For James Krings, MD, MSCI, Assistant Professor of Medicine in the Division of Pulmonary & Critical Care, settling in at WashU for his career in scientific research seems always to have been written in the stars.
Originally from St. Louis, MO, Krings returned home after attending medical school at Stanford University and completing his residency at Northwestern University. But before he had even finished medical school, Krings was already making his mark at WashU and within the ICTS.
While in college, Krings worked directly with former WashU professor Michael DeBaun, MD MPH, on projects related to sickle-cell disease and asthma. Then from 2011-2012, Krings came to WashU between his second and third year of medical school as the recipient of the Doris Duke Clinical Research Fellowship, where he worked with Jay Piccirillo, MD, on studies using large data to answer clinical questions. In large part due to these positive experiences working with WashU faculty and staff, returning to his hometown to continue his career and become an academic clinical investigator himself was an easy decision for Krings.
Career Development & Funding Sources
From 2018-2020 at WashU, Krings completed his clinical fellowship in Pulmonary and Critical Care Medicine under the mentorship of former WashU professor Mario Castro, MD, MPH. During this time, Krings also completed the Mentored Training Program in Clinical Investigation (MTPCI) through the ICTS’ Clinical Research Training Center (CRTC) and received an additional Master of Science in Clinical Investigation (MSCI) degree. He also received a KL2 Career Development Award working with Eric Lenze, MD, on an ongoing pragmatic randomized controlled trial.
Krings was also named to the 2020 cohort in the CRTC K12 Mentored Training in Implementation Science (MTIS) Program. He praises these types of developmental programs and says they set early-stage investigators up for a good trajectory in their research efforts.
“I would encourage people to meet with leaders who are heavily involved with the ICTS to learn about all of the resources that are out there,” says Krings. “At the CRTC, the training programs are very key for early-stage investigators, especially. And programs like the MTPCI and the KL2, for example, help you get to know others from across the campus who are like-minded and trying to do the same sort of thing, and help you build a network of colleagues you can rely on.”
Not only has Krings utilized the developmental programs offered by the CRTC, he has also been granted an ample amount of funding for his research efforts from the ICTS. In 2022-2023, Krings was funded through the Clinical and Translational Research Funding Program (CTRFP). Krings says this funding helped provide important preliminary data and inform his external grant application that includes adults and adolescents.
Krings has also been awarded through the Just-in-Time (JIT) Core Usage Funding Program in 2021 for the use of Administrative Data Core Services.
“The ICTS is a humongous resource, probably more than people even realize,” says Krings. “The funding opportunities are obviously great, but there are other programs as well that can be very helpful – the Grants Library, the Mock Study Section, the Research Forum, just to name a few. Without the training programs, the funding and the networking I’ve found through the ICTS, I would not academically be where I am today.”
From Bedside to Bench and Bridging the Gap
Krings officially joined the WashU Department of Medicine in September 2020 – in the heart of the COVID-19 pandemic. He started his 1st year of faculty membership being very active in the clinical space, due to the needs of the healthcare system and being an ICU provider. But Krings decided he wanted to pursue more time in the clinical research space, specifically in the area of improving the care of patients with asthma and chronic obstructive pulmonary disease (COPD).
Krings’ current research focus is to partner with local clinics to evaluate how to improve the uptake of guideline-recommended asthma care in community healthcare settings. This study, entitled CHEST, which stands for “A Collaboration with Community Health Centers to Implement SMART for Asthma” is set to officially launch in April of this year. Krings says, although scientists know what the best evidence-based therapies are in caring for asthma, many providers are not prescribing these recommended methods. Krings says this could be particularly detrimental, and it offers an opportunity for improvement in cities like St. Louis, which are marked by healthcare disparities.
“Asthma morbidity and asthma outcomes vary dramatically depending on what ZIP code you live in the St. Louis area,” says Krings. “And the lower-resource communities have dramatically worse outcomes in asthma. Many people in lower-resource communities in St. Louis are receiving care from federally-qualified community health centers. So, we know that if we want to implement guideline-recommended asthma care to benefit the most patients, we need to be working with these community centers directly. This is the work we are going to be doing over the next few years.”
