The Utah Center for Clinical and Translational Science: Transformation through Collaboration

Introduction

The Intermountain West encompasses a 400,000 square mile area that includes the states of Utah, Idaho, Wyoming, and Montana. Within the region the University of Utah Health Sciences Center (UUHSC) is the only academic health center and Intermountain Healthcare (Intermountain), a not‐for‐profit corporation, is the largest healthcare provider. The UUHSC and Intermountain are competitors for clinical market share in most service lines. Both UUHSC and Intermountain have significant research enterprises and each has different strengths. The University of Utah developed the first Biomedical Informatics Department in the nation, is internationally recognized for research in human genetics, and has robust programs in molecular medicine and other laboratory‐based sciences. Intermountain is internationally recognized for health services research and programs in quality improvement. The impetus for collaboration in the research enterprise was however, limited before the national initiative to establish a consortium of academic health centers supported through the National Institutes of Health (NIH) clinical and translational science awards (CTSA). Here we describe the transformation of the clinical research environment in the Intermountain West as a result of the collaborative relationships developed between UUHSC and Intermountain following the establishment of the Utah Center for Clinical and Translational Science (CCTS) through the CTSA consortium.

Founded in 1905, the University of Utah School of Medicine, located in Salt Lake City, houses 16 clinical and 6 basic science departments. In collaboration with UUHSC, the faculty and staff of the University of Utah educate and train healthcare professionals, conduct research, and provide medical care for adults and children in Utah and the surrounding Intermountain states. Intermountain Healthcare (Intermountain), founded in 1975, is a not‐for‐profit, integrated healthcare delivery system based in Salt Lake City, Utah. Intermountain is the largest healthcare provider in the Intermountain West, providing healthcare services in southeastern Idaho plus the entire state of Utah and operating 23 inpatient facilities including one tertiary children's hospital, Primary Children's Medical Center (PCMC) in Salt Lake City, UT. Over 500 multispecialty physicians are employed through the Intermountain Medical Group and hundreds of other affiliated providers practice in Intermountain hospitals and clinics.

Within the region, competition related to clinical market share decreased the ability of institutions to collaborate. Exceptions included (1) the delivery of inpatient pediatric care at PCMC which is owned and operated by Intermountain and staffed by both UUHSC and Intermountain physicians and (2) the training of physicians to serve several western states in both urban and rural locations which resulted in a well‐developed affiliation agreement defining teaching programs operated in several Intermountain hospitals for UUHSC trainees. Intermountain and UUHSC operate integrated residency and fellowship programs in medicine, obstetrics and gynecology, pediatrics, radiation therapy, and surgery. In contrast, the collaboration in the research enterprise for the past three decades had been limited to the efforts of individual investigators and there were no institutional policies or infrastructure to systematically support the research efforts across institutions or to share resources.

The national competition to join the CTSA consortium provided an opportunity to reevaluate the research relationship and to and develop and support research collaboration between both institutions. UUHSC and Intermountain joined forces in order to apply for a CTSA and to represent the Intermountain West in the consortium. The Utah Center for Clinical and Translational Science (CCTS) became part of the national CTSA consortium in 2008. Linkages created through the CCTS across both organizations have served to create productive and trusting work relationships, allowing us to provide a shared research infrastructure that takes advantage of our innovative systems and shared intellectual capital of personnel. These linkages have increased collaboration and resulted in significant benefits for both instituions.

CCTS Infrastructure that has Increased Collaboration

Master collaboration agreement

Clinical research is a priority for both institutions and a major barrier to transinstitutional projects was the lack of a legal agreement addressing policies and procedures related to collaborative research. To reduce these challenges, a Master Collaboration Agreement (MCA), signed by both institutions, was developed in order to create the CCTS. The MCA defines and establishes a formal process for collaboration, research oversight through single or dual institutional review boards, and assignment of intellectual property.

The unprecedented agreement was possible because of the enhanced trust that developed between the partner institutions as a result of working together to draft the CTSA application and to create the CCTS.

