Ihc Health Services Inc

CHILDREN'S HOSPITALS GRADUATE MEDICAL EDUCATION PAYMENT PROGRAM

HEALTH CARE INNOVATION CHALLENGE

CHILDREN'S HOSPITALS GRADUATE MEDICAL EDUCATION PAYMENT PROGRAM

CHILDREN'S HOSPITALS GRADUATE MEDICAL EDUCATION PAYMENT PROGRAM

CHILDREN'S HOSPITALS GRADUATE MEDICAL EDUCATION PAYMENT PROGRAM

CHILDREN'S HOSPITALS GRADUATE MEDICAL EDUCATION PAYMENT PROGRAM

CHILDREN'S HOSPITALS GRADUATE MEDICAL EDUCATION PAYMENT PROGRAM

CHILDREN'S HOSPITALS GRADUATE MEDICAL EDUCATION PAYMENT PROGRAM

CHILDREN'S HOSPITALS GRADUATE MEDICAL EDUCATION PAYMENT PROGRAM

CHILDREN'S HOSPITALS GRADUATE MEDICAL EDUCATION PAYMENT PROGRAM

CHILDREN'S HOSPITALS GRADUATE MEDICAL EDUCATION PAYMENT PROGRAM

IMPLEMENTATION OF COORDINATED SPONTANEOUS AWAKENING AND BREATHING TRIALS USING TELEHEALTH-ENABLED, REAL-TIME AUDIT AND FEEDBACK FOR CLINICIAN ADHERENCE: A TYPE II HYBRID EFFECTIVENESS-IMPLEMENTATION - PROJECT SUMMARY ALTHOUGH INVASIVE MECHANICAL VENTILATION (IMV) IS A LIFESAVING TREATMENT FOR ABOUT 300,000 U.S. PATIENTS WITH ACUTE RESPIRATORY FAILURE EACH YEAR, IT IS ASSOCIATED WITH SIGNIFICANT RISKS. SPONTANEOUS AWAKENING AND BREATHING TRIALS DURING IMV IMPROVE PATIENT OUTCOMES. COORDINATION OF SPONTANEOUS AWAKENING AND BREATHING TRIALS (C-SAT/SBT) IS COMPLEX AND SIGNIFICANT BARRIERS TO IMPLEMENTATION EXIST AND ADHERENCE WITH C-SAT/SBT ACROSS INSTITUTIONS IS HIGHLY VARIABLE. ALTHOUGH NATIONAL GUIDELINES RECOMMEND DAILY COORDINATED C-SAT/SBT IN IMV PATIENTS THEY ARE UNDERUSED. TELEHEALTH-ENABLED REMOTE CARE IS POSITIONED TO IMPROVE C-SAT/SBT USE. AT INTERMOUNTAIN HEALTHCARE, WE HAVE SYSTEM-WIDE TELE-CRITICAL CARE SERVICES STAFFED BY CRITICAL CARE PHYSICIANS, NURSES, AND RESPIRATORY THERAPISTS WHO REMOTELY MONITOR AND ASSIST WITH PATIENTS IN ICUS USING REAL-TIME AUDIOVISUAL COMMUNICATION, A SYSTEMWIDE ELECTRONIC MEDICAL RECORD (EMR), ELECTRONIC DASHBOARDS, AND CLINICAL DECISION SUPPORT. WE RECENTLY STUDIED THE IMPACT OF IMPLEMENTATION STRATEGIES TO IMPROVE EVIDENCE-BASED PRACTICES FOR LUNG PROTECTIVE VENTILATION (LPV) IN 3 PILOT ICUS, AND THEN ADOPTED A TELEHEALTH-ENABLED, REAL-TIME AUDIT AND FEEDBACK FOR CLINICIAN ADHERENCE (“TEACH”) TO DISSEMINATE LPV ADHERENCE STRATEGIES TO THE OTHER 14 ICUS, ACHIEVING OVER 90% ADHERENCE (NCT 03984175). THIS SUCCESSFUL APPROACH COULD HELP IDENTIFY CANDIDATES FOR C-SAT/SBT PROTOCOLS, PROMPT BEDSIDE PROVIDERS TO PERFORM C-SAT/SBT, AND GUIDE EXECUTION. THE SPECIFIC AIMS OF THIS RESEARCH ARE TO (1) ADAPT BASELINE IMPLEMENTATION STRATEGIES AND TO TARGET C- SAST/SBT USING THE CONSOLIDATED FRAMEWORK FOR IMPLEMENTATION RESEARCH; (2) CONDUCT A TYPE II CLUSTER- RANDOMIZED HYBRID EFFECTIVENESS-IMPLEMENTATION TRIAL TO COMPARE A USUAL AUDIT AND FEEDBACK IMPLEMENTATION APPROACH TO A USUAL AUDIT AND FEEDBACK IMPLEMENTATION APPROACH AUGMENTED WITH A TELEHEALTH-ENABLED, REAL- TIME AUDIT AND FEEDBACK FOR CLINICIAN ADHERENCE (“TEACH”) TO PROMOTE C-SAT/SBT; AND (3) EVALUATE SUSTAINED ADHERENCE TO THE TEACH ENHANCEMENT IN THE FINAL YEAR AFTER THE RCT HAS ENDED. COMPLETION OF THIS PROJECT WILL ADVANCE KNOWLEDGE REGARDING THE EFFECTIVE AND SUSTAINABLE STRATEGIES FOR C- SAT/SBT IMPLEMENTATION SPECIFICALLY AND THE EFFECTIVENESS GENERALLY OF TELEHEALTH REMOTE MONITORING AND PROMPTING STRATEGIES TO AID BEST PRACTICE IMPLEMENTATION IN ICUS. THE PROPOSED RESEARCH BUILDS ON THE STUDY TEAM’S EXISTING WORK AND HAS POTENTIAL TO DEVELOP MORE INFORMED AND EFFECTIVE CARE OF PERSONS WITH RESPIRATORY FAILURE. SPREAD AND SCALE OF THIS TELEHEALTH-ENABLED, CENTRAL MONITORING OF CRITICAL ASPECTS OF CARE FOR ICU PATIENTS IS PARTICULARLY IMPORTANT TO STUDY NOW, GIVEN THE VULNERABILITY OF ICU STAFF TO COVID-19 EXPOSURE.

