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Research Committee Chair Reflects
Before Andy Auerbach, MD, MPH, concludes a four-year term as chair of SHM’s Research Committee, I talked with him about his perspective on hospital medicine research. Dr. Auerbach is an associate professor of medicine at the University of California, San Francisco.
He received a career development award from the National Institutes of Health (NIH) early in his career and is the principal investigator of an R01 research project grant from the NHLBI titled “Improving use of perioperative beta-blockers through a multidimensional QI program.”
He is also a co-author of “Outcomes of Patients Treated by Hospitalists, General Internists, and Family Physicians” in the December 2007 New England Journal of Medicine, which found statistically significant differences in length of stay and cost. He received his medical degree from Dartmouth Medical School in Hanover, N.H., and did his residency training in internal medicine at Yale New Haven Hospital in Connecticut. He completed an MPH in clinical epidemiology at the Harvard School of Public Health in Boston in 1998.
Q: So, is academia as glamorous as it sounds?
Dr. Auerbach: Way more glamorous—you should see my office. And yes, we are in a white tower.
Q: How did you get your start in research?
Dr. Auerbach: I actually started out my research fellowship wanting to be a cardiologist and go into the cath lab while developing the skills to participate in and teach research methods. I found I really enjoyed the work, particularly the creative and entrepreneurial aspects of developing a project or grant and seeing it through to completion.
Q: What are the research options for hospitalists practicing in nonteaching settings?
Dr. Auerbach: I think the most straightforward way to participate in research is to partner with a clinical research organization to help enroll patients in their trials. While you don’t get the opportunity to design the study, you do get to get a feel for consent/enrollment and internal review board [IRB] processes.
The next best way to get involved with research is to partner with a researcher—and this need not be a hospitalist—at your site or very near by. Many QI projects are close to being research-ready and may provide an opportunity to make that work count twice. But it will require you to learn about analytic methods.
I’d also be remiss if I didn’t mention the value of other very useful academic products—rigorous reports of a QI intervention (think of both success and failure stories) and patient case reports. If well referenced and used as teaching documents, these can be very useful ways to advance knowledge.
Q: Are there any particular prerequisites in terms of training that you find especially helpful as you conduct your research?
Dr. Auerbach: It is hard to be a capital-R “Researcher” and compete for career development grants and NIH funding without some advanced [degrees] and a clinical research fellowship. I hesitate to call these prerequisites, but they are nearly so.
Q: What do you like best about your career as a hospitalist?
Dr. Auerbach: I really like acute care medicine, but didn’t want to subspecialize—otherwise I’d be wearing lead in a cath lab now. I also like the questions and processes in the hospital a bit more than the clinic setting.
Q: Who are your mentors and how did you find them?
Dr. Auerbach: I’ve had a remarkable set of mentors from fellowship [Mary Beth Hamel, Roger Davis, Russ Phillips] through my early career [Lee Goldman, Bob Wachter, Ralph Gonzales]. Now that I am early-mid career, I’m trying to pass their teaching on.
Q: Any advice for hospitalists interested in research but daunted by the prospect of starting their own studies?
Dr. Auerbach: If you want to do a scholarly/academic project to round out your personal/career satisfaction, I think the daunting nature of research can be overcome with the right questions and right support—and by defining what these are well before you actually dive into a dataset or implementation project. You also have to decide how much satisfaction you will get from the project in the end compared to the incremental nights/weekends you will spend to plan and execute your project—not to mention publish.
If you are thinking of research as a career, be aware of what makes you happy. If you like to write, enjoy the process of hypothesis generating/testing, and take rejection well you may be happy as a researcher. There are still plenty of nights/weekends to be spent, though.
Making a switch from full-time clinical or administrative work to research means making a very big commitment to going back to get the skills as part of a fellowship.
Q: Do researchers interested in quality improvement questions still have to run their work past the IRB?
Dr. Auerbach: Unfortunately this is now an area of uncertainty for people—unnecessarily so. Until recent events, IRBs have not required approval for QI projects that seek to enhance care according to an evidence-based standard, especially if that standard is endorsed by the institution. If you plan to publish your findings—particularly if you talk to or touch patients, or collect personal health information—I think it is nearly always wise to at least call your local IRB to ask for how you can or should conduct the study. This is best done before you start the project, obviously.
If you want to publish your results using deidentified data after the project is done, our IRB would say that is exempt from review [e.g., no need for approval]. But I think even this case would be worth a phone call to ensure your IRB feels similarly.
Whether or not you get IRB approval, be very aware of how and where you store data. TH
Before Andy Auerbach, MD, MPH, concludes a four-year term as chair of SHM’s Research Committee, I talked with him about his perspective on hospital medicine research. Dr. Auerbach is an associate professor of medicine at the University of California, San Francisco.
He received a career development award from the National Institutes of Health (NIH) early in his career and is the principal investigator of an R01 research project grant from the NHLBI titled “Improving use of perioperative beta-blockers through a multidimensional QI program.”
He is also a co-author of “Outcomes of Patients Treated by Hospitalists, General Internists, and Family Physicians” in the December 2007 New England Journal of Medicine, which found statistically significant differences in length of stay and cost. He received his medical degree from Dartmouth Medical School in Hanover, N.H., and did his residency training in internal medicine at Yale New Haven Hospital in Connecticut. He completed an MPH in clinical epidemiology at the Harvard School of Public Health in Boston in 1998.
