James K. Kirklin, M.D., director of cardiothoracic surgery and John W. Kirklin Chair of Cardiovascular SurgeryThe name Kirklin resounds across the campus of the University of Alabama at Birmingham. John W. Kirklin, a pioneering heart surgeon, was recruited to the fledgling UAB from the Mayo Clinic in 1966. His name adorns the Kirklin Clinic of UAB Hospital, UAB Medicine’s outpatient clinical facility.
John’s son James K. Kirklin followed his father, becoming a pre-eminent cardiothoracic surgeon specializing in surgery for congenital heart disease, heart transplantation and mechanical circulatory support of the failing heart. He became the director of cardiac transplantation at UAB in 1986, took the reins as director of the Division of Cardiothoracic Surgery in 2006, and was instrumental in opening the congenital cardiac surgery program at Children’s of Alabama in 2012.
The elder Kirklin passed away in 2004, and James will step down as division director this year, as UAB honors them with the creation of the James and John Kirklin Institute for Research in Surgical Outcomes, or KIRSO. James Kirklin will be the inaugural director of KIRSO.
“Outcomes research was always a passion of my father’s, and I share that passion,” said Kirklin, who holds the John W. Kirklin Chair of Cardiovascular Surgery named for his father. “As he built the cardiothoracic program here, he was among the first to recognize the importance of outcomes research.”
| Outcomes research helps identify the best evidence to guide patient care and produce the most optimal outcomes. It critically appraises the results of a procedure, its global impact on patient health and well-being, satisfaction, functional status, lifespan, and the health care system. |
Outcomes research helps identify the best evidence to guide patient care and produce the most optimal outcomes. It critically appraises the results of a procedure, its global impact on patient health and well-being, satisfaction, functional status, lifespan, and the health care system. Outcomes researchers then translate the knowledge gained into practice and policy by working with surgeons, payers and purchasers of health care.
John Kirklin began the first surgical outcomes studies at UAB in the 1980s, partnering with Gene Blackstone, M.D., recipient of an endowed university chair at UAB for cardiovascular surgical research, who is now at the Cleveland Clinic.
Beginning in the early 1990s, James Kirklin partnered in outcomes research with David Naftel, Ph.D., an internationally recognized outcomes researcher and disciple of Blackstone, also holder of the endowed surgical research chair, who developed new techniques of statistical analysis of cardiac outcomes. James and Naftel have formed an inseparable research team for the past 25 years.
In 2005, James Kirklin become the principal investigator of the Interagency Registry for Mechanically Assisted Circulatory Support, or INTERMACS, an NHLBI-funded national registry that tracks patients who are receiving mechanical circulatory support device therapy to treat advanced heart failure. The registry, now in its 10th year, enhanced UAB’s national position in outcomes research and now facilitates the introduction of novel devices, refinement of clinical practice, improvements in patient outcomes and enhancement of quality of life for thousands of patients.
Building on INTERMACS, James worked with Naftel to expand the scope of outcomes research at UAB, creating a research team of 35, including surgeons, biostatisticians and research scientists. The group is conducting nearly 100 different studies involving cardiovascular surgery at UAB, along with collaborations with a number of other universities. That team forms the core of KIRSO, as the formal creation of the Institute cements its place at UAB.
The KIRSO project team meets weekly for updates on the progress of each research study.“The Institute will strengthen and grow the surgical outcomes research enterprise that first John and now Jim Kirklin have been building at UAB,” said Selwyn M. Vickers, M.D., senior vice president and dean of the UAB School of Medicine. “Outcomes research — the science of understanding how best to care for patients in both short- and long-term scenarios — is one of the most important endeavors in medicine.”
Working with Department of Surgery Chairman Herbert Chen, M.D., the Fay Fletcher Kerner Endowed Chair of Surgery, Kirklin says KIRSO will be available to supply research support to investigators throughout the department. Eventually, the goal will be to provide outcomes research expertise to nonsurgical disciplines across UAB.
“We have decades of experience in how to construct, organize and conduct outcomes studies,” Kirklin said. “We have unparalleled expertise in evaluating results and performing analytics. We are poised to bring that experience to surgical and nonsurgical disciplines across UAB and to other universities and research institutions globally.”
Over the years, the Kirklins and their collaborators have created a method for outcomes research. James Kirklin and Naftel have distilled it into a 10-step process, following a template that establishes a consistent routine that can be amended as needed. Each study is led by a project manager with experience in health care research. The entire team meets each Monday morning to review the progress of every study and determine what steps are required to move the research forward.
“The key to outcomes research is to assess the same level of scientific rigor to outcomes data as you would to any other research study,” Kirklin said. “In many ways, the process is similar to a cardiac operation, with the same level of planning, training, effort and dedication that is required in surgery.”
KIRSO will offer investigators expert services in project management, data collection, database design, statistics, reporting results, regulatory affairs, informatics, research consultation, and education and training.
“We will establish a training program through fellowships and internships that would reach out not only to young surgeons, but also to students in other fields such as public health and epidemiology,” Kirklin said. “I truly believe this Institute will be a transformative step in our understanding of how to determine best outcomes, and a critical component is disseminating that information around the world. And I think this would have made my father smile.”