Baystate Medical Center Inc

MASSACHUSETTS JUSTICE COMMUNITY OPIOID INNOVATION NETWORK (JCOIN) CLINICAL RESEARCH CENTER

GERIATRICS WORKFORCE ENHANCEMENT PROGRAM

DRUG INJECTION SURVEILLANCE AND CARE ENHANCEMENT FOR RURAL NORTHERN NEW ENGLAND (DISCERNNE)

AFFORDABLE CARE ACT: PRIMARY CARE RESIDENCY EXPANSION

IMPROVING PARTICIPATION IN PULMONARY REHABILITATION THROUGH PEER-SUPPORT AND STORYTELLING - ABSTRACT EXACERBATIONS OF CHRONIC OBSTRUCTIVE PULMONARY DISEASE (COPD) LEAD TO ROUGHLY 1.5 MILLION ED VISITS AND 700,000 HOSPITALIZATIONS ANNUALLY. RECOVERY IS SLOW, AND ACCOMPANIED BY HIGH LEVELS OF ACUTE CARE UTILIZATION AND MORTALITY. PULMONARY REHABILITATION (PR) IS A STRUCTURED PROGRAM OF EXERCISE AND SELF-MANAGEMENT SUPPORT THAT HAS BEEN SHOWN TO RELIEVE DYSPNEA AND IMPROVE QUALITY OF LIFE. CLINICAL GUIDELINES RECOMMEND PR FOR PATIENTS WITH STABLE COPD AND AFTER AN EXACERBATION. UNFORTUNATELY, EVEN WHEN REFERRED BY PHYSICIANS, OUR RESEARCH HAS SHOWN THAT FEW PATIENTS WHO MIGHT BENEFIT FROM PR EVER BEGIN TREATMENT. THE PRIMARY GOAL OF THIS PROJECT IS TO IDENTIFY EFFECTIVE STRATEGIES FOR PROMOTING AND SUSTAINING PARTICIPATION IN PR. PEER SUPPORT INVOLVES PAIRING A PATIENT WITH A TRAINED PEER FROM A SIMILAR BACKGROUND, AND FACING SIMILAR HEALTH CHALLENGES, WHO HAS COMPLETED PR. THERE IS A GROWING BODY OF EVIDENCE DEMONSTRATING THE FEASIBILITY, ACCEPTABILITY, AND EFFECTIVENESS OF TELEPHONIC PEER SUPPORT FOR CHRONIC DISEASE MANAGEMENT. NARRATIVE INTERVENTIONS, OR `STORYTELLING', ARE NOVEL APPROACHES FOR CHANGING ATTITUDES AND BEHAVIORS OF PATIENTS THAT INVOLVE CREATING AND DISSEMINATING VIDEOS NARRATED BY INDIVIDUALS WITH LIVED EXPERIENCE WITH THE SAME CONDITION OR FACING THE SAME TREATMENT. STORYTELLING INTERVENTIONS HAVE BEEN SHOWN TO HELP PATIENTS ACHIEVE BETTER BLOOD PRESSURE CONTROL, AND STORYTELLING IS BEING STUDIED IN A VARIETY OF OTHER CLINICAL CONTEXTS. IN THE R61 PHASE, WE WILL RECRUIT AND TRAIN A COHORT OF PEER COACHES IN BEHAVIOR CHANGE TECHNIQUES, AND WILL RECRUIT A DIVERSE GROUP OF STORYTELLERS, CAPTURE THEIR NARRATIVES ON VIDEO, AND CREATE A LIBRARY OF 6-8 POWERFUL STORIES. WE WILL FINALIZE OUR PROTOCOL, TRIAL INFRASTRUCTURE, AND PILOT OUR RECRUITMENT STRATEGY. DURING THE R33 PHASE, WE WILL RECRUIT 305 ADULTS TREATED FOR EXACERBATION OF COPD, AND RANDOMIZE THEM TO 1) ENHANCED “USUAL CARE” (EUC); 2) EUC + STORYTELLING; OR 3) EUC + PEER SUPPORT. WE WILL EVALUATE THE EFFECTIVENESS OF EACH STRATEGY COMPARED TO EUC, AND TO EACH OTHER, AT PROMOTING PARTICIPATION IN PR AT 6 MONTHS. USING A MIXED-METHODS APPROACH, WE WILL EVALUATE INTERVENTION ACCEPTABILITY, SUSTAINABILITY, AND COST, FROM THE PERSPECTIVES OF THE PATIENTS AND PEER COACHES AS WELL AS PR PROGRAM STAFF AND HOSPITAL LEADERSHIP. WE WILL USE THESE FINDINGS TO REFINE THE STRATEGIES AND TO DISSEMINATE AN IMPLEMENTATION PACKAGE THAT WILL ENABLE OTHER PR PROGRAMS TO ADOPT THESE APPROACHES. THIS PROJECT ENGAGES KEY STAKEHOLDERS IN STUDY CONCEPTUALIZATION, EXECUTION, AND DISSEMINATION, AND IS RESPONSIVE TO THE NHLBI/CDC COPD NATIONAL ACTION PLAN THAT CALLS FOR THE DEVELOPMENT OF STRATEGIES TO INCREASE THE NUMBER OF AMERICANS THAT BENEFIT FROM PR.

IMPLEMENTING EFFECTIVE SMOKING CESSATION PHARMACOTHERAPY FOR HOSPITALIZED SMOKERS WITH CARDIOPULMONARY DISEASE - PROJECT SUMMARY TOBACCO USE REMAINS THE LEADING CAUSE OF DEATH IN THE UNITED STATES AND CONTRIBUTES TO MORE THAN 7 MILLION HOSPITALIZATIONS ANNUALLY. HOSPITALIZATION OFFERS A CRITICAL WINDOW FOR INTERVENTION: HOSPITAL POLICIES PROHIBIT SMOKING, PATIENTS ARE HIGHLY MOTIVATED TO QUIT, AND SOCIETAL GUIDELINES RECOMMEND THAT CLINICIANS SHOULD COUNSEL PATIENTS AND PRESCRIBE SMOKING CESSATION PHARMACOTHERAPY (SCP) TO VIRTUALLY ALL SMOKERS. NEVERTHELESS, ONLY 22% OF PATIENTS ARE EVER PRESCRIBED SCP WHILE HOSPITALIZED AND ONLY 1% OF PATIENTS ARE PRESCRIBED GUIDELINE-CONCORDANT SCP. THIS FAILURE ULTIMATELY CONTRIBUTES TO A 70-80% SMOKING RELAPSE RATE, MOST OF WHICH OCCURS WITHIN A FEW DAYS OF HOSPITAL DISCHARGE – WELL BEFORE OUTPATIENT FOLLOW-UP CAN OCCUR. IF WE ARE TO CAPITALIZE ON THE OPPORTUNITY THAT HOSPITALIZATION PROVIDES TO MAXIMIZE SMOKING CESSATION TREATMENT AND OUTCOMES, NEW STRATEGIES ARE NEEDED TO OVERCOME THE LOW UPTAKE OF GUIDELINE-CONCORDANT SCP BY PHYSICIANS AND PATIENTS. TO ADDRESS THIS PROBLEM, WE PROPOSE TO DEPLOY A NURSE PRACTITIONER-LED, HOSPITAL- BASED TOBACCO TREATMENT TEAM TO: 1) PRESCRIBE INDIVIDUALLY TAILORED AND GUIDELINE-CONCORDANT SCP; 2) COUNSEL AND MOTIVATE PATIENTS TO USE SCP PROPERLY; AND 3) AND MANAGE A MOBILE PHONE-BASED TEXT-MESSAGING SYSTEM TO KEEP PATIENTS MOTIVATED AND ADHERENT TO SCP. OUR PRELIMINARY DATA SUGGEST THAT SUCH AN APPROACH IS FEASIBLE AND ACCEPTABLE TO PATIENTS, PHYSICIANS, AND HOSPITAL ADMINISTRATORS. IN AIM 1, WE WILL PERFORM A PARALLEL-GROUP IMPLEMENTATION-EFFECTIVENESS RANDOMIZED TRIAL AMONG 424 HOSPITALIZED SMOKERS WITH A CARDIOPULMONARY DISEASE IN A LARGE TERTIARY HOSPITAL. WE WILL COMPARE RATES OF SCP USE AND SMOKING CESSATION BETWEEN PATIENTS WHO RECEIVED THE INTERVENTION AND THOSE WHO DID NOT. IN AIM 2, WE WILL MEASURE THE ECONOMIC VALUE OF THE INTERVENTION FROM BOTH A HOSPITAL AND PAYER PERSPECTIVE TO BETTER INFORM HOSPITAL AND INSURANCE POLICIES AND SUSTAINABILITY. IN AIM 3, WE WILL PERFORM QUALITATIVE INTERVIEWS WITH PATIENTS, PHYSICIANS, STAFF MEMBERS, AND HOSPITAL ADMINISTRATORS TO EVALUATE THE ACCEPTABILITY AND SUSTAINABILITY OF OUR STRATEGIES. WE HYPOTHESIZE THAT OUR INTERVENTION WILL: IMPROVE GUIDELINE-CONCORDANT SCP USE; INCREASE 6- MONTH SMOKING CESSATION RATES; BE ACCEPTABLE TO PATIENTS, CLINICIANS, AND ADMINISTRATORS; AND BE COST-EFFECTIVE AND SUSTAINABLE. OUR MULTI-DISCIPLINARY TEAM HAS BROAD EXPERIENCE IN CARDIOPULMONARY MEDICINE, TOBACCO TREATMENT, IMPLEMENTATION SCIENCE, MEDICATION ADHERENCE, QUALITATIVE METHODS, HEALTH ECONOMICS, AND TEXT MESSAGE TECHNOLOGY. AT THE CONCLUSION OF THIS GRANT, OUR TEAM WILL DEVELOP A DETAILED, EVIDENCE-INFORMED IMPLEMENTATION GUIDE FOR A HOSPITAL-BASED TOBACCO TREATMENT TEAM. ULTIMATELY, WE ANTICIPATE THE KNOWLEDGE GAINED FROM THIS STUDY WILL FACILITATE WIDESPREAD AND EFFECTIVE HOSPITAL-BASED TOBACCO TREATMENT SO THAT MORE PATIENTS LEAD LIVES FREE FROM TOBACCO AND CARDIOPULMONARY DISEASE.

CHILD ADVOCACY TRAINING AND SUPPORT CENTER (CATS) - THE CHILD ADVOCACY TRAINING AND SUPPORT CENTER (CATS) AT BAYSTATE MEDICAL CENTER WILL COORDINATE AND CONSOLIDATE THE VAST RESOURCES AND EXPERTISE OF THE NATIONAL CHILD TRAUMATIC STRESS NETWORK (NCTSN) TO SUPPORT CHILD ADVOCACY CENTERS (CACS) IN MEETING THEIR MISSION AND THE NATIONAL CHILDREN’S ALLIANCE’S (NCA) STANDARDS FOR ACCREDITED MEMBERS WITH THE PRIMARY GOAL OF INCREASING ACCESS TO TRAUMA INFORMED SERVICES FOR CHILDREN AND THEIR FAMILIES. THE CATS CENTER TEAM, IN PARTNERSHIP WITH NATIONAL EXPERTS ON CAC SERVICE DELIVERY, EVIDENCE-BASED TREATMENT (EBT) TRAUMA CURRICULUM DEVELOPERS, AND STAKEHOLDERS REPRESENTING EACH MULTIDISCIPLINARY TEAM (MDT) DISCIPLINE WILL IMPLEMENT COMPREHENSIVE, COORDINATED CAPACITY-BUILDING EFFORTS FOCUSED ON DISSEMINATION OF TRAUMA-FOCUSED EBTS. THE CATS CENTER WILL BE THE VEHICLE FOR DISSEMINATION OF TRAUMA INFORMED CARE (TIC) ACROSS THE CAC SYSTEM, EMBEDDED WITHIN THE MDT MODEL IN A WAY THAT WILL PROMOTE COMPREHENSIVE TIC AND SUSTAINABILITY, EFFECTIVELY IMPACTING THE 350,000 YOUTH WHO ARE SERVED THROUGH CACS ANNUALLY. THE CATS CENTER WILL ACHIEVE THIS IN THE FOLLOWING WAYS: 1) ESTABLISH A NATIONAL TRAINING CENTER TO SUPPORT CACS IN ENSURING THEIR MDT MEMBERS ARE TRAUMA-INFORMED AND HAVE SPECIALIZED TOOLS, SKILLS, AND RESOURCES FOR EFFECTIVE SERVICE DELIVERY BY LEVERAGING EXISTING EXPERTISE AND PARTNERSHIPS. 2) INCREASE SYSTEM CAPACITY AND COMPETENCIES OF THE CAC MDT PROFESSIONALS’ (I.E., MEDICAL, MENTAL HEALTH, LAW ENFORCEMENT, CHILD-WELFARE, VICTIM ADVOCATES) TRAUMA-INFORMED RESPONSE USING A LEARNING COLLABORATIVE MODEL AND SPECIALIZED CURRICULUM SPECIFIC TO EACH DISCIPLINE. (MEETING 8 HOURS OF CHILD ABUSE TRAINING OUTLINED AS AN ESSENTIAL COMPONENT IN THE STANDARDS) 3. INCREASE AVAILABILITY OF TRAINING IN EBTS, SUCH AS TRAUMA-FOCUSED COGNITIVE-BEHAVIORAL THERAPY TO MENTAL HEALTH PROFESSIONALS WITHIN CACS (MEETING 40 HOURS OF TRAINING IN EBTS ANOTHER ESSENTIAL COMPONENT OF THE STANDARDS). 3) SUPPORTING SUSTAINABILITY OF TIC THROUGHOUT CAC MDTS BY SERVING AS A CONTINUING RESOURCE FOR TRAINING, CONSULTATION, AND TECHNICAL ASSISTANCE TO CAC MDTS FOR 6 MONTHS AFTER THEIR INITIAL ILC AND PROVIDING ADDITIONAL TRAINING AND CONSULTATION REGARDING PRIORITY AREAS SUCH AS COMMERCIAL SEXUAL EXPLOITATION AND TRAFFICKING, PROBLEM SEXUAL BEHAVIORS, SCREENING AND ENGAGEMENT, AND SECONDARY TRAUMATIC STRESS PREVENTION. 4) DEVELOP AND CONSOLIDATE NCTSN PRODUCTS SPECIFICALLY FOR CAC SERVICE SYSTEMS SUCH AS FACTSHEETS AND WEBINARS, AND CREATE A SPECIFIC LOCATION FOR THESE RESOURCES ON THE NCTSN WEBSITE FOR EASE OF ACCESSIBILITY, WITH LINKAGE TO NCA. THE CATS CENTER WILL REACH 80% OF ALL CACS THROUGH TRAINING AND RESOURCE DISTRIBUTION WITH EMPHASIS ON SELECTING CACS THAT ARE UNDER RESOURCED OR ATTEMPTING TO MEET THE NCA’S STANDARDS FOR ACCREDITED MEMBERS.

