1
|
Cramer AE, King LS, Buckley MT, Casteleyn P, Ennis C, Hamidi M, Rodrigues GMC, Snyder DC, Vattikola A, Eisenstein EL. Improving eSource Site Start-Up Practices. RESEARCH SQUARE 2024:rs.3.rs-4414917. [PMID: 38826202 PMCID: PMC11142311 DOI: 10.21203/rs.3.rs-4414917/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2024]
Abstract
Background eSource software that copies patient electronic health record data into a clinical trial electronic case report form holds promise for increasing data quality while reducing data collection, monitoring and source document verification costs. Integrating eSource into multicenter clinical trial start-up procedures could facilitate the use of eSource technologies in clinical trials. Methods We conducted a qualitative integrative analysis to identify eSource site start-up key steps, challenges that might occur in executing those steps, and potential solutions to those challenges. We then conducted a value analysis to determine the challenges and solutions with the greatest impacts for eSource implementation teams. Results There were 16 workshop participants: 10 pharmaceutical sponsor, 3 academic site, and 1 eSource vendor representatives. Participants identified 36 Site Start-Up Key Steps, 11 Site Start-Up Challenges, and 14 Site Start-Up Solutions for eSource-enabled studies. Participants also identified 77 potential impacts of the Challenges upon the Site Start-Up Key Steps and 70 ways in which the Solutions might impact Site Start-Up Challenges. The most important Challenges were: (1) not being able to identify a site eSource champion and (2) not agreeing on an eSource approach. The most important Solutions were: (1) vendors accepting electronic data in the FHIR standard, (2) creating standard content for eSource-related legal documents, and (3) creating a common eSource site readiness checklist. Conclusions Site start-up for eSource-enabled multi-center clinical trials is a complex socio-technical problem. This study's Start-Up Solutions provide a basic infrastructure for scalable eSource implementation.
Collapse
Affiliation(s)
| | | | | | | | - Cory Ennis
- Duke University School of Medicine, Vice Dean's Office
| | | | | | - Denise C Snyder
- Duke University School of Medicine, Duke Office of Clinical Research
| | | | | |
Collapse
|
2
|
Moore JB, Smith SC, Russell LP, Serdoz ES, Dilts NA, Alexander AA, Reboussin DM, Bagwell BM, Spainhour MH, Reeves-Daniel AM, Wesley-Farrington DJ, Ma L, Freedman BI. Creation of a Single Institutional Review Board for Collaborative Research in Nephrology: The APOLLO Experience. Clin J Am Soc Nephrol 2023; 18:1362-1365. [PMID: 37163584 PMCID: PMC10578633 DOI: 10.2215/cjn.0000000000000197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Accepted: 05/02/2023] [Indexed: 05/12/2023]
Affiliation(s)
- J. Brian Moore
- Institutional Review Board and Clinical and Translational Science Institute, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - S. Carrie Smith
- Department of Internal Medicine, Section on Gerontology, Wake Forest University School of Medicine, Winston-Salem, North Carolina
- Vanderbilt Institute for Clinical and Translational Research, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Laurie P. Russell
- Division of Public Health Sciences, Department of Biostatistics and Data Science, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - Emily S. Serdoz
- Vanderbilt Institute for Clinical and Translational Research, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Natalie A. Dilts
- Vanderbilt Institute for Clinical and Translational Research, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Amir A. Alexander
- Division of Public Health Sciences, Department of Biostatistics and Data Science, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - David M. Reboussin
- Division of Public Health Sciences, Department of Biostatistics and Data Science, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - Benjamin M. Bagwell
- Department of Internal Medicine, Section on Nephrology, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - Mitzie H. Spainhour
- Department of Internal Medicine, Section on Nephrology, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - Amber M. Reeves-Daniel
- Department of Internal Medicine, Section on Nephrology, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - Deborah J. Wesley-Farrington
- Institutional Review Board and Clinical and Translational Science Institute, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - Lijun Ma
- Department of Internal Medicine, Section on Nephrology, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - Barry I. Freedman
- Department of Internal Medicine, Section on Nephrology, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| |
Collapse
|
3
|
Mullen CG, Houlihan JY, Stroo M, Deeter CE, Freel SA, Padget AM, Snyder DC. Leveraging retooled clinical research infrastructure for Clinical Research Management System implementation at a large Academic Medical Center. J Clin Transl Sci 2023; 7:e127. [PMID: 37313387 PMCID: PMC10260330 DOI: 10.1017/cts.2023.550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 05/02/2023] [Accepted: 05/05/2023] [Indexed: 06/15/2023] Open
