Medstar Inc

LONG TERM DPP FOLLOW-UP STUDY

SCALING SOCIAL DETERMINANTS OF HEALTH SCREENING, SOCIAL SUPPORT AND ANTI-RACISM TRAINING TO REDUCE INEQUITIES IN MINORITY CANCER SURVIVOR HEALTH AND WELLBEING IN WASHINGTON, DC

REHABILITATION AND RESEARCH TRAINING CENTER ON HEALTH AND FUNCTION FOR PEOPLE WITH PHYSICAL DISABILITIES FOCUSED ON NEUROGENIC LOWER URINARY TRACT DYSFUNCTION

RYAN WHITE PART C OUTPATIENT EIS PROGRAM

CVD IN AMERICAN INDIANS BIOMARKER LAB AND ARIZONA FIELD CENTER

RYAN WHITE PART C OUTPATIENT EIS PROGRAM

THE PATIENT-PARTNERED DIAGNOSTIC CENTER OF EXCELLENCE - PROJECT SUMMARY DIAGNOSTIC ERRORS ARE A SIGNIFICANT PUBLIC HEALTH CONCERN AND THE LEADING CAUSE OF HARM DUE TO MEDICAL CARE IN THE U.S. ESTIMATES SUGGEST THAT ONE OF EVERY TWENTY PATIENTS SEEKING HEALTHCARE IN THE U.S. EXPERIENCES A DIAGNOSTIC ERROR, HALF OF WHICH RESULT IN SERIOUS HARM. THERE ARE MANY REASONS FOR DIAGNOSTIC FAILURES. FAILURES IN THE PROCESS OF DIAGNOSIS ARE MULTIFOCAL, AND MAY RELATE TO PATIENT, CLINICIAN, OR SYSTEMS BREAKDOWNS AND LEAD TO POTENTIAL PATIENT HARM. WHILE THERE HAVE BEEN MODEST IMPROVEMENTS IN REDUCING DIAGNOSTIC ERROR, MUCH OF THIS RESEARCH HAS FOCUSED ON DEFINING THE SCOPE OF THE PROBLEM AND DEVELOPING TOOLS FOR DOCTORS TO PREVENT ERRORS, LARGELY IGNORING THE CRITICAL ROLE OF THE PATIENT IN FINDING AND FIXING ERRORS IN THEIR OWN HEALTHCARE. OUR TEAMS PRIOR WORK SHOWS THAT PATIENTS AND THEIR FAMILIES PROVIDE VALUABLE INFORMATION OFTEN MISSING IN MEDICAL RECORDS THAT CAN INFORM SAFETY PROBLEMS ACROSS DIFFERENT CARE SETTINGS; THIS INCLUDES DIAGNOSTIC SAFETY EVENTS. FURTHERMORE, MAKING ACCURATE AND TIMELY DIAGNOSES REQUIRES A PATIENT-CENTERED, TEAM-BASED APPROACH INVOLVING COLLABORATION AMONG MULTIPLE HEALTHCARE PROFESSIONALS, WITH THE PATIENT AND THEIR FAMILY AT ITS CORE AND RECOGNITION OF THE IMPORTANCE OF INPUT FROM PATIENTS ACROSS THE SPECTRUM OF PATIENT POPULATIONS. THE PATIENT-PARTNERED DIAGNOSTIC CENTER OF EXCELLENCE (THE CENTER) WILL FILL THESE GAPS BY CONDUCTING RESEARCH THAT HAS BEEN IDENTIFIED AND PRIORITIZED BY PATIENTS AS IMPORTANT TO ADVANCE DIAGNOSTIC SAFETY RESEARCH. THE CENTER IS GOVERNED BY EXPERIENCED PATIENT-PARTNERED SCIENTISTS AND DIRECTED BY A COMMITTEE OF PATIENTS AND AN ADVISORY PANEL OF EXPERTS WHO COLLECTIVELY WILL DEVELOP EXPERTISE IN SAFETY I ERROR DETECTION AND PREVENTION TO DECREASE DIAGNOSIS ERROR FREQUENCY AND SAFETY II METHODS OF RESILIENCE TO IMPROVE SAFER CARE. THE CENTER TAKES THE NOVEL APPROACH OF EXAMINING DIAGNOSTIC SAFETY USING A SAFETY I AND II LENS FROM THE PATIENT'S EXPERIENCE OF THE DIAGNOSTIC JOURNEY. WE ARE COMMITTED TO MEANINGFULLY PARTNERING WITH MINORITY AND EQUITY SEEKING COMMUNITIES TO DRIVE MEANINGFUL SOLUTIONS WITH BROAD APPLICATION FOR REACHING HISTORICALLY MARGINALIZED PATIENTS. OUR CENTER CONVENES AROUND THREE AIMS, ORGANIZED INTO FOUR WORKSTREAMS LED BY A CO-PI/CO-I WITH DEMONSTRATED EXPERTISE IN THAT WORKSTREAM. OUR WORKSTREAMS WILL WORK TOGETHER TO INFORM SOLUTION DEVELOPMENT, COCREATING IMPROVEMENTS IN DETECTION AND DRIVING DIAGNOSTIC SAFETY SYSTEM RESILIENCE IN PARTNERSHIP WITH DIVERSE PATIENTS. OUR CENTER BENEFITS FROM STRONG SCIENTIFIC EXPERTISE IN DIVERSE, RELEVANT DISCIPLINES; DIVERSE ORGANIZATIONAL AND CULTURAL RESEARCH SITES PARTNERED WITH CARE DELIVERY SYSTEMS; BUT MOST IMPORTANTLY MEANINGFUL ENGAGES PATIENTS AND COMMUNITY PARTNERS IN CODESIGN OF SOLUTIONS TO PREVENT DIAGNOSTIC ERRORS. THE CENTER'S FINDINGS WILL INFORM OTHER DIAGNOSTIC CENTERS OF EXCELLENCE AND PATIENT-CENTERED OUTCOMES RESEARCH. OUR AGGRESSIVE ATTENTION TO THE INCLUSION OF EQUITY SEEKING POPULATIONS IN CODESIGN AND EVALUATION WILL YIELD DIAGNOSTIC SAFETY SOLUTIONS THAT WILL BE ADOPTED BROADLY BY DIVERSE CARE SETTINGS, PATIENTS, AND THE CLINICIANS THAT SERVE THEM.

HEALTHY START INITIATIVE-ELIMINATING RACIAL/ETHNIC DISPARITIES

REHABILITATION RESEARCH AND TRAINING CENTERS

CARDIOVASCULAR DISEASE IN PIMA INDIANS

NATIONAL INSTITUTE ON DISABILITY AND REHABILITATION RESEARCH - SPINAL CORD INJURY MODEL DEMONSTRATIONS

REMOTE SYMPTOM COLLECTION TO IMPROVE POSTOPERATIVE CARE (RECOVER) - THIS PROPOSAL AIMS TO LEVERAGE ARTIFICIAL INTELLIGENCE (AI) AND NATURAL LANGUAGE PROCESSING (NLP) AND CONDUCT A RANDOMIZED CLINICAL TRIAL TO EXAMINE HOW A VOICE-ASSISTED REMOTE PATIENT SYMPTOM MONITORING SYSTEM (VARSMS) CAN BE USEFUL IN REDUCING ETHNORACIAL DISPARITIES AFTER GASTROINTESTINAL (GI) CANCER SURGERY. THERE ARE SIGNIFICANT DISPARITIES AMONG ETHNORACIAL MINORITIES ALONG THE CONTINUUM OF GI SURGICAL CANCER CARE. EVEN AFTER CONTROLLING FOR KEY FACTORS, BLACK AND HISPANIC PATIENTS ARE TWICE AS LIKELY AS WHITE PATIENTS TO EXPERIENCE OPERATIVE DEATHS AND COMPLICATIONS AFTER GI CANCER SURGERY IN PART DUE TO POOR COMMUNICATION, LOW HEALTH LITERACY, UNDERSTANDING OR FOLLOW-UP ACROSS A RANGE OF FACTORS. RESEARCH INDICATES THAT DISPARITIES IN OUTCOMES FOR MINORITY SURGICAL PATIENTS MAY BE DRIVEN BY EVENTS DURING THE VULNERABLE PHASE OF SURGICAL TRANSITIONS WHEN PATIENTS ARE RECOVERING AT HOME UNDER DIFFICULT SOCIAL AND MEDICAL CONDITIONS. LACK OF EARLY RECOGNITION OR MANAGEMENT OF POSTOPERATIVE SYMPTOMS CAN LEAD TO COMPLICATIONS AND READMISSIONS. REMOTE PATIENT SYMPTOM MONITORING MAY BE A POWERFUL TOOL TO REDUCE DISPARITIES IN POST-DISCHARGE COMPLICATIONS BY FACILITATING PATIENT-FRIENDLY CONNECTIONS TO THE CARE TEAM. OUR PILOT TEST, BUILT ON AMAZON ALEXA AND ECHO DEVICES, HAS SHOWN SUCCESSFUL USAGE OF THIS INNOVATIVE TECHNOLOGY AMONG A SAMPLE OF MOSTLY ETHNORACIAL MINORITY PATIENTS (70%) TO WHICH IT WAS TARGETED. BUT LARGE-SCALE EVIDENCE IS LACKING. TO ADDRESS THIS TIMELY GAP, WE PROPOSE TO CONDUCT A RANDOMIZED CLINICAL TRIAL TO EXAMINE HOW A VOICE-ASSISTED REMOTE PATIENT SYMPTOM MONITORING SYSTEM CAN REDUCE DISPARITIES IN GI CANCER SURGERY OUTCOMES WITHIN ONE OF THE LARGEST AND ETHNORACIALLY RICH (50% BLACK) HEALTHCARE SYSTEMS IN THE MID-ATLANTIC REGION. OUR OVERARCHING GOAL IS TO INCREASE PATIENT-CLINICIAN COMMUNICATION IN REPORTING POST-DISCHARGE SYMPTOMS USING AN INNOVATIVE VOICE-ASSISTED SYSTEM TO BETTER INFORM EARLY CLINICAL INTERVENTION DECISIONS AND THEREBY REDUCE READMISSIONS, COMPLICATIONS, AND EMERGENCY ROOM (ER) VISITS. BUILDING ON THE SUCCESS OF A PILOT CLINICAL TRIAL THAT LEVERAGED VOICE-ASSISTED REMOTE PATIENT SYMPTOM MONITORING AND THE CARE TRANSITION CONCEPTUAL FRAMEWORK, OUR COLLABORATIVE MULTIDISCIPLINARY TEAM TO: AIM 1: TO CONDUCT A RANDOMIZED CLINICAL TRIAL TO EVALUATE THE EFFECTIVENESS OF A VARSMS AT REDUCING THE NUMBER OF ADVERSE EVENTS ASSESSED BY A COMPOSITE OUTCOME INCLUDING IN-PATIENT READMISSIONS AND ER VISITS AMONG GI CANCER SURGERY PATIENTS FOR 40 DAYS POST-DISCHARGE. AIM 2: TO EVALUATE THE EFFICACY OF VARSMS IN IMPROVING PATIENT-CLINICIAN COMMUNICATION AND ADHERENCE DURING POST-DISCHARGE CARE TRANSITION AFTER GI CANCER SURGERY FOR MINORITY PATIENTS COMPARED TO WHITE PATIENTS. AIM 3: TO EVALUATE PROVIDER’S EXPERIENCE WITH THE VARSMS SYSTEM DURING POST-DISCHARGE CARE TRANSITION AFTER GI CANCER SURGERY, WITH SPECIAL ATTENTION TO NON-WHITE PATIENTS.

RYAN WHITE TITLE IV WOMEN, INFANTS, CHILDREN, YOUTH AND AFFECTED FAMILY MEMBERS AIDS HEALTHCARE

COGNITIVE ENGINEERING FOR COMPLEX DECISION MAKING & PROBLEM SOLVING IN ACUTE CARE

RE-ENGINEERING FOR ACCURATE, TIMELY, AND COMMUNICATED DIAGNOSIS OF CARDIOVASCULAR DISEASE IN WOMEN (DREAM LAB)

PILOT MULTICENTER STUDY OF RESUSCITATION WITH ENTERAL FLUIDS

IDENTIFICATION OF MECHANISMS UNDERLYING THE EFFECTS OF PLASMA INCLUSIVE RESUSCITATION IN MAJOR THERMAL INJURY ON HEMOSTASIS AND VASCULAR HOMEOSTASIS...NEW COOPERATIVE AGREEMENT, SIGNED 9/17/2019, EFFECTIVE 9/30/2019, DISTRIBUTED 9/18/2019, FAADC 9/18/2019