RURAL MATERNITY AND OBSTETRICS MANAGEMENT STRATEGIES PROGRAM - IHC HEALTH CARE SERVICES, INC. DBA INTERMOUNTAIN HEALTHCARE 36 S STATE STREET, SALT LAKE CITY, UT 84111 REGIONAL HEALTHCARE SYSTEM INCLUDING RURAL HOSPITALS AND CLINICS; HTTPS://INTERMOUNTAINHEALTHCARE.ORG PROJECT DIRECTOR: KERRY PALAKANIS, EXECUTIVE DIRECTOR COMMUNITY CONNECT CARE PHONE NUMBER: (385)707-7175; E-MAIL ADDRESS: KERRY.PALAKANIS@IMAIL.ORG HEALTHY SOUTHWEST MONTANA - RMOMS PROGRAM GOAL IS TO INCREASE ACCESS TO AND CONTINUITY OF MATERNAL AND OBSTETRICS CARE IN RURAL MONTANA, GRANITE AND POWELL COUNTIES. THE TARGET POPULATION IS WOMEN OF CHILDBEARING AGE IN RURAL FRONTIER COUNTIES IN CENSUS TRACT 000200 AND 961700. THE REQUESTED FUNDING AMOUNT: YEAR 1: $998,153 YEAR 2: $997,497 YEAR 3: $999,475 YEAR 4: $998,632 SINCE 2018, HEALTHY GRANITE COUNTY NETWORK HAS RESPONSE TO COMMUNITY NEEDS. THE CORE NETWORK HAS REPRESENTATIVES FROM SOUTHWEST MONTANA COMMUNITY HEALTH CENTER, INTERMOUNTAIN HEALTH, GRANITE COUNTY MEDICAL CENTER, DEER LODGE MEDICAL CENTER, GRANITE COUNTY PUBLIC HEALTH, PHLIPSBURG AND DRUMMOND SCHOOL DISTRICTS, GRANITE COUNTY COMMISSIONERS, WESTERN MONTANA MENTAL HEALTH, AMERICAN FOUNDATION FOR SUICIDE PREVENTION, GRANITE COUNTY MEDICAL FOUNDATION, GRANITE COUNTY SHERIFF’S DEPARTMENT, A PRIVATE PRACTICE LCSW, RETIRED PRACTITIONERS AND COMMUNITY MEMBERS ARE VESTED IN THE HEALTH OF THE COUNTIES. ALL HAVE SIGNED THE MOA/U. THE NETWORK IS BEING EXPANDED TO MEET THE PROGRAM NEEDS TO IMPROVE MATERNAL AND OBSTETRICS HEALTH CARE. EXCEPT FOR INTERMOUNTAIN AND THE STATE MEDICAID OFFICE, ALL MEMBERS ARE RURAL. SCL ST. JAMES AND SOUTHWEST MONTANA COMMUNITY HEALTH CENTER ARE LOCATED IN A COUNTY ADJACENT TO THE SERVICE AREA. THEY ARE THE CLOSEST LEVEL III MATERNAL CARE FACILITY AND FQHC RESPECTIVELY. ALL PROJECT FUNDS ARE BEING SPENT IN RURAL COMMUNITIES WITH THE EXCEPTION OF INDIRECT COSTS AND THE BUSINESS ANALYST. ALL ORGANIZATIONS HAVE THE EXPERTISE TO IMPLEMENT THIS PROJECT SUCCESSFULLY. THESE ORGANIZATIONS SERVE THE RURAL POPULATIONS OF THE COUNTIES THAT HAVE BEEN DEFINED AS MATERNAL CARE DESERTS. THE RMOMS PROGRAM SEEKS TO CLOSE THAT GAP BY LEVERAGING CURRENT NETWORK MEMBERS AND EXPANDING WITH THE ADDITION OF OTHERS. PROPOSED ACTIVITIES AND/OR SERVICES WILL BE ACCOMPLISHED THROUGH THE CREATION, IMPLEMENTATION AND TESTING OF: 1. CARE COORDINATION SYSTEM USING COMMUNITY HEALTH WORKERS (CHW) SERVING PARTICIPANTS FROM PRECONCEPTION THROUGH ONE YEAR POSTPARTUM; 2. CARE CONTINUUM FROM PRECONCEPTION THROUGH POSTPARTUM USING A SHARED SERVICES MODEL WHEREIN THE CAHS AND THEIR RURAL HEALTH CLINICS SHARE THE SERVICES OF THE PROPOSED CHWS AND A CERTIFIED NURSE MIDWIFE SUPPORTED BY OBSTETRIC PHYSICIANS VIA TELEHEALTH. THIS WILL INCLUDE RISK STRATIFICATION OF PARTICIPANTS BASED ON PRENATAL CARE, INCLUDING REMOTE PATIENT MONITORING (RPM) AND OPENING LABOR AND DELIVERY SERVICES AT ONE CAH FOR LOW RISK PREGNANCIES AND LINKING HIGH RISK PATIENTS TO A BIRTH PLAN AT A LEVEL III FACILITY; 3. WORKFORCE CAPACITY BUILDING AND INFRASTRUCTURE IMPROVEMENTS NEEDED FOR A SAFE DELIVERY ENVIRONMENT; AND 4. NETWORK BUSINESS PLAN THAT INCLUDES SUSTAINABLE FINANCING MODELS. EXPECTED OUTCOMES: TO (I) IMPROVE MATERNAL AND NEONATAL OUTCOMES WITHIN A RURAL REGION; (II) DEVELOP A SUSTAINABLE NETWORK APPROACH TO INCREASE THE DELIVERY AND ACCESS OF PRECONCEPTION, PRENATAL, PREGNANCY, LABOR AND DELIVERY, AND POSTPARTUM SERVICES; (III) DEVELOP A SAFE DELIVERY ENVIRONMENT WITH THE SUPPORT AND ACCESS TO SPECIALTY CARE FOR PERINATAL PATIENTS AND INFANTS; AND (IV) DEVELOP SUSTAINABLE FINANCING MODELS FOR THE PROVISION OF MATERNAL AND OBSTETRICS CARE IN RURAL HOSPITALS AND COMMUNITIES. A FUNDING PREFERENCE IS BEING REQUESTED BASED ON HPSA AND MUC/P. GRANITE COUNTY IS IN A DESIGNATED HPSA AND MUC/MUP FOCUSING ON PRIMARY CARE, DENTAL AND MENTAL HEALTH. POWELL COUNTY MUC/MUP FOCUSING MENTAL HEALTH. SPECIAL CONSIDERATION IS BEING REQUESTED BASED ON THE INCLUSION OF A SIGNED MOA/U WITH THE STATE MEDICA

APC AND RETINOIDS IN ZEBRAFISH ENTEROCYTE DEVELOPMENT

DEVELOPMENT OF SMART ON FHIR INTEROPERABLE CLINICAL DECISION SUPPORT FOR EMERGENCY DEPARTMENT PATIENTS WITH PNEUMONIA AND PILOT DEPLOYMENT INTO NOVEL EPIC ELECTRONIC HEALTH RECORD ENVIRONMENTS - PROJECT SUMMARY IN THE UNITED STATES, MORE THAN 1.5 MILLION ADULTS ARE HOSPITALIZED EACH YEAR WITH COMMUNITY-ACQUIRED PNEUMONIA. DESPITE AVAILABILITY OF HIGH-QUALITY GUIDELINES FOR THE TREATMENT OF PATIENTS WITH PNEUMONIA, GUIDELINE ADHERENCE REMAINS POOR AND PATIENT CARE IS VARIABLE. LACK OF OBJECTIVE RISK ASSESSMENT LEADS TO UNNECESSARY HOSPITAL ADMISSIONS AND MISALLOCATION OF SCARCE INTENSIVE CARE RESOURCES. THUS, THERE IS A CRITICAL NEED FOR WELL-DESIGNED CLINICAL DECISION SUPPORT (CDS) TOOLS TO ASSIST CLINICIANS WITH ACCURATE DIAGNOSIS AND APPROPRIATE TREATMENT FOR PATIENTS WITH PNEUMONIA. INTERMOUNTAIN HEALTHCARE DEVELOPED AND DEPLOYED REAL-TIME ELECTRONIC CDS (CALLED EPNA) EMBEDDED IN THE CERNER ELECTRONIC HEALTH RECORD (EHR) ACROSS 20 ADULT HOSPITAL EMERGENCY DEPARTMENTS. EPNA GATHERS REAL- TIME AND HISTORICAL DATA FROM THE EHR COMBINED WITH ARTIFICIAL INTELLIGENCE PROCESSING OF CHEST IMAGES (CHEXED) TO GUIDE PNEUMONIA DIAGNOSIS, RISK STRATIFICATION, SITE OF CARE, RISK OF ANTIBIOTIC RESISTANCE, AND TREATMENT. EPNA SMOOTHS TRANSITIONS OF CARE BETWEEN CLINICIANS. OUR WORK INCORPORATES THE FIVE RIGHTS OF CDS TO OPTIMIZE THE TECHNOLOGY’S STRENGTHS IN THE CLINICAL ENVIRONMENT. TWO CONTROLLED STUDIES DEMONSTRATE THAT EPNA INCREASES GUIDELINE-RECOMMENDED, BEST PRACTICE CARE AND DECREASES 30-DAY ALL-CAUSE MORTALITY IN ADULTS WITH PNEUMONIA. EPNA IS READY TO BE DEPLOYED TO ADDITIONAL ENVIRONMENTS WITH DISTINCT PATIENT POPULATIONS AND EHRS. HOWEVER, SILOED EHRS LIMIT TECHNOLOGY DEVELOPED WITHIN ONE VENDOR FROM BEING SHARED WITH OTHERS. THE OBJECTIVE OF THIS PROPOSAL IS TO ENABLE BROAD DISSEMINATION OF EPNA BY OPTIMIZING ITS INTEROPERABILITY, SCALABILITY, AND USABILITY. ACCORDINGLY, WE AIM TO (1) DEVELOP A SMART ON FHIR EPNA APPLICATION CAPABLE OF INTERFACING WITH BOTH THE CERNER AND EPIC EMRS AND CONDUCT A FORMATIVE EVALUATION THROUGH AN ITERATIVE DESIGN PROCESS. WE WILL RAPIDLY REFINE AND VALIDATE THE NEW EPNA APPLICATION. (2) ENGAGE PATIENTS AND CLINICIANS TO INFORM THE PATIENT-CENTEREDNESS OF EPNA’S CLINICAL INTERFACE. THE PROJECT WILL INCORPORATE FEEDBACK FROM STAKEHOLDER CLINICIANS, ADMINISTRATORS, AND PATIENTS TO UNDERSTAND CONTEXTUAL FACTORS AFFECTING IMPLEMENTATION SUCCESS IN A NOVEL GEOGRAPHIC AND DEMOGRAPHIC ENVIRONMENT. (3) EVALUATE THE FEASIBILITY AND ACCEPTABILITY OF EPNA THROUGH A PILOT IMPLEMENTATION TRIAL GUIDED BY THE RE-AIM QUEST FRAMEWORK. OUR PROPOSAL IS LIKELY TO FACILITATE GUIDELINE ADHERENT CARE FOR PATIENTS WITH PNEUMONIA BROADLY ACROSS DIFFERENT HEALTHCARE SYSTEMS.

