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Pelazza C, Betti M, Marengo F, Roveta A, Maconi A. The clinical trial activation process: a case study of an Italian public hospital. Trials 2024; 25:240. [PMID: 38581073 PMCID: PMC10998293 DOI: 10.1186/s13063-024-08059-z] [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: 07/12/2023] [Accepted: 03/14/2024] [Indexed: 04/07/2024] Open
Abstract
BACKGROUND/AIMS In order to make the centers more attractive to trial sponsors, in recent years, some research institutions around the world have pursued projects to reorganize the pathway of trial activation, developing new organizational models to improve the activation process and reduce its times. This study aims at analyzing and reorganizing the start-up phase of trials conducted at the Research and Innovation Department (DAIRI) of the Public Hospital of Alessandria (Italy). METHODS A project was carried out to reorganize the trial authorization process at DAIRI by involving the three facilities responsible for this pathway: clinical trial center (CTC), ethics committee secretariat (ESC), and administrative coordination (AC). Lean Thinking methodology was used with the A3 report tool, and the analysis was carried out by monitoring specific key performance indicators, derived from variables representing highlights of the trials' activation pathway. The project involved phases of analysis, implementation of identified countermeasures, and monitoring of timelines in eight 4-month periods. The overall mean and median values of studies activation times were calculated as well as the average times for each facility involved in the process. RESULTS In this study, 298 studies both sponsored by research associations and industry with both observational and interventional study design were monitored. The mean trial activation time was reduced from 218 days before the project to 56 days in the last period monitored. From the first to the last monitoring period, each facility involved achieved at least a halving of the average time required to carry out its activities in the clinical trials' activation pathway (CTC: 55 days vs 23, ECS: 25 days vs 8, AC 29 days vs 10). Average activation time for studies with agreement remains longer than those without agreement (100 days vs. 46). CONCLUSIONS The reorganization project emphasized the importance of having clinical and administrative staff specifically trained on the trial activation process. This reorganization led to the development of a standard operating procedure and a tool to monitor the time (KPIs of the process) that can also be implemented in other clinical centers.
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Affiliation(s)
- Carolina Pelazza
- Research Training Innovation Infrastructure, Research and Innovation Department (DAIRI), Azienda Ospedaliero-Universitaria SS. Antonio E Biagio E Cesare Arrigo, Alessandria, Italy.
| | - Marta Betti
- Research Training Innovation Infrastructure, Research and Innovation Department (DAIRI), Azienda Ospedaliero-Universitaria SS. Antonio E Biagio E Cesare Arrigo, Alessandria, Italy
| | - Francesca Marengo
- Research Training Innovation Infrastructure, Research and Innovation Department (DAIRI), Azienda Ospedaliero-Universitaria SS. Antonio E Biagio E Cesare Arrigo, Alessandria, Italy
| | - Annalisa Roveta
- Research Laboratories, Research and Innovation Department (DAIRI), Azienda Ospedaliero-Universitaria SS. Antonio E Biagio E Cesare Arrigo, Alessandria, Italy
| | - Antonio Maconi
- Research Training Innovation Infrastructure, Research and Innovation Department (DAIRI), Azienda Ospedaliero-Universitaria SS. Antonio E Biagio E Cesare Arrigo, Alessandria, Italy
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Mathebula L, Malinga T, Mokgoro M, Ndwandwe D, Wiysonge CS, Gray G. Cholera vaccine clinical trials: A cross-sectional analysis of clinical trials registries. Hum Vaccin Immunother 2023; 19:2261168. [PMID: 37759348 PMCID: PMC10619520 DOI: 10.1080/21645515.2023.2261168] [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: 05/26/2023] [Accepted: 09/17/2023] [Indexed: 09/29/2023] Open