AFFORDABLE CARE ACT: PRIMARY CARE RESIDENCY EXPANSION

SURVIVING TRAUMA WITH EVIDENCE-BASED PRACTICES (STEP)

A MIXED METHODS STUDY TO ANALYZE THE USE OF PULMONARY REHABILITATION FOLLOWING HOSPITALIZATION FOR COPD, AND TO IDENTIFY EFFECTIVE STRATEGIES FOR INCREASING RATES OF PARTICIPATION

SYSTEM FACTORS INFLUENCING THE POSTPARTUM TRANSITION TO PRIMARY CARE FOR CARDIOVASCULAR DISEASE RISK MANAGEMENT AMONG WOMEN WITH HYPERTENSIVE DISORDERS IN PREGNANCY - PROJECT SUMMARY CARDIOVASCULAR DISEASE (CVD) IS THE LEADING CAUSE OF DEATH AMONG WOMEN IN THE UNITED STATES. WOMEN WHO EXPERIENCE HYPERTENSIVE DISORDERS IN PREGNANCY (HDP), INCLUDING CHRONIC HYPERTENSION, GESTATIONAL HYPERTENSION, AND PRE-ECLAMPSIA/ECLAMPSIA, FACE SUBSTANTIALLY HIGHER FUTURE CVD RISK. ABOUT ONE IN SEVEN WOMEN EXPERIENCE HDP BY THE END OF THEIR CHILDBEARING YEARS, WITH HIGHER RATES AMONG WOMEN OF COLOR. TRANSITIONING TO PRIMARY CARE POSTPARTUM IS RECOMMENDED FOR ALL WOMEN, BUT HAS PARTICULAR URGENCY FOR WOMEN WITH HDP. WOMEN WITH HDP HAVE A HIGH RISK OF ADVERSE OUTCOMES IN THE IMMEDIATE POSTPARTUM PERIOD (E.G. MATERNAL MORBIDITY AND MORTALITY), ONE TO THREE YEARS POSTPARTUM (E.G., HYPERTENSION, METABOLIC SYNDROME ONSET), AND LONG-TERM (E.G. ISCHEMIC HEART DISEASE, HEART FAILURE, STROKE). THE LIMITED EXISTING RESEARCH ON POSTPARTUM PRIMARY CARE UTILIZATION SHOWS THAT UP TO 80% OF WOMEN WHO EXPERIENCED HDP DO NOT RECEIVE PRIMARY CARE IN THE YEAR FOLLOWING BIRTH. PRIMARY CARE IS AN APPROPRIATE SETTING FOR SHORT AND LONG-TERM CVD RISK MANAGEMENT, INCLUDING IDENTIFICATION AND TREATMENT OF HYPERTENSION AND HYPERLIPIDEMIA. HOWEVER, LITTLE IS KNOWN ABOUT THE PRIMARY CARE PROVIDED FOR POSTPARTUM WOMEN WITH HDP AND WHETHER IT RESPONDS TO THEIR HEIGHTENED CVD RISK. DESPITE LOW RATES OF POSTPARTUM TRANSITION TO PRIMARY CARE FOR WOMEN WITH HDP, LITTLE IS KNOWN ABOUT HOW SYSTEMS FACTORS IMPACT THIS TRANSITION AND PRIMARY CARE CVD RISK ASSESSMENT AND MANAGEMENT IN THE POSTPARTUM YEAR. USING AN EXPLANATORY-SEQUENTIAL MIXED METHODS DESIGN, WE EXAMINE THE POSTPARTUM TRANSITION TO PRIMARY CARE FOR CVD RISK MANAGEMENT FOR WOMEN WITH HDP IN MASSACHUSETTS AND NATIONALLY. THESE AIMS ADDRESS NHLBI’S STRATEGIC OBJECTIVE TO “INVESTIGATE FACTORS THAT ACCOUNT FOR DIFFERENCES IN HEALTH AMONG POPULATIONS,” WHICH INCLUDES MANAGING CARDIOMETABOLIC RISK TO IMPROVE HEALTH TRAJECTORIES IN SEX-SPECIFIC POPULATIONS. THE SPECIFIC AIMS ARE 1) TO DETERMINE THE ROLE OF SYSTEMS FACTORS IN THE TRANSITION TO PREVENTIVE PRIMARY CARE FOR WOMEN WITH HDP IN THE POSTPARTUM YEAR; 2) TO CHARACTERIZE AND EXAMINE CLINICIAN AND ORGANIZATIONAL FACTORS INFLUENCING CARDIOMETABOLIC RISK ASSESSMENT AND MANAGEMENT IN PRIMARY CARE IN THE POSTPARTUM YEAR; AND 3) TO IDENTIFY ORGANIZATIONAL AND CONTEXTUAL FACTORS SHAPING THE POSTPARTUM TRANSITION TO PRIMARY CARE AND CVD RISK MANAGEMENT IN PRIMARY CARE. WITH INPUT FROM A MULTI-STAKEHOLDER ADVISORY BOARD, WE WILL INTEGRATE RESULTS ACROSS AIMS TO DEVELOP PRACTICE AND POLICY RECOMMENDATIONS TO IMPROVE CARE QUALITY FOR WOMEN WITH HDP TO REDUCE FUTURE CVD RISK. RESULTS FROM THIS STUDY WILL CONTRIBUTE TO AN IMPROVED UNDERSTANDING OF SYSTEMS FACTORS ASSOCIATED WITH SUCCESSFUL TRANSITION TO POSTPARTUM PRIMARY CARE FOR WOMEN AT HIGH CVD RISK, AND HELP TO IDENTIFY INTERVENTIONS, HEALTHCARE QUALITY METRICS, AND POLICY LEVERS TO IMPROVE CLINICAL PRACTICE.

CASE MANAGEMENT FOR UNDERSERVED HISPANIC TYPE 2 DIABETES POPULATIONS

IMPROVING OUTCOMES FROM CARDIAC REHABILITATION AMONG OLDER ADULTS THROUGH EXERCISE TESTING AND INDIVIDUALIZED EXERCISE INTENSITY PRESCRIPTIONS - PROJECT SUMMARY HEART DISEASE AND ITS TREATMENTS, INCLUDING HOSPITALIZATION, SURGERY, AND PROCEDURES, CAN RESULT IN DEVASTATING LOSS OF FUNCTION, PARTICULARLY IN INACTIVE OLDER ADULTS, WHO OFTEN FACE A PROLONGED RECOVERY. MAXIMIZING FITNESS AND PROMOTING ADEQUATE PHYSICAL ACTIVITY (PA) ARE CRITICAL TARGETS FOR HEALTHY AGING AND RECOVERY AFTER A CARDIAC EVENT. CARDIAC REHABILITATION (CR) PROVIDES UP TO 36 SUPERVISED EXERCISE TRAINING SESSIONS AND LIFESTYLE COUNSELING TO THESE PATIENTS AND IS THUS IDEALLY POSITIONED TO PROMOTE FULL RECOVERY, ENCOURAGE REGULAR PA, OPTIMIZE CARDIAC HEALTH, AND SUPPORT MORE SUCCESSFUL AGING FOR THESE PATIENTS. HOWEVER, MANY CR PROGRAMS FAIL TO MEET ESTABLISHED BENCHMARKS FOR IMPROVING FITNESS AMONG THEIR PATIENTS. THIS FAILURE IS LIKELY ATTRIBUTABLE TO MARKED DIFFERENCES IN EXERCISE INTENSITY PRESCRIPTION PRACTICES ACROSS CR PROGRAMS, WHICH HAVE RECENTLY BEEN IDENTIFIED. SPECIFICALLY, THE MOST COMMON METHOD FOR PRESCRIBING EXERCISE INTENSITY IN CR IS THE USE OF RATINGS OF PERCEIVED EXERTION (RPE) COUPLED WITH A “RULE OF THUMB” APPROACH TO ACHIEVE AN EXERCISE TRAINING HEART RATE (HR) THAT IS 20-30 BPM HIGHER THAN RESTING HR. WHILE EASY TO IMPLEMENT, THESE USUAL CARE (UC) TECHNIQUES OFTEN RESULT IN A SELF-SELECTED AND SUBOPTIMAL EXERCISE INTENSITY. THIS, IN TURN, LEADS TO LOWER GAINS IN FITNESS AND FAILURE TO REACH ESTABLISHED BENCHMARKS. INSTEAD, SOCIETAL GUIDELINES RECOMMEND PATIENTS UNDERGO A GRADED EXERCISE TEST (GXT) TO MEASURE A PEAK EXERCISE HR AND BE PRESCRIBED EXERCISE INTENSITY USING A COMPUTED TARGET HEART RATE RANGE (THRR). THIS APPROACH (GXT-THRR) ALLOWS TAILORING OF EXERCISE BASED ON THE INDIVIDUAL PATIENT’S RESPONSE TO ACUTE EXERCISE. HOWEVER, NO STUDIES TO DATE HAVE TESTED THE EFFICACY OF GXT- THRR COMPARED TO UC, AND THIS CRITICAL KNOWLEDGE GAP IS LIKELY RESPONSIBLE FOR THE MARKED DIFFERENCES IN EXERCISE INTENSITY PRESCRIPTION TECHNIQUES ACROSS PROGRAMS. OUR PRELIMINARY DATA SUGGEST GXT-THRR WILL LEAD TO GREATER GAINS IN FITNESS IN CR, BOOST SELF-EFFICACY, REDUCE FEAR OF EXERCISE, AND IMPROVE OUTCOMES. TO ADDRESS THIS FUNDAMENTAL QUESTION, WE WILL PERFORM A 320-PERSON RANDOMIZED TRIAL COMPARING GXT- THRR TO UC AMONG OLDER ADULTS WITH HEART DISEASE ATTENDING CR. IN AIM 1, WE WILL MEASURE IMPROVEMENTS IN FITNESS DURING CR. IN AIM 2, WE WILL ASSESS THE IMPACT OF GXT-THRR ON PSYCHOLOGICAL FACTORS ASSOCIATED WITH EXERCISE ADHERENCE (SELF-EFFICACY AND FEAR). IN AIM 3, WE WILL EVALUATE HOW THE USE OF GXT-THRR IMPACTS LONG-TERM PA, QUALITY OF LIFE, FITNESS, AND CLINICAL OUTCOMES. OUR MULTI-DISCIPLINARY TEAM HAS BROAD EXPERIENCE IN ALL ASPECTS OF THIS PROPOSAL, INCLUDING EXERCISE PHYSIOLOGY, CR, CARDIOLOGY, GERIATRICS, AND PSYCHOLOGY. OUR APPROACH IS INFORMED BY A SUCCESSFUL PILOT TRIAL WHICH DEMONSTRATED THE CLEAR FEASIBILITY AND POTENTIAL EFFECTIVENESS OF GXT-THRR. ULTIMATELY, WE ANTICIPATE OUR RESULTS WILL PROMOTE EVIDENCE-BASED EXERCISE INTENSITY PRACTICES IN CR PROGRAMS, LEADING TO GREATER IMPROVEMENTS IN FITNESS, PA, AND EXERCISE SELF-EFFICACY, AND MORE SUCCESSFUL AGING.

