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Govindarajan cer saem 2011
- 1. Prasanthi Govindarajan MD, MAS Assistant Professor of Emergency Medicine University of California, San Francisco
- 16. Questions
Editor's Notes
- First of all, I would like to thank the organizers of this didactic session, Brendan and Rahul for giving me an opportunity to talk here. I am PG, asst professor of emergency medicine at UCSF, a clinical researcher with a interest in the field of prehospital care and neurovascular emergencies. I will be discussing a few examples of funded research in Comparative Effectiveness Research in clinical care in emergency medicine, systems based research in prehospital care and public health. By presenting these examples, my goal is to let the group know about successful grants in emergency medicine and CER and also encourage young researchers to learn from these successful grants to prepare future grant applications.
- This is a grant awarded to an EM investigator and was funded by the Agency of Healthcare Research and Quality to study HIV screening in the ED. Following the CDC mandate to perform non-targeted opt out screening for HIV in healthcare settings, the investigators designed a study to compare conventional methods (high risk screening) versus a HIV screening using a clinical prediction rule to identify high risk patients in the ED. This is an example of a effectiveness study comparing clinical outcomes of HIV identification for diagnostic test in the ED.
- R01 – CER funding (UCSF PI). The second example is a R01 grant funded by AHRQ to study the effectiveness of three strategies in the ED for diagnosis of urolithiasis. This is a RCT and falls under CER since this compares diagnostic accuracy and effectiveness of modalities as well as cost of the strategies.
- Another example of a funded research is similar to the HIV diagnostic test we talked about earlier. This is funded by the NIH and compares standard of care screening tool with another research tool for early diagnostic testing in undifferentiated CP and SOB in the ED. This falls under CER since we are comparing the diagnostic accuracy of two tests and its impact on outcomes in the second stage of the study
- The next example I will be talking about is a study comparing the diagnostic accuracy of two triage protocols for stroke which has been funded by the American Heart/Stroke Association, Western States Affiliate Clinical research program. Since I am the PI of the study, I can elaborate on this a bit more than the others. The aims of this study are to compare the diagnostic accuracy of the old stroke protocol – card 28 with the new stroke protocol which is a combination of Card 28 and Cincinnati Stroke Scale. This is a prospective study and although not funded through the CER mechanism, this falls under CER since two diagnostic tests are being compared for accuracy of stroke recognition.
- I would like to now shift gears and move onto examples from systems based research ( research with partnerships with community based healthcare settings)
- Funded by K08 AHRQ to study the comparative effectiveness of regionalized and non-regionalized stroke care. This was funded by the CER program and aims to compare the rates of IV t-PA before and after regionalization of stroke in two counties in the state of CA. We will also compare the diagnostic accuracy of prehospital triage before and after regionalization and study the impact on treatment rates. In other words, we will compare the diagnostic accuracies after a system-wide intervention and effectiveness of the intervention on clinical outcomes.
- R01 –AHRQ ( UCSF –PI). The second example is a R01 funded application to reduce inappropriate use of antibiotics for acute respiratory tract infections. They compared community education versus community and physician directed education on outcomes of care. This was also funded by AHRQ as 2 R01 grants. The first step involved comparing strategies in the office based setting and the second stage involved comparing effects of a multi-faceted intervention in the EDs and its impact on outcomes
- The last example is also a R01 funded by AHRQ. This is different from the other studies I have presented in that this aims to create a statewide database to promote research in the future. The ARRA definition of CER includes “Encourage the development and use of clinical registries, clinical data networks, and other forms of electronic health data that can be used to generate or obtain outcomes data” and this study is an example of creating a linked database to obtain outcome data for assessment of prehospital care.