NATIONAL CAPITAL SPINAL CORD INJURY MODEL SYSTEM (NC-SCIMS) - THIS NATIONAL CAPITAL - SPINAL CORD INJURY MODEL SYSTEM (NC-SCIMS) APPLICATION TARGETS PEOPLE WITH SPINAL CORD INJURY (SCI) AND NEUROGENIC LOWER URINARY TRACT DYSFUNCTION (NLUTD) AND THE CLINICIANS WHO CARE FOR THEM. OUR VISION IS TO MEANINGFULLY ADVANCE THE RESEARCH AND CLINICAL CARE AROUND COMPLICATED URINARY TRACT INFECTION (CUTI) AMONG PEOPLE WITH SCI WITH A NOVEL INTERVENTION, AND THE DEVELOPMENT OF CRITICAL GUIDELINES FOR IDENTIFICATION OF CUTI TO STRENGTHEN CLINICAL AND SELF-MANAGEMENT DECISION-MAKING. THE NC-SCIMS HAVE AN ENDURING IMPACT ON THE SCI COMMUNITY, INCLUSIVE OF CONSUMERS, CLINICIANS AND SCIENTISTS, AND WILL SUPPORT ANTI-MICROBIAL STEWARDSHIP. THE NC-SCIMS WILL LEVERAGE EXPERTISE AND STRENGTHS IN THE AREAS OF: REHABILITATION RESEARCH AND CLINICAL CARE; CLINICAL TRIAL DESIGN AND CONDUCT; OUTCOME DEVELOPMENT AND IMPLEMENTATION; SCI RESEARCH; ADVOCACY; CONSUMER ENGAGEMENT IN RESEARCH AND KNOWLEDGE TRANSLATION; NATIONWIDE ACTIVE INVOLVEMENT FROM CLINICIANS WITH EXPERIENCE AND EXPERTISE IN OUR RESEARCH TARGET AREA; ONLINE EDUCATION DEVELOPMENT; AND KNOWLEDGE TRANSLATION AND DISSEMINATION. BECAUSE OF OUR CLOSE PROXIMITY TO NATIONAL ELECTED OFFICIALS AND POLICYMAKERS, THIS SCIMS SITE CAN ALSO BE A PARTICULARLY COMPELLING ADVOCATE FOR PERSONS WITH SCI. LED BY MEDSTAR NATIONAL REHABILITATION HOSPITAL (MEDSTAR NRH), WHOSE CREDO IS TO “ADD LIFE TO YEARS”, THE NC-SCIMS IS A COLLABORATION OF MEDSTAR NRH WITH GEORGETOWN UNIVERSITY (GU), UNITED SPINAL ASSOCIATION, UNITED SPINAL WASHINGTON DC CHAPTER, AND TWO INDEPENDENT LIVING CENTERS (SERVING OUR DC, VA AND MD COMMUNITIES), AND CLINICIANS/SCIENTISTS FROM THE INFECTIOUS DISEASES SOCIETY OF AMERICA AND THE NEUROGENIC BLADDER RESEARCH GROUP. MEDSTAR NRH IS AN IDEAL HOME FOR THIS NC-SCIMS BECAUSE MEDSTAR HEALTH IS THE PRIMARY PROVIDER OF MEDICAL (INCLUDING REHABILITATION) CLINICAL SERVICES WITHIN THE BALTIMORE - WASHINGTON CORRIDOR, AND TOGETHER MEDSTAR HEALTH AND GU REPRESENT ONE OF THE STRONGEST ACADEMIC–RESEARCH-CLINICAL INFRASTRUCTURES IN THE COUNTRY. WE PROPOSE ONE SITE SPECIFIC RESEARCH PROJECT (SSRP) AND ONE MODULE PROJECT (MP), BOTH AT THE INTERVENTION EFFICACY (STAGE C) STAGE OF RESEARCH. OUR SSRP AND MP EACH SQUARELY MEET SCIMS AND NIDILRR PRIORITIES. IN OUR SSRP, WE ASSESS OUR NOVEL INTERVENTION, SELF-MANAGED INTRAVESICAL INSTILLATION OF LACTOBACILLUS PROBIOTIC IN A RANDOMIZED, CONTROLLED COMPARATIVE EFFECTIVENESS CLINICAL TRIAL AS (A) A TREATMENT FOR THE MOST COMMON URINARY SYMPTOMS EXPERIENCED BY PEOPLE WITH SCI WHO USE INTERMITTENT CATHETERS; AND (B) PROPHYLAXIS TO PREVENT URINARY SYMPTOMS AND THEIR SEQUELAE (SUCH AS INTERACTIONS WITH THE HEALTH CARE SYSTEM, AND TIME LOST FROM ACTIVITIES). THE PROPOSED MP WILL LEVERAGE THE NC-SCIMS STRENGTHS AND THE AUTHORITATIVE POWER OF THE SCIMS CENTERS WITH A COLLABORATIVE MIXED METHODS STUDY THAT BUILDS ON OUR EXISTING URINARY SYMPTOM QUESTIONNAIRES AND THEIR DECISION-MAKING ALGORITHMS. WE PROPOSE TO INTEGRATE EXPERTISE FROM A RANGE OF CLINICIANS (PHYSICAL MEDICINE & REHABILITATION, INFECTIOUS DISEASE, UROLOGY, PRIMARY CARE, AND EMERGENCY MEDICINE) TO DEVELOP SCIMS CUTI CONSENSUS GUIDELINES. WE WILL THEN DEVELOP ONLINE TRAINING MATERIALS FOR BOTH CONSUMERS AND CLINICIANS AND THEN IMPLEMENT THESE MATERIALS IN A PROSPECTIVE STUDY OF CONSUMERS (ASSESSING IMPACT) AND CLINICIANS (ASSESSING UPTAKE). CONSUMER EXPERTS (PEOPLE WITH SCI OR CAREGIVERS OF PEOPLE WITH SCI) HAVE BEEN AND WILL CONTINUE TO BE INTEGRATED WITH ALL RESEARCH, KNOWLEDGE TRANSLATION, AND DISSEMINATION TO ENSURE THAT OUR RESEARCH ACTIVITIES ARE RELEVANT AND IMPACTFUL FOR THE COMMUNITY OF PEOPLE WITH SCI, NLUTD AND CUTI. IN SUM, THE NC-SCIMS IS POISED TO TRANSFORM PATIENT CARE AND SCIENCE AROUND CUTI. THE RESEARCH ACTIVITIES COMPRISE TWO RIGOROUS RESEARCH PROJECTS, WITH COLLABORATIONS FROM CONSUMERS, ADVOCACY ORGANIZATIONS, AND PROFESSIONALS NATIONWIDE, THAT WILL PROFOUNDLY SHIFT RESEARCH, CARE

IMPROVING PATIENT SAFETY AND CLINICIAN COGNITIVE SUPPORT THROUGH EMAR REDESIGN

RYAN WHITE TITLE IV WOMEN, INFANTS, CHILDREN, YOUTH AND AFFECTED FAMILY MEMBERS AIDS HEALTHCARE

LATIN AMERICAN CANCER RESEARCH COALITION

INTRAVESICLE LACTOBACILLUS TO REDUCE URINARY SYMPTOMS AFTER SPINAL CORD INJURY .

DETERMINING THE CHRONOLOGY OF OCCULT AND GROSS COAGULOPATHY IN THERMALLY INJURED PATIENTS: A SYSTEM

GENETICS OF CORONARY ARTERY DISEASE IN ALASKA NATIVES (*

STROKE NATIONAL CAPITAL AREA NETWORK FOR RESEARCH (SCANR)

TRANSFORMING PATIENT SAFETY EVENT DATA INTO ACTIONABLE INSIGHTS THROUGH ADVANCED ANALYTICS

INTRAVESICAL GENTAMICIN COUPLED WITH LACTOBACILLUS RHAMNOSUS FOR URINARY HEALTH

COMMUNITY PROJECT FUNDING/CONGRESSIONALLY DIRECTED SPENDING - CONSTRUCTION

A SYSTEMS ENGINEERING APPROACH TO OPTIMIZE PEDIATRIC MEDICATION SAFETY - ABSTRACT THE OBJECTIVE OF THE PROPOSED RESEARCH IS TO IMPROVE PEDIATRIC MEDICATION SAFETY IN THE ELECTRONIC HEALTH RECORD (EHR) THROUGH OPTIMIZATION, DEPLOYMENT, AND TESTING OF AN ASSESSMENT TOOL DESIGNED TO IDENTIFY PEDIATRIC WEIGHT- BASED DOSING ERRORS. THE SELF-EVALUATION TOOL IS DESIGNED FOR USE BY ANY HEALTHCARE PROVIDER ORGANIZATION, REGARDLESS OF USABILITY EXPERTISE OR INFORMATICS RESOURCES. IN AIM 1, WE WILL OPTIMIZE AN EXISTING PEDIATRIC MEDICATION SAFETY EVALUATION TOOL FOR THE EHR BY ENGAGING WITH SUBJECT MATTER EXPERTS IN PEDIATRICS, MEDICATION SAFETY, TOOL DEVELOPMENT, AND INFORMATICS; THIS TOOL WAS DEVELOPED THROUGH FUNDING FROM THE PENNSYLVANIA PATIENT SAFETY AUTHORITY. WE WILL USE THE EVIDENCE-BASED IMPLEMENTATION FRAMEWORK OF REACH EFFECTIVENESS ADOPTION IMPLEMENTATION MAINTENANCE (RE-AIM) TO DEPLOY AND TEST THE TOOL. IN AIM 2, WE WILL DEPLOY THE TOOL FOR TESTING IN AT LEAST TWENTY DIFFERENT HEALTHCARE PROVIDER ORGANIZATIONS THAT WILL BE PURPOSEFULLY SELECTED TO ENSURE DIVERSITY IN GEOGRAPHICAL LOCATION, PATIENT POPULATION, AND EHR VENDOR. IN AIM 3, WE WILL COMPARE PEDIATRIC MEDICATION ERRORS BETWEEN SITES THAT ARE ABLE TO MAKE CHANGES IN THE EHR TO ADDRESS ITEMS FLAGGED AS DEFICIENT ON THE ASSESSMENT TOOL VS. THOSE THAT ARE UNABLE TO MAKE THE CHANGES. THE RESEARCH EFFORT IS A UNIQUE COLLABORATION BETWEEN MEDSTAR HEALTH'S NATIONAL CENTER FOR HUMAN FACTORS IN HEALTHCARE AND CHILDREN'S HEALTHCARE OF ATLANTA/EMORY UNIVERSITY. THIS PROJECT UTILIZES THE COLLECTIVE EXPERTISE OF THE DIVERSE RESEARCH TEAM WHICH INCLUDES HUMAN FACTORS ENGINEERING, PEDIATRIC MEDICATION SAFETY, HEALTH INFORMATION TECHNOLOGY, USABILITY, AND PATIENT SAFETY. THE RESEARCH TEAM HAS EXTENSIVE EXPERIENCE DEVELOPING ASSESSMENT TOOLS, DISSEMINATING THESE TOOLS FOR WIDESPREAD USE, AND IDENTIFYING IMPORTANT AREAS FOR TECHNOLOGY AND SAFETY IMPROVEMENT. AT THE END OF THIS PROJECT, WE WILL HAVE DEVELOPED A TOOL WITH ACCOMPANYING TEST CASES TO ASSESS EHR SAFETY FOR PEDIATRIC WEIGHT-BASED DOSING ERRORS. IN ADDITION, WE WILL ALSO IDENTIFY BARRIERS AND FACILITATORS TO TOOL USE ACROSS SETTINGS WITH VARYING LEVELS OF RESOURCE AVAILABILITY. FINALLY, WE WILL DEVELOP RECOMMENDATIONS ON HOW TO CUSTOMIZE THE TOOL TO ENABLE ASSESSMENT ACROSS DIVERSE HEALTHCARE SETTINGS THAT HAVE VARYING LEVELS OF RESOURCES AVAILABLE FOR IMPROVING PATIENT SAFETY AND QUALITY.

SAFE AND EQUITABLE TELEHEALTH FOR CHRONIC CONDITIONS (SAFE-T C2) LEARNING LABORATORY - ABSTRACT THE OBJECTIVE OF THE PROPOSED RESEARCH IS TO DEVELOP A PATIENT SAFETY LEARNING LABORATORY THAT WILL IDENTIFY PROMINENT PATIENT SAFETY ISSUES ASSOCIATED WITH TELEHEALTH (SYNCHRONOUS VIDEO AND PHONE VISITS), WITH A FOCUS ON PATIENTS WITH CHRONIC CONDITIONS, AND DESIGN, DEVELOP, IMPLEMENT, AND EVALUATE NOVEL SAFETY SOLUTIONS. THE SAFE AND EQUITABLE TELEHEALTH FOR CHRONIC CONDITIONS (SAFE-T C2) LEARNING LABORATORY ADDRESSES NUMEROUS AGENCY FOR HEALTHCARE RESEARCH AND QUALITY PRIORITIES AND WILL FOCUS ON IMPROVING SAFETY, QUALITY, AND VALUE OF HEALTHCARE. THE LABORATORY WILL ADDRESS CHRONIC CONDITIONS, HEALTH EQUITY AND VULNERABLE POPULATIONS, AND PRIMARY CARE. AT THE FOUNDATION OF THE LEARNING LABORATORY IS A SOCIO-TECHNICAL SYSTEM ENGINEERING FRAMEWORK THAT CONSIDERS MULTIPLE FACTORS THAT MAY CONTRIBUTE TO PATIENT SAFETY ISSUES INCLUDING TECHNOLOGY, PEOPLE, PROCESSES, AND POLICIES. AIM 1 IS THE PROBLEM ANALYSIS PHASE AND A MULTIPRONGED APPROACH WILL BE USED TO IDENTIFY TELEHEALTH RELATED PATIENT SAFETY ISSUES. AIM 2 IS THE SOLUTION DESIGN AND DEVELOPMENT PHASE. IN THIS PHASE A DIVERSE SET OF STAKEHOLDERS, INCLUDING INDUSTRY PARTNERS, WILL CO-DESIGN AND DEVELOP SAFETY SOLUTIONS. AIM 3 IS THE IMPLEMENTATION AND EVALUATION PHASE. DEVELOPED SOLUTIONS WILL BE IMPLEMENTED IN DIFFERENT OUTPATIENT CLINICS ACROSS MULTIPLE HEALTHCARE SYSTEMS AND PROCESS MEASURES AND OUTCOME MEASURES WILL BE USED TO DETERMINE EFFECTIVENESS OF THE SOLUTIONS IN ADDRESSING THE INTENDED PATIENT SAFETY ISSUES. THE RESEARCH EFFORT IS A UNIQUE COLLABORATION BETWEEN MEDSTAR HEALTH, STANFORD HEALTH CARE, AND INTERMOUNTAIN HEALTHCARE. THIS PROJECT UTILIZES THE EXTENSIVE EXPERTISE OF THE DIVERSE RESEARCH TEAM WHICH INCLUDES SYSTEM ENGINEERS AND HUMAN FACTORS EXPERTS, HEALTH EQUITY RESEARCHERS, CLINICIANS AND OPERATIONAL LEADERS, DATA SCIENTISTS AND CLINICAL APPLICATION DEVELOPERS, AS WELL AS IMPLEMENTATION SCIENTISTS. THE LABORATORY ALSO INCLUDES INDUSTRY PARTNERS, A HEALTH EQUITY ADVISORY TEAM, A HEALTH EQUITY COMMUNITY ADVISORY BOARD, AND A PATIENT AND FAMILY ADVISORY BOARD THAT WILL INFORM ALL ASPECTS OF THE PROJECT. CONTRIBUTIONS FROM THIS RESEARCH WILL INCLUDE IDENTIFICATION OF PROMINENT SAFETY ISSUES, DEVELOPMENT AND IMPLEMENTATION OF SAFETY SOLUTIONS THAT CAN BE SCALED ACROSS DIFFERENT HEALTHCARE FACILITIES, AND NEW KNOWLEDGE OF WHICH SAFETY SOLUTIONS ARE MOST EFFECTIVE TO IMPROVING TELEHEALTH SAFETY. OUR RIGOROUS DISSEMINATION PLAN INCLUDES COMMUNICATION OF RESULTS TO POLICYMAKERS AND ADVOCACY GROUPS, CLINICAL LEADERS AND OTHER ORGANIZATIONS THAT SERVE TO IMPROVE CLINICAL PRACTICE, AS WELL AS ACADEMIC AUDIENCES. RESULTS WILL BE AVAILABLE WITHIN 4-6 MONTHS OF PROJECT START AND WE WILL DISSEMINATE OUR FINDINGS THROUGHOUT THE COURSE OF THE PROPOSED FOUR-YEAR PROJECT.

REGENERATIVE PERIPHERAL NERVE INTERFACES TO TREAT PAINFUL DIGIT AND HAND NEUROMAS AFTER AMPUTATION: A RANDOMIZED, PROSPECTIVE STUDY.

