#406 - 🔵 [NEO CONFERENCE] - Conducting family centered research in the private practice world (Dr. Kaashif Ahmad)

Hello friends 👋

Can groundbreaking neonatal research thrive outside of academic medicine? Live from the NEO Conference, Ben and Daphna sit down with Dr. Kaashif Ahmad, Vice President of Research at Pediatrix. Dr. Ahmad shatters the myth that community NICUs can't drive clinical science, discussing how everyday documentation in systems like Baby Steps quietly fuels hundreds of publications. He also unveils "The Parent Network," a revolutionary initiative designed to partner with family-led organizations from day one to establish comparative effectiveness trial priorities. Tune in to discover how private practice clinicians are successfully balancing bedside care with robust, meaningful research.

Link to episode on youtube: https://youtu.be/PGRKC0pk_Wo

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Short Bio: Kaashif Ahmad, MD is a clinical neonatologist with Pediatrix Neonatology of San Antonio and Houston, where he serves as Director of Clinical Research for both practices. He also holds the role of Vice President of Research for Pediatrix Medical Group, which oversees more than 350 NICUs nationwide, and serves as NICU Clinical Medical Director at The Woman's Hospital of Texas. He holds faculty appointments as Clinical Professor at the University of Houston Tilman J. Fertitta Family College of Medicine, Baylor College of Medicine, and the Uniformed Services University of the Health Sciences. Dr. Ahmad completed medical school at Aga Khan University in Karachi, Pakistan, followed by pediatric residency and chief residency at Saint Louis University and Cardinal Glennon Children's Hospital, and a neonatology fellowship at Baylor College of Medicine and Texas Children's Hospital. His research interests include clinical trials, neonatal CPR, neuroprotection, and large database research. He has authored or co-authored over 100 peer-reviewed manuscripts.

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The transcript of today's episode can be found below 👇

Ben Courchia MD (00:00.174)

You look anywhere you want. Hello everybody. Welcome back to the Incubator Podcast. We're live at the NEO conference in Las Vegas, Nevada, and we are joined by Dr. Kaashif Ahmad. Welcome to the podcast.

Kaashif Ahmad MD (00:14.178)

Thank you so much.

Ben Courchia MD (00:15.054)

You are a neonatologist by training, you work for Pediatrix and you have taken over recently for the giant Dr. Reese Clark, who we've had on the show before I believe, and you're leading research and quality improvement initiative efforts within the Pediatrix practice group. Can you tell us a little bit about what this new role is like?

Kaashif Ahmad MD (00:43.566)

Sure, Reese was with the company for decades and was the leader for research, education, quality, and safety. And so about a year and a half or so ago, I had the opportunity when Reese transitioned to retirement to take over the research piece of his role. And so since that time, I've been the vice president of research for Pediatrix. I have really enjoyed taking on that role and trying to find my own pathway to do it in a way that is hopefully different.

Ben Courchia MD (01:13.678)

It's always tough to replace somebody very successful. We work for Pediatrix, so we're very fortunate that they picked the right person. You are definitely the right choice. Congratulations and we're very thankful for that.

Daphna Yasova Barbeau MD (01:21.086)

Right, absolutely.

Kaashif Ahmad MD (01:29.452)

Yeah, thank you. I'm involved in quality improvement, but I certainly don't lead quality improvement. We have other very talented people, Robert Ursprung and Dan Ellsbury, who help to lead QI. We all work very closely together.

Daphna Yasova Barbeau MD (01:42.294)

Yeah, I mean, they're individually huge roles, right? So it makes sense that they were distributed a little bit so that you could focus on one. Tell us some of the goals, your mission.

Kaashif Ahmad MD (01:54.062)

Pediatrix is obviously a large organization. There's 380 NICUs, and it manages 20% of the babies across the United States who are in NICUs. And many of those physicians and nurse practitioners at these sites want to be engaged in research, have this real passion and desire to be engaged in research, even if they're not working in academic medical centers. And so as I stepped into this role, the piece that I felt was most important in terms of serving all the physicians and nurse practitioners in our organization is how we can find ways to bring research to them and streamline and smooth out their glide path to get engaged in research, whether they've ever done it before or not. Whether you're in a level two or a rural level three or a big urban level four referral center, I feel like we should find a way that anyone can do clinical research, recruiting patients at the ground level if they want to.

