title: Workflow in clinical trial sites & its association with near miss events for data quality: ethnographic, workflow & systems simulation.
abstract: BACKGROUND
  With the exponential expansion of clinical trials conducted in (Brazil, Russia, India, and China) and VISTA (Vietnam, Indonesia, South Africa, Turkey, and Argentina) countries, corresponding gains in cost and enrolment efficiency quickly outpace the consonant metrics in traditional countries in North America and European Union. However, questions still remain regarding the quality of data being collected in these countries. We used ethnographic, mapping and computer simulation studies to identify/address areas of threat to near miss events for data quality in two cancer trial sites in Brazil.
  
  
  RESULTS
  Two sites in Sao Paolo and Rio Janeiro were evaluated using ethnographic observations of workflow during subject enrolment and data collection. Emerging themes related to threats to near miss events for data quality were derived from observations. They were then transformed into workflows using UML-AD and modeled using System Dynamics. 139 tasks were observed and mapped through the ethnographic study. The UML-AD detected four major activities in the workflow evaluation of potential research subjects prior to signature of informed consent, visit to obtain subject́s informed consent, regular data collection sessions following study protocol and closure of study protocol for a given project. Field observations pointed to three major emerging themes: (a) lack of standardized process for data registration at source document, (b) multiplicity of data repositories and (c) scarcity of decision support systems at the point of research intervention. Simulation with policy model demonstrates a reduction of the rework problem.
  
  
  CONCLUSIONS
  Patterns of threats to data quality at the two sites were similar to the threats reported in the literature for American sites. The clinical trial site managers need to reorganize staff workflow by using information technology more efficiently, establish new standard procedures and manage professionals to reduce near miss events and save time/cost. Clinical trial sponsors should improve relevant support systems.
authors: Research on Research Group, Department of Surgery, Duke University, Durham, North Carolina, United States of America.
authors: Elias Cesar Araujo
authors: EC
authors: de Carvalho
authors: Adelia Portero
authors: AP
authors: Batilana
authors: Wederson
authors: W
authors: Claudino
authors: Luiz Fernando Lima
authors: LF
authors: Reis
authors: Rafael A
authors: RA
authors: Schmerling
authors: Jatin
authors: J
authors: Shah
authors: Ricardo
authors: R
authors: Pietrobon
mesh_terms: D000884:Anthropology, Cultural / Q000379:methods*; D035843:Biomedical Research / Q000458:organization & administration; D001938:Brazil; D002986:Clinical Trials as Topic; D003198:Computer Simulation; D006291:Health Policy; D006801:Humans; D008962:Models, Theoretical; D012107:Research Design; D009626:Terminology as Topic; D057188:Workflow