Geisinger Clinic

KEYSTONE BEACON COMMUNITY: PROPOSAL FOR A RURAL COMMUNITY-WIDE MEDICAL HOME

GEISINGER CANCER INSTITUTE ONCOLOGY RESEARCH PROGRAM

GENE DOSAGE IMBALANCE IN NEURODEVELOPMENTAL DISORDERS

LEVERAGING RARE GENETIC ETIOLOGIES TO ADVANCE KNOWLEDGE AND TREATMENT OF NEURPSYCHIATRIC DISORDERS

REAL-TIME GENETIC DIAGNOSIS AT THE POINT OF CARE - SUMMARY THE BURDEN ON PATIENTS AND CAREGIVERS WHEN COMPLEX DISEASES ARISE CREATES A TAXING TOLL FOR BOTH FAMILIES AND HEALTHCARE SYSTEMS. MULTIPLE INPATIENT HOSPITALIZATIONS AND VARIOUS TESTING PROCEDURES OFTEN BRING MORE UNKNOWNS AND GRIEF TO AN ALREADY DIFFICULT SITUATION. HOSPITAL VISITS DISRUPT PATIENT SCHEDULES, AND ALSO PLACE UNNECESSARY BURDENS ON A HEALTHCARE SYSTEM WHOSE PURPOSE IS TO MAXIMIZE THE HEALTH OUTCOMES OF THE PATIENTS. THESE COMPLEX DISEASES UTILIZE EXTRA VISITS AND UNNECESSARY TESTING. WE WANT TO DEVELOP A SYSTEM THAT WOULD IDENTIFY PATIENTS WHO COULD BENEFIT FROM ACCESSING THEIR EXISTING GENETIC INFORMATION. PHYSICIANS MAY STRUGGLE TO UNDERSTAND THE CORRECT TIME TO ORDER GENETIC TESTING, AND WITH THE RAPID PACE OF CHANGE WITHIN THE GENETICS FIELD, MANY PHYSICIANS ARE NOT UTILIZING THE GENETIC TESTING THAT IS AVAILABLE AT AN APPROPRIATE TIME. GENETIC TESTING ALSO REQUIRES HOSPITAL RESOURCES FROM A LIMITED POOL OF WORKERS, THUS EVERY PATIENT THAT PRESENTS AS A COMPLEX CASE MAY NOT BE A SUITABLE CANDIDATE FOR GENETIC TESTING. IDENTIFYING WHICH PATIENTS SHOULD BE ACCESSING THEIR GENETIC INFORMATION REQUIRES AN INNOVATIVE APPROACH. AT GEISINGER, WE HAVE A COHORT OF 150,000 PATIENTS WHO HAVE BEEN SEQUENCED AND WE CURRENTLY HAVE THEIR GENETIC DATA. WE PROPOSE STARTING WITH THE PATIENTS CLINICAL PRESENTATIONS THAT ARE CURRENTLY CHARTED INTO AN ELECTRONIC HEALTH RECORD TO IDENTIFY PHENOTYPE TERMS THAT WOULD TRIGGER GENETIC RESOURCES TO BE AVAILABLE. THESE GENETIC RESOURCES WOULD INCLUDE WORKFLOWS THAT SHOW OPTIMAL POINTS OF IMPACT FOR THE PATIENTS TO IMPROVE HEALTHCARE OUTCOMES. TO REALIZE THIS VISION, WE HAVE IDENTIFIED THREE AREAS THAT WE WOULD LIKE TO ADDRESS. IDENTIFICATION OF PATIENTS WITH A CANDIDATE CONDITION IN REAL TIME, FOLLOWED BY A CONCURRENT BIOINFORMATIC ANALYSIS OF THE GENOMIC SEQUENCE DATA. FINALLY, WE WANT TO ADDRESS RETURNING THE GENETIC TEST RESULT TO THE PROVIDER AND PATIENT SO THAT BOTH PARTIES HAVE THE APPROPRIATE INFORMATION TO GUIDE CONDITION-SPECIFIC CARE. IN ORDER TO ADDRESS THESE THREE NEEDS, WE HAVE DEVELOPED THREE SPECIFIC AIMS WITH THE EXPERTS AT GEISINGER IN MIND FOR IMPLEMENTATION. AIM 1. DEVELOPMENT OF A HIGH IMPACT PHENOTYPE IDENTIFICATION SYSTEM (HIPIS). AIM 2. DEVELOP DYNAMIC VIRTUAL GENETIC PANELS (DVGP) FOR REAL-TIME GENETIC DIAGNOSIS. AIM 3. ANALYSIS OF CLINICAL WORKFLOWS FOR OPTIMAL POINT OF CARE INTEGRATION OF REAL TIME GENETIC DIAGNOSIS. COLLABORATION WITH GEISINGER EXPERTS AS WELL AS EXPERTS IN HUMAN PHENOTYPING (PETER ROBINSON) WILL INCREASE UNDERSTANDING ABOUT INTEGRATING GENETIC INFORMATION INTO PATIENT CARE. THIS TRANSFORMATION WILL ALLOW THE WORK OF MANY EXPERTS IN VARIOUS FIELDS TO BE SITTING AT THE FINGERTIPS OF PRIMARY CARE PHYSICIANS WHILE RESEARCHING THE BEST DIRECTION FOR COMPLEX DISEASES.

EMR-LINKED BIOBANK FOR TRANSLATIONAL GENOMICS

IDENTIFICATION METHODS, PATIENT ACTIVATION, AND CASCADE TESTING FOR FH: IMPACT-FH

CLINICAL AND GENETIC STUDY OF PRESCRIPTION OPIOID ADDICTION

GEISINGER EGENONIC MEDICINE (GEM) PROGRAM

IMPLEMENTING UNIVERSAL LYNCH SYNDROME SCREENING ACROSS MULTIPLE HEALTHCARE SYSTEMS: IDENTIFYING STRATEGIES TO FACILITATE AND MAINTAIN PROGRAMS IN DIFFERENT ORGANIZATIONAL CONTEXTS

REPORTING ADULT-ONSET GENOMIC RESULTS TO PEDIATRIC BIOBANK PARTICIPANTS AND PARENTS

COMPONENT A: A MULTI-LEVEL STUDY OF COMMUNITY CONTEXT AND TYPE 2 DIABETES AND CORONARY HEART DISEASE USING ELECTRONIC HEALTH RECORD AND NEW PRIMARY DATA ACROSS NESTED GEOGRAPHIES IN PENNSYLVANIA

DIMENSIONAL ANALYSIS OF DEVELOPMENTAL BRAIN DISORDERS USING AN ONLINE, GENOME-FIRST APPROACH

GEISINGER CLINICAL ONCOLOGY PROGRAM

A PRECISION MEDICINE APPROACH TO ARRHYTHMOGENIC CARDIOMYOPATHY

COLLABORATIVE RESEARCH TO EXPLORE GENETIC VARIATION AND PHENOTYPIC SPECTRUM OF ELASTIN AND RELATED GENES

IMPROVING RISK STRATIFICATION IN FAMILIAL HYPERCHOLESTEROLEMIA (RISK-FH) - PROJECT SUMMARY IT IS NOW WELL UNDERSTOOD THAT FAMILIAL HYPERCHOLESTEROLEMIA (FH) IS AN UNDER DIAGNOSED AND UNDER TREATED CAUSE OF PREMATURE ATHEROSCLEROTIC CARDIOVASCULAR DISEASE (ASCVD). RECENT ADVANCES IN GENETICS AND RESULTS FROM POPULATION-BASED STUDIES OF FH SUGGEST THAT THE BROAD PHENOTYPIC DEFINITION OF FH, SEVERELY ELEVATED LOW DENSITY LIPOPROTEIN CHOLESTEROL (LDL-C), AND POSITIVE FAMILY HISTORY OF PREMATURE ASCVD OR HIGH CHOLESTEROL, ENCOMPASSES FOUR DISTINCT CLINICAL SUBTYPES: 1) MONOGENIC FH CAUSED BY A PATHOGENIC VARIANT IN AN FH GENE, 2) POLYGENIC HYPERCHOLESTEROLEMIA CAUSED BY THE CUMULATIVE INHERITANCE OF MANY COMMON ALLELES ASSOCIATED WITH INCREMENTAL INCREASES IN LDL-C, 3) ELEVATED LIPOPROTEIN (A) (LP(A)) AND SEVERE HYPERCHOLESTEREMIA, AND 4) SEVERE HYPERCHOLESTEREMIA IN THE ABSENCE OF A GENETIC CAUSE. WE HYPOTHESIZE THAT DIFFERENCES IN RISK OF INCIDENT ASCVD EXIST AMONG THE FOUR FH SUBTYPES. RISK ASSESSMENT IN FH HAS BECOME INCREASINGLY COMPLEX WITH MULTIPLE FACTORS INFLUENCING OUTCOMES: LDL-C LEVEL, PRESENCE OF A GENETIC VARIANT, PRESENCE OF ADDITIONAL ASCVD RISK FACTORS, LP(A) LEVEL, PRE-EXISTING ASCVD, AGE, AND GENDER. FURTHER COMPLICATING RISK ASSESSMENT ARE HEALTH DISPARITIES RELATED TO AGE, SEX, RURALITY, AND RACE/ETHNICITY. CURRENT SHORTCOMINGS IN FH CARE SUGGEST TWO IMMEDIATE NEEDS: MORE ACCURATE RISK ASSESSMENT AND STRATEGIES TO COMMUNICATE THIS RISK INFORMATION TO THE DIVERSE POPULATION IMPACTED. THE GOALS OF THIS PROPOSAL ARE TO 1) DEMONSTRATE THE IMPACT OF FH SUBTYPE ON ASCVD PROGNOSIS, AND 2) STUDY THE BEST WAYS TO COMMUNICATE THIS COMPLEX FH RISK INFORMATION TO CLINICIANS AND PATIENTS, WITH CONSIDERATION OF HEALTH DISPARITIES AS BARRIERS TO CARE FOR BOTH CLINICIANS AND PATIENTS. IN AIM 1, THIS PROPOSAL WILL DEVELOP A FOUNDATION FOR ACCOMPLISHING THESE GOALS BY CREATING A COHORT OF OVER 800K PEOPLE USING INDIVIDUAL-LEVEL DATA FROM GEISINGER, MT. SINAI, AND THE UK BIOBANK INTEGRATED WITH VARIANT-LEVEL DATA FROM THE CLINVAR GENETIC DATABASE, ALLOWING MOLECULAR ASSIGNMENT OF FH SUBTYPES, ASCVD PHENOTYPING, AND CHARACTERIZATION OF RISK. OUR ANTICIPATED STUDY SAMPLE WILL INCLUDE APPROXIMATELY 2,500 INDIVIDUALS WITH A PATHOGENIC FH VARIANT AND 50,000 INDIVIDUALS WITH A VARIANT-NEGATIVE FH SUBTYPE. IN AIM 2, WE WILL USE THIS COHORT TO DETERMINE ASCVD OUTCOMES IN THE FOUR SUBTYPES, INCLUDING ASSESSMENT OF THE IMPACT OF CONVENTIONAL RISK FACTORS AND POLYGENIC RISK FOR ASCVD INDEPENDENT OF BLOOD LIPIDS. WE WILL ALSO ASSESS THE IMPACT OF HEALTH DISPARITIES ON OUTCOMES. AT THE SAME TIME, IN AIM 3 WE WILL USE IMPLEMENTATION SCIENCE TO INVESTIGATE BARRIERS AND FACILITATORS TO THE COMMUNICATION OF PREVENTATIVE HEALTH INFORMATION AT GEISINGER AND MT. SINAI. WE WILL FOCUS ON ATTITUDES AND PERCEPTIONS OF PATIENTS AND PROVIDERS WITH AN EMPHASIS ON KNOWN CARE DISPARITIES AND THEIR IMPACT ON CARE. THIS PROPOSAL WILL SHOW THE BENEFIT OF A PRECISE GENOMIC CHARACTERIZATION OF FH RISK, AND THE VALUE OF ADDITIONAL ASCVD RISK ASSESSMENT. BY UNDERSTANDING THE BARRIERS TO CARE AT THE CLINICIAN AND PATIENT LEVEL AND THE VALUE OF ACCOUNTING FOR KNOWN DISPARITIES, WE WILL DEMONSTRATE BEST PRACTICES FOR COMMUNICATING THIS INFORMATION IN A WAY THAT IMPROVES CLINICAL PRACTICE AND PATIENT UNDERSTANDING.