Ben Courchia MD (02:52.11)

Yeah, I think that the verb is very interesting because you can do research, can be the principal and primary investigator of a research study, but 100% of anybody working in a NICU wants to participate in research. And I feel like this is true for me. Do I have the shoulders to say, "Okay, I'm going to take on a multi-center randomized control trial?" No. Would I like to participate in an effort to answer a meaningful question? 100% yes. And I think that the two are not mutually exclusive. And so I think that this is such a great opportunity for anybody working in clinical care to add their piece to the edifice of helping babies and their outcomes.

Kaashif Ahmad MD (03:37.272)

I think there's a halo effect for research. I think everyone, even if you left a university setting where you did fellowship and you went into a private practice setting and you never want to do research and never want to be the active leader in your site, everyone wants to be in a place where research is at least happening and wants to support it at least in a secondary way. And so I think it's really helpful for everyone to be in a place in which thoughtful investigation is happening, in which important questions are being answered. And even if you're supporting it by seeing patients so you can free up someone else to help do that work, I think that is just as meaningful as the person who's doing the research. And it gives more value and a sense of satisfaction that you're contributing, even if it's in a different way.

Daphna Yasova Barbeau MD (04:19.384)

We just finished talking with Dr. Wally Carlo and that's something that he said. Clinicians at the bedside are very much aware of what research questions might need to be asked because they're dealing with them every single day. And we're doing the work, right? Doing the interventions, or doing the controls, and putting in the data. The data is there, and finding a way to hone that so that everybody is engaged potentially, I think, can move medicine forward faster for our little babies.

Kaashif Ahmad MD (04:57.558)

Yeah, there are so many ways to be involved in research. One of the wonderful things that Reese and others developed 20 years ago was this consistent, uniform, electronic documentation system called Baby Steps, which every single clinician in the company is using. And so whether you're at an Epic hospital or a Cerner hospital or a Meditech hospital like the three of us are, for better or worse. That's the interface that we actually work with every day—is not Epic or Cerner or Meditech. It is Baby Steps, which is owned by Pediatrix and which can interface with any EMR to be able to transfer our notes. And so that means we have a uniform documentation platform across 350-plus sites. And we can control the way in which the documentation happens.

So with Baby Steps, it was very thoughtfully designed in that there are, of course, lots of places where we can use free text, but every medication, every diagnosis is all through a picklist system in which it is very much locked in and it can be de-identified and used for research on the backend through the Clinical Data Warehouse. And so whether they're aware of it or not, the Clinical Data Warehouse has had just over 300 publications now out of it over the last 20 years. So every Pediatrix clinician has actually contributed to all of that research because it's all through their data entry prospectively for every baby we see.

Ben Courchia MD (06:19.864)

That's right. And we joined Pediatrix a couple of months ago, and one of the things that was very pleasant to see was an email from you about a project that you're spearheading called The Parent Network. And it's an amazing research initiative. Do you want to tell us a little bit more about what The Parent Network aims to be?

Kaashif Ahmad MD (06:39.926)

So the genesis behind The Parent Network is that there needs to be a mechanism by which we can partner with families and with family-led organizations to do comparative effectiveness research at community hospitals. And so the idea really is, I reached out to all of our sites and I said, "Who's interested in doing research, whether you've ever done it or not?" And one of the amazing things was that virtually every site I reached out to immediately raised their hand and said, "We want in, whether we do research or not." The idea is that every site would have family partners that are engaged in research at their site, and that we build a structure in which we have at the site level multiple family partners and a site principal investigator. We had about 55 sites across the country that said they were interested in participating. And so we ended up setting up six regional hubs that would coordinate priorities.

And so through the families locally, through the regional hubs, we will circulate and upstream, start to bring family-based priorities on what the research is that families find valuable. Because I think rather than having a paradigm in which we as investigators decide what we think is interesting, and then we apply for funding, and then we say to all the families, "This is what we're doing," it's really much more valuable to flip the paradigm and let parents tell us what they think is really the most important thing. Yeah, ultimately we're not doing the research for our benefit, we're doing it for their benefit and for their baby's benefit. And so they really should have a say at the ground level in the research priorities for a network of units. And so the design that we are envisioning here is that we have this large network of NICUs, 50 to 60 NICUs across the network. They will slowly bring up ideas from the ground level. There's a centralized steering committee that will help decide priorities. But I think a really important piece of this is that we also partner with family-led organizations. Organizations such as Hope for HIE and the NEC Society, with Hand to Hold, with Family Voices, and then also organizations like the March of Dimes have also been interested, so we all work together and submitted an application to PCORI recently to do this. And as happens, it didn't get funded right away, and so we're retooling it and we're going to resubmit it again. The plan is for the next cycle. But I think the part of the design that I really like the most is that the families and the family-led organizations are partners, and they have equal say in what the priorities are. And so I think the design can't be one in which we are telling them what we're going to do. It should be really more that they're telling us what we should do, and as long as we feel like it is feasible to execute it, then we should be working with them together to package things in grant applications and submit it to different organizations and get funding to do research. And so that's the vision. The vision is still at a very early stage, but that's really what we'd like to do.

