Elizabeth A. Martinez, MD, MHS Johns Hopkins Medical Institutions September 10, 2008 Organization of Care and Outcomes in Cardiac Surgery AHRQ grant 1K08HS013904-01A1.
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Elizabeth A. Martinez, MD, MHSJohns Hopkins Medical Institutions
September 10, 2008
Organization of Care and Outcomes in Cardiac Surgery
AHRQ grant 1K08HS013904-01A1
Building a Health Services Career
Background
• Interest in research as a senior resident and fellow
• Stepping stones♦ Became involved in ongoing projects
♦ Took advantage of “evening” classes in research
Life prior to the K
• Stayed involved in multiple projects
♦ NO theme
♦ NO expertise
♦ NO advancement
♦ NO likelihood of independence
I did have a mentor
Building a Health Services Career
Personal Career Goals:
1. Develop and conduct the proposed research
♦ Define area of interest
♦ Develop the research protocol and grant
♦ Core curriculum required
2. Develop into an independent investigator
♦ What does it take?
3. Become a leader in Health policy
Building a Health Services Career
How to achieve the goals:
• Define area of interest
♦ Define your passion
♦ What links your experiences?
● Clinical
● Research
● Personal
Life prior to the K
• Further focused my clinical and research area of interest♦ Became more involved in performance improvement
and patient safety projects in cardiac surgery
• Identified sub-areas of interest/potential research questions
• Further recognized my limitations especially when it came to measurement, analysis and transforming care.
• Participated in the GCRC grant review committee
Applied for University Support
• Recognition of limitations• Interest in pursuing an advanced degree♦ Precedence in our department
• Encouragement of my chairman and mentor• Johns Hopkins University♦ Sought to gain local support first
• Johns Hopkins Clinician Scientist Award
Life prior to the K• One of the courses included “grant writing”
♦ Helped with focusing thoughts and first iterations of the development of my abstract for the eventual grant.
♦ Broke it down into manageable pieces
• Overwhelming at first
• Made the psychological commitment to complete the grant♦ Johns Hopkins University Clinician Scientist Award first
♦ If it were easy, everybody would be doing it!
Life in K-Limbo
• Resubmitted the grant twice to AHRQ
• Challenging to wait for funding♦ Some delays in funding with a “fundable”
score♦ Proposed project most appropriate for AHRQ
• Some experience with NIH and couldn’t find a home for this type of grant proposal
• Started to (needed to) consider alternative career path
Life during the K• Meet with advisors
♦ High rate of attendance!
♦ Taken seriously with the award—
• Reflects hard work to get there (writing the grant!) and quality of the planned project
– The process of writing the grant (and, of course, resubmitting it!) DOES improve it
• Pursue advanced coursework in Health Services
Building a Health Services Career
How to achieve the goals:
1. Develop and conduct the proposed research
♦ Define area of interest
♦ Write the research protocol and grant
♦ Core curriculum required
2. Develop into an independent investigator
♦ What does it take?
♦ How the K08 facilitates this
3. Be a leader in Health policy
Building a Health Services Career
How to achieve the goals:
♦ Core curriculum required
• Epidemiology and Biostatistics
• Health systems
• Organizational and behavioral change
• Leadership change
Why formal training?
• Health services and outcomes research is very complex♦ Need to be an expert in epi, biostats♦ Need to be able to be address biases♦ Measurement in outcomes research
remains a challenge
• Need sophisticated background to develop independence and a leadership role
Develop into an Independent Investigator
• Formal training additional importance♦ Just like lab researchers♦ Very complex systems that are being evaluated♦ Need to be an expert in many fields♦ Form professional relationships
• Skills in project management• Gain experience outside of the proposed project
and coursework♦ National professional societies♦ Research conferences
• Broaden professional relationships
Life during the K
• Member of national committee for professional society to develop quality measures for anesthesia
• Have been asked to represent the American Society of Anesthesiologists in development of national guidelines
• And, of course, the grant work……
Organization of Care and Outcomes in Cardiac Surgery
• 700,000 cardiac surgical cases in US• Hypothesis:
Differences in the processes of postoperative care contribute to differences in mortality in low-volume and high-volume hospitals.
• Primary goal:♦ Identify the structure and processes of the
perioperative management of patients undergoing cardiac surgery that impact their mortality.
Organization of Care and Outcomes in Cardiac Surgery
• Variation in Care♦ Cardiac ICU physician staffing
♦ Cardiac ICU nurse staffing
♦ Cardiac ICU mid-level provider staffing
♦ Protocols
• Link variation in care to outcomes
Life during the K
• Completed preliminary site visits to explore current practices in cardiac surgery
• Developed pilot survey
♦ Iterative process
♦ Survey development course
• Piloted survey
♦ Lessons learned
Life during the K
The importance of pilot testing• It’s true!• Found significant issues with questions
♦ Despite reviewing while visiting sites♦ Outline a plan to remedy
• Explore contributors
• Revise the survey
• Re-pilot!
Impact of research on Healthcare Delivery
• Significantly advance our knowledge of how cardiac surgical patients are managed postoperatively and how the differences in organizational characteristics are related to their outcomes.
• Identify strategies to reduce mortality in low-volume hospitals and to decrease variation in mortality within all centers.
Become a Leader in Health Policy:
• Professional societies
♦ Inform/develop quality measures for cardiac surgery
• Inform insurers whether cardiac surgery should be included in the volume or intensivist measure
• Prioritization of efforts to improve cardiac surgical care
Thank you.
Elizabeth Martinezemartine@jhmi.edu
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