Do the Clinical and Translational Science Awards Make the Grade?

Since last year, the Clinical and Translational Science Awards (CTSA) program—which was created in 2006 and is now funded by the National Institutes of Health (NIH) National Center for Advancing Translational Sciences (NCATS)—has been under review by the NIH and the Institute of Medicine (IOM) in order to strengthen the program and help it achieve its mission and goals. In our role as an advocate for the field of health services research and policy, AcademyHealth had submitted public comments in response to an Request For Information published in the Federal Register by NCATS, and Dr. Lisa Simpson testified at a workshop held on January 24, 2013, to support the program’s goal of translating new findings into improved patient care and value, individual health outcomes, and population health. Last week, the IOM released its resultant committee report, making the following recommendations:

Strengthen NCATS leadership of the CTSA Program
Reconfigure and streamline the CTSA Consortium
Build on the strengths of individual CTSAs across the spectrum of clinical and translational research
Formalize and standardize evaluation processes for individual CTSAs and the CTSA Program
Advance innovation in education and training programs
Ensure community engagement in all phases of research
Strengthen clinical and translational research relevant to child health

The IOM acknowledged the need to emphasize interdisciplinary learning and collaboration as well as training and mentoring for new and established researchers across this translational continuum. It also underscored the importance of thorough and deliberate direction from NIH/ NCATS on how the full range of research should continue to be supported and integrated as the CTSA program matures. The IOM report states,

“without clear incentives, metrics, and evaluation internally and from NCATS, the potential value in engaging community participants in the full range of activities—from basic discovery through patient outcomes—will not be realized.” (Page 126)

We found the IOM recommendations largely consistent with many of the comments AcademyHealth submitted to NIH last year. Our comments, developed in consultation with AcademyHealth leadership, members, and senior staff who have experience with and significant knowledge about the CTSA program, expressed our support of this critical research, and offered a short set of recommendations for strengthening the program: 1) NCATS should sustain support for the full spectrum of T1-T4 science in the CTSA program. CTSA investments in the full research continuum should prioritize the active involvement of end users of research results-- community members, patients, caregivers, clinicians, and policymakers. NCATS can help overcome barriers in moving research into practice along the translational pipeline by encouraging and supporting the training aspects of the CTSA. 2) Dissemination & implementation research and improvement science needs further emphasis. This research is needed across many dimensions of quality, including safety, effectiveness, equity, efficiency, and patient and family-centeredness— and cuts across CTSA-wide core areas like community engagement, informatics, and clinical research. This includes more than just innovation—we need to look at how to build upon innovation to pilot test, assess, replicate, spread, and, ultimately, scale-up solutions to have broad real-world impact. These linkages will be vital for finding new and effective models of care delivery and improved population health. 3) Infrastructure development needs to be enhanced—including human capital, data, informatics, and analytic methods to study care delivery systems, comparative effectiveness research, and implementation research. It remains to be seen how the IOM’s recommendations will impact the CTSA program, and in particular, how the financial and administrative challenges to implementing the IOM recommendations are met. Efforts to preserve and expand the work of the CTSAs may be impacted by the economic and political realities of Washington.