Interdisciplinary Interdisciplinary Research: Research: Developing Strong Developing Strong Partnerships Partnerships Kathleen A. Dracup, RN, DNSc, FAAN Kathleen A. Dracup, RN, DNSc, FAAN Professor and Dean Professor and Dean University of California, San Francisco University of California, San Francisco School of Nursing School of Nursing
49
Embed
Interdisciplinary Research: Developing Strong Partnerships Kathleen A. Dracup, RN, DNSc, FAAN Professor and Dean University of California, San Francisco.
This document is posted to help you gain knowledge. Please leave a comment to let me know what you think about it! Share it to your friends and learn new things together.
Collaboration: The Collaboration: The Alternative ViewAlternative View
To cooperate with an To cooperate with an enemy invader of enemy invader of
one’s territoryone’s territory
Historical PerspectiveHistorical Perspective
Traditional Model
Physician
Registered Nurses
Ancillary Personnel
Patients
Historical PerspectiveHistorical Perspective
Many physicians are aware of the nurse ‘doing her [sic] job over there, while I do mine over here; as long as they carry out my orders, and we get along….’
Tellis-Nayak, Soc Sci Med 1984
Turf WarsTurf Wars
Collaboration
Inclusion
Turf
Exclusion
RN-MD CollaborationRN-MD Collaboration
• Physician’s role as ‘gatekeeper’ has changed• Nurse scientists are often better prepared
educationally to conduct research than the physicians with whom they collaborate
• In today’s fiscal environment, academic physicians have heavy clinical burdens and little protected research time
Increased scientific role for RNsIncreased scientific role for RNs
Collaboration LandmarksCollaboration Landmarks
1970s IOM foundedNINR (Center)
1980s AHCPR (AHRQ)
2001 Crossing the Quality Chasm (IOM)
2003 Summit on Health Professions and Education
4/5/03 K. Dracup
BENEFITSBENEFITS
Why Do We Need Why Do We Need Interdisciplinary Research?Interdisciplinary Research?
• Growth in knowledge and technology– Advances in biology, genetics, physiology,
pathophysiology, disease processes
– Increasing complexity in diagnosis, treatment, prevention
– 10,000 published clinical trials/year
– Need for large sample sizes
Why Do We Need Why Do We Need Interdisciplinary Research?Interdisciplinary Research?
• Demographics– aging population
– increase in prevalence of chronic illness
– 50% of population has more than one disease
Why Do We Need Why Do We Need Interdisciplinary Research?Interdisciplinary Research?
• To bridge the gap between
– the behavioral and biological sciences
– clinical trials and application in practice
– scientists and the community
GapsGaps
• Efficacy of interventionsin trials
• Potential
• Intention
• Information
• Effectiveness of interventions in practice
• Reality
• Action
• Behavior
Hill, Circ. 1998;97:807-810
Example: NHANESExample: NHANES
Trends in Awareness, Treatment, & Control of High Trends in Awareness, Treatment, & Control of High Blood Pressure in Adults: US, 1976-1994Blood Pressure in Adults: US, 1976-1994
• Emphasis on basic science and translation into clinical research has led to struggles in funding priorities and handicapped our understanding of how to implement interventions shown to be effective in RCTs
Hill, Circ. 1998;97:807-810
Why Do Gaps Exist?Why Do Gaps Exist?• We assume that:
– practice guidelines will be followed and patients will improve
– if we know the cause of illness, therapies can be applied, patients will adhere, the problem will be solved
REALITY:REALITY:• Healthcare providers and patients are influenced by
several factors, many beyond their control• Physical and social environments, health care systems &
policies influence adoption of therapiesHill, Circ. 1998;97:807-810
Why Do Gaps Exist?Why Do Gaps Exist?
• Organizational structures, staffing, and reimbursement of academic medical centers do not encourage interdisciplinary work, despite results from large, interdisciplinary RCTs
Hill, Circ. 1998;97:807-810
AHA Awards - 2001AHA Awards - 2001BASIC SCIENCE $826 72.4%
Genetics Vascular Cardiac pathology Obesity CV repair and remodeling
Current Funding in Current Funding in Interdisciplinary ResearchInterdisciplinary Research
MIND-BODY INTERACTIONS AND HEALTH: Exploratory/Developmental Research Program (R21) – “A central goal of this program is to facilitate facilitate
interdisciplinary collaborationinterdisciplinary collaboration and innovation in mind-body and health research while providing essential and cost-effective core services in support of the development, conduct, and translation into practice of mind-body and health research based in centers or comparable administrative units.”
– ineffective communication– poor conflict management– lack of collaboration etiquette
Strategies and Solutions-Strategies and Solutions-Structural & Historical BarriersStructural & Historical Barriers
• Structural
– Establish supportive structures within the institution (e.g., centers, advisory boards)
– Give priority for space and funding allocation to interdisciplinary teams
– Frequent meetings and/or conference calls
Strategies and Solutions- Strategies and Solutions- Interpersonal BarriersInterpersonal Barriers
• Investigator-based – At the first project meeting discuss:
• ground rules• strengths, skill sets, and responsibilities of all members
– Encourage direct communication between team members– Acknowledge contributions of all team members– Publications - establish guidelines at the beginning for:
• authorship• topics
Criteria for Success for SurgeonsCriteria for Success for Surgeons(also apply to interdisciplinary research!)(also apply to interdisciplinary research!)
•Ability•Affability
•Availability
4/5/03 K. Dracup
A Case Study in A Case Study in Interdisciplinary ResearchInterdisciplinary Research
Exercise and Heart Failure:
Effects on the Autonomic Nervous System, Immune Function, Health-
Related Quality of Life, Clinical and Cost Outcomes
(funded by American Heart Association)
Purpose & DesignPurpose & Design
• Delineate the safety and efficacy of using a combination of aerobic and resistance exercise training modalities in a population of adults with decreased left ventricular systolic function and clinical HF
• Randomized, prospective trial
Aerobic + Resistive Exercise
EF
Autonomic Function
Immune Function
Hemodynamics
Functional Status
Rehospitalization
Mortality
Quality of Life
Figure 1. Underlying theoretical framework for study
• cardiopulmonary exercise stress testing with expired gas analysis
• muscular strength determination
• pulmonary function testing• serum norepinephrine (NE) • skin tests to recall antigens • immunologic assay• health-related quality of life• clinical outcomes/costs of care
nurses
physicians
economists
immunologists
exercise physiologists
4/5/03 K. Dracup
Survival Curves for All Survival Curves for All Cause MortalityCause Mortality
0102030405060708090
100
0 1 2 3 4 5 6 7 8 9 10 11 12
ControlsExercise
Breslow p = 0.010
Tarone-Ware p = 0.018
Log Rank p = 0.043
ConclusionConclusion
• Historical, structural, and interpersonal barriers can impede effective interdisciplinary collaboration
• The benefits to overcoming these barriers are great
• Interdisciplinary collaboration in science must also be rooted in education and practice