RURAL COMMUNITIES OPIOID RESPONSE PROGRAM - MEDICATION ASSISTED TREATMENT ACCESS - ADDRESS: IHC HEALTH SERVICES, INC. DBA INTERMOUNTAIN HEALTHCARE; 36 S STATE STREET SALT LAKE CITY, UTAH 84111 PROJECT DIRECTOR NAME: SARAH DIEFENDORF, PHD, DIRECTOR OF COMMUNITY HEALTH CONTACT PHONE NUMBERS: 603-738-5809 EMAIL ADDRESS: SARAH.DIEFENDORF@IMAIL.ORG WEBSITE ADDRESS, IF APPLICABLE: WWW.INTERMOUNTAINHEALTHCARE.ORG LIST ALL GRANT PROGRAM FUNDS REQUESTED IN THE APPLICATION, IF APPLICABLE: $694,178 IN YEAR ONE; $751,220 IN YEAR TWO; AND $765,355 IN YEAR THREE. BRIEF DESCRIPTION OF THE PROPOSED PROJECT INCLUDING THE NEEDS TO BE ADDRESSED, THE PROPOSED SERVICES, AND THE POPULATION GROUP(S) TO BE SERVED: THE SOUTHERN UTAH COMMUNITY OPIOID MAT PROGRAM ACCESSING SERVICES & SUPPORT (COMPASS) PROGRAM WILL REDUCE THE MORBIDITY AND MORTALITY OF SUBSTANCE USE DISORDER (SUD), INCLUDING OPIOID USE DISORDER (OUD) AND ALCOHOL USE DISORDER (AUD), IN THE RURAL AREAS OF WASHINGTON COUNTY, UTAH. THE OVERARCHING GOAL IS TO IMPROVE HEALTH CARE IN RURAL AREAS BY ESTABLISHING NEW MEDICATION ASSISTED TREATMENT (MAT) ACCESS POINTS AND INCREASING THE CAPACITY FOR SUSTAINABLE MAT SERVICE PROVISIONS IN TARGET AREA. OFFICIAL PARTNERS ARE IHC HEALTH SERVICES DBA INTERMOUNTAIN HEALTHCARE (INTERMOUNTAIN), PURGATORY CORRECTIONAL FACILITY (PCF), HURRICANE FAMILY PHARMACY (HFP), AND FAMILY HEALTHCARE, A FEDERALLY QUALIFIED HEALTH CENTER (FQHC). HURRICANE POLICE DEPARTMENT WILL ALSO PARTNER IN THE PROJECT, HOWEVER AS THEIR AUTHORIZED SIGNER IS NOT AVAILABLE AT THE TIME OF THIS APPLICATION, THEY WILL BE ADDED AS AN OFFICIAL PARTNER UPON NOTICE OF THE GRANT AWARD. THE PARTNERS WILL WORK TOGETHER TO: 1) CREATE NEW MAT ACCESS POINTS IN WASHINGTON COUNTY, UT; 2) PROVIDE MAT SERVICES TO THE RURAL COMMUNITY THROUGH TELEHEALTH AND BY SUPPORTING LOCAL PROVIDERS IN IMPLEMENTING MAT SERVICES; 3) PROVIDE PEER RECOVERY SUPPORT, EDUCATION, AND OTHER WRAPAROUND SERVICES; 4) TRAIN COMMUNITY MEMBERS AND FIRST RESPONDERS IN MENTAL HEALTH FIRST AID (MHFA); 5) SCREEN INCARCERATED IN DIVIDUALS PRIOR TO RELEASE FROM PCF FOR SUD, AUD, AND MAT NEEDS AND LINK THEM TO CARE; AND 6) LINK THE RURAL COMMUNITY TO PARTNERS FOR BEHAVIORAL HEALTH AND SPECIALTY AND PRIMARY CARE HEALTHCARE, AS NEEDED. THE TARGET POPULATION IS RESIDENTS OF THE RURAL AREAS OF WASHINGTON COUNTY, UT WHO ARE EITHER AT-RISK FOR OUD AND/OR AUD (O/AUD), ARE DIAGNOSED WITH O/AUD, ARE IN TREATMENT AND/OR RECOVERY FOR O/AUD, THE FAMILIES/AND OR CAREGIVERS OF THESE INDIVIDUALS AND FIRST RESPONDERS, HEALTH CARE PROVIDERS, AND OTHER COMMUNITY MEMBERS WHO ARE OTHERWISE IMPACTED BY O/AUD. WHILE NOT ALL OF THE COUNTY IS RURAL, THIS PROJECT WILL SERVE PERSONS IN ALL OF THE COUNTY’S RURAL CENSUS TRACTS WHICH ARE 270200, 270100, 271000, 270901, AND 270902. MORE THAN HALF OF THE COUNTY’S POPULATION IS RURAL. IN YEAR ONE, THE PROJECT SERVICES WILL BE CONCENTRATED IN HURRICANE, UT WITH TELEHEALTH OPTIONS TO INCREASE ACCESSIBILITY. IN SUBSEQUENT YEARS THE PROJECT SERVICES WILL EXPAND TO OTHER RURAL COMMUNITIES IN THE COUNTY. THE TARGET POPULATION WILL INCLUDE POPULATIONS THAT HAVE HISTORICALLY SUFFERED FROM POORER HEALTH OUTCOMES, HEALTH DISPARITIES, AND OTHER INEQUITIES AS COMPARED TO THE REST OF THE POPULATION. WASHINGTON COUNTY HAS HIGHER RATES OF NATIVE AMERICANS, SENIORS, VETERANS, AND PERSONS WITH DISABILITIES. THE MEDIAN INCOME IN THE COUNTY IS LOW WITH A HIGH RATE OF PERSONS USING PUBLIC INSURANCE AND UNINSURED. THE PCF HOUSES BETWEEN 400 AND 500 INMATES AT ANY GIVEN TIME. INCARCERATED INDIVIDUALS ARE DISPROPORTIONATELY MEMBERS OF MINORITY GROUPS AND LOW-INCOME. INMATES AND THEIR FAMILIES WILL RECEIVE SERVICES AS WELL.

COMMUNITY OUTREACH MAT PEER ADDICTION SUPPORT SERVICES (COMPASS) - PROJECT PARTICIPANTS WILL BE ACTIVELY ENROLLED IN THE PROJECT FOR 12 MONTHS. THE FIRST SIX MONTHS WILL BE AN INTENSIVE OUTPATIENT PROGRAM (IOP) PHASE AND INCLUDE MAT ALONG WITH APPLICABLE COMPREHENSIVE OUD PSYCHOSOCIAL SERVICES AND WEEKLY PEER RECOVERY SPECIALIST MEETINGS. THE REMAINING SIX MONTHS WILL CONTINUE MAT TREATMENT WITH LESS FREQUENT PEER RECOVERY SPECIALIST MEETINGS. ALL PARTICIPANTS WILL BE ASSISTED IN OVERCOMING SOCIAL DETERMINANTS OF HEALTH ISSUES. PROJECT NAME: COMMUNITY OUTREACH MAT PEER ADDICTION SUPPORT SERVICES (COMPASS). POPULATION TO BE SERVED: PERSONS WHO ARE HOMELESS OR ARE RECEIVING ONGOING SUPPORT THROUGH HOUSING SUBSIDIES LINED TO A HOMELESS PROVIDER (AT RISK OF HOMELESSNESS DUE TO RECENT HOUSING INSTABILITY (AROH)); LESBIAN, GAY, BISEXUAL, TRANSGENDER, AND QUESTIONING (LGBTQ); AND/OR VETERANS IN SALT LAKE COUNTY, UTAH WITH PRESCRIPTION DRUG AND/OR OPIOID ADDICTIONS. STRATEGIES/INTERVENTIONS: THESE INCLUDE: AN INTENSIVE OUTPATIENT PROGRAM (IOP) PHASE FOR IX MONTHS WHERE PARTICIPANTS RECEIVE MAT ALONG WITH APPLICABLE COMPREHENSIVE OUD PSYCHOSOCIAL SERVICES; RECOVERY SUPPORT SERVICES INCLUDING PEER RECOVERY SPECIALISTS WITH LIVED EXPERIENCE IN ONE OF THE TARGET POPULATIONS AND MONTHLY SOBER SOCIALS, A SECONDARY, SIX MONTH LESS INTENSIVE PHASE THAT INCLUDE MAT AND RELATED TREATMENT; ASSISTANCE IN REDUCING SOCIAL DETERMINANTS OF HEALTH (SDOH) BARRIERS TO CARE; AND TELEHEALTH, INCLUDING THE USE OF AN APP DESIGNED TO IMPROVE PARTICIPANT COMPLIANCE WITH TREATMENT AND BOLSTER PATIENT OUTCOMES. GOALS AND OBJECTIVES: THE OVERALL GOAL OF THE PROJECT IS TO REDUCE THE MORBIDITY AND MORTALITY FROM PRESCRIPTION DRUG AND OPIOID ADDICTION IN SALT LAKE COUNTY, UTAH WITH A FOCUS ON HOMELESS, LGBTQ, AND VETERAN POPULATIONS. OBJECTIVE 1: ANNUALLY, 70% OF ENROLLED PARTICIPANTS WILL COMPLETE THE SIX MONTH INTENSIVE OUTPATIENT PORTION (IOP) OF THE PROJECT. OBJECTIVE 2: ANNUALLY, 50% OF ENROLLED PARTICIPANTS WILL COMPLETED THE SIX MONTH INTENSIVE OUTPATIENT PORTION (IOP) OF THE PROJECT WILL COMPLETE THE FULL ONE YEAR PROJECT. OBJECTIVE 3: ANNUALLY, 75% OF THOSE PARTICIPATING IN THE PROJECT FOR MORE THAN 90 DAYS WILL DEMONSTRATE A DECREASE IN ILLICIT OPIOID AND PRESCRIPTION DRUG USE (AS APPLICABLE) AT SIX AND TWELVE MONTHS AS COMPARED TO AN INTAKE BASELINE. IN YEAR ONE, 125 UNDUPLICATED PERSONS WILL BE SERVED WITH 150 UNDUPLICATED PERSONS SERVED ANNUALLY IN YEARS TWO THROUGH FIVE FOR A TOTAL OF 725 PERSONS SERVED.

