AHRQ K12 PARTNERS Program

Applied Research Transforming Engaged Real-world Systems

Overview

Supported by a grant from the Agency for Healthcare Research and Quality, this program is designed to train clinician-researchers for the effective generation and uptake of patient centered outcomes research (PCOR). PARTNERS (PATIENT CENTERED OUTCOMES RESEARCH: Applied Research TraNsforming Engaged Real-world Systems) is a collaboration between the Palo Alto Medical Foundation Research Institute (PAMFRI), the University of California San Francisco (UCSF) and San Francisco General Hospital and Trauma Center (SFGH). The name reflects how we view PCOR. To be more than just a collection of peer-reviewed publications, research needs to be adopted, often with adaptations, in real-world settings. This requires researcher understanding of the constraints, expectations, and time frames of such settings; such understanding, moreover, leads to much better research. Classic research is typically built around individual PIs bringing their own disciplinary perspective to a project, then leaving it to others (usually with less in-depth expertise) to reconcile differences in findings. In contrast, we believe researchers have an obligation to go further and we see PCOR involving partnerships of many disciplines—clinicians, social scientists, data experts—engaging with patients to understand how to better provide services that patients value. This may require 'unlearning' the some of the assumptions implicit in how research is typically done in academic settings.

Scholars who participate in the PARTNERS program will receive $82,000 per year of salary support for two years, as well as have access to $8,000 in additional funds for research support. They will be expected to dedicate at least 75% effort to the program. While this program has some similarities to traditional NIH career development awards (K awards), it differs in several important ways. Please note that this program is only available to those with a clinical degree.

Patient centered outcomes research (PCOR) can simply be a new label for comparative effectiveness research or outcomes research, or it can involve quite different approaches to doing research. The new Patient Centered Outcomes Research Institute (PCORI) wants patients to be engaged in the research projects it funds, not just be on an advisory committee; we extend this notion by analogy to delivery systems. The PARTNERS training program focuses on training early-stage researchers to undertake research embedded within, or truly engaged with, delivery systems. This is a different style of research, in which the delivery system is not a passive provider of data or venue for a study, but explicitly or implicitly an active participant in doing and potentially implementing the research. In this type of work, the researcher cannot expect to fully control the execution of the experiment or study because the delivery system may decide things need to change for operational or other reasons mid-study. This requires different methodologies and ways of thinking about how to generate findings from the study that are convincing both to the delivery system and external peer reviewers.

In the past, successful career-development K-award proposals reflected the applicants' own research priorities, were submitted to study sections used to reviewing tightly controlled studies, and were sufficiently “timeless” to survive multiple review rounds before starting. By that time that the work began, however, an innovative delivery system could have changed its processes several times. For these reasons, we have structured our program differently, seeking to train researchers focused on "skating to where the puck will be," rather than where it is. We have not seen individual K announcements compatible with the type of research we are proposing, but expect they will appear in the next few years. Nonetheless, we anticipate an increased demand for this type of work. Take note that this is a program not for those seeking the conventional research path, but for those willing to risk taking a different path.

Applicants for this two-year training program will already have both the clinical and research skills to undertake excellent research, but want to learn about doing such research embedded within, or in true partnerships with, delivery systems. The three Scholars will each work closely with two mentors—one in a similar, and one in a different, discipline. In the PARTNERS program, applicants do not apply with a lead mentor. Instead, mentors will be identified and finalized as part of the selection process. K12 PARTNERS Scholars will work alongside their mentors on ongoing projects and will also develop their own projects. These projects will be responsive to the needs of the institution; while Scholars will have wide latitude in choosing projects, the selection of projects will be grounded in the needs of the partner institution.