Abstract
Quality clinical research is essential for health care progress and is the mission of academic health centers. Yet ensuring quality depends on an institution's ability to measure, control, and respond to metrics of trial performance. Uninformed clinical research provides little benefit to health care, drains institutional resources, and may waste participants' time and commitment. Opportunities for ensuring high-quality research are multifactorial, including training, evaluation, and retention of research workforces; operational efficiencies; and standardizing policies and procedures. Duke University School of Medicine has committed to improving the quality and informativeness of our clinical research enterprise through investments in infrastructure with significant focus on optimizing research management system integration as a foundational element for quality management. To address prior technology limitations, Duke has optimized Advarra's OnCore for this purpose by seamlessly integrating with the IRB system, electronic health record, and general ledger. Our goal was to create a standardized clinical research experience to manage research from inception to closeout. Key drivers of implementation include transparency of research process data and generating metrics aligned with institutional goals. Since implementation, Duke has leveraged OnCore data to measure, track, and report metrics resulting in improvements in clinical research conduct and quality.
Collapse
Affiliation(s)
- Catherine G. Mullen
- Duke Office of Clinical Research, Duke University School of Medicine, Durham, NC, USA
- Clinical and Translational Science Institute, Duke University, Durham, NC, USA
| | - Jessica Y. Houlihan
- Duke Office of Clinical Research, Duke University School of Medicine, Durham, NC, USA
- Clinical and Translational Science Institute, Duke University, Durham, NC, USA
| | - Marissa Stroo
- Duke Office of Clinical Research, Duke University School of Medicine, Durham, NC, USA
- Clinical and Translational Science Institute, Duke University, Durham, NC, USA
| | - Christine E. Deeter
- Duke Office of Clinical Research, Duke University School of Medicine, Durham, NC, USA
- Clinical and Translational Science Institute, Duke University, Durham, NC, USA
| | - Stephanie A. Freel
- Duke Office of Clinical Research, Duke University School of Medicine, Durham, NC, USA
- Clinical and Translational Science Institute, Duke University, Durham, NC, USA
| | - Angela M. Padget
- Duke Office of Clinical Research, Duke University School of Medicine, Durham, NC, USA
- Clinical and Translational Science Institute, Duke University, Durham, NC, USA
| | - Denise C. Snyder
- Duke Office of Clinical Research, Duke University School of Medicine, Durham, NC, USA
- Clinical and Translational Science Institute, Duke University, Durham, NC, USA
| |
Collapse
|
4
|
Eisenstein EL, Walden A, Donovan K, Zozus MN, Yu FB, West VL, Hammond WE, Muhlbaier LH. Economic analysis of a single institutional review board data exchange standard in multisite clinical studies. Contemp Clin Trials 2022; 122:106953. [PMID: 36202199 PMCID: PMC10015373 DOI: 10.1016/j.cct.2022.106953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 08/17/2022] [Accepted: 09/29/2022] [Indexed: 01/27/2023]
Abstract
BACKGROUND Single Institutional Review Boards (sIRB) are not achieving the benefits envisioned by the National Institutes of Health. The recently published Health Level Seven (HL7®) Fast Healthcare Interoperability Resources (FHIR®) data exchange standard seeks to improve sIRB operational efficiency. METHODS AND RESULTS We conducted a study to determine whether the use of this standard would be economically attractive for sIRB workflows collectively and for Reviewing and Relying institutions. We examined four sIRB-associated workflows at a single institution: (1) Initial Study Protocol Application, (2) Site Addition for an Approved sIRB study, (3) Continuing Review, and (4) Medical and Non-Medical Event Reporting. Task-level information identified personnel roles and their associated hour requirements for completion. Tasks that would be eliminated by the data exchange standard were identified. Personnel costs were estimated using annual salaries by role. No tasks would be eliminated in the Initial Study Protocol Application or Medical and Non-Medical Event Reporting workflows through use of the proposed data exchange standard. Site Addition workflow hours would be reduced by 2.50 h per site (from 15.50 to 13.00 h) and Continuing Review hours would be reduced by 9.00 h per site per study year (from 36.50 to 27.50 h). Associated costs savings were $251 for the Site Addition workflow (from $1609 to $1358) and $1033 for the Continuing Review workflow (from $4110 to $3076). CONCLUSION Use of the proposed HL7 FHIR® data exchange standard would be economically attractive for sIRB workflows collectively and for each entity participating in the new workflows.