SIGNALING SEPSIS: DEVELOPING A FRAMEWORK TO OPTIMIZE ALERT DESIGN

GLUCOSE HOMEOSTASIS AND THE RISK OF ALZHEIMER'S DISEASE AND ALZHEIMER'S DISEASE RELATED DEMENTIAS IN THE MULTI-ETHNIC STUDY OF ATHEROSCLEROSIS - PROJECT SUMMARY ALZHEIMER’S DISEASE AND ALZHEIMER’S DISEASE RELATED DEMENTIAS POSE AN ENORMOUS PUBLIC HEALTH CHALLENGE. IN THE ABSENCE OF A CURE, PREVENTION OR DELAY OF PATHOLOGY OFFERS THE MOST PROMISING AVENUE TO CONTROL THE DISEASE. DESPITE GROWING RECOGNITION THAT CARDIOMETABOLIC RISK FACTORS ARE MAJOR CONTRIBUTORS TO COGNITIVE DECLINE, ALZHEIMER’S DISEASE, AND ALZHEIMER’S DISEASE RELATED DEMENTIAS, MANY GAPS REMAIN IN OUR UNDERSTANDING OF THE MECHANISMS AND PATHWAYS BETWEEN GLUCOSE HOMEOSTASIS AND COGNITIVE FUNCTION. WHILE TYPE 2 DIABETES (T2D) IS INCREASINGLY RECOGNIZED AS A MAJOR PREVENTABLE RISK FACTOR FOR ALZHEIMER’S DISEASE AND RELATED DEMENTIAS, INTENSIVE GLUCOSE CONTROL IN T2D HAS NOT BEEN SHOWN TO PREVENT COGNITIVE DECLINE IN TRIALS. THIS FINDING AND INCONSISTENT RESULTS FOR THE INFLUENCE OF GLUCOSE CONTROL (HBA1C) ON COGNITIVE DECLINE POSE THE QUESTION: WHAT ASPECTS OF DYSGLYCEMIA, AND ITS INVERSE GLUCOSE HOMEOSTASIS, INCREASE THE RISK OF ALZHEIMER’S DISEASE OR RELATED DEMENTIAS? THIS STUDY’S OVERALL GOAL IS TO INVESTIGATE THE ROLE OF DYSGLYCEMIA ACROSS THE GLUCOSE SPECTRUM ON INCIDENT NEUROCOGNITIVE MARKERS OF ALZHEIMER’S DISEASE AND ALZHEIMER’S DISEASE RELATED DEMENTIAS IN A MULTI-ETHNIC COHORT: THE MULTI-ETHNIC STUDY OF ATHEROSCLEROSIS (MESA). MESA ENROLLED 6814 MEN AND WOMEN BEGINNING IN 2000. MESA PARTICIPANTS HAVE BEEN EXTENSIVELY STUDIED WITH RESPECT TO CARDIOVASCULAR RISK FACTORS AND OUTCOMES AND MESA-MIND, A COGNITIVE ANCILLARY, ADDS COMPREHENSIVE COGNITIVE TESTING AND NEUROIMAGING INCLUDING BRAIN MRI AND AMYLOID Β PET SCANS. MESA HAS A 7TH EXAM OCCURRING BETWEEN 2021-2023 THAT WILL BE CONCORDANT WITH THE SECOND MESA-MIND VISIT. WHILE FASTING GLUCOSE WAS OBTAINED AT EVERY EXAM, AND HBA1C AND HOMA-IR MEASURED AT SOME EXAMS, CONTINUOUS GLUCOSE HAS NOT BEEN MEASURED. ADDING CONTINUOUS GLUCOSE MONITORING WEARABLE TECHNOLOGY TO MESA EXAM 7 AND REPEATED TWO YEARS LATER PROVIDES A UNIQUE AND TIMELY OPPORTUNITY TO ANSWER CHALLENGING QUESTIONS ABOUT THE ROLE OF DYSGLYCEMIA THAT CONTINUE TO IMPEDE THE DEVELOPMENT OF SUCCESSFUL PREVENTION STRATEGIES FOR ALZHEIMER’S DISEASE AND ALZHEIMER’S DISEASE RELATED DEMENTIAS. THIS STUDY WILL ALSO ADD NEW MEASUREMENTS OF INSULIN RESISTANCE (HOMA-IR). THIS ANCILLARY TO MESA WILL 1) INVESTIGATE THE ANTECEDENT DETERMINANTS OF GLUCOSE HOMEOSTASIS (FROM CONTINUOUS GLUCOSE MONITORS AT EXAM 7 (N=2000) AND CHANGE OVER TWO YEARS (N=1000), 2. DETERMINE WHETHER CONTINUOUS GLUCOSE MARKERS OF GLUCOSE HOMEOSTASIS, DYSGLYCEMIA, AND CHANGE OVER TIME ARE ASSOCIATED WITH INCIDENT NEUROCOGNITIVE INDICATORS OF ALZHEIMER’S DISEASE OR ALZHEIMER’S DISEASE RELATED DEMENTIAS (N=2000), AND 3. INVESTIGATE THE CONTRIBUTIONS OF DYSGLYCEMIA TO ALZHEIMER’S DISEASE AND RELATED DEMENTIA PATHOLOGIES BY SEX AND RACE/ETHNICITY (N=2000). FINDINGS FROM THIS RESEARCH WILL IDENTIFY NEW MECHANISMS FOR THE DEVELOPMENT OF ALZHEIMER’S DISEASE AND ALZHEIMER’S DISEASE RELATED DEMENTIAS, DISCOVER NEW PRIMARY AND SECONDARY PREVENTION TARGETS, AND HAVE THE POTENTIAL TO CHANGE CLINICAL CARE.

PRACTICAL DELIVERY OF GERIATRIC ASSESSMENT IN COMMUNITY ONCOLOGY SETTINGS - OLDER ADULTS WILL CONSTITUTE 75% OF THE PROJECTED 22.2 MILLION US CANCER SURVIVORS BY 2030, WITH THE LARGEST GROWTH AMONG OLDER SURVIVORS (AGE 65 AND UP). THIS OLDER POPULATION IS AT HIGHER RISK OF ADVERSE EVENTS DUE TO CANCER TREATMENT, BUT THESE ADVERSE OUTCOMES CAN BE MITIGATED BY PERSONALIZED TREATMENT PLANS ACCOUNTING FOR DOMAINS OF AGING. OUR LONG-TERM GOAL IS TO INCREASE DELIVERY OF PRACTICAL GERIATRIC ASSESSMENT IN COMMUNITY ONCOLOGY SETTINGS TO IMPROVE PATIENT OUTCOMES IN CLINICS WITH LIMITED SPECIALIZED RESOURCES. GERIATRIC ASSESSMENT WAS RECOMMENDED BY THE NATIONAL COMPREHENSIVE CANCER NETWORK AND THE AMERICAN SOCIETY OF CLINICAL ONCOLOGY (ASCO) FOR ADULTS AGE 65 AND OLDER WHO ARE CANDIDATES FOR SYSTEMIC THERAPY, WITH UPDATED GUIDELINES RELEASED IN 2023. WHILE GERIATRIC ASSESSMENT IS AN EVIDENCE-BASED APPROACH TO IMPROVE PATIENT OUTCOMES AND IS RECOMMENDED BY THESE KEY PROFESSIONAL SOCIETIES, IT IS NOT WIDELY USED IN PRACTICE. WE WILL COMPARE ASCO EDUCATIONAL MATERIALS FOR PRACTICAL GERIATRIC ASSESSMENT (CONTROL) TO SIX MONTHS OF THE SAME INFORMATION DELIVERY SUPPLEMENTED WITH IMPLEMENTATION SUPPORT, FOLLOWED BY TWELVE MONTHS OF MAINTENANCE SUPPORT (INTERVENTION). TO THIS END, WE WILL FIRST PILOT OUR IMPLEMENTATION SUPPORTS IN THREE PRACTICES AND WILL REFINE OUR PROTOCOL (UG3) TO PREPARE FOR OUR UH3-PHASE PARALLEL PRACTICE RANDOMIZED TRIAL INCLUDING 20 PRACTICES IN THE NCI COMMUNITY ONCOLOGY RESEARCH PROGRAM (NCORP). THE CONTROL MATERIALS WILL INCLUDE ASCO EDUCATIONAL MATERIALS FOR PROVIDERS INCLUDING THE GUIDELINES, “HOW TO” VIDEOS, AND AN ACTION TABLE FOR HOW TO OPERATIONALIZE SCREENING RESULTS. IMPLEMENTATION SUPPORTS WILL INCLUDE PROMOTING ADAPTABILITY, FACILITATION (WORKFLOW TAILORING), AND EDUCATION AND TRAINING, TO OVERCOME IDENTIFIED IMPLEMENTATION BARRIERS. IN AIM 1, WE WILL MEASURE REACH (% PATIENTS RECEIVING PRACTICAL GERIATRIC ASSESSMENT; PRIMARY OUTCOME), ADOPTION (% PROVIDERS DELIVERING PRACTICAL GERIATRIC ASSESSMENT), IMPLEMENTATION (DOCUMENTATION OF GA-GUIDED MANAGEMENT), AMONG N=960 PATIENT CHART REVIEWS. IN AIM 2 WE WILL SURVEY PATIENTS TO ASSESS EFFECTIVENESS (PROVIDER COMMUNICATION, TOXICITY, AND QUALITY OF LIFE). IN AIM 3, TO ASSESS SUSTAINABILITY, WE WILL CONDUCT A CHART REVIEW AMONG A DISTINCT SAMPLE OF N=960 TO ASSESS MAINTENANCE (PRACTICAL GERIATRIC ASSESSMENT >6 MONTHS AFTER COMPLETION OF IMPLEMENTATION SUPPORTS; SECONDARY), ADAPTATIONS TO THE PGA DELIVERY, AND CONTEXTUAL FACTORS AFFECTING DELIVERY OF PRACTICAL GERIATRIC ASSESSMENT. GUIDED BY THE PRACTICAL, ROBUST IMPLEMENTATION AND SUSTAINABILITY MODEL (PRISM), WE WILL USE SURVEYS, INTERVIEWS, AND SITE OBSERVATIONS TO DOCUMENT CONTEXTUAL FACTORS THAT INFLUENCE INTERVENTION DELIVERY, WITH ATTENTION TO DIFFERENCES IN DELIVERY BASED ON CONSIDERATION OF PATIENT AND ORGANIZATIONAL CHARACTERISTICS SUCH AS INSURANCE COVERAGE, GEOGRAPHIC LOCATION, CLINIC STAFFING AND VOLUME, AND PROXIMITY TO REFERRAL OFFICES.

DEVELOPING EVIDENCE- BASED USER CENTERED DESIGN AND IMPLEMENTATION GUIDELINES TO IMPROVE HEALTH INFORMATION TECHNOLOGY USABILITY

TOXIC PRODUCTS OF COMBUSTION IN BURN AND SMOKE INHALATION INJURIES

ASSESSING HEALTH OUTCOMES OF POLYSUBSTANCE USE DURING PREGNANCY THROUGH EHR DATA COMPONENT A

DEVELOPMENT AND PERFORMANCE OF MEDICAID ACOS

SYSTEMS BIOLOGY STUDIES OF SOCIAL DEFEAT STRESS IN MUS MUSCULUS

EQUITY ENGINES: LEVERAGING HUJAN-IN-THE-LOOP PATIENT-GENERATED HEALTH DATA WITH AUTOMATION TO OPTIMIZE EQUITY ENHANCED CARE - EMERGING DIGITAL TECHNOLOGIES PROVIDE EXCITING OPPORTUNITIES FOR PATIENT GENERATED HEALTH DATA (PGHD), DEFINED BY THE OFFICE OF THE NATIONAL COORDINATOR FOR HEALTH INFORMATION TECHNOLOGY (ONC) AS HEALTH-RELATED DATA CREATED, RECORDED, OR GATHERED BY OR FROM PATIENTS (OR FAMILY MEMBERS OR OTHER CAREGIVERS) TO HELP ADDRESS A SPECIFIC HEALTH CONCERN. PGHD INCLUDE BUT ARE NOT LIMITED TO: HEALTH AND TREATMENT HISTORY, BIOMETRIC DATA, SYMPTOMS, AND LIFESTYLE CHOICES. PGHD WILL CONSIDERABLY ALTER THE WAY IN WHICH CLINICIANS AND RESEARCHERS INTERACT WITH PATIENT DATA, CLOSE CARE GAPS, AND PROVIDE A HOLISTIC VIEW OF PATIENT DATA. GIVEN THE TREND TOWARD PATIENT-CENTERED CARE AND AVAILABILITY OF DATA COLLECTION TOOLS VIA CONSUMER DEVICES (E.G., SMARTPHONES, WEARABLES), THERE ARE EXCITING OPPORTUNITIES TO COLLECT AND LEVERAGE PGHD TO OPTIMIZE CARE OUTCOMES BUT ALSO EMERGING SOCIO-TECHNICAL CHALLENGES (E.G., EHR WORKFLOW INTEGRATION) WHICH MAY LIMIT THEIR USE. ADDITIONALLY, THE DIGITAL DIVIDE HAS BEEN IDENTIFIED AS THE NEWEST SOCIAL DETERMINANT OF HEALTH, ULTIMATELY IMPACTING PATIENT WELLNESS AND HEALTH EQUITY. THE PROJECT “EQUITY ENGINES: LEVERAGING HUMAN-IN-THE-LOOP PATIENT-GENERATED HEALTH DATA WITH AUTOMATION TO OPTIMIZE EQUITY ENHANCED CARE” ADDRESSES THE ONC LEAP AREA OF INTEREST 2: DEMONSTRATE THE USE OF EQUITY-ENHANCING PATIENT-GENERATED HEALTH DATA (PGHD) FOR CLINICAL CARE AND RESEARCH. THE PURPOSE OF OUR PROJECT IS TO DEVELOP THE INFRASTRUCTURE AND STANDARDS-BASED PGHD TECHNOLOGIES NEEDED TO DEMONSTRATE THE SCALABLE USE OF EQUITY ENHANCING PGHD FOR CLINICAL CARE AND RESEARCH FROM THE POINT OF CARE TO THE RESEARCHER. SPECIFICALLY, WE WILL (1) PERFORM AN ENVIRONMENTAL SCAN TO UNDERSTAND CURRENT STANDARDS AND INTEROPERABILITY OF PGDF RELATED TO OUR PROPOSED PGHD TECHNOLOGY SOLUTION; (2) DEVELOP THE EQUITY ENGINE (PGHD TECHNOLOGY SOLUTION) THAT COLLECTS AND SHARES PGHD AMONG PATIENTS, PROVIDERS, AND RESEARCHERS AROUND CLINICAL CARE AND RESEARCH THAT REQUIRE PGHD AND INCORPORATE THE NEEDS OF UNDERSERVED COMMUNITIES; (3) CONDUCT TWO DEMONSTRATION PROJECTS IN AT LEAST TWO SEPARATE HEALTHCARE LOCATIONS FOR AT LEAST TWO USE CASES USING THE SAME UNDERLYING TECHNOLOGY SOLUTION TO DEMONSTRATE SCALABILITY; (4) EVALUATE OPERATIONAL UTILITY OF THE NOVEL SOLUTION TO REPORT THE POTENTIAL IMPACT, OPPORTUNITIES, AND CHALLENGES. OUR EQUITY ENGINE SOLUTION WILL BE CO-DESIGNED WITH INPUT FROM THE ONC, A COALITION OF KEY STAKEHOLDERS INCLUDING PATIENTS, AND STANDARDS DEVELOPMENT ORGANIZATIONS. WE WILL LEVERAGE THE ORGANIZATIONAL CAPACITY OF MEDSTAR HEALTH AND TECHNICAL EXPERTISE IN CLINICAL INFORMATICS AND TECHNICAL INTEGRATION THROUGH OUR PARTNERSHIP WITH HEALTH LAB. OUR MULTIDISCIPLINARY TEAM IS UNIQUELY POSITIONED TO SUCCESSFULLY EXECUTE THIS PROJECT GIVEN OUR EXPERTISE AND EXPERIENCE IN HUMAN FACTORS, HEALTH EQUITY, CLINICAL INFORMATICS, PATIENT-REPORTED OUTCOMES, AND USABILITY. THE RESULT OF OUR TWO YEAR PROJECT WILL BE THE DELIVERY OF AN OPEN-SOURCE SOLUTION TO CAPTURE AND INTEGRATE PGHD INCLUDING PATIENT REPORTED OUTCOMES AND PATIENT GENERATED HEALTH METRICS. OUR FINAL REPORT WILL DOCUMENT LESSONS LEARNED, CHALLENGES ENCOUNTERED, AND RECOMMENDATIONS FOR A BLUEPRINT THAT CAN BE USED BY OTHERS TO ADVANCE THE USE OF PGHD FOR RESEARCH AND IN CLINICAL CARE.

