SAHRI

Ultimate goal: to improve health of the South Asian community across the globe!

How do we accomplish that?
It is a complex problem requiring a complex solution.  We need to address each and every aspect of the problem individually.

1.  It starts by doing the research - easy said. 

2.  It requires translating the findings of the research into clinical practice

3.  It requires translating the findings of the research into educating patients.

Let's take each of the tasks and break them down. Each of them are monumental tasks on their own right. 

1.  Research
1a. requires funding
1b. requires interest, time and collaboration
1c. requires the knowledge on how to perform the research
1d. will require basic science research (cell lines, lab space etc.)

2. Clinical Practice
2a. requires informing the physicians in practice, in communities to know the risk factors, treatment differences that may be present and most importantly get them to change their behavior

3.  Educating the community
3a. educating the patients on their diseases, their risk factors and energizing them to change their risky behavior (if present)

Research

How do you encourage and perform research?
- Funding (well, funding will come if you have the right plan)...
- collaboration --- this will be a key for SAHRI.  One of the goals is to bring the resources together under one organization.  Even if researchers and scholars are working across the globe, they can collaborate with SAHRI's help.  SAHRI will maintain a database of resources which will include:
- all the research that has already been done (categorized based on evidence)
- all the research that is ongoing
- all the research that is planned
- ideas that we want to work on

intelligent resources
- list of basic science researchers and their interests
- list of clinical science researchers and their interests
- list of epidemiologists, database designers, survey specialists, social scientists, public health advocates (all the resources that can be used in various ways).

--- let me give you a few examples of what I think will happen soon.
I.  A researcher in Iowa wants to study patients' understanding of diabetes in South Asian Community.  Unfortunately in his/her practice there are only 25 patients.  He needs n=250 to get valid results.  He contacts SAHRI and looks up in the database other people who have similar interests and they collaborate. 

II.  A medical student is interested in finding out the incidence of prostate cancer in the South Asian population. (S)he can log in to the SAHRI database of medical information and look up a study or studies on incidence of prostate cancer.  (S)he can also talk to an expert oncologist or epidemiologist who is interested in the either "prostate cancer" or "epidemiology of cancers." 

III.  The above mentioned student is now a resident and is interested in studying the complications of diabetes and wants to study how long it takes for a diabetic patient to proceed to nephropathy.  But he has no research background and doesn't know where to start.  He contacts few of the endocrinologists and nephrologists who have some interest in the subject.  They help him what is the "specific research question he wants to examine."  He does not know how to figure that out.  He contacts a research designer at SAHRI who helps him understand research design, and by working with the designer, they develop a "clinical question for research," and a proposal for protocol which they take to the endocrinologist/nephrologist. 

Benefits of the above organizational structure is that it allows for
- sharing of knowledge and ideas
- transfer of knowledge and ideas to the next generation of students
- promotes the sense of collaboration and sense of "community"

2.  Changing Clinical Practice
Changing clinical practice is a science in itself.  A while ago, I had read an article in Chest that said that the evidence so far suggests that there are a few ways to change clinician's practice (because it is many times a reflex mechanism).
- $$$ incentives
- expert opinion
- someone checking on them (hospital, RNs, patients).
- Patients checking on them

How do we use this information? We will try to achieve the change in clinician practice by doing the following:
- Grand Rounds (expert opinion), literature
- educating the patients (probably the most powerful tool available).  For example, we can provide patients with check lists (that they take to their physicians and ensure that physician comments on it). 

3. Educating and Changing Patient Behavior

Again, a large science behind this.  And we will have to study this in a prospective trials to learn which are the best techniques to teach patients and change their behaviors.  Once we find the answer to those questions, with our collaboration with other community organizations we can effectively apply those principles. 

A thought for the South Asian population - using the airwaves would be a good idea.

Biren

6/10/05 (edited 6/22/05)