FEASIBILITY AND ASSESSMENT OF A CASCADE TRACEBACK SCREENING PROGRAM - FACTS

COLLABORATIVE APPROACH TO REACH EVERYONE WITH FAMILIAL HYPERCHOLESTEROLEMIA: CARE-FH - PROJECT SUMMARY FAMILIAL HYPERCHOLESTEROLEMIA (FH) IS A COMMON GENETIC DISORDER (PREVALENCE 1 IN 250) THAT REQUIRES LIFELONG SUSTAINED MEDICAL CARE. EVIDENCE-BASED GUIDELINES FOR SCREENING AND TREATMENT FOR FH EXIST. THESE INCLUDE UNIVERSAL SCREENING OF CHILDREN AGES 9-11, OF ADOLESCENTS AGES 18-20, AND OF ADULTS AGES 40 AND ABOVE; APPROVED DIAGNOSTIC TOOLS INCLUDING LIPID PANELS AND GENETIC TESTING; AND RECOMMENDATIONS FOR INITIATION OF LIPID LOWERING MEDICATION. FH DIAGNOSIS IS CURRENTLY MADE TOO LATE IN LIFE, OFTEN AFTER A PREMATURE HEART ATTACK HAS OCCURRED CREATING A CARE GAP THAT RESULTS IN EXCESS CARDIOVASCULAR MORBIDITY AND MORTALITY. DIAGNOSING FH IN THE PRIMARY CARE SETTING WOULD OPTIMIZE TREATMENT FOR INDIVIDUALS WITH FH AND CLOSE THIS CARE GAP. UTILIZING TOOLS FROM IMPLEMENTATION SCIENCE AND HUMAN CENTERED DESIGN, AND BY CONSIDERING UPTAKE, ACCEPTABILITY, AND SUSTAINABILITY OF PROGRAMS RELATED TO FH CARE SHOULD IMPROVE EARLIER DIAGNOSIS. IMPLEMENTATION STRATEGIES THAT INCLUDE INSIGHTS FROM PATIENTS, CLINICIANS, AND HEALTHCARE SYSTEMS ARE NECESSARY. OUR LONG-TERM GOAL IS TO CREATE AN EFFECTIVE FH DIAGNOSIS PROGRAM THAT IS PRACTICAL AND SUSTAINABLE IN THE REAL-WORLD SETTING. THE MAIN OBJECTIVE OF THIS PROJECT IS TO DETERMINE THE UPTAKE OF AN FH DIAGNOSIS PROGRAM INTEGRATED INTO PRIMARY CARE PRACTICES TO PROMOTE EARLY IDENTIFICATION OF ADULT AND PEDIATRIC PATIENTS THAT IS GENERALIZABLE TO OTHER HEALTHCARE SETTINGS. OUR RESEARCH QUESTION IS, DOES USING A MULTI-LEVEL IMPLEMENTATION STRATEGY PACKAGE, DESIGNED TO ADDRESS THE SPECIFIC NEEDS OF PATIENTS, CLINICIANS, AND HEALTHCARE SYSTEMS, IMPROVE THE DIAGNOSIS AND ACTIVATION OF CARE MANAGEMENT FOR INDIVIDUALS WITH FH. OUR SPECIFIC AIMS ARE TO: 1) TO DESIGN A CLINICAL TRIAL TO ASSESS MULTI-LEVEL IMPLEMENTATION STRATEGIES FOR IMPROVING FH DIAGNOSIS IN AN INTEGRATED HEALTH SYSTEM, 2) COMPARE FH DIAGNOSIS RATES AMONG PRIMARY CARE CLINICIANS WHO RECEIVE THE IMPLEMENTATION STRATEGY PACKAGE VERSUS THOSE WHO DO NOT, 3) TO MEASURE IMPLEMENTATION SUCCESS OF AN ORGANIZED FH DIAGNOSIS PROGRAM, AND 4) TO EXPLORE PATIENT-RELATED SERVICE AND HEALTH OUTCOMES RELATED TO AN FH DIAGNOSIS PROGRAM.

CHARACTERIZING THE SPECTRUM OF GENOMIC AND PHENOTYPIC VARIATION IN CEREBRAL PALSY - PROJECT SUMMARY/ABSTRACT CEREBRAL PALSY (CP) IS A COMMON (PREVALENCE 1 IN 500), NONPROGRESSIVE DEVELOPMENTAL BRAIN DISORDER (DBD) CHARACTERIZED BY NEUROMOTOR IMPAIRMENTS OFTEN ACCOMPANIED BY OTHER NEURODEVELOPMENTAL AND MEDICAL DISORDERS. BIRTH ASPHYXIA, LONG CONSIDERED THE MOST FREQUENT CAUSE OF CP, ACCOUNTS FOR <10% OF CASES AND A SPECIFIC CAUSE REMAINS UNKNOWN FOR MOST INDIVIDUALS. A GROWING BODY OF EVIDENCE SUGGESTS THAT A LARGE PROPORTION OF CP IS CAUSED BY RARE GENOMIC VARIANTS, AS HAS BEEN SHOWN FOR OTHER DBDS. ADDITIONALLY, THE CONTRIBUTION OF COMMON GENOMIC VARIANTS TO CP HAS NOT BEEN ADEQUATELY EVALUATED. HERE, WE PROPOSE TO ELUCIDATE THE COMPLETE GENOMIC ARCHITECTURE OF CP, INCLUDING THE CONTRIBUTION OF RARE AND COMMON GENOMIC VARIANTS. WE WILL CAPITALIZE ON DATA GENERATED FROM TWO COMPLEMENTARY SOURCES: 1) A PEDIATRIC CP COHORT REFERRED FOR EXOME SEQUENCING (ES) TO A CLINICAL GENETICS LABORATORY (GENEDX) AND 2) AN ADULT CP COHORT FROM GEISINGER’S MYCODE STUDY, A LARGE-SCALE GENOMICS INITIATIVE WITH PAIRED ELECTRONIC HEALTH RECORD (EHR), ES, AND SNP GENOTYPE DATA. AS WITH OTHER DBDS, CLINICAL VARIABILITY IS COMMON IN CP AND DETAILED GENOTYPE-PHENOTYPE CORRELATION STUDIES ARE REQUIRED TO CHARACTERIZE THE CONTRIBUTORS TO PHENOTYPIC VARIANCE. SIMILARLY, NEUROIMAGING STUDIES REVEAL BRAIN ABNORMALITIES IN 70-90% OF INDIVIDUALS WITH CP; HOWEVER, FINDING A NEUROIMAGING ABNORMALITY DOES NOT ESTABLISH THE UNDERLYING CAUSE FOR MOST INDIVIDUALS WITHOUT FURTHER EVALUATIONS AND THERE IS A LACK OF NEUROIMAGING STUDIES TO LINK GENOMIC FINDINGS WITH CP. WE WILL ADDRESS THESE SIGNIFICANT KNOWLEDGE GAPS THROUGH THE FOLLOWING AIMS: 1) EXTRACT AND STANDARDIZE GENOMICS, EHR, AND NEUROIMAGING DATA TO CREATE A LARGE, HARMONIZED CP DATASET FOR ANALYSIS. WE WILL LEVERAGE GENOTYPE AND PHENOTYPE DATA FROM 4,000 INDIVIDUALS WITH CP AND HARMONIZE THEIR AVAILABLE GENOMIC, EHR, AND NEUROIMAGING DATA. 2) DETERMINE THE CONTRIBUTION OF RARE GENOMIC VARIANTS TO THE ETIOLOGY OF CP AND IDENTIFY NEW GENE-DISEASE RELATIONSHIPS AND CP-RELATED GENES; 3) EVALUATE THE ROLE OF COMMON GENOMIC VARIANTS IN CP AND THE INFLUENCE OF GENOMIC LIABILITY FOR DBD ON CP. WE WILL COMPREHENSIVELY ASSESS THE FULL GENOMIC LANDSCAPE OF CP, INCLUDING MULTIPLE CLASSES OF GENOMIC VARIANTS. 4) DEVELOP A GENOMICALLY-INFORMED APPROACH TO NEUROIMAGING INTERPRETATION IN CP AND CHARACTERIZE GENOTYPE- PHENOTYPE CORRELATIONS FOR CP-RELATED GENES. WE WILL PERFORM GENOMICALLY-INFORMED NEUROIMAGING INTERPRETATION IN A SUBGROUP OF PARTICIPANTS WITH PATHOGENIC VARIANTS TO IDENTIFY PROFILES OF BRAIN ABNORMALITIES RELATED TO SPECIFIC GENES. WE WILL ALSO EXPLORE THE CONTRIBUTORS TO CLINICAL VARIABILITY AMONG INDIVIDUALS WITH RARE VARIANTS IN THE SAME GENE. OVERALL, THERE IS A VERY HIGH LIKELIHOOD OF SUCCESS THAT THIS PROJECT WILL LEAD TO THE IDENTIFICATION OF NOVEL GENOMIC VARIANTS THAT CAUSE CP. AN IMMEDIATE OUTCOME OF THIS STUDY WILL BE THE GENERATION OF REQUIRED EVIDENCE TO SUPPORT THE INCORPORATION OF CLINICAL GENOMIC TESTING INTO ROUTINE CLINICAL CARE FOR INDIVIDUALS WITH CP. THIS PROJECT WILL FOSTER FUTURE RESEARCH INTO MOLECULAR MECHANISMS OF DISEASE, WHICH WILL BE CRITICAL TO DEVELOPING TARGETED THERAPIES FOR SPECIFIC GENOMIC VARIANTS, AND WILL INFORM CLINICAL GENOMIC TESTING FOR INDIVIDUALS WITH CP.

