Rhonda G. Kost, M.D., and Jonathan N. Tobin, Ph.D., who co-direct the Community Engaged Research Core at The Rockefeller University's Center for Clinical and Translational Science (CCTS), regularly work together to facilitate conversations among three groups of people: basic scientists in the laboratory, clinicians in the New York City area and health care providers at community health centers. A clear channel of communication across these groups is a necessity, and for NCATS, this work is helping to overcome a key translational research hurdle.

"Basic scientists and community physicians tend to speak different languages and have different priorities," said Kost, the academic navigator and clinical research officer at Rockefeller's CCTS, an NCATS Clinical and Translational Science Awards (CTSA) Program hub. "Our goal is for them to understand each other and where their interests align, and find ways to more quickly move science discoveries out of the lab and into interventions to improve people's lives."

With this goal in mind, Rockefeller's CCTS leadership and investigators partnered with Clinical Directors Network (CDN), a practice-based research network of clinicians working in underserved communities, with sites in the New York City area and across the country, to create a program that fosters interdisciplinary research partnerships. This collaborative effort, called the community-engaged research navigation (CEnR-Nav) program, has resulted in more than 40 research projects, including more than 20 clinical research studies. Rockefeller CCTS participants frequently include clinical scholar trainees and early career physician-scientists, in addition to faculty and graduate students.

"We want to engage community and research participants in all phases of research that we do, including designing studies and thinking about how the information can best be converted into programs and policies that have an impact on public health," added Rockefeller CCTS Director Barry Coller, M.D.

Tobin, who also is CDN president/CEO, works closely with Kost to navigate and foster community engagement opportunities. Together, they have wide-ranging responsibilities, from coordinating meetings and matchmaking among potential collaborators to helping participants brainstorm research questions of mutual interest and developing study goals and methodological approaches. Although community health concerns and needs often drive research projects, ideas can come from many sources, including a critical laboratory discovery; conversations among patients, clinicians and investigators; or a grant proposal opportunity.

Understanding Bacterial Resistance

For example, Rockefeller scientists parlayed a faculty member's expertise in studying drug-resistant bacteria outbreaks in hospitals on three continents and New York City into a collaboration with New York City-area community health centers to monitor drug resistance in households.

Rockefeller microbiologist Alexander Tomasz, Ph.D., studied the causes of drug resistance in outbreaks of methicillin-resistant Staphylococcus aureus (MRSA), a potentially life-threatening bacterial infection, in hospitals in England, Japan and Brazil. In earlier work, he had discovered a change in a gene that makes bacteria antibiotic resistant.

Tomasz was also studying patterns of hospital-acquired MRSA infection in New York City hospitals and had organized a surveillance network that sent MRSA samples to his lab for detailed examination. Coller brought Tomasz, Tobin and Kost together to study the distribution, causes, treatments and outcomes of community-acquired MRSA. They partnered with community clinicians to establish a community-based surveillance system to determine whether MRSA resistance was a problem in health centers and households and, if so, identify the molecular underpinning of the resistance.

CTSA Program support then enabled the research team to collect preliminary prospective data and identify research questions of interest to investigators and clinicians. Additional NCATS funding supported the enrollment of 150 patients across CDN sites in New York and Texas to collect biological specimens and clinical information to help understand the dynamics of the infection in the community.

The research has resulted in a comparative effectiveness study, created with patient and community clinician perspectives in mind and funded by the Patient-Centered Outcomes Research Institute, to examine approaches for preventing recurrence of community-acquired MRSA. The scientists, clinicians and community partners are studying patients, household members and home environments as potential reservoirs of infections and are characterizing the bacteria living on the surfaces of homes and in household members. The goal is to determine whether evidence-based hospital infection prevention procedures can be implemented in homes by community health workers and whether these procedures are effective in reducing reinfection and household transmission.

Affecting Birth Outcomes

Tobin previously also led an NIH National Institute of Mental Health-funded study that involved 14 New York City hospitals and health centers. For this project, clinicians enrolled over 1,200 pregnant teens who were randomized to receive either usual individual prenatal care or prenatal care in a group setting. The researchers wanted to see which model was more effective in reducing the incidence of low-birthweight babies. They found that teenagers receiving prenatal care in the group setting were less likely to have smaller babies for their gestational ages and had better birth outcomes, including babies with more normal birth weights and fewer days in the neonatal intensive care unit.

With support from Rockefeller's CCTS and the Sackler Foundation, Tobin and his community colleagues reconvened this partnership and built a research data collection system based on extracting routine clinical care observations from the electronic health records of primary care practices. With Rockefeller investigators Jan Breslow, M.D., and Peter Holt, M.D., the research team is currently examining diet, behavioral and genetic influences, and other factors that can affect birth outcomes and cardiometabolic health in this teenaged population affected by health disparities.

The Rockefeller CCTS CEnR-Nav program approach aligns with the CTSA Program goal of including the community perspective in research.

"It's important for us to get a good sense of what the community is concerned about," Coller said. "The CEnR-Nav community engagement model brings together community members, patients, scientists and clinicians to help guide hypothesis-driven science that can lead to improved community health."