1
|
Monach PA. The Future of Vasculitis: A Manifesto. Rheum Dis Clin North Am 2023; 49:713-729. [PMID: 37331742 DOI: 10.1016/j.rdc.2023.03.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/20/2023]
Abstract
Predictions for a general path forward in vasculitis care and research are provided based on advances made in the past 20 years. Prospects for advances in translational research with potential to improve care are highlighted, including identification of hemato-inflammatory diseases, autoantigens, disease mechanisms in animal models, and biomarkers. A list of active randomized trials is provided, and areas of potential paradigm shifts in care are highlighted. The importance of patient involvement and international collaboration is noted, and a plea is made for innovative trial designs that would improve access of patients to trials and to clinical experts at referral centers.
Collapse
Affiliation(s)
- Paul A Monach
- Rheumatology Section, VA Boston Healthcare System, 150 South Huntington Avenue, Boston, MA 01230, USA.
| |
Collapse
|
2
|
Voit K, Skuban-Eiseler T, Orzechowski M, Steger F. Informed Consent in COVID-19-Research: An Ethical Analysis of Clinical Studies Performed during the Pandemic. Healthcare (Basel) 2023; 11:1793. [PMID: 37372911 DOI: 10.3390/healthcare11121793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 06/08/2023] [Accepted: 06/15/2023] [Indexed: 06/29/2023] Open
Abstract
Health crises such as the current COVID-19 pandemic pose challenges to the conduct of clinical studies. Aspects of research ethics, such as obtaining informed consent (IC), can be complicated. We are concerned with whether or not the proper IC procedures were followed in the context of clinical studies at Ulm University in the years 2020 to 2022. We identified all protocols of clinical studies dealing with COVID-19 that the Research Ethics Committee of Ulm University has reviewed and voted on in the years 2020 to 2022. We then performed a thematic analysis regarding the following aspects: study type, handling of IC, type of patient information, means of communication, applied security precautions, and the approach to participants from vulnerable groups. We identified n = 98 studies that dealt with COVID-19. In n = 25 (25.51%), IC was obtained traditionally in written form, in n = 26 (26.53%) IC was waived, in n = 11 (11.22%) IC was obtained delayed, and in n = 19 (19.39%) IC was obtained by proxy. No study protocol was accepted that waived IC in case IC would have been required in times outside of pandemics. It is possible to obtain IC even in times of severe health crises. In the future, it is necessary to address in greater detail and with legal certainty which alternative methods of obtaining IC are possible and under which circumstances IC can be waived.
Collapse
Affiliation(s)
- Katja Voit
- Institute of the History, Philosophy and Ethics of Medicine, Ulm University, 89081 Ulm, Germany
| | - Tobias Skuban-Eiseler
- Institute of the History, Philosophy and Ethics of Medicine, Ulm University, 89081 Ulm, Germany
- kbo-Isar-Amper-Klinikum Region München, 85540 Haar, Germany
| | - Marcin Orzechowski
- Institute of the History, Philosophy and Ethics of Medicine, Ulm University, 89081 Ulm, Germany
| | - Florian Steger
- Institute of the History, Philosophy and Ethics of Medicine, Ulm University, 89081 Ulm, Germany
| |
Collapse
|
3
|
Davies A, Ormel I, Bernier A, Harriss E, Mumba N, Gobat N, Schwartz L, Cheah PY. A rapid review of community engagement and informed consent processes for adaptive platform trials and alternative design trials for public health emergencies. Wellcome Open Res 2023; 8:194. [PMID: 37654739 PMCID: PMC10465998 DOI: 10.12688/wellcomeopenres.19318.1] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/19/2023] [Indexed: 09/02/2023] Open
Abstract
Background : Public Health Emergencies (PHE) demand expeditious research responses to evaluate new or repurposed therapies and prevention strategies. Alternative Design Trials (ADTs) and Adaptive Platform Trials (APTs) have enabled efficient large-scale testing of biomedical interventions during recent PHEs. Design features of these trials may have implications for engagement and/or informed consent processes. We aimed to rapidly review evidence on engagement and informed consent for ADTs and APTs during PHE to consider what (if any) recommendations can inform practice. Method : In 2022, we searched 8 prominent databases for relevant peer reviewed publications and guidelines for ADTs/APTs in PHE contexts. Articles were selected based on pre-identified inclusion and exclusion criteria. We reviewed protocols and informed consent documents for