TBX3-REGULATED ALTERNATIVE RNA PROCESSING IN CARDIAC CONDUCTION SYSTEM DEVELOPMENT

NATURAL HISTORY OF STRESS, URGE AND MIXED URINARY INCONTINENCE IN WOMEN

RESIDENCY TRAINING IN PRIMARY CARE

7/7-PSYCHEMERGE: ADVANCING PRECISION PSYCHIATRY - PROJECT SUMMARY PSYCHIATRIC DISORDERS REMAIN A LEADING CAUSE OF DISABILITY IN THE US AND ARE ASSOCIATED WITH INCREASED MORBIDITY AND MORTALITY. EARLY DETECTION AND TREATMENT IS ESSENTIAL TO IMPROVING LONG-TERM OUTCOMES, YET A SUBSTANTIAL PROPORTION OF PATIENTS WITH PSYCHIATRIC COMPLAINTS EXPERIENCE LONG DIAGNOSTIC ODYSSEYS BEFORE RECEIVING AN APPROPRIATE DIAGNOSIS AND INITIATING EFFECTIVE TREATMENT. “LEARNING HEALTH CARE SYSTEMS” AIM TO SHORT-CIRCUIT THIS SLOW PROCESS BY LEVERAGING THE DIAGNOSTIC, TREATMENT, AND UTILIZATION PATTERNS LEFT BEHIND IN “BIG DATA” (E.G., CLINICAL, GENOMIC, AND SOCIAL DETERMINANTS OF HEALTH) TO MORE EFFICIENTLY AND ACCURATELY MATCH THE RIGHT PATIENT WITH THE RIGHT DIAGNOSIS/TREATMENT, AT THE RIGHT TIME. FURTHERMORE, OVER THE PAST SEVERAL YEARS, A NEW PARADIGM– PRECISION MEDICINE–HAS MOVED TO THE FOREFRONT OF BIOMEDICAL RESEARCH AND CLINICAL PRACTICE. PRECISION MEDICINE HAS BEEN DEFINED AS “AN APPROACH TO DISEASE TREATMENT AND PREVENTION THAT SEEKS TO MAXIMIZE EFFECTIVENESS BY TAKING INTO ACCOUNT INDIVIDUAL VARIABILITY IN GENES, ENVIRONMENT, AND LIFESTYLE.” SINCE ITS INCEPTION IN 2018, THE MISSION OF THE PSYCHEMERGE NETWORK HAS BEEN TO ADVANCE PRECISION PSYCHIATRY IN A LEARNING HEALTH CARE SYSTEM FRAMEWORK. THIS APPLICATION, WHICH WAS DEVELOPED COLLABORATIVELY BY PSYCHEMERGE NETWORK MEMBERS, REPRESENTS AN OPPORTUNITY FOR PROFOUND ADVANCEMENT OF BOTH BASIC AND TRANSLATIONAL RESEARCH IN PRECISION PSYCHIATRY. WE PROPOSE EXTENDING OUR FOUNDATIONAL EFFORTS TO NOW ADDRESS BARRIERS TO SCALABILITY, UTILITY OF GENOMIC DATA, CLINICAL APPLICATION, AND TRANSLATION TO CLINICAL PRACTICE IN A PRECISION PSYCHIATRY PARADIGM. SPECIFICALLY, AIM 1 CREATES A NATION-WIDE FEDERATED TRANSFER-LEARNING PLATFORM FOR THE DEVELOPMENT OF GENERALIZABLE AND BIAS-AWARE ALGORITHMS. AIM 2 INTEGRATES STATE-OF-THE-ART METHODS TO PERFORM INCLUSIVE TRANS-ANCESTRY GENOMIC ANALYSIS OF BIOBANK SAMPLES AND FURTHER INNOVATES BY LEVERAGING THE BREADTH AND DEPTH OF MEDICAL RECORD DATA TO DISCOVER NOVEL BIOLOGY THAT CAN FURTHER INFORM PRECISION PSYCHIATRY PARADIGMS. AIM 3 ADDRESSES THE APPLICATION OF ALGORITHMS BY FOCUSING ON TWO USE CASES INCLUDING (A) DIFFERENTIAL DIAGNOSIS BETWEEN BIPOLAR DISORDER 1 AND OTHER MOOD DISORDERS, AS WELL AS (B) PROBABILISTIC TREATMENT RESPONSE TO ANTIDEPRESSANTS FOR ACUTE DEPRESSIVE EPISODES. LASTLY, AIM 4 USES MIXED METHODS TO ASSESS THE FEASIBILITY, UTILITY, AND ATTITUDES TOWARDS PRECISION PSYCHIATRY TOOLS. OUR COMBINED SAMPLE OF CLINICAL EHR DATA EXCEEDS 29 MILLION INDIVIDUALS AND OF THOSE, NEARLY 2 MILLION ALSO HAVE GENETIC DATA ALREADY AVAILABLE FOR ANALYSIS ACROSS THE TWELVE SITES INCLUDED IN THIS APPLICATION. A CROSS-CUTTING THEME THROUGHOUT THE APPLICATION IS THE INTENTIONAL FOCUS ON EQUITABLE PERFORMANCE OF ALGORITHMS, INNOVATIVE INTEGRATION OF SOCIAL DETERMINANTS OF HEALTH, AND INCLUSIVE METHODS FOR GENOMIC ANALYSES. THE SITES INCLUDED ARE ALSO REPRESENTATIVE OF MANY DIVERSE COMMUNITIES ACROSS THE UNITED STATES INCLUDING THE EAST AND WEST COASTS, THE SOUTH, AND THE MIDWEST. THIS APPLICATION REPRESENTS A MAJOR STEP TOWARDS EQUITABLE PRECISION PSYCHIATRY AND BRINGS THE FIELD CLOSER TO THE GOALS OUTLINED IN THE UPDATED NIMH STRATEGIC PLAN.

ADDICTION MEDICINE FELLOWSHIP

MENTAL HEALTH DISORDERS, SUICIDE RISK, AND TREATMENT SEEKING AMONG FORMERLY DEPLOYED NATIONAL GUARD AND RESERVE SERVICE MEMBER SEEN IN NON-VA FACILIT

EXPLORING THE ROLE OF DYSSYNCHRONY IN PEDIATRIC HEART DISEASE WITH MRI

INTEGRATED SUBSTANCE USE DISORDER (SUD) TRAINING PROGRAM

AN INTEGRATED APPROACH TO STUDY GPCR VARIANTS ASSOCIATED WITH COMPLEX DISEASES

THE ROLE OF FGF8 DURING CARDIOVASCULAR DEVELOPMENT

THE INNOVATIVE CARDIOVASCULAR HEALTH PROGRAM - NON-HISPANIC BLACK (NHB) AND HISPANIC ADULTS IN THE UNITED STATES (U.S.) ARE MORE LIKELY TO BE UNEMPLOYED, WORK LOW PAYING JOBS, BE UNINSURED, AND HAVE LOWER EDUCATIONAL ATTAINMENT THAN NON-HISPANIC WHITE (NHW). THESE FACTORS ARE CONSISTENTLY LINKED WITH POOR CARDIOVASCULAR HEALTH AND UNDERLYING MAJOR DISPARITIES IN CARDIOVASCULAR DISEASE (CVD) BY RACE AND ETHNICITY. NHB ADULTS HAVE A HIGHER BURDEN OF CVD RISK FACTORS, SUCH AS HYPERTENSION AND ARE MORE THAN TWICE AS LIKELY TO DIE OF CVD THAN NHW ADULTS. OVER THE LAST DECADE, HISPANIC ADULTS EXPERIENCED A SLOWER DECLINE IN STROKE MORTALITY AND GREATER RISE IN HEART FAILURE MORTALITY RATE THAN NHW ADULTS. THE PREVALENCE OF HIGH CHOLESTEROL IN NHB IS COMPARABLE TO OR LOWER THAN IN NHW, RACIAL-ETHNIC DISPARITIES OCCUR AT DIAGNOSIS AND MANAGEMENT. THERE IS A DEMAND FOR EQUITY-FOCUSED HEALTH SYSTEM INTERVENTIONS TO MITIGATE THESE DISPARITIES IN HYPERTENSION AND HYPERCHOLESTEREMIA AWARENESS, TREATMENT, AND OUTCOMES. GEISINGER SERVES A RURAL AND INCREASINGLY DIVERSE PATIENT POPULATION THAT HAS VARIED ACCESS TO HEALTH CARE RESOURCES DEPENDING ON LOCATION AND DISTANCE FROM HEALTH CARE CENTERS. HISPANIC AND NHB POPULATIONS ARE GROWING WITHIN THE GEISINGER SERVICE AREA AND ARE AT SIGNIFICANT RISK OF CVD DUE TO SOCIAL RISK FACTORS THAT DISPROPORTIONATELY IMPACT THESE COMMUNITIES ESPECIALLY CONSIDERING THEIR RURAL NATURE. IN THIS INITIATIVE, WE WILL FOCUS ON NARROWING THE CARE GAP FOR ADULT PATIENTS THAT IDENTIFY AS HISPANIC AND/OR NHB WITHIN THE GEISINGER SERVICE AREA, TARGETING CENSUS TRACTS WITH A CRUDE PREVALENCE OF 53% HYPERTENSION AND IMPLEMENT PROGRAMS TO HELP THEM RECEIVE EQUITABLE HEALTHCARE. THE OVERALL APPROACH OF THIS PROJECT IS TO IMPROVE THE HEALTH AND HEALTH CARE ACCESS FOR THOSE WITH HYPERTENSION AND HYPERCHOLESTEROLEMIA IN UNDERSERVED POPULATIONS WITHIN THE GEISINGER SERVICE AREA. WE WILL DEVELOP AN APPROACH THAT USES GEOGRAPHIC INFORMATION SYSTEM (GIS) TECHNOLOGY AND ELECTRONIC HEALTH RECORD DATA TO IDENTIFY INDIVIDUALS WHERE POPULATIONS WITH HIGH PREVALENCE OF THESE TWO CONDITIONS RESIDE. ONCE IDENTIFIED, WE WILL WORK TO DEVELOP A LEARNING COLLABORATIVE WITH COMMUNITY PARTNERS THAT ALREADY PROVIDE SERVICES IN THE TARGET AREAS TO DEVELOP AND IMPLEMENT A PLAN TO IMPROVE HEALTH AND HEALTH CARE ACCESS. WE WILL THEN DEPLOY THESE RESOURCES TO IMPROVE HYPERTENSION AND HYPERCHOLESTEROLEMIA CONTROL IN THESE APPROVED POPULATIONS OF FOCUS. THE FOLLOWING STRATEGIES WILL BE IMPLEMENTED IN GEISINGER SERVICE AREA: STRATEGY 1. TRACK AND MONITOR CLINICAL MEASURES SHOWN TO IMPROVE HEALTH AND WELLNESS, HEALTH CARE QUALITY, AND IDENTIFY PATIENTS WITH HYPERTENSION AND HIGH CHOLESTEROL, STRATEGY 2. IMPLEMENT TEAM-BASED CARE TO PREVENT AND REDUCE CVD RISK WITH A FOCUS ON HYPERTENSION AND HIGH CHOLESTEROL PREVENTION, DETECTION, CONTROL, AND MANAGEMENT, AND STRATEGY 3. LINK COMMUNITY RESOURCES AND CLINICAL SERVICES THAT SUPPORT COMPREHENSIVE BIDIRECTIONAL REFERRAL AND FOLLOW-UP SYSTEMS AIMED AT MITIGATING SOCIAL SUPPORT BARRIERS FOR OPTIMAL HEALTH OUTCOMES. WITH GUIDANCE FROM THE LEARNING COLLABORATIVE, A MULTIDISCIPLINARY TEAM OF CLINICIANS; EXPERTS IN DIVERSITY, EQUITY, AND INCLUSION; IMPLEMENTATION SCIENTISTS; AND DATA SCIENTISTS WILL DEVELOP AND EXECUTE A PLAN TO EVALUATE THE IMPLEMENTATION AND IMPACT OF THESE STRATEGIES.

BLOOD TRAUMA, VASCULAR REMODELING, AND VASOREGULATION WITH TOTAL BODY CONTINUOUS VERSUS PULSATILE ARTIFICIAL CIRCULATION - PROJECT ABSTRACT LEFT VENTRICULAR ASSIST DEVICE SUPPORT IS STANDARD THERAPY FOR PATIENTS WITH ADVANCED, LIFE-THREATENING HEART FAILURE. HOWEVER, CURRENT-GENERATION IMPELLER-BASED BLOOD PUMPS HAVE INTRODUCED A NEW “NON-PULSATILE” PHYSIOLOGY WITH FREQUENT ADVERSE EVENTS. LACK OF PULSATILITY CONTRIBUTES TO BLOOD TRAUMA, ENDOTHELIAL AND ARTERIAL REMODELING, AND ABNORMALITIES IN VASOREGULATION THAT PREDISPOSE PATIENTS TO BLEEDING, THROMBOSIS, DIASTOLIC HYPERTENSION, AND STROKE. CYCLIC SPEED MODULATION IN WHICH DEVICE IMPELLER SPEED IS RAPIDLY INCREASED/DECREASED HAS BEEN DEVELOPED TO GENERATE PULSATILE BLOOD FLOW. THIS EMERGING TECHNOLOGY HAS POTENTIAL TO COMBINE DURABILITY OF IMPELLER-DRIVEN DEVICES WITH PHYSIOLOGIC BENEFITS OF PULSATILITY IN ORDER TO REDUCE ADVERSE EVENTS AND IMPROVE QUALITY OF LIFE FOR PATIENTS WITH ARTIFICIAL CIRCULATION DEVICES. TO DATE, NO INVESTIGATION HAS CHARACTERIZED (PATHO)PHYSIOLOGIC EFFECTS OF TOTAL-BODY PULSATILE VERSUS NON-PULSATILE BLOOD FLOW WITH THE SAME DEVICE. THE BIVACOR TOTAL ARTIFICIAL HEART IS A FIRST-OF-ITS-KIND, IMPELLER-BASED TOTAL ARTIFICIAL HEART WITH THE ABILITY TO GENERATE CONTINUOUS (NON-PULSATILE) OR PULSATILE BLOOD FLOW THROUGH CYCLIC IMPELLER SPEED MODULATION. IN A CHRONIC BOVINE MODEL, WE PROPOSE TO INVESTIGATE IN VIVO EFFECTS OF NON-PULSATILE VERSUS PULSATILE FLOW WITH THE BIVACOR ON BLOOD TRAUMA, ARTERIAL REMODELING, AND VASOREGULATION. WE ANTICIPATE THAT COMPARED TO NON-PULSATILE SUPPORT, PULSATILE FLOW WILL 1) REDUCE BLOOD TRAUMA, 2) PREVENT PATHOLOGIC CHANGES IN ENDOTHELIAL AND ARTERIAL WALL ARCHITECTURE AND FUNCTION, AND 3) MAINTAIN NORMAL VASOREGULATION DURING POSTURAL CHANGES, TRANSITION TO EXERCISE, SLEEP, AND OTHER ACTIVITIES OF DAILY LIVING. DATA WILL PROVIDE INSIGHT INTO PATHOPHYSIOLOGIC MECHANISMS OF ADVERSE EVENTS IN PATIENTS WITH IMPELLER-BASED BLOOD PUMPS. FINDINGS WILL ALSO BE USEFUL FOR THE DEVELOPMENT OF ARTIFICIAL PULSATILITY ALGORITHMS THAT MIMIC PHYSIOLOGIC PULSATILITY IN ORDER TO MINIMIZE BLOOD TRAUMA, PREVENT ARTERIAL REMODELING, AND APPROPRIATELY MODULATE VASOMOTOR TONE DURING DAILY ACTIVITIES.

