The northern california perinatal research unit: a hybrid model bridging research, quality improvement and clinical practice

Abstract

Kaiser Permanente (KP) has a long-standing commitment to conduct research and report publicly. Simultaneously, it faces a different imperative: harnessing information systems to leverage internal improvements in outcomes, efficiency, and costs. Now that KP HealthConnect, the KP electronic health record, is fully implemented, research challenges at KP are moving away from issues of data access and toward the mechanisms through which raw data create meaningful clinical knowledge that is based on rigorous research. In this report we describe a model for research-the Northern California Division of Research Perinatal Research Unit-that leverages internal and external resources to fulfill these twin missions.

Figure 1

Timeline from idea to actionable knowledge. ¹ 0.4–2.3 years from the time of application for funding until reciept of award (NIAID tutorial:aaa.niaid.nih.mgov/ncn/grants/cycle/part01.htm#a). ² Average length of NCI/NHLBI trials is 2.91 years (Meinert CL, Tonascia S. Clinical trials: design, conduct, and analysis. New York, Oxford University Press, 1986:40). ^3,4 Kumar PD. Publication lag intervals—a reason for authors' apathy? J Assoc Physicians India 1992 Sep:40(9):623–4. ⁵ Poyer RK. Time lag in four indexing services. Spec Lib 1982 Apr;73:142–6. ⁶ Antman EM, Lau J, Kupelnick B, Mosterller F, Chalmers TC. A comparison of results of meta-analyses of randomized control trials and recommendations of clinical experts. Treatments for myocardial infarction. JAMA 1992 Jul:268(2):240–8. ⁷ Balas ES, Boren SA. Managing clinical knowledge for health care improvement. Yearbook of Medical Informatics 2000: Patient-centered Systems. Stuttgart, Germany: Schattauer, 2000:65–70.

Figure 2

Flow of thought, information, and action in the Northern California neonatal community. DOR = Division of Research; KPHC = Kaiser Permanente HealthConnect, the Kaiser Permanente electronic health record; NICU = neonatal intensive-care unit; PRU = Perinatal Research Unit. (Courtesy of Allen Fischer, MD.)