a sample of large platform trials and consulted with key informants from ADTs/APT trial teams. Data were extracted and summarised using narrative synthesis. Results : Of the 49 articles included, 10 were guidance documents, 14 discussed engagement, 10 discussed informed consent, and 15 discussed both. Included articles addressed ADTs delivered during the West African Ebola epidemic and APTs delivered during COVID-19. PHE clinical research guidance documents highlight the value of ADTs/APTs and the importance of community engagement, but do not provide practice-specific guidance for engagement or informed consent. Engagement and consent practice for ADTs conducted during the West African Ebola epidemic have been well-documented. For COVID-19, engagement and consent practice was described for APTs primarily delivered in high income countries with well-developed health service structures. A key consideration is strong communication of the complexity of trial design in clear, accessible ways. Conclusion: We highlight key considerations for best practice in community engagement and informed consent relevant to ADTs and APTs for PHEs which may helpfully be included in future guidance. Protocol: The review protocol is published online at Prospero on 15/06/2022: registration number CRD42022334170.
Collapse
Affiliation(s)
- Alun Davies
- Health Systems Collaborative, Nuffield Department of Medicine, University of Oxford, Oxford, England, UK
| | - Ilja Ormel
- Faculty of Health Sciences, Department of Health Research Methods, Evidence & Impact, McMaster University, Hamilton, Ontario, Canada
| | - Alexe Bernier
- Faculty of Social Sciences, School of Social Work, McMaster University, Hamilton, Ontario, Canada
| | - Eli Harriss
- Bodleian Health Care Libraries, University of Oxford, Oxford, England, UK
| | - Noni Mumba
- The KEMRI-Wellcome Trust Research Programme, Kilifi, 80108, Kenya
| | - Nina Gobat
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, England, UK
| | - Lisa Schwartz
- Faculty of Health Sciences, Department of Health Research Methods, Evidence & Impact, McMaster University, Hamilton, Ontario, Canada
| | - Phaik Yeong Cheah
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Salaya, Nakhon Pathom, Thailand
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, England, UK
| |
Collapse
|
4
|
Dassum SR, Ferguson R, Woods P, Flynn M, Visnaw K, Holmberg E, Schiller S, Shannon C, Brophy M, Monach P, Leatherman S, Branch-Elliman W. Patient- reported reasons for non-participation in a COVID-19 therapeutics clinical trial: Findings from a multi-center investigation. Contemp Clin Trials 2023; 126:107082. [PMID: 36632925 PMCID: PMC9827740 DOI: 10.1016/j.cct.2023.107082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2022] [Revised: 12/15/2022] [Accepted: 01/06/2023] [Indexed: 01/11/2023]
Abstract
BACKGROUND Early in the pandemic, there were no evidence-based treatments for SARS-CoV-2, creating an urgent need to identify effective therapeutics. However, public participation in medical research is low; trial enrollment in the US is typically 10-20%. Thus, the aim of this study was to identify common themes underpinning patient reasons to decline participation and evaluate the impact of specific contextual factors. METHODS This sub-study was conducted in five VISN-1 Clinical Trials Network participating facilities from 4/10/2020-2/3/2021. The trial evaluated the addition of the IL-6-inhibitor, Sarilumab, to the current standard of care for inpatients with moderate-to-severe SARS-CoV-2. Consent procedures varied by site and included fully in-person and fully remote processes. Reasons for declining enrollment were collected among eligible patients who declined to participate but agreed to answer a short follow-up question. Qualitative data were analyzed using directed content analysis. Enrollment rates were assessed using simple, descriptive statistics. RESULTS N = 417 COVID-19 positive inpatients were screened and 53/162 eligible patients enrolled. Enrollment varied across study sites and by study period. Prior to identification of effective treatment, the enrollment rate was 10/11 (91%) versus 43/144 (30%) during the later period of the study. N = 85/102 patients who did not enroll answered the follow-up question. The most commonly reported responses were: concerns about the study drug and participation in clinical research in general, comorbidity concerns, competing priorities, external factors, and external advice and influence from family members and clinicians. CONCLUSIONS Identifying reasons behind declining to enroll may help investigators develop strategies to increase research participation.