FREE2BMOM - GEISINGER CLINIC IS APPLYING TO THE PPW GRANT PROGRAM FOR ITS FREE2BMOM(F2BM) PROGRAM. GEISINGER'S F2BM IS A CARE DELIVERY MODEL THAT HELPS MOTHERS AND BABIES AFFECTED BY OPIOID USE DISORDER/SUBSTANCE USE DISORDER PHYSICALLY, PSYCHOLOGICALLY, AND SOCIALLY. THE PROGRAM WAS DESIGNED TO BRING CURRENT SERVICES OFFERED IN OBSTETRICS, ADDICTION MEDICINE, PEDIATRICS, BEHAVIORAL HEALTH AND COMMUNITY-BASED SERVICES INTO ONE INTERDISCIPLINARY CARE TEAM. THE F2BM PROGRAM BEGAN IN 2019 WITH A PILOT IN LUZERNE COUNTY, PENNSYLVANIA AND HAS EXPANDED TO AN ADDITIONAL FIVE COUNTIES (COLUMBIA, MONTOUR, NORTHUMBERLAND, SNYDER, AND UNION) SINCE ITS INCEPTION. ANY PREGNANT WOMAN SEEKING ADDICTION TREATMENT IN THESE COUNTIES, ALONG WITH HER ENTIRE HOUSEHOLD, IS ELIGIBLE TO PARTICIPATE. THIS PROPOSAL AIMS TO EXPAND PROGRAM OFFERINGS IN THESE COUNTIES AND EXPAND RURAL CENTRAL PENNSYLVANIA AFTER A NEW COMMUNITY HEALTH NEEDS ASSESSMENT IS COMPLETED. GEISINGER ANTICIPATES SERVING THE FOLLOWING NUMBER OF UNDUPLICATED PATIENTS (AND THEIR HOUSEHOLD MEMBERS) IN EACH YEAR OF THE GRANT: YEAR 1: 75 (206), YEAR 2: 55 (151), YEAR 3: 67 (184), YEAR 4: 88 (242), YEAR 5: 108 (297), TOTAL: 393 (1,080) THE GOALS OF F2BM ARE TO INCREASE THE ACTIVATION OF ELIGIBLE PREGNANT MOTHERS IN TREATMENT AND HEALTH CARE, INCREASES THE INITIATION, ACCESS, AND ADHERENCE FOR PREGNANT MOMS WITH MAT, AND INCREASE MOM'S LONG-TERM HEALTH STATUS BY IMPLEMENTING EVIDENCE BASED PRACTICES AROUND SOCIAL AND BEHAVIORAL HEALTH CASE MANAGEMENT SUPPORT. GOALS AND OBJECTIVES INCLUDE: 1) 1) IDENTIFY POTENTIAL PROGRAM PARTICIPANTS AS EARLY AS POSSIBLE IN THEIR PREGNANCY TO IMPROVE THE BIRTH AND HEALTH OUTCOMES OF BABIES BORN TO MOMS WITH OUD/SUD. - BY MARCH 1, 2023, THE TEAM WILL COMPLETE 25 OUTREACH CONNECTIONS TO PROVIDERS AND POTENTIAL REFERRAL PARTNERS TO EDUCATE THEM ON F2BM. - WITHIN 90 DAYS OF EMPLOYMENT, ALL F2BM STAFF WILL RECEIVE MENTAL HEALTH FIRST AID TRAINING, TRAINING ON NEIGHBORLY, AND EDUCATION ON THE OUTCOMES AND EVALUATION PLAN. 2) INCREASE THE CONNECTION OF PREGNANT WOMEN TO COMPREHENSIVE HEALTH, TREATMENT AND RECOVERY SERVICES TO ACHIEVE AND MAINTAIN SOBRIETY. - WITHIN 90 DAYS OF THE START OF THE PROJECT, F2BM WILL EXECUTE AGREEMENTS WITH 100% OF PROVIDERS AND COMMUNITY ORGANIZATIONS TO ADDRESS EACH OF THE AREAS OF THE WORKPLAN. - AT LEAST 80% OF PROGRAM PARTICIPANTS WITH A DOCUMENTED INITIAL ASSESSMENT BY THE F2BM TEAM WILL RECEIVE A FOLLOW UP CONNECTION/ASSESSMENT WITHIN 90 DAYS. - BY THE END OF THE PROJECT PERIOD, AT LEAST 35% OF THE ACTIVE PARTICIPANTS WILL HAVE ENGAGED IN THE FORMAL EVALUATION INTERVIEWS/PROCESS. 3) INCREASE THE NUMBER OF HOUSEHOLD MEMBERS REFERRED TO SUPPORTIVE SERVICES. - WITHIN 120 DAYS OF ENROLLMENT, AT LEAST 75% OF THE PARTICIPANT'S HOUSEHOLD MEMBERS WILL HAVE MET WITH A CASE MANAGER AND BEEN REFERRED TO APPROPRIATE SERVICES. 4) INCREASE THE INITIATION AND ADHERENCE FOR PREGNANT MOMS IN TREATMENT. - ENROLL 100% OF MOTHERS IN A COORDINATED TREATMENT PLAN AND INCREASE PROGRAM ADHERENCE BY 10% IN YEAR 1, 15% IN YEAR 2 AND 20% IN YEARS 3-5. 5) INCREASE MOM'S LONG-TERM HEALTH STATUS BY IMPLEMENTING EVIDENCE-BASED PRACTICES AROUND SOCIAL, RECOVERY AND CASE MANAGEMENT SUPPORT. - BY ONE YEAR OF ENROLLMENT, PROVIDE EACH WOMAN A MINIMUM OF THREE SERVICE REFERRALS. - THROUGH YEAR 5, ATTAINMENT OF ZERO NEW CRIMINAL JUSTICE ENCOUNTERS FOR EACH WOMAN ENROLLED.

IMPROVING RURAL HEALTHCARE TRANSITIONS THROUGH HEALTH INFORMATION EXCHANGE

RYAN WHITE PART C OUTPATIENT EIS PROGRAM

ROLE OF AN ALTERNATIVELY SPLICED NUCLEAR VARIANT OF ERBB3 IN THE NERVOUS SYSTEM

MOLECULAR AND CELLULAR ANALYSIS OF G PROTEIN FUNCTION

EARLY DETECTION OF HEART FAILURE VIA THE ELECTRONIC HEALTH RECORD IN PRIMARY CARE

ELECTRONIC HEALTH RECORD-BASED SURVEILLANCE OF DIABETES BY TYPE IN YOUNG ADULTS IN PENNSYLVANIA

MAKING GENOMIC MEDICINE ROUTINE IN A RURAL HEALTHCARE SYSTEM - ABSTRACT THE NATIONAL HUMAN GENOME RESEARCH INSTITUTE’S 2020 STRATEGIC VISION CHARTS A PATH TOWARD AN AUDACIOUS GOAL – THAT IN 10 YEARS GENOMIC MEDICINE WILL SIMPLY BE MEDICINE. TODAY, THOUGH, GENOMIC MEDICINE IS NEITHER ROUTINE NOR EQUITABLY DISTRIBUTED. CONTRIBUTING FACTORS INCLUDE LACK OF STRUCTURED GENOMIC DATA IN THE ELECTRONIC HEALTH RECORD (EHR) TO FACILITATE POINT-OF-CARE DECISION SUPPORT, LIMITED PORTABILITY OF GENOMIC DATA ACROSS HEALTH SYSTEMS, AND INADEQUATE ACCESS TO GENOMIC MEDICINE EXPERTISE IN RURAL AND OTHER UNDERSERVED COMMUNITIES. WE PROPOSE TO ADDRESS THESE CHALLENGES AS A CLINICAL SITE IN THE GENOMIC-ENABLED LEARNING HEALTH SYSTEM (GLHS) NETWORK. WE WILL USE IMPLEMENTATION SCIENCE METHODS AND LEARNING HEALTH SYSTEM (LHS) PRINCIPLES TO GENERATE GENOMIC MEDICINE RESOURCES THAT CAN BE IMPLEMENTED EFFECTIVELY ACROSS DIVERSE HEALTHCARE SETTINGS. GEISINGER IS AN ESTABLISHED LHS AND RECOGNIZED LEADER IN GENOMICS, WITH THE WORLD’S LARGEST BIOBANK-BASED GENOMIC SCREENING PROGRAM. GEISINGER PROVIDES CARE IN ALL MEDICAL SPECIALTIES ACROSS THE LIFESPAN TO A LARGELY RURAL, SOCIOECONOMICALLY DIVERSE PATIENT POPULATION. OUR LHS IS ENABLED BY A ROBUST RESEARCH, INNOVATION AND DATA INFRASTRUCTURE. FURTHER, OUR INVESTIGATOR TEAM INCLUDES NATIONAL LEADERS IN GENOMIC MEDICINE, EXPERTS IN GENOMIC AND CLINICAL DATA SCIENCE, IMPLEMENTATION SCIENCE, HEALTH COMMUNICATION, AND DECISION SCIENCE, AND REPRESENTATIVES FROM COMMUNITY HEALTH SYSTEMS THAT DIFFER FROM GEISINGER IN KEY CHARACTERISTICS. IN YEAR 1 OF THE GLHS NETWORK WE WILL COLLABORATE WITH THE NETWORK TO IDENTIFY GENOMIC MEDICINE INTERVENTIONS THAT AIM TO HAVE SIGNIFICANT POPULATION HEALTH IMPACT: 1) GENOMIC SCREENING IN PRIMARY CARE FOR CLINICALLY ACTIONABLE DISEASE RISK; 2) EHR-INTEGRATED IMPLEMENTATION OF PGX FOR PATIENTS AGE 50+ ON MULTIPLE MEDICATIONS; AND 3) EHR- INTEGRATED CLINICIAN- AND PATIENT-FACING CLINICAL DECISION SUPPORT FOR MANAGING HEREDITARY CANCER RISK. IN YEARS 2- 4 WE WILL IMPLEMENT AND EVALUATE THE GENOMIC MEDICINE INTERVENTIONS SELECTED BY THE NETWORK. WE WILL USE THE CONCEPTUAL MODEL OF IMPLEMENTATION RESEARCH (CMIR) TO INFORM OUTCOMES TO ASSESS ACROSS THE INTERVENTIONS. GROUNDING THIS CYCLE OF IMPLEMENTATION AND EVALUATION IN THE CMIR WILL ALLOW US TO TAKE THE SAME THEORETICAL APPROACH REGARDLESS OF WHICH INTERVENTIONS THE NETWORK SELECTS. AND IT WILL ALLOW IDENTIFICATION OF CORE IMPLEMENTATION ELEMENTS AND DOCUMENTATION OF INSTITUTION-SPECIFIC ADAPTATIONS TO STANDARDIZE OUTCOMES AND LOWER BARRIERS TO IMPLEMENTATION OF RESOURCES IN OTHER HEALTH SYSTEMS. IN THE FINAL GRANT YEAR, WE WILL USE IMPLEMENTATION MAPPING AND A SUSTAINABILITY FRAMEWORK TO INFORM DESIGN OF QUALITATIVE INTERVIEWS WITH KEY OPERATIONAL AND STRATEGIC LEADERS IN OUR COMMUNITY PARTNERS’ HEALTH SYSTEMS. WE WILL THEN ADAPT THE NETWORK- SELECTED RESOURCES AND IMPLEMENTATION STRATEGIES ACCORDING TO FINDINGS FROM THE QUALITATIVE INTERVIEWS, USING IMPLEMENTATION SCIENCE FRAMEWORKS TO DOCUMENT ADAPTATIONS TO RESOURCES AND STRATEGIES. THROUGH THE GLHS NETWORK, WE EXPECT TO PRODUCE RESOURCES AND STRATEGIES FOR IMPLEMENTATION THAT WILL SUBSTANTIALLY ADVANCE NHGRI’S AUDACIOUS GOAL OF ROUTINE, EQUITABLE GENOMIC MEDICINE.