ACUTE LUNG INJURY GROUP NEW ENGLAND PROGRAM TO SUPPORT PETAL NETWORK RESEARCH

PARTNERS IN CARE: COMMUNITY-BASED IMPLEMENTATION OF EBT

BRIDGE IN MOTION - BAYSTATE MEDICAL CENTER, THE HAMPDEN COUNTRY SHERIFF'S DEPARTMENT, CODAC, HOLYOKE HEALTH CENTER, CARING HEALTH CENTER AND THE CENTER FOR ADDICTION RECOVERY WILL COLLABORATE ON BRIDGE IN MOTION, EXPANDING ACCESS TO MEDICATION ASSISTED TREATMENT (MAT) IN JAIL/TREATMENT AND AFTER RELEASE TO HAMPDEN COUNTY SHERIFF'S DEPARTMENT FACILITIES' OFFENDERS AND CIVILLY COMMITTED WITH AN OPIOID USE DISORDER (OUD) IN WESTERN MASSACHUSETTS. OUR POPULATION OF FOCUS IS MEN AND WOMEN, 18 YEARS AND OLDER, WHO HAVE AN OUD, AND ARE WITHIN FOUR MONTHS OF SCHEDULED RELEASE FROM HAMPDEN COUNTY SHERIFF'S DEPARTMENT (HCSD) TO RETURN TO THEIR COMMUNITY IN HAMPDEN COUNTY, MA. THIS INCLUDES INDIVIDUALS WHO ARE IN TREATMENT FUR TO CIVIL COMMITMENT FOR OUD, INDIVIDUALS WHO ARE PRETRIAL WITH A BAIL OF $5,000 OR LESS, AND INDIVIDUALS WHO ARE INCARCERATED FOR A CRIMINAL OFFENSE. OUR DESIRED OUTCOMES ARE: 10 AN INCREASE IN THE NUMBER OF INDIVIDUALS RECEIVING MAT BEFORE AND AFTER RELEASE AND 2) A DECREASE IN ILLICIT OPIOID DRUG USE AND PRESCRIPTION OPIOID DRUG MISUSE AT THREE AND SIX MONTHS POST RELEASE. THE SHERIFF'S DEPARTMENT'S ELECTRONIC MEDICAL RECORD SYSTEM SHOWS AN OUD PREVALENCE RATE OF 40% FOR MEN AND 53% FOR WOMEN. OVER TWO-THIRDS OF THE NEWLY RELEASED PERSONS WITH AN OPIOID DISORDER WILL SEEK TO ENGAGE IN TREATMENT SERVICES WHEN THEY RETURN TO THEIR HOME COMMUNITY. RISK OF OPIOID OVERDOSE IN MARKEDLY INCREASED FOLLOWING RELEASE FROM INCARCERATION/COMMITMENT. CASE MANAGEMENT STAFF WILL SERVE AS THE CRUCIAL LINK TO COMPREHENSIVE PSYCHOSOCIAL AND HEALTH CARE SUPPORT SERVICES, INCLUDING PRIMARY HEALTH CARE, MENTAL HEALTH CARE AND PEER SUPPORT PROGRAMS TO SUSTAIN TREATMENT AND RECOVERY. WE WILL USE THE EVIDENCE-BASED CRITICAL TIME INTERVENTION (CTI) PROGRAM MODEL, WHICH INVOLVES TWO COMPONENTS: 1) STRENGTHENING THE INDIVIDUAL'S LONG-TERM TIES TO SERVICES, FAMILY AND FRIENDS; AND 2)PROVIDING EMOTIONAL AND PRACTICAL SUPPORT DURING THE TRANSITION BACK TO THE COMMUNITY. IT IS EXPECTED THAT CONTINUATION OF MAT SERVICES AND OPIOID USE ABSTINENCE AFTER RELEASE WILL INCREASE WITH INTENSIVE CASE MANAGEMENT AND COMMUNITY SUPPORT. WE WILL ALSO USE MOTIVATIONAL INTERVIEWING. THROUGH THE BRIDGE IN MOTION PROGRAM, WE AIM TO IMPROVE OVERALL HEALTH BY PROVIDING A COMPREHENSIVE NETWORK OF SUBSTANCE USE AND MENTAL HEALTH TREATMENT AND RECOVERY SUPPORT SERVICES THAT WILL REDUCE THE LIKELIHOOD OF RECIDIVISM. EACH YEAR OF THE GRANT PERIOD, WE WILL SERVE 50 CLIENTS. THE TOTAL NUMBER OF UNDUPLICATED INDIVIDUALS WE WILL SERVE OVER THE FIVE-YEAR GRANT PERIOD IS 250.

IMPLEMENTATION AND OUTCOMES OF NONINVASIVE VENTILATION IN COPD

BAYSTATE BEHAVIORAL HEALTH CENTER FOR YOUNG CHILDREN AND FAMILIES (CYCAF) - THE BAYSTATE BEHAVIORAL HEALTH CENTER FOR YOUNG CHILDREN AND FAMILIES (CYCAF) AT BAYSTATE HEALTH HAS THE OVERARCHING GOAL OF ADDRESSING CRITICAL GAPS IN SERVICES FOR INFANTS AND YOUNG CHILDREN AGES 0-5, PRIORITIZING LATINO CHILDREN, WHO SHOW EARLY SIGNS OF OR WHO HAVE BEEN DIAGNOSED WITH MENTAL ILLNESS INCLUDING SERIOUS EMOTIONAL DISTURBANCE (SED) AND/OR SYMPTOMS THAT MAY BE INDICATIVE OF DEVELOPING SED, INCLUDING CHILDREN WITH A HISTORY OF IN-UTERO EXPOSURE TO SUBSTANCES AND THEIR CAREGIVERS. CYCAF WILL ACHIEVE THIS GOAL IN THE FOLLOWING OVERLAPPING PHASES: 1. INCREASING ACCESS TO ASSESSMENTS AND EVIDENCED BASED PRACTICES (EBP) FOR TREATMENT OF EARLY CHILDHOOD MENTAL HEALTH CONCERNS FOR CHILDREN 0-5 Y/O AND THEIR CAREGIVERS BY PROVIDING TRAUMA INFORMED MENTAL HEALTH ASSESSMENTS (350 ASSESSMENTS OVER THE COURSE OF THE PROJECT), MULTIGENERATIONAL EVIDENCED-BASED THERAPY (250 CHILDREN AND FAMILIES SERVED OVER THE COURSE OF THE PROJECT) AND ACCESS TO A PEER NAVIGATOR WITH LIVED EXPERIENCE TO HELP ENGAGEMENT, COORDINATION OF SERVICES AND PROVIDE SHORT TERM FOLLOW UP (SERVING 375 FAMILIES OVER THE COURSE OF THE PROJECT). 2. PROVIDING SPECIALIZED IECMH CONSULTATION TO EARLY CHILDHOOD EDUCATIONAL PROGRAMS INCLUDING DIRECT CARE WORKERS (50 GROUP CONSULTATIONS A YEAR USING REFLECTIVE SUPERVISION TO IMPROVE ENGAGEMENT AND DECREASE BURNOUT IN STAFF, 500 CHILDREN SERVED THOUGH ON-DEMAND CLASSROOM CONSULTATION) AND BUILDING THE CAPACITY OF INFANT AND EARLY CHILD-SERVING SERVICE SYSTEMS (CSSS) TO IDENTIFY, RESPOND EFFECTIVELY TO, AND PREVENT MENTAL ILLNESS IN CHILDREN 0-5Y/O WHO ARE AT RISK FOR OR HAVE BEEN DIAGNOSED WITH MENTAL ILLNESS AND THEIR CAREGIVERS BY PROVIDING TRAINING IN THE DIAGNOSTIC CLASSIFICATION OF MENTAL HEALTH AND DEVELOPMENTAL DISORDERS OF INFANCY AND EARLY CHILDHOOD (DC-0-5), COLLABORATIVE PROBLEM SOLVING, AND SPECIAL TOPICS RELATED TO THE TARGET POPULATION (890 CSSS PROFESSIONALS TRAINED OVER THE COURSE OF THE PROJECT). 3. STRENGTHENING IECMH COMPETENCE IN THE MENTAL HEALTH WORKFORCE AT ALL STAGES OF CAREER IN ORDER TO PROMOTE SUSTAINABILITY BY PROVIDING TRAINING IN THE FOLLOWING EBPS: PARENT-CHILD PSYCHOTHERAPY, COLLABORATIVE PROBLEM SOLVING, MOTHERING FROM THE INSIDE OUT, AS WELL AS DC 0-5 FOR CLINICAL PROFESSIONALS (122 MENTAL HEALTH PROVIDERS TRAINED IN THE COURSE OF THE GRANT) AND INCORPORATING IECHM DIDACTICS IN MENTAL HEALTH HIGHER EDUCATIONAL LEVELS (PSYCHIATRY RESIDENTS AND FELLOWS, PSYCHOLOGY AND SOCIAL WORK STUDENTS) AND CREATING CYCAF ROTATIONS FOR TWO CHILD PSYCHIATRY FELLOWS AND TWO PSYCHOLOGY DOCTORAL STUDENTS A YEAR IN ORDER TO PROMOTE INTEREST AND INCREASE COMPETENCY EARLY IN THEIR CAREERS. THUS, CYCAF WILL ADDRESS CRITICAL GAPS IN SERVICES FOR INFANTS AND YOUNG CHILDREN WITH BEHAVIORAL HEALTH NEEDS WITH THE ULTIMATE GOAL TO ACHIEVE BETTER LONG-TERM OUTCOMES FOR CHILDREN AND CAREGIVERS BY IDENTIFYING, AND INTERVENING WITH, CHILDREN AT AN EARLY AGE IN ORDER TO PREVENT THE DEVELOPMENT OF SED.

BUILDING RESILIENCY IN YOUNG CHILDREN (BRYC) - THE BUILDING RESILIENCY IN YOUNG CHILDREN (BRYC) PROGRAM AT BAYSTATE MEDICAL CENTER HAS THE OVERARCHING GOAL OF IMPROVING ACCESS TO AND QUALITY OF TRAUMA-INFORMED SERVICES FOR ALL CHILDREN 0-5 YEARS OLD, PRIORITIZING LATINO CHILDREN, WHO SHOW EARLY SIGNS OF OR WHO HAVE BEEN DIAGNOSED WITH MENTAL ILLNESS DUE TO ADVERSE LIFE EXPERIENCE, INCLUDING NEGLECT SECONDARY TO PARENTAL SUBSTANCE MISUSE OR MULTIGENERATIONAL TRAUMA, AND THEIR CAREGIVERS. BRYC WILL ACHIEVE THIS GOAL IN THE FOLLOWING OVERLAPPING PHASES: 1. INCREASE COMMUNITY-LEVEL OUTREACH AND ENGAGEMENT IN ORDER TO RAISE AWARENESS OF EARLY CHILDHOOD TRAUMA AND IMPROVE IDENTIFICATION OF CHILDREN 0-5 Y/O EXHIBITING EARLY SIGNS OF MENTAL HEALTH NEEDS. THIS WILL BE DONE BY COLLABORATING WITH EXISTING INFANT AND EARLY CHILDHOOD SYSTEMS OF CARE ALREADY IN EXISTENCE TO PROVIDE EDUCATIONAL OPPORTUNITIES AND SHARING OF RESOURCES. 2. EXPAND ACCESS TO AND COORDINATION OF TRAUMA-INFORMED EARLY CHILDHOOD MENTAL HEALTH SERVICES FOR CHILDREN 0-5Y/O AND THEIR CAREGIVERS BY PROVIDING TRAUMA-INFORMED MENTAL HEALTH ASSESSMENTS (450 ASSESSMENTS OVER THE COURSE OF THE PROJECT), EVIDENCE-BASED TRAUMA-INFORMED THERAPY (400 CHILDREN AND FAMILIES SERVED OVER THE COURSE OF THE PROJECT), AND PSYCHOEDUCATION GROUPS FOR FOSTER PARENTS AND BIOLOGICAL CAREGIVERS, IN ORDER TO PROMOTE RESILIENCE WITHIN THE NATURAL SUPPORT SYSTEM. ADDITIONALLY, BRYC WILL ENSURE THAT ALL CHILDREN RECEIVING A NEEDS ASSESSMENT ARE REFERRED TO APPROPRIATE SERVICES (410 CHILDREN OVER THE COURSE OF THE PROJECT). 3. BUILD THE CAPACITY OF CHILD-SERVING SERVICE SYSTEMS TO IDENTIFY, RESPOND EFFECTIVELY TO, AND PREVENT TRAUMA IN CHILDREN 0-5Y/O WHO ARE AT RISK FOR OR HAVE EXPERIENCED TRAUMA AND THEIR CAREGIVERS. BRYC WILL USE NCTSN DEVELOPED TRAUMA-INFORMED CURRICULUM TO INCREASE THE TRAUMA-INFORMED PRACTICE WITHIN EARLY CHILDHOOD CHILD-SERVING SYSTEMS. ADDITIONALLY, CONSULTATION IN SPECIALTY TOPICS ENSURING CULTURAL COMPETENT CARE OF LATINO CHILDREN AND FAMILIES AFTER TRAUMA, WORKING WITH CAREGIVERS RECOVERING FROM SUBSTANCE MISUSE, AND SUPPORTING RESILIENCE IN YOUNG CHILDREN WILL BE PROVIDED TO IMPROVE COMPETENCE OF PROFESSIONALS WORKING WITH THE TARGET POPULATION (800 TOTAL PROFESSIONALS WILL RECEIVE THIS SUPPORT). LASTLY, TO SUPPORT SUSTAINABILITY IN THE CHILD SERVING WORKFORCE, INTERVENTIONS WILL BE PROVIDED REGARDING SECONDARY TRAUMATIC STRESS AND VICARIOUS TRAUMA. DURING THE COURSE OF THIS PROJECT 1260 CHILDREN WILL BE SERVED WITH TRAUMA-INFORMED EVIDENCE-BASED PRACTICES.

PVLSI BREAST CANCER RESEARCH PROGRAM: BIOMARKERS AND CHEMOPREVENTION

SPECIAL PROJECTS OF NATIONAL SIGNIFICANCE

IMPLEMENTATION OF INTERPROFESSIONAL TRAINING TO IMPROVE UPTAKE OF NONINVASIVE VENTILATION IN PATIENTS HOSPITALIZED WITH SEVERE COPD EXACERBATION