Collapse
Affiliation(s)
- Samira Reyes Dassum
- Beth Israel Deaconess Medical Center, Department of Infectious Disease, Boston, MA, United States.
| | - Ryan Ferguson
- VA Boston Healthcare System, Cooperative Studies Program, Boston, MA, United States; Boston University School of Medicine, Boston, MA, United States of America; Boston University School of Public Health, Boston, MA, United States of America
| | - Patricia Woods
- VA Boston Healthcare System, Cooperative Studies Program, Boston, MA, United States
| | - Maura Flynn
- VA Boston Healthcare System, Cooperative Studies Program, Boston, MA, United States
| | - Karen Visnaw
- VA Boston Healthcare System, Cooperative Studies Program, Boston, MA, United States
| | - Erika Holmberg
- VA Boston Healthcare System, Cooperative Studies Program, Boston, MA, United States
| | - Sara Schiller
- VA Boston Healthcare System, Cooperative Studies Program, Boston, MA, United States
| | - Colleen Shannon
- VA Boston Healthcare System, Cooperative Studies Program, Boston, MA, United States
| | - Mary Brophy
- VA Boston Healthcare System, Cooperative Studies Program, Boston, MA, United States; Boston University School of Medicine, Boston, MA, United States of America
| | - Paul Monach
- VA Boston Healthcare System, Cooperative Studies Program, Boston, MA, United States; VA Boston Healthcare System, Department of Medicine, Boston, MA, United States; Harvard Medical School, Boston, MA, United States of America
| | - Sarah Leatherman
- VA Boston Healthcare System, Cooperative Studies Program, Boston, MA, United States
| | - Westyn Branch-Elliman
- VA Boston Healthcare System, Department of Medicine, Boston, MA, United States; VA Boston Center for Healthcare Organization and Implementation Research (CHOIR), Boston, MA, United States; Harvard Medical School, Boston, MA, United States of America
| | | |
Collapse
|
5
|
Shepherd V, Hood K, Wood F. Unpacking the 'black box of horrendousness': a qualitative exploration of the barriers and facilitators to conducting trials involving adults lacking capacity to consent. Trials 2022; 23:471. [PMID: 35668460 PMCID: PMC9167903 DOI: 10.1186/s13063-022-06422-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Accepted: 05/24/2022] [Indexed: 11/10/2022] Open
Abstract
Background Trials involving adults who lack capacity to consent encounter a range of ethical and methodological challenges, resulting in these populations frequently being excluded from research. Currently, there is little evidence regarding the nature and extent of these challenges, nor strategies to improve the design and conduct of such trials. This qualitative study explored researchers’ and healthcare professionals’ experiences of the barriers and facilitators to conducting trials involving adults lacking capacity to consent. Methods Semi-structured interviews were conducted remotely with 26 researchers and healthcare professionals with experience in a range of roles, trial populations and settings across the UK. Data were analysed using thematic analysis. Results A number of inter-related barriers and facilitators were identified and mapped against key trial processes including during trial design decisions, navigating ethical approval, assessing capacity, identifying and involving alternative decision-makers and when revisiting consent. Three themes were identified: (1) the perceived and actual complexity of trials involving adults lacking capacity, (2) importance of having access to appropriate support and resources and (3) need for building greater knowledge and expertise to support future trials. Barriers to trials included the complexity of the legal frameworks, the role of gatekeepers, a lack of access to expertise and training, and the resource-intensive nature of these trials. The ability to conduct trials was facilitated by having prior experience with these populations, effective communication between research teams, public involvement contributions, and the availability of additional data to inform the trial. Participants also identified a range of context-specific recruitment issues and highlighted the importance of ‘designing in’ flexibility and the use of adaptive strategies which were especially important for trials during the COVID-19 pandemic. Participants identified a need for better training and support. Conclusions Researchers encountered a number of barriers, including both generic and context or population-specific challenges, which may be reinforced by wider factors such as resource limitations and knowledge deficits. Greater access to expertise and training, and the development of supportive interventions and tailored guidance, is urgently needed in order to build research capacity in this area and facilitate the successful delivery of trials involving this under-served population.