ADDICTION MEDICINE FELLOWSHIP - THE PURPOSE OF THE GEISINGER ADDICTION MEDICINE FELLOWSHIP GRANT APPLICATION IS TO TRAIN 20 ADDICTION MEDICINE FELLOWS IN OUR ACGME ACCREDITED ADDICTION MEDICINE FELLOWSHIP PROGRAM TO PRACTICE AS ADDICTION MEDICINE SPECIALISTS IN MEDICALLY UNDERSERVED, COMMUNITY-BASED SETTINGS THAT INTEGRATE PRIMARY CARE WITH MENTAL HEALTH DISORDER AND SUBSTANCE USE DISORDER (SUD) PREVENTION AND TREATMENT SERVICES. TRAINING WILL INCLUDE PREVENTION AND TREATMENT IN MEDICALLY UNDERSERVED, COMMUNITY-BASED SETTINGS, INCLUDING IN RURAL AREAS THAT HAVE LIMITED ACCESS TO SUD TREATMENT. THE GEISINGER ADDICTION MEDICINE FELLOWSHIP WILL 1) INCREASE THE NUMBER OF FELLOWS BY 20 TRAINED TO PRACTICE ADDICTION MEDICINE IN RURAL AND OTHER MEDICALLY UNDERSERVED COMMUNITY-BASED SETTINGS. 2) ENHANCE 4 PARTNERSHIPS WITH CLINICAL ROTATIONS SITES IN RURAL AND MEDICALLY UNDERSERVED AREAS, THAT FOCUS ON THE INTEGRATION OF PRIMARY CARE WITH MENTAL HEALTH AND SUD PREVENTION AND TREATMENT SERVICES. 3) INCREASE FELLOWS’ KNOWLEDGE AND ABILITY TO ASSIST THEIR PATIENTS WITH REFERRALS TO NAVIGATE THE LEGAL AND SOCIAL SYSTEMS RELATED TO PATIENTS’ CLINICAL OR CARE NEEDS. 4) INCREASE AWARENESS OF THE SPECIALTY AND REDUCE PROVIDER STIGMA TO INCREASE THE NUMBER OF PHYSICIANS INTERESTED IN PURSUING CAREERS IN ADDICTION MEDICINE THROUGH THE PROVISION OF CLINICAL ROTATIONS LEAD BY FELLOWS TEACHING MEDICAL RESIDENTS TO PRACTICES IN ADDICTION MEDICINE AND THROUGH EDUCATION AND CONSULTATION. THE GEISINGER ADDICTION MEDICINE FELLOWSHIP WILL CONTINUE TO TRAIN PHYSICIANS IN ROTATION SITES IN HIGH POVERTY AREAS. SPECIFICALLY, 64% OF ROTATION SITE LOCATIONS ARE IN HIGH POVERTY AREAS. IN THE NORTHEAST TRAINING TRACK 60% OF ROTATION SITES ARE IN MEDICALLY UNDERSERVED AREAS AND 8% ARE IN RURAL AREAS. IN THE CENTRAL TRAINING TRACK 60% OF ROTATION SITES ARE CONSIDERED RURAL SITES WHILE 8% ARE IN MEDICALLY UNDERSERVED AREAS. THEREFORE, GEISINGER IS REQUESTING PRIORITY 3: RURAL, TRIBAL OR UNDERSERVED COMMUNITIES. THE GEISINGER ADDICTION MEDICINE FELLOWSHIP WILL DELIVER EXPERIENTIAL CLINICAL TRAINING THAT DEVELOPS COMPETENCIES IN INTEGRATED, INTERPROFESSIONAL TEAM-BASED CARE, FOCUSED ON AT RISK POPULATIONS FOR OUD AND OTHER SUD PREVENTION, TREATMENT, AND RECOVERY SERVICES INCLUDING MEDICATION. THE EXPERIENTIAL CLINICAL TRAINING WILL BE DELIVERED PURSUANT TO THE NOFO, SPECIFICALLY, THE GEISINGER ADDICTION MEDICINE FELLOWSHIP WILL PROVIDE IN TRAINING TRACKS THAT PROVIDE A VIRTUAL TRAINING TRACK THAT INCLUDES AN IN-PERSON ROTATION AT A TEACHING HEALTH CENTER OR IN A COMMUNITY-BASED SETTING FOLLOWED BY A VIRTUAL ROTATION WHEREBY THE FELLOW WILL UTILIZE TELEHEALTH TO CONTINUE TO SUPPORT PATIENT CARE. ADDITIONALLY, THE GEISINGER ADDICTION MEDICINE FELLOWSHIP WILL PROVIDE IN PERSON TRAINING TRACKS THAT INCLUDE ROTATIONS FOR FELLOWS IN COMMUNITY-BASED SETTINGS AND IN COMMUNITY -BASED SETTINGS THAT SPECIALIZE IN THE TREATMENT OF CHILDREN, ADOLESCENTS AND PREGNANT AND POSTPARTUM WOMEN. THE GEISINGER ADDICTION MEDICINE FELLOWSHIP TOTAL FUNDING REQUEST FOR YEAR 1 IS $594,802 WITH A FIVE-YEAR TOTAL OF $2,969,996.

TELEHEALTH NETWORK GRANT PROGRAM

SUPPLEMENTAL FUNDING TO SUPPORT COVID-19 AND INFLUENZA VACCINE IN CAMBIAMOS AND SCRANTON - BETWEEN 1990 AND 2000, THE UNITED STATES GAINED 11.3 MILLION IMMIGRANTS, THE LARGEST INCREASE THIS COUNTRY HAS EVER EXPERIENCED, A GROWTH RATE OF 57 PERCENT. AN ESTIMATED 40 MILLION FOREIGN-BORN INDIVIDUALS NOW CALL THE UNITED STATES HOME. SCRANTON, PENNSYLVANIA IS 1 OF ONLY 9 METROPOLITAN AREAS ACROSS THE COUNTRY THAT EXPERIENCED AT LEAST A DOUBLING OF THEIR FOREIGN-BORN POPULATIONS BETWEEN 2000 AND 2010, ACCORDING TO THE BROOKINGS INSTITUTE.A TOTAL OF 45.81% OF THE HISPANICS LIVING IN SCRANTON ARE BELOW THE POVERTY LINE ACCORDING TO THE CENSUS BUREAU. POVERTY LEADS TO DELAYED HEALTHCARE, WITH INDIVIDUALS OFTEN SELF-DIAGNOSING AND TREATING THEIR CONDITIONS AT HOME. THIS, OF COURSE, RESULTS IN WORSENING OF HEALTH, OFTEN REQUIRING EXPENSIVE EMERGENCY CARE IN THE HIGH-COST ENVIRONMENTS OF THE EMERGENCY DEPARTMENT AND HOSPITAL. THROUGH THIS FUNDING, OUR COMMUNITY COALITION WILL WORK TO IMPROVE THE ACCESS TO HIGH QUALITY NUTRITION, OPPORTUNITIES FOR PHYSICAL ACTIVITY, AND INCREASE THE COMMUNITY AND CLINICAL LINKAGES THAT ARE CRITICAL STEPS IN REDUCING HEALTH DISPARITIES OF THE HISPANICS IN SCRANTON.THE PURPOSE OF ?CAMBIAMOS- TRANSFORMING THE HEALTH OF SCRANTON? IS TO ORGANIZE AND ALIGN THE HEALTH EFFORTS BEING CONDUCTED BY INDIVIDUAL ORGANIZATIONS ACROSS THE REGION TO CREATE AND EMPOWER THEIR COLLECTIVE ABILITY AND IMPACT. THROUGH THIS, WE WILL BE ABLE TO COLLABORATIVELY SHOW TARGETED IMPROVEMENTS FOR IMPORTANT HEALTH AND SOCIAL OUTCOMES FOR THE HISPANIC COMMUNITY IN SCRANTON. WITH A FOCUS ON POPULATION-WIDE SOLUTIONS TO POOR NUTRITION, PHYSICAL INACTIVITY AND LINKAGES AT THE COMMUNITY HEALTH LEVEL, WE AIM TO PREVENT CERTAIN BEHAVIOR-RELATED CHRONIC DISEASES SUCH AS HYPERTENSION, HEART DISEASE, TYPE 2 DIABETES AND OBESITY, AS WELL AS EMPOWER PEOPLE TO TAKE A LEADING ROLE IN BETTERING THEIR OWN HEALTH AND THAT OF THEIR FAMILIES.GEISINGER, THROUGH ITS SPRINGBOARD HEALTH PROGRAM, WILL FACILITATE AND ORGANIZE EFFORTS TO MEET THE GOALS OF THE GRANT. GEIS INGER CREATED SPRINGBOARD HEALTH IN 2016 WITH THE BELIEF THAT HEALTH SYSTEMS HAVE THE RESPONSIBILITY TO HELP MAKE THEIR COMMUNITIES HEALTHIER, NOT JUST THROUGH DIRECT MEDICAL CARE BUT ALSO THROUGH TACKLING THE SOCIAL DETERMINANTS OF HEALTH.THE GOALS WE AIM TO MEET BY THE END OF THE FIFTH YEAR INCLUDE: A MINIMUM OF 20 NEW LOCATIONS OFFERING HEALTHIER FOODS, A MINIMUM OF 12 NEW BREASTFEEDING SUPPORT ACTIONS, A 7% INCREASE OF THE NUMBER OF PERSONS WITH ACCESS TO HEALTHY FOODS, MINIMUM OF 10 NEW OR EXISTING PLACES WITH IMPROVED COMMUNITY DESIGN BY CONNECTING TO PHYSICAL ACTIVITY, 16% INCREASE FROM BASELINES OF PERSONS WITH ACCESS TO PHYSICAL ACTIVITY, AND A MINIMUM OF 40% OF THE TARGET POPULATION WILL HAVE AT LEAST ONE NEW LINKAGE TO SERVICES/PROGRAMS THROUGH ASSISTANCE OF COMMUNITY HEALTH WORKERS. WE WILL PARTNER WITH AN EXTERNAL EVALUATOR, THE INSTITUTE FOR PUBLIC POLICY & ECONOMIC DEVELOPMENT, TO COMPLETE THE GRANT OUTCOMES, PERFORMANCE PLAN AND DATA MANAGEMENT PLAN.GEISINGER HAS A LONG-STANDING COMMITMENT TO THE HEALTH OF ITS COMMUNITY AND IS UNIQUELY QUALIFIED TO LEAD THIS TYPE OF PROJECT. THROUGH UTILIZING THE RESOURCES AVAILABLE FROM EXISTING NETWORKS, ENGAGING COMMUNITY ASSETS, AND COUPLING THEM WITH THE INROADS THAT GEISINGER IS ALREADY MAKING WITH INNOVATIVE HEALTHCARE SOLUTIONS, SCRANTON RESIDENTS WHO IDENTIFY AS HISPANIC COULD FINALLY BE IN A PLACE WHERE THE HEALTHCARE NEEDLE IS BEING MOVED IN A POSITIVE DIRECTION.

