2024
PI: Edmond Ramly, PhD
Funding Agency: Agency for Healthcare Research & Quality (AHRQ)
What problem is this study trying to solve?
Following evidence-based guidelines to reverse cardiovascular disease (CVD) risk would prevent more than 50% of annual deaths in middle-aged US adults; however, guidelines are not uniformly implemented. Tailoring strategies to address local barriers has potential to improve adherence to guidelines, based on previous results such as increasing follow-up on blood pressure management and smoking cessation. Yet tailoring strategies is expensive and burdensome in practice and may be even less feasible given the expansion of telemedicine due to the pandemic.
What will be studied?
This 5-year Agency for Healthcare Research & Quality (AHRQ)-funded study will use configurable solutions to address local barriers without engaging in an expert-led individual tailoring process. Four CVD quality metrics will be targeted:
- Blood pressure control for patients with hypertension
- Aspirin, statins, and smoking cessation for patients with coronary artery disease
A configurable toolkit for CVD prevention will be developed using multi-stakeholder design and informed by large clinical data. The toolkit will be studied in a pragmatic, practice-based trial.
What could the study mean for clinicians and patients?
This project addresses challenges in consistent implementation of evidence-based CVD prevention guidelines, including new challenges related to the use of telemedicine. By using a configurable toolkit, implementation strategies can be matched to local barriers faced by primary care practices, which could result in improved patient outcomes.
PI: Heidi Brown, MD, MAS, FACOG
Funding Agency: Agency for Healthcare Research and Quality’s (AHRQ)
What problem is this study trying to solve?
Urinary Incontinence (UI) affects a large number of women. More than half of women over 20 years of age reported any urinary leakage. Overall, about 30% of older women in the US report moderate to severe UI, which can increase depression and work disability. What’s more, fewer than 50% of women seek care for UI symptoms. Finally, there is a significant gap between evidence-based care and actual practice. Fewer than 30% of women (> age 40) with UI report receiving any care for UI symptoms, despite available safe and effective non-surgical treatments for UI, according to a systematic review.
What will be studied?
This project builds on AHRQ’s EvidenceNOW Model, which previously showed that free practice facilitation for small- and medium-sized primary care practices supported improvements in the delivery of guideline-based care for heart disease. We aim to use the model to help primary care practices implement effective nonsurgical interventions for UI such as behavioral approaches, medications, and neuromodulation. By facilitating partnerships between primary care practices and community and subspecialist organizations, we hope to overcome barriers to increase the diagnosis and treatment of UI among women in primary care. This project aims to connect primary care practices to local and national resources through partnerships with the WI Institute for Healthy Aging, WI Department of Health Services, and the American Urogynecologic Society.
What could this study mean for patients?
By supporting the implementation and maintenance of non-surgical interventions for women with UI being seen in primary care, we hope to improve outcomes and symptoms that can threaten daily functioning.
PI: Aleksandra Zgierska, MD, PhD
UW Madison Site PI: Bruce Barrett, MD, PhD
UW Madison Site Co-PI: Mary Henningfield PhD
Collaborators:
The University of Utah – Site PI: Eric Garland
Harvard Medical School/Brigham & Women’s Hospital – Site PI: Robert Edwards
Funding Agency: Patient-Centered Outcomes Research Institute (PCORI)
What problem is this study trying to solve?
Chronic low-back pain has no known effective treatment. Although often treated with long-term opioid therapy, opioids do not work well for many patients and can cause serious side effects, including addiction, poorer mental health, and overdose death. Alternatives to opioids and the development of tools to help patients manage their chronic pain are needed.
What will be studied?
This study will compare Mindfulness Meditation and Cognitive Behavioral Therapy for improving health and quality-of-life for adults with opioid-treated chronic low back pain.
What could the study mean for patients?
The results of this trial will help to determine which therapy is viewed as useful by patients for managing their chronic low back pain, increasing physical function, improving quality-of-life, and decreasing daily opioid dose.
2023
PI: Art Walaszek, MD
Funding Agency: UW Madison – Institute for Clinical and Translational Research (UW ICTR)
What problem is this study trying to solve?