INTERMOUNTAIN HEALTHCARE CLINICAL CENTER (CC) FOR THE NHLBI PREVENTION AND EARLY

COMMUNITY HEALTH WORKER TRAINING PROGRAM - APPLICANT AND ADDRESS: IHC HEALTH CARE SERVICES, INC. DBA INTERMOUNTAIN HEALTHCARE; 6355 S. BUFFALO DR.; LAS VEGAS, NV. 89113--2133 PROJECT DIRECTOR NAME: KERRY PALAKANIS, DNP, APRN; CONTACT PHONE NUMBERS: 385.707.7175 PHONE, 801-442-8478 FAX; EMAIL ADDRESS; KERRY.PALAKANIS@IMAIL.ORG WEBSITE ADDRESS: HTTPS://INTERMOUNTAINHEALTHCARE.ORG/ LIST ALL GRANT PROGRAM FUNDS REQUESTED IN THE APPLICATION: $1,846,406 OVER THREE YEARS. A BRIEF OVERVIEW: THIS PROJECT WILL SERVE FOUR SOUTHERN NEVADA COUNTIES – CLARK, NYE, LINCOLN, AND ESMERELDA. CLARK COUNTY INCLUDES LAS VEGAS, WHERE THE MAJORITY OF ITS RESIDENTS RESIDE. IN FACT, 74% OF NEVADANS LIVE IN CLARK COUNTY. THE REMAINING SERVICE AREA IS RURAL AND UNDERSERVED WITH HIGH PERCENTAGES OF NON-NATIVE ENGLISH SPEAKERS, WITH SPANISH AND TAGALOG BEING THE MOST COMMONLY SPOKEN LANGUAGES AFTER ENGLISH. THE REGION IS A MAJORITY-MINORITY AREA WITH HIGH LEVELS OF POVERTY AND SPECIAL POPULATIONS INCLUDING SENIORS, PEOPLE LIVING WITH HIV/AIDS (PLWHA), LGBTQ+, DISABLED, AND VETERANS. THE PROJECT WILL TRAIN 150 COMMUNITY HEALTH WORKERS (CHW) OVER THREE YEARS, WITH AT LEAST 75% OF THESE WORKERS BEING NEW TO THE FIELD AND THE REMAINING BEING CHWS AND HEALTH SUPPORT PERSONNEL UPSKILLING. A REGISTERED APPRENTICESHIP PROGRAM WILL BE ESTABLISHED FOR THE PROJECT WITH AT LEAST 29 INDIVIDUALS ENROLLED IN THE APPRENTICESHIP BY THE END OF THE PROJECT PERIOD. THE TARGET TRAINEE POPULATION ARE U.S. CITIZENS AND FOREIGN NATIONALS HAVING IN HIS/HER POSSESSION A VISA PERMITTING PERMANENT RESIDENCE IN THE UNITED STATES THAT EITHER LIVE OR WORK IN THE SERVICE AREA. TRAINEES WILL BE AT LEAST 18 YEARS OF AGE AND HAVE EITHER A HIGH SCHOOL DIPLOMA OR EQUIVALENT. AT LEAST 75% OF TRAINEES WILL BE A MEMBER OF AN UNDERSERVED COMMUNITY. SPECIFIC, MEASURABLE OBJECTIVES THAT THE PROJECT WILL ACCOMPLISH: BY THE END OF THE PROJECT PERIOD, AT LEAST 25% OF THOSE IN THE NEW CHW TRAINING PROGRAM WILL ENROLL IN THE REGISTERED APPRENTICESHIP PROGRAM BY THE END OF THE PROJECT PERIOD: AT LEAST 75% OF TRAINEES WILL BE IN THE NEW CHW TRAINING PROGRAM TRACK; 75% OF ALL TRAINEES WILL BE FROM AN UNDERSERVED POPULATION OR GROUP;100% OF TRAINING COMPLETERS WILL RECEIVE AN EDUCATION CREDENTIAL; 95% OF COMPLETERS WILL BE CONNECTED TO FIELD PLACEMENT OR REGISTERED APPRENTICESHIP; 90% OF THOSE WHO COMPLETE A TRAINING PROGRAM WILL APPLY FOR AND RECEIVE A NEVADA CHW CERTIFICATION. 150 TRAINEES WILL BE SERVED WITH AT LEAST 29 OF THEM ENROLLING IN A REGISTERED APPRENTICESHIP. WHICH OF THE HHS/HRSA CLINICAL PRIORITIES WILL BE ADDRESSED; COVID-19, HEALTH EQUITY, TELEHEALTH, RURAL HEALTH, BEHAVIORAL HEALTH, OPIOIDS/SUBSTANCE USE DISORDER, CHILDHOOD OBESITY HOW THE PROPOSED PROJECT WILL BE ACCOMPLISHED; PARTNERS FOR THE PROJECT INCLUDE KEY ORGANIZATIONS IN HEALTHCARE, TRAINING, ACCESS TO CARE, HEALTH EQUITY, AND DIVERSITY WITHIN THE PUBLIC HEALTH WORKFORCE. IHC HEALTH CARE SERVICES, INC. (DBA INTERMOUNTAIN HEALTHCARE) WILL: BE THE APPLICANT, CREATE THE REGISTERED APPRENTICESHIP PROGRAM, AND SERVE AS THE FIELD PLACEMENT AND APPRENTICESHIP SITE. NVCHWA IS APPROVED TO PROVIDE CHW I AND CHW II TRAINING IN NEVADA. THEY WILL ENHANCE THEIR CURRENT TRAINING PROGRAM TO MEET THE GOALS OF THE PROJECT, PROVIDE CHW I AND II TRAINING, AND ADVISE THE PROJECT TEAM ON EMERGING TRENDS IN THE FIELD, LOCAL NEEDS, AND BEST PRACTICES IN THE FIELD. THE TOTAL FUNDING AMOUNT REQUESTED. $ 1,846,406 OVER THREE YEARS.