ARP ECONOMIC DEVELOPMENT GRANT FOR RURAL HEALTH CARE FACILITIES

TELEMEDICINE GRANT

EVALUATION OF A PEER RECOVERY SUPPORT PROGRAM ADAPTED TO TARGET RETENTION IN CLINIC-BASED MEDICATION FOR OPIOID USE DISORDER TREATMENT - PROJECT ABSTRACT DRUG OVERDOSES ARE AT RECORD LEVELS IN THE US, DRIVEN PRIMARILY BY THE ONGOING OPIOID USE DISORDER (OUD) EPIDEMIC. MEDICATIONS FOR OPIOID USE DISORDER (MOUD) HAVE BEEN SHOWN TO SAFELY AND EFFECTIVELY TREAT OUD, REDUCE OVERDOSE AND OVERDOSE DEATH, AND FACILITATE LONG-TERM RECOVERY. HOWEVER, RETENTION IN MOUD TREATMENT OFTEN FALLS SHORT OF THE 6-12-MONTH DURATION NECESSARY FOR SUSTAINED RECOVERY, AND EARLY TERMINATION FROM MOUD IS A RISK FACTOR FOR OVERDOSE. PEER RECOVERY SUPPORT (PRS; I.E., SUPPORT SERVICES PROVIDED BY TRAINED “PEERS” WITH LIVED EXPERIENCE OF ADDICTION AND RECOVERY) HOLDS SUBSTANTIAL PROMISE AS A STRATEGY FOR IMPROVING RETENTION IN MOUD, YET VIRTUALLY NO RIGOROUS RESEARCH HAS BEEN CONDUCTED ON ITS EFFECTIVENESS IN THIS SETTING. THE OVERARCHING AIM OF THE PROPOSED PROJECT IS TO ENGAGE STAKEHOLDERS TO ADAPT PRS SPECIFICALLY FOR USE IN OUTPATIENT MOUD SETTINGS AND EVALUATE THE EFFECTIVENESS OF THE PRS PROGRAM IN IMPROVING PATIENT RETENTION ACROSS MULTIPLE GEOGRAPHICALLY DIVERSE MOUD CLINICS. THE PRACTICAL, ROBUST IMPLEMENTATION AND SUSTAINABILITY MODEL (PRISM), A CONTEXTUALLY EXPANDED VERSION OF THE REACH, ADOPTION, EFFECTIVENESS, IMPLEMENTATION, AND MAINTENANCE (RE- AIM) FRAMEWORK WILL BE USED ACROSS THE TWO PHASES OF THE PROJECT TO ENSURE THAT THE RESULTING PRS PROGRAM AND STUDY FINDINGS CAN BE TRANSLATED DIRECTLY INTO PRACTICE. IN THE R61 PHASE, WE PROPOSE A COMMUNITY-BASED PARTICIPATORY RESEARCH APPROACH TO ADAPTING PRS SERVICES FOR OUTPATIENT MOUD TREATMENT SETTINGS. WE WILL ASSEMBLE AND COLLABORATE WITH TWO COMMUNITY BOARDS THROUGHOUT THE R61 AND R33 PHASES TO CO-DEVELOP ALL ASPECTS OF THE PRS PROGRAM, TRAINING AND SUPERVISION PLAN FOR PEER RECOVERY SPECIALISTS, AND ELEMENTS OF THE SUBSEQUENT CLINICAL TRIAL. COMMUNITY BOARDS WILL INCLUDE: 1) PATIENTS WITH LIVED EXPERIENCE WITH MOUD TREATMENT; AND 2) MOUD PROVIDERS/STAFF/ADMINISTERS, PEER RECOVERY SPECIALISTS, AND PAYORS. NEXT, WE WILL CONDUCT A MIXED- METHODS PILOT EVALUATION TO TEST FEASIBILITY AND MAKE REFINEMENTS TO THE PRS PROGRAM, PEER TRAINING AND SUPERVISION PLAN, AND TRIAL METHODS. IN THE R33 PHASE, WE WILL CONDUCT A RANDOMIZED CONTROLLED TRIAL COMPARING STANDARD OUTPATIENT MOUD CARE (SC) VERSUS SC PLUS THE ADAPTED PRS PROGRAM (SC+PRS). THE PRIMARY OUTCOMES ARE TREATMENT RETENTION AND LENGTH OF TIME IN TREATMENT AT 6 MONTHS; SECONDARY OUTCOMES INCLUDE 12- MONTH RETENTION, ILLICIT OPIOID USE, AND PATIENT SATISFACTION WITH MEETING TREATMENT GOALS. EXPLORATORY ANALYSES WILL EXAMINE POTENTIAL MODERATORS (E.G., RURALITY, ADDICTION SEVERITY) AND MEDIATORS (E.G., RECOVERY CAPITAL, INTERNALIZED STIGMA) OF THE EFFECT OF SC+PRS, INCLUDING HOW THE DEGREE OF ENGAGEMENT WITH PRS IMPACTS EFFECTIVENESS. FINALLY, THIS PROJECT WILL EVALUATE FACILITATORS AND BARRIERS TO PRS PROGRAM DELIVERY AND SUSTAINABILITY USING A MIXED METHOD APPROACH; RESULTS OF THIS ANALYSIS WILL INFORM FUTURE IMPLEMENTATION STRATEGIES. IF SUCCESSFUL, THIS STUDY WILL PROVIDE MUCH-NEEDED EVIDENCE REGARDING THE IMPACT OF PRS ON MOUD TREATMENT RETENTION AND WILL RESULT IN A PATIENT-CENTERED PRS PROGRAM THAT CAN BE IMPLEMENTED IN GEOGRAPHICALLY DIVERSE OUTPATIENT MOUD PROGRAMS, INCLUDING UNDERSERVED RURAL AREAS THAT ENCOMPASS A KEY HEALTH DISPARITIES POPULATION FOR OUD.

RURAL HEALTH NETWORK DEVELOPMENT PROGRAM

MORBID OBESITY, BARIATRIC SURGERY, AND KIDNEY FUNCTION

UNDERSTANDING THE ROLE OF COMMUNITY DETERMINANTS IN OPIOID USE DISORDER AND PROGRAM IMPLEMENTATION FACTORS INFLUENCING PATIENT ADHERENCE TO OPIOID AGONIST THERAPY

RURAL AGING STUDY (GEISINGER) - OBJECTIVE 1: CONTINUE TO STUDY THE OLDEST PARTICIPANTS IN THE EXISTING GEISINGER RURAL AGING STUDY COHORT, IN RELATION TO LONGITUDINAL HEALTH OUTCOMES AND MORTALITY. PERFORM SUB-ANALYSES ON ALL OF THOSE WHO SURVIVE TO 100 YEARS OF AGE OR OLDER, WHETHER CURRENTLY SURVIVING OR NOT, WITH A FOCUS ON NUTRITION RISK, QUALITY OF LIFE AND HEALTH OUTCOMES AS PREDICTORS OF LIVING TO BECOME A CENTENARIAN. OBJECTIVE 2: CONDUCT SECONDARY ANALYSES OF THE ENTIRE EXISTING GEISINGER RURAL AGING STUDY DATASET TO RELATE NUTRITION RISK AND OTHER LIFESTYLE VARIABLES AT BASELINE ENROLLMENT WITH ADDITIONAL HEALTH OUTCOMES NOT PREVIOUSLY EXPLORED IN OUR INVESTIGATIONS (E.G., DEMENTIA).

ADVANCING PERINATAL GENOMIC DISCOVERIES THROUGH PATIENT ENGAGEMENT AND DATA SHARING - PROJECT SUMMARY/ABSTRACT FETAL ANOMALIES ARE OBSERVED IN ~2-4% OF PREGNANCIES RESULTING IN REFERRAL FOR GENETIC COUNSELING AND CONSIDERATION OF GENETIC TESTING. ALTHOUGH DIAGNOSTIC YIELDS FOR FETAL ANOMALIES HAVE IMPROVED, SUBSTANTIAL BARRIERS TO IDENTIFYING GENOMIC DIAGNOSES EXIST AND UNCERTAINTY REMAINS REGARDING WHICH RESULTS ARE APPROPRIATE TO DISCLOSE PRENATALLY. GENOMIC AND HEALTH DATA SHARING HAS RESULTED IN RAPID IMPROVEMENTS IN OUR UNDERSTANDING OF POSTNATAL GENE-DISEASE RELATIONSHIPS AND VARIANT PATHOGENICITY; SIMILAR EFFORTS ARE NEEDED TO ADVANCE OUR UNDERSTANDING OF PRENATAL GENETIC DIAGNOSIS. HERE, WE BRING TOGETHER LEADERS FROM CLINGEN’S GENOMECONNECT AND THE REPOSITORY OF THE INTERNATIONAL FETAL GENOMICS CONSORTIUM (RIFGC), AN EXPANDING EFFORT THAT AGGREGATES AND STANDARDIZES GENOMIC AND PRENATAL PHENOTYPE DATA FROM LABORATORIES, CLINICIANS, AND RESEARCHERS. TOGETHER, WE WILL PROVIDE TOOLS FOR PATIENTS TO LONGITUDINALLY ENGAGE WITH THEIR GENOMIC DATA THROUGH EDUCATION AND BIDIRECTIONAL DATA SHARING INCLUDING THE OPPORTUNITY TO RECEIVE RESULT UPDATES THROUGH THE WORK OF CLINGEN EXPERT PANELS EXAMINING GENE-DISEASE VALIDITY AND VARIANT PATHOGENICITY. OUR OVERARCHING GOAL IS TO ENABLE THE TRANSLATION OF GENOMIC DATA INTO PRECISION MEDICINE FOR PATIENTS UNDERGOING DIAGNOSTIC FETAL SEQUENCING (ES/GS) AND TO FOSTER ONGOING ENGAGEMENT. THIS GOAL ADDRESSES THE NHGRI’S NOTICE OF SPECIAL INTEREST IN DEVELOPMENT AND IMPLEMENTATION OF CLINICAL INFORMATICS TOOLS TO ENHANCE PATIENTS’ USE OF GENOMIC INFORMATION (NOT-HG-22-011). WE WILL ACHIEVE OUR GOALS THROUGH THE FOLLOWING AIMS: AIM 1: ENGAGE PARTICIPANTS WHO HAVE HAD FETAL SEQUENCING TO DEVELOP A PATIENT AND HEALTH RECORD-DRIVEN REGISTRY FOCUSED ON THE LONGITUDINAL COLLECTION AND SHARING OF GENOMIC AND PHENOTYPE DATA. AIM 2: UTILIZE PARTICIPANT-PROVIDED DATA TO DEFINE GENE-DISEASE RELATIONSHIPS, VARIANT CLASSIFICATION, AND NATURAL HISTORY OF DISORDERS IDENTIFIED VIA FETAL SEQUENCING, ENABLING PARTICIPANTS TO RECEIVE UPDATED HEALTH INFORMATION LONGITUDINALLY. AIM 3: EVALUATE PARENTAL EXPERIENCES AND PREFERENCES FOR FETAL SEQUENCING REANALYSIS PRACTICES AND RESULT RETURN TO INFORM STUDY-RELATED PROCEDURES AND BROADER PRACTICES.

