Research News

The Patient-Centered Outcomes Research Institute (PCORI) has chosen Cleveland Clinic for a nationwide initiative to improve how healthcare systems translate research findings to clinical practice.

PCORI’s Health Systems Implementation Initiative (HSII) connects 42 healthcare systems to reduce the time it takes to move a discovery in research to a new treatment for patients – an estimated 17-year gap. Healthcare systems that are part of the initial HSII will propose projects that implement findings from PCORI-funded research, which includes more than 800 research studies focused on patient care.

This is the nonprofit’s first time offering this type of implementation funding. PCORI has committed an initial investment of up to $50 million to support the initiative.

Research funding provides data on how to improve treatment, recovery and healthcare maintenance, as well as the predictive tools and structures healthcare systems use to deliver services. Implementing the findings requires additional money, training and infrastructure, which is where health systems can hit roadblocks.

PCORI is offering a first phase of funding to build capacity for upcoming implementation projects – up to $500,000 per health system. Healthcare systems will then pitch implementation projects for the second phase of funding, which will range from $500 - $5 million per project.

“We know there is a gap, that it takes years to move a scientific discovery into clinical practice. Now, PCORI is providing the resources,” says Anita Misra-Hebert, MD, MPH, director of Cleveland Clinic’s Healthcare Delivery & Implementation Science Center. “These health systems can also benefit from learning how others accelerate this process, continuously improving and tailoring care to benefit patients.”

Cleveland Clinic launched its own Healthcare Delivery & Implementation Science Center in 2019, initiated by Tom Mihaljevic, MD, CEO, President and Morton L. Mandel CEO Chair of Cleveland Clinic.

The center serves as a system-wide resource for research implementation, connecting researchers with operations leadership. The center offers consultation and education programs and funds implementation projects through grants. Accepted projects include using 3-D models in imaging, screening prenatal testing during COVID-19 and using data to predict readmission risk.

Dr. Misra-Hebert is co-lead on programs through HSII with Beri Ridgeway, MD, Cleveland Clinic’s Chief of Staff.

“One of the key aspects of implementing new programs or standardizing care is translating knowledge generated from research into real world practice,” says Dr. Misra-Hebert.

“This initiative allows us to continue building infrastructure that will further expedite the adoption and implementation of scientific discoveries,” Dr. Ridgeway adds.

Adopting research evidence in care at Cleveland Clinic: Readmissions risk calculator

A physician or scientist at Cleveland Clinic finds research evidence to solve an ongoing problem or improve a process – what's next?

The implementation process involves several steps. After designing a new concept, protocol or service delivery strategy using research data, a healthcare system must then introduce it to physicians and other staff for adoption.

As the implementation process continues, operational leaders and researchers then evaluate the project to see whether it improves patient outcomes.

What might work for one healthcare system might not work for another, Dr. Misra-Hebert says, so this evaluation step is critical for serving a specific patient population.

One example of the implementation process is the Cleveland Clinic’s readmission risk calculator, a project started in 2017. Hospital readmission refers to when a patient returns to the hospital after a 30-, day period for follow-up care related to the initial hospital stay.

Cleveland Clinic’s calculator uses aggregated data from electronic medical records (EMR) to help predict chance of readmission, using 18 variables like patients’ medical history, blood measurements and potential barriers to accessing care. The risk calculator pulls that information into one place and provides a score in the patient’s EMR. Physicians can then use that information to inform their care plans, like connecting patients to certain resources or programs that could help prevent readmission.

After three years, a research team led by Dr. Misra-Hebert analyzed discharge and admission data from more than 600,000 patient discharges to evaluate the calculator’s accuracy. Findings published in the Journal of Internal Medicinein 2022 showed the data model consistently performed well, but identified some improvement areas. The study also pointed out areas for future study, like how to prompt patients to take advantage of post-care resources.

By reviewing these outcomes, developers can then fine tune the model to make it more accurate and useful.

“Implementation doesn’t stop when people start using the new tool or protocol – it runs for years afterward. Healthcare delivery research ensures you’re serving the people who are coming in for care and that what you’ve implemented is actually working,” Dr. Misra-Hebert says. “Our involvement with HSII will loop us in to a nationwide network – all of us working toward doing this in the most effective way we can.”