Collapse
Affiliation(s)
| | - Kerenza Hood
- Centre for Trials Research, Cardiff University, Cardiff, UK
| | - Fiona Wood
- PRIME Centre Wales, Cardiff, UK.,Division of Population Medicine, Cardiff University, Cardiff, UK
| |
Collapse
|
6
|
McCarthy MS, McCarthy MW. Ethical challenges of prospective clinical trials during the COVID-19 pandemic. Expert Rev Anti Infect Ther 2022; 20:549-554. [PMID: 34797183 PMCID: PMC8631693 DOI: 10.1080/14787210.2022.2009343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Accepted: 11/18/2021] [Indexed: 10/29/2022]
Abstract
INTRODUCTION The COVID-19 pandemic has created an unprecedented opportunity to reimagine clinical research. While much has been written about the challenges associated with generating real-world evidence during the COVID-19 pandemic, comparatively little attention has been paid to the ethical challenges facing patients, clinicians, researchers, and regulatory bodies. AREAS COVERED In this manuscript, we examine these challenges through the lens of informed consent and explore how the consenting process changes as our understanding of the disease is altered. EXPERT OPINION We also suggest ways to limit these ethical hurdles through the use of embedded pragmatic clinical trials, which generate real-world data without the limitations associated with observational trials or the resources and lack of generalizability that are obstacles to conducting conventional randomized clinical trials. We argue that clinical research must become more nimble, and must include embedded researchers to ensure that relevant questions and ethical issues are properly addressed.
Collapse
Affiliation(s)
| | - Matthew W. McCarthy
- Weill Cornell Medical College, Division of General Internal Medicine, New York-Presbyterian Hospital, New York, NY, USA
| |
Collapse
|
7
|
Branch-Elliman W, Ferguson R, Doros G, Woods P, Leatherman S, Strymish J, Datta R, Goswami R, Jankowich MD, Shah NR, Taylor TH, Page ST, Schiller SJ, Shannon C, Hau C, Flynn M, Holmberg E, Visnaw K, Dhond R, Brophy M, Monach PA. Subcutaneous sarilumab for the treatment of hospitalized patients with moderate to severe COVID19 disease: A pragmatic, embedded randomized clinical trial. PLoS One 2022; 17:e0263591. [PMID: 35213547 PMCID: PMC8880885 DOI: 10.1371/journal.pone.0263591] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Accepted: 12/09/2021] [Indexed: 12/15/2022] Open
Abstract
IMPORTANCE AND OBJECTIVE The aim of this pragmatic, embedded, adaptive trial was to measure the effectiveness of the subcutaneous anti-IL-6R antibody sarilumab, when added to an evolving standard of care (SOC), for clinical management of inpatients with moderate to severe COVID-19 disease. DESIGN Two-arm, randomized, open-label controlled trial comparing SOC alone to SOC plus sarilumab. The trial used a randomized play-the-winner design and was fully embedded within the electronic health record (EHR) system. SETTING 5 VA Medical Centers. PARTICIPANTS Hospitalized patients with clinical criteria for moderate to severe COVID-19 but not requiring mechanical ventilation, and a diagnostic test positive for SARS-CoV-2. INTERVENTIONS Sarilumab, 200 or 400 mg subcutaneous injection. SOC was not pre-specified and could vary over time, e.g., to include antiviral or other anti-inflammatory drugs. MAIN OUTCOMES AND MEASURES The primary outcome was intubation or death within 14 days of randomization. All data were extracted remotely from the EHR. RESULTS Among 162 eligible patients, 53 consented, and 50 were evaluated for the primary endpoint of intubation or death. This occurred in 5/20 and 1/30 of participants in the sarilumab and SOC arms respectively, with the majority occurring in the initial 9 participants (3/4 in the sarilumab and 1/5 in the SOC) before the sarilumab dose was increased to 400 mg and before remdesivir and dexamethasone were widely adopted. After interim review, the unblinded Data Monitoring Committee recommended that the study be stopped due to concern for safety: a high probability that rates of intubation or death were higher with addition of sarilumab to SOC (92.6%), and a very low probability (3.4%) that sarilumab would be found to be superior. CONCLUSIONS AND RELEVANCE This randomized trial of patients hospitalized due to respiratory compromise from COVID-19 but not mechanical ventilation found no benefit from subcutaneous sarilumab when added to an evolving SOC. The numbers of patients and events were too low to allow definitive conclusions to be drawn, but this study contributes valuable information about the role of subcutaneous IL-6R inhibition in the treatment of hospitalized COVID-19 patients. Methods developed and piloted during this trial will be useful in conducting future studies more efficiently. TRIAL REGISTRATION Clinicaltrials.gov-NCT04359901; https://clinicaltrials.gov/ct2/show/NCT04359901?cond=NCT04359901&draw=2&rank=1.
