Innovation and Quality Program
A major part of our mission involves innovation, both to deliver the highest quality care today, and to define new treatments for the future. Our Innovation and Quality (IQ) Program serves to facilitate these goals. The IQ program includes principal investigators, biostatisticians, research nurses, coordinators, data managers, programmers, research assistants, and hospital and clinic administrations.
The IQ Program has two components. First, it works directly with clinicians, using data and detailed feedback to help physicians improve their performance and lead to better patient outcomes. Second, the IQ program provides a platform and support to efficiently conduct a wide range of investigational studies. Specifically, the IQ Program aims to:
- Organize data to improve physician and service performance
- Foster innovative ways to measure quality and track long-term patient outcomes
- Enhance infrastructural support to enable faculty to conduct a range of clinical trials and patient-centered research
The Program recognizes that the key to enhancing the quality of healthcare is giving providers timely and detailed feedback regarding their performance. Such regular reports not only make physicians more aware of their own personal quality benchmarks but also enable them to identify specific areas in which they can improve. And because this feedback comes in the form of metrics and data that the physicians themselves have defined and validated, providers are more likely to embrace these change initiatives.
To streamline the compilation and delivery of these reports, the IQ Program set about creating datasets for neurosurgical conditions to monitor overall physician performance and patient outcome. Treatment responses in cases of Traumatic Brain Injury (TBI), for example, are evaluated by adding specific measures recommended by the National Institute of Neurological Disorders and Stroke to the IQ Program’s own metrics. By incorporating these standardized neurological outcomes measures at specified intervals, a patient’s progression can be compared to baseline as well as to group norms for their neurological condition.
But quality results are not solely determined by measuring the physician’s performance. The IQ Program recognizes that patient outcome and satisfaction are crucial components of a comprehensive evaluation of care. In the past, physicians and nurses have regularly tracked standard quality metrics; now, they are specifically examining how positive as well as negative patient outcomes are related to different interventions by medical providers. To that end, the IQ program incorporates multiple outcome measures into routine clinical visits for each patient. Utilizing these outcome instruments, we can make long-term measurements of facets of recovery such as cognitive and neurological status, pain and disability levels, quality of life and how the patient views the result of our intervention. The tracking of long-term outcomes will generate a more accurate and detailed picture of our performance as well as of the efficacy of our treatments.
Included in the IQ program is the Neuroscience Research Repository, a large bio-bank housing patient samples for research. During admission to our hospital patients are invited to participate in the Neuroscience Research Repository (NRR). With an affirmative response, de-identified clinical data coupled with residual tissue samples (blood, cerebrospinal fluid, tumors) are collected for research purposes. By using the NRR to collect DNA samples and obtain detailed family histories on intracranial aneurysm patients, Dr. Dong Kim and Dr. Teresa Santiago-Sim, for example, were able to identify a gene mutation present in a subset of patients who develop intracranial aneurysms. Furthermore, Gigi Hergenroeder, Pramod Dash, Ph.D., Alex Choi, M.D. and Jay Zhu, M.D. use NRR to obtain blood and cerebrospinal fluid to look for biomarkers in spinal cord injury, traumatic brain injury, subarachnoid hemorrhage and brain tumors. Biomarkers may facilitate the evaluation of responses to treatment and the determination of patient-specific treatments, that is to say, more personalized medicine. From a research perspective, biomarkers can also be used as early surrogate measures of outcomes, thus decreasing the time and cost of clinical trials.
The facilitation of clinical trials is another focus of the IQ program. In addition to statistical and regulatory support, the IQ team includes nurses, a physical therapist, a genetic counselor, research coordinators and assistants to screen, consent and enroll patients and process samples. One example of an ongoing trial is HypOthermia for Patients requiring Evacuation of Subdural Hematoma: a Multicenter, Randomized Clinical Trial, “The HOPES Trial”. The primary objective of this study is to test whether hypothermia improves patient outcomes following a traumatic brain injury with subdural hematoma. We are the lead center in this trial and we expect it to provide definitive evidence regarding the utility of early hypothermia in the treatment of subdural hematoma. We also have a large number of active clinical studies to foster innovation. A sample of current trials is listed below.
The result of these efforts is an active quality program that has placed us among the best programs in the country.
- Reconstruction of glioblastoma multiforme (GBM) using iPSC and CRISPR technologies. PI: Ying Liu, Ph.D.
- Validation of a new tool to identify Glioblastoma Subtypes by Biomarkers. PI: Jay Zhu, M.D.
- Investigation of Molecular Abnormalities in Postmortem Glioblastoma Specimens Treated with Temozolomide and Bevacizumab and Correlation with MRI Changes. PI: Jay Zhu, M.D.
- Perihematomal Response to Tissue Injury and Clinical Outcomes (PORTICO). PI: Spiros Blackburn, M.D.
- Coagulation and Outcome from Acute Neurologic Injury Using Thrombelastography. PI: Tiffany Chang, M.D.
- Sample Analysis for Biomarker Discovery in TBI. PI: Pramod Dash, Ph.D.
- A Mechanism for Global Cerebral Edema after Subarachnoid Hemorrhage: Pathophysiology of early brain injury. PI: H. Alex Choi, M.D.
- Genetic Basis of Cerebral Aneurysms. PI: Dong H. Kim, M.D.
- The creation of vector-free human iPS cells from fibroblasts from acute and chronic SCI patients by direct delivery of reprogramming proteins. PI: Qi Lin Cao, Ph.D.
- Phase I/II Dose-Escalation Study of TPI 287 in Combination with Bevacizumab Followed by Randomized Study of the Maximum Tolerated Dose of TPI 287 in Combination with Bevacizumab versus Bevacizumab Alone in Adults with Recurrent Glioblastoma. PI: Sigmund Hsu, M.D.
- The Intra-arterial Vasospasm Trial: A Multicenter Randomized Study. PI: Peng Roc Chen, M.D.
- Methotrexate Infusion Directly into the Fourth Ventricle in Children with Malignant Fourth Ventricular Brain Tumors: A Pilot Clinical Trial. PI: David I. Sandberg, M.D.
- The National Center for Testing Treatments in Chronic Spinal Cord and Traumatic Brain Injury (NCTT). PI Dong Kim, MD
- The Will Erwin Headache Research Center Study of Cluster Headache and Trigeminal Neuralgia (WEC). PI: Mark Burish, MD
- Subarachnoid Hemorrhage Recovery and Galantamine (SAHRANG). PI: H. Alex Choi, MD
- Restoring Hand Function Utilizing Nerve Transfers in Persons with Cervical Spinal Cord Injuries. PI: Daniel Kim, MD and Dong Kim, MD
Spiros Blackburn, MD
Mark Burish, MD
Tiffany Chang, MD
Alex Choi, MD
Joseph Hsieh, MD
Sigmund Hsu, MD
Daniel H. Kim, MD
Ryan Kitagawa, MD
Kiwon Lee, MD
Karl Schmitt, MD
Jay Zhu, MD