A TYPE I HYBRID EFFECTIVENESS-IMPLEMENTATION TRIAL OF "MOTHERING FROM THE INSIDE OUT" (MIO) - PROJECT SUMMARY/ABSTRACT MOTHERS WITH SUBSTANCE USE DISORDERS (SUDS) FACE UNIQUE CHALLENGES WITH RESPECT TO THE INTERSECTION OF PARENTING AND RECOVERY. FOR THIS REASON, THEY RARELY BENEFIT FROM EVIDENCE-BASED PARENTING INTERVENTIONS THAT HAVE BEEN BROUGHT TO SCALE WITH THE GENERAL PUBLIC OR CHILD BEHAVIORAL PROBLEMS IN MIND. A DIFFERENT APPROACH IS NEEDED. MOTHERING FROM THE INSIDE OUT (MIO) IS THE FIRST ATTACHMENT-BASED PARENTING INTERVENTION FOR MOTHERS WITH SUDS THAT TARGETS PARENTAL REFLECTIVE FUNCTIONING (RF). PARENTAL RF IS THE CAPACITY TO (A) IDENTIFY AND REGULATE EMOTIONS THAT ARE ACTIVATED DURING STRESSFUL PARENTING SITUATIONS AND (B) ACCURATELY RECOGNIZE AND UNDERSTAND YOUNG CHILDREN’S NEED FOR STABILITY, SECURITY, AND SENSITIVITY IN THE MOTHER-CHILD RELATIONSHIP. MIO HAS BEEN SHOWN TO HAVE BIGENERATIONAL BENEFIT BY IMPROVING PARENTAL RF, MATERNAL CAREGIVING, AND CHILDREN’S ATTACHMENT SECURITY WHILE ALSO REDUCING MATERNAL PSYCHIATRIC DISTRESS AND RELAPSE TO SUBSTANCE USE WHEN DELIVERED BY RESEARCHERS IN RANDOMIZED CLINICAL TRIALS WITH MOTHERS ENROLLED IN OUTPATIENT SUBSTANCE USE TREATMENT. HOWEVER, IN THE THIRD COMMUNITY-BASED EFFICACY TRIAL WHEN DELIVERED BY SUD TREATMENT COUNSELORS, MIO WAS NOT ASSOCIATED WITH THE SAME MAGNITUDE OF IMPROVEMENT IN RF OR CAREGIVING BEHAVIORS, RAISING IMPORTANT QUESTIONS ABOUT THE SCIENCE-TO-SERVICE GAP. THERE REMAINS A CRITICAL NEED TO UNDERSTAND THE IMPLEMENTATION FACTORS THAT MAY BE RELATED TO ENHANCED TREATMENT OUTCOMES FOR MIO WHEN DELIVERED UNDER ‘REAL-WORLD’ CONDITIONS. THEREFORE, WE PROPOSE TO TEST MIO’S EFFECTIVENESS WHEN DELIVERED IN FOUR SUBSTANCE USE TREATMENT PROGRAMS WHERE RESPONSIBILITY FOR MIO TRAINING AND DELIVERY WILL BE ASSUMED BY COMMUNITY-BASED TREATMENT PROVIDERS. WE ALSO PROPOSE TO CONDUCT AN IMPLEMENTATION EVALUATION TO EXAMINE KEY IMPLEMENTATION CONSTRUCTS WHEN INTEGRATED IN FOUR OUTPATIENT SUD TREATMENT CLINICS. IN THIS TYPE I HYBRID EFFECTIVENESS- IMPLEMENTATION STUDY, WE WILL (A) CONDUCT A RANDOMIZED EFFECTIVENESS TRIAL WHERE 200 MOTHERS WILL BE RANDOMIZED TO RECEIVE MIO PLUS STANDARD OUTPATIENT SUD SERVICES VERSUS STANDARD OUTPATIENT SUD SERVICES ALONE; (B) REPLICATE TESTING OF THE MIO MECHANISM OF CHANGE WITH A LARGER COHORT OF COUNSELORS AND CLIENTS; AND (C) ASSESS THE IMPACT OF KEY IMPLEMENTATION CONSTRUCTS ON REAL-WORLD DELIVERY OF MIO. DATA COLLECTED IN THE EFFECTIVENESS TRIAL AND THE IMPLEMENTATION EVALUATION WILL ALLOW US TO TEST CAUSAL EFFECTS AND MECHANISMS OF CHANGE WITHIN MIO UNDER NATURAL CONDITIONS WHILE ALSO GAINING GREATER UNDERSTANDING OF THE IMPLEMENTATION PROCESS TO GUIDE FUTURE LARGE-SCALE IMPLEMENTATION AND DISSEMINATION PROJECTS. MIO HAS DEMONSTRATED THE POTENTIAL TO INTERRUPT A PERNICIOUS CYCLE INVOLVING THE DISRUPTION OF EARLY ATTACHMENT RELATIONSHIPS THAT REPRESENTS RISK FOR THE HEALTH OF BOTH MOTHER AND CHILD. THIS TYPE I HYBRID EFFECTIVENESS-IMPLEMENTATION STUDY WILL ACCELERATE OUR PROGRESS IN BRINGING MIO TO SCALE WHILE ENSURING CONTINUED METHODOLOGICAL RIGOR AIMED AT OPTIMIZING TREATMENT OUTCOMES UNDER REAL-WORLD CONDITIONS.

BRIDGE II OFFENDER REENTRY PROGRAM

BAYSTATE ED COMPLEX ADDICTION AND PAIN SERVICE TEAM (BAYSTATE CAPS) - WITH A SAMHSA ED-ALT AWARD, BAYSTATE MEDICAL CENTER (BMC) IN SPRINGFIELD, MASSACHUSETTS WILL CREATE AND LAUNCH AN EMERGENCY DEPARTMENT BASED COMPLEX ADDICTION AND PAIN SERVICE (CAPS) TEAM. THE CAPS TEAM WILL BE A MULTIDISCIPLINARY TEAM OF MEDICAL PROFESSIONALS WITH THE GOAL OF IMPROVING CARE IN PAIN MANAGEMENT AND OUD IN THE BMC ED AND ADDRESSING CONTINUITY OF CARE AND FOLLOW UP DISPARITIES THAT IMPACT RESIDENTS OF HAMPDEN COUNTY, WHICH HAS SECOND HIGHEST OPIOID DISPENSING RATE AND THE HIGHEST RATE OF DRUG OVERDOSE DEATHS IN MASSACHUSETTS. IN THE THREE YEARS OF THE ED-ALT GRANT PROJECT, THE CAPS TEAM WILL SERVE MORE THAN 3,000 RESIDENTS, WITH A FOCUS ON THE HISPANIC COMMUNITY WHO HAS SUFFERED THE GREATEST IMPACT OF THE OPIOID EPIDEMIC AND THE HIGHEST RATES OF DRUG OVERDOSE DEATHS. THE CAPS TEAM WILL CONSIST OF A FULL-TIME NURSE PRACTITIONER WITH EXPERIENCE IN PAIN MANAGEMENT AND ADDICTION, A FULL TIME BILINGUAL (SPANISH/ENGLISH) SUBSTANCE USE DISORDER RECOVERY COACH, AND A PART TIME PHYSICIAN SUPERVISOR WITH EXPERIENCE IN BOTH EMERGENCY AND ADDICTION MEDICINE. SUPPORTING THE TEAM WILL BE A PART TIME PAIN MANAGEMENT PHYSICIAN, AN EMERGENCY DEPARTMENT CLINICAL PHARMACIST, HOSPITAL-BASED IT CONSULTANT, AND BIOSTATISTICIAN. THE PRIMARY ROLE OF THE CAPS TEAM WILL BE TO PROVIDE DIRECT CARE TO ED PATIENTS WITH COMPLEX PAINFUL CONDITIONS, THOSE ON CHRONIC OPIOID MEDICATIONS FOR PAIN, AND FOR PATIENTS WITH OUD. THE CAPS TEAM WILL ALSO EDUCATE ED STAFF ON PAIN MANAGEMENT OPIOID ALTERNATIVES, TREATMENT OF OUD AND CULTURALLY COMPETENT HARM REDUCTION STRATEGIES, AS WELL AS WORK WITH IT CONSULTANTS TO CREATE ELECTRONIC HEALTH RECORD (EHR) STRUCTURE AND PROGRAMS TO PROMOTE EVIDENCE BASED, CONSISTENT CARE.

PROJECT MOTION

QUALITY OF CARE AND OUTCOMES OF HEALTHCARE-ASSOCIATED PNEUMONIA

SOUTH CAROLINA CYBER GRIND

CANCER CENTER EQUIPMENT AND TECHNOLOGY FOR THE LOGAN REGIONAL HOSPITAL

TAS::89 0222::TAS PIONEER VALLEY LIFE SCIENCES INSTITUTE PROGRAM IN ENDOCRINOLOGY AND METABOLISM; PI: LAWRENCE SCHWARTZ

IDEAS FOR A HEALTHY BABY: REDUCING DISPARITIES IN CONSUMER USE OF QUALITY DATA

WITH FUNDING THROUGH THE OVC 2024 INTEGRATED SERVICES FOR MINOR VICTIMS OF HUMAN TRAFFICKING BAYSTATE MEDICAL CENTER, INC LOCATED IN SPRINGFIELD, MASSACHUSETTS PROPOSES A PROJECT TITLED ONE MISSION: A COMPREHENSIVE SERVICE PROGRAM FOR VICTIMS OF HUMAN TRAFFICKING (ONE MISSION). THE PRIMARY PURPOSE IS TO EXPAND AND STRENGTHEN TRAUMA-INFORMED VICTIM-CENTERED SERVICES THAT INCLUDES COMPREHENSIVE SCREENING, INDIVIDUALIZED CASE MANAGEMENT, AND EVIDENCE-BASED THERAPEUTIC SERVICES FOR HUMAN TRAFFICKING VICTIMS. THE PRIMARY ACTIVITIES ARE TO 1) IMPROVE AND INCREASE THE TRAUMA-INFORMED SCREENING OF HUMAN TRAFFICKING VICTIM; 2) EXPAND ACCESS TO EVIDENCE-BASED, TRAUMA-INFORMED THERAPEUTIC AND CASE MANAGEMENT SERVICES; 3) INCREASE COMMUNITY-LEVEL ENGAGEMENT THROUGH TRAUMA-INFORMED TRAININGS TO RAISE AWARENESS OF HUMAN TRAFFICKING AND IMPROVE IDENTIFICATION AND REFERRALS FOR SERVICES; AND 4) PROVIDE AND ENHANCE OUTREACH AND INTERAGENCY COLLABORATIONS TO DELIVER A COORDINATED RESPONSE TO MEET TRAFFICKING VICTIMS NEEDS AND EXPAND THE AVAILABILITY OF SERVICES. THE EXPECTED OUTCOMES ARE AN INCREASE IN SCREENING PRACTICES, RESULTING IN A 10% INCREASE IN MALES AND LGBTQ+ VICTIMS IDENTIFIED; SERVING 100 VICTIMS IN YEAR 1 AND 115 VICTIMS IN YEARS 2 AND 3; PROVIDE 2500 SERVICES PROVISION UNITS THROUGH ONGOING CASE MANAGEMENT, ADVOCACY AND ACCOMPANIMENT, EXPLANATION OF BENEFITS AND SOCIAL SERVICE ADVOCACY, INFORMATION AND REFERRALS, EDUCATION, LIFE SKILLS BUILDING, AS WELL AS EMOTIONAL/MORAL SUPPORT; TRAUMA-INFORMED THERAPY OFFERED TO ALL VICTIMS IN NEED WITH A TARGET OF SERVING 30 VICTIMS A YEAR THROUGH INDIVIDUAL THERAPY/MENTAL HEALTH SERVICES, CRISIS INTERVENTION, AND SAFETY PLANNING; PROVIDING 10 TRAININGS A YEAR TO EDUCATE 1000 PROFESSIONALS OVER THE COURSE OF THE PROGRAM; AND PROVIDING TEN OUTREACH ACTIVITIES TO INCREASE AWARENESS OF SERVICES, WITH A SPECIAL FOCUS ON AGENCIES/ORGANIZATIONS THAT CAN BETTER SUPPORT MALES, LGBTQ+, AND LABOR TRAFFICKING. THE GEOGRAPHIC SERVICE AREA IS HAMPDEN COUNTY IN THE STATE OF MASSACHUSETTS WITH A TARGET AUDIENCE OF MINOR VICTIMS OF HUMAN TRAFFICKING AGES 0-17, AND THEIR FAMILIES, WITH FOCUS ON SPECIALTY POPULATIONS TO INCLUDE: MALES AND LGBTQ+ YOUTH, AND LABOR TRAFFICKING. THERE ARE NO SUBRECIPIENTS FOR THIS AWARD.

CONTEXTUAL FACTORS ASSOCIATED WITH IMPLEMENTATION EFFECTIVENESS WITHIN A QICOLLA

SPOILER: TOWARDS SAFER PRESCRIBING OF LEGAL OPIOIDS FROM THE EMERGENCY ROOM

DE-IMPLEMENTATION OF LOW VALUE IMAGING IN PULMONARY EMBOLISM (DELVE PE) - 1 PROJECT SUMMARY 2 TWO PERCENT (2%) OF ALL 120 MILLION ANNUAL EMERGENCY DEPARTMENT (ED) VISITS IN THE UNITED STATES UNDERGO COMPUTED 3 TOMOGRAPHIC PULMONARY ANGIOGRAPHY (CTPA) FOR PULMONARY EMBOLISM (PE) EVERY YEAR. HOWEVER, MANY OF THESE ARE 4 AVOIDABLE. UNNECESSARY TESTING SUBJECTS PATIENTS TO ADDITIONAL COSTS, IONIZING RADIATION, AND RISK OF ANAPHYLAXIS FROM CONTRAST 5 MEDIA. FURTHER, BECAUSE FALSE POSITIVE CTPAS ARE COMMON (ESTIMATED AT 5-26%), OVERDIAGNOSIS AND OVERTREATMENT ARE 6 GROWING PROBLEMS IN THE UNITED STATES. DESPITE GUIDELINES RECOMMENDING THE REDUCTION OF LOW-VALUE IMAGING FOR PE, THE 7 VOLUME OF UNNECESSARY IMAGING STUDIES FOR PE IN US EDS CONTINUES TO RISE, EXPOSING PATIENTS TO HARM FROM OVERTESTING AND 8 OVERDIAGNOSIS. PRIOR STRATEGIES HAVE ATTEMPTED TO CLOSE THIS KNOWLEDGE-PRACTICE QUALITY GAP BUT ONLY HAD MODEST SUCCESS, 9 POSSIBLY BECAUSE CHANGING PROVIDER BEHAVIOR IS CHALLENGING AND MOST INITIATIVES FOCUSED ON ISOLATED STRATEGIES. WE PROPOSE 10 TO DEVELOP, PILOT, AND EVALUATE A MULTI-DIMENSIONAL `ENHANCED' AUDIT-FEEDBACK STRATEGY (EAF) TO DE-IMPLEMENT LOW-VALUE 11 IMAGING IN PE. THE CORE STRATEGY, AUDIT-FEEDBACK, WAS CHOSEN TO TARGET DRIVERS OF LOW-VALUE IMAGING IN PE DISCOVERED IN 12 OUR FOUNDATIONAL WORK: KNOWLEDGE, PEER PRESSURE, EMOTION, AND BELIEF ABOUT CONSEQUENCES. WE DESIGNED THE STRATEGY USING 13 A NOVEL AUDIT-FEEDBACK THEORY, THE CLINICAL PERFORMANCE FEEDBACK INTERVENTION THEORY (CP-FIT). THE AUDIT-FEEDBACK IS 14 `ENHANCED' BY COMPLEMENTARY STRATEGIES TO ASSIST IN ACTION PLANNING AND EMPOWER CLINICIANS TO CHANGE THEIR BEHAVIOR. THIS 15 INCLUDES AN AID FOR APPROPRIATE TESTING THAT GUIDES CLINICIANS THROUGH AN UNAMBIGUOUS ALGORITHM FOR EVALUATION OF PE, AN 16 EDUCATIONAL PODCAST, AND LOCAL CHAMPIONS. IN AIM 1, WE WILL DEVELOP, REFINE, AND OPERATIONALIZE THE DE-IMPLEMENTATION 17 STRATEGY COMPONENTS. WE WILL CONDUCT COGNITIVE TESTING OF THE PROTOTYPES OF THE AUDIT-FEEDBACK REPORTS, DEVELOP AN 18 ELECTRONIC HEALTH RECORD (EHR)-INTEGRATED AID, RECORD THE EDUCATIONAL PODCAST, AND IDENTIFY AND TRAIN LOCAL CHAMPIONS. IN 19 AIM 2, WE WILL PILOT ALTERNATIVE VERSIONS OF THE EAF STRATEGY IN 5 EDS TO EVALUATE ACCEPTABILITY AND APPROPRIATENESS. WE 20 WILL ALTER THE DELIVERY OF THE COMPONENTS OF FEEDBACK (LOCAL CHAMPION VERSUS DEPARTMENTAL CHAIR), EDUCATIONAL PODCAST (WITH 21 OR WITHOUT A REAL PATIENT NARRATIVE), AND THE AID FOR APPROPRIATE TESTING (STATIC VERSUS EHR-INTEGRATED AID) TO ASCERTAIN THE 22 ACCEPTABILITY, APPROPRIATENESS, AND ADDED VALUE OF THESE ITERATIONS. WE WILL PILOT DIFFERENT VERSIONS OF THE STRATEGY TO EVALUATE 23 ASPECTS OF CP-FIT INCLUDING COMPLEXITY, SOCIAL INFLUENCE, AND ACTIONABILITY, WHICH CP-FIT SUGGESTS DRIVE THE AUDIT-FEEDBACK 24 CYCLE AND, ULTIMATELY, BEHAVIOR CHANGE. WE WILL USE MIXED METHODS TO EVALUATE THE STRATEGY AND SELECT A REFINED STRATEGY FOR 25 A MULTI-CENTER TRIAL. IN THIS K23 APPLICATION, WE HAVE PROPOSED A DETAILED CAREER DEVELOPMENT PLAN IN WHICH I WILL GAIN 26 METHODOLOGICAL AND TECHNICAL EXPERTISE IN ADVANCED IMPLEMENTATION SCIENCE STRATEGIES, METHODS, AND TRIAL DESIGN. I AM WELL 27 SUPPORTED BY AN EXPERIENCED TEAM OF MENTORS AND ADVISORS. AT THE END OF THIS MENTORED CAREER DEVELOPMENT AWARD, I WILL 28 HAVE A ROBUST EMPIRICALLY-DERIVED AND THEORY-INFORMED STRATEGY AND WILL BE POSITIONED TO TEST THIS STRATEGY IN A MULTI-CENTER 29 TRIAL AS AN INDEPENDENT INVESTIGATOR. 30