Q: So, is academia as glamorous as it sounds?
Dr. Auerbach: Way more glamorous—you should see my office. And yes, we are in a white tower.
Q: How did you get your start in research?
Dr. Auerbach: I actually started out my research fellowship wanting to be a cardiologist and go into the cath lab while developing the skills to participate in and teach research methods. I found I really enjoyed the work, particularly the creative and entrepreneurial aspects of developing a project or grant and seeing it through to completion.
Q: What are the research options for hospitalists practicing in nonteaching settings?
Dr. Auerbach: I think the most straightforward way to participate in research is to partner with a clinical research organization to help enroll patients in their trials. While you don’t get the opportunity to design the study, you do get to get a feel for consent/enrollment and internal review board [IRB] processes.
The next best way to get involved with research is to partner with a researcher—and this need not be a hospitalist—at your site or very near by. Many QI projects are close to being research-ready and may provide an opportunity to make that work count twice. But it will require you to learn about analytic methods.
I’d also be remiss if I didn’t mention the value of other very useful academic products—rigorous reports of a QI intervention (think of both success and failure stories) and patient case reports. If well referenced and used as teaching documents, these can be very useful ways to advance knowledge.
Q: Are there any particular prerequisites in terms of training that you find especially helpful as you conduct your research?
Dr. Auerbach: It is hard to be a capital-R “Researcher” and compete for career development grants and NIH funding without some advanced [degrees] and a clinical research fellowship. I hesitate to call these prerequisites, but they are nearly so.
Q: What do you like best about your career as a hospitalist?
Dr. Auerbach: I really like acute care medicine, but didn’t want to subspecialize—otherwise I’d be wearing lead in a cath lab now. I also like the questions and processes in the hospital a bit more than the clinic setting.
Q: Who are your mentors and how did you find them?
Dr. Auerbach: I’ve had a remarkable set of mentors from fellowship [Mary Beth Hamel, Roger Davis, Russ Phillips] through my early career [Lee Goldman, Bob Wachter, Ralph Gonzales]. Now that I am early-mid career, I’m trying to pass their teaching on.
Q: Any advice for hospitalists interested in research but daunted by the prospect of starting their own studies?
Dr. Auerbach: If you want to do a scholarly/academic project to round out your personal/career satisfaction, I think the daunting nature of research can be overcome with the right questions and right support—and by defining what these are well before you actually dive into a dataset or implementation project. You also have to decide how much satisfaction you will get from the project in the end compared to the incremental nights/weekends you will spend to plan and execute your project—not to mention publish.
If you are thinking of research as a career, be aware of what makes you happy. If you like to write, enjoy the process of hypothesis generating/testing, and take rejection well you may be happy as a researcher. There are still plenty of nights/weekends to be spent, though.
Making a switch from full-time clinical or administrative work to research means making a very big commitment to going back to get the skills as part of a fellowship.
Q: Do researchers interested in quality improvement questions still have to run their work past the IRB?
Dr. Auerbach: Unfortunately this is now an area of uncertainty for people—unnecessarily so. Until recent events, IRBs have not required approval for QI projects that seek to enhance care according to an evidence-based standard, especially if that standard is endorsed by the institution. If you plan to publish your findings—particularly if you talk to or touch patients, or collect personal health information—I think it is nearly always wise to at least call your local IRB to ask for how you can or should conduct the study. This is best done before you start the project, obviously.
If you want to publish your results using deidentified data after the project is done, our IRB would say that is exempt from review [e.g., no need for approval]. But I think even this case would be worth a phone call to ensure your IRB feels similarly.
Whether or not you get IRB approval, be very aware of how and where you store data. TH
Before Andy Auerbach, MD, MPH, concludes a four-year term as chair of SHM’s Research Committee, I talked with him about his perspective on hospital medicine research. Dr. Auerbach is an associate professor of medicine at the University of California, San Francisco.
He received a career development award from the National Institutes of Health (NIH) early in his career and is the principal investigator of an R01 research project grant from the NHLBI titled “Improving use of perioperative beta-blockers through a multidimensional QI program.”
He is also a co-author of “Outcomes of Patients Treated by Hospitalists, General Internists, and Family Physicians” in the December 2007 New England Journal of Medicine, which found statistically significant differences in length of stay and cost. He received his medical degree from Dartmouth Medical School in Hanover, N.H., and did his residency training in internal medicine at Yale New Haven Hospital in Connecticut. He completed an MPH in clinical epidemiology at the Harvard School of Public Health in Boston in 1998.
Q: So, is academia as glamorous as it sounds?
Dr. Auerbach: Way more glamorous—you should see my office. And yes, we are in a white tower.
Q: How did you get your start in research?
Dr. Auerbach: I actually started out my research fellowship wanting to be a cardiologist and go into the cath lab while developing the skills to participate in and teach research methods. I found I really enjoyed the work, particularly the creative and entrepreneurial aspects of developing a project or grant and seeing it through to completion.
Q: What are the research options for hospitalists practicing in nonteaching settings?
Dr. Auerbach: I think the most straightforward way to participate in research is to partner with a clinical research organization to help enroll patients in their trials. While you don’t get the opportunity to design the study, you do get to get a feel for consent/enrollment and internal review board [IRB] processes.
The next best way to get involved with research is to partner with a researcher—and this need not be a hospitalist—at your site or very near by. Many QI projects are close to being research-ready and may provide an opportunity to make that work count twice. But it will require you to learn about analytic methods.
