# Presentation: 369136

## Building Successful Infrastructures: Lessons Learned in Achieving and Measuring Success

**BRIC Program Case Study **
**Creighton Health Services Research Program**

**Kimberly A. Galt, Pharm.D., Ph.D.(c)**
**Professor of Pharmacy Practice**
**Associate Dean for Research**
**Director, Creighton Health Services Research Program (CHRP)**
**School of Pharmacy and Health Professions**

## Location: Omaha, Nebraska on a 120-acre campus adjacent to the downtown business district.

**Location**: Omaha, Nebraska on a 120-acre campus adjacent to the downtown business district.
**Affiliation**: Jesuit Catholic University
**Founded:** 1878
**Enrollment:** 6,700 from the U.S. and other countries.
**Distinctions**: Ranked 1st U.S. News and World Report as a Masters level private university 11 years

**Notes:**
  The 28 Jesuit colleges and universities in the United States are located in 19 states across the country.  The institutions range from major research universities to comprehensive universities, from smaller colleges and universities that combine the liberal arts and professional studies to one strictly liberal arts college.

  In addition to being among 221 Catholic institutions and 1600 independent colleges and universities in the United States, American Jesuit colleges and universities are part of a network of approximately 133 Jesuit institutions of higher learning throughout the world, thus having the distinction of being at once local, regional, national and international.

## Objectives of Our BRIC Grant

- Develop both faculty and infrastructure to achieve and maintain a long-term, sustainable health services research effort.
- Implement our **Institutional Research Infrastructure Development Plan **and a** nationally competitive and timely research project.**

## Institutional Research Infrastructure Development Plan

**Develop** the skills and abilities of faculty
**Develop** the infrastructure and provide resources for CHRP research faculty
**Develop** the processes that support forming and maintaining an interdisciplinary health services research team
**Develop** the processes that support timely dissemination of products
**Prepare **a nationally competitive application

## Research Project Aims

**Develop** a model to explain technology acceptance in primary care in the clinical decision support context
**Describe** the use and acceptance of technology by Nebraska and South Dakota primary care physicians
**Predict** the likelihood of voluntary implementation of technology and clinical decision support
**Explore** how the findings may be used with MEPS data to predict the potential impact on prescribing safety
**Translate the findings** back to practitioners for consideration in practice improvement decisions
**Develop** an external research grant proposal (R01)

## Faculty ResearchScientist Development

**Skills**
**Performance**
**Focus **
**Direction**

## CU In Kind Sources of Infrastructure and Development Support

- Health Futures Foundation – launch monies
- School of Pharmacy and Health Professions
- CHRP Administrator – 10%
- CHRP Administrative Assistant – 10%
- Data Management/Analyst Position – 75%
- In kind salary/time for 2 faculty (Galt,Paschal)
- School of Nursing
- In kind salary/time for 1 faculty (Abbott)
- Development expenses shared with CHRP

## Strategic Development Plan

**Phase I**
- Creighton Health Services Research Program (CHRP)
- Health Futures Foundation Funding
**Phase II**
- Build Research Infrastructure Capacity (BRIC) Funding
- Development efforts:
- CHRP Research Fellow Mentees
- CHRP Leadership
- Community Partnerships
- University Relationships to build sustainable health services research
**Phase III**
- University contribution to sustain CHRP infrastructure
- BRIC 2 to expand and advance development
**Phase IV**
- To infinity and beyond!

## Strategic Development Plan

|  | Phase I |  | Phase II |  |  | Phase III (now) |  |
| --- | --- | --- | --- | --- | --- | --- | --- |
|  | HFF | CU | HFF | CU | BRIC | CU
BRIDGE | BRIC 2
    ? |
| Shared Infrastructure Support |   |   |   |   |   |   |   |
| Expanded Infrastructure |  |  |  |  |  |   |   |
| Shared Mentorship |   |   |   |   |   |   |   |
| Expand Mentorship in University |  |  |  |  |  |   |   |
| Individual Expertise Skills |   |   |   |   |   |   |   |
| Interprofessional Team Skills |  |  |  |  |   |   |   |
| Project Development Skills |   |  |   |   |   |   |   |
| Project Implementation Skills |   |  |   |   |   |   |   |
| Project Dissemination Skills |   |  |   |   |   |   |   |
| Community/Partner Relationships |   |  |   |   |   |   |   |
| Submit a competitive research project for external funding |  |  |  |  |   |  |  |
| Submit several competitive research projects for external funding |  |  |  |  |  |  
 |   |

