Using real world decisions to develop a modified central IRB model

描述（由申请人提供）：IRB对多中心研究的审查已知效率低下，产生可变的结果，并且可能无法充分保护人类受试者。一个提议的解决办法是利用中央审查委员会（CIRB）审查；然而，现有的CIRB模型存在显著的可扩展性问题，并且由于利用率低而缺乏有效性的经验证据。了解IRB如何以及为什么在研究环境中决定什么IRB评审模型是最好的，对于设计一个适应这些决策的模型是必不可少的。考虑到多中心研究对CIRB或其他IRB评审模型的适用性可能差异很大，单一的IRB评审模型可能不足以用于多个不同机构的研究。可以利用支持IRBshare的现有基础设施来容纳多个IRB审查模型——包括共享审查、中心审查和本地审查——并为随后在操作过程中捕获数据提供一个真实世界的平台。假设授权机构有机会根据机构和研究特点选择在具体情况下最有效的模式，将鼓励更多的利用，从而提高多地点IB审查的伦理质量和效率。当多个审查选项可用时（“IRB选择”），将使用定性和定量测量和分析来分析为给定研究选择IRB审查模型的选择、利用、过程和基本原理。具体目标：1)使用适应性信息系统和协调程序来跟踪现实世界的决策，并捕获在选择IRB依赖模型时使用的基本原理，包括在机构、法律、HRPP/IRB、研究者和研究层面使用替代IRB审查模型的促进因素和障碍；2)在关键过程和结果度量方面比较不同的评审模型：a)伦理质量，b)评审过程的效率，以及c)多个利益相关者（IRB、发起人/资助者、研究者/研究团队）对评审过程的满意度；3)制定和共享政策和程序，以减轻道德或后勤问题，并最大限度地提高与动态使用替代审查模型（包括CIRB模型）相关的效率。

DESCRIPTION (provided by applicant): The IRB review of multicenter studies has known inefficiencies, produces variable outcomes, and may not sufficiently protect human subjects. One proposed solution has been the utilization of central IRB (CIRB) review; however, existing CIRB models have significant scalability issues and lack empirical evidence of effectiveness due to low utilization. Understanding how and why IRBs decide what IRB review model is best within the study context is essential to designing a model that accommodates these decisions. Given that the suitability of a multicenter study for CIRB or an alternative IRB review model may vary widely, a single IRB review model may not be sufficient for a study with multiple, diverse institutions. The existing infrastructure supporting IRBshare can be leveraged to accommodate multiple IRB review models - including shared review, central review, and local review - and provide a real world platform for subsequently capturing data in the course of operations. It is hypothesized that empowering institutions with the opportunity to choose the model that contextually works best-based on the institutional and study characteristics-will encourage greater utilization that can in turn improve the ethical quality and efficaciousness of multisite IB review. The choices, utilization, process, and rationale for selecting an IRB review model for a given study when multiple review options are available ("IRBchoice") will be analyzed using qualitative and quantitative measures and analyses. SPECIFIC AIMS: 1) To use an adapted informatics system and coordinated program to track real world decisions and capture the rationale used when selecting an IRB reliance model, including the facilitators and barriers to utilizing alternative IRB review models at the institutional, legal, HRPP/IRB, investigator, and study levels; 2) To compare the alternative review models on key process and outcome measures: a) ethical quality, b) efficiency of the review process, and c) satisfaction with the review process by multiple stakeholders (IRB, sponsor/funder, investigator/study team); and 3) To develop and share policies and procedures to mitigate ethical or logistical issues and maximize efficiency related to the dynamic use of alternative review models including the CIRB model.