RELAX: REDUCING LENGTH OF ANTIBIOTICS FOR CHILDREN WITH EAR INFECTIONS - PROJECT SUMMARY/ABSTRACT: ACUTE OTITIS MEDIA (AOM) IS THE MOST COMMONLY CITED INDICATION FOR ANTIBIOTICS IN CHILDREN, ACCOUNTING FOR 24% OF ALL PEDIATRIC ANTIBIOTIC PRESCRIPTIONS AND AFFECTING 60% OF CHILDREN BY 3 YEARS OF AGE. FOR MOST CHILDREN = 2 YEARS OF AGE WITH AOM, 5-7 DAYS, RATHER THAN 10 DAYS, OF ANTIBIOTICS HAVE BEEN SHOWN TO BE SUFFICIENT AND RESULT IN FEWER ADVERSE DRUG EVENTS WITH SIMILAR FAILURE AND RECURRENCE RATES. THUS, NATIONAL GUIDELINES RECOMMEND SHORT DURATIONS OF ANTIBIOTICS FOR NON-SEVERE AOM IN THIS AGE GROUP. DESPITE THESE RECOMMENDATIONS, >94% OF CHILDREN =2 YEARS OF AGE ARE PRESCRIBED LONGER THAN RECOMMENDED ANTIBIOTIC DURATIONS AND OVER 41% OF ANTIBIOTIC EXPOSURE DAYS FOR AOM IN THIS AGE GROUP ARE LIKELY UNNECESSARY. IN A RECENT PILOT STUDY THAT COMPARED A LOW-COST HIGH-INTENSITY INTERVENTION WITH CLINICIAN EDUCATION, INDIVIDUALIZED CLINICIAN AUDIT AND FEEDBACK WITH PEER COMPARISON AND ELECTRONIC HEALTH RECORD (EHR) CHANGES OF PRESCRIPTION FIELDS TO A LOW-INTENSITY INTERVENTION WITH ONLY EHR CHANGES PRESCRIBING OF RECOMMENDED SHORT ANTIBIOTIC DURATIONS INCREASED SIGNIFICANTLY (76% AND 50%, ABSOLUTE PERCENTAGE). A DEFINITE STUDY IS NEEDED TO MAKE APPROPRIATE RECOMMENDATIONS ON WHICH INTERVENTION TO IMPLEMENT, WHILE MINIMIZING RESOURCE UTILIZATION. THE OVERARCHING GOAL OF THIS STUDY IS TO EVALUATE THE EFFECTIVENESS AND IMPLEMENTATION OUTCOMES OF TWO LOW-COST PRAGMATIC INTERVENTIONS OF DIFFERENT INTENSITIES TO INCREASE PRESCRIBING OF RECOMMENDED SHORT ANTIBIOTIC DURATIONS FOR AOM FOR CHILDREN 2 YEARS OF AGE AND OLDER. A MULTI-CENTER CLUSTER RANDOMIZED CONTROLLED TRIAL USING A HYBRID TYPE 2 IMPLEMENTATION EFFECTIVENESS DESIGN WILL BE USED TO EVALUATE INTERVENTIONS. THE HIGH-INTENSITY INTERVENTION WILL INCLUDE CLINICIAN EDUCATION, INDIVIDUALIZED CLINICIAN AUDIT AND FEEDBACK WITH PEER COMPARISON, AND EHR CHANGES OF PRESCRIPTION FIELDS, WHEREAS THE LOW-INTENSITY INTERVENTION WILL INCLUDE CLINICIAN EDUCATION AND EHR CHANGES. IN TOTAL, 46 COMMUNITY-BASED CLINICS AND/OR URGENT CARE CENTERS ACROSS TWO DISTINCT GEOGRAPHIC REGIONS IN THE UNITED STATES WILL BE RANDOMIZED TO ONE OF THE TWO INTERVENTIONS. THE PRACTICAL ROBUST IMPLEMENTATION AND SUSTAINABILITY MODEL WILL BE USED TO GUIDE IMPLEMENTATION AND THE REACH EFFECTIVENESS ADOPTION IMPLEMENTATION MAINTENANCE FRAMEWORK WILL BE USED TO EVALUATE OUTCOMES. A MIXED- METHODS APPROACH WILL BE USED IN THE PRE-IMPLEMENTATION AND EVALUATION PHASES AND WILL UTILIZE QUANTITATIVE ANALYSES, SEMI-STRUCTURED INTERVIEWS, FOCUS GROUPS, SURVEYS, AND COST ANALYSES. NATIONAL STAKEHOLDERS AT THE AMERICAN ACADEMY OF PEDIATRICS AND THE CENTERS FOR DISEASE CONTROL AND PREVENTION WILL ASSIST WITH DISSEMINATION OF FINDINGS AND SCALING OF INTERVENTIONS.

IMPACT OF ADVANCED IMAGING AND ENHANCED RISK PROFILING ON MITRAL VALVE PROLAPSE - SUMMARY: MITRAL VALVE PROLAPSE (MVP) IS A COMMON CARDIAC CONDITION THAT IS FREQUENTLY ASSOCIATED WITH TRACE TO MILD MITRAL REGURGITATION, IS USUALLY ASYMPTOMATIC, AND MOST OFTEN IGNORED. WHEN MVP PROGRESSES TO SIGNIFICANT REGURGITATION, PATIENTS MAY DEVELOP HEART FAILURE, ATRIAL FIBRILLATION, AND PULMONARY HYPERTENSION AND IS A FREQUENT INDICATION FOR INTERVENTION. HOWEVER, MVP IS A PHENOTYPICAL PRESENTATION OF NUMEROUS UNDERLYING DISEASES AND IS COMMONLY ENCOUNTERED IN COLLAGEN VASCULAR DISORDERS AND A LARGE VARIETY OF CONGENITAL DISORDERS. UNDERLYING TISSUE CHARACTERISTICS INCLUDING FIBROSIS OF THE LEFT VENTRICLE AND PAPILLARY MUSCLES, AND MITRAL ANNULUS DISJUNCTION ARE ASSOCIATED WITH MVP, PREDISPOSE TO VENTRICULAR ARRHYTHMIAS WHICH MAY BE FATAL, AND DO NOT NECESSARILY CORRELATE WITH SEVERITY OF MVP AND REGURGITATION. THE PURPOSE OF THIS PROJECT IS TO ENHANCE THE CLINICAL IDENTIFICATION OF PEOPLE WHO ARE AT RISK OF MODERATE TO SEVERE MVP OR HAVE ASSOCIATED FACTORS THAT INDICATE RISK OF UNEXPECTED HEALTH EVENTS OR COMPLICATE THE TREATMENT. IN AIM 1, THIS PROJECT WILL DESCRIBE THE HISTORY OF MVP, RELATED CARDIAC MORBIDITIES, AND OTHER CONDITIONS THAT MAY CONTRIBUTE TO OR IDENTIFY THE RISK OF POOR HEALTH OUTCOMES. THIS WILL INVOLVE EVALUATION OF A LARGE POPULATION IN INTERMOUNTAIN HEALTH, A HEALTH SYSTEM WITH MORE THAN 30 YEARS OF DATA WAREHOUSING OF ELECTRONIC HEALTH RECORD (EHR) DATA. INTERMOUNTAIN’S 33 HOSPITALS, 385 MEDICAL CLINICS, AND INTEGRATED SERVICES PROVIDE HEALTH AND HEALTHCARE SERVICES TO PEOPLE ACROSS 7 MOUNTAIN STATES AND INCLUDES A BROAD RURAL HEALTH COMPONENT. OUTCOMES WILL INCLUDE MVP DIAGNOSIS AND POST-DIAGNOSIS HEALTH EVENTS. FOR AIM 2, THE PROJECT WILL EVALUATE HERITABLE RISK FACTORS FOR MVP ENDPOINTS. THIS WILL FIRST LEVERAGE A UNIQUE POPULATION GENEALOGY OF TENS OF MILLIONS OF PEOPLE IN FAMILY PEDIGREES AND LINKED EHR DATA TO EXAMINE FAMILIAL RISKS. IT WILL ALSO EMPLOY A LARGE-SCALE GENETIC TESTING PROJECT WITH HUNDREDS OF THOUSANDS OF PARTICIPANTS TO EVALUATE POLYGENIC RISK SCORES. UNFORTUNATELY, NO RISK STRATIFICATION NOMOGRAM EXISTS FOR ASSESSING MVP RISKS AND PREDICTORS OF MVP ONSET AND PROGRESSION ARE REPORTED IN PIECEMEAL FORM, THUS IN AIM 3, DRAWING TOGETHER CLINICAL AND GENETIC RISK PREDICTION APPROACHES, A NOVEL SET OF CLINICAL DECISION TOOLS WILL BE CREATED USING EHR DATA TO EMPOWER THE IDENTIFICATION OF PEOPLE WHO ARE AT RISK OF MVP-ASSOCIATED OUTCOMES. MOST IMPORTANTLY, THIS WILL INCLUDE MULTIVARIABLE RISK EQUATIONS FOR STRATIFYING RISK OF SEVERE HEALTH ENDPOINTS FOR PEOPLE WITH MVP THAT CAN BE USED TO INFORM RISK ASSESSMENT AND CLINICAL CARE PLANS IN GUIDING MANAGEMENT AND TREATMENT OF PEOPLE WITH ELEVATED RISK OF DEATH OR MAJOR HEALTH EVENTS. ONE SET OF RISK MODELS WILL BE DEVELOPED WITH THE AIM OF CREATING A CLINICAL DECISION TOOL THAT PREDICTS A NEAR-MAXIMUM AMOUNT OF VARIANCE IN RISK USING A PARSIMONIOUS SET OF CLINICALLY-AVAILABLE FACTORS THAT CAN BE USED IN THE EHR BACKGROUND TO CALCULATE A RISK SCORE THAT THE EHR DELIVERS TO THE POINT OF CARE WITHOUT NEEDING MODIFIED DATA COLLECTION OR CLINICIAN INPUT IN THE EHR PROCESS. THIS PROJECT WILL RESOLVE DISCONNECTS IN MVP RISK ASSESSMENT AND TREATMENT, PROVIDING DECISION TOOLS THAT CAN BE CLINICALLY IMPLEMENTED FOR STANDARDIZED MVP RISK ASSESSMENT TO ACHIEVE THE HEALTHIEST MVP OUTCOMES POSSIBLE.