Approximately 90% of people with dementia have behavioral and psychological symptoms of dementia (BPSD), such as depression, agitation, or paranoia. BPSD can be distressing to patients and potentially dangerous to them and people around them. Primary care clinicians are often directly involved in managing BPSD, which can be complicated because of risks associated with pharmacological interventions. The project aims to use a clinician educational program to help improve the care of people with dementia.
What will be studied?
We aim to study two clinical/educational approaches to assisting healthcare professionals with managing BPSD: academic detailing and DICE. Academic detailing is an evidence-based approach to changing clinician behavior through brief educational encounters. DICE is an evidence-based framework for teaching people to use behavioral and environmental approaches to BPSD instead of medications. As part of our project, we will survey clinicians about their knowledge of and experience with BPSD and their interest in educational approaches to assisting their care. Academic detailing and DICE will be implemented in two primary care clinics in Wisconsin.
What could the study mean for clinicians and patients?
The survey will provide insights as to the educational needs of clinicians with regard to BPSD. Through academic detailing and DICE, we aim to support primary care clinicians with the goal of improving the care of people with BPSD.
PI(s): Sarina Schrager, MD, MS; Makeba Williams, MD, NCMP, FACOG; Mary Henningfield, PhD; Earlise Ward, PhD
Funding Agency: UW Madison Department of Family Medicine & Community Health
What problem is this study trying to solve?
African American women have more severe vasomotor symptoms, experience symptoms for longer durations than white women, and have more interrupted sleep. African American women also describe not being heard by members of the health care system. Thus, the menopausal care needs of African American women are doubly underserved.
What will be studied?
This project aims to explore African American women’s experiences with menopause and with the health care system. We will conduct focus groups and interviews with African American women to obtain a rich dataset of experiences to ensure that the perspectives of African American women are adequately heard.
What could the study mean for clinicians and patients?
This study will provide information that can help primary care clinicians better understand and treat African American women for their menopause symptoms.
PI: Annette Totten, PhD
UW Madison Site PI: Sarina Schrager, MD, MS
Funding Agency: Patient-Centered Outcomes Research Institute (PCORI)
What problem is this study trying to solve?
Advance Care Planning (ACP) is not routinely used in primary care settings. Primary care practices are ideally suited for ACP; however, barriers such as time constraints often impair the ability of clinicians to complete ACP conversations with their patients.
What will be studied?
This project is designed to study use of a serious illness conversation (SIC) guide for conversations between patients and either their physician or their healthcare team. The SIC provides questions to enable clinicians to understand their patients’ values and preferences. The study will measure how well the care received by patients aligned with the goals they discussed in ACP conversations.
What could the study mean for patients and their families?
Patients, caregivers, and their families could benefit from ACP conversations by helping to ensure that their wishes are known and implemented. In addition, ACP conversations can help increase the satisfaction of patients and clinicians with their communication and relationship.
PI: Rachel Grob, PhD
Funding Agency: UW Madison – Institute for Clinical and Translational Research (UW ICTR)
What problem is this study trying to address?
Long COVID has emerged as a significant health care issue with millions of Americans reported to be experiencing long-COVID symptoms. Minority groups have been disproportionately affected by SARS-CoV-2 infections, hospitalizations, and deaths. Post-COVID conditions represent a wide array of symptoms and best practices to care for patients with long COVID have not been fully defined. This study aims to use information about patient experiences of long COVID to create education materials for use by primary care clinics to effectively care for patients with long COVID and address health care inequities.
What will this study accomplish?
This study will use a community-partnered approach to learning together to effectively address long COVID in primary care. We will create, pilot, and evaluate the impact of an educational intervention comprised of a catalyst film of clips from audio- or video-recorded patient interviews and an accompanying toolkit of actionable approaches to care.
What could the study mean for clinicians and patients?
Learning from patients and community advocates will help inform best practices for an indication with uncertainty about best practices for clinical care and few known interventions. The project will explore the needs of historically underserved patients to address inequities faced by those suffering from long COVID.