I’d also be remiss if I didn’t mention the value of other very useful academic products—rigorous reports of a QI intervention (think of both success and failure stories) and patient case reports. If well referenced and used as teaching documents, these can be very useful ways to advance knowledge.
Q: Are there any particular prerequisites in terms of training that you find especially helpful as you conduct your research?
Dr. Auerbach: It is hard to be a capital-R “Researcher” and compete for career development grants and NIH funding without some advanced [degrees] and a clinical research fellowship. I hesitate to call these prerequisites, but they are nearly so.
Q: What do you like best about your career as a hospitalist?
Dr. Auerbach: I really like acute care medicine, but didn’t want to subspecialize—otherwise I’d be wearing lead in a cath lab now. I also like the questions and processes in the hospital a bit more than the clinic setting.
Q: Who are your mentors and how did you find them?
Dr. Auerbach: I’ve had a remarkable set of mentors from fellowship [Mary Beth Hamel, Roger Davis, Russ Phillips] through my early career [Lee Goldman, Bob Wachter, Ralph Gonzales]. Now that I am early-mid career, I’m trying to pass their teaching on.
Q: Any advice for hospitalists interested in research but daunted by the prospect of starting their own studies?
Dr. Auerbach: If you want to do a scholarly/academic project to round out your personal/career satisfaction, I think the daunting nature of research can be overcome with the right questions and right support—and by defining what these are well before you actually dive into a dataset or implementation project. You also have to decide how much satisfaction you will get from the project in the end compared to the incremental nights/weekends you will spend to plan and execute your project—not to mention publish.
If you are thinking of research as a career, be aware of what makes you happy. If you like to write, enjoy the process of hypothesis generating/testing, and take rejection well you may be happy as a researcher. There are still plenty of nights/weekends to be spent, though.
Making a switch from full-time clinical or administrative work to research means making a very big commitment to going back to get the skills as part of a fellowship.
Q: Do researchers interested in quality improvement questions still have to run their work past the IRB?
Dr. Auerbach: Unfortunately this is now an area of uncertainty for people—unnecessarily so. Until recent events, IRBs have not required approval for QI projects that seek to enhance care according to an evidence-based standard, especially if that standard is endorsed by the institution. If you plan to publish your findings—particularly if you talk to or touch patients, or collect personal health information—I think it is nearly always wise to at least call your local IRB to ask for how you can or should conduct the study. This is best done before you start the project, obviously.
If you want to publish your results using deidentified data after the project is done, our IRB would say that is exempt from review [e.g., no need for approval]. But I think even this case would be worth a phone call to ensure your IRB feels similarly.
Whether or not you get IRB approval, be very aware of how and where you store data. TH
Network of Knowledge
By now almost everyone has heard about the social network site MySpace. More than 50 million people—mostly between ages 14 and 24—post and view online profiles connected by links to friends in the system. It’s one of the most heavily trafficked sites on the Internet.
MySpace is remarkable not only for consistent, double-digit growth rate, but also because visitors average two hours on the site modifying their profiles, and checking out friends’ profiles and commenting on them. MySpace has become ubiquitous to a generation using this public space to create and modify their identity on a daily basis—with technology that only recently has become available.
While recognizing that it may be a long time before www.hospitalmedicine.org becomes a household destination, the SHM Research Committee aims to generate similar excitement among our peers for connecting with each other over hospital medicine research on the Web.
Chapter Summary
Las Vegas
The SHM Las Vegas Chapter held its quarterly administrative meeting June 26 at Roy’s in Las Vegas. Gary Skankey, MD, infectious disease specialist and associate clinical professor at the University of Nevada School of Medicine, presented “Treating Complicated Skin and Skin Infections in an Era of Increasing Resistance.” The chapter will host a CME Program on surviving sepsis Sept. 28-29. Visit the chapter page for further program details.
Nashville
The SHM Nashville Chapter meeting June 6 at Stoney River restaurant was sponsored by Ortho McNeil and HCA Physician Recruitment. Eric Siegal, MD, with the University of Wisconsin Hospital in Madison, was the featured presenter and led an interactive session during “Malpractice for the Hospitalists: Identifying and Mitigating Risks.” The next meeting is scheduled for this month. Details will be posted at a later date.
At the SHM Research Committee meeting in Dallas in May, the conversation covered many topics, including the need for research mentorship, training, and career development. Plans for short- and medium-term measures to support SHM members in these areas are in the works, with a focus on Internet-based resources.
Over the long term, the committee would like to see its efforts result in national, high-impact hospital medicine studies and well-trained researchers. Whether driven by a curiosity in a particular area and/or the desire to provide better care by incorporating the best research, the universal challenge is to free enough time to pursue the answers and for appropriate recognition systems to be in place—be they promotion, funding to support further work, or recognition that leads to new connections.
The 249 abstracts published in a supplement to the Journal of Hospital Medicine only hinted at the depth and enthusiasm behind SHM members’ work. Anyone who walked through the exhibit hall during the poster session at the SHM Annual Meeting and talked with the people behind the research was impressed with their dedication and relative youth. They are the future of hospital medicine and are looking for ways to collaborate and continue to learn. The SHM Research Committee is dedicated to finding ways to support their efforts.
It seems as if many SHM members either engage in research, think about a research project, or wish they could evaluate their everyday practice in a way that can help others. However, it is difficult to discern how best to support individual hospitalists working in diverse settings across the country.