HEALTH CARE AND OTHER FACILITIES

TAS::89 0222::TAS; NEW; PIONEER VALLEY LIFE SCIENCES INSTITUTE TRANSLATIONAL BIOMEDICAL RESEARCH; PAUL FRIEDMANN, PI

INTEGRATING A PARENTING INTERVENTION FOR MOTHERS WITH OPIOID USE DISORDERS INTO CHILD DEVELOPMENT SERVICES

CONVERSATIONS CAN SAVE LIVES: TALKING ABOUT BUPRENORPHINE & METHADONE FOR OPIOID USE TREATMENT INITIATION (TALK ABOUT) - PROJECT SUMMARY IN THE PAST TWO DECADES, OVER HALF A MILLION PEOPLE IN THE UNITED STATES HAVE DIED OF AN OPIOID OVERDOSE, AND CURRENTLY NEARLY 3 MILLION AMERICANS STRUGGLE WITH OPIOID USE DISORDER. MEDICATIONS FOR OPIOID USE DISORDER (MOUD), SUCH AS BUPRENORPHINE AND METHADONE, ARE EFFECTIVE IN DECREASING A PERSON’S RISK OF DEATH AND DISEASE FROM OPIOID USE. HOWEVER, ONLY A SMALL MINORITY OF PEOPLE WHO WOULD BENEFIT FROM THESE MEDICATIONS HAVE ACCESS TO THEM. ALTHOUGH THIS TREATMENT GAP IS MULTIFACTORIAL, TREATMENT INITIATION LOCALES OUTSIDE OF THE CURRENT ADDICTION PARADIGM ARE NECESSARY TO ADDRESS THE INCREASING MORBIDITY AND MORTALITY OF THE OPIOID EPIDEMIC. EXISTING EVIDENCE DEMONSTRATES THAT BUPRENORPHINE DISPENSED FROM THE EMERGENCY DEPARTMENT (ED) INCREASES THE LIKELIHOOD A PERSON WILL BE IN TREATMENT AT 30 DAYS, AND TREATMENT ADHERENCE IS STRONGLY LINKED TO MORBIDITY AND MORTALITY. BASED ON THE KNOWN EFFECTIVENESS OF MOUD, THE AMERICAN COLLEGE OF EMERGENCY PHYSICIANS RECENTLY RELEASED A RECOMMENDATION THAT ALL APPROPRIATE PATIENTS BE OFFERED THESE MEDICATIONS WHEN SEEN FOR ED CARE. HOWEVER, MOST PATIENTS SEEN IN A US ED ARE NOT OFFERED THESE MEDICATIONS. RESEARCH DEMONSTRATES THAT INTERPERSONAL BARRIERS SUCH AS STIGMA AND MISTRUST MAY PRECLUDE EFFECTIVE CONVERSATIONS REGARDING THESE TREATMENT OPTIONS. SHARED DECISION-MAKING (SDM) – WHERE CLINICIANS SPECIFICALLY INVITE PATIENTS INTO CLINICAL DECISION-MAKING WHEN OPTIONS ARE AVAILABLE – HAS BEEN USED TO INCREASE THE PATIENT-CENTEREDNESS OF CARE IN NUMEROUS SETTINGS BUT HAS GENERALLY NOT BEEN EMPLOYED IN THE ED FOR PATIENTS WITH OPIOID USE DISORDER. THROUGH STAKEHOLDER ENGAGEMENT, OUR TEAM HAS CREATED AN INTERVENTION, TALK ABOUT IT, WHICH USES AN SDM FRAMEWORK TO FACILITATE CONVERSATIONS ABOUT MOUD IN THE ED. CONVERSATIONS CAN FOSTER EMPATHY, BUILD TRUST, DIMINISH STIGMA, AND HELP PEOPLE START THEIR PATH TO RECOVERY. ADDITIONALLY, U.S. POLICY REGARDING THE PRESCRIPTION OF MOUD RECENTLY CHANGED, VASTLY INCREASING THE NUMBER OF POTENTIAL PRESCRIBERS. THESE PROVIDERS, HOWEVER, WILL NEED TOOLS FOR THESE CHALLENGING CONVERSATIONS. OUR LONG-TERM GOAL IS TO INCREASE AND IMPROVE DISCUSSIONS ABOUT MOUD IN THE ED, INCREASING INITIATION AND ADHERENCE, AND DECREASING MORBIDITY AND MORTALITY. IN AIM 1 OF THIS R34, WE WILL REFINE OUR INTERVENTION VIA QUALITATIVE AND QUANTITATIVE FEEDBACK FROM CLINICIANS AND PATIENTS. IN AIM 2, WE WILL PILOT PROCEDURES FOR A FULLY POWERED MULTICENTER TRIAL. AIM 2 INCLUDES: A) A PILOT OF THE TRAINING INTERVENTION FOR CLINICIANS, INCLUDING THE COLLECTION OF BASELINE AND 12-MONTH DATA; B) PROSPECTIVE ENROLLMENT OF PATIENTS AND COLLECTION OF PATIENT- CENTERED OUTCOMES; C) ASSESSMENT OF CLINICAL OUTCOMES; AND D) A FEASIBILITY ANALYSIS OF STUDY PROCEDURES. THIS WILL BE THE FIRST STUDY TO USE THE PATIENT-CENTERED FRAMEWORK OF SHARED DECISION-MAKING TO ADDRESS THIS SUBSTANTIAL TREATMENT GAP – INCREASING THE ABILITY OF ED CLINICIANS TO MEANINGFULLY ADDRESS THE DEVASTATING MORBIDITY AND MORTALITY OF THE OPIOID EPIDEMIC.

SHARED DECISION-MAKING FOR THE PROMOTION OF PATIENT-CENTERED IMAGING IN THE EMERGENCY DEPARTMENT: SUSPECTED KIDNEY STONES

THE ROLE OF INSURANCE NETWORKS AND ORGANIZATIONAL FACTORS IN GUIDELINE-CONCORDANT CARE FOR SERIOUS MENTAL ILLNESS - PROJECT SUMMARY SERIOUS MENTAL ILLNESS AFFECTS MORE THAN 5% OF THE UNITED STATES POPULATION, BUT ONLY A SMALL PROPORTION OF THESE INDIVIDUALS RECEIVE ADEQUATE TREATMENT. SCHIZOPHRENIA IMPACTS ONE PERCENT OF THE POPULATION AND IS PARTICULARLY DEBILITATING. INDIVIDUALS WITH SCHIZOPHRENIA HAVE HIGH RATES OF POOR HEALTH AND SOCIAL OUTCOMES, INCLUDING PREMATURE MORTALITY, HOMELESSNESS, AND SUBSTANCE USE. INDIVIDUALS WITH SCHIZOPHRENIA ARE AT INCREASED RISK OF SUICIDE AND HAVE HIGH RATES OF COMORBID DISEASE. GUIDELINE-CONCORDANT CARE (GCC) – INCLUDING APPROPRIATE MEDICATIONS AND PSYCHOTHERAPY – IMPROVES OUTCOMES FOR INDIVIDUALS WITH SCHIZOPHRENIA, INCLUDING MORTALITY. HOWEVER, RATES OF GCC ARE LOW, WITH SIGNIFICANT VARIATION ACROSS PATIENT DEMOGRAPHIC GROUPS, CLINICAL CONDITIONS, AND CLINICIAN TYPES. ALTHOUGH SOME DIFFERENCES MAY BE EXPLAINED BY PATIENT PREFERENCES, SYSTEM FACTORS AT THE INSURANCE AND ORGANIZATION LEVELS LIKELY CONTRIBUTE TO LOW RATES OF GCC. BETTER UNDERSTANDING SYSTEM FACTORS – INCLUDING THE ROLE OF INSURANCE NETWORKS AND ORGANIZATIONS – THAT HELP GUIDE TREATMENT PATHWAYS TOWARDS GCC AND IMPROVE PATIENT OUTCOMES IS AN IMPORTANT CONTRIBUTION TO IMPROVING CLINICAL PRACTICE FOR INDIVIDUALS LIVING WITH SCHIZOPHRENIA. PURSUANT TO THE GOALS OF PAR-19-189, THE OBJECTIVE OF THIS PILOT SERVICES RESEARCH IS TO IDENTIFY MUTABLE HEALTH CARE SYSTEM FACTORS RELATED TO ACCESS AND QUALITY OF MENTAL HEALTH SERVICES. USING COMPREHENSIVE HEALTH INSURANCE ENROLLMENT AND CLAIMS DATA FROM MASSACHUSETTS WE QUANTIFY AND EXAMINE VARIATION IN INSURANCE NETWORKS FOR THOSE WITH SCHIZOPHRENIA, EXAMINE ASSOCIATIONS OF THESE NETWORK CHARACTERISTICS – INCLUDING SIZE AND COMPOSITION (REFLECTING AVAILABILITY OF MENTAL HEALTH CLINICIANS) – WITH PATIENT OUTCOMES OF GUIDELINE-CONCORDANT CARE RECEIPT AND SELF-HARM. AS A POTENTIAL MECHANISM FOR UNDERSTANDING HOW INSURANCE NETWORKS MAY INFLUENCE PATIENT OUTCOMES, WE EXAMINE ASSOCIATIONS OF ORGANIZATIONAL CHARACTERISTICS – ORGANIZATION SIZE AND PROPORTION OF MENTAL HEALTH CLINICIANS – WITH PATIENT OUTCOMES. WE CONDUCT SENSITIVITY ANALYSES LIMITING TO INDIVIDUALS WITH FIRST EPISODE PSYCHOSIS DUE TO THE CLINICAL URGENCY OF COMPREHENSIVE CARE AND POLICY INTEREST IN THIS POPULATION, AND ESTABLISH A CAUSAL RELATIONSHIP BETWEEN INSURANCE NETWORKS AND ORGANIZATIONS AND OUTCOMES USING A YOUNG ADULT SAMPLE. UNDERSTANDING FACTORS ASSOCIATED WITH GCC AND OUTCOMES WILL HELP IDENTIFY EFFECTIVE POLICY LEVERS TO IMPROVE CARE. FINDINGS FROM THIS PILOT STUDY WILL GUIDE FUTURE IMPROVEMENTS IN MENTAL HEALTH SERVICES DELIVERY, AS WELL AS IDENTIFY AVENUES FOR FUTURE RESEARCH ON POLICY CHANGES INFLUENCING CRITICAL SYSTEM CHARACTERISTICS.

