About The Center for Health Care Research & Policy

From the Center's 2006 Progress Report

DIRECTOR’S SUMMARY AND COMMENTS

Since my last report, the Center’s accomplishments have continued to exceed my high expectations. In this annual narrative, I will briefly summarize our academic accomplishments and comment on targeted areas for growth, including our increasing need both to lead and strengthen our partnerships with others in Northeast Ohio.

OVERVIEW OF ACCOMPLISHMENTS

Grants in Research and Training
Center faculty led 12 and collaborated on 6 other newly awarded grants since mid-2005. Our broad-based portfolio of 52 active grants generate over $13M in total support in 2006 and include $8.6M in awards on which Center faculty serve as Principal or Co-Principal Investigator, divided almost equally between research and training. Central themes include the development of methods and descriptive studies as well as prospective trials to improve the quality of care for aging patients and others with chronic conditions in Northeast Ohio. I was especially pleased by new awards to our junior faculty: Andy O’Connor, for a trial to improve community-based care in hypertension, supported by the American Heart Association; Irene Katzan, for an extension of her NIH K23 award on community-based stroke care, to examine racial differences in stroke outcomes, also supported by AHA; and Senior Scholar Jennifer Bailit, for a retrospective cohort study to examine quality of intrapartum obstetric care, supported by the Agency for Healthcare Research and Quality.

Publications
Since the beginning of 2005, Center faculty and Senior Scholars published 110 peer-reviewed articles, book chapters, and invited manuscripts. These included important policy-relevant papers in Medical Care, Health Services Research, and Health Policy, as well as clinical investigations in the New England Journal of Medicine and a number of specialty journals in medicine and health economics. In addition to the anticipated impact of these publications, I was gratified by the number of studies that are co-authored by investigators from multiple disciplines (20) and with trainees throughout the university (13), representing our commitments to multidisciplinary research and to a new generation of leaders in health care and health care policy.

Education, Training, and Mentorship
During this second year of the citywide “Roadmap K12” Multidisciplinary Clinical Research Training Program, we developed five new courses for our trainees under the umbrella of the Masters of Science program in Clinical Research (CRSP), now in its 6th year. These include courses led by our colleagues at Weatherhead and the School of Nursing as well as those developed and taught by faculty at MetroHealth, University Hospitals, and the Cleveland Clinic. I was pleased again this year that our popular "Introduction to Clinical Research" summer course (directed by Doug Einstadter) was attended by a record number of 58 residents, fellows, and junior faculty, leading to additional scholars-in-training that we advise and mentor. Matriculation in the M.S. program continues to grow, and our 16 M.S. graduates reflect the citywide reach of the program, including researchers at CCF (5), UH (7), and MHMC (4).

Individual Awards
Once again in 2006, Assistant Professor of Neurology Irene Katzan receives the award for the most awards! In recognition of her exceptional productivity and commitment to improving regional stroke care, Irene received the Michael Pessin Stroke Leadership Award at the annual meeting of the American Academy of Neurology, the Pacesetter Award for Excellence in Stroke Research from the American Stroke Association Northeast Ohio Branch, and was named, again, among the Best Doctors in America. In addition to Irene, others recognized as “Best Doctors” in Greater Cleveland in 2006 include Neal Dawson (General Medicine), Pat Murray (Physical Medicine and Rehabilitation), and Allan Garland (Pulmonary and Critical Care Medicine) – proving that one can be both an excellent researcher and clinician! Last, but certainly not least, the longstanding academic excellence of Ash Sehgal and Doug Einstadter were recognized by their well-deserved promotions to Professor this year.

Recruitment
We looked long and hard for accomplished candidates to contribute and lead our priority area in clinical research informatics - capitalizing on opportunities to improve quality of care and our research by using MetroHealth’s state-of-the-art electronic medical records (EMR) system. Our diligence and patience were rewarded this year. Rhoderick Machekano, Ph.D., M.P.H. recently joined our Biostatistics and Evaluation Unit from the University of California, Berkeley. Rhoderick has special skills in longitudinal studies and chronic illnesses, and he already is contributing to our EMR-catalyzed project to improve diabetes care and outcomes. We were fortunate to discover Bob Elson, M.D., M.S. in our own back yard! Bob is an informatics-trained family practitioner, joining us part time this year as he completes a large grant to study e-prescribing in Northeast Ohio. Needless to say, we are delighted to have both Rhoderick and Bob aboard!

COMMENTS - TARGETED GROWTH, LEADERSHIP, AND PARTNERSHIPS

Center faculty achieved a record level of grant support in 2006 despite challenging conditions for research funding, both nationally and in our region. At the federal level, we expect that funding available for new research will be flat or declining for two more years, although there are causes for optimism in selected areas that match well with our mission. Targeted growth, leadership, and partnerships are vital to our continued success.

At last year's retreat at Squire Valleevue Farm, Center faculty targeted three priority areas for strategic growth:

• Interdisciplinary research, to provide richer insights into health and health care that are best enabled by disciplinary cross-pollination;
• Creating community-wide health information networks, including the development of a program in clinical research informatics, to improve patient care and research; and,
• Improving the care and outcomes for disadvantaged populations, the elderly, and others with chronic conditions.
  

We are making strong progress in each of these areas, with recent and new grants in research and interdisciplinary training, new faculty to help shape our research in clinical informatics, and a variety of established and new initiatives that are reaching out to examine and improve the care for our community's most needy residents. In the area of chronic disease care, our work is catalyzed increasingly by our ambulatory EMR system, made possible by MetroHealth's visionary commitment in the mid-1990s. Leveraging MetroHealth’s investment, we have several important research and quality improvement initiatives that use our EMR system to study and improve care, supported by grants from federal agencies, the American Heart Association, and the St. Luke's Foundation of Greater Cleveland.

Both leadership and partnerships with others are central to our mission and success. Recognizing our role in regional leadership has become increasingly critical as a result of recent departures throughout the university and the widely publicized economic challenges to Greater Cleveland. As an example, Julia Rose recently stepped up to leadership roles in vacated research posts at the university in aging, adding exciting new opportunities but also adding three more grants to her burgeoning responsibilities in the Center, at the VA, and in the School of Medicine. As another, one of my most exciting recent "callings" was to lead a proposal to the Robert Wood Johnson Foundation to establish a community-wide initiative to measure, report, and improve the care for patients with chronic conditions in Northeast Ohio. My experience in this "Aligning Forces for Quality" application was personally inspiring. I had the opportunity to hear first-hand the passionate commitments of a large number of physicians and other advocates for patient engagement, public health, and more rational approaches to delivering and financing health care. Since the technical underpinnings of our
proposal are driven by state-of-the-art health information technology ("HIT"), I also had the pleasure to connect with and obtain enthusiastic support from regional HIT experts, including Lev Gonick at OneCommunity and the leadership of NEO-RHIO, Northeast Ohio's fledgling but growing regional health information organization. There are a number of truly world-class and visionary HIT experts in our community, creating opportunities through partnerships both to improve our community's health and provide an infrastructure for economic growth.

I am grateful to The MetroHealth System for continued support of Center roles - both as leader and partner - and to our faculty and scholars throughout the university, for their commitment to our mission.

Randall D. Cebul, M.D.
September, 2006