Collapse
Affiliation(s)
| | - Anita Walden
- Oregon Health & Science University, Portland, OR, USA.
| | - Katrina Donovan
- University of Arkansas for Medical Sciences, Little Rock, AR, USA.
| | - Meredith N Zozus
- University of Texas Health Science Center at San Antonio, San Antonio, TX, USA.
| | - Feliciano B Yu
- University of Arkansas for Medical Sciences, Little Rock, AR, USA.
| | | | | | | |
Collapse
|
5
|
Drivers of Start-Up Delays in Global Randomized Clinical Trials. Ther Innov Regul Sci 2020; 55:212-227. [PMID: 32959207 PMCID: PMC7505220 DOI: 10.1007/s43441-020-00207-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Accepted: 08/19/2020] [Indexed: 11/16/2022]
Abstract
Background Global, randomized clinical trials are extremely complex. Trial start-up is a critical phase and has many opportunities for delay which adversely impact the study timelines and budget. Understanding factors that contribute to delay may help clinical trial managers and other stakeholders to work more efficiently, hastening patient access to potential new therapies. Methods We reviewed the available literature related to start-up of global, Phase III clinical trials and then created a fishbone diagram detailing drivers contributing to start-up delays. The issues identified were used to craft a checklist to assist clinical trial managers in more efficient trial start-up. Results We identified key drivers for start-up delays in the following categories: regulatory, contracts and budgets, insurance, clinical supplies, site identification and selection, site activation, and inefficient processes/pitfalls. Conclusion Initiating global randomized clinical trials is a complex endeavor, and reasons for delay are well documented in the literature. By using a checklist, clinical trial managers may mitigate some delays and get clinical studies initiated as soon as possible.
Collapse
|
6
|
Nesom GL, Petrof I, Moore TM. Operational Characteristics of Institutional Review Boards (IRBs) in the United States. AJOB Empir Bioeth 2019; 10:276-286. [PMID: 31618119 DOI: 10.1080/23294515.2019.1670276] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Background:Federal Law requires approval from an Institutional Review Board prior to conducting human subjects research to ensure ethical distribution of benefits and harms. Notwithstanding this role and almost no prescriptive requirements about design or operation, there is little systematic research describing the key attributes of IRBs, as reported by IRB personnel themselves. Methods: Here, 55 IRB directors completed a survey of 77 questions. The goals of the study were to establish what a typical US IRB "looks like," determine whether IRB characteristics can be summarized by a smaller number of overarching components, determine the best predictors of IRB speed and efficiency, and determine whether IRBs differ by high-level qualitative characteristics such as institution type. The above was explored and tested using the general linear model and principal components analysis, and for the former, dependent variables of interest were, a) the time necessary for an IRB to approve a study, and b) efficiency of the review process for full board and expedited reviews. IVs of interest included multiple IRB characteristics. Results: 1) IRB characteristics can be summarized by four key components; 2) IRB speed and efficiency are most strongly determined by tendency to receive biomedical submissions, especially drug-related; and 3) IRBs do vary by institution type on some key variables. Conclusion: These results are the first step toward establishing national norms and building a working model of US IRBs to which other IRBs can compare themselves.