Collapse
Affiliation(s)
- Westyn Branch-Elliman
- VA Boston Healthcare System, Boston, Massachusetts, United States of America
- Harvard Medical School, Boston, Massachusetts, United States of America
| | - Ryan Ferguson
- VA Boston Healthcare System, Boston, Massachusetts, United States of America
- Evans Department of Medicine, Section of General Internal Medicine, Boston University School of Medicine, Boston, Massachusetts, United States of America
| | - Gheorghe Doros
- VA Boston Healthcare System, Boston, Massachusetts, United States of America
- Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts, United States of America
| | - Patricia Woods
- VA Boston Healthcare System, Boston, Massachusetts, United States of America
| | - Sarah Leatherman
- VA Boston Healthcare System, Boston, Massachusetts, United States of America
| | - Judith Strymish
- VA Boston Healthcare System, Boston, Massachusetts, United States of America
| | - Rupak Datta
- Hospital Epidemiology and Infection Prevention Program, VA Connecticut Healthcare System, West Haven, Connecticut, United States of America
- Section of Infectious Diseases, Yale School of Medicine, New Haven, Connecticut, United States of America
| | - Rekha Goswami
- Section of Infectious Diseases, VA Maine Healthcare System, Togus, Maine, United States of America
| | - Matthew D. Jankowich
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Providence VA Medical Center, Alpert Medical School of Brown University, Providence, Rhode Island, United States of America
| | - Nishant R. Shah
- Division of Cardiology, Department of Medicine, Providence VA Medical Center, Alpert Medical School of Brown University, Providence, Rhode Island, United States of America
| | - Thomas H. Taylor
- Infectious Diseases and Rheumatology, White River Jct. VA Medical Center, Hartford, Vermont, United States of America
| | - Sarah T. Page
- VA Boston Healthcare System, Boston, Massachusetts, United States of America
| | - Sara J. Schiller
- VA Boston Healthcare System, Boston, Massachusetts, United States of America
| | - Colleen Shannon
- VA Boston Healthcare System, Boston, Massachusetts, United States of America
| | - Cynthia Hau
- VA Boston Healthcare System, Boston, Massachusetts, United States of America
| | - Maura Flynn
- VA Boston Healthcare System, Boston, Massachusetts, United States of America
| | - Erika Holmberg
- VA Boston Healthcare System, Boston, Massachusetts, United States of America
| | - Karen Visnaw
- VA Boston Healthcare System, Boston, Massachusetts, United States of America
| | - Rupali Dhond
- VA Boston Healthcare System, Boston, Massachusetts, United States of America
- Evans Department of Medicine, Section of General Internal Medicine, Boston University School of Medicine, Boston, Massachusetts, United States of America
| | - Mary Brophy
- VA Boston Healthcare System, Boston, Massachusetts, United States of America
| | - Paul A. Monach
- VA Boston Healthcare System, Boston, Massachusetts, United States of America
| |
Collapse
|
8
|
Monach PA, Branch-Elliman W. Reconsidering 'minimal risk' to expand the repertoire of trials with waiver of informed consent for research. BMJ Open 2021; 11:e048534. [PMID: 34521663 PMCID: PMC8442055 DOI: 10.1136/bmjopen-2020-048534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Progress in therapeutic research is slowed by the regulatory burden of clinical trials, which provide the best evidence for guiding treatment. There is a long delay from evidence generation to adoption, highlighting the need for designs that link evidence generation to implementation. OBJECTIVE To identify clinical trial designs that confer minimal risk above that inherent in clinical care, to obviate the need for cumbersome consenting processes to enrol patients in prospective clinical research studies. These designs extend the scope of the Learning Healthcare System, a framework for leveraging retrospective 'big data' to