IDENTIFYING EFFECTIVE STRATEGIES TO IMPROVE PARTICIPATION IN CARDIAC REHABILITATION AFTER AN ACUTE CARDIAC HOSPITALIZATION

RESEARCH AND MENTORING IN COMPARATIVE EFFECTIVENESS AND IMPLEMENTATION SCIENCE

HEALTH CARE AND OTHER FACILITIES

COMPARING NONINVASIVE AND INVASIVE VENTILATION IN ACUTE RESPIRATORY FAILURE

STEPPED CARE VERSUS CENTER-BASED CARDIOPULMONARY REHABILITATION FOR OLDER FRAIL ADULTS LIVING IN RURAL MA - PROJECT SUMMARY CARDIAC REHABILITATION (CR) DECREASES MORTALITY AND BOTH CR AND PULMONARY REHABILITATION (PR) IMPROVE FUNCTION, QUALITY OF LIFE, AND DECREASE READMISSION RATES. DESPITE THEIR PROVEN EFFICACY, BOTH PROGRAMS ARE GROSSLY UNDERUTILIZED, WITH FEWER THAN 20% OF ELIGIBLE PERSONS PARTICIPATING. PATIENTS WITH HEART AND LUNG DISEASE LIVING IN RURAL COMMUNITIES HAVE EVEN LOWER RATES OF PARTICIPATION. THE OBJECTIVE OF THIS PROPOSAL IS TO TEST THE FEASIBILITY OF PERFORMING A FULL-SCALE RANDOMIZED CONTROLLED TRIAL (RCT) TO COMPARE THE EFFECTIVENESS AND VALUE OF A STEPPED CARE (SC) MODEL VERSUS TREATMENT AS USUAL (TAU) IN OLDER FRAIL ADULTS LIVING RURAL COUNTIES. TAU REFERS TO CENTER-BASED REHABILITATION (CBR). THE SC MODEL INCLUDES INITIAL ENROLLMENT INTO CBR FOLLOWED BY POSSIBLE STEP UP TO THREE INTERVENTIONS BASED ON PRESPECIFIED NON-RESPONSE CRITERIA: 1) TRANSPORTATION-SUBSIDIZED CBR, 2) HOME-BASED TELEREHABILITATION (TR), AND 3) COMMUNITY HEALTH WORKER-(CHW) SUPPORTED HOME-BASED TR. UNLIKE TRADITIONAL SC MODELS, THE INITIAL TREATMENT IN THIS MODEL, I.E. CBR, IS NOT THE LEAST RESOURCE INTENSIVE. CBR WAS CHOSEN AS THE INITIAL OPTION BECAUSE IT IS CURRENTLY CONSIDERED THE STANDARD OF CARE. WE WILL CONDUCT A PARALLEL, 2-ARM, RANDOMIZED CONTROLLED FEASIBILITY TRIAL. ELIGIBLE PARTICIPANTS WILL BE RANDOMIZED TO TAU (CBR) OR SC. BECAUSE OF THE URGENT NEED TO ADDRESS UNDERUSE OF BOTH CR AND PR IN RURAL REGIONS, THE PROPOSED FEASIBILITY TRIAL WILL ENROLL PATIENTS REFERRED TO EITHER CR OR PR. BOTH ARMS INCLUDE AN IN-PERSON INTAKE EVALUATION CONDUCTED BY A CERTIFIED REHABILITATION NURSE IN THE REHABILITATION CENTER TO DETERMINE EXERCISE TOLERANCE AND DESIGN A TAILORED 8-WEEK REHABILITATION PROGRAM. PATIENTS RANDOMIZED TO TAU PARTICIPATE IN TWO WEEKLY SESSIONS AT THE CENTER AND ARE ENCOURAGED TO EXERCISE AT HOME IN BETWEEN SESSIONS. PATIENTS RANDOMIZED TO THE SC ARM WILL ALSO BE ENROLLED IN THE CBR PROGRAM. THOSE WHO MEET PRESPECIFIED NON- RESPONSE CRITERIA WILL BE STEPPED UP TO TRANSPORTATION-SUBSIDIZED CBR. PROVIDING TRANSPORTATION MAY NOT BE SUFFICIENT FOR FRAIL OLDER ADULTS WHO ARE RELUCTANT TO LEAVE THEIR HOMES IN THE WINTER, UNFAMILIAR WITH EXERCISING, OR DO NOT WANT TO EXERCISE IN A GROUP SETTING. THUS, NON-RESPONDERS, WILL BE STEPPED UP TO HOME-BASED TR. HOME-BASED REHABILITATION WILL BE SUPPORTED BY CHANL HEALTH, A VIRTUAL PLATFORM THAT SUPPORTS EDUCATION AND SELF-MANAGEMENT, REMOTE MONITORING, AND COACHING BY REHABILITATION SPECIALISTS. NON-RESPONDERS WILL BE STEPPED UP TO CHW-SUPPORTED HOME-BASED TR. THE CHW WILL BE HELP PARTICIPANTS USE THE MOBILE APP, ACCESS EDUCATIONAL MATERIALS, CLARIFY EDUCATIONAL CONTENT, AND EXERCISE DURING BIWEEKLY IN-PERSON VISITS. IF THE FEASIBILITY TRIAL IS SUCCESSFUL, WE WILL PROCEED TO CONDUCT A PARALLEL, 2-ARM, SINGLE BLIND, MULTI-SITE SUPERIORITY RCT TO COMPARE THE EFFECTIVENESS AND VALUE (COST-EFFECTIVENESS) OF SC VERSUS TAU (CBR) IN OLDER FRAIL ADULTS LIVING RURAL COUNTIES. OUR LONG-TERM OBJECTIVE IS TO PROVIDE HOSPITAL SYSTEMS WITH HIGH QUALITY EVIDENCE ON HOW BEST TO OPTIMIZE UPTAKE OF CR AND PR FOR OLDER FRAIL ADULTS LIVING IN RURAL COMMUNITIES.

A COMMUNITY HEALTH WORKER INTERVENTION TO IMPROVE LUNG CANCER SCREENING UPTAKE IN COMMUNITY HEALTH CENTERS SERVING BLACK AND HISPANIC COMMUNITIES - PROJECT SUMMARY: LUNG CANCER IS THE LEADING CAUSE OF CANCER DEATH, AND LUNG CANCER SCREENING (LCS) CAN REDUCE LUNG CANCER- RELATED MORTALITY BY 20%. HOWEVER, ONLY 5-10% OF ELIGIBLE INDIVIDUALS HAVE RECEIVED AN INITIAL LCS EXAM, WITH BLACK AND HISPANIC INDIVIDUALS LESS LIKELY TO BE SCREENED AND MORE LIKELY TO SUFFER DELAYS IN DIAGNOSIS AND TREATMENT, CONTRIBUTING TO HIGHER MORTALITY FROM LUNG CANCER. COMMUNITY HEALTH WORKERS (CHWS) ARE AN EFFECTIVE STRATEGY TO PROMOTE SCREENING AND MITIGATE DISPARITIES IN OTHER CANCER SETTINGS. WHETHER CHWS CAN BE EFFECTIVE IN THE CONTEXT OF LCS AND ADDRESS KEY BARRIERS TO RECEIVING LCS REMAINS UNKNOWN. THE GOAL OF THIS STUDY IS TO DEVELOP AND PILOT TEST A FOUR-PART CHW INTERVENTION TO IMPROVE LCS UPTAKE AND MITIGATE DISPARITIES, WHICH INCLUDES: 1) PATIENT OUTREACH, 2) PATIENT-CENTERED SHARED DECISION-MAKING, 3) SMOKING CESSATION COUNSELING, AND 4) NAVIGATION OF LOGISTICAL BARRIERS. OUR CENTRAL HYPOTHESIS, BASED ON OUR QUALITATIVE WORK AND INFORMED BY THE EXPANDED HEALTH BELIEF MODEL, POSITS THAT CHWS CAN ADDRESS KEY MODIFIABLE FACTORS TO IMPROVE LCS AWARENESS, ENGAGEMENT, AND BARRIERS TO ACCESSING CARE, LEADING TO INCREASED LCS UPTAKE OVERALL AND AMONG BLACK AND HISPANIC COMMUNITIES. OUR AIMS ARE TO: JOINTLY “TRANSCREATE” A CHW INTERVENTION TO INCREASE LCS UPTAKE AMONG PATIENTS SERVED BY COMMUNITY HEALTH CENTERS (AIM 1); CONDUCT A PILOT RANDOMIZED CONTROLLED TRIAL OF THE CHW INTERVENTION (AIM 2A); AND OBTAIN EMPIRIC ESTIMATES OF EFFECT SIZE IN LCS AND TOBACCO TREATMENT UTILIZATION (AIM 2B). WE FIRST SEEK TO JOINTLY “TRANSCREATE” A CHW INTERVENTION WITH OUR COMMUNITY ADVISORY BOARD, COMPRISED OF KEY STAKEHOLDERS IN LCS AND PATIENTS WITH LIVED EXPERIENCE, APPLYING THE TRANSCREATION FRAMEWORK FOR COMMUNITY-ENGAGED BEHAVIORAL INTERVENTIONS TO REDUCE HEALTH DISPARITIES. THEN WE WILL CONDUCT A PILOT RANDOMIZED CONTROLLED TRIAL OF THE CHW INTERVENTION AT BAYSTATE HEALTH’S THREE COMMUNITY HEALTH CENTERS. WE WILL RANDOMIZE 80 LCS-ELIGIBLE INDIVIDUALS (40 IN EACH ARM) TO EITHER THE CHW-LED INTERVENTION OR ENHANCED USUAL CARE (I.E., MAILED LCS EDUCATIONAL MATERIALS AND USUAL LCS AS PER PRIMARY CARE PROVIDER). PRIMARY PILOT OUTCOMES ARE FOCUSED ON FEASIBILITY, INCLUDING PARTICIPANT RECRUITMENT, MEASURE COMPLETION, RETENTION, FIDELITY, AND ACCEPTABILITY. WE WILL ALSO CONDUCT AN EVALUATION OF SECONDARY TRIAL OUTCOMES, INCLUDING LCS AND TOBACCO TREATMENT UTILIZATION, AS WELL AS EXPLORE POTENTIAL MEDIATORS (E.G., KNOWLEDGE, FACILITATION OF LOGISTICAL BARRIERS). THE PROPOSED ACTIVITIES WILL PROVIDE ME CRUCIAL SKILLS IN HEALTH EQUITY RESEARCH, IMPLEMENTATION SCIENCE, AND CLINICAL TRIAL DESIGN, AND LAUNCH MY CAREER AS A CLINICIAN-SCIENTIST DEDICATED TO ADDRESSING HEALTH DISPARITIES. THIS WORK WILL ALSO LAY THE GROUNDWORK FOR A SUBSEQUENT R01 GRANT CONDUCTING A FULLY POWERED RANDOMIZED CONTROLLED TRIAL OF THE CHW INTERVENTION THAT DIRECTLY ADDRESSES TOP PRIORITIES FROM THE PRESIDENT’S CANCER MOONSHOT AND NCI’S MISSION TO DEVELOP MULTI- LEVEL INTERVENTIONS THAT FACILITATE EQUITABLE ACCESS TO CANCER SCREENING AND REDUCE LUNG CANCER MORTALITY.

ONE MISSION: A COMPREHENSIVE SERVICE PROGRAM FOR VICTIMS OF HUMAN TRAFFICKING (ONE MISSION)

ONE MISSION: A COMPREHENSIVE SERVICE PROGRAM FOR VICTIMS OF HUMAN TRAFFICKING

ENHANCING DELIVERY OF PARENTING SUPPORT WITHIN A PEER RECOVERY SUPPORT SERVICE MODEL - PROJECT SUMMARY/ABSTRACT PARENTAL SUBSTANCE USE DISORDERS (SUDS) DISRUPT THE PARENT-CHILD RELATIONSHIP, RESULTING IN DETRIMENTAL EFFECTS FOR BOTH PARENTAL RECOVERY AND LONG-TERM CHILD HEALTH, BEHAVIOR, AND DEVELOPMENT. WHILE PARENTING STRESS MAY BE A POTENT TRIGGER FOR DRUG CRAVINGS AND RELAPSE AMONG PARENTS WITH SUDS, WITH ADEQUATE SUPPORT THE PARENT- CHILD RELATIONSHIP CAN SERVE AS A SOURCE OF JOY, PURPOSE, AND AN IMPORTANT MOTIVATOR TO SEEK RECOVERY. FAMILY- FOCUSED PEER RECOVERY SUPPORT SERVICE (PRSS) HAS EMERGED AS A POTENTIAL APPROACH FOR PROVIDING COMPREHENSIVE SUPPORT TO FAMILIES AFFECTED BY SUDS. HOWEVER, THE PRSS MODEL FACES CHALLENGES TO ACHIEVING THE FULL BIGENERATIONAL BENEFIT FOR FAMILIES BECAUSE PEER SUPPORT SPECIALISTS OFTEN STRUGGLE TO DELIVER PARENTING SUPPORT IN THIS CONTEXT. WE PROPOSE TAILORING AN IMPLEMENTATION STRATEGY BUNDLE AIMED AT IMPROVING DELIVERY OF EVIDENCE-BASED PARENTING SUPPORT FOR A PEER RECOVERY SUPPORT SPECIALIST AUDIENCE. THE MULTILEVEL IMPLEMENTATION BUNDLE, CALLED RELATIONAL HEALTH ENHANCED PARENTING SUPPORT (RHEP), INCLUDES TRAINING, CONSULTATION, AND IMPLEMENTATION BLUEPRINT MAPPING TO HELP OVERCOME BARRIERS TO THE DELIVERY OF PARENTING SUPPORT. BUILDING UPON A LONGSTANDING COMMUNITY-ACADEMIC PARTNERSHIP, WE WILL COLLABORATE WITH THE MASSACHUSETTS DEPARTMENT OF PUBLIC HEALTH (MDPH) AND THEIR SPECIALIZED HOME VISITING PROGRAM FIRST STEPS TOGETHER (FST) TO TEST RHEP. FST IS CENTERED ON THE FAMILY-FOCUSED PRSS MODEL AND IS DELIVERED AT SIX SITES ACROSS THE STATE. RHEP-ENHANCED IMPLEMENTATION OF PARENTING SUPPORT HAS THE POTENTIAL TO AMPLIFY THE ONGOING WORK OF FST PEER STAFF BY TRULY INTEGRATING PARENTING AND RECOVERY SUPPORTS WITHIN A SCALABLE MODEL. IN PHASE 1 (R61), WE WILL REFINE RHEP TRAINING AND CONSULTATION MATERIALS AND PROCEDURES FOR THE PRSS MODEL AND WORKFORCE WITH ENGAGEMENT FROM OUR COMMUNITY PARTNERS. FURTHERMORE, WE WILL CO-CREATE AN AGENCY-LEVEL IMPLEMENTATION BLUEPRINT FOR FST, OPERATIONALIZED VIA A TAILORED STAGES OF IMPLEMENTATION COMPLETION® TOOL TO EVALUATE THE IMPLEMENTATION PROCESS. IN PHASE 2 (R33), WE PROPOSE A HYBRID STEPPED-WEDGE CLUSTER RANDOMIZED DESIGN WITH SIX SITES TO TEST THE EFFECTIVENESS AND IMPLEMENTATION OF FST PLUS RHEP. WE WILL: (AIM 1) DETERMINE THE EFFECTIVENESS OF FST ALONE VERSUS FST PLUS RHEP TO IMPROVE PARENTING-RELATED FACTORS, SUD TREATMENT RETENTION, AND REDUCTION IN SUBSTANCE USE; (AIM 2) INVESTIGATE VARIATION IN THE IMPLEMENTATION PROCESS ACROSS SITES TO INFORM FUTURE DISSEMINATION; AND (AIM 3) EXAMINE THE UNIQUE IMPACT OF PEER STAFF ON IMPLEMENTATION AND EFFECTIVENESS OUTCOMES. UPON COMPLETION OF THIS STUDY, WE WILL HAVE GAINED KEY INSIGHTS INTO THE DELIVERY OF EFFECTIVE SUPPORT FOR PARENTS IN RECOVERY AND INTO CRITICAL FACTORS INFLUENCING PEER WORKFORCE DEVELOPMENT, AND WE WILL PRODUCE AN IMPLEMENTATION TOOLKIT TO FACILITATE DISSEMINATION OF PARENTING SUPPORT ACROSS PEER-LED NON-CLINICAL MODELS OF CARE. THIS STUDY IS PART OF THE NIH’S HELPING TO END ADDICTION LONG-TERM (HEAL) INITIATIVE TO SPEED SCIENTIFIC SOLUTIONS FOR THE OVERDOSE EPIDEMIC, INCLUDING OPIOID AND STIMULANT USE DISORDERS. THE NIH HEAL INITIATIVE BOLSTERS RESEARCH ACROSS NIH TO ADDRESS THE NATIONAL OPIOID PUBLIC HEALTH CRISIS AND IMPROVE TREATMENT FOR OPIOID MISUSE AND ADDICTION.