Collapse
Affiliation(s)
- Genevieve L Nesom
- Metabolic Disorders, The Children's Hospital of Philadelphia , Philadelphia , Pennsylvania , USA
| | - Iraklis Petrof
- Gastroenterology, The Children's Hospital of Philadelphia , Philadelphia , Pennsylvania , USA
| | - Tyler M Moore
- Psychiatry, Hospital of the University of Pennsylvania , Philadelphia , Pennsylvania , USA
| |
Collapse
|
7
|
Hahn C, Kaufmann P, Bang S, Calvert S. Resources to assist in the transition to a single IRB model for multisite clinical trials. Contemp Clin Trials Commun 2019; 15:100423. [PMID: 31388602 PMCID: PMC6667781 DOI: 10.1016/j.conctc.2019.100423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Revised: 07/11/2019] [Accepted: 07/18/2019] [Indexed: 11/03/2022] Open
Affiliation(s)
- Cynthia Hahn
- Integrated Research Strategy, LLC, United States
| | - Petra Kaufmann
- National Center for Advancing Translational Sciences, National Institutes of Health, United States
| | | | - Sara Calvert
- Clinical Trials Transformation Initiative, United States
| |
Collapse
|
8
|
Vardeny O, Hernandez AF, Cohen LW, Franklin A, Baqai M, Palmer S, Bierer BE, Cobb N. Transitioning to the National Institutes of Health single institutional review board model: Piloting the use of the Streamlined, Multi-site, Accelerated Resources for Trials IRB Reliance. Clin Trials 2019; 16:290-296. [PMID: 30866676 DOI: 10.1177/1740774519832911] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND/AIMS Obtaining ethical approval from multiple institutional review boards is a long-standing challenge to multi-site clinical trials and often leads to significant delays in study activation and enrollment. As of 25 January 2018, the National Institutes of Health began requiring use of a single institutional review board for US multi-site trials. To learn more and further inform the research and regulatory communities around aspects of transitioning to single institutional review board review, this study evaluated the efficiency, resource use, and user perceptions of a nascent institutional review board reliance model (Streamlined, Multi-site, Accelerated Resources for Trials IRB Reliance). METHODS This research was embedded within the Influenza Vaccine to Effectively Stop Cardio Thoracic Events and Decompensated Heart Failure trial-a multi-site trial of two influenza vaccine formulations. In the first year of the trial, a sample of sites agreed to use the developing Streamlined, Multi-site, Accelerated Resources for Trials IRB Reliance model and participated in its evaluation. In keeping with a least burdensome approach, short surveys were developed and obtained from each reporting entity (relying sites, non-relying site, lead site, and reviewing institutional review board). Data regarding time to institutional review board approval and site activation, costs, and user perceptions of reliant review were self-reported and collected via the survey form. Quantitative and qualitative analyses were performed, with costs analyzed as actual versus estimated due to the lack of established baseline cost data. RESULTS A total of 13 sites ceded review and received institutional review board approval. Mean time to approval was substantially faster in sites that ceded review using the Streamlined, Multi-site, Accelerated Resources for Trials IRB Reliance model versus the site that did not cede review (81 vs 121 days). The mean time to approval was also faster than published averages for academic medical centers (81 vs 103 days). Time to first enrollment was faster for ceding sites versus the non-ceding site, and also faster than published averages (126 vs 149 and 169 days, respectively). Costs were higher than estimates for local institutional review board review and approval. Nearly half (47%) the stakeholders reported being very satisfied or satisfied with the reliance experience, although many noted the challenge related to institutional culture change. CONCLUSION Implementation of a single institutional review board represents a shift in practice and culture for many institutions. Evaluation of the reliance arrangements for this study highlights both the potential of, and challenges for, institutions as they transition to single institutional review board review. Although efficiencies were observed for study start-up, we anticipate a learning curve as institutions and research teams implement necessary process and resource changes to adapt to single institutional review board oversight. Findings may inform research teams but are, however, limited by the relatively small number of sites and lack of a control group.
