Involving Professional Nurses In Policy Making Discussion

HHS Public Access Author manuscript Author Manuscript J Racial Ethn Health Disparities. Author manuscript; available in PMC 2018 April 28. Leading by Success: Impact of a Clinical & Translational Research Infrastructure Program to Address Health Inequities Bruce Shiramizu1, Vicki Shambaugh2, Helen Petrovich2, Todd B. Seto3, Tammy Ho4, Noreen Mokuau5, and Jerris R. Hedges4 1Department of Tropical Medicine, Medical Microbiology & Pharmacology, John A. Burns School of Medicine (JABSOM), University of Hawaii at Manoa (UHM), Honolulu, HI Author Manuscript 2Pacific Health Research and Education Institute, Honolulu, HI 3Department 4JABSOM, 5Myron of Medicine, JABSOM, UHM, Honolulu, HI UHM, Honolulu, HI B. Thompson School of Social Work, UHM, Honolulu, HI Abstract Author Manuscript Building research infrastructure capacity to address clinical and translational gaps has been a focus of funding agencies and foundations. Clinical and Translational Sciences Awards, Research Centers in Minority Institutions Infrastructure for Clinical and Translational Research (RCTR) and the Institutional Development Award Infrastructure for Clinical and Translational Research funded by United States (US) government to fund clinical translational research programs have existed for over a decade to address racial and ethnic health disparities across the US. While the impact on the nation’s health can’t be made in a short period, assessment of a program’s impact could be a litmus test to gauge its effectiveness at the institution and communities. We report the success of a Pilot Project Program in the University of Hawaii RCTR Award in advancing careers of emerging investigators and community collaborators. Our findings demonstrated that the investment has a far-reaching impact on engagement with community-based research collaborators, career advancement of health disparities investigators, and favorable impacts on health policy. Keywords health disparity; clinical research; health inequity; translational research Author Manuscript INTRODUCTION Health inequities continue to persist in communities across the disease spectrum throughout the United States (US) and globally1–3. Contributing to the culture of health disparities has Correspondence: Bruce Shiramizu, 651 Ilalo Street, BSB 325AA, Honolulu, Hawaii, 96813; bshirami@hawaii.edu.

COMPLIANCE WITH ETHICAL STANDARDS The scope of the work did not involve human participants as reviewed by the University of Hawaii Institutional Review Board. The authors have no other potential conflicts of interests except for the funding agencies as acknowledged. Shiramizu et al. Page 2 Author Manuscript Author Manuscript partly been a function of the imbalance of biomedical research funding from government agencies, private foundations, industry and other sources4–7. Innovative concepts and bold initiatives to increase collaborations and partnerships were established through government, industry and foundations to increase translation of research into practice to accelerate medical research6–10. Concepts and ideas to increase capacity to address clinical and translational gaps in the health of the population included new approaches to discovery, developing partnerships between government and private sectors, identifying research teams, and redesigning the clinical research paradigm6, 10. A number of research initiatives were instituted by various funding agencies to address clinical and translational gaps to bring entities together to accelerate the pace of discovery, from the earliest discovery stages through clinical research11–17. What followed in the USA, amongst many other infrastructure programs, were the Clinical and Translational Sciences Award program (CTSA) funded by the National Center for Advancing Translational Sciences (NCATS)18, 19, Research Centers in Minority Institutions (RCMI) Infrastructure for Clinical and Translational Research (RCTR) funded by National Institute of Minority Health and Health Disparities (NIMHD)20, and the Institutional Development Award Program Infrastructure for Clinical and Translational Research (IDeA-CTR) funded by National Institute of General Medical Sciences (NIGMS), Table 1. Author Manuscript Author Manuscript Recognizing that building capacity to engage in clinical translational research at institutions across the USA requires collaborations and partnerships, the CTSA mechanism was launched to support programs and infrastructures for translational science7, 19. The success of the CTSA programs impacted geographical regions based at the institutions involved with their respective CTSA programs21–25. On a smaller scale and owing to the limitations placed by the NIH IDeA Program, institutions from IDeA-eligible states developed clinical and translational research capacity at their institutions beginning in 201426. In a similar fashion, RCMI institutions were provided opportunities to develop infrastructures to conduct clinical and translational research11–17. The University of Hawaii (UH), as an RCMI institution, established the RCMI Multidisciplinary And Translational Research Infrastructure Expansion (RMATRIX) Program as an RCTR which has grown to be a successful clinical and translational research foundation for faculty members at UH.20 Nationally, millions of federal and foundation dollars have been invested into these and other clinical and translational research infrastructure programs. We report the success of a Pilot Project Program of RMATRIX at UH which not only built research capacity locally but also impacted clinical and translational research far beyond Hawaii through the support of academic investigators with Pilot Project Awards.