## Challenges

- Within our university:
- Educate academic community to “know health services research” when they see it
- Create an institutional vision of health services research
- Establish “relationships without walls”
- Secure funding to support sustainability

## Challenges

- Among BRIC scientists:
- Develop clear concept for career trajectory
- Early need for team formation realized
- Additional time needed to form team work
- Engage in simultaneous training and ambitious research product
- Rapidly disseminate research as findings are generated in the research process
- Integration of emerging opportunities onto the project roadmap...revised deadlines
- Success breeds opportunities

## Successes

**Successes**

- Engagement and Dissemination

- This project is being supported in part by the grant "Enhancing Clinical Practices through the Adoption of Health Information Technology in Nebraska" through the Nebraska Medical Association and the Creighton Health Services Research Program grant no. 1P20 HS015816 Building Research Infrastructure Capacity from the Agency for Healthcare Research and Quality (AHRQ).

- Scientific Leadership
- Relationship Leadership
- Translating Research to Service

## Status of HIT in Nebraska:  Focus on Electronic Health Records in Physician Offices

- Andjela Drincic, M.D.; Mark V. Siracuse, Pharm.D., Ph.D.;
- Kimberly A. Galt, Pharm.D., Ph.D. (c); James D. Bramble, Ph.D.;
- Karen A. Paschal, DPT, MS; Amy A. Abbott,Ph.D., RN;
- Kevin T. Fuji, Pharm.D.; Ted A. Kasha, BS
- June 5, 2008

*	**Acknowledgement of sponsors: * This project is sponsored by the grant “Enhancing Clinical Practices through the Adoption of Health Information Technology in Nebraska” from the Nebraska Medical Association/Foundation, and in part by grant no. 1P20 HS015816 Building Research Infrastructure Capacity from the Agency for Healthcare Research and Quality (AHRQ). Thanks to Ms. Jamie Barbee for assistance with this manuscript.

## Successes

**Successes**

## Successes

**Successes**

## “Name Brand” RecognitionCommunity and Government Relationships

**UNL** – BUROS Institute

**UNMC - **School of Allied Health

## Growth and Accomplishments of Individuals

| Health Services Researcher Team | Published abstracts/ manuscript | Federal Grant Reviews | Grants/ Contract Submits | Grants/ Contract Awards | Presentations | Appointments | Others |
| --- | --- | --- | --- | --- | --- | --- | --- |
| J.D. Bramble, Ph.D.
Associate Professor | 10 
(2 not peer –reviewed) | AHRQ Special Emphasis
Panel | 5 | 3 | 18 | NA | NA |
| Karen A. Paschal, PT, DPT, MS
Associate Professor | 9 | NA | 4 | 3 | 10 | Co-Chair State e-Health HISPC committee | NA |
| Mark Siracuse, Pharm.D., Ph.D.
Assistant Professor | 19 | AHRQ Special Emphasis
Panel | 6 | 3 | 26 | State E-Rx Workgroup;
Creighton University IRB | NA |
| Amy A. Abbott, Ph.D., RN
Assistant Professor | 3 | NA | 2 | 1 | 9 | NA | Ph.D. May 2008 |
| Kevin Fuji, Pharm.D.
Instructor | 2 | NA | 4 | 3 | 6 | State PHR Workgroup | Post-grad Fellowship |
| Andjela Drincic, M.D.
Assistant Professor | 12 | NA | 4
 | 2 | 9 | NA | NA |
| Kimberly A. Galt, Pharm.D, Ph.D. (c)
Professor | 18 | AHRQ Study section member | 5 | 5 | 27 | National: AHRQ Study section; several SEPs; NIH SEPs
Co-Chair State E-health council; state e-Rx workgroup; state PHR workgroup; state HISPC committee | Ph.D. (c)  in Research Methods – expected May 2009 |

## Lessons Learned

- Relationships are key to sustainability and success
- Development and growth requires an organizational champion
- Scientist faculty must share the vision
- Funding for infrastructure support is key to success
- Two years of external funding is an underinvestment to secure sustainability - “too lean and mean”
- Our two years prior to receiving BRIC was an essential “head start”
- Our early successes were important to garner bridge funding (HFF) while we are hopeful for BRIC 2

**Notes:**
Identify the relationships that are vital.
Take care of your relationships.
Deliver on expectations and promises.

