The arthroplasty registry of Catalonia and the collaboration between clinicians and researchers

25 Oct
Jorge Arias

Establishing collaborations with different research projects driven from the arthroplasty registry of Catalonia (RACat) reveals the importance of the relationships and communication between professionals who manage and analyse data on the one hand and clinicians on the other.

A registry is a data base with a huge potential. The RACat, both in the number of cases registered and in the way data is used, is a very powerful research tool which needs the collaboration between clinicians and researchers. It concerns two visions, both equally necessary and complementary.

Today, we interview Jorge Arias, a researcher that works at the RACat who is involved in different research projects driven by the registry itself at the AQuAS.

Do clinicians and researchers speak the same language?

Yes and no. Even though we are usually in it together, we do not have the clinical experience to be able to fully interpret results and propose sufficiently precise studies which reflect the reality of clinical practice. Clinicians, on the other hand, are often not used to the different analyses used so that collaboration becomes a key element to obtain results of interest.

How do you solve this?

By speaking, of course.

Who decides what statistical analyses are done?

I would say that the researcher directs things but in practice it doesn’t happen quite like this. In some ways, the analysis is determined by the data itself and the objective that is established.

Let me explain. Depending on what one wants to investigate, to achieve the greatest possible precision the analysis needs to be “pre-defined”, in some way or another, so to speak. It is true that there is always scope for innovation and you almost always need to choose (from among several approaches to the problem) the most appropriate one. But in my opinion, in most cases the type of analysis is determined, as I mentioned before, by the aim of the research and the data available.

What are you working on at the moment?

At a Catalan level, we are starting a relatively new line of work in our environment in collaboration with the Hospital de Sant Rafael. It is related to the assessment of results according to the annual volume of procedures (arthroplasties in our case), and we are pleased with the interest which the project seems to be generating.

When you talk of interest, what are you referring to?

In this case, we are referring to the fact that we presented our results at the congress Sociedad Española de Cirugía Ortopédica (SECOT) (Spanish Society for Orthopaedic Surgery) and several

hospitals have since contacted us showing their interest in collaborating in this line. We feel this is very important.

Could you point out any other experience?

Yes. We are also involved in comparing results based on specific models of prosthesis, in comparing a “more general” type of implant, bone cements and in analysing the possible influence of comorbidity in surgical results.

In terms of patients, how do you incorporate their views or experiences?

Although the patient is at the centre of all the projects mentioned, in particular I would like to highlight the projects related to those known as “PROMS”, Patient Reported Outcome Measures. These results are particularly interesting because it is in fact the patient who rates the surgical results in terms of, for example, pain and improvement in life quality.

Focusing on the idea of collaboration, I would like to highlight what I think is a particularly relevant project. We began it with clinicians at the University of Exeter in the United Kingdom by “looking for” the questionnaires we could include in the registry, but seeing that the most used questionnaires in other registries were not available in our context we decided to take the initiative and adapt them ourselves.

In addition, in the following weeks, we hope to obtain a “direct” product from this project in collaboration with the University of León and the University of Oviedo, respectively, because I am in fact right now working with them to pilot one of these questionnaires on the quality of life, more specifically the HOOS, Hip disability and Osteoarthritis Outcome Score.

What do all these experiences have in common?

Without doubt, collaboration.

In your opinion, what influence can this collaboration have?

Collaboration in any field of science is basic and necessary in order to obtain results with real practical implications which in the end improve some important aspect.

We have spoken of collaboration at a clinical-researcher level but I guess we should talk of the need for this collaboration at all levels; that is, not only with clinicians but also with patients, managers and even the industry.

The subject is vast but focusing on the clinician-researcher collaboration, I would like to end by saying that from the RACat we encourage and are delighted to work with health professionals with foresight and clinical experience that want to collaborate with us. And, it goes without saying, us with them.

Towards research in nursing with a (greater) impact

15 Mar
Núria Radó

What is it that makes a particular research have an impact on society beyond the strictly academic and which is truly transformative? Can a whole series of actions be planned in the way that one follows a cooking recipe which leads directly to the desired social impact? Unfortunately, the answer is no. The impact is multifactorial and depends on so many different elements and actors that it is difficult to establish a formula to guarantee it.

However, having said that, the fact that there is research which has a particular social impact does not mean that it is a totally random phenomenon and that there is no way of predicting, facilitating or promoting it. Years ago, from the Research Assessment group at the Agency for Health Quality and Assessment of Catalonia (AQuAS), and with the help and complicity of the International School on Research Impact Assessment, ISRIA, we identified a series of facilitators with regards the impact of research.

A fundamental facilitator is people, and the values, culture and capacity of leadership they have. Two identical results of research can have different impacts if the capacity of leadership, drive and will to get beyond academic impact is different. But this is still not enough. The strategy, organisation, collaborations and openness that institutions have will be a great facilitator or barrier for the researchers that have carried out the research.

Finally, both people and institutions will need two indispensable elements in order to aspire to having an impact: on the one hand, a close and effective communication with the different social actors that can play a role in transferring the results of research, and on the other, an approach focused on the participation of all these key players.

To paraphrase Confucius when he said “explain it to me and I will forget, show me and maybe I will remember, involve me and I will understand”, it is all about involving all the necessary actors to bring about a real change and make research transformative.

It is in this context that SARIS (Catalan acronym) came into being, the Assessment System of Research and Innovation in Health. It is a strategic tool which emerged from the PERIS (Strategic Plan for Research and Innovation in Health 2016-2020) with the aim of assessing the research carried out in health in Catalonia from the perspective of always wanting to facilitate and influence so that it has an impact beyond academia. To do this, the motivation and involvement of actors has been defined as a key factor for its development.

Last November, we started a series of participative sessions with nurses who were selected from the PERIS 2017 call in which a line of intensification of nursing professionals was financed.

It is important to emphasise that launching this line with nursing research makes full sense for three reasons: on the one hand, one of the thematic priorities of the PERIS is clearly that of “the development of clinical and translational research which facilitates the growth of scientific and technological knowledge, putting special emphasis on primary care agents and research in nursing”. In addition, the PERIS 2017 nursing fund has been the first to come to an end and it was appropriate to address ourselves to them first and foremost.

Last but not least, the conditions in which nursing research is carried out, with patients and their recovery as its central goal, makes it especially appropriate to ensure that this research has a direct impact on health. Hence, it is important that the research done in nursing be capable of demonstrating the impact that this group of professionals has because it can give it a comparative advantage with regards other biomedical disciplines. Indeed, nursing research is intrinsically translational.

Therefore, the first session centred on identifying the influential actors and in empowering the nurse to carry out an effective communication which amplifies the productive interactions needed to transform the results obtained into benefits for a better and improved health for patients.

We would like to express our deepest gratitude to the nurses for their participation (readiness and motivation) who attended of their own free will and in their time off work ensuring thus that the session was a success. This demonstrates that from the AQuAS we have leverage to give support to those researchers who are motivated to driving the impact of their research.

At present, we are preparing other sessions that will enable mutual learning between researchers and the assessment agents at the AQuAS.

Post written by Núria Radó Trilla (@nuriarado).

Jornada SARIS: Participación en recerca Barcelona, April 4th 2018.