Research education and training core

Shared education and training programs that leverage the individual strengths of UUHSC and Intermountain have been a priority for the CCTS. The CCTS Education Core includes key faculty members from both UUHSC and Intermountain. The Masters of Science in Clinical Investigation (MSCI) uses the expertise of both partners. Two degree tracks are offered, one that emphasizes the inherited basis of human disease, mechanism‐oriented clinical research, and bench‐to‐bedside translational research and another track that emphasizes epidemiology, health services research, and bedside‐to‐community translational research. The combined resources of UUHSC and Intermountain allow the CCTS to offer two tracks of study and increase the number of trainees served.

The CCTS K12 career development program offers another example of collaboration. The CCTS received funding for two K12 positions as part of the CTSA. Both UUHSC and Intermountain scientists are eligible to apply for the positions. To help prepare junior investigators, a monthly grant review session, referred to as the K club is held, with senior faculty members from both the UUHSC and Intermountain serving as reviewers and mentors. To date, the CCTS has supported eight K12 faculty scholars with four of these conducting research in Intermountain facilities and four in UUHSC facilities. The success of the K12 program led Intermountain, through the Primary Children's Medical Center Foundation to fund a third K12 position dedicated to child health research in 2011.

Clinical Research Core Facilities

Biorepository

The Utah BioHealth Initiative represents a new collaboration between Intermountain and the UUHSC and received federal support in 2010. The initiative established a physical, informatics and governance infrastructure designed to support the scientific, operational, legal, societal, and business aspects of a multiinstitutional biorepository. This multiinstitutional biorepository is comprised of biospecimens and a linked virtual data repository integrating data on biological samples with demographic, medical, environmental, and other relevant information on their donors. The biorepository is linked to the Utah Population Database (described below). The Utah BioHealth repository is one of the only multiinstitutional repositories in the United States and when completed will represent most of the population of Utah. The biorepository is a resource that will support clinical research efforts at both institutions in the fields of in human genetics and personalized healthcare. At a national level the collaboration between the UUHSC and Intermountain has resulted in a unique population‐based resource that can further national research efforts.

Data resources

A unique, shared community asset is the Utah Population Database (UPDB). The UPDB is a computerized integration of pedigrees, vital statistics, and public records that are linked to medical records at Intermountain and the UUHSC. With more than eight million linked records, the UPDB is an unparalleled resource that provides information to biomedical researchers for clinical trials, genetic, epidemiological, demographic, and public health studies.

Through the CCTS, the Federated Utah Research and Translational Health eRepository (FURTHeR) has been created. FURTHeR is the informatics platform integrating the considerable research resources at the University with the major healthcare delivery networks in our state and the Utah Department of Health. The collaboration covers over 85% of the state's clinical data and nearly 100% of statewide public health data. This extensive collection of data is being integrated with the UPDB and the Utah Biohealth repository. The architecture of FURTHeR is designed to federate the disparate data sources in a virtual, statewide repository accessible through a Web‐based portal to researchers, clinicians, and community partners. The portal allows users at UUHSC, Intermountain or other locations to “discover” available resources, construct meaningful queries, view results, and create datasets for deeper analysis. Designed with scalability and connectivity as key architectural requirements, FURTHeR uses informatics and industrial standards throughout, while enforcing privacy protections through integration with our CCTS ethics core.

Extramural Funding

Through establishing the CCTS, investigators at both Intermountain and the UUHSC increased their collaborative research efforts. The shared infrastructure and data resources are able to better support collaborative research. These advances have resulted in increased extramural funding at both institutions. In addition, several new awards with principal and coinvestigators from both institutions have been received. These new dollars support innovative programs such as the Career Development Program in Translational‐Comparative Effectiveness Research (NIH/NCI 5KM1CA156723) that benefit both institutions by increasing research capacity.

Summary

The creation of the CCTS has furthered the alignment and collaboration of our partner institutions and has transformed the research environment in Utah. Benefits of collaboration have been realized in the areas of research education and training, data infrastructure, and in the performance of clinical research. Both institutions have benefited and will seek to further the collaborative efforts with the renewal of the CCTS.