Center on Health Services Training and Research (CoHSTAR)
Fellowship Training Sites Environment Description
CoHSTAR Training Sites Environment Overview:
Each CoHSTAR Fellowship Trainee will be primarily based at a single participating institution and
matched with a primary mentor from that institution. Each CoHSTAR collaborating institution possesses
the resources needed for a robust health services training experience and has a proven track record of
fellowship training.
Fellowship trainees can customize their training experience by focusing their study in one of the three
health services research foundational areas:
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Analysis of large data sets (Brown University)
Rehabilitation outcomes measurement (Boston University)
Implementation science and quality assurance (University of Pittsburgh)
Fellowship trainees can also work across institutions on more than one focus area, as desired.
I. CoHSTAR’s Brown University Training Site Environment
Brown University School of Public Health has more than 200 faculty and 275 undergraduate and
graduate students, and over $50 million in annual external research funding across 11 Centers for Public
Health Research. Among Brown University’s three Public Health doctoral programs, there are nearly 50
Ph.D. students and approximately 25 post-doctoral fellows, more than a critical mass for both shared
educational programs and social mixing.
CoHSTAR fellowship trainees will be located within the Brown University Center for Gerontology and
Health Care Research which is nationally renowned for health services research focusing on chronic
illness and long-term care. The research portfolio at the Center for Gerontology spans multiple settings
(Veterans Administration [VA], hospitals, nursing homes and other post-acute settings, outpatient
rehabilitation services). Brown University has been an Agency for Healthcare Research and Quality
(AHRQ) Health Services Research training site for over 30 years, and has trained more than 50
interdisciplinary post-doctoral health services researchers, focusing on chronic disease management and
aging.
CoHSTAR’s training program at Brown University complements existing highly regarded and established
as well as new training programs at Brown University School of Public Health and its clinical affiliates,
such as the two T32 research training grants (from AHRQ and the National Institute for Aging; Vincent
Mor, Program Director in the Department of Health Services Policy & Practice (HSPP), the newly funded
K12 research training program at the Center for Evidence Based Medicine (CEBM) (PI: Joseph Lau), the
newly-funded R25 research training grant in Comparative Effectiveness Research (CER) (PI: Christopher
Schmid), the Women’s Reproductive Health Research K12 research training grant program at the Brown
University/Rhode Island Women and Infants Hospital (PI: Maureen Phipps), and the established PhD
programs in Health Services Research, Biostatistics, and Epidemiology, and Master of Science program
in Clinical and Translational Research (MS-CTR).
CoHSTAR’s Research Career Training Program Core is co-located with the Brown University Center for
Evidence Based Medicine (CEBM)/AHRQ Evidence Based Practice Center (EPC). The CEBM was
established in 2012 when Brown University recruited five CER investigators from Tufts University
(Schmid, Lau, Trikalinos, Dahabreh, and Wallace). CEBM faculty members have over 20 years of
research experience and experience in training others in the fundamentals of CER methods. In 2012,
CEBM successfully competed to become an AHRQ Evidence Based Practice Center (EPC), one of 11
such centers in North America. The Brown EPC routinely conducts stakeholder-driven comparative
effectiveness reviews, technology assessments, and future research needs prioritization exercises for
major questions in clinical medicine and public health. The CEBM/EPC offers many opportunities for
CER experiential learning and research. Faculty members of CEBM are innovators and leaders in CER
methods. The CEBM is the site of a K12 research training grant mentored clinical scientist development
program (funded in 2014) and a newly funded R25 grant for a training center for CER. The K-12 research
training grant program aims to develop scholars' proficiency in CER methods, stakeholder engagement,
research ethics, leadership development, manuscript preparation, and grantsmanship. The goal of the R25 grant is to produce a national workforce that will increase the production of high quality CER and
patient centered outcome research (PCOR) products efficiently and inexpensively. The R25 grant
teaches CER/PCOR methods focused on systematic review, along with cutting-edge computational and
information technology focused on producing, interpreting, and utilizing evidence about best healthcare
practices, using a combination of didactic, asynchronous, peer, and experiential methods. It will expand
upon the traditional CER workforce definition to include consumers and other non-traditional groups,
such as payers (health plans), professional societies, patients and advocacy groups, commercial sector
(pharmaceuticals), government agencies, policy makers, research funders, librarians, journalists, and
legislators.
