WREN Projects

PIs: Sarina Schrager MD, MS; Mary Henningfield, PhD; Earlise Ward, PhD

Funding Agency: University of Wisconsin Department of Family Medicine and Community Health

What problem is this project trying to address?

African American women in Wisconsin face a 50% higher breast cancer death rate compared to white women, partly because the disease is often diagnosed at a later stage. Additionally, medical mistrust among African American women may play a role in lower screening rates and these health disparities.

How will this be achieved?

This project will focus on creating and testing materials about shared decision-making (SDM) for breast cancer screening with African American women. A virtual focus group with midlife African American women from the community will be held to get feedback on the materials and process. Using their input, materials will be updated, and the group will be reconvened to review. The focus groups will be led by two midlife African American women. Five to 10 primary care doctors who treat diverse women will be interviewed to understand their experiences with SDM. Finally, the updated materials will be tested in a primary care clinic to see if they are practical and effective.

What could this mean for African American women?

The goal of this project is to help African American women confidently make choices about mammography screening. It aims to improve communication between doctors and their African American patients, leading to better decision-making, more trust, following screening guidelines, and reducing racial disparities in breast cancer diagnoses.

PIs: Sarina Schrager, MD, MS; Mary Henningfield, PhD; Earlise Ward, PhD, LP, HSP; Yao Liu, MD, MS

Funding Agency: National Institute of Health (NIH) Common Fund

WREN is part of a groundbreaking pilot program developed by the National Institutes of Health (NIH). The CARE for Health award designated WREN as one of three inaugural primary care Network Research Hubs. CARE for Health aims to address barriers to clinical research participation by integrating innovative research into routine clinical care in real world settings. By engaging rural clinics, patients, and communities, Network Research Hubs are integrating research into rural primary clinics to improve health outcomes.

“As part of the CARE for Health initiative, WREN will leverage existing relationships with rural clinics to increase opportunities for community members to participate in and provide input on clinical trials to improve health outcomes for their communities. This work is critical to the goals of the initiative to establish a foundation for sustained engagement with communities underrepresented in clinical research, including people who live in rural environments,” says Henningfield, WREN executive director.

WREN’s mission to promote and conduct primary care research and education in partnership with primary care clinicians and the communities they serve aligns with the goals of CARE for Health to improve access to clinical research to inform medical care. Building on its decades-long history of productive, high-quality research and quality improvement projects in rural communities, WREN is well poised to serve as a rural Network Research Hub.

CARE for Health is part of the NIH Common Fund under Other Transactions Agreement number OT2OD038373. The NIH Common Fund supports cross-cutting programs expected to have exceptionally high impact. This is the first round of CARE for Health funding issued by NIH.

Learn more about the CARE for Health Initiative.

PIs:

• Jennifer McNeely, MD, MS – New York University School of Medicine
• Jane Liebschutz, MD, MPH – FACP University of Pittsburgh School of Medicine

Funding Agency: Engagement of WREN rural clinics in Co-Care is funded by the National Institutes of Health through the CARE for Health initiative. The National Institute on Drug Abuse (NIDA) is the Co-Care study sponsor.

What problem is this project trying to address?

Most patients with polysubstance use disorders (including opioids, stimulants, and alcohol) are not seen in addiction treatment programs. Thus, there is an unmet need for better management of patients with polysubstance use disorders in other settings.

How will this be achieved?

• Primary care clinics have the potential to be an optimal setting to care for patients with polysubstance use disorders as most people have primary care visits.
• The Co-Care study will test a collaborative care approach in primary care clinics for management of patients with polysubstance use disorders.
• The study involves a nurse care manager who will work with primary care clinicians to coordinate patient care, including contingency management for patients with stimulant use disorders.

What could this mean for participants?

Patients with polysubstance use disorders may receive better care through a collaborative team approach in primary care clinics.

Clinicaltrials.gov; NCT: 116266 https://clinicaltrials.gov/study/NCT06116266

PI: Eric Simpson, MD, MCR
UW Madison Site PI: Sarina Schrager, MD, MS

Funding Agency: National Institutes of Health – National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIH-NIAMS)

What problem is this study trying to solve?

