Jumping in the research game
Community hospitals see benefits in improved care, new therapies, grant money
Bernard Fox leads a varied work life. One day he's checking on laboratory mice with cancer to see if a vaccine he's studying has delayed the growth of their tumors. The next day he's submitting data in hopes of securing a National Institutes of Health grant to conduct a clinical trial in human subjects.
Fox knows it may be years before his work actually yields a widely accepted therapy, if it ever does. That's never a surprise to a cancer researcher. What is surprising is that Fox is performing his research at Providence Portland Medical Center, a community hospital - not a medical school, where research is the norm.
'People don't even know he comes from a nonuniversity setting because they've accepted that this place does the same things a university does,' says Walter Urba, a cancer researcher himself and director of two cancer centers run by Providence.
But Urba has a good sense of the value Fox and his work bring to Providence. 'His success is what attracts other people,' Urba says.
And that's exactly the perception Urba, the newly appointed head of a Providence Health Systems research initiative, wants to see become more common.
For years, Oregon Health and Science University has been the undisputed king of medical research in the Portland area - and since OHSU is the only university hospital in the state, that made sense. Historically, the bulk of medical research has taken place at hospitals connected with medical schools, where physicians double as researchers with the expectation that grants will cover significant portions of their salaries.
OHSU's research budget this year is $294 million, and it has grown steadily from $86 million in 1995. Most of that money came from national grants just like the ones Bernard Fox uses to support his research. OHSU will conduct more than 600 clinical trials this year. In contrast, Providence has a research budget of $17 million and will host 140 clinical trials.
But nationally, many community hospitals are deciding they can't afford to leave research to the university medical centers. From basic test-tube work to clinical trials of new therapies, community hospitals are beginning to compete for funding and the scientists who make discoveries.
New path for Providence
In 1997 Legacy Health Systems took over the abandoned Holladay Park Hospital in Northeast Portland and turned it into a 50,000-square-foot research center, with everything from new laboratories to operating rooms and animal testing facilities.
Today the Legacy research facility brings in $15 million a year in research funding.
Providence, on the other hand, only recently has made a decision to increase its focus on research. There hasn't been an official announcement yet, no ribbon-cutting on a new facility. There isn't even a name for the new initiative.
Urba, renowned heart surgeon and inventor Albert Starr and administrator Calvin Harrison are starting to put together a plan and an estimate of its costs. Urba says they expect to have a budget presentation in about nine months. But he insists Providence is serious about doing more research. Hospitals can't afford not to, he says, if they want to provide the best care to their patients.
Cancer, Urba says, provides a prime example.
'We see more cancer patients than anybody in the state of Oregon, and we want to provide those patients the best care,' Urba says. 'To do that we need to be on the forefront of that disease specialty. The best treatment for patients is generally the current clinical trial for that disease.'
Research has other benefits
Providence's large patient pool - it serves about 38 percent of the Portland metro area's hospital patients - provides a good starting point for clinical trials. But giving patients access to state-of-the-art care is only one of the benefits that come to hospitals that do research, Urba says.
For instance, patients who come to a hospital because of a cutting-edge therapy, Urba says, end up using the rest of the hospital's resources, from lab tests and imaging to intensive care after surgery.
Also, research attracts the top physicians and nurses to a hospital, he says. And hospitals with research generally have medical staffs that are more up to date on the latest advances in their field.
In Dallas, Texas, Baylor Health Care System, a community-based hospital that made a major effort to increase its research capacity in 2000, already is planning a new building to support its increasing numbers of researchers with grant money.
Over the past six years Baylor has secured $30 million in grants from the National Institutes of Health alone, and its total annual research budget now is $50 million. The hospital has built a 40,000-square-foot research facility. Six years ago Baylor hosted 250 clinical trials a year; this year that number will reach 660.
Even more important, according to Michael Ramsay, the research institute's president, is the outcome of those clinical trials.
Before the institute was formed and hospital researchers were performing trials on their own, only about half of the trials were successfully completed. Some never enrolled enough patients; others never saw their data appear in peer-reviewed publications. The physician researchers, Ramsay says, were simply too busy to conduct their research properly.
The institute makes sure that doesn't happen. The $30 million the hospital has invested includes a staff large enough to take over all the paperwork for its researchers, and to track their results to ensure everything is being done as intended.
That's the type of service Legacy Health System's Anthony Melaragno has set up to offer as chief of research at the Legacy Health System Clinical Research and Technology Center.
Five years ago the center took in 25 grants and had a budget of $11 million. This year the budget is $15 million, most of it from 40 federal grants.
Melaragno says his job is to 'make it as user-friendly as possible' for physicians who want to do research. Melaragno's staff helps Legacy physicians find studies they might want to pursue, works with drug companies that need studies done, does the paperwork for trials, negotiates budgets, finds patients for the trials - all the work that might otherwise make a practicing doctor decide he or she doesn't have the time to do research, Melaragno says.
Investment is required
But that hospital support, Melaragno says, adds cost. And that cost means that research, even factoring in the rare breakthrough advances that produce patents and royalties, is not a moneymaker.
'There isn't money in research,' Melaragno says. 'It's not about making money. It's about improving health care. It also stimulates people to think about things.'
Turning a community hospital into a major research player requires a considerable investment, and Providence isn't yet willing to put a dollar amount on its commitment.
The competition for grant money nationally has become fierce. Daniel Dorsa, vice president for research at OHSU, says the federal budget for grants has remained flat for years. But national rankings of hospitals consistently correlate with the size of their research funding, Dorsa says.
In one sense, the new Providence investment in research has begun. Urba and crew already know where they are going to get laboratories. The new Providence cancer center, set to open in 2008, will have one entire story, dedicated to cancer research. The laboratories currently used for cancer research will become available for researchers in other fields.
Can a community hospital still fulfill its mission without a major emphasis on research? That depends on how they define their mission, says Baylor's Ramsay.
'They can certainly give good safe care, but can they give the latest therapies? Can they bring optimal therapies? They have to wait for them to trickle down. If you're doing clinical research you've got them right there.'