In 2003 Dr. Elias Zerhouni1, then director of the National Institutes of Health (NIH), described a national initiative, dubbed the “NIH Roadmap,” to examine medical research and how it should be conducted. It set out three themes:
- New pathways in discovery to foster understanding of complex biological systems and give biomedical researchers a better “toolbox”;
- Research teams that bring together scientists from various physical and biological sciences and create public-private partnerships to stimulate discovery;
- A reengineering of the clinical research enterprise to expand the research in ways that improve efficiency and better inform basic science.
The Roadmap targeted translational research as an NIH priority to ensure that discovery in the life sciences, which has been accelerating at an unprecedented rate, could and would be used to benefit people. Toward that goal, the NIH began forming centers of translational research at its institutes and launched the Clinical and Translational Science Award (CTSA) program in 2006. By July 2010, 55 such centers were in operation; by 2012, the NIH plans to support 60 CTSA centers with $500 million annually.
But what is translational research? Dr. Steven Wolfe2 states, “Effective translation of the new knowledge, mechanisms and techniques generated by advances in basic science research into new approaches for prevention, diagnosis and treatment of disease is essential for improving health.”
Two factors are sparking a sense of urgency for translational research: progress in fundamental biomedical research (human genomics, proteomics, bioinformatics, molecular imaging) and the reality that skyrocketing health care spending appears to be unsustainable. More effective, efficient clinical application of new discoveries could help counter that trend while improving patient and public health.
Clinical research features three “translational blocks,” T1, T2 and T3. T1 is the transfer of laboratory discoveries into the “development of new methods for disease diagnosis, therapy and prevention and their first testing in humans.” T2 is the “translation of results from clinical studies into everyday clinical practice and health decision making.” T3 involves testing “how to deliver high-quality care reliably and in all settings.”3
So translational research encompasses both “bench to bedside” (T1) and “health services research” (T2) in community and ambulatory care centers. Because DMU is already collaborating with partners in Iowa in T2-oriented projects and is eager to do more, we are ideally positioned to seize the opportunities translational research offers to enhance health care and improve patients’ lives.
For example, starting in 2012, Medicare and Medicaid will no longer reimburse hospitals for costs incurred by patients who are readmitted within 30 days. DMU is partnering with Catholic Health Initiatives on a pilot project to evaluate the efficacy of “transition health coaches” in reducing 30-day readmission rates. That will create a critical role for these coaches, who will guide patients from initial admission to discharge to post-discharge care. Training the coaches is just one project DMU is exploring.
Other health services research under way at the University with collaborators includes evaluating atrial fibrillation in pacemaker patients, managing stroke patients, and measuring the presence of antibiotic-resistant staph in outpatient and family practice clinics.
Most important, translational research requires interdisciplinary teams willing to work together to tackle diverse and difficult problems we face in improving the health of our population. But I believe that’s the biggest strength DMU brings to the translational table – open-minded scientists, clinicians, health care professionals, collaborators and students with a shared passion for serving patients through discovery and its application.