Because clinical responsibilities will not slow down anytime soon, we will have to work within the current, hectic environment and use technology as an equalizer to enable communication. In the spectrum of professional medical societies, SHM could be considered similar to the age 14-24 demographic attracted to the fluidity, instant communication/information and innovation that fuels MySpace.
Our long-term research goals could be powerfully advanced by a peer-catalyzed hospitalist research network.
The term “research network” can refer to many types of collaboration. One type that has been successful is the collection, analysis, and reporting of data in a registry or repository. In this example, medical care can be measured through the collection, analysis, and reporting of data. The National Cardiovascular Data Registry (established in 1998 by the American College of Cardiology Foundation) is a well-known example, but there are many others that have been organized for the purposes of improving quality and providing educational and research activities.
A second type of research network is the developing partnership between the American Medical Association (AMA) and Sermo, an online community where physicians exchange medical opinions. The partnership attempts to use technology to harness innovation, support physicians, and improve the capability of a peer network to influence the care patients receive by letting them share information with each other regarding patient care, pertinent scientific research, and advocacy issues. This is a looser network—without the constraints of data dictionaries—that relies on technology to make the connection between physician peers. While its start-up costs may be lower, its impact will be more difficult to measure.
A third example is the Gotham Prize for Cancer Research, which requires investigators to qualify by logging onto a Web site (www.gothamprize.org), posting a short proposal, and answering questions. If accepted by the expert panel of cancer researchers into this active forum, the new member will not only be eligible to receive the annual prize for the best idea, these individuals and their ideas will be matched to funding agencies and other scientists who may be able to support, assist, and/or collaborate. This limited-access network requires more facilitation than the previous AMA example, and the incentives and outcomes are more clearly defined.
The SHM Research Committee sees potential in exploring a network for hospital medicine researchers, through which members can access resources, collaborate, and innovate. Internet technology has the potential to level the playing field and erase the barriers of time differences and geography. By organizing around areas of interest designed to attract a critical mass of interested hospitalists, the goal of this network is to position SHM to lead hospital medicine research and ensure long-term success and sustainability by enabling powerful, high-impact studies in hospital medicine and supporting well-trained hospitalist researchers. Although this discussion is in the early stages of development, the SHM Research Committee plans to consider the following questions:
How would a network help hospital medicine and hospitalists? During the meeting in May in Dallas, the SHM Research Committee articulated the need for research mentorship, training, and career development. Any proposed network must further these aims. Hospital medicine investigators and SHM members would be involved in refining these goals at the earliest stages. Opportunities for training a new generation of hospital medicine investigators and strengthening the existing ones through such a network will be explored, including options for training in outcomes research and opportunities to link participants with mentors.
What questions should a network focus on? Hospitalists are well positioned to lead or collaborate on a range of key questions—questions that, in the short term, likely will focus on effectiveness and implementation research (related to quality improvement). Over the longer term, hospitalists should position themselves to be involved in all facets of clinical translational research, including T1 (bench-to-bedside research) and T2 (effectiveness research, such as larger randomized studies, and health services research). As hospital medicine grows, the potential areas where hospitalists might focus their scientific interests will expand. As hospitalists assume greater roles in caring for patients outside general medicine (e.g., surgical, cardiovascular, neurology, and oncology patients), the breadth of scientific inquiry will expand. In many of these cases, research networks exist; SHM will have to facilitate collaboration whenever possible.
How will the network engage a broad swath of hospitalists? By selecting research questions important to public health and anticipating a changing clinical environment, we hope to enhance the interest and relevance of an SHM research network. The SHM Research Committee will focus on how best to design a research network that is practical and useful for hospital medicine researchers and enable straightforward studies. A main goal will be promoting visibility for investigators and coordinators through opportunities for authorship and presentation of results at national meetings.
Healthcare reform has become a hot political issue again—more than a year before the presidential election. All three leading Democratic candidates (Hillary Clinton, Barack Obama, and John Edwards) have proposed some sort of a central institute to assess treatment options and disseminate research and information to providers. Hospitalists (as generalists and team leaders in an arena where approximately 30% of the healthcare dollar is spent) are a key part of any national solution.
Whether this research requires a catalyst such as a hospitalist network—and what that network would look like—remains to be seen. The SHM Research Committee is considering mechanisms to provide research mentorship, training, and career development, and weighing the best use of resources. We count on your input. Contact Carolyn Brennan, director of research program development for SHM, at cbrennan@hospitalmedicine.org for more information or to get involved. TH
SHM Behind the Scenes
PRIS updates in Salt Lake City
By Todd Von Deak
Each year, one of the premier events in pediatric hospital medicine is a summer conference presented by the American Academy of Pediatrics (AAP), the Ambulatory Pediatric Association (APA), and SHM. This year’s conference, held last month in Salt Lake City under the lead sponsorship of the AAP, was no exception.
More than 300 pediatric hospitalists, medical directors, residents, nurse practitioners, and physician assistants came together for four days to network, get answers, and learn from colleagues at 30 sessions. Charlie Homer, CEO of the National Institute for Children’s HealthCare Quality in Cambridge, Mass., was the keynote speaker. Dr. Homer highlighted the roles hospitalists can and must play to improve children’s health, and challenged all present to create a dashboard that includes quality indicators for care that is efficient, equitable, evidence-based, safe, and family-centered.