## How the grant has impacted research activities - In the short term

- Obtained external funding to augment the BRIC research project (Nebraska and South Dakota)
- Obtained external funding to extend the research beyond the original BRIC project; related research questions are being asked by state government and BRIC faculty are actively engaged in formulation and conduct of this research
- Driven faculty to rapidly engage with translation and dissemination opportunities directly related to the research
- Facilitated interdisciplinary team formation and productivity in health services research
- BRIC faculty have been sought to mentor other faculty who know of their advancing skills and abilities
- Employed additional infrastructure staff to support these additional efforts

## How the grant has impacted research activities - In the long term

- A higher level of excellence in research is sustainable through the talents of the faculty
- Expectations within the university now include applying for federal funding in the health services research area
- A snowball effect is observed as the BRIC faculty are sought as research experts to teach and participate in other projects that faculty need expert mentoring in
- The university had little experience with AHRQ; the management of this grant resulted in the university research support staff becoming informed and experienced with the agency
- Health services translational research is now identified with Creighton University by various stakeholders in the state

## Future Plans

**Continue Research Scientist Advancement**
-   Identifying Research Streams for Individuals
-   Identifying Research Platform for Research Team
-   Support grant application development
**Respond to Expanded Interest**
-   New faculty have requested support
-   Expand our external partner engagement
-   Engage scientists outside our university
**Further Develop Sustainability Plan**
-   Extend vision across campus
-   Include others not yet involved

## Future PlansPost Award Efforts to Establish Funded Support

| Participant | External Funding Application Type | Agency or Source | 1st Target Date to Apply | 2nd Target Date to Apply |
| --- | --- | --- | --- | --- |
| Bramble, J.D. | R03 or R01 | AHRQ | October 16/5, 2008 | February 16/5, 2009 |
| Paschal, K.A. | K02 | AHRQ | October 12, 2008 | February 12, 2009 |
| Siracuse, M.V. | K02 | AHRQ | October 12, 2008 | February 12, 2009 |
| Drincic, A. | K08 (Galt Mentor) | AHRQ | October 12, 2008 | February 12, 2009 |
| Galt, K.A. | State Grants/BRIC 2 | AHRQ | Fall 2008/Spring 2009 | Various dates
BRIC 2? |
| Fuji, K.T. | K08 (Galt Mentor) | AHRQ | June 12, 2008 | October 12, 2008 |

## 
  How do we sustain what we have developed?

-   How do we sustain what we have developed?

**Notes:**
How do we support others who want to be engaged in this activity within the university? How do we accommodate those who want and need this support?
How do we provide others these opportunities?
How do we support growing institutionalization?

## Our rapid success ...facilitated by federal funding...and now interrupted... forces us to ask...  where will we land?

**Our rapid success ...facilitated by federal funding...and now interrupted... forces us to ask...  where will we land?**

**Notes:**
HFF first investment – led to BRIC – which supported our development of a track record – which led to HFF bridge funding...
Where is the ‘track’ going?

## Contact Information

- Kimberly A. Galt, Pharm.D., Ph.D.(c)
- Professor of Pharmacy Practice
- Associate Dean for Research
- Director, Creighton Health Services Research Program (CHRP)
- School of Pharmacy and Health Professions
- Creighton University
- 2500 California Plaza - Boyne 143C
- Omaha, NE 68178
- kgalt@creighton.edu
- 402-280-4259
- Go to _[http://chrp.creighton.edu](http://chrp.creighton.edu/)_ to view CHRP activities and opportunities.