Principal Investigator: Corrine Voils, PhD – UW SMPH, Dept of General Surgery
Project Summary: This study will provide critical insight into the efficacy of systematically involving domestic partners to optimize long-term weight loss. Results from the mediation analyses will provide unique knowledge about the mechanisms underlying a couples’-based approach for patient weight management. As such, the results will inform future intervention refinements to optimize patient outcomes and scalability. Completion of this study will contribute to our long-term goal of identifying and implementing efficacious, cost-effective approaches to reduce obesity and associated outcomes.
Funding Agency: National Institutes of Health (R01)
PI(s): Mary Henningfield, PhD
Funding Agency: UW Madison Department of Family Medicine and Community Health
What problem is this study trying to solve?
The COVID-19 pandemic has had a significant impact on health care systems and effects on rural primary care physicians have been especially impactful. Available research tends to focus on negative aspects of the pandemic (ie, burnout among clinicians) with limited work on understanding the impact on relationships with their patients, physician colleagues, staff, and communities. This pilot study seeks to fill the information gap by documenting the experiences of 10 to 15 rural clinicians during the pandemic through 1:1 interviews.
What will be studied?
This pilot project will interview rural primary care physicians to understand the impact of the pandemic on relationships as well as their well-being. Strategies that helped physicians and their clinic staff cope with the impact of the pandemic will be recorded.
What could the study mean for clinicians and patients?
This study will provide insights into the unique experiences of physicians practicing in rural areas. By documenting real experiences and identifying strategies that supported clinicians practicing in rural areas, we aim to inform future efforts to address pandemics and preserve knowledge assets to provide care to patients in rural areas.
2022
Principal Investigator(s): Cassandra Sundaram, MS – UW Madison Department of Family Medicine & Community Health
Project Summary: 3-Minute Mental Makeover: This project aims to facilitate the use of an expressive writing tool, the 3MMM, in conversations between clinicians and their patients with chronic pain. The tool and associated surveys have been developed, but support is needed to train clinicians on use of the tool. Funding is additionally needed to produce study materials and support study staff to collect data, and conduct and review data analyses.
Funding Agency: UW Madison Department of Family Medicine & Community Health
Principal Investigator(s): Edmond Ramly, PhD – UW Madison Department of Family Medicine & Community Health
Project Summary: Our long-term goal is to improve evidence based care for chronic conditions in primary care while reducing health disparities. The overall objective is to engage a patient advisory board and a stakeholder advisory board in co-designing the AGILE tool, supported by an expert advisory panel. The resulting tool will enable primary care clinics to map strategies to address local barriers for adapting implementation of evidence based guidelines to the needs of racially/ethnically diverse populations in the midst of telehealth adaptations.
Funding Agency: UW Institute for Clinical and Translational Research-Stakeholder & Patient Engaged Research (ICTR-SPER)
Principal Investigator(s): Sarina Schrager, MD UW Madison School of Medicine & Public Health / Department of Family Medicine & Community Health
Project Summary: The purpose of this grant is to utilize the materials developed by our team to support the use of SDM for breast cancer screening and package them into CME and MOC part IV modules for use by primary care clinicians.
Funding Agency: DFMCH Small Grant
Principal Investigator(s): Rachel Grob, MA, PhD – UW Madison Department of Family Medicine & Community Health
Project Summary: To understand patients’ experiences with COVID-19 in the state of Wisconsin. Our understanding of the natural history, diagnosis, and treatment of COVID-19 is still in nascent stages of development, particularly related to long-term effects, and more work is needed to develop best practices to care for patients with long COVID. The work will help address knowledge gaps of the patient experience with long COVID.
Funding Agency: UW Madison Department of Family Medicine & Community Health
Principal Investigator(s): Sarina Schrager, UW Madison Department of Family Medicine & Community Health; Amye Tevaarwerk, UW Madison School of Medicine & Public Health
Project Summary: In order to improve breast cancer screening rates and survivorship in Prairie Ridge Health’s (PRH’s) rural service area, the reasons why residents are not obtaining mammography must be identified, understood and addressed. A more in depth evaluation is needed to develop a comprehensive plan to address the array of limitations specific to PRH’s rural location (biology, individual characteristics, social and physical contexts, and political/economic environment).