Leaders from the AAP, APA, and SHM opened the morning sessions the next day with brief presentations that highlighted the role of pediatric hospitalists in each organization, and the potential to work together to continue to develop pediatric hospital medicine and advance the care of hospitalized children. Participants were then free to choose from more than 16 sessions ranging from clinical issues such as the management of apparent life-threatening events and appropriate maintenance IV fluids, to practice management (Coding 101 and 201), quality improvement, and resident teaching and research.
Capping the schedule of events was a luncheon presentation from Christopher P. Landrigan, MD, director of the Pediatric Research in Inpatient Settings network. He presented “PRIS Update: The Need for Collaborative Hospitalist Research in 2007.” PRIS is an independent collaborative entity established by the same organizations that sponsor the Salt Lake City conference and is designed to allow for collaborative study of key questions in inpatient pediatrics.
Linda Snelling, MD, inpatient director and chief of pediatric critical care at Hasbro Children’s Hospital in Providence, R.I., followed with a talk on how pediatric hospitalists can effectively negotiate for themselves and the field. Her key insights included, “ ‘No.’ is a complete sentence.”
According to Jack Percelay, MD, past chair of SHM’s Pediatric Committee and a practicing pediatric hospitalist in New York and New Jersey, the conference exceeded its goals. “The energy at the conference was tremendous,” he said. “Sessions were filled with attendees learning of and debating cutting-edge issues for pediatric hospitalists. The buzz in the hotel was so intoxicating we were worried that we were violating Salt Lake City liquor laws. The AAP put on a spectacular meeting. SHM is looking forward to following this tradition of excellence as we take the lead for putting on an even larger meeting in Denver July 24-27, 2008.”
Given that the 2008 meeting sold out six weeks in advance, pediatric hospitalists will do well to stay tuned to The Hospitalist and visit SHM’s Web site, www.hospitalmedicine.org, for more details as the 2008 conference approaches. TH
By now almost everyone has heard about the social network site MySpace. More than 50 million people—mostly between ages 14 and 24—post and view online profiles connected by links to friends in the system. It’s one of the most heavily trafficked sites on the Internet.
MySpace is remarkable not only for consistent, double-digit growth rate, but also because visitors average two hours on the site modifying their profiles, and checking out friends’ profiles and commenting on them. MySpace has become ubiquitous to a generation using this public space to create and modify their identity on a daily basis—with technology that only recently has become available.
While recognizing that it may be a long time before www.hospitalmedicine.org becomes a household destination, the SHM Research Committee aims to generate similar excitement among our peers for connecting with each other over hospital medicine research on the Web.
Chapter Summary
Las Vegas
The SHM Las Vegas Chapter held its quarterly administrative meeting June 26 at Roy’s in Las Vegas. Gary Skankey, MD, infectious disease specialist and associate clinical professor at the University of Nevada School of Medicine, presented “Treating Complicated Skin and Skin Infections in an Era of Increasing Resistance.” The chapter will host a CME Program on surviving sepsis Sept. 28-29. Visit the chapter page for further program details.
Nashville
The SHM Nashville Chapter meeting June 6 at Stoney River restaurant was sponsored by Ortho McNeil and HCA Physician Recruitment. Eric Siegal, MD, with the University of Wisconsin Hospital in Madison, was the featured presenter and led an interactive session during “Malpractice for the Hospitalists: Identifying and Mitigating Risks.” The next meeting is scheduled for this month. Details will be posted at a later date.
At the SHM Research Committee meeting in Dallas in May, the conversation covered many topics, including the need for research mentorship, training, and career development. Plans for short- and medium-term measures to support SHM members in these areas are in the works, with a focus on Internet-based resources.
Over the long term, the committee would like to see its efforts result in national, high-impact hospital medicine studies and well-trained researchers. Whether driven by a curiosity in a particular area and/or the desire to provide better care by incorporating the best research, the universal challenge is to free enough time to pursue the answers and for appropriate recognition systems to be in place—be they promotion, funding to support further work, or recognition that leads to new connections.
The 249 abstracts published in a supplement to the Journal of Hospital Medicine only hinted at the depth and enthusiasm behind SHM members’ work. Anyone who walked through the exhibit hall during the poster session at the SHM Annual Meeting and talked with the people behind the research was impressed with their dedication and relative youth. They are the future of hospital medicine and are looking for ways to collaborate and continue to learn. The SHM Research Committee is dedicated to finding ways to support their efforts.
It seems as if many SHM members either engage in research, think about a research project, or wish they could evaluate their everyday practice in a way that can help others. However, it is difficult to discern how best to support individual hospitalists working in diverse settings across the country.
Because clinical responsibilities will not slow down anytime soon, we will have to work within the current, hectic environment and use technology as an equalizer to enable communication. In the spectrum of professional medical societies, SHM could be considered similar to the age 14-24 demographic attracted to the fluidity, instant communication/information and innovation that fuels MySpace.
Our long-term research goals could be powerfully advanced by a peer-catalyzed hospitalist research network.
The term “research network” can refer to many types of collaboration. One type that has been successful is the collection, analysis, and reporting of data in a registry or repository. In this example, medical care can be measured through the collection, analysis, and reporting of data. The National Cardiovascular Data Registry (established in 1998 by the American College of Cardiology Foundation) is a well-known example, but there are many others that have been organized for the purposes of improving quality and providing educational and research activities.