MOBILIZING A MILLION HEARTS: LEVERAGING HEALTH IT ARCHITECTURE TO ADVANCE CLINICAL KNOWLEDGE AND CARE COORDINATION

IMPROVING DIAGNOSTIC EQUITY IN AMBULATORY CARE SETTINGS (I.D.E.A.S.): RESEARCH TO PRACTICE - PROJECT SUMMARY THE DIAGNOSTIC PROCESS IS AN ITERATIVE, TIME-DEPENDENT, AND COLLABORATIVE DECISION-MAKING PROCESS UNDER UNCERTAINTY TO REACH AN EXPLANATION FOR THE PATIENT’S HEALTH CONDITION(S) AND COMMUNICATE THIS EXPLANATION TO THE PATIENT. APPROPRIATE HEALTHCARE DELIVERY DEPENDS ON THE PROXIMITY BETWEEN A PATIENT’S HEALTH CONDITION AND DIAGNOSIS AND YET, DIAGNOSTIC ERRORS REMAIN A LEADING CAUSE OF MORBIDITY AND MORTALITY IN THE U.S. CONSIDERING THE VOLUME AND VARIETY OF PRIMARY CARE PATIENTS, COMBINED WITH THE PRACTICAL CHALLENGES OF SCARCE AND COSTLY REFERRAL AND TESTING RESOURCES, THE INCIDENCE OF DIAGNOSTIC ERRORS CAN DISPROPORTIONALLY AFFECT MEDICALLY UNDERSERVED AND VULNERABLE PATIENT POPULATIONS. DIAGNOSTIC DISPARITIES OCCUR WHEN PREVENTABLE DIAGNOSTIC ERRORS ARE EXPERIENCED DISPROPORTIONATELY AMONG CERTAIN PATIENT DEMOGRAPHIC SUBGROUPS. RESEARCH HAS SHOWN DISPARITIES IN DIAGNOSTIC ERROR S BY RACE AND ETHNICITY, SEX, GENDER, GEOGRAPHIC LOCATION, AND SOCIOECONOMIC STATUS, IN PART DUE TO IMPLICIT BIAS, DISCRIMINATION, AND STIGMA. HOWEVER, THE RELATIONSHIP BETWEEN DIAGNOSTIC EQUITY (I.E., DIAGNOSTIC DISPARITIES RELATED TO DIAGNOSTIC ERROR DUE TO SYSTEMIC CHALLENGES IN POLICIES AND PRACTICES) AND DIAGNOSTIC UNCERTAINTY (I.E., SUBJECTIVE PERCEPTION OF AN INABILITY TO PROVIDE AN ACCURATE EXPLANATION OF THE PATIENT'S HEALTH PROBLEM) IS POORLY UNDERSTOOD. DIAGNOSTIC UNCERTAINTY, A CONCEPT THAT HAS YET TO BE ADEQUATELY OPERATIONALIZED IN MEDICAL PRACTICE, IS A NATURAL PART OF MEDICINE AND MORE COMMON IN PRIMARY CARE THAN ANY OTHER SPECIALTY. IDENTIFICATION OF INDICATORS AND CAUSES FOR DIAGNOSTIC ERRORS IS CRUCIAL TO AVOID PATIENT HARM. PREVIOUS STUDIES LINKED DIAGNOSTIC UNCERTAINTY TO DIAGNOSTIC VARIATION (I.E., PHYSICIANS PROVIDING DIFFERENT DIAGNOSIS FOR THE SAME PATIENT), OVER-TESTING, INCREASED HOSPITALIZATION, AND REFERRALS. YET, THE CONNECTION BETWEEN DIAGNOSTIC UNCERTAINTY AND DIAGNOSTIC EQUITY REMAINS AN UNDERSTUDIED DOMAIN. WHILE THERE IS AN INCREASING NEED TO DEVELOP DATA-DRIVEN AND EVIDENCE-BASED METHODS TO STUDY THE RELATIONSHIP BETWEEN DIAGNOSTIC EQUITY AND DIAGNOSTIC UNCERTAINTY, THE COMPLEXITY, TIME DEPENDENCY, AND UNCERTAINTY OF THE DIAGNOSTIC PROCESS MAKES THIS CHALLENGING. THEREFORE, WE HAVE DEVELOPED THE IMPROVING DIAGNOSTIC EQUITY IN AMBULATORY CARE SETTINGS (I.D.E.A.S.): RESEARCH TO PRACTICE STUDY TO EVALUATE DIAGNOSTIC ERRORS IN THE CONTEXT OF DIAGNOSTIC EQUITY AND DIAGNOSTIC UNCERTAINTY THROUGH THE APPLICATION OF DECISION-MODELING AND HUMAN FACTORS METHODOLOGIES. THE NOVELTY OF THE PROPOSED STUDY LIES IN ITS UNIQUE INTERDISCIPLINARY APPROACH, BRINGING TOGETHER CLINICAL DIAGNOSTICIAN EXPERTISE, DATA SCIENCE, OPERATIONS RESEARCH, AND HUMAN FACTORS ENGINEERING, TO WORK TOWARDS METHODOLOGICAL ADVANCES IN CONCEPTUALIZING AND MEASURING DIAGNOSTIC ERRORS. EXPECTED OUTCOMES WILL LAY THE FOUNDATION FOR DESIGNING A COMPREHENSIVE FRAMEWORK VIA AN EQUITY LENS TO CONNECT DIAGNOSTIC EQUITY AND DIAGNOSTIC UNCERTAINTY TO INFORM INTERVENTIONS AIMED AT REDUCING DIAGNOSTIC INEQUITY AND IMPROVING THE MANAGEMENT OF DIAGNOSTIC UNCERTAINTY.

FHIR FACTORIES: AN EVOLVING DIGITAL ARCHITECTURE TO SCALE HEALTH RESEARCH

A MULTI-SITE EVALUATION OF PRIMARY CARE ACCESSIBILITY AND UTILIZATION DURING COVID-19 - ABSTRACT THE OBJECTIVE OF THE PROPOSED RESEARCH IS TO EVALUATE HOW PATIENT ACCESS AND UTILIZATION OF PRIMARY CARE WAS DISRUPTED BY COVID-19 ACROSS THREE HEALTHCARE SYSTEMS, WITH A FOCUS ON PATIENTS WITH CHRONIC CONDITIONS. OUR RIGOROUS EVALUATION HAS THREE AIMS. AIM 1 IS TO DETERMINE WHETHER PATIENTS WERE ABLE TO ACCESS PRIMARY CARE AND, FOR THOSE WHO DID ACCESS CARE, IDENTIFICATION OF THE MODALITIES TO ACCESS CARE (IN-PERSON, TELEHEALTH (VIDEO OR PHONE), ASYNCHRONOUS COMMUNICATION, OR MULTIPLE MODALITIES). FURTHER, WE WILL IDENTIFY SUBPOPULATIONS THAT WERE DISPROPORTIONATELY AFFECTED INCLUDING AND MAY NOT HAVE BEEN ABLE TO ACCESS CARE AT ALL. AIM 2 IS TO IDENTIFY BARRIERS AND FACILITATORS TO DIGITAL HEALTH ACCESS ACROSS THREE SITES. AIM 3 IS TO EVALUATE HOW THE MODALITY USED TO ACCESS PRIMARY CARE, OR THE LACK OF ACCESS TO PRIMARY CARE, DURING COVID-19 IMPACTS FUTURE HEALTHCARE ACCESS AND UTILIZATION FOR PATIENTS WITH CHRONIC CONDITIONS, AND OTHER AT-RISK POPULATIONS. THE RESEARCH EFFORT IS A UNIQUE COLLABORATIVE BETWEEN MEDSTAR HEALTH, STANFORD HEALTH CARE, AND INTERMOUNTAIN HEALTHCARE. THIS PROJECT UTILIZES THE EXTENSIVE EXPERTISE OF THE DIVERSE RESEARCH TEAM WHICH INCLUDES DATA SCIENTISTS, HUMAN FACTORS EXPERTS, INFORMATICISTS, HEALTH DISPARITIES RESEARCHERS AND CLINICAL EXPERTS IN DIGITAL HEALTH. THE PROPOSAL IS DIRECTLY ALIGNED WITH AHRQ’S PRIORITY AREA OF MAKING HEALTH CARE ACCESSIBLE AND SAFER. TO ACHIEVE AIMS ONE AND THREE WE WILL USE RIGOROUS DATA SCIENCE AND INFORMATICS METHODS. TO ACHIEVE AIM 2, WE WILL USE A MIXED METHODS APPROACH THAT INCLUDES INTERVIEWS OF SUBJECT MATTER EXPERTS AND PATIENTS FROM EACH OF THE THREE SITES WITH A SOCIO-TECHNICAL SYSTEMS MODEL AS THE FOUNDATION FOR OUR INTERVIEWS. CONTRIBUTIONS FROM THIS RESEARCH WILL INCLUDE A DETAILED UNDERSTANDING OF ACCESS MODALITIES THAT ARE MOST FREQUENTLY USED, PATIENT POPULATIONS THAT MAY BE DISPROPORTIONATELY IMPACTED BY COVID-19, AND IDENTIFICATION OF BARRIERS AND FACILITATORS TO DIGITAL HEALTH MODELS OF CARE. OUR RIGOROUS DISSEMINATION PLAN INCLUDES COMMUNICATION OF RESULTS TO POLICYMAKERS AND ADVOCACY GROUPS, CLINICAL LEADERS AND OTHER ORGANIZATIONS THAT SERVE TO IMPROVE CLINICAL PRACTICE, AS WELL AS ACADEMIC AUDIENCES. RESULTS FROM AIM 1 WILL BE AVAILABLE WITHIN 4- 6 MONTHS OF PROJECT START AND THE ENTIRE PROJECT WILL BE COMPLETED IN TWO YEARS.

COMMUNITY PROJECT FUNDING/CONGRESSIONALLY DIRECTED SPENDING - CONSTRUCTION

BRIDGING THE GAP: DELIVERING EQUITABLE COLORECTAL CANCER SCREENING - SUMMARY COLORECTAL CANCER (CRC) IS THE THIRD MOST COMMON CAUSE OF CANCER AND CANCER MORTALITY IN THE U.S., WITH SIGNIFICANT DIFFERENCES IN OUTCOMES IN HISTORICALLY MARGINALIZED POPULATIONS. BLACK INDIVIDUALS HAVE THE HIGHEST MORTALITY RATE FOR CRC; HALF OF THE DISPARITY HAS BEEN ASSOCIATED WITH LOWER SCREENING RATES. CRC SCREENING IS RECOMMENDED BY THE UNITED STATES PREVENTATIVE SERVICES TASK FORCE FOR ADULTS AGE 45-75. PATIENT NAVIGATION IS AN EVIDENCE-BASED STRATEGY TO INCREASE SCREENING RATES AMONG RACIAL AND ETHNIC MINORITIES. WHILE PATIENT NAVIGATION IS AN EVIDENCE-BASED APPROACH TO IMPROVE SCREENING, THERE IS A GAP IN UNDERSTANDING THE MULTI-LEVEL INFLUENCES ON IMPLEMENTATION OF SUCH PROGRAMS ACROSS PRIMARY CARE PRACTICES, PARTICULARLY USING A HEALTH- EQUITY FOCUSED, STAKEHOLDER-CENTERED APPROACH. OUR LONG-TERM GOAL IS TO PROMOTE HEALTH EQUITY THROUGH UNDERSTANDING CONTEXTUAL FACTORS INCLUDING SYSTEM AND INTERPERSONAL RACISM AND IMPLEMENTATION STRATEGIES NEEDED TO IMPLEMENT PATIENT NAVIGATION ACROSS PRIMARY CARE SETTINGS WITH DIVERSE RACIAL AND ETHNIC POPULATIONS. WE PROPOSE MIXED METHODS ALONG WITH AN ADVISORY BOARD COMPRISED OF COMMUNITY ORGANIZATIONS TO ITERATIVELY ADAPT THE PATIENT NAVIGATION INTERVENTION TO CONSIDER THE PATIENT POPULATION, THE CLINICAL WORKFLOWS AND STAFFING, AND THE COMMUNITY CONTEXT. GUIDED BY THE PRACTICAL, ROBUST IMPLEMENTATION AND SUSTAINABILITY MODEL (PRISM) AND CORE HEALTH AND RACIAL EQUITY PRINCIPLES, WE AIM TO INCREASE REACH OF PATIENT NAVIGATION AND SHOW EFFECTIVENESS THROUGH IMPROVEMENT IN THE PERCENTAGE OF BLACK AND HISPANIC PATIENTS COMPLETING CRC SCREENING. WE WILL ALSO UTILIZE LONGITUDINAL TRACKING OF IMPLEMENTATION STRATEGIES TO BETTER TRACK IMPLEMENTATION OR INTERVENTION ADAPTATIONS NAVIGATION DELIVERY IN ORDER TO INFORM FUTURE SCALE UP. WE WILL CONDUCT A STEPPED- WEDGED, RANDOMIZED TRIAL TO ROLL OUT PATIENT NAVIGATION AND PATIENT AND PROVIDER REMINDERS ACROSS 15 CLINICS (3 CLINICS PER STEP, 5 SIX-MONTH STEPS). IMPLEMENTATION STRATEGIES WILL INCLUDE ASSESSING FOR READINESS, AUDIT AND FEEDBACK, BUILDING A COMMUNITY COALITION, ENGAGING CONSUMERS, MODIFYING REFERRAL TRACKING, AND TRAINING AND EDUCATING CLINICAL STAKEHOLDERS. WE WILL USE THE ELECTRONIC HEALTH RECORD DATA WITH CONSIDERATION FOR THE OBSERVATIONAL MEDICAL OUTCOMES PARTNERSHIP (OMOP) COMMON DATA MODEL, ADDITIONAL PATIENT-REPORTED DATA, AND STUDY TRACKING LOGS TO MEASURE REACH, EFFECTIVENESS, ADOPTION, IMPLEMENTATION (FIDELITY, FEASIBILITY, ACCEPTABILITY, APPROPRIATENESS), AND WILL USE QUALITATIVE MEASURES AND SITE OBSERVATIONS TO DOCUMENT CONTEXTUAL FACTORS, INCLUDING EXAMINATION OF DISCRIMINATION IN PATIENT EXPERIENCES AND PROVIDER REFERRAL PATTERNS THAT MAY INFLUENCE INTERVENTION DELIVERY OR CRC SCREENING COMPLETION. PARTNERSHIP WITH THE NATIONAL COMMITTEE ON QUALITY ASSURANCE (NCQA) WILL FURTHER ALLOW US TO EXAMINE SUSTAINABILITY OF A COMMUNITY-ENGAGED MODEL FOR DELIVERY OF EVIDENCE-BASED INTERVENTIONS.