Funding Agency: UW Madison Carbone Cancer Center
Principal Investigator(s): Paul Hunter, MD; Mary Henningfield, PhD – UW Madison School of Medicine & Public Health / Department of Family Medicine & Community Health
Project Summary: In 2019, the Advisory Committee on Immunization Practices (ACIP) changed its age-based recommendations for pneumococcal conjugate vaccine 13 valent (PCV13) to a shared decision-making (SDM) process. The overall goal of this QI project is to evaluate the use of telehealth for SDM conversations regarding PCV13 vaccinations for adults being seen in the primary care setting. A secondary goal is the development of a template for clinicians to seek maintenance of certification (MOC) part IV for QI projects related to implementation of SDM via telehealth for vaccinations in adults.
Funding Agency: Pfizer, Inc.
Principal Investigator(s): Robin Gal, Jaeb Center for Health Research
Project Summary: This study will assess feasibility and efficacy of establishing a virtual diabetes clinic with a focus on introduction of CGM technology and ongoing CGM use to minimize such rate-limiting factors as geography, cost and access to specialty care.
The objective of this study is to evaluate a virtual diabetes clinic model, for adults with either T1D or T2D, that supports integration of CGM into diabetes self-management and evaluates use of decision support technology within the virtual clinic model.
Funding Agency: Helmsley Charitable Trust
2021
Principal Investigator(s): Shelbey Hagen, BS and Mary Henningfield, PhD UW Madison School of Medicine & Public Health / Department of Family Medicine & Community Health
Project Summary: The purpose of the study is address three aims, which are as follows: how participants believe weight stigma impacts their willingness to receive healthcare, how participants believe weight stigma impacts their satisfaction with their healthcare, and how participants believe weight stigma impacts their readiness to make healthy behavior changes.
Funding Agency: DFMCH Small Grant
Principal Investigator: Ronald Aronson, MD Bristol-Myers Squibb
Project Summary: Pragmatic study of approximately 52,000 with Asymptomatic Atrial Fibrillation. An abnormal heart rhythm called atrial fibrillation (AF) can increase the risk of having a stroke if a blood clot forms and travels through the blood stream to the brain. The purpose of this study is to determine if screening patients with a device to detect abnormal heart rhythms reduces the risk of stroke compared to usual standard of care. Since abnormal heart rhythms can come and go, monitoring can increase the chance of detecting AF that is otherwise undiagnosed.
Funding Agency: Bristol-Myers Squibb
Principal Investigator: Ellen Goldstein, PhD, UW SMPH – Department of Family Medicine and Community Health
Project Summary: The first few years of life are a period of exponential brain growth and development. The effects of early exposure to opioids on infant and child development are unknown. To address this knowledge gap, NIH is supporting research to better understand typical brain development, beginning in the prenatal period and extending through early childhood, including variability in development and how it contributes to cognitive, behavioral, social, and emotional function. Knowledge of normative brain trajectories is critical to understanding how brain development may be affected by exposure to opioids and other substances (e.g., alcohol, tobacco, cannabis), stressors, trauma, and other significant environmental influences, including those that promote resilience.
Funding Agency: National Institute of Health
2019
Principal Investigator: Olayinka Shiyanbola, PhD – UW Madison School of Pharmacy
Project Summary: Surveys will be distributed to African American patients with Type II Diabetes taking oral medications to understand their attitudes around medication adherence. The survey will be repeated after 6 months to gauge if any changes in attitudes have occurred. These data will form the basis for developing appropriate interventions for increasing medication adherence that can be tested in future studies.
Funding Agency: UW Madison – School of Pharmacy
Principal Investigator: Paul Smith, MD (PI)
Project Summary: Our primary goal is to pilot test the effectiveness of a promising behavioral change program to improve communication between caregivers of older adults and healthcare professionals with a randomized wait-list controlled trial. We will evaluate a program developed and tested in 2014 which significantly improved communication confidence for a small sample of caregivers of older adults in rural Wisconsin.
Funding Agency: American Academy of Family Physicians (AAFP)
Principal Investigator: Amye Tevaarwerk, MD – UW SMPH Carbone Cancer Center
Project Summary: Our interdisciplinary team of experts in oncology, cancer survivorship, primary care and engineering will identify the necessary elements to develop a PCP-centered care plan from an existing patient-centered and EHR-based care plan. Collaborating with a large primary care research network, we propose a 12-month study relying on systems engineering approaches to accomplish this re-design.
