Presenters: Chris Bonafide, MD, MSCE, Kim Albanowski, MHS-MA, Canita Brent, MPH, and Brooke Luo, MD
A team from Children’s Hospital of Philadelphia (CHOP) is leading a national multicenter project looking at ending monitoring overuse (EMO) in children with bronchiolitis. The CHOP EMO research team gained knowledge and insights through this project and shared this with the PHM 2023 Conference attendees.
The team first addressed the reasons for choosing a multicenter trial. Single-center sites have limitations that could prevent generalizability, whereas multisite projects can build on what single-site projects have started. It’s important to think through the improvements needed and questions remaining when moving from single-site to multisite studies. Multisite studies also allow for larger sample sizes, and testing interventions, and are specifically geared toward implementation or (as in the case of EMO) de-implementation work. One issue the leaders of EMO noted is that when intervention (or study period) ceases, the change that was initiated often goes away as well.
Regulatory and financial aspects also impact the success of multisite studies. It’s important to have a skilled research staff. The clinical research assistants are vital, as they’re the face of the study. Project managers work closely with the principal investigators to keep track of budgeting and timeline projections and ensure these are in line with the aims of the overall project. Building partnerships with the collaborating sites allowed EMO to succeed. Collaborations include reliance agreements to allow for the institutional review board reviews to successfully move forward.
Engaging the hospitalists involved in EMO was another key aspect of its success. Leaders from CHOP discussed spoon-feeding communication and using a consistent but digestible amount of knowledge for each communication dissemination. Enthusiasm for the project from research staff is important for engaging hospitalists nationally. Additionally, allowing for flexibility for various sites within their needs allowed a greater breadth of engagement. Lastly, tracking everyone involved and every data piece keeps the study team on top of the current status and next steps. Rolling out multisite interventions requires thoughtful project management. Initiation, planning, execution, and monitoring all impact the end success.
• Multisite trials are useful for building on what is known from single-site trials and can be a great resource for implementation or de-implementation work.
• Engaging hospitalists at multiple sites requires great communication, enthusiasm, organization, agility, and data-driven focus in a research team.
• Ironing out the regulatory and financial aspects of a multisite trial can help ease hospitalists’ involvement.
Dr. Peterson is a med-peds hospitalist at Cincinnati Children’s Hospital in Cincinnati.