CoHSTAR trainees at Brown University will have the opportunity to work with investigators at the
Providence VA Medical Center (PVAMC), home to a VA Health Services Research and Development
(HSR&D) Center of Innovation in Health Services Research (COIN) on Long-Term Services and
Supports for Vulnerable Veterans (LTSS COIN). The primary goal of the LTSS COIN is to improve
access, quality and value of long-term services and supports (LTSS) for vulnerable Veteran populations
by facilitating partnered, relevant health services research in LTSS. The PVAMC is also home to a
Collaborative Research to Enhance and Advance Transformation and Excellence Center (CREATE)
focusing on long-term care. These VA HSR&D Centers have launched numerous career development
awardees and additional funded projects. The COIN itself offers pilot funding to meritorious VA-relevant
HSR&D projects. CoHSTAR fellowship trainees will have the opportunity to work within the VA
environment with funded VA investigators, utilize extensive VA data resources, and compete for VA
funding. The VA HSR&D funds research that underscores all aspects of VA healthcare: patient care,
care delivery, health outcomes, cost, and quality and offers career development programs, small and
large grant funding.
II. CoHSTAR’s Boston University Training Site Environment
The Boston University School of Public Health (BUSPH) is a leader in advancing health services
research and supports training to promote innovations in healthcare through doctoral and postdoctoral
programs, conferences and webcasts. The School of Public Health offers MS and PhD degree programs
in health services research and is closely affiliated the Center for Healthcare Organization and
Implementation Research (CHOIR), which is based in both the Boston and Bedford VA. CHOIR
represents the merger of the Center for Health Quality, Outcomes and Economic Research (CHQOER)
and the Center for Organization, Leadership and Management Research (COLMR). CHOIR has a staff of
principal investigators with expertise in a variety of fields including implementation science,
epidemiology, clinical medicine, health psychology, treatment decision-making, medical informatics,
quality measurement, medical sociology, qualitative methods and health status assessments.
The BUSPH Health Services Research department offers a doctoral program focused on developing
independent research scientists and scholars with excellent methodological skills and strong substantive
knowledge of health care settings and policies. This program has particular strengths in health services
research on health care quality and outcomes, on health economics, on organizational behavior and
transformation, and on how to improve the implementation and sustainability of desired changes in
health care. The Health Services Research doctoral program is based upon the theoretical knowledge
and core competencies that the program has identified as critical foundations. In particular, the program
focuses on developing the ability to apply or develop theoretical and conceptual models relevant to
health services research. Doctoral students in the program develop the ability to create trans-disciplinary
models that incorporate elements of frameworks from multiple fields, depending on the depth of their
previous background and additional perspectives gained in the program.
The Health and Disability Research Institute, located in the BUSPH, focuses on advancing the science of
rehabilitation and promotes interdisciplinary health services research. The Health and Disability
Research Institute is directed by Alan Jette, PT, PhD, an internationally renowned leader in physical
therapy and expert in rehabilitation. Dr. Jette has been instrumental in advancing the development and
use of rehabilitation outcome measures and has provided leadership in promoting health services
research.
Within the Health and Disability Research Institute, two specific grant-supported activities enhance the
training environment and provide evidence of the Boston University’s capacity to support CoHSTAR. The
Boston Rehabilitation Outcome Measurement Center (Boston ROC), funded by the National Center for
Medical Rehabilitation Research (NCMRR), is an R-24 rehabilitation research infrastructure center grant
dedicated to advancing rehabilitation research by improving rehabilitation outcome measurement. Boston
ROC focuses on three types of rehabilitation outcome measures: Patient/Clinician Reported Outcomes,
Performance-Based Measures, and Instrumented Outcome Measures. Boston ROC is a collaborative
effort among researchers from Boston University (Drs. Jette, Slavin, Latham and Coster), Spaulding
Rehabilitation Hospital (Drs. Zafonte, Bean, and Bonato), and Tufts University (Dr. Fielding). Boston
ROC supports a successful Visiting Scientist program and a pilot studies program. Boston ROC also
provides consultative services. Boston ROC has also sponsored several successful conferences and
webcasts focused on health services research that have attracted large national audiences. In addition to
Boston ROC, the Health and Disability Research Institute houses a National Institute on Disability and
Rehabilitation Research (NIDRR) -funded Advanced Rehabilitation Research Training (ARRT) fellowship
program, directed by Dr. Jette.
Boston University’s Medical School also offers additional resources to support CoHSTAR. The Clinical
and Translational Science Institute (CTSI) is part of the National Institutes of Health Clinical and
Translational Science Awards (CTSA) program, funded by the National Center for Advancing
Translational Science. The program aims to speed discovery and advance science aimed at improving
health. Finally, Boston Medical Center is funded by an AHRQ Institutional Health Services Research
Training Program grant (T32) that aims to train predoctoral and postdoctoral health services researchers.