Collapse
Affiliation(s)
- Orly Vardeny
- 1 School of Medicine, University of Minnesota, Minneapolis, MN, USA
| | - Adrian F Hernandez
- 2 Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, USA.,3 Department of Medicine, Duke University School of Medicine, Durham, NC, USA
| | - Lauren W Cohen
- 2 Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, USA
| | - Amy Franklin
- 2 Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, USA
| | - Mina Baqai
- 2 Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, USA
| | - Sarah Palmer
- 2 Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, USA
| | - Barbara E Bierer
- 4 Brigham and Women's Hospital and the Harvard Clinical and Translational Science Center, Harvard Medical School, Boston, MA, USA
| | - Nichelle Cobb
- 5 Health Sciences Institutional Review Boards, University of Wisconsin-Madison, Madison, WI, USA
| |
Collapse
|
9
|
Tenaerts P, Madre L, Landray M. A decade of the Clinical Trials Transformation Initiative: What have we accomplished? What have we learned? Clin Trials 2018; 15:5-12. [DOI: 10.1177/1740774518755053] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The Clinical Trials Transformation Initiative reflects on 10 years of working to improve the quality and efficiency of clinical trials. This article highlights many of the Clinical Trials Transformation Initiative’s accomplishments and offers examples of the impact that the Clinical Trials Transformation Initiative has had on the clinical trials enterprise. After conducting more than 25 projects and issuing recommendations for specific strategies to improve the design and execution of clinical trials, some common themes and lessons learned have emerged. Lessons include the importance of engaging many stakeholders, advanced planning to address critical issues, discontinuation of non-value added practices, and new opportunities presented by technology. Through its work, the Clinical Trials Transformation Initiative has also derived some operational best practices for conducting collaborative, multi-stakeholder projects covering project selection, project team dynamics and execution, and multi-stakeholder meetings and team discussions. Through these initiatives, the Clinical Trials Transformation Initiative has helped move the needle toward needed change in the clinical trials enterprise that has directly impacted stakeholders and patients alike.
Collapse
Affiliation(s)
- P Tenaerts
- Clinical Trials Transformation Initiative, Durham, NC, USA
| | - L Madre
- Clinical Trials Transformation Initiative, Durham, NC, USA
| | | |
Collapse
|
10
|
Choi YJ, Beck SH, Kang WY, Yoo S, Kim SY, Lee JS, Burt T, Kim TW. Knowledge and Perception about Clinical Research Shapes Behavior: Face to Face Survey in Korean General Public. J Korean Med Sci 2016; 31:674-81. [PMID: 27134486 PMCID: PMC4835590 DOI: 10.3346/jkms.2016.31.5.674] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2015] [Accepted: 02/17/2016] [Indexed: 11/25/2022] Open
Abstract
Considering general public as potential patients, identifying factors that hinder public participation poses great importance, especially in a research environment where demands for clinical trial participants outpace the supply. Hence, the aim of this study was to evaluate knowledge and perception about clinical research in general public. A total of 400 Seoul residents with no previous experience of clinical trial participation were selected, as representative of population in Seoul in terms of age and sex. To minimize selection bias, every fifth passer-by was invited to interview, and if in a cluster, person on the very right side was asked. To ensure the uniform use of survey, written instructions have been added to the questionnaire. Followed by pilot test in 40 subjects, the survey was administered face-to-face in December 2014. To investigate how perception shapes behavior, we compared perception scores in those who expressed willingness to participate and those who did not. Remarkably higher percentage of responders stated that they have heard of clinical research, and knew someone who participated (both, P < 0.001) compared to India. Yet, the percentage of responders expressed willingness to participate was 39.3%, a significantly lower rate than the result of the India (58.9% vs. 39.3%, P < 0.001). Treatment benefit was the single most influential reason for participation, followed by financial gain. Concern about safety was the main reason for refusal, succeeded by fear and lack of trust. Public awareness and educational programs addressing these negative perceptions and lack of knowledge will be effective in enhancing public engaged in clinical research.