THE INTERMOUNTAIN WEST-ATLANTIC CENTER (INTERACT) FOR THE APS PHENOTYPING CONSORTIUM - PROJECT SUMMARY THIS PROPOSAL PRESENTS THE INTERMOUNTAIN WEST-ATLANTIC CENTER (INTERACT), WHICH BRINGS TOGETHER FOUR ROBUST INVESTIGATIVE SITES TO PARTICIPATE IN THE APS PHENOTYPES CONSORTIUM. INTERACT PROPOSES TO USE ROBUST STATISTICAL AND MACHINE LEARNING METHODS TO PHENOTYPE PATIENTS WITH ACUTE RESPIRATORY DISTRESS SYNDROME (ARDS), PNEUMONIA, AND SEPSIS IN TWO BROAD PROPOSALS. IN THE FIRST PROPOSAL FOR THE ENTIRE CONSORTIUM, WE WILL USE MULTIPLEX CYTOKINE ARRAYS AND CLINICAL VARIABLES IN THE SETTING OF NORMALIZED TREATMENT TRAJECTORIES TO IMPROVE THE ACCURACY OF PHENOTYPING BY ACCOUNTING FOR THE ROLE TREATMENT PLAYS. THIS METHOD CREATES PHENOTYPES THAT WILL BE CONFIRMED, WITH AN EYE TOWARD THERAPEUTIC IMPLICATIONS, IN EMULATED CLINICAL TRIALS. IN THE SECOND PROPOSAL FOR THE CENTER SPECIFICALLY, WE WILL FOCUS OUR STATISTICAL METHODOLOGY ON NEW WORK INVESTIGATING THE PATTERN OF TISSUE INJURY AND REPAIR, WITH A FOCUS ON HYALURONAN AND SOLUBLE RECEPTOR FOR ADVANCED GLYCATION ENDPRODUCTS (SRAGE) AS TISSUE INJURY BIOMARKERS AND PREDICTORS OF DYSREGULATED INFLAMMATION. THIS WORK WILL CULMINATE IN EMULATED TRIALS OF NOVEL AGENTS THAT MODULATE THE PATHOLOGIC CONSEQUENCES OF TISSUE INJURY. TOGETHER THESE HIGHLY INNOVATIVE PROPOSALS PROMISE ACTIONABLE, TREATMENT-RESPONSIVE PATIENT PHENOTYPES FOR FUTURE CLINICAL TRIALS.

STUDY OF TREATMENT'S ECHOCARDIOGRAPHIC MECHANISMS (CLOVERS-STEM)

COVID-19 ADDRESSING POST-INTENSIVE CARE SYNDROME AMONG SURVIVORS OF COVID (APICS-COVID)

RADIATION EXPOSURE SCREENING AND EDUCATION PROGRAM

ADAPTATION AND PILOT IMPLEMENTATION OF A VALIDATED, ELECTRONIC REAL TIME CLINICAL DECISION SUPPORT TOOL FOR CARE OF PNEUMONIA PATIENTS IN 12 UTAH URGENT CARE CENTERS

ADDRESSING POST-INTENSIVE CARE SYNDROME (PICS) AMONG SURVIVORS OF ACUTE LUNG INJURY

TELEHEALTH NETWORK GRANT PROGRAM

RADIATION EXPOSURE SCREENING AND EDUCATION PROGRAM

MEASURING AND LEARNING FROM CARE VARIATION IN SEPSIS - PROJECT SUMMARY/ABSTRACT SEPSIS IS A SYNDROME OF LIFE-THREATENING ORGAN FAILURE RESULTING FROM SERIOUS INFECTION THAT CONTRIBUTES TO AT LEAST 1.7 MILLION U.S. HOSPITAL ADMISSIONS ANNUALLY. WITH MORTALITY OF 15-20%, SEPSIS KILLS 11 MILLION PEOPLE EACH YEAR AROUND THE WORLD. PROMPT, APPROPRIATE THERAPY WITH ANTIBIOTICS AND IV FLUIDS CAN IMPROVE SEPSIS OUTCOMES, BUT MANY PATIENTS WITH SEPSIS DO NOT RECEIVE OPTIMAL THERAPY. UNWARRANTED VARIATION IN PRACTICE BETWEEN PHYSICIANS IS AN IMPORTANT CONTRIBUTOR TO THIS PROBLEM. IN SOME AREAS OF TREATMENT, HOWEVER, PRACTICE VARIATION REFLECTS THE FACT THAT THE OPTIMAL SEPSIS TREATMENT STRATEGY IS NOT CLEAR. IN BOTH SITUATIONS, THE MECHANISMS UNDERLYING BETWEEN-PHYSICIAN VARIATION IN SEPSIS CARE ARE LARGELY UNKNOWN. THIS RESEARCH PROGRAM WILL APPLY ADVANCED EPIDEMIOLOGIC, STATISTICAL, MACHINE LEARNING, AND QUALITATIVE RESEARCH METHODS TO LARGE, GRANULAR CLINICAL DATASETS TO DETERMINE HOW PHYSICIANS MAKE CRITICAL MANAGEMENT DECISIONS — INCLUDING DECISIONS RELATED TO ANTIBIOTIC INITIATION, INTRAVENOUS FLUID RESUSCITATION, AND EMERGENCY DEPARTMENT DISPOSITION — FOR PATIENTS WITH SEPSIS. A KEY FOCUS WILL BE UNDERSTANDING HOW DIFFERENT STYLES OF DECISION MAKING INTERACT WITH DIFFERENT PHENOTYPES OF THIS HETEROGENEOUS SYNDROME TO AFFECT PATIENT TREATMENT AND OUTCOMES. INVESTIGATIONS WILL ALSO HARNESS OBSERVED VARIATION TO INFORM CAUSAL INFERENCE ABOUT OPTIMAL SEPSIS MANAGEMENT STRATEGIES WHERE CURRENT EVIDENCE IS INADEQUATE. IN THE PROCESS, THIS RESEARCH WILL PRODUCE VALIDATED, SCALABLE, AND GENERALIZABLE TOOLS TO SUPPORT HIGH-QUALITY “BIG DATA” SEPSIS RESEARCH. THE PROPOSED RESEARCH, WHICH IS WELL MATCHED TO THE NIGMS SEPSIS RESEARCH PRIORITIES, WILL HELP HEALTH SYSTEMS, RESEARCHERS, AND CLINICIANS DESIGN AND DELIVER SEPSIS CARE, PROVIDE EVIDENCE TO BUILD DECISION SUPPORT TOOLS CUSTOMIZED TO PATIENT PHENOTYPES AND CLINICIAN DECISION STYLES, AND LAY THE GROUNDWORK FOR FUTURE TRIALS OF SEPSIS CARE STRATEGIES AND IMPLEMENTATION METHODS.

RADIATION EXPOSURE SCREENING AND EDUCATION PROGRAM

IMPLEMENTATION OF COMPUTERIZED CLINICAL SUPPORT FOR MECHANICAL VENTILATION OF PATIENTS WITH ACUTE RESPIRATORY DISTRESS SYNDROME

RURAL HEALTH CARE SERVICES OUTREACH GRANT PROGRAM

RURAL COMMUNITIES OPIOID RESPONSE-IMPLEMENTATION

PREHOSPITAL ACTIVATION OF ED TEAMS TO IMPROVE SEPSIS CARE

BUILDING COMPLEX DISEASE MODELS USING ONTOLOGIES AND DATA REPOSITORIES

INTERMOUNTAIN HEALTHCARE'S UTAH VALLEY REGIONAL MEDICAL CENTER IMAGING AND ONCOLOGY EQUIPMENT

AN INTEGRATED APPROACH TO THE VALIDATION OF NOVEL GASTRIC CANCER ONCOGENES

RYAN WHITE PART C OUTPATIENT EIS PROGRAM

CARDIOVASCULAR VARIABILITY AND CONTROL IN EARLY SEPSIS

RURAL COMMUNITIES OPIOID RESPONSE PROGRAM-PSYCHOSTIMULANT SUPPORT

THIS AWARD FUNDS THE APPROVED 2025?26 FGP PROGRAM. YOUR 2025?26 STATUTORY MATCH IS 10% AND YOUR BUDGETARY MATCH IS 10.31%. THIS AWARD FUNDS THE REST OF YEAR 1, WHICH WAS STARTED UNDER GRANT 25SFDMT001. THIS GRANT IS SCHEDULED TO RENEW FOR THE PROJECT PERIOD BEGINNING JULY 1, 2028.