advance clinical research, to include data collected from prospective controlled trials. SUMMARY Pragmatic trials may use simplified eligibility criteria, unblinded interventions and objective outcome measures that can all be monitored through the electronic health records (EHR), to reduce costs and speed study conduct. Most pragmatic trials continue to suffer from substantial regulatory burden. Written consent to participate in research can be waived only if the research produces minimal risk above what is encountered in everyday life. However, the 'consent' processes for prescribing Federal Drug Administration-approved medications in clinical medicine are informal, even when they involve decisions of uncertain benefit and higher levels of risk. We propose that trial designs that mimic clinical decision-making in areas of uncertainty (clinical equipoise) and in which no data are generated outside of usual care (ideally by EHR embedding) confer minimal additional risk. Trial designs meeting this standard could, therefore, be conducted with minimal documentation of consent, even when interventions contain different risks. To align with risk encountered in clinical practice, allocation to treatment arms should change (adaptive randomisation) as data are collected and analysed. Embedding of informatics tools into the EHR has the additional benefit that, as adaptive randomisation progresses, evidence-generation transitions into implementation via decision-support tools-the ultimate realisation of the Learning Healthcare System.
Collapse
Affiliation(s)
- Paul A Monach
- Rheumatology Section, VA Boston Health Care System Jamaica Plain Campus, Boston, Massachusetts, USA
| | - Westyn Branch-Elliman
- Infectious Diseases Section, VA Boston Health Care System West Roxbury Campus, West Roxbury, Massachusetts, USA
| |
Collapse
|
9
|
Dhond R, Acher R, Leatherman S, Page S, Sanford R, Elbers D, Meng F, Ferguson R, Brophy MT, Do NV. Rapid implementation of a modular clinical trial informatics solution for COVID-19 research. INFORMATICS IN MEDICINE UNLOCKED 2021; 27:100788. [PMID: 34786452 PMCID: PMC8588694 DOI: 10.1016/j.imu.2021.100788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Revised: 11/01/2021] [Accepted: 11/11/2021] [Indexed: 01/31/2023] Open
Abstract
Veterans Health Administration (VHA) services are most frequently used by patients 65 years and older, an age group that is disproportionally affected by COVID-19. Here we describe a modular Clinical Trial Informatics Solution (CTIS) that was rapidly developed and deployed to support a multi-hospital embedded pragmatic clinical trial in COVID-19 patients within the VHA. Our CTIS includes tools for patient eligibility screening, informed consent tracking, treatment randomization, EHR data transformation for reporting and interfaces for patient outcome and adverse event tracking. We hope our CTIS component descriptions and practical lessons learned will serve as a useful building block for others creating their own clinical trial tools and have made application and database code publicly available.
Collapse
Affiliation(s)
- Rupali Dhond
- VA Boston Healthcare System, Boston, MA, USA,Boston University School of Medicine, Boston, MA, USA,Corresponding author. VA Boston Healthcare System, 150 S Huntington Ave, Boston, MA, 02130, USA
| | - Ryan Acher
- VA Boston Healthcare System, Boston, MA, USA
| | | | - Sarah Page
- VA Boston Healthcare System, Boston, MA, USA
| | | | - Danne Elbers
- VA Boston Healthcare System, Boston, MA, USA,University of Vermont, Burlington, VT, USA
| | - Frank Meng
- VA Boston Healthcare System, Boston, MA, USA,Boston University School of Medicine, Boston, MA, USA
| | | | - Mary T. Brophy
- VA Boston Healthcare System, Boston, MA, USA,Boston University School of Medicine, Boston, MA, USA
| | - Nhan V. Do
- VA Boston Healthcare System, Boston, MA, USA,Boston University School of Medicine, Boston, MA, USA
| |
Collapse
|