Editor’s Note: Our guest blogger, Lindsay Waqar, MPH, CCRC, is the lead clinical research coordinator for the Division of Rheumatology at Children’s Hospital of Philadelphia. In this guest blog, she describes a collaborative quality improvement project presented at the Eighth Annual CHOP Quality and Safety Day between her research team and clinical fellows’ team to improve communication and research recruitment across the division.
What happens when researchers and clinicians team up to improve the identification of eligible research patients newly diagnosed with a chronic condition? Areas of change are discussed, low effort/high impact interventions are implemented, and research recruitment rates improve. This was the goal of the Division of Rheumatology’s fellow quality improvement project for FY18.
Innovative research is important for improving health outcomes in chronically ill patients. However, poor recruitment has been cited in the literature as a common reason for the premature termination of research studies. In pediatric Rheumatology, new diagnoses are uncommon and often important opportunities for understanding disease states and treatment outcomes. Therefore, early identification of newly diagnosed patients eligible for research studies and the subsequent collection of time-sensitive samples for biorepository studies is critical to the success of research within the field.
Unfortunately, retrospective screening from June 2017 to January 2018 of pediatric Rheumatology patients seen at CHOP showed that only 45 percent of patients eligible for a biorepository study were identified by the clinician to the research team at the point of care. Additionally, only 28 percent of these patients consented to providing a biorepository sample.
In examining the potential causes of low recruitment rates, the improvement team, consisting of pediatric Rheumatology fellows and clinical researchers, found that communication failures, specifically inconsistent physician identification of eligible patients, was the most common reason that eligible participants were missed. Using the Plan-Do-Study-Act (PDSA) quality improvement framework, the collaborative team identified pre-clinic huddles between physicians and research staff, as well as positive feedback for recruitment successes, as low effort/high impact interventions for a first test of change.
The overall goal of the project was to increase the proportion of eligible patients identified for biorepository studies to 75 percent by June 30, 2018. Within two months of implementation, this goal was quickly surpassed, as 100 percent of eligible patients were identified to the study team. For each patient successfully identified at the point of care, an email acknowledgement of the provider(s) who effectively communicated to the study team was distributed to the entire Division of Rheumatology.
The early success of this project was achieved using research/clinician team huddles and positive feedback to enhance communication and situational awareness. Providers were able to maintain their established clinic flow while the research team gained greater awareness of potential subjects. These foundational elements of effective communication and recognition can be replicated by study teams in a variety of clinical settings where research recruitment may be challenging.
As a result of this project, subsequent barriers to successful research recruitment were also identified. Challenges, such as insurance capitation, have made it difficult to collect biorepository samples on eligible patients. Newly diagnosed patients often require clinical labs, and insurance companies often dictate where a patient must go for blood work, which predominantly is a central laboratory outside of CHOP. Capitation then minimizes the opportunities for successful research recruitment once potential patients are identified. Therefore, the next step in improving research recruitment rates is to focus on methods that overcome the capitation barriers. If anyone has experienced similar research challenges or is interested in collaborating on this project, the Division of Rheumatology would like to hear from you!
If interested in collaborating or sharing experiences, please contact Lindsay Waqar.