A second type of research network is the developing partnership between the American Medical Association (AMA) and Sermo, an online community where physicians exchange medical opinions. The partnership attempts to use technology to harness innovation, support physicians, and improve the capability of a peer network to influence the care patients receive by letting them share information with each other regarding patient care, pertinent scientific research, and advocacy issues. This is a looser network—without the constraints of data dictionaries—that relies on technology to make the connection between physician peers. While its start-up costs may be lower, its impact will be more difficult to measure.
A third example is the Gotham Prize for Cancer Research, which requires investigators to qualify by logging onto a Web site (www.gothamprize.org), posting a short proposal, and answering questions. If accepted by the expert panel of cancer researchers into this active forum, the new member will not only be eligible to receive the annual prize for the best idea, these individuals and their ideas will be matched to funding agencies and other scientists who may be able to support, assist, and/or collaborate. This limited-access network requires more facilitation than the previous AMA example, and the incentives and outcomes are more clearly defined.
The SHM Research Committee sees potential in exploring a network for hospital medicine researchers, through which members can access resources, collaborate, and innovate. Internet technology has the potential to level the playing field and erase the barriers of time differences and geography. By organizing around areas of interest designed to attract a critical mass of interested hospitalists, the goal of this network is to position SHM to lead hospital medicine research and ensure long-term success and sustainability by enabling powerful, high-impact studies in hospital medicine and supporting well-trained hospitalist researchers. Although this discussion is in the early stages of development, the SHM Research Committee plans to consider the following questions:
How would a network help hospital medicine and hospitalists? During the meeting in May in Dallas, the SHM Research Committee articulated the need for research mentorship, training, and career development. Any proposed network must further these aims. Hospital medicine investigators and SHM members would be involved in refining these goals at the earliest stages. Opportunities for training a new generation of hospital medicine investigators and strengthening the existing ones through such a network will be explored, including options for training in outcomes research and opportunities to link participants with mentors.
What questions should a network focus on? Hospitalists are well positioned to lead or collaborate on a range of key questions—questions that, in the short term, likely will focus on effectiveness and implementation research (related to quality improvement). Over the longer term, hospitalists should position themselves to be involved in all facets of clinical translational research, including T1 (bench-to-bedside research) and T2 (effectiveness research, such as larger randomized studies, and health services research). As hospital medicine grows, the potential areas where hospitalists might focus their scientific interests will expand. As hospitalists assume greater roles in caring for patients outside general medicine (e.g., surgical, cardiovascular, neurology, and oncology patients), the breadth of scientific inquiry will expand. In many of these cases, research networks exist; SHM will have to facilitate collaboration whenever possible.
How will the network engage a broad swath of hospitalists? By selecting research questions important to public health and anticipating a changing clinical environment, we hope to enhance the interest and relevance of an SHM research network. The SHM Research Committee will focus on how best to design a research network that is practical and useful for hospital medicine researchers and enable straightforward studies. A main goal will be promoting visibility for investigators and coordinators through opportunities for authorship and presentation of results at national meetings.
Healthcare reform has become a hot political issue again—more than a year before the presidential election. All three leading Democratic candidates (Hillary Clinton, Barack Obama, and John Edwards) have proposed some sort of a central institute to assess treatment options and disseminate research and information to providers. Hospitalists (as generalists and team leaders in an arena where approximately 30% of the healthcare dollar is spent) are a key part of any national solution.
Whether this research requires a catalyst such as a hospitalist network—and what that network would look like—remains to be seen. The SHM Research Committee is considering mechanisms to provide research mentorship, training, and career development, and weighing the best use of resources. We count on your input. Contact Carolyn Brennan, director of research program development for SHM, at cbrennan@hospitalmedicine.org for more information or to get involved. TH
SHM Behind the Scenes
PRIS updates in Salt Lake City
By Todd Von Deak
Each year, one of the premier events in pediatric hospital medicine is a summer conference presented by the American Academy of Pediatrics (AAP), the Ambulatory Pediatric Association (APA), and SHM. This year’s conference, held last month in Salt Lake City under the lead sponsorship of the AAP, was no exception.
More than 300 pediatric hospitalists, medical directors, residents, nurse practitioners, and physician assistants came together for four days to network, get answers, and learn from colleagues at 30 sessions. Charlie Homer, CEO of the National Institute for Children’s HealthCare Quality in Cambridge, Mass., was the keynote speaker. Dr. Homer highlighted the roles hospitalists can and must play to improve children’s health, and challenged all present to create a dashboard that includes quality indicators for care that is efficient, equitable, evidence-based, safe, and family-centered.
Leaders from the AAP, APA, and SHM opened the morning sessions the next day with brief presentations that highlighted the role of pediatric hospitalists in each organization, and the potential to work together to continue to develop pediatric hospital medicine and advance the care of hospitalized children. Participants were then free to choose from more than 16 sessions ranging from clinical issues such as the management of apparent life-threatening events and appropriate maintenance IV fluids, to practice management (Coding 101 and 201), quality improvement, and resident teaching and research.
Capping the schedule of events was a luncheon presentation from Christopher P. Landrigan, MD, director of the Pediatric Research in Inpatient Settings network. He presented “PRIS Update: The Need for Collaborative Hospitalist Research in 2007.” PRIS is an independent collaborative entity established by the same organizations that sponsor the Salt Lake City conference and is designed to allow for collaborative study of key questions in inpatient pediatrics.
Linda Snelling, MD, inpatient director and chief of pediatric critical care at Hasbro Children’s Hospital in Providence, R.I., followed with a talk on how pediatric hospitalists can effectively negotiate for themselves and the field. Her key insights included, “ ‘No.’ is a complete sentence.”
