ADAPTING THE RAO MODEL TO FOUR TYPES OF COMMUNITY-BASED PROVIDERS

这个子项目是许多研究子项目中的一个 由NIH/NCRR资助的中心赠款提供的资源。子项目和 研究者（PI）可能从另一个NIH来源获得了主要资金， 因此可以在其他CRISP条目中表示。所列机构为 研究中心，而研究中心不一定是研究者所在的机构。 描述（由申请人提供）：NIH已经确定了阻碍临床研究或将临床研究结果转化为临床实践的多个障碍。 许多转化障碍可以通过建立合格的社区提供者/研究者网络来消除或减少，这些提供者/研究者被称为国家临床研究协会（NCRA），他们有资格，受过培训，渴望快速启动研究，并将为社区提供研究及其结果。 美国国立卫生研究院（NIH）建议研究助理组织（RAO）可以通过招募和维持社区医疗实践（CMP）来加速和促进临床研究。 RAO将培训，认证，支持和报销中医的研究活动。 研究人员建议进行试点研究，以开发和评估RAO的概念与社区参与资源组成部分的临床和转化科学奖（CTSA）合作。 使用由哥伦比亚大学的临床研究再工程项目开发的工具（由NIH路线图计划支持）和正在进行的CTSA社区参与资源活动，研究人员将在四种类型的CMP中进行焦点小组，时间运动观察和调查，以确定不同社区卫生保健提供系统进行临床研究的障碍。 中医药管理计划包括：1）郊区私人医疗实践（大多数是有私人保险的患者），2）城市私人医疗实践（大多数是有医疗补助的患者），3）纽约长老会医院附属的大型多地点小组实践（大多数是有医疗补助的患者），以及4）哥伦比亚高级实践护士协会门诊护理实践（80%是女性，大多数是商业保险）。 在未来几年，他们将开发基础设施，以减轻翻译障碍，并在CMP中启动临床研究。 由NIH集中协调的RAO全国网络可以大大缩短从实验室创新到最佳临床实践的时间，从而加速人类健康的进步。 RAO的同一网络可以直接向研究参与者和其他社区提供者传播研究结果，从而促进新医学发现的快速和广泛介绍。 RAO的全国性网络所带来的效率提高不仅将加速医疗保健的进步，而且还将降低将医学研究创新纳入医疗保健主流的成本。

This subproject is one of many research subprojects utilizing the resources provided by a Center grant funded by NIH/NCRR. The subproject and investigator (PI) may have received primary funding from another NIH source, and thus could be represented in other CRISP entries. The institution listed is for the Center, which is not necessarily the institution for the investigator. DESCRIPTION (provided by applicant): The NIH has identified multiple roadblocks that impede clinical research or translation of clinical research results into clinical practice. Many translational barriers could be removed or reduced by establishing networks of qualified community-based providers/investigators, called National Clinical Research Associates (NCRA), who are qualified, trained, and eager to initiate research studies quickly, and who will provide community access to studies and their results. NIH has proposed that Research Associate Organizations (RAO) might accelerate and facilitate clinical research by recruiting and maintaining community-based medical practices (CMP). The RAO will train, credential, support, and reimburse the CMPs for their research activities. The investigators propose to conduct pilot studies to develop and evaluate the RAO concept in collaboration with the Community Engagement Resource component of their Clinical and Translational Science Award (CTSA). Using tools developed by Columbia University's Clinical Research Re-engineering project (supported by a NIH Roadmap Initiative) and the ongoing activities of the CTSA Community Engagement Resource, the investigators will conduct focus groups, time-motion observations, and surveys in four types of CMPs to identify barriers to the conduct of clinical research by different community health care delivery systems. The CMPs include: 1) suburban private medical practice (mostly patients with private insurance), 2) urban private medical practice (mostly patients with Medicaid, 3) large multi-site group practice affiliated with New York-Presbyterian Hospital (mostly patients with Medicaid), and 4) the Columbia Advanced Practice Nurse Associates ambulatory care practice (80% women, mostly with commercial insurance). In future years, they will develop infrastructure to alleviate translational barriers and initiate clinical research in the CMP. A nationwide network of RAO, centrally coordinated by NIH, could dramatically shorten the time from laboratory innovation to best clinical practices, thus accelerating advances in human health. The same network of RAOs can disseminate study results directly to study participants and also to other community providers, thereby promoting rapid and widespread introduction of new medical findings. The increased efficiency rendered by a nationwide network of RAO would not only accelerate advances in health care, but also decrease the cost of bringing medical research innovation into the mainstream of health care.