IMPROVING PARTICIPATION IN PULMONARY REHABILITATION THROUGH PEER-SUPPORT AND STORYTELLING - ABSTRACT EXACERBATIONS OF CHRONIC OBSTRUCTIVE PULMONARY DISEASE (COPD) LEAD TO ROUGHLY 1.5 MILLION ED VISITS AND 700,000 HOSPITALIZATIONS ANNUALLY. RECOVERY IS SLOW, AND ACCOMPANIED BY HIGH LEVELS OF ACUTE CARE UTILIZATION AND MORTALITY. PULMONARY REHABILITATION (PR) IS A STRUCTURED PROGRAM OF EXERCISE AND SELF-MANAGEMENT SUPPORT THAT HAS BEEN SHOWN TO RELIEVE DYSPNEA AND IMPROVE QUALITY OF LIFE. CLINICAL GUIDELINES RECOMMEND PR FOR PATIENTS WITH STABLE COPD AND AFTER AN EXACERBATION. UNFORTUNATELY, EVEN WHEN REFERRED BY PHYSICIANS, OUR RESEARCH HAS SHOWN THAT FEW PATIENTS WHO MIGHT BENEFIT FROM PR EVER BEGIN TREATMENT. THE PRIMARY GOAL OF THIS PROJECT IS TO IDENTIFY EFFECTIVE STRATEGIES FOR PROMOTING AND SUSTAINING PARTICIPATION IN PR. PEER SUPPORT INVOLVES PAIRING A PATIENT WITH A TRAINED PEER FROM A SIMILAR BACKGROUND, AND FACING SIMILAR HEALTH CHALLENGES, WHO HAS COMPLETED PR. THERE IS A GROWING BODY OF EVIDENCE DEMONSTRATING THE FEASIBILITY, ACCEPTABILITY, AND EFFECTIVENESS OF TELEPHONIC PEER SUPPORT FOR CHRONIC DISEASE MANAGEMENT. NARRATIVE INTERVENTIONS, OR `STORYTELLING', ARE NOVEL APPROACHES FOR CHANGING ATTITUDES AND BEHAVIORS OF PATIENTS THAT INVOLVE CREATING AND DISSEMINATING VIDEOS NARRATED BY INDIVIDUALS WITH LIVED EXPERIENCE WITH THE SAME CONDITION OR FACING THE SAME TREATMENT. STORYTELLING INTERVENTIONS HAVE BEEN SHOWN TO HELP PATIENTS ACHIEVE BETTER BLOOD PRESSURE CONTROL, AND STORYTELLING IS BEING STUDIED IN A VARIETY OF OTHER CLINICAL CONTEXTS. IN THE R61 PHASE, WE WILL RECRUIT AND TRAIN A COHORT OF PEER COACHES IN BEHAVIOR CHANGE TECHNIQUES, AND WILL RECRUIT A DIVERSE GROUP OF STORYTELLERS, CAPTURE THEIR NARRATIVES ON VIDEO, AND CREATE A LIBRARY OF 6-8 POWERFUL STORIES. WE WILL FINALIZE OUR PROTOCOL, TRIAL INFRASTRUCTURE, AND PILOT OUR RECRUITMENT STRATEGY. DURING THE R33 PHASE, WE WILL RECRUIT 305 ADULTS TREATED FOR EXACERBATION OF COPD, AND RANDOMIZE THEM TO 1) ENHANCED “USUAL CARE” (EUC); 2) EUC + STORYTELLING; OR 3) EUC + PEER SUPPORT. WE WILL EVALUATE THE EFFECTIVENESS OF EACH STRATEGY COMPARED TO EUC, AND TO EACH OTHER, AT PROMOTING PARTICIPATION IN PR AT 6 MONTHS. USING A MIXED-METHODS APPROACH, WE WILL EVALUATE INTERVENTION ACCEPTABILITY, SUSTAINABILITY, AND COST, FROM THE PERSPECTIVES OF THE PATIENTS AND PEER COACHES AS WELL AS PR PROGRAM STAFF AND HOSPITAL LEADERSHIP. WE WILL USE THESE FINDINGS TO REFINE THE STRATEGIES AND TO DISSEMINATE AN IMPLEMENTATION PACKAGE THAT WILL ENABLE OTHER PR PROGRAMS TO ADOPT THESE APPROACHES. THIS PROJECT ENGAGES KEY STAKEHOLDERS IN STUDY CONCEPTUALIZATION, EXECUTION, AND DISSEMINATION, AND IS RESPONSIVE TO THE NHLBI/CDC COPD NATIONAL ACTION PLAN THAT CALLS FOR THE DEVELOPMENT OF STRATEGIES TO INCREASE THE NUMBER OF AMERICANS THAT BENEFIT FROM PR.

IDENTIFYING FACTORS ASSOCIATED WITH HIGH QUALITY PEDIATRIC PRIMARY CARE

HEALTH CARE AND OTHER FACILITIES

HEALTH CARE AND OTHER FACILITIES

VIRTUAL REALITY AT THE POINT OF CARE TO INCREASE UPTAKE OF MOUD IN THE ED - PROJECT SUMMARY DESPITE THE WIDESPREAD EFFORTS TO CURB THE OPIOID EPIDEMIC, THE NUMBER OF DRUG OVERDOSE DEATHS INCREASED BY NEARLY 30% FROM 2019 TO 2020, OF WHICH APPROXIMATELY 75% INVOLVED AN OPIOID. NIH AND SAMHSA HAVE DIRECTED SIGNIFICANT FUNDS TOWARDS IMPROVING ACCESS TO INCREASE THE NUMBERS OF PERSONS WITH OPIOID USE DISORDER (OUD) RECEIVING TREATMENT. HOWEVER, THE TREATMENT GAP CONTINUES TO GROW, WITH ONLY A SMALL MINORITY OF ELIGIBLE PATIENTS TAKING OPIOID AGONIST THERAPY (OAT). ALTHOUGH CURBING THE EPIDEMIC WILL REQUIRE EFFORTS ACROSS MULTIPLE SECTORS, AN IMMEDIATE GOAL IS TO INCREASE ADOPTION OF STRATEGIES ALREADY PROVEN TO BE EFFECTIVE. INITIATING BUPRENORPHINE IN THE EMERGENCY DEPARTMENT (ED) IS AN IMPORTANT LOW THRESHOLD STRATEGY TO IMPROVE ACCESS, YET IT REMAINS GROSSLY UNDERUTILIZED. INTERVENTIONS AIMED AT DECREASING SYSTEM AND PROVIDER LEVEL BARRIERS HAVE NOT INCREASED UPTAKE. THEREFORE, INCREASING ED-INITIATED BUPRENORPHINE RATES WILL LIKELY NOT BE REALIZED UNLESS PATIENT LEVEL BARRIERS (I.E., PREFERENCES) ARE EXPLICITLY ADDRESSED. THE OBJECTIVE OF THIS PROPOSAL IS TO DEVELOP AND TEST A NOVEL APPROACH USING VIRTUAL REALITY (VR) TO INCREASE UPTAKE OF BUPRENORPHINE IN THE ED. WE HYPOTHESIZE THAT PARTICIPATING IN AN IMMERSIVE VR EXPERIENCE MAY BE MORE EFFECTIVE THAN CURRENTLY AVAILABLE COUNSELING APPROACHES AND DECISION AIDS BASED ON THE SUPERIOR ABILITY OF VR TO ACTIVATE EMOTIONAL RESPONSES COMPARED TO OTHER MEDIA OR MOTIVATIONAL APPROACHES. OUR INTERVENTION IS BASED ON THE EMOTION- IMBUED CHOICE MODEL WHICH DESCRIBES THE MULTIPLE EFFECTS OF EMOTION ON DECISION MAKING AND BEHAVIOR. FOR EXAMPLE, POSITIVE AFFECT ENHANCES FLEXIBILITY AND WILLINGNESS TO EXAMINE ALTERNATIVE OPTIONS, AND ACTIVATION OF POSITIVE AFFECT IS A CONSISTENT FINDING OF VR EXPOSURE IN HEALTH-RELATED APPLICATIONS. DURING THE R21 PHASE WE WILL EMPLOY A STAKEHOLDER-CENTERED AND USER EXPERIENCE ITERATIVE DESIGN APPROACH TO DEVELOP AND OPTIMIZE AN IMMERSIVE VR EXPERIENCE DESIGNED TO MOTIVATE PATIENTS WITH MODERATE TO SEVERE OUD TO AGREE TO TREATMENT WITH BUPRENORPHINE WHILE IN THE ED. DURING THE R33 PHASE, WE WILL CONDUCT A PARALLEL, 2-ARM, RANDOMIZED CONTROLLED FEASIBILITY TRIAL. THE DATA GENERATED FROM THE FEASIBILITY TRIAL WILL DETERMINE THE FEASIBILITY OF PERFORMING A DEFINITIVE FULL-SCALE RANDOMIZED CONTROLLED TRIAL (RCT) TO ASCERTAIN WHETHER VR- CHOICE INCREASES THE RATE OF ED-INITIATED BUPRENORPHINE COMPARED TO TAU. ELIGIBLE PARTICIPANTS WILL BE RANDOMIZED 1:1 TO VR-CHOICE OR TREATMENT AS USUAL (TAU). WE HYPOTHESIZE THAT THIS FEASIBILITY RCT WILL MEET PRESPECIFIED PROCESS CRITERIA JUSTIFYING A FULL-SCALE RCT. THE FIVE PROCESS INDICATORS ARE AVERAGE NUMBER OF ELIGIBLE PATIENTS RANDOMIZED PER MONTH, BASELINE MEASURE COMPLETION, PROPORTION RANDOMIZED TO THE VR-CHOICE ARM COMPLETING THE VR PROGRAM, PROPORTION IN VR-CHOICE ARM DEVELOPING VR-RELATED SYMPTOMS, AND ACCEPTABILITY OF VR-CHOICE. EACH OF THESE PROCESS INDICATORS WILL BE EVALUATED BY PRESET “STOP” AND “GO” THRESHOLDS. WE WILL CONCLUDE THAT A FULL-SCALE RCT IS NOT FEASIBLE IF ONE OR MORE PROCESS CRITERIA MEET THE STOP THRESHOLD.

BETTER TOMORROW (BT) IS A PROJECT OF BAYSTATE HEALTH (BH), IN COORDINATION WITH ROCA, THE SPRINGFIELD POLICE DEPARTMENT AND THE HAMPDEN COUNTY DISTRICT ATTORNEY.  BH IS SEEKING $999,998.40 IN SUPPORT OF AN INNOVATIVE COMBINATION OF HOSPITAL-BASED VIOLENCE INTERVENTION SERVICES, A COMMUNITY-BASED LONG-TERM COGNITIVE INTERVENTION MODEL, RESTORATIVE JUSTICE, AND COMMUNITY ORGANIZING TO REDUCE VIOLENCE IN SPRINGFIELD, MA’S BIGGEST HOTSPOTS FOR GUN VIOLENCE.  WHILE THE HOSPITAL-BASED COMPONENT OF BT WILL SERVE ALL OF HAMPDEN COUNTY, THE PROJECT WILL FOCUS ON ITS COMMUNITY-BASED CRIME PREVENTION EFFORTS IN THE FOLLOWING SPRINGFIELD COMMUNITIES, BRIGHTWOOD, FOREST PARK, SOUTH END, METRO CENTER, MEMORIAL SQUARE, SIX CORNERS, OLD HILL, AND MCKNIGHT (NEIGHBORHOODS ENCOMPASSED BY ZIP CODES 01103, 01104, 01105, 01108, AND 01109.)     THE BT PARTNERSHIP, WHICH ALSO INCLUDES A VARIETY OF THE CRIMINAL JUSTICE AND COMMUNITY-BASED SERVICE PROVIDERS, IS FOCUSED ON REDUCING GUN VIOLENCE.  THE BT PARTNERSHIP IS COMMITTED TO CREATING LONG-TERM SUSTAINABLE CHANGE, MEASURABLE THROUGH THE REDUCTION IN VIOLENCE WITH A SPECIFIC FOCUS ON THE REDUCTION OF RETALIATORY VIOLENCE, WHILE AT THE SAME TIME PROMOTING POSITIVE ALTERNATIVES TO VIOLENCE. BT WILL FOCUS ITS COMMUNITY-BASED WORK ON YOUNG PEOPLE BETWEEN THE AGES OF 18 AND 25 WHO ARE DRIVING VIOLENCE IN THESE CRITICAL HOTSPOTS.    HOSPITAL-BASED WORK WILL BE DELIVERED TO ALL GUNSHOT VICTIMS TREATED THROUGH BH’S TRAUMA UNIT, AND THE HOSPITAL-BASED TEAM WILL REFER ALL YOUNG PEOPLE BETWEEN 18 AND 24 TO OUR COMMUNITY BASED SERVICES.    BT WILL PROMOTE POSITIVE ALTERNATIVES TO VIOLENCE AND SUPPORT POSITIVE SOCIOECONOMIC CHANGES THAT PREVENT REINJURY AND FOSTER HOSPITAL, CRIMINAL JUSTICE SYSTEM, AND COMMUNITY COLLABORATION TO ADVANCE EQUITABLE, ANTIRACIST, TRAUMA-INFORMED CARE TO PATIENTS.  BT WILL SUPPORT COMMUNITY-BASED ENGAGEMENT IN VIOLENCE REDUCTION AND IMPROVED RELATIONSHIPS AND COMMUNICATIONS BETWEEN POLICE AND OUR TARGETED COMMUNITIES.  FINALLY, BT WILL WORK TO CREATE SYSTEMS CHANGE WITHIN OUR CRIMINAL JUSTICE PARTNERS, INCREASING THEIR EFFECTIVENESS IN WORKING WITH OUR HIGHEST-RISK YOUNG PEOPLE.   BH WILL EMPLOY A FULL-TIME COORDINATOR TO SUPPORT THIS PROJECT AND WORK WITH OUR COMMUNITY BASED AND CRIMINAL JUSTICE PARTNERS TO COORDINATE ALL OF OUR VIOLENCE PREVENTION WORK UTILIZING A DATA-DRIVEN PLAN THAT WILL RESULT IN A REDUCTION IN GUN VIOLENCE IN SOME OF OUR MOST TROUBLED COMMUNITIES.  DATA WILL BE USED TO NOT ONLY UNDERSTAND COMMUNITY-LEVEL IMPACTS BUT ALSO THE BEHAVIOR CHANGES AND CHANGES IN VIOLENCE RELATED HEALTH OUTCOMES FOR ALL INDIVIDUALS SERVED BY BT.  THE BT PARTNERS WILL COORDINATE OUR WORK WITH THE US ATTORNEY’S OFFICE AND ALL OTHER FEDERALLY FUNDED VIOLENCE PREVENTION PROJECTS.