One of unique characteristics of Hawaii was that as the 50th state of the USA, its geographical isolation in the Pacific Ocean distinguished it as having the only accredited USA medical school within a 2400 mile radius. With its diverse ethnic population including Native Hawaiians, Pacific Islanders, Asians and Filipinos, the RMATRIX program at UH was uniquely situated with its infrastructure to potentially contribute to the clinical translational landscape in Hawaii to benefit its population. One component of the RMATRIX program was the Pilot Project program which provided resources and funds for emerging investigators to support research projects focusing on health inequities in the communities. We report that the investment not only built the clinical and translational research infrastructure at UH but the dollars had a J Racial Ethn Health Disparities. Author manuscript; available in PMC 2018 April 28. Shiramizu et al. Page 3 Author Manuscript far-reaching impact that connected communities and collaborators both locally and nationally where health inequities also persisted. METHODS RMATRIX Program Author Manuscript The Institutional Review Board (IRB) of the UH Human Studies Program reviewed the principle of the project. The RMATRIX Program was initially funded as an RCTR in 2010 for 3 years with a 1 year no-cost extension in response to an NIH Program Announcement, PAR-09-261, “Limited Competition for Research Centers in Minority Institutions Infrastructure for Clinical and Translational Research”. Following a competitive renewal application, RMATRIX was refunded for 5 years in 2014. Through the RCTR award, RMATRIX was established as the integrated “home” for clinical and translational science in Hawaii through the UH. Author Manuscript In the first 4 years, we reorganized and expanded existing (and previously disconnected) RCMI research infrastructure programs at UH working with community and hospital partners. The RMATRIX Key Functions were carefully designed to provide the clinical and translational research infrastructure to expand proposed HEALTH (Health, Equity and Lifestyle Transformation in Hawai’i) Initiatives to address health disparities throughout Hawaii. The RMATRIX Key Functions which served as resources to support investigators (during study development and implementation and career development) included: Program Administration, Professional Development, Collaborations and Partnerships, Biomedical Informatics, Clinical Research Resources and Facilities, Community-Based Research, Research Design and Biostatistics, Regulatory Knowledge, and Evaluation. These 8 Key Functions focused initially on projects and investigators interested in health disparity issues related to six HEALTH Initiatives: cardiovascular; respiratory; nutrition & metabolic; cancer; perinatal, growth, & development; and aging & neurocognition. In the successful renewal application, lessons learned allowed the program to focus on three HEALTH Initiatives which resonated with the communities and investigators through needs assessments: nutrition & metabolic health; reproductive growth & developmental health; and aging & chronic disease prevention/management. While RMATRIX supported investigators interested in clinical and translational research across the spectrum of the HEALTH Initiatives, this report will highlight the continuing activities of investigators from the first three years of the RMATRIX Pilot Project Program. Data from 3–5 years after the pilot projects were award provided facts and figures on the ongoing impact of the RMATRIX program which informed this report. Author Manuscript RMATRIX Pilot Project Program The Pilot Project Program promoted inter-professional translational research in health disparities by supporting research endeavors and collaborations among emerging investigators.