According to Jack Percelay, MD, past chair of SHM’s Pediatric Committee and a practicing pediatric hospitalist in New York and New Jersey, the conference exceeded its goals. “The energy at the conference was tremendous,” he said. “Sessions were filled with attendees learning of and debating cutting-edge issues for pediatric hospitalists. The buzz in the hotel was so intoxicating we were worried that we were violating Salt Lake City liquor laws. The AAP put on a spectacular meeting. SHM is looking forward to following this tradition of excellence as we take the lead for putting on an even larger meeting in Denver July 24-27, 2008.”
Given that the 2008 meeting sold out six weeks in advance, pediatric hospitalists will do well to stay tuned to The Hospitalist and visit SHM’s Web site, www.hospitalmedicine.org, for more details as the 2008 conference approaches. TH
By now almost everyone has heard about the social network site MySpace. More than 50 million people—mostly between ages 14 and 24—post and view online profiles connected by links to friends in the system. It’s one of the most heavily trafficked sites on the Internet.
MySpace is remarkable not only for consistent, double-digit growth rate, but also because visitors average two hours on the site modifying their profiles, and checking out friends’ profiles and commenting on them. MySpace has become ubiquitous to a generation using this public space to create and modify their identity on a daily basis—with technology that only recently has become available.
While recognizing that it may be a long time before www.hospitalmedicine.org becomes a household destination, the SHM Research Committee aims to generate similar excitement among our peers for connecting with each other over hospital medicine research on the Web.
Chapter Summary
Las Vegas
The SHM Las Vegas Chapter held its quarterly administrative meeting June 26 at Roy’s in Las Vegas. Gary Skankey, MD, infectious disease specialist and associate clinical professor at the University of Nevada School of Medicine, presented “Treating Complicated Skin and Skin Infections in an Era of Increasing Resistance.” The chapter will host a CME Program on surviving sepsis Sept. 28-29. Visit the chapter page for further program details.
Nashville
The SHM Nashville Chapter meeting June 6 at Stoney River restaurant was sponsored by Ortho McNeil and HCA Physician Recruitment. Eric Siegal, MD, with the University of Wisconsin Hospital in Madison, was the featured presenter and led an interactive session during “Malpractice for the Hospitalists: Identifying and Mitigating Risks.” The next meeting is scheduled for this month. Details will be posted at a later date.
At the SHM Research Committee meeting in Dallas in May, the conversation covered many topics, including the need for research mentorship, training, and career development. Plans for short- and medium-term measures to support SHM members in these areas are in the works, with a focus on Internet-based resources.
Over the long term, the committee would like to see its efforts result in national, high-impact hospital medicine studies and well-trained researchers. Whether driven by a curiosity in a particular area and/or the desire to provide better care by incorporating the best research, the universal challenge is to free enough time to pursue the answers and for appropriate recognition systems to be in place—be they promotion, funding to support further work, or recognition that leads to new connections.
The 249 abstracts published in a supplement to the Journal of Hospital Medicine only hinted at the depth and enthusiasm behind SHM members’ work. Anyone who walked through the exhibit hall during the poster session at the SHM Annual Meeting and talked with the people behind the research was impressed with their dedication and relative youth. They are the future of hospital medicine and are looking for ways to collaborate and continue to learn. The SHM Research Committee is dedicated to finding ways to support their efforts.
It seems as if many SHM members either engage in research, think about a research project, or wish they could evaluate their everyday practice in a way that can help others. However, it is difficult to discern how best to support individual hospitalists working in diverse settings across the country.
Because clinical responsibilities will not slow down anytime soon, we will have to work within the current, hectic environment and use technology as an equalizer to enable communication. In the spectrum of professional medical societies, SHM could be considered similar to the age 14-24 demographic attracted to the fluidity, instant communication/information and innovation that fuels MySpace.
Our long-term research goals could be powerfully advanced by a peer-catalyzed hospitalist research network.
The term “research network” can refer to many types of collaboration. One type that has been successful is the collection, analysis, and reporting of data in a registry or repository. In this example, medical care can be measured through the collection, analysis, and reporting of data. The National Cardiovascular Data Registry (established in 1998 by the American College of Cardiology Foundation) is a well-known example, but there are many others that have been organized for the purposes of improving quality and providing educational and research activities.
A second type of research network is the developing partnership between the American Medical Association (AMA) and Sermo, an online community where physicians exchange medical opinions. The partnership attempts to use technology to harness innovation, support physicians, and improve the capability of a peer network to influence the care patients receive by letting them share information with each other regarding patient care, pertinent scientific research, and advocacy issues. This is a looser network—without the constraints of data dictionaries—that relies on technology to make the connection between physician peers. While its start-up costs may be lower, its impact will be more difficult to measure.
A third example is the Gotham Prize for Cancer Research, which requires investigators to qualify by logging onto a Web site (www.gothamprize.org), posting a short proposal, and answering questions. If accepted by the expert panel of cancer researchers into this active forum, the new member will not only be eligible to receive the annual prize for the best idea, these individuals and their ideas will be matched to funding agencies and other scientists who may be able to support, assist, and/or collaborate. This limited-access network requires more facilitation than the previous AMA example, and the incentives and outcomes are more clearly defined.