Scholars will be embedded in the Palo Alto Medical Foundation, UCSF Medical Center, and San Francisco General Hospital and Trauma Center and its network of community health clinics. Unlike traditional K-awards that emphasize individual projects, the PARTNERS projects will typically be undertaken in multidisciplinary collaborative teams. The Scholars will initially join a pre-existing group; by the end of the two-year period, however, the Scholar should be prepared to lead an effort. If they do not already have appointments that grant principal investigator status, the Scholars will be appointed in the professional researcher series at their host institution. They will be seen as young colleagues, not trainees, with high expectations and support for productivity. Required coursework, unless previously taken, will include a series of 5 courses in implementation and dissemination science offered through the UCSF Training in Clinical Research Program relating to individual and organizational behavior change theory, community engagement, and influencing policy makers (Epi 245-249). Scholars will also participate in an ongoing weekly seminar series on Partnered Research. The PARTNERS program is led by Dr. Luft at PAMFRI and Drs. Gonzales and Kushel at UCSF.

Our program seeks early-stage investigators with clinical training (e.g., medicine, nursing, pharmacy, or clinical psychology) and the traditional research skills needed for excellent research. The program will provide closely mentored experiences in how to develop and nurture partnerships between academically focused PCOR researchers and the delivery systems in which the fruits of PCOR will be implemented. We expect some of our trainees to go on to careers in settings such as PAMFRI—a strong research unit within a delivery system and in settings such as UCSF—an academic powerhouse that is strengthening its integration with its medical center. Others will go to academic settings seeking true partnerships with external delivery systems.

Goal

Patient centered outcomes research undertaken through long-term partnership relationships with delivery systems can offer substantial advantages in speed, relevance, and likelihood of being translated into practice. Such "partnerships," however, require new ways of thinking about research questions, study designs, and their execution. This program offers clinicians with research skills additional training in doing this type of work within an integrated delivery system, teaching hospital, and safety net provider system.

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Eligibility

Candidates for AHRQ K12 awards must:

  • Be a U.S. Citizen or Permanent Resident; individuals on temporary or student visas are not eligible
  • Possess a clinical doctoral-level degree (MD, PhD, PharmD, DDS, RN/PhD etc.) and either have an appointment as a junior faculty member at UCSF or PAMFRI or be eligible for appointment as a professional researcher.
  • Commit 75% of professional effort to the program
  • Not be or have been a principal investigator on an NIH R01, or project leader on a subproject of a Program Project (P01), Center (P50, P60, U54), mentored career development grant (K23, K08, K01, etc.), or equivalent non-PHS peer reviewed research grant that is over $100,000 in direct costs per year. May have had support on a NRSA grant (F or T) or have been PI of an NIH small grant (R03 or R21).

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Scholar Selection Criteria

A Selection Committee comprised of Drs. Luft, Gonzales, Kushel and key institutional partners will review the scholar applications following the model of the NIH peer review process. Selection criteria will focus on:

  1. Track Record: Creativity of the candidate and potential to lead excellent multidisciplinary research judging by track record in: patient centered outcomes research; projects with, or in, delivery systems; collaborations with people in various social science and analytical disciplines.
  2. Scoping Document Responses: In lieu of a traditional research plan, and in recognition of the unique nature of this program, applicants will be asked to provide "scoping memos" (500 words each) responding to two potential project scenarios. In their scoping memos, applicants must describe how they would define and approach the research question, implement the research, and what data sources they would rely on. They must note potential barriers and limitations and how they would seek to overcome them. They will be given examples to choose from and must use at least one of the provided examples; they may use a second example from the list or choose their own scenario. Scoping memos will be judged on the degree to which they convey an appreciation for the unique environmental and social contexts that must be considered in partnering with delivery systems in research.
  3. Candidate Statement of Career Goals: We will ask for a statement describing the applicant's career goals, including the type of work and setting in which s/he will be doing it 5 and 10 years from now.
  4. Career Potential: Global assessment of the likelihood that the candidate will develop a career as an effective leader in health care delivery systems

Individuals with disabilities and from economically disadvantaged or underrepresented racial/ethnic minority groups are encouraged to apply, and special consideration will be given to individuals in departments and disciplines that have traditionally been under-represented in health care delivery system research.