COMMUNITY PROJECT FUNDING/CONGRESSIONALLY DIRECTED SPENDING - CONSTRUCTION

BEHAVIORAL HEALTH DETERMINANTS OF ADHERENCE IN WOMEN LIVING WITH HIV

TODAY'S TRUTH - RESEARCH BRINGS HOPE: ETHICAL ISSUES IN HEALTH DISPARITIES AND AC

SOCIO-STRUCTURAL INTERVENTION TO IMPROVE PRE-EXPOSURE PROPHYLAXIS (PREP) SERVICES FOR CISGENDER WOMEN (CGW) (PREP-CGW) - PROJECT SUMMARY CISGENDER WOMEN (CGW) ACCOUNT FOR NEARLY 20% OF NEW HIV DIAGNOSES IN THE UNITED STATES (US) AND BOTH RESEARCH AND PUBLIC HEALTH EFFORTS IN HIV PREVENTION IN THIS POPULATION HAVE FALLEN SHORT. MOST CGW ACQUIRE HIV VIA HETEROSEXUAL TRANSMISSION, AND BLACK CGW ARE DISPROPORTIONATELY AFFECTED. WASHINGTON, D.C. (DC) IS AN EPICENTER OF THE HIV EPIDEMIC IN THE SOUTHERN US; HIV PREVALENCE AMONG CGW IS SEVEN-FOLD HIGHER THAN THE NATIONAL AVERAGE, AND TEN-FOLD HIGHER AMONG BLACK CGW. GIVEN THE SEVERITY AND PERVASIVENESS OF THE EPIDEMIC, DC IS THE MODEL LOCATION TO EFFICIENTLY DEVELOP AND PILOT A HIV PREVENTION INTERVENTION FOR CGW TO BE TESTED ACROSS THE SOUTHERN US. HIV IS HIGHLY PREVENTABLE THROUGH CONSISTENT USE OF BARRIER CONTRACEPTION AND HIV PRE-EXPOSURE PROPHYLAXIS (PREP), HOWEVER THERE ARE SIGNIFICANT SOCIO-STRUCTURAL BARRIERS TO PREP USE AMONG CGW, INCLUDING MEDICAL MISTRUST, COST, STIGMA, AND LACK OF ACCESS. OUR PRELIMINARY RESEARCH IN REPRODUCTIVE-AGE CGW AT HIGH RISK FOR HIV ECHOED THE CRITICAL IMPORTANCE OF MEDICAL PROVIDER AND PEER SUPPORT IN ENGAGEMENT AND RETENTION IN THE PREP CASCADE REPORTED IN THE LITERATURE. THERE IS MOUNTING EVIDENCE TO SUPPORT THE IMPORTANCE OF SOCIO-STRUCTURAL INTERVENTIONS TO ADDRESS IDENTIFIED BARRIERS TO SUCCESSFUL PREP DELIVERY AND UTILIZATION. THERE ARE CURRENTLY NO EVIDENCED-BASED INTERVENTIONS TO IMPROVE PREP INITIATION, ADHERENCE, AND PERSISTENCE AMONG CGW IN THE US. THIS PLANNING PROPOSAL BUILDS UPON THE SUCCESSFUL MULTI-PRONGED APPROACH OF PROJECT SHIKAMANA, A SOCIO- STRUCTURAL INTERVENTION TO PREVENT HIV AMONG CGW IN TANZANIA (A NIMH R01 AWARD, RECOGNIZED BY CDC AS AN EVIDENCE-BASED INTERVENTION (EBI) LED BY DR. KERRIGAN (CO-I) AND UPON THE PI’S FORMATIVE RESEARCH WITH REPRODUCTIVE-AGE CGW AT HIGH-RISK FOR HIV IN DC. IN THIS PROPOSAL, WE PLAN TO ADAPT AND TAILOR THE PROJECT SHIKAMANA APPROACH TO ADDRESS THE CULTURALLY-SPECIFIC, SOCIO-STRUCTURAL BARRIERS TO HIV PREVENTION. OUR SPECIFIC AIMS ARE: 1) INTERVENTION DEVELOPMENT: WE WILL ADAPT THE EXISTING MULTI-PRONGED PROJECT SHIKAMANA INTERVENTION FOR USE WITH SOUTHERN US REPRODUCTIVE-AGE BLACK CGW. THIS INTERVENTION WILL INTEGRATE A) PROVIDER TRAINING TO MITIGATE IMPLICIT BIASES AND POSITIVELY REFRAME HIV PREVENTION AS PART OF PATIENT-CENTERED CARE, AND B) PEER NAVIGATION TO ADDRESS SOCIO-STRUCTURAL BARRIERS TO PREP INITIATION, ADHERENCE, AND PERSISTENCE. 2) FEASIBILITY & ACCEPTABILITY TESTING: WE WILL EVALUATE THE FEASIBILITY AND ACCEPTABILITY OF THIS HIV PREVENTION INTERVENTION. ADDITIONALLY, WE WILL EVALUATE THE FEASIBILITY OF USING A REGRESSION DISCONTINUITY DESIGN AND THE COLLECTION OF ASSOCIATED OUTCOME MEASURES TO INFORM A FUTURE TRIAL. WE WILL UTILIZE THE PRISM FRAMEWORK TO ASSESS PATIENT AND ORGANIZATIONAL PERSPECTIVES, REACH, ADOPTION, AND INTERVENTION ACCEPTABILITY AND FEASIBILITY IN PREPARATION FOR OUR PLANNED, MULTI-SITE TRIAL TO INCREASE ENGAGEMENT AND RETENTION IN THE PREP CASCADE.

VALIDATION OF AN AFFORDABLE AND ACCESSIBLE ALTERNATIVE SIMULATION TECHNOLOGY

HUMAN FACTORS ENGINEERING TO OPTIMIZE DESIGN OF IMAGING SYSTEMS FOR NON-RADIOLOG

FIELD INITIATED

EARLY IDENTIFICATION AND LINKAGE TO CARE FOR PERSONS WITH CHR

DIABETES TO GO INPATIENT

NUTRITION RESEARCH TO REDUCE THE RISK OF DISEASE

BIPHASIC COAGULOPATHIES AND ENDOTHELIOPATHY IN BURN INJURED PATIENTS: AN ANALYSIS OF MECHANISMS AND INTERPLAY

BARRIERS TO SCREEN FOR DOMESTIC VIOLENCE AMONG WOMEN IN EMERGENCY DEPARTMENT - PROJECT SUMMARY ABSTRACT DOMESTIC VIOLENCE (DV) INCLUDES PHYSICAL AND SEXUAL VIOLENCE, THREATS, ECONOMIC, AND EMOTIONAL/PSYCHOLOGICAL ABUSE, OR OTHER ABUSIVE BEHAVIOR AS PART OF A SYSTEMATIC PATTERN OF CONTROL AND POWER PERPETRATED BY ONE INTIMATE PARTNER AGAINST ANOTHER. IT CAUSES A SIGNIFICANT BURDEN FOR THE HEALTHCARE SYSTEMS BY INCREASING MORBIDITY AND MORTALITY AMONG VICTIMS. WOMEN ARE DISPROPORTIONATELY AFFECTED, ALTHOUGH MEN MAY EXPERIENCE DV AS WELL. THE RECENT COVID-19 PANDEMIC LED TO MOVEMENT RESTRICTIONS AND STAY AT HOME ORDERS. WHILE THESE DECISIONS WERE ESSENTIAL TO PREVENT SPREAD OF THE VIRUS, SUCH EXTENDED DOMESTIC STAYS MAY EXACERBATE THE NUMBER THE TOTAL AS WELL AS REPORTED INCIDENTS OF DV. AS A RESULT, IN RECENT YEARS, DV HAS TRANSFORMED INTO A SHADOW PANDEMIC, WHICH FURTHER COMPLICATED THIS PUBLIC HEALTH ISSUE AND INCREASED THE NEED TO PERFORM ACCURATE AND TIMELY INTERVENTIONS. DV OFTEN FORMS A PATTERN, AND MANY OF THE VICTIMS EXPERIENCE REPEATED ACTS OF PHYSICAL OR MENTAL ABUSE. VICTIMS OF DV MAY SEEK CARE IN HOSPITAL SETTINGS WHICH MAKES TIMELY INTERVENTIONS CRITICAL AND EVEN LIFESAVING. WHILE THERE IS A SERIOUS NEED FOR GOVERNMENT TO REINFORCE COMMITMENTS MADE TO ELIMINATE ALL FORMS OF DV AGAINST WOMEN, THE HEALTH SECTOR PLAYS AN ESSENTIAL ROLE IN BREAKING THE CYCLE OF ABUSE. HEALTH PROVIDERS CAN PREVENT REOCCURRENCE OF SUCH VIOLENT INCIDENTS BY IDENTIFYING WOMEN WHO ARE EXPERIENCING DV, AND THEN PROVIDE COMPREHENSIVE SERVICES AND TRAIN HEALTH PROVIDERS IN RESPONDING TO THE NEEDS OF SURVIVORS IN ADDITION TO CARING FOR PHYSICAL INJURIES. ABUSED WOMEN RARELY DISCLOSE THE REASON FOR EMERGENCY DEPARTMENT (ED) VISIT DUE TO VARIOUS REASONS INCLUDING SHAME, FEAR OF THE PERPETRATOR OR FINANCIAL DEPENDENCIES. WHILE THESE FACTORS FORM PATIENT-SPECIFIC BARRIERS TO SCREEN FOR DV, THE BARRIERS TO SCREENING, DETECTING AND HELPING DV VICTIMS CAN BE RECOGNIZED AT DIFFERENT LEVELS DURING AN ED VISIT. SINCE THESE BARRIERS ARE NOT CLEAR, MORE EXPLORATION IS NEEDED TO UNDERSTAND IMPORTANT FEATURES BY ANALYZING EHR DATA TO GAIN FURTHER UNDERSTANDING OF THE CLINICAL EXPERIENCE AND ENVIRONMENT. IN AIM 1 OF THIS PROPOSAL, WE WILL USE THE DV-RELATED ICD-9/ICD-10 DIAGNOSIS CODES TO FIND POSITIVE CASES OF DV AMONG THE VISITS TO ED. THEN ADAPT MARKET-BASKET ANALYSIS, WHICH IS A DATA MINING METHOD ORIGINATED IN THE FIELD OF MARKETING, TO OUR OBJECTIVE AND IDENTIFY PATTERNS OF INJURY AND HEALTH PROBLEMS WHICH ARE OBSERVED TOGETHER FREQUENTLY. THEN, WE WILL UTILIZE STATE-OF-THE-ART DEEP LEARNING-BASED NATURAL LANGUAGE PROCESSING (NLP) MODELS TO LEARN THE PATTERNS IN ELECTRONIC HEALTH RECORDS CLINICAL NOTES RELATED TO DV. IN AIM 2, WE WILL CONDUCT SEMI- STRUCTURED INTERVIEWS WITH ED HEALTH PROVIDERS TO INVESTIGATE THE BARRIERS TO SCREENING FOR DV DURING PATIENT- PROVIDER ENCOUNTER. THE OUTCOMES OF THIS STUDY HAVE THE POTENTIAL TO ADD SIGNIFICANT INSIGHTS TO IMPROVE THE SCREENING PROCESS AND THE CARE WE PROVIDE OUR PATIENTS IN THE ED. 1

STOP ATHEROSCLEROSIS IN NATIVE DIABETICS STUDY (SANDS)

USE P105(SR) TO STUDY P50 HOMODIMER IN SKIN TUMOR/CANCER

COGNITIVE BEHAVIORAL THEORY-ASSISTED VIRTUAL REALITY FOR CHRONIC CANCER PAIN (VR-CAN): DEVICE PROTOTYPE DEVELOPMENT AND FEASIBILITY TESTING - PROJECT ABSTRACT OVER 50% OF PATIENTS LIVING WITH CANCER EXPERIENCE PAIN EARLY IN THE DISEASE COURSE, INCREASING TO AT LEAST 75% OF PATIENTS WHO HAVE PROGRESSED TO MORE ADVANCED STAGES. OPIOID THERAPIES REMAIN A CORNERSTONE TO CHRONIC CANCER PAIN MANAGEMENT – NEVERTHELESS, CLINICAL LITERATURE AND EXPERT OPINION REINFORCE THAT MAXIMIZING EFFECTIVE, APPROPRIATE NON-PHARMACOLOGIC THERAPIES IS CRITICAL TO ACHIEVING THE BEST POSSIBLE PAIN CONTROL, WELL-BEING, AND RETURN TO FUNCTION. VIRTUAL REALITY (VR) IS A RAPIDLY DEVELOPING TECHNOLOGY THAT CAN TEMPORARILY IMMERSE INDIVIDUALS IN A CALM, PLEASANT ENVIRONMENT, AND HAS DEMONSTRATED EFFICACY IN ACUTE AND CHRONIC PAIN MANAGEMENT SETTINGS BY PROVIDING DISTRACTION FROM PAIN AND LOWERING PAIN SENSATION. NEVERTHELESS, DESPITE GROWING EVIDENCE SUPPORTING THE EFFICACY OF VR-BASED INTERVENTIONS FOR ANALGESIA, FEW DATA ARE AVAILABLE THAT PROVIDE AN UNDERSTANDING OF ITS ROLE IN MITIGATING PERSISTENT PAIN IN PATIENTS WITH CANCER AND EXISTING STUDIES HAVE USED OFF-THE-SHELF VR PRODUCTS THAT ARE NOT EVIDENCE- BASED OR DESIGNED TO MEET THE UNIQUE AND COMPLEX NEEDS OF PATIENTS WITH CANCER PAIN. THIS COLLABORATION BETWEEN DUKE UNIVERSITY AND MEDSTAR HEALTH LEVERAGES EXPERIENCE CONDUCTING CLINICAL TRIALS OF VR TO MITIGATE CANCER PAIN IN BOTH INPATIENT AND OUTPATIENT SETTINGS (BOTH SITES), EXPERTISE IN THE DEVELOPMENT AND IMPLEMENTATION OF BEHAVIORAL PAIN AND SYMPTOM MANAGEMENT INTERVENTIONS FOR PATIENTS WITH CANCER (DUKE), AND EXPERIENCE DEVELOPING VR APPLICATIONS FOR HEALTHCARE SETTINGS (MEDSTAR). FOLLOWING THE NIH BEHAVIORAL INTERVENTION DEVELOPMENT STAGE MODEL, OUR SHARED GOAL IS TO DEVELOP (I.E., PATIENT FOCUS GROUPS, PROVIDER AND EXPERT INTERVIEWS, PATIENT BETA TESTING) AND PILOT TEST (RCT N=40) A NEW VR THERAPY THAT INTEGRATES EVIDENCE-BASED STRATEGIES AND IS UNIQUELY CO-DESIGNED BY PATIENTS LIVING WITH CHRONIC CANCER PAIN. AIM 1. ITERATIVELY DEVELOP AND REFINE A CBT-ASSISTED VR PROTOTYPE FOR PATIENTS WITH CHRONIC CANCER PAIN (VR-CAN) BASED ON LITERATURE AND THE INVESTIGATIVE TEAM’S RESEARCH AND CLINICAL EXPERTISE, AND FEEDBACK COLLECTED VIA FOCUS GROUPS WITH PATIENTS LIVING WITH MODERATE-SEVERE CHRONIC CANCER PAIN FROM BOTH URBAN (WASHINGTON DC) AND SUBURBAN/RURAL (DURHAM, NC) COMMUNITIES (N=24) AND INTERVIEWS WITH PROVIDERS (N=6; ONCOLOGISTS, NURSES), AND EXPERTS IN THE FIELD (N=6; E.G., VR TECHNOLOGY, CANCER SURVIVORSHIP, NON-PHARMACOLOGICAL PAIN MANAGEMENT). LEVERAGING HUMAN FACTORS SCIENCE, THIS PROTOTYPE WILL THEN BE TESTED FOR USABILITY IN THE LAB BY PATIENT PARTICIPANTS (N=6), ITERATIVELY MODIFIED BASED ON FEEDBACK, AND THEN AT HOME BY UNIQUE PARTICIPANTS (N=6) DAILY FOR ONE WEEK. AIM 2. CONDUCT A RANDOMIZED CONTROLLED TRIAL TO EXAMINE THE FEASIBILITY (PRIMARY AIM), ACCEPTABILITY, USABILITY, SAFETY, AND INITIAL CLINICAL IMPACT (PAIN, PSYCHOLOGICAL DISTRESS, PAIN SELF-EFFICACY, PAIN CATASTROPHIZING) OF THE DEVELOPED VR-CAN PROTOTYPE COMPARED TO A TABLET-BASED TWO-DIMENSIONAL VIDEO CONTROL GROUP. AIM 3 (EXPLORATORY). COLLECT AND EVALUATE QUALITATIVE POST-INTERVENTION DATA ON VR-CAN PARTICIPANTS’ (60%; N=12) PREFERENCES, THOUGHTS, AND FEELINGS ABOUT THE VR-CAN PROTOCOL IN ORDER TO OPTIMIZE AND MANUALIZE THE VR- CAN PROTOCOL THAT CAN BE EFFICACY TESTED IN A LARGER, FULLY POWERED RANDOMIZED CONTROLLED TRIAL. THIS WORK HAS SIGNIFICANT POTENTIAL TO DECREASE BURDEN FOR A CANCER POPULATION THAT EXPERIENCES HIGH SYMPTOM BURDEN AND DISABILITY.