Funding Agency: University of Wisconsin Institute for Clinical and Translational Research (UW ICTR)
Principal Investigator: Meghan Brennan, MD, MS – UW SMPH, Dept of Infectious Diseases
Project Summary: Long-term objective is to reduce the risk of major amputation and death for rural patients with diabetic foot ulcers by developing and implementing interventions that promote integrated care in the rural, ambulatory setting. Primary objective in this proposal, which is the next step in pursuit of that goal, is to identify existing, ad hoc strategies developed by rural providers, and barriers they continue to face, when attempting to provide integrated care for rural patients with diabetic foot ulcers.
Funding Agency: Institute for Clinical and Translational Research (UW ICTR) Community Academic Partnerships (CAP)
Principal Investigator: Matthew Halanski, MD – UW SMPH Department of Orthopedics & Rehabilitation
Project Summary: This project is a combination of retrospective and prospective chart review to develop a comprehensive database of interventions and outcomes of children with SMA, and to develop a prospective, PROM-based data collection method for future project development.
Funding Agency: UW SMPH – Department of Orthopedics & Rehabilitation
Principal Investigator: Elizabeth Burnside, MD, MPH, MS, FACR – UW SMPH, Dept of Radiology
Project Summary: This project will seek to optimize the Shared Decision Making Process of mammography screening for women aged 65 and over. The project will utilize a risk-assessment tool and will engage both patients and primary care clinicians in development of an optimum screening dialogue.
Funding Agency: National Institutes of Health/National Cancer Institute
Principal Investigator: Robin L Gal, M.S.P.H., C.C.R.A.
Project Summary: This pilot study will assess whether initiating CGM remotely (outside of the clinic setting) using a Peer trainer can be performed safely and effectively and will test procedures that could be used in a larger subsequent study.
Funding Agency: Helmsley Trust
Principal Investigator: Sarina Schrager, MD, MS – UW SMPH Department of Family Medicine & Community Health
Project Summary: Propose to develop, pilot and implement an integrated clinic team training program to address knowledge, perceptions, Shared Decision Making (SDM) competence, and cost concerns to improve the use of SDM with average-risk patients eligible for breast and lung cancer screening. Ultimately, the hope is that this training will increase provision of SDM in cancer screening across the UW Health enterprise.
Funding Agency: UW Health Innovations Grant
Principal Investigator: Tosha Wetterneck, UW Medicine
PI Department: Department of Family Medicine & Community Health
Summary of Study: An Industrial Engineering initiated project as follow up to SAFE-C concentrating on the cognitive workload of EMR use.
Objective: The purpose of this project is to develop and test electronic health record (EHR) interface design requirements that support the cognitive work of primary care clinicians and their clinical teams.
The specific aims are
- to identify the cognitive work requirements of primary care clinicians and teams, and
- to develop and test specific EHR interface design requirements by performing usability testing of EHR prototypes with primary care clinicians.
Study Design: We will be using a specific method of CTA, namely, goal directed task analysis (GDTA). GDTA is a type of cognitive task analysis specifically designed for determining cognitive work requirements in order to design information technologies (IT) that support these requirements. The goal of GDTA is to develop IT that provides high levels of situation awareness (SA) for users by giving them the information they need and having them input the right information. For EHRs used by primary care clinicians and clinician teams, this would mean having EHR interfaces that (1) request meaningful information for the clinicians to enter and (2) display the right information for clinicians to produce quick, accurate, and complete pictures of the patients (i.e., the EHR provides high Situational Awareness). What is specifically innovative about GDTA is that it (1) focuses on goals, not tasks, and (2) determines cognitive work requirements so that IT can be developed that supports and extends the cognitive work of the users. GDTA takes information learned from observations and interviews of workers to create cognitive maps of individual and teams of worker’s goals, decision-making and information needs to understand the work that occurs; essentially a non-linear representation of work that can be used to create information technology, in our case, electronic heath records, that better supports the work to be done by individual clinicians and teams of clinicians.
Looking for additional information related to past WREN projects? Please contact WREN at wren@fammed.wisc.edu.
