What are the responsibilities of the clinical research center?
My job is to provide support in setting up clinical trials. This ranges from drafting research protocols to submitting them to the ethics committee, conducting statistical analyses, and writing manuscripts for publication. By handling these processes, we aim to make clinicians’ work easier and encourage them to launch new projects. I also provide support in managing quality registries at the hospital level.
What added value does research bring to our patients?
For us, clinical research is a tool that allows us to adapt to patients and their lifestyles, thereby offering them the best possible quality of life while reducing overall healthcare costs.
How so?
Thanks to all the data collected, we can, for example, optimize care pathways to prevent or detect complications by identifying certain risk factors (age, comorbidities, activity level, etc.). Research, combined with the physician’s experience, allows us to tailor treatment to restore the best possible quality of life based on the patient’s expectations. We do not perform joint replacement surgery in the same way for a 50-year-old athlete as we do for an 85-year-old who is not physically active.
We strive to provide high-value, high-quality care in accordance with the principles of Value-Based Healthcare (VBHC), a central focus at Hôpital de La Tour. For example, the value of a procedure can be determined by comparing the quality of care provided to the patient (pain reduction, increased mobility, absence of complications, etc.) with the directly associated costs. Using this approach, we have already observed—particularly in the case of shoulder replacements with Dr. Alexandre Lädermann—that the most expensive prosthesis does not necessarily offer patients a better quality of life in the short term. Further studies are underway to determine whether this prosthesis proves to be more beneficial in the long term than the standard prosthesis for the same type of condition. We can then rely on precise data to make the right choices, rather than relying on more subjective criteria.
Are patients generally receptive to the importance of research?
Today, 90% of hospitalized patients agree to have their data used for research purposes. This is a key factor in the success of research. The reason today’s patients receive such good care is that others before them—5, 10, or 20 years ago—granted access to their data to expand our knowledge and optimize treatments. There’s a lot of talk about collaboration among experts within the hospital, but without collaboration and the bond of trust built with patients, research would be nothing.
Collecting this data was, in fact, one of the areas we needed to improve when I arrived in early 2020: There were already doctors very active in research, but we needed to redouble our efforts to best comply with new regulatory requirements while standardizing and facilitating access to clinical data through the implementation of a systematic institutional consent process for patients.
We now know immediately whether a patient admitted to Hôpital de La Tour has given consent for their data to be reused in our research activities, which is a significant gain in time and efficiency.
Have you observed a renewed interest among clinicians thanks to the support that has been put in place?
Absolutely! I’ve seen firsthand just how much of a barrier the regulatory aspect can be. Drafting protocols, submitting them to ethics committees… It takes time and a wide range of skills to launch a study. How many patients are needed? What criteria, what statistics? There are many details to consider. By guiding them or relieving them of these burdens, I’ve noticed that many clinicians—especially doctors—come to me to launch new clinical studies.
We’ve also worked to expand the reach of our publications by creating a dedicated webpage on this topic on the Hôpital de La Tour website and by now funding the publication of open-access articles in medical journals. It’s an investment, but it significantly increases the visibility of our clinicians by ensuring that readers at other hospitals don’t have to pay to access our studies. This has opened up new possibilities, leading to an increase of more than 40% in the number of our publications between 2019 and 2020.
Clinical research is generally associated with academic institutions. Is it perceived differently in a private institution like ours?
Research is certainly no longer the exclusive domain of university hospitals! It is an integral part of our work and is directly linked to our medical training programs, as Axelle Alibert, who heads these two departments, points out. At the same time, we’re carrying out digitization projects that allow us to easily and automatically collect a wealth of data that we didn’t have before.
This data enables us to better monitor patients during and after their stay, and to assess and evaluate their progress from clinical, functional, and radiological perspectives, among others. This enables us to conduct so-called “quality assurance” studies, through which we can self-assess and compare our performance to that published by other hospitals in the scientific literature. This allows us to improve our understanding of certain conditions and to identify areas for improvement in patient care pathways.
It is not uncommon, as a result of this work, for new studies to be launched to objectively assess the effects of this continuous improvement and to identify patients at risk of complications or disappointing clinical outcomes. This allows us to monitor them more closely to improve their care. Private institutions therefore have a clear interest in engaging in clinical research.
But aren’t the research areas necessarily the same?
As we’ve seen, our priority is patients’ quality of life and the medico-economic aspects. The idea is to optimize treatments as much as possible through a multidisciplinary approach that ensures the best possible restoration of quality of life while avoiding complications. For example, in many situations, surgery can drastically increase the costs of a patient’s medical care. Thanks to the results of clinical studies, we can identify patients for whom conservative treatment would work just as well in the short term and thus delay surgical treatment as much as possible. Once again, this is beneficial for the patient but also for healthcare costs.
Academic research is, of course, interested in these aspects, but it has more resources to address much more specialized topics.
What are the next research challenges at Hôpital de La Tour?
We want to strengthen our partnerships with other institutions, including international ones. We’ll also need to gradually expand to keep pace with the increase in demand and the volume of data collected through digitalization. The data we collect is a valuable treasure trove of information, but we’ll need more resources to process it all.
We’ll also expand our use of artificial intelligence to try to predict treatment failures, readmissions, and reoperations. This will allow us to identify in advance which patients will have the most difficulty regaining their quality of life after treatment and to monitor them more closely—for example, through connected devices—to anticipate their return or to tailor their treatment so they won’t have to come back.
Interview by Yannick Richter, Communications Officer
What Our Clinicians Say
In addition to the benefits for patients, our Clinical Research Center is a significant asset for our clinicians. Three of them share their experiences with us.
PD Dr. med. Alexandre Lädermann, shoulder and elbow surgeon
"The quality of our submissions has improved dramatically. Hugo Bothorel has brought even greater scientific rigor, providing assistance with study designs, ethics committee applications, statistical refinements, and critical reviews. The only question I can ask myself is: how did we ever manage without him before?”
Prof. Dr. med. Omar Kherad, Chief of General Internal Medicine
“Hugo Bothorel is the missing piece in a hospital where clinicians wish to conduct research projects alongside their clinical work. Thanks to his expertise in methodology and biostatistics, he enables us to carry out clinical trials and ultimately publish them in peer-reviewed journals, while ensuring the quality of the analyzed data.”
François Fourchet, Head of the Physical Therapy Department: "Hugo Bothorel’s contribution has been decisive. His expertise, particularly in methodology and statistics, has helped improve not only data collection but also data processing. His guidance on drafting research protocols now allows us to submit high-quality applications to the ethics committee more quickly and easily and to receive favorable responses more promptly. Our collaboration will continue to intensify and should result in an increase in scientific publications from our department."