Abstract
Background: The HMORN is an excellent laboratory for translational research, being comprised of a diverse group of health care delivery systems with associated research staff.
Methods: We interviewed each HMO on formal organizational characteristics of the research organization (RO) and the delivery system (DS), as well as the structural relationship between the RO and the ‘parent’ system. The interviews focused on TRIP:
modifiers,
facilitators, and
barriers. HMO confidentiality was maintained for all interview data.
Results: Of the 15 HMORN members, 13 HMOs participated, 9 with individuals from both RO and DS, 2 with individuals from RO only, and 2 with individuals from DS only. Our results contain information from interviews, emailed questionnaires sent to all HMOs, and HMO websites. Results are organized by TRIP areas of focus:
TRIP: We assigned a TRIP score for each HMO as follows (% of HMO): 1=no system for TRIP or dependent on individual clinicians (7.7%); 2=TRIP driven by departments or care teams, with some information technology support (38.5%); 3=systematic TRIP plus electronic medical record (EMR) functions and decision support (46.2%); and 4=RO integrated into level 3 above (7.7%).
Modifiers: We created a variable called ‘chaos’ for both RO and DS where 1=no chaos and 5=total chaos. Most felt a minor degree of chaos was beneficial as it initiated improvement measures. Of the 13 HMOs, 7 were ‘academically’ oriented with research tending to focus on mainstream science (e.g., NIH R01 grant support). A 3rd modifier was EMR with variation in data use by various organizations and the degree to which ROs had direct access.
Facilitators: We identified 4 types of facilitators: quality and types of communication between RO and ‘parent’, extent to which interventional research is conducted in the DS, amount of consulting done by researchers in the DS, and the value placed on publishing results.
Barriers: This consisted primarily of issues related to communication, implementing change, and organizational culture.
Conclusions: Based on the results, our recommendations for increasing TRIP are:
ensure integrated development of a master data warehouse;
improve communication with special emphasis on involving researchers more directly with DS teams;
promote further research to identify what works/does not work in implementing TRIP; and
‘think globally, but translate locally.’ Funded by NIH/AHRQ for the HMORN CCSN (Coordinated Clinical Studies Network).
- Received September 11, 2008.
