UC Davis CTSC and VANCHCS Collaboration


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UC Davis CTSC and VANCHCS Collaboration

  1. 1. UC Davis CTSC andUC Davis CTSC and VANCHCS CollaborationVANCHCS Collaboration Lars Berglund, M.D., Ph.D. Principal Investigator, UC Davis CTSC Staff physician, VA Northern California HCS Associate Dean for Research, UC Davis Ted Wun, M.D. Chief, Hematology Oncology UC Davis SOM and VANCHCS Director, CRRF, UC Davis CTSC
  2. 2. OverviewOverview • VA Northern California Health Care System • UC Davis Health Care System • Chronology of Affiliation to Integration • Accomplishments • Lessons Learned – Facilitators – Barriers
  3. 3. VANCHCS in the 1980’sVANCHCS in the 1980’s • Large inpatient facility based in Martinez, CA • UC Davis affiliated, but not integrated training programs • Separate research programs – Oncology – Infectious Disease – Neurology – Rheumatology
  4. 4. UC Davis School of MedicineUC Davis School of Medicine 1980’s1980’s • First class 1972 - Medical School focused on Primary Care and serving Central Valley • Modest research portfolio • Clinical research minimal • Decision in the early 1990’s to grow the research enterprise – However, no space allocated in new hospital expansion for a GCRC facility
  5. 5. Stimulus to IntegrationStimulus to Integration Loma Prieta Earthquake 1989
  6. 6. VA Medical Center Moved to SacramentoVA Medical Center Moved to Sacramento 8 miles Allowed integration of Faculty and Housestaff
  7. 7. UC Davis/VA GCRCUC Davis/VA GCRC • VA planners had wisely allocated clinical and wet-lab research space in new hospital plans – UC Davis planners had not allocated space for a GCRC • Lars Berglund recruited to be PI – foundation for NIH application developed 2002-2003 • VA hospital completed and GCRC application submitted 2003 • UC Davis/VANCHCS 2nd to last GCRC to be NIH funded (Sept 2004)
  8. 8. Integration of Research?Integration of Research? • Unified clinical research facility but barriers existed – Independent VA and UC Davis IRB’s • UC Davis faculty predominantly unwilling to submit to two IRB’s given an increased regulatory burden and lack of harmonization – Lack of critical mass of researchers – Lack of suitable IDS support • But then a second stimulus arrived, NIH CTSA initiative – VA/UC Davis CTSC (2006)
  9. 9. Transformation of researchTransformation of research infrastructure by the CTSC Integrationinfrastructure by the CTSC Integration
  10. 10. Barriers RemovedBarriers Removed • UC Davis/VA IRB MOU for oncology and neurology studies – Allowed for single consent and IRB committee – Moving towards full affiliation agreement • Shared resources – VA Oncology nurses train UC Davis CTSC nurses in chemotherapy – CTSC resource for infusion studies – VA Task order for UC Davis personnel – Agreement for use of VA clinical labs, nutrition, and ED services – Clinical Research Coordinators, Dietician, Physiologist – Dual VA/UC Davis investigators use CTSC resources (access to pilot funding, training support)
  11. 11. Mutual BenefitMutual Benefit • Significant increase in VA engaged research – Offer cutting edge research to VA patients • Increased accrual to oncology trials for UC Davis NCI-designated cancer center • Clinical research resources that would not otherwise be available for both • Effectively leverage limited FTE • VA researchers participating in CTSC – trainees, pilot funds, workshops
  12. 12. Results to dateResults to date • All applications for CTSC use reviewed for VA engagement and appropriate use and cost recovery of VA resources • Mutual committee participation (CTSC Advisory committee, R&D committee, Research Integration committee) • Increase in CTSC VA engaged studies from 5 to 39 • Increased VA research funding to $32 M
  13. 13. Training and mentoringTraining and mentoring • VA-based trainees eligible to apply for CTSC training programs • CTSC developed multiple education, training and certification programs for research staff – VA staff participating • Established residency research rotation – all residents in Internal Medicine complete month-long research rotation and develop study protocol • Rotation expanded to other disciplines (Anesthesiology)
  14. 14. CTSC funding
  15. 15. Recipe for SuccessRecipe for Success • Champions – Leadership, “middle management”, ground troops • Integration of leadership – Vested in both institutions • Tenacity • Understanding that it is win-win
  16. 16. Barriers Still ExistBarriers Still Exist • There are still parochial interests • Financial • Need for clinical space • But, willingness to discuss issues and ongoing efforts to resolve barriers
  17. 17. But all barriers eventually fallBut all barriers eventually fall