Ben Courchia MD (09:43.694)

Yeah, and I think that the reason why I was mentioning that this email about The Parent Network was so welcomed by Daphna and myself is because we have had the privilege of speaking to Betsy Pilon from Hope for HIE and Jennifer Canvasser from the NEC Society. And this is something that everybody has said, everybody agrees on, but yet has not yet taken place. And so your vision for The Parent Network is actually this. If this vision effectuated really, just saying, "Okay, let's put it into practice." So for me, it's very exciting. It's the next step of neonatology research.

Daphna Yasova Barbeau MD (10:15.594)

For sure. Yeah, that's what I was going to say. It's not so much asking parents what are the outcomes you want to see, but even, what should we even be looking at? I mean, really engaging the stakeholders, right, families and babies right from the get-go about what are the research priorities. I think this is pretty...

Kaashif Ahmad MD (10:36.334)

I think everyone has good intentions, right? And so it's not that people are intentionally doing things in a way that doesn't involve parents from the beginning, but I think it's a lot of work. It's easier to design the full trial and then on the back end say, "Okay, give me input on the informed consent. Now you can give us feedback as we finalize the trial design." But 90% of the trial's already been designed.

Daphna Yasova Barbeau MD (10:47.598)

It's a lot of work.

Ben Courchia MD (11:04.974)

I believe that's exactly right. I think that it would be dismissive to say that any study in the past has not involved parents, but it's like at what stage of the game are we involving the families? And I think that what you're trying to do with The Parent Network is really saying from the get-go, they are part of the team that thinks about every aspect of a trial, not just, "Hey, we're going to come up with a study idea and then we'll bring parents for feedback and then they'll give us feedback on our idea." It's like, no, let's even the conception of the idea.

Kaashif Ahmad MD (11:33.358)

Part of the problem is that we are experts in our domain and we all have egos. And it's really hard for myself included to park our ego at the door and be told by a parent that your idea is not the one that I care about. And so that's, I think all of us when we get into the virtual room or the real room with families and with family-led organizations really have to be mindful about, there's no power, we're not holding power over families. We are partners with families.

Ben Courchia MD (12:04.75)

Very much a flat hierarchy type of approach. Obviously, you're a talented clinician and researcher. You could have been doing this at a university, but you're with Pediatrix in private practice, quote unquote. I know that this is a question we get a lot from trainees who are on the verge of finding a job. "I'm debating what path to choose." Being someone who embodies this success of being able to go into clinical practice and continue to do meaningful work. What is your perspective years into this as to the ability within private practice to do more than just clinical work?

Kaashif Ahmad MD (12:54.126)

It's a great question. My plan originally was not to do all this in a private practice environment. The plan was to be a physician-scientist, was to stay at a university setting. I was a fellow at Texas Children's in this program called the Pediatric Scientist Development Program, which extended my fellowship to four years, and I spent two of those years in the lab. And then realized year three out of four that maybe cutting the heads off of baby mice and dissecting their brains is not what I want to do. Let me transition to clinical research.

And I had along the way found out that there was a way through the University of London to get a master's degree remote. They pioneered this over 100 years ago. And so during residency and fellowship, I did this master's in epidemiology and said, "Let me use this degree and use this as a way to transition to doing clinical research." And so as I was starting to look for a job, I had colleagues that said, "We interviewed at this practice in San Antonio, why don't you go check it out?" And so I said, "Okay, I lived only three hours away, but I had only gone once in the previous three years. So let me go check it out." And it was an amazing opportunity.

