Adapting the RAO Model to Four Types of Community-based Providers

描述(由申请人提供)：美国国立卫生研究院已经确定了阻碍临床研究或将临床研究成果转化为临床实践的多个障碍。许多翻译障碍可以通过建立合格的社区提供者/研究人员网络来消除或减少，这些网络被称为国家临床研究助理(NCRA)，他们经过合格的培训，渴望快速启动研究研究，并将为社区提供访问研究及其结果的机会。美国国立卫生研究院建议，研究助理组织(RAO)可以通过招募和维护基于社区的医疗实践(CMP)来加速和促进临床研究。RAO将对中医的研究活动进行培训、认证、支持和报销。研究人员建议与他们的临床和翻译科学奖(CTSA)的社区参与资源部分合作进行试点研究，以开发和评估RAO概念。 使用由哥伦比亚大学临床研究再工程项目(由NIH路线图倡议支持)和CTSA社区参与资源正在进行的活动开发的工具，研究人员将在四种类型的中医中进行焦点小组、时间运动观察和调查，以确定不同社区医疗保健提供系统进行临床研究的障碍。中医包括：1)郊区私人诊所(主要是私人保险的患者)，2)城市私人诊所(主要是医疗补助的患者)，3)附属于纽约长老会医院的大型多站点团体诊所(主要是医疗补助的患者)，以及4)哥伦比亚高级实践护士协会的门诊护理实践(80%是女性，大部分是商业保险)。在未来几年，他们将发展基础设施，以缓解翻译障碍，并启动中医的临床研究。 由NIH集中协调的全国RAO网络可以极大地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的同一网络可以将研究结果直接传播给研究参与者，也可以传播给其他社区提供者，从而促进新医学发现的快速和广泛引入。RAO全国网络带来的效率提高不仅将加快医疗保健的进步，还将降低将医学研究创新纳入医疗保健主流的成本。

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.