The Pilot Project Program released an annual institution-wide request for proposals which encouraged multiple principal investigators and/or collaborators across disciplines. Presentations at department and school faculty meetings were also held to J Racial Ethn Health Disparities. Author manuscript; available in PMC 2018 April 28. Shiramizu et al. Page 4 Author Manuscript disseminate information about the funding opportunities. Direct costs up to $30,000 per year for 1-year projects were allowed, with priority given to those studies which focused on one of the HEALTH Initiatives. From 2010–2012, 18 Pilot Project Investigators were awarded from 55 Pilot Project applications which were submitted in response to the RFP. At the time of the RFP release, webinars were held to guide and provide potential applicants information on the Pilot Project application process. Each cycle of applications underwent external review with at least 2 experienced external reviewers assigned to each application and scored similarly to the current NIH extramural grant review guidelines.27 The level of funding available in 2010–2012 determined the number of Pilot Project Awards which were provided in each year: 3 awards to 3 investigators in 2010; 8 awards to 8 investigators in 2011; and 6 awards to 7 investigators in 2012. The Pilot Project investigators’ disciplines and Pilot Project titles are summarized in Table 2. Author Manuscript RMATRIX Pilot Project Program Evaluation Author Manuscript The RMATRIX evaluators (from the second funding cycle) consisted of one MD and one MA/MPH with over 30 years each in health research including federal funding on multi-year grants and contracts as well as infrastructure development grants in minority health involving academia, medical centers, and community organizations throughout Hawaii. The Evaluators were from an independent, nonprofit organization with research backgrounds who were each funded by grants and contracts and each understanding challenges that researchers faced. They employed qualitative methodology using semi-structured interviews to collect information on Pilot Project Investigators’ perspectives and experiences. The semistructured interview process permitted maximum use of face-to-face time with each Pilot Project Investigator. Interviews were conducted at a location selected by the Pilot Project Investigator; usually a conference room at their department or in their office at the University or Medical Center. Author Manuscript Data were collected beginning 1 year after each Pilot Project Investigator was awarded the RMATRIX Pilot Award through December 2015. RMATRIX Pilot Project Investigators received their awards in 2010, 2011, and 2012, providing 3 to 5 years of follow-up data for analysis. A standardized list of outcomes was used to guide the interview process while not restricting the Pilot Project Investigator from sharing additional information he/she felt important. This included: publications; presentations; patents; further research after pilot award; continuation of pilot or new research; research role; awards/recognitions; promotions; job/career change; research findings that brought change to clinical or social service practice, resulted in change in organizational, local, state, or federal policies; findings used in advocacy; collaborators; disciplines; community involvement; and federal contacts, Table 3. A copy of the outcomes to be discussed as well as evaluation questions were sent to all Pilot Project Investigators before their interview. Each Pilot Project Investigator was requested to send an updated resume to the Evaluators prior to the in-person meeting. This allowed the Evaluators to review the resume, note outcomes, and identify additional questions for the meeting. This helped to maximize the interview process and keep the total interview time to one hour. The academic professional outcomes and measurements were reported based on the interview information of the pilot project investigators, Table 3. J Racial Ethn Health Disparities. Author manuscript; available in PMC 2018 April 28. Shiramizu et al. Page 5 Author Manuscript RESULTS Eighteen Pilot Project Investigators received seventeen pilot awards from 2010–2012 in RMATRIX. Involving Professional Nurses In Policy Making Discussion

Seventeen of eighteen investigators in RMATRIX were contacted; however, the lack of contact information for the last investigator prevented follow-up. Fifteen investigators provided updated resumes and met with the Evaluators. One Pilot Project Investigator provided a resume but elected to not participate in the interview while a second who moved to the mainland United States furnished an updated resume and answered the evaluation questions via email. The data presented summarizes information from 17 investigators based on self-report and public documentation. The academic demographics of the investigators represented diverse disciplines across the spectrum and academic ranks, Table 4. Author Manuscript Scholarly Assessment Author Manuscript Scholarly assessment was measured by the publications, presentations at scientific meetings and by funded grants. The successful achievements of the Pilot Project Investigators were highlighted by publications in peer-reviewed journals and books since receiving their pilot awards as well as their contributions at scientific meetings with presentations, Table 4. Since the completion of their Pilot Project, the 17 investigators had 47 grants which were currently active at the time of this report. An additional 34 grants were funded and completed since their Pilot Projects. In addition to the funding agencies noted in Table 2, private foundations and pharmaceutical companies also contributed as sources.