The training program is based at Boston Medical Center, New England's largest safety-net hospital. Its
principal curricular components include two years of didactic education at BUSPH, seminars, mentoring
and direct research experiences.
III. CoHSTAR’s University of Pittsburgh Training Site Environment
University of Pittsburgh Schools of the Health Sciences - The six Schools of the Health Sciences include
the Graduate School of Public Health and the Schools of Dental Medicine, Health and Rehabilitation
Sciences, Medicine, Nursing and Pharmacy. Since the late 1990s, the University of Pittsburgh has been
among the top 10 recipients of NIH funding. In fiscal year 2011, the University of Pittsburgh received
$576 million in grants alone from NIH, placing the University of Pittsburgh among the six top universities
nationwide. The University of Pittsburgh Medical Center (UPMC) is affiliated with each of Pitt’s six
schools of the health sciences and is one of the leading nonprofit health systems in the U.S. UPMC
comprises 20 hospitals, more than 2,700 employed physicians, 400 doctors’ offices and outpatient sites,
long-term care facilities, and a major health insurance services division covering 1.58 million members.
The Centers for Rehabilitation Services (CRS) is an affiliate of UPMC and consists of over 60 outpatient
and inpatient rehabilitation facilities throughout the greater Pittsburgh metropolitan area and western
Pennsylvania.
The University of Pittsburgh received funding by the NIH Roadmap Clinical and Translational Science
Award (CTSA). The flagship of this award is the cross-institutional Clinical and Translational Science
Institute (CTSI: http://www.ctsi.pitt.edu) and serves as the academic home for clinical and translational
scientists across the Schools of Health Sciences, the UPMC, Carnegie Mellon University, and regional
community organizations. Relevant to this application, the Physical Therapy Clinical and Translational
Research Center (PT-CTRC) is supported by the CTSI and directed by Dr. Fitzgerald. The Office of
Academic Career Development (OACD) was established in 2002, and provides professionals at every
level of experience with the tools, resources, and support they need to achieve their full career potential
as national leaders in biomedical and health services research. The specific goals of OACD pertinent to
this application include fostering a supportive environment that promotes successful career development
for clinical and health service researchers and providing academic career development programs and
services that address emerging opportunities and needs in the health sciences community.
The Institute for Clinical Research Education (ICRE) is the home for the University of Pittsburgh's
premier clinical and translational research training programs as well as the home for the Research
Education and Career Development Core of the CTSI. The ICRE's primary objectives are to develop,
nurture, and support clinical and translational scientists by incorporating existing clinical research training
programs to establish more comprehensive programs early research exposure for high school students
to degree programs for faculty. The ICRE can customize training opportunities at every stage of career
researchers in clinical and translational science.
The Graduate School of Public Health (GSPH) at the University of Pittsburgh has consistently ranked in
the top five nationally among schools of public health in total NIH funding. GSPH centers and institutes
that will participate in the TIMRR include The Center for Minority Health (an NIH Research Center of
Excellence in Health Disparities) and the Department of Health Policy and Management (Everett James,
PhD) Drs. Fitzgerald, Brach, and Delitto (members of CoHSTAR’s Executive Committee), all have had
long standing collaborative relationships with the GSPH. The University of Pittsburgh Health Policy
Institute (HPI) has been committed to producing quality, evidence-based policy research and
programming for government, business and the foundation community. The institute’s goal is simple – to
help answer the key policy questions facing the health system through multi-disciplinary, scientific policy
analysis and education. Dr. Delitto serves on the Physical Environmental and Occupational Health
Committee of the HPI.
The Center for Research on Health Care Data Center (DC) at the University of Pittsburgh provides state
of the art data management and analysis services to the University of Pittsburgh’s clinical researchers.
The DC’s mission is to provide researchers with consistent, high quality information technology, data
management, and statistical services. The DC operates as a team, providing expertise in all phases of
research, thus, ensuring efficient use of resources. The DC is committed to quality assurance and
research integrity. With extensive experience, the DC is able to provide research faculty with experts in
data management, data entry, programming, and statistical analyses. PaTh: Towards a Learning Health
System in the Mid-Atlantic Region, is one of 11 Funded Clinical Data Research Networks (CDRN) the
Patient Centered Outcomes Research Institute (PCORI) PCORnet. Together, PCORnet seeks to
improve the nation’s capacity to conduct clinical research by creating a large, highly representative,
national patient-centered network that supports more efficient clinical trials and observational studies.
Pittsburgh is the prime site for PaTH, which also includes Johns Hopkins University, Temple University,
and Penn State-Hershey. PaTH is an infrastructure grant that will provide project management, data
infrastructure, regulatory infrastructure, research and statistical support to scholars in CoHSTAR.