And I would say what I learned was, if you're looking for opportunities, the leadership of where you choose to go is probably the single most important variable, because they have to have a will to support you to do it. Whether that is the will to give you time, or whether that is the will to just say to the rest of the group, "This is important and we're going to support it." Whatever it is. And so I was very fortunate that the chief that I had for those 10 years, Michael Battista, was someone that had the vision and said, "If you want to come here and do this, then we're going to support you. And we're going to say this is the right thing to do." It's a very large practice. It had over 10 NICUs. It has over 200 NICU beds occupied per day. But they weren't doing any research. And so he said, "This is the right thing to do in a private practice, we're not doing research, but we have a mission to produce knowledge that will improve the care of babies. And if we have someone who's willing to come and bring this to us, then why don't we support it?" And he could have easily said, "This is not the thing for us, we're private practice, we don't do that." And then none of my career probably would have happened if he had said that. And so I think the key is really finding that leader or that leadership team that is willing to support that. And so him and the rest of the leadership team were supportive consistently for the whole 10 years that I spent full time in that practice.

Ben Courchia MD (15:18.882)

Good work.

Daphna Yasova Barbeau MD (15:19.582)

I know. And I wanted to highlight something else you said. I think there's a misperception that people may choose private practice because they don't want to do research. You shared the anecdote about how everybody was just hands up wanting to help individually. What has that looked like? What has been the reception for people wanting to be engaged in your project?

Kaashif Ahmad MD (15:41.536)

It's shocking in the sense that before I took this role, I would have anticipated that if I reached out to a random NICU within Pediatrix, for example, that 80% of the time they would say, "We don't have time for this, we're just too busy. Or we're not interested in this." And the opposite has been true. In general, whenever I send out a solicitation to say, "Hey, we're interested in this study," whether it is The Parent Network or an R01 grant recently submitted or a CPAP clinical trial that we're planning, almost always it is 95% or more of the NICUs that raise their hand immediately and they're like, "We want to be a part of this if you have a way to make it happen."

And so we're really fortunate that in our organization, the company supports research. We have a centralized team that will help with all the contracts, all the budgets, that will handle the flow of dollars if we need it. We have some hospitals within the Pediatrix network of NICUs that have Dell Children's in Austin, Cook Children's in Fort Worth, these are big children's hospitals. They have all the infrastructure to do research. They don't need a company like Pediatrix to help. But there are so many rural NICUs, small NICUs, community NICUs, they don't have an office of sponsored programs like a university does. And so then what is someone to do if you don't have a way to do contracts and budgets? And so then in that situation, our team that is central in the company can do all the sponsor negotiations, do all the legal contracts on behalf of the doctors and they just will pass through the dollars to the hospital, pass through the dollars to the neonatologist in their practice.

And we try to make it as simple as possible. We essentially can't hire the research coordinator for the practice. That's where the leadership has to say, "This is something we're invested in, we'll hire a research coordinator for our site." But like all the other nuts and bolts sorts of things that people normally don't know anything about, unless you've done it before, you need to have someone or an organization that's willing to do that on your behalf. And so we're very fortunate that we've had that team there and they're outstanding and are able to do all that because that's the boring part of research that is painful. Nobody wants to do contracts and budgets.

Daphna Yasova Barbeau MD (17:44.174)

And nobody's really trained to do those things anyway.

Kaashif Ahmad MD (17:46.686)

Yeah, no one is trained to do any of those things and so I think having a team that can at least walk you through that process and is willing to teach you that process as you go—that's how you do research. I had literally never done clinical research until I started my job in San Antonio. It was only bench research, pre-med, med school, and then residency and fellowship. And so I had to learn all the stuff I do now on the fly after I got into private practice. And it was through Pediatrix actually supporting 15 years ago their own small studies, and these were chart review studies: what are the causes of mortality in babies. This was a paper they published in Pediatrics probably 15 years ago. And that was how I learned: How do I submit an IRB? How do I do a data use agreement? How do I get the legal contracts done from the hospital? How do we do all the publications? And so they walked us through all those things step by step to teach us how to do all this. If they didn't have that infrastructure to teach us, that's another barrier that I needed to overcome because I was trained to do molecular biology things, not how to recruit a patient and to do any of these things. And so I think that's a whole separate skill set that even if you have enthusiasm, people have to be willing to give you the time and energy to teach you how to do those things.

Ben Courchia MD (19:03.694)

Absolutely. Kaashif, thank you so much for dropping by the podcast. Thank you for a few minutes. Congratulations and we'll see you around.

Kaashif Ahmad MD (19:10.85)

Yes, welcome to Pediatrix. We're so thrilled to have you. Thank you so much.

Ben Courchia MD (19:14.04)

Thank you.