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CLINICAL AND TRANSLATIONAL SCIENCE AWARDS: A POTENTIAL SOURCE OF SUPPORT FOR PRIMARY CARE RESEARCH

Primary care researchers have long recognized the tremendous difficulties in translating research findings into practice. The huge gaps between what is theoretically possible and what is actually delivered in our health care system have been highlighted in multiple forums, including several reports from the Institute of Medicine. However, translational research faces many complex challenges, including increasing regulatory headaches, few educational programs to prepare researchers for this type of work, growing clinical service demands, and reduced financial margins that have cut protected research time for many clinical and translational researchers. In response to these and other related issues, the NIH developed the NIH Roadmap for Medical Research. One of the themes of the Roadmap Initiative has given rise to the new Clinical and Translational Science Awards, or CTSAs, aimed at reengineering the clinical research infrastructure at academic health centers to catalyze the development of and provide a definable academic home for “a new discipline of clinical and translational science.” The NIH announcement indicates that this is being looked at as a “new program designed to transform clinical and translational research, so that new treatments can be developed more efficiently and delivered more quickly to patients.” 
 
Two Requests for Applications were released by NIH in October 2005, one funding 4 to 7 CTSAs starting in 2006 for a total of $30 million and another with $11.5 million in funding for up to 50 planning grants for academic centers not yet ready to put a full program together. There will not be any further planning grant cycles, but it is anticipated that the number of full CTSA awards will increase each year so that by 2012, 60 CTSAs will receive approximately $500 million per year. These awards take the place of the General Clinical Research Center program, with a gradual phasing out of the GCRCs over the next few years. Clinical research is defined by the CTSA program as including studies that involve human subjects. Translational research is defined as having 2 components: (1) the process of applying discoveries made in labs, testing them in animals, and developing studies in humans, and (2) research aimed at enhancing the adoption of best treatment practices into the medical community. CTSAs have to involve an educational component, training new clinical and translational researchers. Linkages to the community and to health care providers are also stressed as a part of this new initiative. Further information on CTSAs can be found at http://www.ncrr.nih.gov/clinicaldiscipline.asp. 
 
What does this have to do with NAPCRG and those of us in primary care research? It is hard to tell how this initiative will pan out over time, and many of the CTSA applications will likely have little or no input or involvement from primary care researchers. However, the CTSAs could be a tremendous opportunity for those of us in academic medical centers to plug into the research enterprise in ways that we have not dreamed of previously. Our researchers, often more than anyone else, have forged connections with the community and with networks of practices and clinicians. In our community participatory research and our practice based research networks, we have established the bidirectional communications between researchers and the community highlighted in the background materials for the CTSA. We have focused a lot of attention on research aimed at enhancing the adoption of best practices in the community and have a great deal of expertise to share. Our fellowships and other research training programs are already geared toward preparing young researchers for careers in this area and could provide valuable experience and infrastructure for the necessary educational component of the CTSA. Our academic medical centers need us to truly accomplish the goals set out in the CTSA RFA and the accompanying materials—whether they know it or not. It is our job to educate both our academic centers and NIH. I strongly encourage our primary care researchers and other leaders in academic medical centers to plunge into the research politics of your home institution and start the educational process, if you haven’t already done so. There may be a steep learning curve for everyone, but the potential benefits at the end of the process—with much needed infrastructure funding and stronger links to the rest of the research enterprise—are worth it. 
 
NAPCRG will be paying a good bit of attention to our members’ experiences with CTSAs over the next few years, as this is potentially an important development. NAPCRG partnered with the Association of Departments of Family Medicine on a survey of researchers and chairs who submitted proposals in the first round of applications. NAPCRG also offered a special session at the 2006 Annual Meeting designed to share information and the experiences of the applicants. I hope to see some stimulating discussions of this topic at our meetings, as NAPCRG can serve as a source of information and support for our members as they try to become a part of this effort to transform a portion of our research enterprise.