March 15, 2018

Hello,
Ever since World War II, the United States has looked to its universities for scientific discoveries and innovation. Academic medical institutions are home to an innovative group of people passionate about advancing health through research, technology, and patient care.
McGovern Medical School, along with UTHealth, is capitalizing on the strengths of our institution in the heart of the world’s largest medical center by placing a renewed focus on clinical research.
Last year, Dr. Charles “Trey” Miller was appointed associate vice president of clinical research and health care quality. I recently spoke with him to learn how the university is approaching clinical research.
It seems obvious to us that clinical research is important to medicine and clinical care. What is new?
We have a unique opportunity at UTHealth when it comes to clinical research because of the scope, size, and reach of our practice plan and healthcare partnerships. Given the National Academy of Medicine/Institute of Medicine’s (NAM/IOM) emphasis on learning healthcare—wrapping research into clinical care—we are poised to make important contributions by building a model for the rest of the nation.
Please explain what you and NAM/IOM mean by “learning healthcare.”
It means that the practice of healthcare should include research. Research is ingrained in clinical care rather than separate and apart. We are developing such a culture and learning environment here at UT—so that practicing clinicians can and should be learning from what they are doing all of the time. Right now, we talk about clinical research, quality improvement, and clinical care as separate initiatives —but they are all part of a continuum.
What is being done now to promote such a culture?
First, we’ve offered a consultation service for learning healthcare projects—we have statisticians and research design experts to consult with clinicians and researchers, to design studies to test hypotheses in their clinical practices.
We also have a pilot grant program. As an example, one recently funded project was an n-of-1 trial for pediatric patients with high blood pressure. Generally three or four medications are commonly used to treat high blood pressure in children, but we have no clear evidence which one is better for which patient. It is possible to do a trial to give all three medications plus a placebo to each patient, take their blood pressure measurements, and record their symptoms to find out which medication worked best. Dr. Joyce Samuel, assistant professor of pediatrics, did the study and decided that many of the patients didn’t need medication at all and for the rest you could determine the best medication per patient, but that there was no clearly superior medication for all patients—it was personalized medicine. In the next few months, we will be accepting applications to fund new initiatives for this pilot grant program.
In addition, we have a well-established clinical research curriculum, designed by Dr. Jon Tyson, that is open to all members of the TMC community. Classes are offered in the medical school each Wednesday afternoon, 5-6:30 p.m. The curriculum focuses on core competencies as part of the Center for Clinical Research and Evidence Based Medicine.
UTHealth水平,我们的任务force looking at clinical research processes. This is a self-study looking at the IRB process, study feasibility, study enrollment, contracting, and billing. We had a focus group a couple of months ago and will soon reach out to faculty as we seek to improve infrastructure for research, services, and quality.
A recent survey commissioned by Research!America shows that the majority of those responding (75%) agree that taking part in clinical trials is valuable to our health care system. What do you make of those findings?
This is an important observation—we tend to be risk averse and hesitant of getting people involved in studies. The public embraces research more than we give them credit for—or previously understood. As an example, Dr. John Harvin, assistant professor of surgery, is conducting a clinical trial among trauma patients. The trial is being done under federal guidelines that allow exception from informed consent (EFIC) in emergency situations, where patients may not be able to make decisions and a representative may not be available. Dr. Harvin has found that once he can communicate with patients—after enrollment in the trial—the overwhelming majority of patients are enthusiastic to have been enrolled in the study. Enhancing understanding of research in the community and getting community input via two-way communication between the community and the medical school is critical to building research and community care and engagement.
What else to add?
I would encourage every one of us to participate in clinical trials, if we have the opportunity to do so. Clinical research needs to be a big part of our identity. Finally, it is a privilege to work here and have access to our patient population, and we have an obligation to maximize benefit and to provide research and learning from and to the population we serve.
Thank you, Dr. Miller, for leading these efforts on behalf of our institution. I have always liked the term “the science of clinical care,” something you and your colleagues are promoting throughout UTHealth.
I attended theannual meetingof Research!America yesterday. I am proud that my husband, Roger Glass, was honored that evening with theGeoffrey Beene Builders of Science Award.
Warm regards,
Barbara