PERIOPERATIVE USE AND OUTCOMES OF NONINVASIVE VENTILATION IN SLEEP APNEA

TARGETED TEMPERATURE MANAGEMENT EFFECTIVENESS IN THE ELDERLY: INSIGHTS FROM A LARGE REGISTRY

DRUG OVERDOSE OUT-OF-HOSPITAL CARDIAC ARREST EVENTS IN THE UNITED STATES: INSIGHTS FROM A LARGE DATA REGISTRY - PROJECT SUMMARY DRUG OVERDOSE OUT-OF-HOSPITAL CARDIAC ARREST (OD-OHCA) IS A SERIOUS AND GROWING PUBLIC HEALTH THREAT THAT IS WHOLLY UNDERSTUDIED. CURRENTLY, WE LACK A BROADLY-REPRESENTATIVE, CONTEMPORARY CLINICAL PROFILE OF OD-OHCA ACROSS AMERICA AND WE DO NOT KNOW THE RELATIVE SOCIETAL DISEASE BURDEN OF OD-OHCA. IN ADDITION, WE DO NOT HAVE A DIRECT COMPARISON OF OD-OHCA AND PRESUMED CARDIAC ETIOLOGY (C-OHCA) CONTROLS STATISTICALLY MATCHED BY AGE AND OTHER KEY CLINICAL FACTORS. FURTHER, THE OPTIMAL POST-RESUSCITATION TREATMENT FOR OD-OHCA EVENT SURVIVORS IS UNKNOWN. OUR RESEARCH WILL ADDRESS THESE KNOWLEDGE GAPS. OUR CENTRAL HYPOTHESIS IS THAT THERE WILL BE A SUBSTANTIAL PUBLIC HEALTH IMPACT FROM OD-OHCA RELATIVE TO OTHER HIGH-BURDEN DISEASES, STATISTICALLY SIGNIFICANT AND CLINICALLY IMPORTANT DIFFERENCES BETWEEN OD-OHCA AND PROPENSITY-MATCHED C- OHCA OUTCOMES, AND POTENTIAL THERAPEUTIC BENEFIT TO PROVISION OF TARGETED TEMPERATURE MANGEMENT (TTM) DURING POST-RESUSCITATION CRITICAL CARE. THE SCIENTIFIC PREMISE FOR THIS WORK IS THAT WE CURRENTLY DO NOT ADEQUATELY UNDERSTAND THE FULL SCOPE OF OD-OHCA IN AMERICA, AND THE CARDIAC ARREST REGISTRY TO ENHANCE SURVIVAL (CARES) DATASET IS THE LARGEST COLLECTION OF HOMOGENEOUS, CONTEMPORARY DATA ON THIS COHORT FOR ANALYSIS TO FILL THESE IMPORTANT KNOWLEDGE GAPS AND ACCELERATE THE PACE OF DRUG ABUSE RESEARCH IN THIS AREA. FROM CARES, WE WILL CREATE A BROADLY-REPRESENTATIVE, CONTEMPORARY CLINICAL PROFILE OF OD-OHCA ACROSS AMERICA, ESTIMATE THE PUBLIC HEALTH IMPACT OF OD-OHCA AS MEASURED BY DISABILITY-ADJUSTED LIFE YEARS LOST (DALY [INCLUSIVE OF MORTALITY AND MORBIDITY]), COMPARE OD-OHCA PATIENT OUTCOMES TO PROPENSITY-MATCH CONTROLS WITH C-OHCA, AND DETERMINE THE EFFECT OF POST-RESUSCITATION TTM ON PATIENT OUTCOMES AS MEASURED BY HOSPITAL DISCHARGE CEREBRAL PERFORMANCE CATEGORY (CPC) SCALE SCORES. THIS RESEARCH IS SIGNIFICANT BECAUSE CURRENTLY LITTLE IS KNOWN ABOUT SUBSTANCE USE DISORDER FROM THE PERSPECTIVE OF OD-OHCA IN THIS RAPIDLY GROWING SEGMENT OF SOCIETY, AND OUR FINDINGS CAN BE TRANSLATED DIRECTLY INTO CLINICAL CARE PROTOCOLS AND WILL POTENTIALLY MODIFY CARE GUIDELINES TO SAVE LIVES. OUR WORK IS INNOVATIVE IN THAT WE WILL BE ACCESSING AN ENORMOUS, BROADLY-REPRESENTATIVE REPOSITORY OF PROSPECTIVELY COLLECTED AND VALIDATED DATA FROM THROUGHOUT THE COUNTRY. FURTHER, THE HIGHLY CAPABLE RESEARCH TEAM HAS MEMBERS WITH PRIORITY ACCESS TO THE ACTIVELY EXPANDING CARES DATASET FOR THIS ANALYSIS, COLLABORATORS WITH CONSIDERABLE EXPERTISE IN OHCA AS WELL AS VAST EXPERIENCE IN PREDICTIVE MODELING USING LARGE DATASETS. THIS WORK WILL HELP ENABLE HIGH-QUALITY RESEARCH TO ADVANCE SCIENTIFIC KNOWLEDGE ON THIS POTENTIAL CONSEQUENCE OF ADDICTION AND DRUG USE TO DIRECTLY IMPROVE PATIENT CARE FOR THIS STIGMATIZED, VULNERABLE POPULATION.

A CONTEMPORARY SUBGROUP ANALYSIS OF COOLING AFTER NON-SHOCKABLE CARDIAC ARREST: INSIGHTS FROM A LARGE REGISTRY

MEDICAID COVERAGE OF BEHAVIORAL HEALTH SUPPORTS FOR OPIOID USE DISORDER DURING POST-INCARCERATION REENTRY - AS OPIOID OVERDOSES CONTINUE TO OCCUR AT ALARMING RATES IN THE US, FORMERLY INCARCERATED INDIVIDUALS ACCOUNT FOR AT LEAST 9% OF OVERDOSE FATALITIES. THIS POPULATION HAS HIGH PREVALENCES OF OPIOID USE DISORDER (OUD) AND OTHER HEALTH CONDITIONS AND FACES MANY BARRIERS TO ACCESSING CRITICAL HEALTH SERVICES, SUCH AS MEDICATIONS FOR OUD TREATMENT. TO ADDRESS THESE MULTI-FACETED NEEDS, PROMISING MODELS OF POST-INCARCERATION REENTRY HEALTH SERVICES PROVIDE CARE NAVIGATION AND LINKAGE TO SOCIAL RESOURCES, BUT CRITICAL KNOWLEDGE GAPS REMAIN REGARDING THE IMPACTS OF REENTRY NAVIGATION SERVICES FOR OUD WHEN IMPLEMENTED AT SCALE. MEDICAID IS THE MOST APT POLICY LEVER FOR SCALING UP AND SUSTAINABLY FUNDING REENTRY SERVICES, AS 80-90% OF PEOPLE LEAVING CARCERAL FACILITIES ARE MEDICAID-ELIGIBLE IN MOST STATES. IN 2022, THE MASSACHUSETTS MEDICAID PROGRAM LAUNCHED ITS STATEWIDE BEHAVIORAL HEALTH SUPPORTS FOR JUSTICE-INVOLVED INDIVIDUALS (BH- JI) PROGRAM, WHICH CONTRACTS WITH COMMUNITY PROVIDERS IN EACH COUNTY TO COVER CARE NAVIGATION AND REENTRY SUPPORTS FOR RECENTLY INCARCERATED MEMBERS WITH BEHAVIORAL HEALTH NEEDS. THIS MENTORED RESEARCH CAREER DEVELOPMENT AWARD USES THE STATEWIDE IMPLEMENTATION OF BH-JI AS A NATURAL EXPERIMENT TO CONDUCT A MIXED METHODS STUDY WITH THE FOLLOWING SCIENTIFIC AIMS: (AIM 1) TO DETERMINE THE IMPACT OF BH-JI REENTRY CARE NAVIGATION SERVICES ON POST-RELEASE HEALTHCARE UTILIZATION, COSTS, AND OVERDOSE OUTCOMES FOR INDIVIDUALS WITH OUD RELEASED FROM INCARCERATION. THIS QUANTITATIVE AIM USES QUASI-EXPERIMENTAL STUDY DESIGNS AND THE MASSACHUSETTS PUBLIC HEALTH DATA WAREHOUSE, WHICH LINKS INDIVIDUAL-LEVEL DATA FROM AN ALL PAYER CLAIMS DATABASE TO MORE THAN TWENTY STATEWIDE DATABASES, INCLUDING HEALTHCARE, PUBLIC HEALTH, JAILS, AND PRISONS. (AIM 2) TO IDENTIFY THE PERCEIVED FACILITATORS AND BARRIERS TO STATEWIDE POLICY IMPLEMENTATION OF THE BH-JI REENTRY CARE NAVIGATION PROGRAM AND THE MECHANISMS THAT EXPLAIN ANY IMPACT ON CLIENT OUTCOMES. THIS QUALITATIVE AIM USES A POLICY-FOCUSED IMPLEMENTATION SCIENCE APPROACH AND IN- DEPTH INTERVIEWS WITH KEY INFORMANTS, INCLUDING STATE MEDICAID OFFICIALS, HEALTHCARE DELIVERY ORGANIZATIONS, BH-JI PROVIDERS, CARCERAL FACILITIES, AND BH-JI CLIENTS. LASTLY, A CONVERGENT MIXED METHODS ANALYSIS WILL INTEGRATE FINDINGS FROM BOTH AIMS. WITH THE EXCEPTIONAL MENTORSHIP TEAM ASSEMBLED IN THIS K08 AND THROUGH AN INTENSIVE COMBINATION OF FORMAL COURSES, TRAINING WORKSHOPS, FIELD EXPERIENCES, AND APPLIED RESEARCH, THE CANDIDATE WILL: (1) DEEPEN EXISTING SKILLS IN QUANTITATIVE METHODS; (2) CULTIVATE NEW SKILLS FOR POLICY-FOCUSED IMPLEMENTATION SCIENCE, INCLUDING QUALITATIVE AND MIXED METHODS; (3) ENHANCE THEIR ADDICTION MEDICINE AND CORRECTIONAL HEALTHCARE EXPERTISE; AND (4) DEVELOP THE PROFESSIONAL SKILLS OF AN INDEPENDENT PHYSICIAN- INVESTIGATOR. ACQUISITION OF THESE SKILLS WILL PROPEL THE CANDIDATE TO ACCOMPLISH THEIR LONG-TERM CAREER GOAL: TO BECOME A THOUGHT LEADER ON POLICY INNOVATIONS TO IMPROVE HEALTH CARE AND OUTCOMES FOR PEOPLE WITH SUBSTANCE USE DISORDERS AND CRIMINAL LEGAL INVOLVEMENT.

PLACEBO VS. EXTENDED RELEASE STIMULANT CROSSOVER TRIAL IN PRESCHOOLERS WITH ADHD

COLLABORATIVE RESEARCH: PROCESS-CENTERED, ANALYSIS-DRIVEN SYSTEM DEVELOPMENT APPLIED TO HUMAN-INTENSIVE MEDICAL PROCESSES

ADVANCED EDUCATION NURSING TRAINEESHIP

THE AFFORDABLE CONNECTIVITY OUTREACH GRANT PROGRAM PROVIDES ELIGIBLE GOVERNMENTAL AND NON-GOVERNMENTAL ENTITIES WITH THE FUNDING AND RESOURCES NEEDED TO INCREASE AWARENESS OF AND PARTICIPATION IN THE AFFORDABLE CONNECTIVITY PROGRAM AMONG THOSE ELIGIBLE HOUSEHOLDS MOST IN NEED OF AFFORDABLE CONNECTIVITY.

PRIMARY CARE TRAINING AND ENHANCEMENT - RESIDENCY TRAINING IN MENTAL AND BEHAVIORAL HEALTH

EXPANSION AND ENHANCEMENT OF RESEARCH FACILITIES FOR THE PIONEER VALLEY LIFE SCIENCES INSTITUTE

GERIATRICS WORKFORCE ENHANCEMENT PROGRAM COVID

ADVANCED EDUCATION NURSING TRAINEESHIPS

THE BRIDGE-EL PUENTE PROGRAM