A Q&A with Dave Chesla, Director of Research Operations at Spectrum Health
A massive, 10-year national initiative that includes Spectrum Health seeks to change how patients are cared for in America. The National Institutes for Health’s All of Us Research Program seeks to enroll more than 1 million adults and collect information on their health, environment and lifestyles. The program gives researchers and care providers a vast pool of data on what influences human health. The NIH wants to create a research model that accelerates “precision medicine,” where wellness strategies, medical treatments and disease management programs are tailored to the individual and what works best in each specific case. Spectrum Health is one of two organizations in Michigan along with Detroit-based Henry Ford Health System that is partnering with about 100 groups in All of Us, which begins enrolling participants this summer. Dave Chesla, director of research operations at Spectrum Health, spoke with MiBiz about the research project.
How do you define All of Us?
All of Us is a research platform that is intended to accelerate or be a catalyst for future research projects. Usually a research project has a very specific aim and scientific rationale, but it takes a long time to recruit the specific population and the goal would be to answer one of two questions: Either a given therapeutic or device improves the given disease or it does not, but it also answers singular questions. This is very different. They are trying to create a cohort or a platform of 1 million individuals living in the United States, across multiple geographies and multiple populations, largely slicing and dicing diversity in any way you can measure it, and bring them all into a singular program in collecting samples so we can execute tens of thousands of research studies on the back end.
What does the research hope to accomplish?
It is looking at changing the model of who and how we engage in research. Traditionally, research studies are done in large, urban academic environments where medical schools reside, and those individuals that struggle with access to those types of facilities are not represented in research unless they have a chronic or acute disease that drives them to that center. So All of Us is intentional about rural and urban populations that sit outside those large cities.
Why was it important for Spectrum Health to become involved in All of Us?
It’s largely a sense of what we’re trying to do in health care, which is get away from what we call … “disease care.” A lot of times, it’s reactionary. We don’t see people in the wellness journey unless it’s an annual physical, so we recognized we needed to change that model. But you don’t want to interact with somebody’s life cycle only at the times when they’re down or they feel a need or call to action. We want to better understand them when they are well and healthy and keep them there. Or if the first time they interact with Spectrum Health is due to an ailment or a chronic disease to where they transferred over to us, how do we keep them at that point and not allow that to progress? It really gets into individual medicine or precision medicine. That’s the future goal of this.
How do you use the information you collect to advance the use of precision medicine?
Ultimately, to be precise in any care plan, you need participation from the participant or the patient when it’s clinical care. But to do that, you need to understand their literacy of their own health. You need to understand their technical literacy if you’re going to start considering wearables like a FitBit or remote medicine. And then, hopefully, you can predict and prevent progression of a disease — or them coming down with a disease — if you engage early enough with them in their life.
How does understanding a person’s lifestyle fit into this?
We need to understand — do people sit all day or do they get up and walk around? What’s that lifestyle look like? Do they work on third shift? When do they sleep? There is so much more (information) that we do not collect as part of a traditional health care visit. We know it influences (health). We also know that if we only see people once a year for a primary care physical, we’re only seeing a very small snapshot of the year or of that individual. We believe through this we’ll get more information and we’ll be in a better position to analyze it and look for those threads that we further want to explore to see if these are detriments, determinants, or protectors of health.
How will this give you a better understanding of the population you serve as a health system and all of the factors that affect their health?
We’ve known for quite some time that where somebody lives ultimately can impact how well they are provided care or what their life cycle looks like. That’s not only access to care but access to equitable care. A lot of our standards of care are written still from research studies that enrolled white males. It’s unfortunate, but it’s the history of research going to back 70 to 80 years. How does that scale up to 330 million people living across the United States that come from various diverse backgrounds (that are) even probably more diverse in the last 20 years?
What’s the answer to that question?
We’re not sure we have enough data from all of those different populations to say: How do we shape what’s next? How do we move forward? And now how do we implement environmental exposures and genomics into the equation to better understand that very valuable data set that we already have and scale it out?