The 81 grants contributed over $79.5 million in research with each of the 17 investigators being Principal Investigators (PI) on 60 grants which totaled $22.4 million in direct award dollars. The litmus test for RMATRIX investigators’ research successes was based on being awarded federally-funded grants4. Professional Academic Assessment Pilot project investigators were assessed on their academic achievements since being awarded the pilot project funds including promotions and new academic appointments, Table 4. Entrepreneurship Assessment Author Manuscript Entrepreneurship achievements were assessed by successful business ventures or related enterprises, Table 3. Three investigators developed new startup companies based on their research and contributions from their Pilot Project data. These startup companies are employing graduates from UH, providing them with jobs in Hawaii in their discipline. Three patents were received and four intellectual property agreements were filed. Training the Next Generation of Faculty Researchers Assessment Career development of faculty includes developing skills and ability to train emerging investigators and students to contribute to the pipeline of new clinical translational research faculty, Table 3. To accomplish this, continued collaborations with other investigators contribute to the foundation. Involving Professional Nurses In Policy Making Discussion

All of the Pilot Project Investigators continued collaborations from their RMATRIX pilot work. Additionally, they have all become mentors themselves for J Racial Ethn Health Disparities. Author manuscript; available in PMC 2018 April 28. Shiramizu et al. Page 6 Author Manuscript students and other faculty. In 2015 alone, the 17 investigators have mentored 159 mentees including medical students, MDs, Master Candidates, PhD Candidates, PhDs and undergraduate students. Awards/Honors Assessment Author Manuscript Recognition of the accomplishments as a direct or indirect result of the pilot project awards can contribute to clinical translation research through additional funding opportunities and scientific opportunities, Table 3. Among the numerous awards and recognitions cumulatively bestowed upon the RMATRIX Pilot Project Investigators were: the Robert W. Clopton Award, Distinguished Community Service, Certificate of Recognition and Invited Member National Academy of Inventors, Institute of Electrical and Electronics Engineers Fellow, Hawaii Comprehensive Cancer Coalition Chair, American Cancer Society Hawaii/Pacific Chapter Board, Royal Geographical Society Research Fellow, Migrant Clinicians Network External Advisory Board, Washington State Commission on Asian Pacific American Affairs, Queens’s Health Systems, Queen’s Medical Center and Hawaii Pacific Health Board members, American Academy of Neurology Emerging Leadership Forum Award, NSF Career Award, and American College of Physicians Laureate Award. Scientific Impact Assessment Author Manuscript The scientific impact of the pilot project and/or contribution by the investigator was assessed by how the knowledge gained or results contributed to the health of the communities, Table 3. Because of Hawaii’s unique geographic location and diverse population, there are rich opportunities to examine how the environment, race and ethnicity, and culture impact the access, delivery and outcomes of care, and contribute to the significant health inequities identified among Native Hawaiians and Other Pacific Islanders. The potential scientific impact that the awarded Pilot Projects proposed were viewed positively by the external reviewers. As such, the success of the Pilot Projects provided scientific contributions across a wide spectrum including: 1) Physiological radar technology for sleep monitoring; 2) Involving Professional Nurses In Policy Making Discussion

Behavioral modification to reduce health disparities and chronic disease in Native Hawaiians and other high risk populations; 3) Neuroimaging technique targeting monocytes for brain inflammation; 4) Properties of pulmonary surfactant in premature infants; 5) Patent award and product development of a compound to effectively treat box jellyfish stings; and 6) Patent on methods for prevention of cardiac hypertrophy. Advocacy Assessment Author Manuscript The litmus test for effective clinical and translational research that impacts the population in Hawaii is policy and advocacy Table 3. RMATRIX Pilot Project Investigators reported the following actions: 1) Hawaii State Senate Resolution to convene Native Hawaiian Health Task Force addressing health inequities; 2) Establishment of Hawaii State Stroke Registry; and 3) Disparities findings used for advo …Involving Professional Nurses In Policy Making Discussion