ALGORITHMIC ANALYSES OF ACCELEROMETRY DATA TO CAPTURE MEANINGFUL UPPER EXTREMITY USE AND RECOVERY FOLLOWING DISTAL RADIUS FRACTURE REPAIR - PROJECT SUMMARY/ABSTRACT DISTAL RADIUS FRACTURES (DRF) ARE THE MOST COMMON UPPER EXTREMITY FRACTURE. THEY DISPROPORTIONATELY AFFECT OLDER WOMEN, AND THE OVERALL INCIDENCE IS INCREASING WORLDWIDE. DECIDING ON APPROPRIATE DRF TREATMENT REMAINS A CHALLENGE, WITH MULTIPLE HIGH-QUALITY STUDIES REPORTING CONFLICTING RESULTS DUE IN PART TO INADEQUATE PATIENT-SPECIFIC GRANULARITY IN TREATMENT DECISION-MAKING. A BETTER UNDERSTANDING OF THE RECOVERY PROCESS, ESPECIALLY EARLY IN TREATMENT, IS NEEDED. ALTHOUGH SEVERAL OUTCOME MEASURES ARE AVAILABLE TO EVALUATE EARLY RECOVERY FOLLOWING DRF OPEN REDUCTION AND INTERNAL FIXATION (ORIF), INCLUDING STRENGTH/RANGE OF MOTION TESTING, PATIENT-REPORTED OUTCOMES (PROS), AND MOTOR TESTING, THEY ALL FALL SHORT IN ACCURATELY DESCRIBING FUNCTIONAL USE OF THE UPPER EXTREMITY (UE). STANDARD ACCELEROMETRY TRACKING IS ALSO INADEQUATE SINCE IT CANNOT RELIABLY DIFFERENTIATE BETWEEN FUNCTIONAL AND NONFUNCTIONAL UE USE. THE OBJECTIVE OF OUR PROPOSED STUDY IS TO EVALUATE THE APPLICATION OF REFINED MACHINE LEARNING (ML) ALGORITHMS TO PARSE OUT THE ACCELEROMETER DATA AND GAIN UNIQUE INSIGHTS AS TO HOW THE ARM IS BEING USED AS AN INDICATION OF FUNCTIONAL RECOVERY AFTER DRF ORIF. WE WILL TRAIN THESE ALGORITHMS ON PATIENTS’ DATA FROM CONTROLLED ENVIRONMENTS AND THEN TEST ON ACCELEROMETRY DATA FROM AT-HOME USE. THIS TRAINING IS BASED ON VIDEOS OF PATIENTS PERFORMING TASKS IN OUR LAB WITH ACCELEROMETERS ON THEIR WRISTS. THE DATA OBTAINED FROM THE ACCELEROMETERS WILL BE ANALYZED THROUGH A SERIES OF ML ALGORITHMS DESIGNED TO CATEGORIZE FUNCTIONAL VERSUS NON-FUNCTIONAL UE MOVEMENT, THEN COMPARED TO DETERMINATIONS OF UE USE FROM VIDEO REVIEW. ONCE THE ANALYSIS ALGORITHMS ARE REFINED AND RELIABLY INDICATE FUNCTIONAL VERSUS NON-FUNCTIONAL USE FROM ACCELEROMETRY, WE WILL USE THEM TO ANALYZE ACCELEROMETRY DATA OBTAINED AT HOME DURING TASKS THAT WILL ALSO BE VIDEO RECORDED, SCORED, AND COMPARED TO ACCELEROMETRY RESULTS. THIS WILL SHOW HOW ACCURATELY WE CAN USE ACCELEROMETER DATA TO TRACK UE FUNCTIONAL USE IN A NATURAL SETTING. THROUGHOUT THESE PHASES WE WILL OBTAIN PRO DATA AND COMPARE THESE DATA TO VIDEO RESULTS. WITH THIS WE AIM TO UNDERSTAND THE VALUE OF PROS IN DESCRIBING UE FUNCTION, AS WELL AS USE THE ML ALGORITHM ANALYSES OF EARLY ACCELEROMETRY DATA TO PREDICT LONG-TERM RECOVERY AND OUTCOMES. THE SHORTCOMINGS OF AVAILABLE INSTRUMENTS FOR EVALUATING EARLY FUNCTIONAL RECOVERY FOLLOWING DRF ORIF REMAIN. ADDITIONALLY, FULL-TIME PATIENT OBSERVATION IS IMPRACTICAL AND TEDIOUS, WHILE ACCELEROMETRY DATA ALONE ARE INACCURATE IN DIFFERENTIATING FUNCTIONAL VERSUS NONFUNCTIONAL UE USE. OUR APPROACH IS BASED ON PRIOR SUCCESSFUL WORK BUT IS NOVEL AND INNOVATIVE FOR THE EVALUATION AND MANAGEMENT OF SURGICALLY-TREATED DRF. BY ACCOMPLISHING THESE AIMS, WE WILL INTRODUCE AND OPERATIONALIZE A SUITE OF ML ALGORITHMS THAT CAN BE READILY APPLIED TO ACCELEROMETRY DATA AND ACCURATELY CAPTURE FUNCTIONAL UE USE TO HELP OPTIMIZE PATIENT- CENTERED DRF POST-OPERATIVE RECOVERY WITH PATIENT-SPECIFIC GRANULARITY.

PRENATAL STRESS AND ACCELERATED ATHEROSCLEROSIS IN APOE KNOCKOUT MICE

VALIDATION OF A VIRTUAL REALITY FLOOR MAZE TEST TO DETECT EARLY SIGNS OF COGNITIVE IMPAIRMENT - PROJECT SUMMARY/ABSTRACT EARLY DIAGNOSIS AND IDENTIFICATION OF PREDICTORS FOR ALZHEIMER’S DISEASE (AD) IS CRUCIAL AS IT ALLOWS INTERVENTION WITH PREVENTION AND TREATMENT STRATEGIES WHEN NEURONAL LOSS IS AT ITS MINIMUM. SPATIAL NAVIGATION IS A COMPLEX AND MULTI-COMPONENT SKILL THAT GETS IMPAIRED EARLY IN THE COURSE OF BRAIN DISEASES AND MAY BE CONSIDERED A RELEVANT, SENSITIVE AND SPECIFIC MARKER FOR FUTURE CLINICAL PROGRESS OF AD, EVEN IN ITS PRECLINICAL STAGE. ACTIVE SPATIAL NAVIGATION ASSESSMENTS ALLOW TO IDENTIFY MODIFICATIONS OF GAIT ASSOCIATED WITH COGNITIVE DECLINE, AND TO AMPLIFY THE DIFFICULTY OF THE TEST THROUGH A DUAL TASK EFFECT CREATED BY THE INCREASED POSTURAL DEMANDS OF WALKING. THIS STUDY WILL VALIDATE THE FIRST MOTOR-COGNITIVE SCREENING INSTRUMENT ABLE TO EXTRACT DIGITAL MARKERS IN THE FORM OF NAVIGATIONAL AND GAIT PERFORMANCES IN PEOPLE AT RISK OF DEVELOPING AD. WE PROPOSE THAT A FULLY IMMERSIVE VIRTUAL REALITY (VR) NAVIGATIONAL TEST HAS NUMEROUS ADVANTAGES WITH RESPECT TO CLASSICAL TESTS BECAUSE IT ALLOWS THE MANIPULATION OF ENVIRONMENTAL FEATURES BASED ON SPECIFIC NEEDS. WE WILL USE A VR VERSION OF THE FLOOR MAZE TEST (VR-FMT) TO CREATE VIRTUAL MAZES WITH PREFERRED COMPLEXITY AND DISPLAY THEM WITHIN A COMMERCIAL VR HEADSET. COGNITIVELY NORMAL ADULTS AT LOW RISK AND HIGHER RISK OF DEVELOPING AD AND SUBJECTS WITH AMNESIC MILD COGNITIVE IMPAIRMENT WILL COMPLETE TWO VISITS. IN THE FIRST VISIT, A BATTERY OF NEUROPSYCHOLOGICAL TESTS WILL BE TAKEN. IN THE SECOND, PARTICIPANTS WILL PERFORM MULTIPLE NAVIGATIONS INSIDE THE VR-FMT. TWO VISUALS REPRESENTATIONS (VISTA AND ENVIRONMENTAL), AND TWO EXPLORATIONS TYPES (REAL WALKING AND WITH A JOYSTICK) WILL BE TESTED. GAIT WILL BE RECORDED USING VR TRACKERS AND A MOTION CAPTURE SYSTEM. FUNCTIONAL NEAR-INFRARED SPECTROSCOPY (FNIRS) WILL BE USED TO MEASURE RESTING-STATE BRAIN CONNECTIVITY. IN AIM 1 WE WILL VALIDATE THE GAIT MEASURES AND THE MANIPULATIONS OPERATED BY THE VR-FMT. WE HYPOTHESIZE THAT THE PORTABLE TRACKERS WILL SHOW COMPARABLE VALIDITY IN MEASURING GAIT COMPARED TO THE OPTICAL MOTION CAPTURE SYSTEM AND THAT PARTICIPANTS WILL SHOW DIFFERENT NAVIGATION PERFORMANCE IN THE WALKING AND THE IN-PLACE VERSIONS AND IN THE ENVIRONMENTAL AND VISTA SPACES VERSIONS OF THE VR-FMT. IN AIM 2 WE WILL INVESTIGATE THE ABILITY OF THE VR-FMT AS A TEST TO DIFFERENTIATE THE VARIOUS LEVELS OF COGNITIVE IMPAIRMENT. WE HYPOTHESIZE THAT NAVIGATION PERFORMANCE WHILE PERFORMING THE ACTIVE VERSION OF THE VR-FMT IN THE ENVIRONMENTAL SPACE WOULD SHOW SUPERIOR ABILITY TO DISTINGUISH THE GROUPS. THEN, A MACHINE LEARNING ALGORITHM WILL BE USED TO EXTRACT THE MOST SIGNIFICANT FEATURES AND CLASSIFY PARTICIPANTS. WE HYPOTHESIZE THAT BOTH GAIT AND NAVIGATION PERFORMANCES WOULD INCREASE THE SENSITIVITY OF THE CLASSIFIER. IN AIM 3 WE WILL EXPLORE ASSOCIATIONS BETWEEN PERFORMANCE IN THE VR-FMT, NEUROPSYCHOLOGICAL TESTS, AND BRAIN CONNECTIVITY. WE HYPOTHESIZE THAT LOWER NAVIGATION PERFORMANCE WILL BE ASSOCIATED WITH ALTERED BRAIN CONNECTIVITY AND LOWER PSYCHOMOTOR SPEED, MEMORY AND EXECUTIVE FUNCTION SCORES. FINDINGS FROM THIS RESEARCH WILL SET THE STAGE FOR FURTHER LONGITUDINAL STUDIES WHICH WILL BE AIMED AT PREDICTING ACCUMULATING AD BIOMARKERS. THE LONG-TERM GOAL IS TO DEVELOP AN ACCURATE, LOW-COST, USER-FRIENDLY, AND PORTABLE SYSTEM THAT CAN BE USED TO PREDICT COGNITIVE DECLINE.

REHABILITATION RESEARCH AND TRAINING CENTERS (RRTCS) PROGRAM

COLLATERALS IN AGING: ENHANCED BY GENETIC/CELL THERAPY?