Krings and his team have been awarded an NIH/NHLBI KL23 to work towards this goal, and he hopes it will eventually be able to be rolled out throughout the country in a large multicenter randomized effectiveness-implementation trial. Krings stresses this will be a multidisciplinary effort, with the dedication of several different entities playing a part, and that St. Louis has an opportunity to lead the country in implementing the latest evidence-based asthma guidelines. One important piece to this project has been the involvement of the Community Advisory Board (CAB) through the ICTS/IPH Center for Community Health Partnership & Research (CCHPR).
Krings credits people like Vetta Sanders Thompson, PhD, WashU Professor of Racial and Ethnic Diversity and former CCHPR co-Director, and Hilary Broughton, MSW, CCHPR Assistant Director, with helping him become more connected with community members and form relationships with entities like the St. Louis Integrated Health Network.
Next Steps
Krings says that currently, the goal for his research is not only to implement successful methods that see more providers at the community health centers prescribing evidence-based care and improving asthma outcomes, but to also effectively disseminate the findings to the community.
“Our community partners have a vested interest in what we are doing,” says Krings. “And they don’t always find out about the results from an academic, scientific article. So, it’s going to be very important to work with our CAB to figure out how we can successfully disseminate these findings.”
Another important focus in Krings’ work moving forward is continuing to work on health policy and improving access to evidence-based asthma and COPD therapies for patients. Krings says that a lot of healthcare payers, whether it be Medicaid, Medicare or private payers, still do not cover the most evidence-based, guideline-recommended asthma care.
“Missouri Medicaid is good at covering this type of asthma care [SMART], but this is not the case for all states,” says Krings. “Widespread coverage is going to take more cost-analyses, dissemination work, and policy work. We’re incredibly lucky to partner with Ross Brownson, PhD, Mark Huffman, MD MPH, Abigail Barker, PhD, Timothy McBride, PhD, and others at the WashU Brown School and new Public Health school to help with these goals.”
Importance of Mentorship & Team Science
To advance your scientific career, Krings also highlights the importance of finding a mentor who will point you in the right direction of funding opportunities, training programs, research goals, etc. Krings claims he could go on and on about the many mentors and advisors he has had along the way, but there are a few he specifically calls out who have greatly impacted who he is as a person and his success at WashU:
“Scientific research is a team sport,” says Krings. “Mentors deserve a lot of credit, because they help you through all of this with no extra funding and extra use of their time, so it’s really a selfless thing. And any time you are recognized for anything, it’s important to also recognize the mentors who helped get you there.”
Krings is paying it forward and is now a mentor, as well. He has mentored numerous fellows, residents, medical students, and public health students at the Brown School and within the TL1 Predoctoral Clinical Research Program and the Advanced Summer Program for Investigation & Research Education (ASPIRE) through the CRTC. Krings says one of the top pieces of advice he tries to pass to trainees is to know “your why” and learn about and get involved with the ICTS resources and programs.
Krings also points out that it is very important to be collaborative and open to bringing in and creating a solid team with many different views and skillsets to help with your research goals. Krings’ team has a strong partnership with the WashU Institute for Informatics, Data Science & Biostatistics, especially with Mac Hofford, MD and Charles (Chuck) Goss, PhD. Krings says Hofford and Goss are very key team members, as Hofford helps to collect, organize and make sense of all outcomes data, while Goss and his team help with study design and analyses.
“We are a very multidisciplinary group,” says Krings. “Our community partners are considered members of our investigative team, and some of them will absolutely be co-authors on any papers that we write. We’ve partnered with Penina Acayo Laker, MFA, and her Health Communications Design Studio at WashU’s Sam Fox School of Design and Visual Arts to develop a website, create policy documents, and create new asthma action plans designed for community partners. We also work with the Center for Dissemination and Implementation and attend WUNDIR meetings. We believe in a true team science approach, and it really is amazing how you just cannot do this work well without a whole team.”