CONGRESSIONALLY-MANDATED HEALTH INFORMATION TECHNOLOGY GRANTS

THE MOANA PROJECT: THE CONNECTION BETWEEN PACIFIC ISLANDERS AND GENETICS - PROJECT SUMMARY/ABSTRACT DUE TO UNDERREPRESENTATION IN GENETIC STUDIES AND REFERENCE PANELS, THE PROMISE OF PRECISION MEDICINE FOR EARLY DETECTION, TARGETED TREATMENT, AND IMPROVED OUTCOMES HAS NOT BEEN ACHIEVED UNIVERSALLY ACROSS RACIAL AND ETHNIC GROUPS, ESPECIALLY IN THE PACIFIC ISLANDER POPULATION. MOREOVER, THE PACIFIC ISLANDER COMMUNITY’S BELIEFS AND ATTITUDES ABOUT GENETIC TESTING, INCLUDING CULTURALLY APPROPRIATE WAYS OF RECEIVING AND SHARING GENETIC TESTING RESULTS, HAVE NOT BEEN FULLY EXPLORED. WHILE GENETIC RESEARCH INVOLVING PACIFIC ISLANDERS IS STILL IN ITS EARLY STAGES, ESTABLISHING TRUST IS CRUCIAL TO ENSURING THAT CURRENT AND FUTURE GENETIC RESEARCH OFFERS TANGIBLE BENEFITS TO THIS COMMUNITY. FORMING PARTNERSHIPS BETWEEN THE PACIFIC ISLANDER COMMUNITY AND ACADEMIC RESEARCHERS, PROMOTING OPEN DIALOGUES, AND PROVIDING COMMUNITY-SUPPORTED GUIDELINES ARE KEY TO BUILDING TRUST AND ENRICHING FUTURE GENETIC RESEARCH. THE MOANA PROJECT IS DEDICATED TO FOSTERING COMMUNITY ENGAGEMENT AND DIALOGUE ABOUT GENETIC RESEARCH WITHIN THE PACIFIC ISLANDER COMMUNITY (WHICH INCLUDES NATIVE HAWAIIANS, SAMOANS, TONGANS, OTHER POLYNESIANS, MICRONESIANS, AND MELANESIANS). OUR OBJECTIVE IS TO FACILITATE THE FORMATION OF COMMUNITY- LED BEST-PRACTICE GUIDELINES AND RESTRICTIONS FOR FUTURE GENETIC RESEARCH PROJECTS IN THIS COMMUNITY. TO ACCOMPLISH THIS, WE WILL FIRST ESTABLISH A PARTNERSHIP BETWEEN THE PACIFIC ISLANDER COMMUNITY AND ACADEMIC RESEARCHERS THROUGH ENGAGEMENT, DIALOGUE, AND CONSULTATION AROUND GENETIC RESEARCH. THIS WILL BE DONE BY CREATING PARTNERSHIPS WITH THE UTAH PACIFIC ISLANDER HEALTH COALITION AND OTHER PACIFIC ISLANDER COMMUNITY LEADERS. THESE LEADERS WILL BE INTERVIEWED TO OBTAIN THEIR INSIGHTS INTO THE PROJECT AND PERSPECTIVES ON GENETIC RESEARCH IN THEIR COMMUNITIES. THIS PARTNERSHIP WILL HELP ESTABLISH CONNECTIONS FOR ENGAGEMENT SESSIONS OF PACIFIC ISLANDER COMMUNITY MEMBERS TO DETERMINE THEIR THOUGHTS, FEELINGS, AND CONCERNS ABOUT GENETIC RESEARCH. THE PACIFIC ISLANDER COMMUNITY REPRESENTS AN AMALGAMATION OF DIFFERENT ANCESTRY AND CULTURES AND WE WILL SEEK TO CAPTURE THIS WIDER RANGE OF VOICES BY DOING SESSIONS IN DIFFERENT GROUPS. SIMULTANEOUSLY, WE WILL CONDUCT AN ENGAGEMENT SESSION WITH ACADEMIC GENETIC RESEARCHERS TO ENSURE THEIR PERSPECTIVES ARE INCLUDED. BASED ON THESE INTERVIEWS AND SESSIONS, WE WILL CONDUCT COMMUNITY DIALOGUE EVENTS INVOLVING BOTH THE PACIFIC ISLANDER COMMUNITY AND ACADEMIC RESEARCHERS. THESE EVENTS WILL ENDEAVOR TO PROMOTE MUTUAL LEARNING, ANSWER QUESTIONS, AND BUILD RELATIONSHIPS BASED ON TRUST. THE MOANA PROJECT INVESTIGATIONAL TEAM, IN PARTNERSHIP WITH THE UTAH PACIFIC ISLANDER HEALTH COALITION, WILL MEET REGULARLY TO DISCUSS THE RESULTING THEMES FROM THE INTERVIEWS AND ENGAGEMENT SESSIONS. WE WILL DO LITERATURE REVIEWS OF THESE THEMES TO DETERMINE BEST PRACTICES. THESE WILL BE USED TO DEVELOP GUIDELINES AND RESTRICTIONS FOR GENETIC STUDIES INVOLVING PACIFIC ISLANDER COMMUNITIES. THIS DOCUMENT WILL BE PRESENTED AT A COMMUNITY CONSULTATION MEETING AND REVISED BASED ON FEEDBACK. THE OUTCOME OF THIS PROJECT WILL ESTABLISH GUIDELINES FOR ETHICAL GENETIC RESEARCH IN THE PACIFIC ISLANDER COMMUNITY THAT WILL SERVE AS A FOUNDATION FOR FUTURE GENETIC RESEARCH, WITH THE ULTIMATE GOAL OF BETTERING THE HEALTH OF THIS COMMUNITY.

RADIATION EXPOSURE SCREENING AND EDUCATION PROGRAM - RADIATION EXPOSURE SCREENING AND EDUCATION PROGRAM SOUTHWESTERN UTAH RESEP, ST. GEORGE REGIONAL HOSPITAL, INTERMOUNTAIN HEALTH 600 SOUTH MEDICAL CENTER DRIVE, BLDG 7; ST. GEORGE, UT 84790-8723 REBECCA BARLOW, APRN, MSN; PROJECT DIRECTOR PHONE NUMBERS: VOICE: 435-251-4760 EMAIL ADDRESS: REBECCA.BARLOW@IMAIL.ORG PROPOSED SERVICE REGION: WASHINGTON, IRON, KANE, BEAVER, SEVIER, MILLARD AND GARFIELD COUNTIES IN UTAH; NYE AND LINCOLN COUNTIES IN NV, AND MOHAVE COUNTY NORTH OF THE GRAND CANYON IN AZ FROM 1951-1962 THE UNITED STATES GOVERNMENT CONDUCTED ABOVE-GROUND NUCLEAR TESTING IN NYE COUNTY, NEVADA AT THE NEVADA TEST SITE—WHICH SITE IS DIRECTLY WEST OF WASHINGTON, IRON AND KANE COUNTIES IN SOUTHERN UTAH. DURING THIS TESTING, THE FALLOUT, CONTAINING NINETEEN RADIOACTIVE MATERIALS, BLANKETED SOUTHWESTERN UTAH, NORTHERN ARIZONA AND SOUTHEASTERN NEVADA. THE NATIONAL CANCER INSTITUTE REPORTED THAT UTAH’S WASHINGTON AND IRON COUNTIES RECEIVED THE GREATEST AMOUNT OF FALLOUT FROM THE TESTING. POPULATIONS WITHIN THE PROPOSED AFFECTED COUNTIES STATED BELOW (KNOWN AS “DOWNWINDERS” BECAUSE OF THEIR LIVING DOWNWIND TO THE FALLOUT) WERE COLLECTIVELY ESTIMATED AT AROUND 61,000—AND HAVE REMAINED FAIRLY STABLE TO THIS DAY. FOLLOWING THE PERIOD OF NUCLEAR TESTING, THIS COLLECTIVE POPULATION STARTED SHOWING ABNORMALLY HIGH RATES OF MALIGNANT AND NON-MALIGNANT THYROID DISEASE AND NUMEROUS STUDIES ENSUED. AMONG THEM, STUDIES CONDUCTED BY THE UNIVERSITY OF UTAH IN SOUTHWESTERN UTAH CONFIRMED THE LINK BETWEEN RADIOACTIVE FALLOUT AND INCREASED RATES OF THYROID MALIGNANCY AND LEUKEMIA. ADDITIONALLY, DATA FROM THE UTAH CANCER REGISTRY FOR SOUTHWESTERN UTAH FOR THE PERIOD 1991-2000 SHOWED A HIGHER-THAN-EXPECTED INCIDENCE OF LYMPHOMA, BREAST AND THYROID CANCERS. ST. GEORGE REGIONAL HOSPITAL (SGRH); PREVIOUSLY DIXIE REGIONAL MEDICAL CENTER, PROPOSES TO CONTINUE TO SERVE THE POPULATION OF SOUTHERN UTAH AND ADJACENT REGIONS EXPOSED TO RADIATION FROM THIS PERIOD OF NUC LEAR TESTING BY CONTINUING THEIR RADIATION EXPOSURE SCREENING AND EDUCATION PROGRAM (RESEP) CLINIC. TO DATE, THE SOUTHWESTERN UTAH RESEP CLINIC HAS PROVIDED A CANCER HEALTH SCREENING PHYSICAL TO ALMOST 5,700 PATIENTS, GIVEN OUT NEARLY 4,000 RECA APPLICATIONS TO POTENTIAL CLAIMANTS, PROVIDED RECA INFORMATION TO MORE THAN 144,000 INDIVIDUALS, AND CONDUCTED OVER 82,000 RECA COUNSELING SESSIONS. OVER 2,000 KNOWN CLAIMANTS HAVE RECEIVED RECA COMPENSATION. THIS PROGRAM WILL CONTINUE TO PROVIDE EDUCATION TO THESE INDIVIDUALS ON SCREENING FOR HEALTH CONSEQUENCES RELATED TO RADIATION EXPOSURE. SGRH’S BROAD SCOPE OF MEDICAL CAPABILITIES; LOCATION WITHIN THE EXPOSED AREA AND HISTORY OF HEALTH CARE SERVICE TO ITS MOSTLY RURAL COMMUNITIES, MAKE IT WELL SUITED TO CONDUCT THE FULL SCOPE OF ACTIVITIES REQUIRED BY RESEP. ADDITIONALLY, ELIGIBLE URANIUM INDUSTRY WORKERS AND QUALIFIED ONSITE PARTICIPANTS WILL ALSO BE INCLUDED IN THE TARGET POPULATIONS. WHILE IT IS DIFFICULT TO DETERMINE THE EXACT NUMBER OF THE ORIGINAL ESTIMATED ALMOST 61,000 EXPOSED INDIVIDUALS THAT ARE STILL LIVING IN SGRH’S PROPOSED SERVICE AREA, IT IS EXPECTED THERE ARE AT LEAST SEVERAL THOUSAND TO TEN THOUSAND LOCAL RESIDENTS STILL ELIGIBLE FOR THE RESEP CLINIC AND EFFORTS WILL BE MADE TO PROMOTE THE PROGRAM LOCALLY AS WELL AS REGIONALLY. SGRH PROPOSES TO CONTINUE ITS PRESENT SERVICES TO THE POPULATIONS OF WASHINGTON, IRON, KANE, BEAVER, SEVIER, MILLARD AND GARFIELD COUNTIES IN UTAH; NYE AND LINCOLN COUNTIES IN NV, AND MOHAVE COUNTY NORTH OF THE GRAND CANYON IN AZ. THE SOUTHWESTERN UTAH RESEP CLINIC WILL CONTINUE TO BE MANAGED BY THE EXPERTISE OF A NATIONALLY CERTIFIED ONCOLOGY NURSE PRACTITIONER WHO IS TRAINED IN THE HEALTH EFFECTS OF RADIATION. BOTH SHE AND THE RECA COUNSELOR ARE WELL EDUCATED IN THE BIOLOGY OF CANCER AND ARE PASSIONATE ABOUT THE DIFFERENCE THAT PREVENTATIVE SCREENING AND EDUCATION OF CANCER RISK CAN MAKE WITHIN A POPULATION.