Abstract
Cholera has been one of the world's biggest public health challenges for centuries. The presence of this disease brings into focus the social determinants of health in different parts of the world. Research and development efforts to find safe and effective Cholera vaccines are critical to decreasing the disease burden from Vibrio cholerae. We searched the International Clinical Trials Registry Platform (ICTRP) and Cochrane Central Register of Controlled Trials (CENTRAL) on 5 March 2023. We included all registered randomized trials studying Cholera vaccines. We used Microsoft Excel to perform a descriptive analysis of the source registry, geographic distribution, recruitment status, phase of trials, and type of trial sponsor and presented the findings using tables and graphs. The search of ICTRP yielded 84 trials, and 315 trials were identified from CENTRAL. Seventy-four trials were included in the analysis. Most of the trials (66%, n = 49) were registered in ClinicalTrials.gov, followed by Clinical Trials Registry - India (9%, n = 7) and the Cuban Public Registry of Clinical Trials (8%, n = 6). The geographical distribution of the trials indicates that 48% (n = 36) of the trials were conducted in Asia, followed by 23% (n = 17) in North America, 15% (n = 11) in Africa, and 11% (n = 8) in Europe. Results further indicate that 81% (n = 60) of trials have a recruitment status "Not recruiting," followed by 12% (n = 9) with a status "recruiting." With the recent surge in Cholera cases and the limited supply of Cholera vaccines, research indicates the need for Cholera vaccine trials to ensure the availability of vaccines, especially in populations affected.
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Affiliation(s)
- Lindi Mathebula
- Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa
| | - Thobile Malinga
- Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa
| | - Mammekwa Mokgoro
- Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa
| | - Duduzile Ndwandwe
- Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa
| | - Charles S. Wiysonge
- Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa
- Vaccine-Preventable Diseases Programme, World Health Organisation Regional Office for Africa, Brazzaville, Congo
| | - Glenda Gray
- Office of the President and CEO, South African Medical Research Council, Cape Town, South Africa
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Cernik C, Shergina E, Thompson J, Blackwell K, Stephens K, Kimminau KS, Wick J, Mayo MS, Gajewski B, He J, Mudaranthakam DP. Non-cancer clinical trials start-up metrics at an academic medical center: Implications for advancing research. Contemp Clin Trials Commun 2021; 22:100774. [PMID: 34027224 PMCID: PMC8121646 DOI: 10.1016/j.conctc.2021.100774] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Revised: 03/08/2021] [Accepted: 04/05/2021] [Indexed: 11/15/2022] Open
Abstract
The primary goal for any clinical trial after it receives a funding notification is to receive regulatory approval and initiate the trial for recruitment. Every trial must go through documentation and regulatory process before it can start recruiting participants and collecting data; this initial process of review and approval is known as the study start-up process (SSU). We evaluated the average time taken for studies to receive approvals. Using data from clinical trials conducted at the University of Kansas Medical Center, various times to reach the start of the study were calculated based on the dates of individual study. The results of this analysis showed that chart review studies and investigator-initiated trials had a shorter time to activation than other types of studies. Additionally, single-center studies had a shorter activation time than multi-center studies. The analysis also demonstrated that the overall processing time consistently had been reduced over time. The 2018 year’s trend shows reduced time to study start. SSU process for non-cancer trial on an average requires four to six months. The activation time of the SSU process varied for different study types and scopes.