The SHM Research Committee sees potential in exploring a network for hospital medicine researchers, through which members can access resources, collaborate, and innovate. Internet technology has the potential to level the playing field and erase the barriers of time differences and geography. By organizing around areas of interest designed to attract a critical mass of interested hospitalists, the goal of this network is to position SHM to lead hospital medicine research and ensure long-term success and sustainability by enabling powerful, high-impact studies in hospital medicine and supporting well-trained hospitalist researchers. Although this discussion is in the early stages of development, the SHM Research Committee plans to consider the following questions:
How would a network help hospital medicine and hospitalists? During the meeting in May in Dallas, the SHM Research Committee articulated the need for research mentorship, training, and career development. Any proposed network must further these aims. Hospital medicine investigators and SHM members would be involved in refining these goals at the earliest stages. Opportunities for training a new generation of hospital medicine investigators and strengthening the existing ones through such a network will be explored, including options for training in outcomes research and opportunities to link participants with mentors.
What questions should a network focus on? Hospitalists are well positioned to lead or collaborate on a range of key questions—questions that, in the short term, likely will focus on effectiveness and implementation research (related to quality improvement). Over the longer term, hospitalists should position themselves to be involved in all facets of clinical translational research, including T1 (bench-to-bedside research) and T2 (effectiveness research, such as larger randomized studies, and health services research). As hospital medicine grows, the potential areas where hospitalists might focus their scientific interests will expand. As hospitalists assume greater roles in caring for patients outside general medicine (e.g., surgical, cardiovascular, neurology, and oncology patients), the breadth of scientific inquiry will expand. In many of these cases, research networks exist; SHM will have to facilitate collaboration whenever possible.
How will the network engage a broad swath of hospitalists? By selecting research questions important to public health and anticipating a changing clinical environment, we hope to enhance the interest and relevance of an SHM research network. The SHM Research Committee will focus on how best to design a research network that is practical and useful for hospital medicine researchers and enable straightforward studies. A main goal will be promoting visibility for investigators and coordinators through opportunities for authorship and presentation of results at national meetings.
Healthcare reform has become a hot political issue again—more than a year before the presidential election. All three leading Democratic candidates (Hillary Clinton, Barack Obama, and John Edwards) have proposed some sort of a central institute to assess treatment options and disseminate research and information to providers. Hospitalists (as generalists and team leaders in an arena where approximately 30% of the healthcare dollar is spent) are a key part of any national solution.
Whether this research requires a catalyst such as a hospitalist network—and what that network would look like—remains to be seen. The SHM Research Committee is considering mechanisms to provide research mentorship, training, and career development, and weighing the best use of resources. We count on your input. Contact Carolyn Brennan, director of research program development for SHM, at cbrennan@hospitalmedicine.org for more information or to get involved. TH
SHM Behind the Scenes
PRIS updates in Salt Lake City
By Todd Von Deak
Each year, one of the premier events in pediatric hospital medicine is a summer conference presented by the American Academy of Pediatrics (AAP), the Ambulatory Pediatric Association (APA), and SHM. This year’s conference, held last month in Salt Lake City under the lead sponsorship of the AAP, was no exception.
More than 300 pediatric hospitalists, medical directors, residents, nurse practitioners, and physician assistants came together for four days to network, get answers, and learn from colleagues at 30 sessions. Charlie Homer, CEO of the National Institute for Children’s HealthCare Quality in Cambridge, Mass., was the keynote speaker. Dr. Homer highlighted the roles hospitalists can and must play to improve children’s health, and challenged all present to create a dashboard that includes quality indicators for care that is efficient, equitable, evidence-based, safe, and family-centered.
Leaders from the AAP, APA, and SHM opened the morning sessions the next day with brief presentations that highlighted the role of pediatric hospitalists in each organization, and the potential to work together to continue to develop pediatric hospital medicine and advance the care of hospitalized children. Participants were then free to choose from more than 16 sessions ranging from clinical issues such as the management of apparent life-threatening events and appropriate maintenance IV fluids, to practice management (Coding 101 and 201), quality improvement, and resident teaching and research.
Capping the schedule of events was a luncheon presentation from Christopher P. Landrigan, MD, director of the Pediatric Research in Inpatient Settings network. He presented “PRIS Update: The Need for Collaborative Hospitalist Research in 2007.” PRIS is an independent collaborative entity established by the same organizations that sponsor the Salt Lake City conference and is designed to allow for collaborative study of key questions in inpatient pediatrics.
Linda Snelling, MD, inpatient director and chief of pediatric critical care at Hasbro Children’s Hospital in Providence, R.I., followed with a talk on how pediatric hospitalists can effectively negotiate for themselves and the field. Her key insights included, “ ‘No.’ is a complete sentence.”
According to Jack Percelay, MD, past chair of SHM’s Pediatric Committee and a practicing pediatric hospitalist in New York and New Jersey, the conference exceeded its goals. “The energy at the conference was tremendous,” he said. “Sessions were filled with attendees learning of and debating cutting-edge issues for pediatric hospitalists. The buzz in the hotel was so intoxicating we were worried that we were violating Salt Lake City liquor laws. The AAP put on a spectacular meeting. SHM is looking forward to following this tradition of excellence as we take the lead for putting on an even larger meeting in Denver July 24-27, 2008.”
Given that the 2008 meeting sold out six weeks in advance, pediatric hospitalists will do well to stay tuned to The Hospitalist and visit SHM’s Web site, www.hospitalmedicine.org, for more details as the 2008 conference approaches. TH