DEVELOPING AND EVALUATING A PERSONALIZED APPROACH TO INITIAL FLUID RESUSCITATION IN PATIENTS WITH HOSPITAL-ONSET SEPSIS - PROJECT SUMMARY CANDIDATE’S LONG-TERM CAREER GOAL: DR. ELIZABETH MUNROE’S CAREER GOAL IS TO BECOME AN INDEPENDENT PHYSICIAN-SCIENTIST LEADING NOVEL CLINICAL TRIALS TO IMPROVE THE EARLY MANAGEMENT OF CRITICALLY ILL PATIENTS. CLINICAL PROBLEM TO BE ADDRESSED: INTRAVENOUS FLUIDS ARE A CORE COMPONENT OF SEPSIS MANAGEMENT. YET, ADMINISTERING BOTH TOO MUCH AND TOO LITTLE FLUID CAN CAUSE HARM, AND THE OPTIMAL FLUID VOLUME TO PRESCRIBE IS OFTEN UNCLEAR. TRADITIONAL CLINICAL TRIALS MISS THE CRITICAL WINDOW OF INITIAL FLUID RESUSCITATION AND USE ONE-SIZE-FITS- ALL APPROACHES TO FLUID RESUSCITATION. FURTHERMORE, LIKE MOST SEPSIS RESEARCH, FLUID TRIALS HAVE LARGELY EXCLUDED PATIENTS WHO DEVELOP SEPSIS IN THE HOSPITAL (HOSPITAL-ONSET SEPSIS), AN IMPORTANT AND DISTINCT POPULATION THAT EXPERIENCES TWO-TIMES HIGHER MORTALITY THAN PATIENTS WITH COMMUNITY-ONSET SEPSIS. SPECIFIC AIMS: IN THIS K23 PROPOSAL, DR. MUNROE AIMS TO 1) UNDERSTAND THE IMPACT OF INITIAL FLUID VOLUME ON OUTCOMES IN PATIENTS WITH HOSPITAL-ONSET SEPSIS THROUGH AN ELECTRONIC HEALTH RECORD (EHR)-BASED COHORT STUDY, 2) DEVELOP A PERSONALIZED, PHYSIOLOGY (STROKE VOLUME) GUIDED APPROACH TO INITIAL FLUID RESUSCITATION FOR PATIENTS WITH HOSPITAL-ONSET SEPSIS, AND 3) CONDUCT A PILOT PRAGMATIC CLINICAL TRIAL COMPARING PERSONALIZED, STROKE VOLUME GUIDED INITIAL FLUID RESUSCITATION VS USUAL CARE DURING RAPID RESPONSE EVALUATIONS. CANDIDATE BACKGROUND: DR. MUNROE IS A CLINICAL INSTRUCTOR IN PULMONARY AND CRITICAL CARE AT THE UNIVERSITY OF MICHIGAN AND CURRENT NHLBI NRSA F32 AWARDEE. SHE WILL BE PROMOTED TO ASSISTANT PROFESSOR, NOT CONTINGENT ON THE OUTCOME OF THIS APPLICATION. SHE IS RECOGNIZED AS A RISING STAR IN THE FIELD OF SEPSIS, WITH 6 FIRST-AUTHOR PUBLICATIONS, 8 CONFERENCE PRESENTATIONS, AND 5 NATIONAL INVITED LECTURES. CAREER DEVELOPMENT PLAN: THROUGH THIS PROJECT, DR. MUNROE WILL BUILD ON HER EXPERTISE IN SEPSIS MANAGEMENT AND HEALTH SERVICES RESEARCH TO GAIN EXPERTISE IN 1) EHR-DATA EXTRACTION, 2) IMPLEMENTATION SCIENCE-BASED INTERVENTION DESIGN AND EVALUATION, AND 3) PRAGMATIC CLINICAL TRIAL DESIGN, EXECUTION, AND ANALYSIS. HER 5-YEAR TRAINING PLAN CAREFULLY PAIRS HER TRAINING AND RESEARCH AIMS AND IS FURTHER SUPPORTED BY CURATED COURSEWORK AND CAREER DEVELOPMENT ACTIVITIES THAT WILL POSITION HER FOR SUCCESSFUL TRANSITION TO INDEPENDENCE. MENTORS: DR. MUNROE’S PRIMARY MENTOR, DR. HALLIE PRESCOTT, IS A SEPSIS EXPERT WHO HAS MENTORED 5 CLINICIAN- SCIENTISTS ON K-SERIES/CAREER DEVELOPMENT AWARDS. DR. MUNROE AND DR. PRESCOTT HAVE AN EXCELLENT TRACK RECORD OF SUCCESS, WORKING TOGETHER SINCE 2020. DR. MUNROE WILL RECEIVE COMPLEMENTARY SUPPORT FROM CO-MENTORS: DR. MICHAEL SJODING (EHR-BASED DATA SCIENCE), DR. STEPHANIE PARKS TAYLOR (IMPLEMENTATION SCIENCE), AND DR. ROBERT HYZY (CLINICAL TRIALS), AS WELL A NATIONAL ADVISORY TEAM WITH DEEP EXPERTISE IN PRAGMATIC CLINICAL TRIALS. DELIVERABLES: COMPLETING THESE AIMS WILL ADVANCE OUR UNDERSTANDING OF FLUID RESUSCITATION IN HOSPITAL-ONSET SEPSIS, GENERATE PRELIMINARY DATA TO COMPETE FOR R-SERIES AWARDS FOR FOLLOW-UP TRIALS, AND UNIQUELY POSITION DR. MUNROE TO LEAD NOVEL CLINICAL TRIALS OF EARLY INTERVENTIONS IN CRITICAL CARE.

RURAL HEALTH OUTREACH SPECIAL INITIATIVE

COMP B-PRIMARY CHILDREN'S HOSPITAL SPINA BIFIDA PATIENT REGISTRY

DISCOVERY AND PREDICTION OF NOVEL FUNCTIONAL OUTCOME PHENOTYPES FOR ARDS

CONGRESSIONALLY-MANDATED HEALTH INFORMATION TECHNOLOGY GRANTS

HEALTH CARE AND OTHER FACILITIES

PRIMARY CHILDREN'S MEDICAL CENTER SPINA BIFIDA PATIENT REGISTRY

HEALTH CARE AND OTHER FACILITIES

PRECISION ANTIMICROBIAL STEWARDSHIP FOR CLOSTRIDIOIDES DIFFICILE PREVENTION (PASTCDI)

HEALTH CARE AND OTHER FACILITIES

RURAL COMMUNITIES OPIOID RESPONSE (PLANNING)

COMP C-NATIONAL SPINA BIFIDA PATIENT REGISTRY/UROLOGICAL COMPONENT

EXPLORING NEW ED INTAKE STRATEGIES

TELEMEDICINE GRANT