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Affiliation(s)
- Colin Cernik
- Department of Biostatistics & Data Science, University of Kansas Medical Center, Kansas City, KS, USA
| | - Elena Shergina
- Department of Biostatistics & Data Science, University of Kansas Medical Center, Kansas City, KS, USA
| | - Jeffrey Thompson
- Department of Biostatistics & Data Science, University of Kansas Medical Center, Kansas City, KS, USA
| | - Karen Blackwell
- Human Research Protection Program, University of Kansas Medical Center, Kansas City, KS, USA
| | - Kyle Stephens
- Human Research Protection Program, University of Kansas Medical Center, Kansas City, KS, USA
| | - Kim S Kimminau
- Department of Family and Community Medicine, University of Missouri , Columbia, MO, USA
| | - Jo Wick
- Department of Biostatistics & Data Science, University of Kansas Medical Center, Kansas City, KS, USA
| | - Matthew S Mayo
- Department of Biostatistics & Data Science, University of Kansas Medical Center, Kansas City, KS, USA
| | - Byron Gajewski
- Department of Biostatistics & Data Science, University of Kansas Medical Center, Kansas City, KS, USA
| | - Jianghua He
- Department of Biostatistics & Data Science, University of Kansas Medical Center, Kansas City, KS, USA
| | - Dinesh Pal Mudaranthakam
- Department of Biostatistics & Data Science, University of Kansas Medical Center, Kansas City, KS, USA
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Marin-Garcia JA, Vidal-Carreras PI, Garcia-Sabater JJ. The Role of Value Stream Mapping in Healthcare Services: A Scoping Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18030951. [PMID: 33499116 PMCID: PMC7908358 DOI: 10.3390/ijerph18030951] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Revised: 01/04/2021] [Accepted: 01/15/2021] [Indexed: 12/16/2022]
Abstract
Lean healthcare aims to manage and improve the processes in the healthcare sector by eliminating everything that adds no value by improving quality of services, ensuring patient safety and facilitating health professionals’ work to achieve a flexible and reliable organization. Value Stream Mapping (VSM) is considered the starting point of any lean implementation. Some papers report applications of VSM in healthcare services, but there has been less attention paid to their contribution on sustainability indicators. The purpose of this work is to analyze the role of VSM in this context. To do so, a scoping review of works from recent years (2015 to 2019) was done. The results show that most applications of VSM reported are in the tertiary level of care, and the United States of America (USA) is the country which leads most of the applications published. In relation with the development of VSM, a heterogeneity in the maps and the sustainability indicators is remarkable. Moreover, only operational and social sustainability indicators are commonly included. We can conclude that more standardization is required in the development of the VSM in the healthcare sector, also including the environmental indicators.
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Gonzales S, O’Keefe L, Gutzman K, Viger G, Wescott AB, Farrow B, Heath AP, Kim MC, Taylor D, Champieux R, Yen PY, Holmes K. Personas for the translational workforce. J Clin Transl Sci 2020; 4:286-293. [PMID: 33244408 PMCID: PMC7681142 DOI: 10.1017/cts.2020.2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Revised: 12/19/2019] [Accepted: 12/20/2019] [Indexed: 11/07/2022] Open
Abstract
Twelve evidence-based profiles of roles across the translational workforce and two patients were made available through clinical and translational science (CTS) Personas, a project of the Clinical and Translational Science Awards (CTSA) Program National Center for Data to Health (CD2H). The persona profiles were designed and researched to demonstrate the key responsibilities, motivators, goals, software use, pain points, and professional development needs of those working across the spectrum of translation, from basic science to clinical research to public health. The project's goal was to provide reliable documents that could be used to inform CTSA software development projects, educational resources, and communication initiatives. This paper presents the initiative to create personas for the translational workforce, including the methodology, engagement strategy, and lessons learned. Challenges faced and successes achieved by the project may serve as a roadmap for others searching for best practices in the creation of Persona profiles.