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Program Requirements

  1. Duration and Transferability of the Award
    This is an institutional career development award granted to PAMFRI and UCSF, and it is non-transferable; scholars who leave their sponsoring institution will not be able to continue receiving the funding. We therefore ask for a two year commitment to the program. The two years of this K12 support would count as part of the maximum 5 years of K-award support that could be obtained from AHRQ or other sources.
  2. Professional Effort Devoted to the Program and Source of Funding
    Generally, 75% of a Scholar's full-time professional effort must be devoted to the K12 program for the training and clinical research activities. The 75% effort is based on the entire amount of time worked in a typical week, and should include proportionate amounts of normal weekday time. The remaining 25% effort can be divided among other clinical, administrative, and teaching activities that are consistent with the proposed goals of the K12 program. While all scholars are expected to be clinicians, they need not be in practice, and their clinical work does not have to occur at the sponsoring institution.
  3. Didactic Training in Clinical and Translational Research
    Required coursework, unless previously taken, will include a series of 5 courses in implementation and dissemination science offered through the UCSF Training in Clinical Research Program relating to individual and organizational behavior change theory, community engagement, and influencing policy makers (Epi 245-249). Classes are typically on Thursdays (mornings or afternoons), and should be taken in the first year of the program. Scholars will also participate in an ongoing weekly seminar series in Palo Alto on Partnered Research as well as ongoing research workshops at their local sites.
  4. Mentors
    Applicants invited to be interviewed may specify the sites for which they want to be considered (PAMFRI, SFGH, UCSF) along with any faculty who they feel would be particularly appropriate mentors. Through this process, as well as a more detailed exploration of “match compatibility” once scholars have been selected, the program leaders and the scholar will identify primary and secondary mentors. The goal will be to identify the best mentor team to help the scholars in his or her training.
  5. Setting
    Each scholar will have office space at their clinical site. They will meet regularly with the core faculty of the program (Drs. Luft, Gonzales and Kushel) at the local clinical site and/or at the weekly scholars' seminar series in Palo Alto. This seminar will be open to other junior faculty and delivery system members engaged in health systems design work who commit to regular attendance.

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Application

2012 submission cycle is closed.

The application requires these components:

  • Contact information, demographics, and goals
  • Uploaded Statement from your Department Chair/Division Chief (doc 25KB)
  • Uploaded Candidate Statement (doc 27KB)
  • Scoping Memo: please follow directions on the information sheet (pdf 80KB)
  • References: Please have each reference submit his/her online reference form. You may start the reference process in parallel with your application. Please remind each reference to spell your first and last names and email address exactly the same as in your application. If there are any discrepancies, the online reference form may be invalidated.
    • Please have references comment on your research skills and potential, teamwork, and experience with patient-centered/implementation research.
    • Please note that we require submission of two online references in addition to the Department Chair Support Statement. If you can't submit the Department Chair Support Statement, we require three online references.
  • Site preferences: Willingness to be placed at multiple sites increases the likelihood of an offer. If you have a specific site preference, please explain your rationale in the Site Preference Ranking section of the application.
  • If you have an existing appointment at PAMFRI or UCSF (Parnassus, Mt Zion or SFGH), please include a letter from your Division Chief or Department Chair (doc 25KB) attesting that you will be freed from clinical/teaching/administrative responsibilities in order to devote 75% effort to research and training related to the K12 program.
  • For questions about the application process, please contact Elaine Szeto, LCSW or Aria Yow.

Timeline

Notice of Intent due 9:00 a.m. on September 4, 2012
K12 Applications due 9:00 a.m. on September 24, 2012
Interviews of selected applicants October 29 - November 9, 2012
Initial notification of awards December 10, 2012
Appointment start date By December 31, 2012 (Pending approval, awardees may delay their start date to July 1, 2013.)

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