POPULATION PHARMACOKINETIC MODELING AND CLINICAL TRIAL SIMULATION TO OPTIMIZE HIV PREVENTION IN PREGNANCY AND POSTPARTUM - ABSTRACT PRE-EXPOSURE PROPHYLAXIS (PREP) WITH ORAL TENOFOVIR (TFV) DISOPROXIL FUMARATE (TDF) AND EMTRICITABINE (F OR FTC) (F/TDF) IS RECOMMENDED DURING PREGNANCY FOR WOMEN AT RISK FOR HIV ACQUISITION. F/TENOFOVIR ALAFENAMIDE FUMARATE (F/TAF) IS NOT YET APPROVED FOR PREP IN CISGENDER WOMEN DUE TO LACK OF EFFICACY DATA. DESPITE THE IMPORTANCE OF HIV PREVENTION IN PREGNANCY, PREGNANT WOMEN HAVE BEEN EXCLUDED FROM PREP EFFICACY STUDIES. PREP EFFICACY IN PREGNANCY CANNOT BE EXTRAPOLATED FROM NON-PREGNANT POPULATIONS, AS MULTIPLE STUDIES INDICATE THAT TFV CONCENTRATIONS FALL SUBSTANTIALLY IN THE 2ND AND 3RD TRIMESTERS DUE TO INCREASED RENAL CLEARANCE AND VOLUME OF DISTRIBUTION. SIGNIFICANT DECLINES IN FTC CONCENTRATION ARE ALSO REPORTED LARGELY DUE TO INCREASED RENAL EXCRETION. UNLIKE TDF, TAF HAS MINIMAL RENAL CLEARANCE, THOUGH OTHER CHANGES ASSOCIATED WITH PREGNANCY MAY ALSO REDUCE ITS CONCENTRATION. GIVEN THE HIGH TFV BLOOD CONCENTRATIONS REQUIRED IN NON-PREGNANT WOMEN TO ACHIEVE PROTECTIVE CONCENTRATIONS IN CERVICOVAGINAL TISSUE, NEAR PERFECT ADHERENCE TO F/TDF IS REQUIRED TO ACHIEVE HIV PROTECTION. THE DECREASED TFV AND FTC CONCENTRATIONS OBSERVED DURING PREGNANCY RAISE CONCERN THAT A SIGNIFICANT PROPORTION OF PREGNANT WOMEN ON F/TDF FOR PREP WOULD NOT ACHIEVE PROTECTIVE CONCENTRATIONS WITHOUT UPWARD DOSE ADJUSTMENT. IN ANTICIPATION OF THE EVENTUAL APPROVAL OF F/TAF FOR HIV PREVENTION IN CISGENDER WOMEN, EVALUATION OF PHARMACOKINETIC (PK) PARAMETERS AND APPROPRIATE DOSING OF BOTH F/TDF AND F/TAF FOR PREP IN PREGNANCY IS CRITICALLY IMPORTANT TO THE PREVENTION OF BOTH MATERNAL AND PERINATAL TRANSMISSION. TO ASSIST WITH THE FUTURE DESIGN OF CLINICAL TRIALS TO CORRECT FOR THIS PROBABLE UNDERDOSING OF F/TDF AND, POSSIBLY, F/TAF, WE PROPOSE AN EXPLORATION OF F/TAF AND F/TDF PK PARAMETERS IN PREGNANCY AND POSTPARTUM. WE PLAN TO USE F/TDF AND F/TAF PK DATA FROM COMPLETED CLINICAL STUDIES ENROLLING NON-PREGNANT AND PREGNANT CISGENDER WOMEN IN BOTH THE TREATMENT AND PREVENTION SETTINGS, INCLUDING IMPAACT 1026S, CONRAD 137 AND 140, MTN 001, HPTN 066, PARTNERS PREP, PARTNERS DEMONSTRATION PROJECT, AND SEVERAL GILEAD PK TRIALS. OUR SPECIFIC AIMS ARE TO: 1. BUILD A POPULATION PK MODEL OF F/TDF AND F/TAF RELATED DRUG ANALYTES WITH SPECIAL FOCUS ON TIMING RELATIVE TO PREGNANCY IN ADDITION TO VARIATION IN DEMOGRAPHIC AND PHYSIOLOGIC VARIABLES AND BUILDING ON EXISTING PK MODELS AND 2. SIMULATE TWO CLINICAL TRIALS, ONE OF F/TAF AND ONE OF F/TDF PREP DOSING IN PREGNANCY AND POSTPARTUM TO ASSIST WITH THE FUTURE DESIGN OF CLINICAL TRIALS TO VALIDATE PREGNANCY- ADJUSTED DOSES TO MAINTAIN NON-PREGNANT LEVELS OF HIV PROTECTION THROUGHOUT PREGNANCY. THIS POPULATION PK RESEARCH IS THE CRITICAL NEXT STEP TOWARD A PROSPECTIVE RANDOMIZED CLINICAL TRIAL TO BETTER PROTECT PREGNANT WOMEN AND THEIR FETUSES AGAINST HIV ACQUISITION AND IS IN LINE WITH THE NICHD MATERNAL AND PEDIATRIC INFECTIOUS DISEASE BRANCH AND OFFICE OF AIDS RESEARCH'S STATED HIGH PRIORITY OF “REDUCING THE INCIDENCE OF HIV” AND “ADVERSE PREGNANCY AND INFANT OUTCOMES RELATED TO PREVENTION”.

RURAL HEALTH CARE SERVICES OUTREACH GRANT PROGRAM

CONTEXT IS CRITICAL: UNDERSTANDING WHEN AND WHY EHR RELATED SAFETY HAZARDS HAPPEN

AN EHR-BASED SCREENING TOOL TO SUPPORT SAFE DISCHARGES OF COVID-19 PATIENTS IN THE EMERGENCY DEPARTMENT - PROJECT SUMMARY/ABSTRACT THE PROPOSED STUDY WILL DEVELOP A SCREENING TOOL USING ELECTRONIC HEALTH RECORD DATA THAT PREDICTS THE RISK OF ED RETURN AND ASSOCIATED MORBIDITY OR MORTALITY TO SUPPORT SAFE AND APPROPRIATE DISPOSITIONS IN THE ED FOR PATIENTS WITH THE NOVEL CORONAVIRUS DISEASE-2019 (COVID-19). DUE TO THE CHALLENGES OF COVID-19, WITH HIGHLY VARIABLE SYMPTOMS, THE PAUCITY OF EXISTING RESEARCH, AND STRAINS ON ED CAPACITY, EMERGENCY CLINICIANS MUST MAKE RAPID CLINICAL DECISIONS WITH LIMITED INFORMATION. MOREOVER, IN THE ED, PATIENTS OFTEN PRESENT FOR EVALUATION EARLY ON DURING THE COURSE OF THEIR ILLNESS, WHICH IS WHEN THE CLINICAL TRAJECTORY FOR COVID-19 IS MOST VOLATILE AND THE RISK FOR SUBSEQUENT DECOMPENSATION IS HIGHEST. USING PREDICTIVE MODELING WITH NATURAL LANGUAGE PROCESSING (NLP) AND MACHINE LEARNING (ML) TECHNIQUES CAN LEVERAGE THE DATA-RICH ENVIRONMENT OF THE ED TO IMPROVE THE QUALITY OF CARE DELIVERED TO PATIENTS WITH COVID-19. THIS STUDY DIRECTLY ADDRESSES PRIORITIES HIGHLIGHTED IN PA-17-246 BY BRINGING RESEARCH EVIDENCE TO CLINICAL PRACTICE THROUGH THE DEVELOPMENT AND EVALUATION A HEALTH IT SOLUTION THAT COMBINES THE USE OF NLP WITH A DECISION SUPPORT TOOL TO TURN UNSTRUCTURED CLINICAL DATA INTO KNOWLEDGE THAT CAN BE APPLIED TO PRACTICE. DEVELOPING AND OPERATIONALIZING THE PROPOSED COVID-19 ED RETURN SCREENING TOOL (CERST) CAN HELP ED CLINICIANS AVOID PREMATURE DISCHARGES AND ENGAGE IN EVIDENCE-BASED DISCUSSIONS WITH COVID-19 PATIENTS REGARDING DISCHARGE PLANS. IT MAY ALSO REDUCE STRAIN ON HOSPITAL CAPACITY BY IDENTIFYING PATIENTS SAFE FOR DISCHARGE AND RESERVING RESOURCES FOR HIGHER-RISK COVID-19 PATIENTS. THE PROJECT WILL BE EXECUTED BY A MULTIDISCIPLINARY TEAM WITH EXPERTISE IN EMERGENCY CARE, QUALITY OUTCOMES RESEARCH, CARE TRANSITIONS, AND APPLYING DATA SCIENCE TO IMPROVE CLINICAL CARE, INCLUDING ML AND NLP METHODS. IT WILL ALSO USE INNOVATIVE METHODS, INCLUDING A MIXED METHODS APPROACH TO ITERATIVELY DEVELOP THE CONCEPT MAP THAT WILL INFORM THE PREDICTIVE MODEL. MOREOVER, THE PROPOSED PROJECT IS DESIGNED TO OPTIMIZE THE GENERALIZABILITY OF CERST, BY USING A LARGE, DIVERSE STUDY POPULATION, INCLUDING DATA FROM A SECOND HEALTH SYSTEM WITH A DIFFERENT EHR USING FAST HEALTH INTEROPERABILITY RESOURCES (FHIR) SPECIFICATIONS TO ASSIST WITH MODEL INTEROPERABILITY. THIS WILL HELP OPTIMIZE MODEL PERFORMANCE FOR DIFFERING PATIENT POPULATIONS, HEALTH SYSTEMS, AND EHR PLATFORMS. SINCE THE PRIMARY DATA SOURCE FOR THIS STUDY IS READILY ACCESSIBLE TO THE STUDY TEAM, WHO POSSESSES PRIOR EXPERIENCE WORKING WITH THE DATA SOURCES AND PERFORMING THE ANALYTIC PROCEDURES OUTLINED IN THE PROPOSAL, THE TEAM IS WELL-POSITIONED TO EXECUTE THIS STUDY WITH TIMELY DISSEMINATION OF PROJECT FINDINGS.

SEX HORMONES AND RAT ANTERIOR CRUCIATE LIGAMENT STRENGTH

CLINICAL INTERVENTION DIETARY STUDIES TO INVESTIGATE THE RELATIONSHIP BETWEEN FOOD COMPONENTS AND HEALTH

UNDERSTANDING AND OPTIMIZING COORDINATION IN HIGH-RISK HEALTHCARE TEAMS

EARLY DETECTION OF HETEROTOPIC OSSIFICATION FOR EFFECTIVE PREVENTION AND TREATMENT

CLINICAL INTERVENTION DIETARY STUDIES TO INVESTIGATE THE RELATIONSHIP BETWEEN FOOD COMPONENTS AND HEALTH

INTRAVESICAL GENTAMICIN COUPLED WITH LACTOBACILLUS RHAMNOSUS FOR URINARY HEALTH

TEACHING HEALTH CENTER (THC) GRADUATE MEDICAL EDUCATION (GME) PAYMENT PROGRAM - PROJECT TITLE: TEACHING HEALTH CENTER AT COMMUNITY OF HOPE: CARING FOR FAMILIES, IMPROVING LIVES, LEADING CHANGE. ADDRESS: MEDSTAR HEALTH, 10980 GRANTCHESTER WAY, 7TH FLOOR, COLUMBIA, MD 21044. PROJECT DIRECTOR NAME: JAMIE HILL-DANIEL, MD CONTACT PHONE NUMBERS (VOICE, FAX): 301-699-7700 (VOICE), 301-699-7700 (FAX) EMAIL ADDRESS: JAMIE.L.HILL-DANIEL@GUNET.GEORGETOWN.EDU GRANT PROGRAM FUNDS REQUESTED: $2,880,000 (HRSA-25-077) FUNDING PREFERENCE: PRIORITY 1 HEALTH PROFESSIONAL SHORTAGE AREA (HPSA); PRIORITY 2: MEDICALLY UNDERSERVED COMMUNITY DESCRIPTION OF PROPOSED PROJECT: THC-COH IS PROPOSING 2 THCGME SLOTS PER YEAR TRAINING IN WARD 8, WASHINGTON DC, WHICH DEMONSTRATES SIGNIFICANT UNMET HEALTH NEEDS, GAPS IN WORKFORCE DIVERSITY AND CAPACITY. LEARNER TRAINING ADDRESSED AT THC-COH NEEDS ARE PRIMARY CARE, DENTAL, EMOTIONAL WELLNESS, CARE COORDINATION, AND PHARMACY SERVICES. 1. NAME OF PROGRAM: MEDSTAR HEALTH/GEORGETOWN-WASHINGTON HOSPITAL CENTER FAMILY MEDICINE RESIDENCY PROGRAM, MEDSTAR HEALTH GRADUATE MEDICAL EDUCATION CONSORTIUM 2. DISCIPLINE: FAMILY MEDICINE 3. TYPE OF APPLICATION: NEW 4. ELIGIBLE ENTITY TYPE: MEDSTAR HEALTH GME CONSORTIUM TYPE AND NAME OF COMMUNITY-BASED AMBULATORY PATIENT CARE CENTER: FEDERALLY QUALIFIED HEALTH CENTER COMMUNITY OF HOPE, HPSA 21 RESIDENCY PROGRAM OPERATED BY: MEDSTAR GRADUATE MEDICAL EDUCATION CONSORTIUM 5. YEAR PROGRAM FIRST BEGAN TRAINING RESIDENTS: 1978 6. ORGANIZATION WEBSITE ADDRESS: HTTPS://WWW.MEDSTARHEALTH.ORG/EDUCATION/RESIDENCY-PROGRAMS/FAMILY-MEDICINE-IN-WASHINGTON-DC 7. OVERVIEW OF RESIDENCY PROGRAM: THE RESIDENCY PROGRAM, MEDSTAR HEALTH/GEORGETOWN-WASHINGTON HOSPITAL CENTER FAMILY MEDICINE RESIDENCY PROGRAM, ACGME PROGRAM 1201021080, IS A PART OF THE MEDSTAR HEALTH GME CONSORTIUM, WHICH INCLUDES 1,100 RESIDENTS. THE RESIDENCY PROGRAM IS "COMMITTED TO CARING FOR THE UNDERSERVED" WITH COMMUNITY PARTNERSHIPS AND TRAINING EXPERIENCES INTENDED TO PRODUCE GRADUATES COMMITTED TO WORKING IN UNDERSERVED COMMUNITIES. 75% OF GRADUATES REMAIN IN THE AREA AND A LARGE PROPORTION CONTINUE TO WORK IN URBAN UNDERSERVED SITES. THE MAIN PRIMARY CARE TRAINING LOCATION FOR THE EXISTING NON-THCGME RESIDENTS IS MEDSTAR MEDICAL GROUP FAMILY MEDICINE AT FORT LINCOLN, HPSA 17 (MUC), INCLUDING MORE THAN 70% AFRICAN AMERICAN PATIENTS AND 15% HISPANIC, LATINO, OR SPANISH SPEAKING PATIENTS. 8. TOTAL RESIDENT FTE POSITIONS REQUESTED TO BE FUNDED UNDER THIS PROGRAM FOR ALL POSTGRADUATE YEARS OF TRAINING: 6 (2-2-2) RESIDENT FTE ABOVE THE BASELINE RESIDENT FTES TRAINED BY THE PROGRAM IN THE PRIOR AY 2024-2025. 9. RESIDENT FTE POSITIONS REQUESTED TO BE FUNDED UNDER THIS PROGRAM FOR THE FIRST AY OF FUNDING: 2 (2-0-0) FOR AY 2025-2026. 10. ROTATION SITES: FQHC COMMUNITY OF HOPE IS THE MAIN AMBULATORY PATIENT CARE TRAINING SITE FOR THCGME RESIDENTS. FOR NON-THCGME RESIDENTS, MEDSTAR MEDICAL GROUP FAMILY MEDICINE AT FORT LINCOLN IS THE MAIN AMBULATORY PATIENT CARE TRAINING SITE. OTHER AMBULATORY SITES FOR SPECIFIC EXPERIENCES INCLUDE UNITY HEALTH CARE, MEDSTAR SOUTHERN MARYLAND MEDICAL CENTER, MEDSTAR WASHINGTON HOSPITAL CENTER. RESIDENTS WITHIN THE APPLICANT RESIDENCY PROGRAM WILL NOT PERFORM ROTATIONS AT A HOSPITAL ROTATION SITE(S) THAT HAS NOT PROVIDED RESIDENT TRAINING IN ANY PRIOR AY.