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Affiliation(s)
- Sara Gonzales
- Galter Health Sciences Library and Learning Center, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Lisa O’Keefe
- Galter Health Sciences Library and Learning Center, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Karen Gutzman
- Galter Health Sciences Library and Learning Center, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Guillaume Viger
- Galter Health Sciences Library and Learning Center, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Annie B. Wescott
- Galter Health Sciences Library and Learning Center, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Bailey Farrow
- Center for Data-Driven Discovery in Biomedicine, The Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - Allison P. Heath
- Center for Data-Driven Discovery in Biomedicine, The Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - Meen Chul Kim
- Center for Data-Driven Discovery in Biomedicine, The Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - Deanne Taylor
- Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
- Department of Biomedical and Health Informatics, The Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - Robin Champieux
- The Oregon Health & Science University Library, Oregon Health & Science University, Portland, OR, USA
| | - Po-Yin Yen
- Institute for Informatics, Department of Medicine, Division of General Medical Sciences, Washington University School of Medicine, St. Louis, MO, USA
- Goldfarb School of Nursing, Barnes-Jewish College, BJC HealthCare, St. Louis, MO, USA
| | - Kristi Holmes
- Galter Health Sciences Library and Learning Center, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
- Department of Preventive Medicine, Division of Health and Biomedical Informatics, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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Topaloglu U, Palchuk MB. Using a Federated Network of Real-World Data to Optimize Clinical Trials Operations. JCO Clin Cancer Inform 2018; 2:1-10. [PMID: 30652541 PMCID: PMC6816049 DOI: 10.1200/cci.17.00067] [Citation(s) in RCA: 140] [Impact Index Per Article: 23.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Clinical trials, whether industry, cooperative group sponsored, or investigator initiated, have an unacceptable rate of failure as a result of the inability to recruit sufficient numbers of patients. Even those trials that are completed often require time-consuming protocol amendments to achieve accrual goals. These inefficiencies in clinical trial research result in increasing costs and prolong the time needed to bring improved treatments to cancer clinical practice. TriNetX has developed a clinical research collaboration platform-deployed by a federated network of health care organizations (HCOs), pharmaceutical firms (Pharma), and contract research organizations (CROs)-to enable data-driven clinical research study design to reduce accrual failure and protocol amendment. Currently, the network extends to 55 HCOs and covers 84 million patients, mostly within the United States, but with a growing international presence. (Many of the HCOs in United States are Clinical and Translational Science Awardees and/or National Cancer Institute-designated cancer centers.) The TriNetX business model includes Pharma and the CROs as sponsors whose subscriptions financially support the network, including the software and hardware costs of the HCOs. Furthermore, as each HCO network member has their data harmonized with the TriNetX model upon joining, data sharing among them does not require any technical processes to establish connectivity. To date, on the basis of the data on the network, HCOs have been presented approximately 757 studies by Pharma and CROs, and four data-sharing subnetworks have been formed among member HCOs.
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Affiliation(s)
- Umit Topaloglu
- Umit Topaloglu, Wake Forest School of Medicine, Winston Salem, NC; and Matvey B. Palchuk, TriNetX, Cambridge, MA
| | - Matvey B. Palchuk
- Umit Topaloglu, Wake Forest School of Medicine, Winston Salem, NC; and Matvey B. Palchuk, TriNetX, Cambridge, MA
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An Electronic Dashboard to Monitor Patient Flow at the Johns Hopkins Hospital: Communication of Key Performance Indicators Using the Donabedian Model. J Med Syst 2018; 42:133. [PMID: 29915933 DOI: 10.1007/s10916-018-0988-4] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Accepted: 06/07/2018] [Indexed: 10/14/2022]
Abstract
Efforts to monitoring and managing hospital capacity depend on the ability to extract relevant time-stamped data from electronic medical records and other information technologies. However, the various characterizations of patient flow, cohort decisions, sub-processes, and the diverse stakeholders requiring data visibility create further overlying complexity. We use the Donabedian model to prioritize patient flow metrics and build an electronic dashboard for enabling communication. Ten metrics were identified as key indicators including outcome (length of stay, 30-day readmission, operating room exit delays, capacity-related diversions), process (timely inpatient unit discharge, emergency department disposition), and structural metrics (occupancy, discharge volume, boarding, bed assignation duration). Dashboard users provided real-life examples of how the tool is assisting capacity improvement efforts, and user traffic data revealed an uptrend in dashboard utilization from May to October 2017 (26 to 148 views per month, respectively). Our main contributions are twofold. The former being the results and methods for selecting key performance indicators for a unit, department, and across the entire hospital (i.e., separating signal from noise). The latter being an electronic dashboard deployed and used at The Johns Hopkins Hospital to visualize these ten metrics and communicate systematically to hospital stakeholders. Integration of diverse information technology may create further opportunities for improved hospital capacity.
