Academic Health Centers Leading Change in the 21st Century (2004) / Chapter Skim
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5 The Academic Health Center as a Translator of Science: The Research Role
5 The Academic Health Center as a Translator of Science: The Research Role
Pages 77-91
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From page 77... ...
. This chapter examines how the research role of AHCs can be used to improve the health of people and develop the scientific evidence base for health and health care.
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From page 78... ...
-- Increasing the emphasis on clinical research in order to translate new discoveries into clinical practice and evaluate current clinical practices, thereby answering questions about what does and does not work in health care. -- Increasing emphasis on health services research in order to improve understanding of the effectiveness and costs of care, especially the impact of new discoveries on the costs of care and treatment patterns.
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From page 79... ...
More proof-of-concept studies in human subjects are needed if new diagnostic and therapeutic approaches are to emerge from the laboratory to enter clinical practice. Such advances have the potential to provide powerful tools that will improve health and fundamentally alter the practice of medicine.
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From page 80... ...
; visits to specialists in the last 6 months of life ranged from two times in Mason City, Iowa, to more than 25 times in Miami; and the proportion of eligible patients receiving beta blockers after a heart attack ranged from 5 to 92 percent (Wennberg et al., 2002)
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From page 81... ...
For example, some complications from treatment or adverse reactions to medications may be reduced as a result of improvements in basic knowledge of treatment effects and patient responses. An improved evidence base will also result, however, from an increased emphasis on clinical, health services, and prevention research that will improve abilities to apply current knowledge, helping, for example, to eliminate recognized problems of overuse, underuse, and misuse (Chassin et al., 1998)
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From page 82... ...
Health services research is a multidisciplinary field of scientific investigation that studies how social factors, financing systems, organizational structures and processes, health technologies, and personal behaviors affect access to health care, the quality and cost of health care, and, ultimately, health and well-being. Its research domains are individuals, families, organizations, institutions, communities, and populations (AcademyHealth, 2002)
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From page 83... ...
Basic research rarely produces findings in the laboratory that can be used immediately in clinical practice. One means of translating basic research into practice is through clinical trials, but they leave many unanswered questions as well.
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From page 84... ...
Despite growing interest in measuring the effectiveness of medical interventions and developing more valid and robust indictors of effectiveness, AHCs face a number of obstacles in accomplishing these objectives. Several such obstacles are considered here, including training of clinical investigators, creation of the organizational processes required for research across the continuum, inadequate federal funding levels, and ethical issues.
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From page 85... ...
Clinical researchers obtain training in both biomedical sciences and clinical practice, both of which are increasing in complexity. Major debts are incurred from the many years of training required to acquire expertise in both research methods and clinical care, and the demands of retaining skills in both areas over time are enormous (Crowley and Thier, 1996; Nathan, 2002)
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From page 86... ...
. Within AHCs, investigators engaged in patient- and population-based studies have not been promoted as rapidly as individual scientists conducting basic research and have more difficulty in obtaining discretionary resources (The Commonwealth Fund Task Force on Academic Health Centers, 2000)
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From page 87... ...
In another example, the University of Virginia created a Department of Health Evaluation Sciences in 1995 to provide multidisciplinary scientific and analytical services to its Health Sciences Center and the rest of the university. These services involve examining the development of new approaches and strategies in such areas as the prognosis and clinical and genetic risk assessment of health and disease; medical decision making; and medical practice delivery for individuals and populations (University of Virginia Health System, 2003)
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From page 88... ...
In estimating the proportion of NIH support for clinical research, the NIH Director's Panel on Clinical Research used a very broad definition of clinical research that included mechanisms of human disease, therapeutic interventions, clinical trials, development of new technologies, epidemiologic and behavioral studies, and outcomes and health services
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From page 89... ...
Healthrelated research and development by private industry increased 382 percent between 1985 and 1997 (The Commonwealth Fund Task Force on Academic Health Centers, 1999)
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From page 90... ...
We discuss here only some of the ethical concerns that must be addressed. First, although both AHCs and private industry can bring benefits to research partnerships, issues related to conflicts of interest can arise, including financial conflicts of interest, potential biases in reporting positive results, researchers' access to complete data, and effects on research priorities (Korn, 2000; Gelijns and Thier, 2002; U.S.
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From page 91... ...
However, clinical, health services, and prevention research will also be necessary to improve understanding of how to improve health and to translate the findings of basic research into clinical and community settings so its benefits will reach people. In the coming decades, AHCs will need to increase their emphasis on research across the continuum, including clinical, health services, and prevention research in addition to basic research.
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