ADVANCING HEALTH POLICY AND SYSTEMS APPROACHES TO IMPROVED DELIVERY OF SURGICAL LIMB SALVAGE PROCEDURES FOR SEVERE CHRONIC WOUNDS - PROJECT SUMMARY/ABSTRACT IN THE UNITED STATES, 2.4-4.5 MILLION PEOPLE SUFFER FROM CHRONIC LOWER EXTREMITY WOUNDS, COSTING THE HEALTH SYSTEM UP TO $31.7 BILLION ANNUALLY. A MULTIDISCIPLINARY APPROACH IS NECESSARY FOR AMPUTATION REDUCTION IN SEVERE WOUNDS, AS NONTRAUMATIC AMPUTATION LEADS TO A 5-YEAR MORTALITY RATE OF 50-75%. IT HAS BEEN DEMONSTRATED THAT THE ESTABLISHMENT OF LIMB SALVAGE CENTERS REDUCES AMPUTATION RATES, IMPROVES PROVIDER TO PROVIDER EDUCATION RESULTING IN EARLIER REFERRAL, IMPROVES PREVENTION MEASURES AND INCREASES GLOBAL FUNCTIONING OF PATIENTS. CURRENTLY, LITTLE IS KNOWN ABOUT THE STATE OF LIMB SALVAGE ADOPTION BY HOSPITALS IN THE UNITED STATES, INCLUDING WHICH SURGICAL MODALITIES ARE MOST COMMONLY USED, THEIR SPREAD ACROSS REGIONS AND OVER TIME, AND THE SCALE OF OPERATIONS RELATIVE TO COMMUNITY-BASED NEED. EVEN LESS IS KNOWN ABOUT HOW THIS CARE IS ORGANIZED WITHIN LOCAL HOSPITAL MARKETS AND HOW THE STRUCTURE OF THESE MARKETS AFFECTS WHICH PATIENTS RECEIVE LIMB SALVAGE VERSUS AMPUTATIONS. THIS LACK OF FUNDAMENTAL KNOWLEDGE STANDS AS A BARRIER TO IMPROVEMENTS IN THE ORGANIZATION AND DISTRIBUTION OF RESOURCE-INTENSIVE WOUND CARE TEAMS TO TREAT CHRONIC WOUNDS IN THE U.S. AS A RESULT, LIMB SALVAGE IS CHARACTERIZED BY FRAGMENTED DELIVERY, INEQUITABLE PROVISION, FEW QUALITY STANDARDS, AND PERVASIVE FEE-FOR-SERVICE PAYMENT MECHANISMS WITH THEIR WELL-KNOWN LACK OF INCENTIVES FOR QUALITY OR EFFICIENCY. THESE ISSUES ARE LIKELY TO GROW IN IMPORTANCE DURING THE COVID-19 PANDEMIC, AS DELAYS IN CARE WILL LIKELY LEAD TO MORE PATIENTS DEVELOPING SEVERE CHRONIC WOUNDS BEFORE SEEKING TREATMENT. THIS PROJECT WILL ADDRESS THESE GAPS BY CONDUCTING THE FIRST LARGE-SCALE ASSESSMENT OF LIMB SALVAGE SPREAD, PROVISION, AND MARKET EFFECTS FOR LOWER EXTREMITY WOUNDS IN THE UNITED STATES. UNDER AIM 1, WILL USE THE 2005-2017 HEALTHCARE COST AND UTILIZATION PROJECT (HCUP) – STATE INPATIENT DATABASE (SID) LINKED TO THE AMERICAN HOSPITAL ANNUAL (AHA) SURVEY TO EXAMINE THE ROLE OF HOSPITAL MARKET STRUCTURE, HOSPITAL FACTORS, AND PATIENT FACTORS IN THE ADOPTION AND SPREAD OF LIMB SALVAGE PROCEDURES AND ITS EFFECTS ON DISPARITIES IN CARE. UNDER AIM 2, WE WILL ENGAGE AN EXPERT ADVISORY PANEL TO HELP TRANSLATE THE FINDINGS FROM AIM 1 INTO A SET OF ACTIONABLE HEALTH SYSTEM AND POLICY STRATEGIES, DISSEMINATE FINDINGS TO PRACTITIONERS, AND DEVELOP A RESEARCH AGENDA FOR ADVANCING MUCH-NEEDED HEALTHCARE PAYMENT AND DELIVERY REFORMS IN THE PROVISION OF SEVERE CHRONIC WOUND CARE. THIS STUDY WILL ADVANCE AHRQ’S PRIORITY TO SPREAD EVIDENCE-BASED PRACTICES AND DEVELOP THE FOUNDATION TO ADDRESS OTHER PRIORITIES INCLUDING COMPARATIVE PERFORMANCE OF SYSTEMS AND PROVIDERS, AND DEVELOPMENT OF PERFORMANCE-IMPROVEMENT INCENTIVES. THESE FINDINGS WILL BE ESPECIALLY IMPORTANT TO AHRQ PRIORITY POPULATIONS, INCLUDING LOW-INCOME, MINORITY, RURAL, AND PEOPLE WITH CHRONIC ILLNESSES.

A MEMORY-BASED APPROACH TO REDUCING MEDICATION ERRORS

DEVELOPING AND TRAINING INTERRUPTION MANAGEMENT STRATEGIES FOR EMERGENCY PHYSICIA

DESIGNING FOR DEMOGRAPHICS- OPTIMIZING THE USABILITY OF PATIENT PORTALS

IDENTIFYING STRESS-ASSOCIATED FACTORS TO DEVELOP ADVANCED EMERGENCY MEDICINE SIMULATION

CONNECTING THE DOTS: ADVANCED VISUALIZATION TOOLS FOR PATIENT SAFETY REPORT ANALYSIS

GUIDING THE SAFE AND EFFECTIVE INTEGRATION OF AMBIENT DIGITAL SCRIBES INTO PRIMARY CARE - PROJECT SUMMARY PRIMARY CARE PHYSICIAN (PCP) BURNOUT IS A PREVALENT THREAT THAT ENDANGERS PATIENTS, HARMS PROVIDERS WHO HAVE DEDICATED THEIR CAREERS TO IMPROVING THE WELLBEING OF OTHERS, AND CREATES SIGNIFICANT FINANCIAL STRAIN ON HEALTHCARE SYSTEMS. A MAJOR CONTRIBUTING FACTOR TO PCP BURNOUT IS THE BURDEN OF DOCUMENTATION AND OTHER ELECTRONIC HEALTH RECORD (EHR) TASKS. MAJOR HEALTHCARE INDUSTRY PARTNERS (E.G., AMAZON, NUANCE, ORACLE) ARE ALREADY LEVERAGING ADVANCES IN ARTIFICIAL INTELLIGENCE (AI) TO ADDRESS THIS ISSUE, AS SEVERAL AI DOCUMENTATION TECHNOLOGIES ARE CURRENTLY ON THE MARKET. THESE TECHNOLOGIES, REFERRED TO AS AMBIENT DIGITAL SCRIBES (ADSS), UTILIZE AI TECHNOLOGY TO PASSIVELY CAPTURE REAL-TIME PATIENT-PROVIDER CONVERSATIONAL INTERACTIONS AND ASSEMBLE THEM INTO A STRUCTURED NOTE. IN A TESTAMENT TO THE SEVERITY OF THIS DOCUMENTATION PROBLEM AND THE POTENTIAL OF THESE TECHNOLOGIES, ADSS ARE CURRENTLY BEING IMPLEMENTED AND PILOT TESTED AT HOSPITAL SYSTEMS NATIONALLY. AS MANY AS 1 IN 3 PCPS HAVE ALREADY TRIED AI SCRIBE TOOLS, AND IN JANUARY OF 2024, NUANCE ANNOUNCED THEIR ADS IS SET TO BE DEPLOYED AT MORE THAN 150 HEALTH SYSTEMS NATIONWIDE. THE RAPID IMPLEMENTATION OF ADSS IN HEALTHCARE SYSTEMS IS INCONGRUOUS WITH GROWING CONCERNS ABOUT THEIR SAFETY. WHILE ADSS HAVE A GREAT POTENTIAL FOR ADDRESSING DOCUMENTATION BURDEN, THEY, LIKE ANY AI TECHNOLOGY, MAY HAVE DANGEROUS UNINTENDED CONSEQUENCES. WHILE LARGE, FINANCIALLY ROBUST HEALTHCARE SYSTEMS MAY HAVE THE RESOURCES TO ADDRESS THESE CONSEQUENCES, SMALL RURAL HOSPITALS ARE LIKELY TO BE LATE ADOPTERS WITH FEWER RESOURCES TO COMBAT BARRIERS TO THE SAFE AND EFFECTIVE USE OF THIS NEW TECHNOLOGY. THIS WORK, “GUIDING THE SAFE AND EFFECTIVE INTEGRATION OF AMBIENT DIGITAL SCRIBES INTO PRIMARY CARE,” PROPOSES TO DEVELOP A PROTOTYPE GUIDE FOR THE SAFE AND EFFECTIVE INTEGRATION OF ADSS INTO PRIMARY CARE. AS LITTLE IS KNOWN ABOUT THE SAFETY, EFFICACY, AND USABILITY OF THESE NEW TECHNOLOGIES AND THE IMPACT THEY WILL HAVE ON PRIMARY CARE, THIS WORK FIRST SEEKS TO IDENTIFY THE BARRIERS AND FACILITATORS TO SUCCESSFUL ADS IMPLEMENTATION THROUGH THE LENS OF SYSTEMS ENGINEERING. A MIXED METHOD APPROACH CONSISTING OF RETROSPECTIVE DATA ANALYSES AND INTERVIEWS WITH PCPS AND PATIENTS WILL PROVIDE FOUNDATIONAL KNOWLEDGE ON HOW ADSS INTEGRATE INTO THE PRIMARY CARE WORKFLOW. USING KEY INSIGHTS DEVELOPED FROM THIS FOUNDATIONAL DATA, OUR TEAM WILL CO-DEVELOP A PROTOTYPE GUIDE WITH A PANEL OF INTERNATIONALLY RECOGNIZED EXPERTS IN PRIMARY CARE, HEALTHCARE TECHNOLOGIES, PATIENT SAFETY, AND AI. OUR INNOVATIVE APPROACH IS STRATEGICALLY DESIGNED TO BE EFFECTIVE FOR ANY CURRENT OR FUTURE ADS AND REFLECTS THE SPEED AT WHICH AI-DRIVEN TECHNOLOGIES ARE BEING DEVELOPED AND IMPLEMENTED. THIS GUIDE WILL SERVE AS A TOOL TO SUPPORT ADS IMPLEMENTATION AND USE AT HEALTHCARE PROVIDER ORGANIZATIONS OF ALL SIZES RANGING FROM LARGE MULTI-FACILITY HEALTHCARE SYSTEMS TO INDIVIDUAL CLINICS AND FEDERALLY QUALIFIED HEALTH CENTERS, AND THUS WILL HELP IN ADDRESSING EXPECTED RURAL HEALTHCARE DISPARITIES.

RYAN WHITE HIV/AIDS PROGRAM PART C EIS COVID-19 RESPONSE

EFFECTS OF TELEHEALTH USE FOR RAPID SCREENING, TREATMENT, AND DISCHARGE OF PATIENTS WITH LOW-ACUITY CONDITIONS IN THE EMERGENCY DEPARTMENT - PROJECT SUMMARY/ABSTRACT THIS PROPOSAL PRESENTS A RESEARCH PROJECT FOCUSED ON THE STUDY OF A NOVEL EMERGENCY TELEHEALTH STRATEGY WHICH PERFORMS RAPID SCREENING, TREATMENT, AND DISCHARGE OF PATIENTS PRESENTING TO THE EMERGENCY DEPARTMENT (ED) WITH A LOW-ACUITY CONDITION. THIS CARE DELIVERY STRATEGY FACILITATES TIMELY DISCHARGES FOR ELIGIBLE PATIENTS FROM AN ED TRIAGE ROOM IN A WAY THAT RESERVES ED CAPACITY FOR PATIENTS WITH HIGHER ACUITY OR MORE COMPLEX PRESENTATIONS THAT REQUIRE AN IN-PERSON EVALUATION. CLARIFYING GUIDANCE FROM THE FEDERAL GOVERNMENT PERTAINING TO THE USE OF TELEHEALTH TO CONDUCT MEDICAL SCREENING EXAMS UNDER THE EMERGENCY MEDICAL TREATMENT AND LABOR ACT (EMTALA) MADE THE IMPLEMENTATION OF THE ETD WORKFLOW POSSIBLE AS OF MARCH 2020. GIVEN THE NOVELTY OF THIS EMTALA EXCEPTION, THE USE OF TELEHEALTH TO COMPLETE THE ASSESSMENT AND DISCHARGE OF A PATIENT FROM THE ED WITHOUT AN IN-PERSON EXAMINATION HAS NOT YET BEEN EVALUATED. A BETTER UNDERSTANDING OF THE EFFICACY AND SAFETY OF THIS CARE DELIVERY STRATEGY IS NEEDED TO GUIDE LONGER-TERM FEDERAL POLICIES THAT SUPPORT EVALUATE, TREAT, DISCHARGE (ETD) TELEHEALTH CARE FOR APPROPRIATE EMERGENCY DEPARTMENT ENCOUNTERS. THE PROPOSED PROJECT WILL ASSESS THE EFFECTS OF THIS TELEHEALTH STRATEGY ON ED THROUGHPUT, ED CROWDING, AND PATIENT OUTCOMES AFTER DISCHARGE. THIS CARE DELIVERY STRATEGY NOT ONLY HAS POTENTIAL TO IMPROVE EMERGENCY PREPAREDNESS, BUT ALSO IT CAN ADDRESS LONG-STANDING PRE-PANDEMIC CHALLENGES WITH ED CROWDING. ADDITIONALLY, PROJECT FINDINGS WILL GENERATE IMPLICATIONS FOR ED OPERATIONS AND INFORM PRACTICE LEADERS ON THE EFFICACY AND SAFETY OF ADOPTING THIS NEW APPROACH TO EMERGENCY TELEHEALTH. THE STUDY ADDRESSES PRIORITIES HIGHLIGHTED IN PA-18-794 BY FOCUSING ON AN INNOVATIVE TELEHEALTH STRATEGY THAT HARNESSES TECHNOLOGY WITH THE GOAL OF IMPROVING EMERGENCY CARE QUALITY AND PATIENT OUTCOMES. IT ALSO DIRECTLY ADDRESSES AHRQ PRIORITY POPULATIONS, WITH A FOCUSED ANALYSIS OF OUTCOMES DISPARITIES AMONG RACIAL/ETHNIC MINORITIES AND LOW-INCOME INDIVIDUALS AND THE INCLUSION OF SITES LOCATED IN INNER CITY AND RURAL SETTINGS. THE PROJECT WILL BE EXECUTED BY A MULTIDISCIPLINARY TEAM WITH EXPERTISE IN EMERGENCY HEALTH SERVICES RESEARCH, TELEHEALTH, AND HEALTH ECONOMETRIC MODELING. SINCE THE DATA FOR THIS STUDY IS READILY ACCESSIBLE TO THE STUDY TEAM, WITH PRIOR EXPERIENCE WORKING WITH THE DATA SOURCES AND PERFORMING THE ANALYTIC PROCEDURES OUTLINED IN THE PROPOSAL, THE TEAM IS WELL-POSITIONED TO EXECUTE THE STUDY WITH TIMELY DISSEMINATION OF PROJECT FINDINGS.

RURAL HEALTH NETWORK DEVELOPMENT PLANNING GRANT PROGRAM

HEALTH CENTER CLUSTER PLANNING GRANTS

DIETARY STUDIES TO INVESTIGATE THE RELATIONSHIP BETWEEN METABOLISM AND RISK OF DISEASE

COMMUNITY FACILITY GRANTS

RYAN WHITE HIV/AIDS PROGRAM PART D WICY COVID-19 RESPONSE

2020 AMERICAN SPINAL INJURY ASSOCIATION SCIENTIFIC MEETING