The federal government has renewed its support of a learning healthcare system (LHS) T32 training program at Vanderbilt University Medical Center that prepares investigators to discover, evaluate and implement strategies for improving patient outcomes and, ultimately, the overall health of the community.
“The traditional approach to the delivery of health care separates scientific research, generation of evidence and practice,” said Christianne Roumie, MD, MPH, professor of Medicine, Pediatrics, and Health Policy at Vanderbilt. “These siloed systems lead to missed opportunities, waste in health care, and the potential for costly, suboptimal care.”
Learning healthcare systems train postdoctoral health care leaders in the discovery and implementation of new ways to deliver high quality care and advance science simultaneously. “This is a critical next step in the transformation of a ‘reactive’ health care system to one that is ‘proactive’ and capable of improving population health,” Roumie said.
Roumie is co-principal investigator of the grant with Carlos Grijalva, MD, MPH, professor of Health Policy and Biomedical Informatics. The five-year, $2.8 million renewal of research training grant 5T32HS026122 was awarded this spring by the U.S. Agency for Healthcare Research and Quality.
It supports continuation of a program called PROgRESS, for Patient/ pRactice Outcomes and Research in Effectiveness and Systems Science, which since 2018 has provided two years of cross-training in patient-centered outcomes research, implementation science and health policy/community health to 16 investigators.
For Jennifer Richmond, PhD, MSPH, a 2020-2022 trainee, the program “helped me thrive and reach several of my career goals focused on health equity … (It) paired me with supportive mentors and provided outstanding training.
“I especially benefited from the implementation science training and protected time to focus on growing into an independent researcher,” she continued. “This protected time helped me learn new data analysis skills, publish high-impact research, and take advantage of VUMC’s tremendous grant writing and other professional development resources.”
Richmond entered the Vanderbilt program upon completing her PhD in Health Behavior at the University of North Carolina at Chapel Hill in 2020.
During graduate school, she participated as a Health Policy Research Scholar in a leadership development program supported by the Robert Wood Johnson Foundation, and she contributed to several journal articles exploring the negative impact of inequity and medical mistrust on access to health care.
The Vanderbilt program helped her successfully apply for a two-year K99 Pathway to Independence Award for “promising postdoctoral scientists” from the National Cancer Institute that will support her research on ways to improve equity in lung cancer screening in populations disproportionately affected by the disease.
“This research will help address an urgent public health need, to increase screening equity and help eligible patients benefit from a proven strategy for the early detection of lung cancer,” said Richmond, who has accepted a faculty position at Wake Forest University School of Medicine in the fall.
Joseph Starnes, MD, MPH, who will begin the second year of a three- to four-year pediatric cardiology fellowship at VUMC this fall, is one of two trainees entering the PROgRESS program this year.
Like Richmond, Starnes is also interested in investigating ways to improve health equity. His project will examine the accuracy of fingertip pulse oximetry in detecting critical congenital heart disease in newborn babies of darker skin tones.
Pulse oximeters are fingertip devices that can determine the level of oxygen in the blood noninvasively by analyzing a light beam as if passes through the finger. Abnormally low blood oxygen levels are a sign that the heart is not working properly.
“Every baby in the U.S. is screened before they leave the hospital with a pulse oximeter to check (for) congenital heart disease that would need surgery or intervention in the first year of life,” Starnes said.
“There’s a growing body of literature that pulse oximeters are not as accurate in people with darker skin,” he said. “It overestimates oxygenation. So, in theory, there is a group of children who pass the screening because their oxygenation is overestimated, but ultimately have critical congenital heart disease.”
His project will compare oximetry readings to blood gas measurements of needle-drawn blood samples to determine the accuracy of oximetry in newborns with different skin tones. Ultimately, he hopes to develop an algorithm that can correct for skin tone differences and make oximetry more accurate for all babies.
Starnes acknowledged that it’s difficult to obtain funding for pilot projects, like his. That’s why the T32 mentored research support provided through PROgRESS is so important.
It gives him time that is protected from his clinical obligations to learn how to do research, and it will prepare him to compete successfully for independent research grants in the future—all while pursuing an important clinical question that has not been thoroughly investigated before.
Since his medical school days, Starnes has been involved in efforts to improve equity in health care for all. “This project helps bridge that,” he said.