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Gobbini E, Pilotto S, Pasello G, Polo V, Di Maio M, Arizio F, Galetta D, Petrillo P, Chiari R, Matocci R, Di Costanzo A, Di Stefano TS, Aglietta M, Cagnazzo C, Sperduti I, Bria E, Novello S. Effect of Contract Research Organization Bureaucracy in Clinical Trial Management: A Model From Lung Cancer. Clin Lung Cancer 2017; 19:191-198. [PMID: 29153968 DOI: 10.1016/j.cllc.2017.10.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2017] [Revised: 10/10/2017] [Accepted: 10/19/2017] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Contract research organization (CRO) support is largely included in clinical trial management, although its effect in terms of time savings and benefit has not yet been quantified. We performed a retrospective multicenter analysis of lung cancer trials to explore differences in term of trial activation timelines and accrual for studies with and without CRO involvement. MATERIALS AND METHODS Results regarding study timelines from feasibility data to first patient enrollment were collected from 7 Italian thoracic oncology departments. The final accruals (screened/enrolled patients) are reported. We considered CRO/sponsor-administered and CRO-free trials according to who was responsible for the management of the crucial setup phases. RESULTS Of 113 trials, 62 (54.9%) were CRO-administered, 34 (30.1%) were sponsor-administered, and 17 (15.0%) were CRO-free. The median time from feasibility invitation to documentation obtainment was 151 days in the CRO-administered trials versus 128 in the sponsor-administered and 120 in the CRO-free trials. The time from document submission to contract signature was 142 days in the CRO-administered versus 128 in the sponsor-administered and 132 in the CRO-free trials. The time from global accrual opening to first patient enrollment was 247 days for the CRO-administered versus 194 in the sponsor-administered and 151 in the CRO-free trials. No significant differences were observed in terms of the median overall timeline: 21 months in the CRO-administered, 15 in the sponsor-administered, and 18 months in the CRO-free studies (P = .29). CONCLUSION Although no statistically significant differences were identified, the results of our analysis support the idea that bureaucratic procedures might require more time in CRO-administered trials than in sponsor-administered and CRO-free studies. This bureaucratic delay could negatively affect Italian patients' screening and enrollment compared with other countries.
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Affiliation(s)
- Elisa Gobbini
- Department of Oncology, University of Turin, Azienda Ospedaliero-Universitaria San Luigi Gonzaga, Orbassano, Italy
| | - Sara Pilotto
- Department of Medical Oncology, University of Verona, Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italy.
| | - Giulia Pasello
- Department of Medical Oncology 2, Istituto Oncologico Veneto IRCCS, Padua, Italy
| | - Valentina Polo
- Department of Medical Oncology 2, Istituto Oncologico Veneto IRCCS, Padua, Italy
| | - Massimo Di Maio
- Department of Oncology, University of Turin, Mauriziano Hospital, Turin, Italy
| | - Francesca Arizio
- Department of Oncology, University of Turin, Azienda Ospedaliero-Universitaria San Luigi Gonzaga, Orbassano, Italy
| | - Domenico Galetta
- Oncology Unit, Clinical Cancer Center, "Giovanni Paolo II", Bari, Italy
| | - Patrizia Petrillo
- Oncology Unit, Clinical Cancer Center, "Giovanni Paolo II", Bari, Italy
| | - Rita Chiari
- Oncology Unit, "Santa Maria della Misericordia" Hospital, Perugia, Italy
| | - Roberta Matocci
- Oncology Unit, "Santa Maria della Misericordia" Hospital, Perugia, Italy
| | | | | | | | | | - Isabella Sperduti
- Department of Biostatistics, Regina Elena National Cancer Institute, Rome, Italy
| | - Emilio Bria
- Department of Medical Oncology, University of Verona, Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italy
| | - Silvia Novello
- Department of Oncology, University of Turin, Azienda Ospedaliero-Universitaria San Luigi Gonzaga, Orbassano, Italy
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