RURAL RESIDENCY PLANNING AND DEVELOPMENT PROGRAM

MULTIDISCIPLINARY STUDY OF RACE APPEARANCE ANCESTRY DISCRIMINATION & PREJUDICE

SEX- AND SMOKING- SPECIFIC DNA METHYLATION SIGNATURES OF CENTRAL ADIPOSITY CHANGE

BRIDGING CARE SUPPORT AND CARE DELIVERY WITH ENGINEERED LOGISTICS AND TECHNOLOGY

EVALUATION OF A PEER RECOVERY SUPPORT PROGRAM ADAPTED TO TARGET RETENTION IN CLINIC-BASED MEDICATION FOR OPIOID USE DISORDER TREATMENT - PROJECT ABSTRACT DRUG OVERDOSES ARE AT RECORD LEVELS IN THE US, DRIVEN PRIMARILY BY THE ONGOING OPIOID USE DISORDER (OUD) EPIDEMIC. MEDICATIONS FOR OPIOID USE DISORDER (MOUD) HAVE BEEN SHOWN TO SAFELY AND EFFECTIVELY TREAT OUD, REDUCE OVERDOSE AND OVERDOSE DEATH, AND FACILITATE LONG-TERM RECOVERY. HOWEVER, RETENTION IN MOUD TREATMENT OFTEN FALLS SHORT OF THE 6-12-MONTH DURATION NECESSARY FOR SUSTAINED RECOVERY, AND EARLY TERMINATION FROM MOUD IS A RISK FACTOR FOR OVERDOSE. PEER RECOVERY SUPPORT (PRS; I.E., SUPPORT SERVICES PROVIDED BY TRAINED “PEERS” WITH LIVED EXPERIENCE OF ADDICTION AND RECOVERY) HOLDS SUBSTANTIAL PROMISE AS A STRATEGY FOR IMPROVING RETENTION IN MOUD, YET VIRTUALLY NO RIGOROUS RESEARCH HAS BEEN CONDUCTED ON ITS EFFECTIVENESS IN THIS SETTING. THE OVERARCHING AIM OF THE PROPOSED PROJECT IS TO ENGAGE STAKEHOLDERS TO ADAPT PRS SPECIFICALLY FOR USE IN OUTPATIENT MOUD SETTINGS AND EVALUATE THE EFFECTIVENESS OF THE PRS PROGRAM IN IMPROVING PATIENT RETENTION ACROSS MULTIPLE GEOGRAPHICALLY DIVERSE MOUD CLINICS. THE PRACTICAL, ROBUST IMPLEMENTATION AND SUSTAINABILITY MODEL (PRISM), A CONTEXTUALLY EXPANDED VERSION OF THE REACH, ADOPTION, EFFECTIVENESS, IMPLEMENTATION, AND MAINTENANCE (RE- AIM) FRAMEWORK WILL BE USED ACROSS THE TWO PHASES OF THE PROJECT TO ENSURE THAT THE RESULTING PRS PROGRAM AND STUDY FINDINGS CAN BE TRANSLATED DIRECTLY INTO PRACTICE. IN THE R61 PHASE, WE PROPOSE A COMMUNITY-BASED PARTICIPATORY RESEARCH APPROACH TO ADAPTING PRS SERVICES FOR OUTPATIENT MOUD TREATMENT SETTINGS. WE WILL ASSEMBLE AND COLLABORATE WITH TWO COMMUNITY BOARDS THROUGHOUT THE R61 AND R33 PHASES TO CO-DEVELOP ALL ASPECTS OF THE PRS PROGRAM, TRAINING AND SUPERVISION PLAN FOR PEER RECOVERY SPECIALISTS, AND ELEMENTS OF THE SUBSEQUENT CLINICAL TRIAL. COMMUNITY BOARDS WILL INCLUDE: 1) PATIENTS WITH LIVED EXPERIENCE WITH MOUD TREATMENT; AND 2) MOUD PROVIDERS/STAFF/ADMINISTERS, PEER RECOVERY SPECIALISTS, AND PAYORS. NEXT, WE WILL CONDUCT A MIXED- METHODS PILOT EVALUATION TO TEST FEASIBILITY AND MAKE REFINEMENTS TO THE PRS PROGRAM, PEER TRAINING AND SUPERVISION PLAN, AND TRIAL METHODS. IN THE R33 PHASE, WE WILL CONDUCT A RANDOMIZED CONTROLLED TRIAL COMPARING STANDARD OUTPATIENT MOUD CARE (SC) VERSUS SC PLUS THE ADAPTED PRS PROGRAM (SC+PRS). THE PRIMARY OUTCOMES ARE TREATMENT RETENTION AND LENGTH OF TIME IN TREATMENT AT 6 MONTHS; SECONDARY OUTCOMES INCLUDE 12- MONTH RETENTION, ILLICIT OPIOID USE, AND PATIENT SATISFACTION WITH MEETING TREATMENT GOALS. EXPLORATORY ANALYSES WILL EXAMINE POTENTIAL MODERATORS (E.G., RURALITY, ADDICTION SEVERITY) AND MEDIATORS (E.G., RECOVERY CAPITAL, INTERNALIZED STIGMA) OF THE EFFECT OF SC+PRS, INCLUDING HOW THE DEGREE OF ENGAGEMENT WITH PRS IMPACTS EFFECTIVENESS. FINALLY, THIS PROJECT WILL EVALUATE FACILITATORS AND BARRIERS TO PRS PROGRAM DELIVERY AND SUSTAINABILITY USING A MIXED METHOD APPROACH; RESULTS OF THIS ANALYSIS WILL INFORM FUTURE IMPLEMENTATION STRATEGIES. IF SUCCESSFUL, THIS STUDY WILL PROVIDE MUCH-NEEDED EVIDENCE REGARDING THE IMPACT OF PRS ON MOUD TREATMENT RETENTION AND WILL RESULT IN A PATIENT-CENTERED PRS PROGRAM THAT CAN BE IMPLEMENTED IN GEOGRAPHICALLY DIVERSE OUTPATIENT MOUD PROGRAMS, INCLUDING UNDERSERVED RURAL AREAS THAT ENCOMPASS A KEY HEALTH DISPARITIES POPULATION FOR OUD.

ASSESSING THE RELATIONSHIP BETWEEN EXTREME HEAT AND CARDIOVASCULAR AND PULMONARY OUTCOMES TO IDENTIFY STRATEGIES FOR HEALTH SYSTEM INTERVENTION - FREQUENT, INTENSE, AND LONG-LASTING HEAT EVENTS POSE A SIGNIFICANT AND GROWING RISK TO HUMAN HEALTH. HEAT-RELATED MORBIDITY AND MORTALITY RESULT NOT ONLY FROM HEAT ILLNESSES BUT ALSO FROM EXACERBATION OF CHRONIC DISEASES, INCLUDING ADVERSE CARDIOVASCULAR AND PULMONARY OUTCOMES. IN THIS WAY, EXTREME HEAT ADDS TO AN ALREADY SUBSTANTIAL PUBLIC HEALTH BURDEN IN THE UNITED STATES FROM THESE CONDITIONS. HEALTH SYSTEMS HAVE A CRITICAL ROLE TO PLAY IN PROTECTING PATIENTS AND THE COMMUNITIES THEY SERVE FROM HEALTH IMPACTS OF EXTREME HEAT. TO INFORM HEALTH SYSTEM EFFORTS TO REDUCE RISKS TO PATIENTS AND THEIR COMMUNITIES, THE PROPOSED RESEARCH WILL SYSTEMATICALLY IDENTIFY CHARACTERISTICS OF HEAT EXPOSURE THAT PROMPT OR EXACERBATE CARDIOVASCULAR AND PULMONARY CONDITIONS AND EVALUATE HOW INDIVIDUAL AND COMMUNITY FEATURES STRENGTHEN OR REDUCE RELATIONS BETWEEN EXTREME HEAT AND HEALTH. WE WILL STUDY ACUTE EVENTS FOR CHRONIC HEALTH CONDITIONS, SELECTED BASED ON THEIR PUBLIC HEALTH BURDEN AND PROBABILITY OF EXACERBATION BY HEAT: EXACERBATIONS OF ASTHMA AND CHRONIC OBSTRUCTIVE PULMONARY DISEASE; CORONARY ARTERY DISEASE EVENTS, INCLUDING ANGINA PECTORIS AND ACUTE MYOCARDIAL INFARCTION; CONGESTIVE HEART FAILURE; AND STROKE. THE STUDY WILL BE CONDUCTED AT GEISINGER, A LARGE INTEGRATED HEALTH SYSTEM SERVING A SOCIOECONOMICALLY AND GEOGRAPHICALLY HETEROGENEOUS POPULATION IN CENTRAL AND NORTHEAST PENNSYLVANIA. WE WILL USE GEISINGER ELECTRONIC HEALTH RECORD DATA TO IDENTIFY EMERGENCY DEPARTMENT VISITS AND HOSPITALIZATIONS FOR THE STUDY OUTCOMES, LINKING PATIENTS VIA THEIR RESIDENTIAL ADDRESS TO DATA ON HEAT EXPOSURE. THROUGH A SET OF OUTCOME-SPECIFIC CASE-CROSSOVER ANALYSES, WE WILL FIRST RIGOROUSLY ASSESS SEVERAL PARAMETERS OF EXTREME HEAT (INTENSITY, LATENCY, DURATION) AND MODIFICATION BY ACCLIMATIZATION IN ASSOCIATION WITH ACUTE ONSET OF THE HEALTH OUTCOMES, ACCOUNTING FOR AIR POLLUTION, TO ESTABLISH HEAT LEVELS AT WHICH INTERVENTION IS WARRANTED. TO IDENTIFY HEAT-SENSITIVE INDIVIDUALS AND COMMUNITIES TO INFORM POTENTIAL POINTS OF INTERVENTION, WE WILL INVESTIGATE MODERATORS OF HEAT-HEALTH ASSOCIATIONS, INCLUDING INDIVIDUAL FACTORS (E.G., AGE, VARIOUS HEALTH FACTORS, USE OF MEDICATIONS THAT ALTER PHYSIOLOGY AND THERMOREGULATION) AND COMMUNITY FEATURES THAT INCREASE HEAT VULNERABILITY (E.G., POPULATION SUSCEPTIBILITY TO HEAT, BUILT AND NATURAL ENVIRONMENT FEATURES SUCH AS GREENNESS, ACCESS TO SERVICES SUCH AS COOLING FACILITIES). WE WILL DEVELOP HEAT VULNERABILITY INDICES THAT MAY PROVE USEFUL IN IDENTIFYING HEAT-SENSITIVE COMMUNITIES AND INDIVIDUALS FOR FUTURE INTERVENTION. TO ACCELERATE TRANSLATION OF OUR EPIDEMIOLOGIC FINDINGS INTO ACTION, WE WILL ALSO ENGAGE HEALTH SYSTEM STAKEHOLDERS TO SOLICIT INPUT ON INTERVENTION DEVELOPMENT. DEVELOPING ACCEPTABLE, FEASIBLE, AND EFFECTIVE INTERVENTIONS REQUIRES UNDERSTANDING STAKEHOLDERS’ PERSPECTIVES REGARDING INTERVENTIONAL NEEDS, PRIORITIES FOR FUTURE ACTION, AND OBSTACLES AND FACILITATORS OF SUCH ACTION. THE KNOWLEDGE GAINED THROUGH THIS PROJECT IS ESSENTIAL TO MEETING OUR LONG-TERM GOAL TO DEVELOP, IMPLEMENT, AND EVALUATE MULTILEVEL HEALTH SYSTEM INTERVENTIONS TO PROTECT PATIENTS FROM THE HEALTH CONSEQUENCES OF EXTREME HEAT.

CALCIUM SENSING RECEPTOR AND SCAFFOLDS

BETA/GAMMA SUBUNIT HETEROGENIETY IN G PROTEINS

COMPREHENSIVE ANALYSIS, SURVEILLANCE, AND STATISTICS INITIATIVE FOR DIABETES IN THE YOUNG (CASSIDY)

DESCRIPTION:THIS COOPERATIVE AGREEMENT PROVIDES FUNDING UNDER THE INFRASTRUCTURE INVESTMENT AND JOBS ACT (IIJA) FOR GEISINGER CLINIC TO CONDUCT REMEDIATION ACTIVITIES AS AUTHORIZED BY CERLCA 104(K)(3) IN DICKSON CITY MINING RECLAMATION PROJECT, LOCATED IN DICKSON CITY, PENNSYLVANIA. BROWNFIELDS ARE REAL PROPERTY, THE EXPANSION, DEVELOPMENT OR REUSE OF WHICH MAY BE COMPLICATED BY THE PRESENCE OR POTENTIAL PRESENCE OF A HAZARDOUS SUBSTANCE, POLLUTANT, OR CONTAMINANT. ACTIVITIES:SPECIFICALLY, THIS AGREEMENT WILL PROVIDE FUNDING TO THE RECIPIENT TO CLEAN UP A BROWNFIELD SITE. ADDITIONALLY, THE RECIPIENT WILL COMPETITIVELY PROCURE (AS NEEDED) AND DIRECT A QUALIFIED ENVIRONMENTAL PROFESSIONAL (QEP) TO CONDUCT ENVIRONMENTAL SITE ACTIVITIES, WILL CREATE A COMMUNITY INVOLVEMENT PLAN AND ADMINISTRATIVE RECORD FOR THE SITE, AND WILL REPORT ON INTERIM PROGRESS AND FINAL ACCOMPLISHMENTS BY COMPLETING AND SUBMITTING RELEVANT PORTIONS OF THE PROPERTY PROFILE FORM USING EPA'S ASSESSMENT, CLEANUP AND REDEVELOPMENT EXCHANGE SYSTEM (ACRES). SUBRECIPIENT:NO SUBAWARDS ARE INCLUDED IN THIS ASSISTANCE AGREEMENT.OUTCOMES:FURTHER, THE RECIPIENT WILL REMEDIATE THE DICKSON CITY MINING RECLAMATION BROWNFIELD SITE AND ANTICIPATES HOLDING AT LEAST TWO COMMUNITY MEETINGS, FINALIZING ONE ANALYSIS OF BROWNFIELD CLEANUP ALTERNATIVES (ABCA), AND SUBMITTING SIXTEEN QUARTERLY REPORTS. WORK CONDUCTED UNDER THIS COOPERATIVE AGREEMENT WILL BENEFIT THE RESIDENTS, BUSINESS OWNERS, AND STAKEHOLDERS IN AND NEAR DICKSON CITY, PENNSYLVANIA.

