaries. While this structure has contributed profound advancements in health and wellness, there is a limitation. This model may be more challenged to develop care-salient inquiry; hypothesis generation may occur independent of clinical practice input. Thus, hypotheses may lack sensitivity to clinical culture, workforce demands, or opportunities evident in actual clinical practice.
Any one of these limitations challenge intervention implementation, sustainability, insight dissemination or integration (Public Health may face similar challenges when developing hypotheses without input from community partners). My health system, one of the newest Academic Medical Centers (AMC), innovated the AMC paradigm. The Greenville Health System serves at the core of scholarly inquiry, and has established unions with Universities to embed academicians into the clinical environment. This is one initiative my colleagues and I facilitate to enhance research saliency and ensure evidence dissemination advancing care quality.
Describe the goals and work of the NCI’s Coordinating Committee for cancer care delivery research (CCDR), for which you are a member.
NCI’s Community Oncology Research Program (NCORP) is a national network of investigators, cancer care provider and academic institutions conducting multi-site cancer clinical trials in diverse, community-based health care systems. NCORP’s research agenda includes traditional aspirations to advance clinical trials informing cancer risk and incidence reduction strategies. However, NCORP is increasingly invested in cancer care delivery research (CCDR). This research examines how social factors, financing systems, organizational structures/processes, health technologies, provider, and individual behavior interact to influence cancer care access, quality, and cost. The Coordinating Committee aligns the scholarship interests of community care systems and researchers bases. Thus, the coordinating committee acts as a liaison between research organizations, NCI and community sites to ensure robust engagement and input into care delivery assessment. The coordinating committee additionally understands data availability is a fundamental antecedent to addressing CCDR aspirations. Therefore, I served on a subcommittee assessing community site’s data characteristics, and infrastructure necessary to extract data.