Collapse
Affiliation(s)
- Yun Jung Choi
- Asan Medical Center, Clinical Trial Center, Seoul, Korea
| | - Sung-Ho Beck
- Asan Medical Center, Clinical Trial Center, Seoul, Korea
| | - Woon Yong Kang
- Asan Medical Center, Clinical Trial Center, Seoul, Korea
| | - Soyoung Yoo
- Asan Medical Center, Human Research Protection Center, Seoul, Korea
| | - Seong-Yoon Kim
- Asan Medical Center, Human Research Protection Center, Seoul, Korea
- Department of Psychiatry, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Ji Sung Lee
- Asan Medical Center, Clinical Research Center, Seoul, Korea
| | - Tal Burt
- Duke Global Proof-of-Concept (POC) Research Network, Duke Clinical Research Unit (DCRU) & Duke Clinical Research Institute (DCRI), Duke University, Durham, NC, USA
- Department of Psychiatry and Behavioral Sciences, Duke University, Durham, NC, USA
| | - Tae Won Kim
- Asan Medical Center, Clinical Trial Center, Seoul, Korea
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| |
Collapse
|
11
|
Ervin AM, Taylor HA, Meinert CL, Ehrhardt S. RESEARCH ETHICS. Evidence gaps and ethical review of multicenter studies. Science 2015; 350:632-3. [PMID: 26542556 DOI: 10.1126/science.aac4872] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Affiliation(s)
- Ann-Margret Ervin
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
| | - Holly A Taylor
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA. Johns Hopkins Berman Institute of Bioethics, Baltimore, MD, USA
| | - Curtis L Meinert
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Stephan Ehrhardt
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| |
Collapse
|
12
|
O'Rourke PP, Carrithers J, Patrick-Lake B, Rice TW, Corsmo J, Hart R, Drezner MK, Lantos JD. Harmonization and streamlining of research oversight for pragmatic clinical trials. Clin Trials 2015; 12:449-56. [PMID: 26374678 DOI: 10.1177/1740774515597685] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
The oversight of research involving human participants is a complex process that requires institutional review board review as well as multiple non-institutional review board institutional reviews. This multifaceted process is particularly challenging for multisite research when each site independently completes all required local reviews. The lack of inter-institutional standardization can result in different review outcomes for the same protocol, which can delay study operations from start-up to study completion. Hence, there have been strong calls to harmonize and thus streamline the research oversight process. Although the institutional review board is only one of the required reviews, it is often identified as the target for harmonization and streamlining. Data regarding variability in decision-making and interpretation of the regulations across institutional review boards have led to a perception that variability among institutional review boards is a primary contributor to the problems with review of multisite research. In response, many researchers and policymakers have proposed the use of a single institutional review board of record, also called a central institutional review board, as an important remedy. While this proposal has merit, the use of a central institutional review board for multisite research does not address the larger problem of completing non-institutional review board institutional review in addition to institutional review board review—and coordinating the interdependence of these reviews. In this article, we describe the overall research oversight process, distinguish between institutional review board and institutional responsibilities, and identify challenges and opportunities for harmonization and streamlining. We focus on procedural and organizational issues and presume that the protection of human subjects remains the paramount concern. Suggested modifications of institutional review board processes that focus on time, efficiency, and consistency of review must also address what effect such changes have on the quality of review. We acknowledge that assessment of quality is difficult in that quality metrics for institutional review board review remain elusive. At best, we may be able to assess the time it takes to review protocols and the consistency across institutions.
Collapse
Affiliation(s)
| | | | - Bray Patrick-Lake
- Clinical Trials Transformation Initiative, Duke University, Durham, NC, USA
| | - Todd W Rice
- Division of Allergy, Pulmonary, and Critical Care Medicine, Department of Medicine, Vanderbilt University, Nashville, TN, USA
| | - Jeremy Corsmo
- Office of Research Compliance and Regulatory Affairs, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Raffaella Hart
- Biomedical Research Alliance of New York, Lake Success, NY, USA
| | - Marc K Drezner
- School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, USA
| | - John D Lantos
- Children's Mercy Bioethics Center, Children's Mercy Hospital, Kansas City, MO, USA
| |
Collapse
|