TELEMEDICINE GRANT

MARCELLUS SHALE DEVELOPMENT, RESPIRATORY & REPRODUCTIVE OUTCOMES IN PENNSYLVANIA

DEVELOPING PTSD RISK ASSESSMENT TOOLS USING THE WORLD TRADE CENTER OUTCOME STUDY

FUNCTIONAL SELECTIVITY IN MC4R SIGNALING

PRECISION MEDICINE AT GEISINGER

COLLABORATIVE APPROACH TO REACH EVERYONE WITH FAMILIAL HYPERCHOLESTEROLEMIA: CARE-FH - PROJECT SUMMARY FAMILIAL HYPERCHOLESTEROLEMIA (FH) IS A COMMON GENETIC DISORDER (PREVALENCE 1 IN 250) THAT REQUIRES LIFELONG SUSTAINED MEDICAL CARE. EVIDENCE-BASED GUIDELINES FOR SCREENING AND TREATMENT FOR FH EXIST. THESE INCLUDE UNIVERSAL SCREENING OF CHILDREN AGES 9-11, OF ADOLESCENTS AGES 18-20, AND OF ADULTS AGES 40 AND ABOVE; APPROVED DIAGNOSTIC TOOLS INCLUDING LIPID PANELS AND GENETIC TESTING; AND RECOMMENDATIONS FOR INITIATION OF LIPID LOWERING MEDICATION. FH DIAGNOSIS IS CURRENTLY MADE TOO LATE IN LIFE, OFTEN AFTER A PREMATURE HEART ATTACK HAS OCCURRED CREATING A CARE GAP THAT RESULTS IN EXCESS CARDIOVASCULAR MORBIDITY AND MORTALITY. DIAGNOSING FH IN THE PRIMARY CARE SETTING WOULD OPTIMIZE TREATMENT FOR INDIVIDUALS WITH FH AND CLOSE THIS CARE GAP. UTILIZING TOOLS FROM IMPLEMENTATION SCIENCE AND HUMAN CENTERED DESIGN, AND BY CONSIDERING UPTAKE, ACCEPTABILITY, AND SUSTAINABILITY OF PROGRAMS RELATED TO FH CARE SHOULD IMPROVE EARLIER DIAGNOSIS. IMPLEMENTATION STRATEGIES THAT INCLUDE INSIGHTS FROM PATIENTS, CLINICIANS, AND HEALTHCARE SYSTEMS ARE NECESSARY. OUR LONG-TERM GOAL IS TO CREATE AN EFFECTIVE FH DIAGNOSIS PROGRAM THAT IS PRACTICAL AND SUSTAINABLE IN THE REAL-WORLD SETTING. THE MAIN OBJECTIVE OF THIS PROJECT IS TO DETERMINE THE UPTAKE OF AN FH DIAGNOSIS PROGRAM INTEGRATED INTO PRIMARY CARE PRACTICES TO PROMOTE EARLY IDENTIFICATION OF ADULT AND PEDIATRIC PATIENTS THAT IS GENERALIZABLE TO OTHER HEALTHCARE SETTINGS. OUR RESEARCH QUESTION IS, DOES USING A MULTI-LEVEL IMPLEMENTATION STRATEGY PACKAGE, DESIGNED TO ADDRESS THE SPECIFIC NEEDS OF PATIENTS, CLINICIANS, AND HEALTHCARE SYSTEMS, IMPROVE THE DIAGNOSIS AND ACTIVATION OF CARE MANAGEMENT FOR INDIVIDUALS WITH FH. OUR SPECIFIC AIMS ARE TO: 1) TO DESIGN A CLINICAL TRIAL TO ASSESS MULTI-LEVEL IMPLEMENTATION STRATEGIES FOR IMPROVING FH DIAGNOSIS IN AN INTEGRATED HEALTH SYSTEM, 2) COMPARE FH DIAGNOSIS RATES AMONG PRIMARY CARE CLINICIANS WHO RECEIVE THE IMPLEMENTATION STRATEGY PACKAGE VERSUS THOSE WHO DO NOT, 3) TO MEASURE IMPLEMENTATION SUCCESS OF AN ORGANIZED FH DIAGNOSIS PROGRAM, AND 4) TO EXPLORE PATIENT-RELATED SERVICE AND HEALTH OUTCOMES RELATED TO AN FH DIAGNOSIS PROGRAM.

RURAL AGING STUDY (GEISINGER) - 1: CONTINUE TO VALIDATE THE RECENTLY DEVELOPED DIET QUALITY SCREENING QUESTIONNAIRE (DQSQ) IN RELATION TO LONGITUDINAL HEALTH OUTCOMES AND MORTALITY AMONG THE 4,009 REMAINING PARTICIPANTS. 1A: TEST CRITERION VALIDITY: A. ASCERTAIN WHETHER LOW DQSQ SCORES PLACE PERSONS OF ADVANCED AGE AT RISK FOR ADVERSE HEALTH OUTCOMES. B. ASCERTAIN WHETHER LOW DQSQ SCORES PLACE PERSONS OF ADVANCED AGE AT RISK FOR INCREASED MORTALITY. 2: CONDUCT COMPREHENSIVE DIETARY ASSESSMENTS OF A REPRESENTATIVE SUBSET OF 200 COMMUNITY-DWELLING PARTICIPANTS FROM THE COHORT TO INCLUDE 24 HOUR DIETARY RECALLS, FOOD SECURITY, DQSQ, FUNCTIONAL LIMITATIONS, AND QUALITY OF LIFE MEASURES. 2A: EXTEND CRITERION VALIDITY TESTING OF THE DQSQ IN A SAMPLE OF VERY ADVANCED AGE BY CONTRASTING THE ASSOCIATIONS OF DIETARY PATTERNS, HEI, AND DQSQ, WITH THE HEALTH AND LIFE QUALITY OUTCOMES OF INTEREST WITH THOSE FROM THE ORIGINAL DATASET OF THE YOUNGER SAMPLE THAT WAS EVALUATED IN 2004 WITH THE SAME COMPREHENSIVE ASSESSMENT AND THAT WAS USED TO ORIGINALLY DEVELOP AND VALIDATE THE DQSQ.

GERIATRIC CONDITIONS AND TREATMENT BURDEN IN OLDER ADULTS WITH NON-MUSCLE-INVASIVE BLADDER CANCER AND THEIR CAREGIVERS

HEALTHCARE ACCESS

OBESITY AND DIETARY ASSESSMENT IN AGING RURAL POPULATIONS

GEISINGER RURAL AGING STUDY (GRAS)

GEISINGER RURAL AGING STUDY (GRAS)

GEISINGER RURAL AGING STUDY (GRAS)

GEISINGER RURAL AGING STUDY (GRAS)

RURAL AGING STUDY (GEISINGER)

RURAL AGING STUDY (GEISINGER)

RURAL AGING STUDY (GEISINGER)

NOVEL TOOLS FOR DETECTING FGF8 FOR DEVELOPMENTAL BIOLOGY RESEARCH

GNG5 FUNCTION IN NEURAL PROGENITORS

HEALTH CARE AND OTHER FACILITIES

GEISINGER RURAL AGING STUDY (GRAS)

KEYHIE_STAR

6 MONTH NO COST EXTENSION

AUTISM SECONDARY DATA ANALYSIS PROGRAM - ADDRESSING THE INTERSECTION OF NEURODEVELOPMENTAL DISORDERS, HOME ENVIRONMENTS, AND OBESITY IS ESSENTIAL FOR MITIGATING THE GROWING PUBLIC HEALTH CRISIS OF CHILDHOOD OBESITY. CHILDREN WITH AUTISM AND DEVELOPMENTAL DISORDERS FACE HIGHER RISKS FOR OBESITY-RELATED COMPLICATIONS, INCLUDING METABOLIC DISORDERS, CARDIOVASCULAR ISSUES, AND REDUCED QUALITY OF LIFE. APPROXIMATELY 8.6% OF US CHILDREN HAVE AUTISM OR A DEVELOPMENTAL DISORDER WITH THE PREVALENCE OF AUTISM INCREASING OVER THE PAST SEVERAL DECADES. WHILE THERE IS STRONG EVIDENCE FOR INCREASED RISK OF OBESITY AMONG CHILDREN WITH AUTISM, LITTLE IS KNOWN ABOUT HOW SPECIFIC TYPES OR INTENSITY OF SYMPTOMS RELATE TO OBESITY RISK. UTILIZING THE GEISINGER AUTISM AND DEVELOPMENTAL MEDICINE INSTITUTE (ADMI) MAKING ADVANCES POSSIBLE (MAP) DATABASE AND THE GEISINGER CHILD AND ADOLESCENT TRENDS (CAT) DATABASE WE PROPOSE A SECONDARY DATA ANALYSIS THAT CONSISTS OF TWO PRINCIPAL OBJECTIVES: 1) TO ASSESS THE ASSOCIATION BETWEEN AUTISM SPECTRUM DISORDER (ASD) AND OTHER DEVELOPMENTAL DISORDERS (DDS) WITH OBESITY AND OBESOGENIC RISK BEHAVIORS (E.G., PHYSICAL INACTIVITY, DIETARY PATTERNS, SCREEN TIME) AMONG CHILDREN AND ADOLESCENT PEDIATRIC PATIENTS; AND 2) INVESTIGATE SOCIAL AND STRUCTURAL DETERMINANTS OF HEALTH AS MODERATORS AND MEDIATORS ON THE RELATIONSHIPS BETWEEN ASD/DDS AND BODY WEIGHT /OBESOGENIC RISK BEHAVIORS. THIS PROPOSAL ALIGNS WITH SEVERAL HEALTHY PEOPLE 2030 OBJECTIVES, INTERAGENCY AUTISM COORDINATING COMMITTEE’S STRATEGIC PLAN OBJECTIVES, THE BLUEPRINT FOR CHANGE, AND FINALLY THE MCHB MISSION TO IMPROVE THE HEALTH AND WELL-BEING OF CHILDREN, AND GOAL OF ACHIEVING HEALTH EQUITY FOR MCH POPULATIONS, SPECIFICALLY CHILDREN WITH SPECIAL HEALTH CARE NEEDS. THE RESULTS OF THIS PROJECT WILL PROVIDE A GREATER UNDERSTANDING OF INDIVIDUAL, FAMILY, AND COMMUNITY FACTORS THAT CONTRIBUTE TO EXCESS RISK FOR OBESITY AND CHRONIC AMONG INDIVIDUALS WITH AUTISM/DD. BY IDENTIFYING KEY RISK FACTORS, WE CAN IMPROVE PREVENTATIVE SERVICES BY TAILORING INTERVENTIONS TO TARGET TO THE MOST IMPORTANT RISK FACTORS OR BY DELIVERING THEM TO THE MOST AT-RISK SUBPOPULATIONS, ENSURING THE MOST EFFICIENT USE OF LIMITED TIME AND RESOURCES IN CLINICAL CARE.

CONGRESSIONALLY-MANDATED HEALTH INFORMATION TECHNOLOGY GRANTS

RURAL HEALTH OUTREACH SPECIAL INITIATIVE

RYAN WHITE TITLE III HIV CAPACITY DEVELOPMENT AND PLANNING GRANTS

AORTIC WALL DISTENSIBILITY IN THE GROWTH AND RUPTURE OF ABDOMINAL AORTIC ANEURYSM

HMORN CONFERENCE ON CLINICAL EFFECTIVENESS

UNIVERSAL NEWBORN HEARING AND SCREENING