Atopic dermatitis (AD) affects more than 9 million children in the US and ranks first among all skin conditions in global disability burden. AD negatively affects not only the quality of life of children and families but has a significant socioeconomic impact. Despite decades of research, effective strategies to prevent AD are needed.

What will be studied?

This pragmatic, multisite, randomized community-based trial will enroll dyads of a parent or legal guardian and an infant age 0 to 2 months to see whether use of emollient therapy from birth can prevent or delay the onset of AD.

What could the study mean for patients?

Identifying an effective strategy to reduce the prevalence of AD would benefit patients and their families by reducing the morbidity associated with AD. If effective for prevention of AD, the use of emollients could mean a substantial cost savings to the health care systems. In addition, preventing AD development and protecting the skin barrier early in life could potentially modify food allergy and asthma risk.

PIs: 

• David Feldstein, MD – University of Wisconsin–Madison
• Devin Mann, MD – New York University Langone Health

Funding Agency: National Institutes of Health

What problem is this study trying to solve?

Up to 50% of antibiotic prescriptions for patients with acute respiratory tract infections are inappropriate, contributing to the worsening problem of antibiotic resistance and treatment-resistant infections. New strategies to ensure appropriate antibiotic prescribing patterns are needed.

What will be studied?

Patients with cough or sore throat will be triaged to determine which patients with mild or moderate symptoms are appropriate for nurse visits. At the visits, nurses trained by study team members will evaluate the patients using clinical decision support tools to determine the patient’s risk of having either strep throat or pneumonia. Low-risk patients will receive education and reassurance. Intermediate- and high-risk patients will be tested and treated with antibiotics if positive. The research team will evaluate the rates of inappropriate antibiotic prescribing in nurse visits compared to physician and APP visits. Nurse, physician, and APP burnout, patient satisfaction, and cost-effectiveness will also be evaluated.

What could the study mean for nurses and patients?

The research team believes this strategy will decrease inappropriate antibiotic prescribing by using standardized criteria to determine the need for testing and antibiotic treatment. This will minimize the potential harm to patients from unnecessary antibiotics. This will also contribute to decreased nurse burnout by empowering nurses to work to the top of their license and improve cost-effectiveness of caring for low acuity patients with cough and sore throat. This study will provide a model for leveraging nurse-provided patient care using clinical decision support to provide high quality patient care across other diseases.

PIs: Michael Leasure, MD; Mary Henningfield, PhD

Funding Agency: University of Wisconsin Department of Family Medicine and Community Health

What problem is this project trying to address?

Over the past few decades, the United States has grown increasingly divided — politically, economically, and socially. Many of us feel this polarization not just in headlines, but in our daily lives: in conversations with neighbors, in the tone of public discourse, and in the widening gaps between communities. At the same time, we’ve witnessed a troubling decline in population health, especially among individuals with a high school education or less.

These parallel trends — deepening inequality and deteriorating health — raise urgent questions. Are they connected? And if so, how? What role can the health care system play in addressing not just symptoms, but the structural forces driving these outcomes? Where do we, as clinicians, public health professionals, and community leaders, have the power to intervene?

This study explores a promising path forward: civic engagement. Emerging evidence suggests that when individuals are empowered to participate in civic life — whether through voting, volunteering, or community organizing — they not only strengthen the democratic fabric of their communities but also experience better health outcomes. In this way, civic engagement may serve as a powerful bridge: linking improved public health with a more cohesive, resilient society.

How will this be achieved?

This proposal centers on a vital first step: launching a survey to better understand civic engagement among patients served in primary care settings. Our initial pilot will take place at the UW Health Odana Road Clinic, providing an essential foundation for broader outreach.

While our long-term mission is to focus on low-income and underrepresented populations, those often overlooked in both civic and health care systems, we’ll begin by casting a wide net within the pilot site to ensure strong participation and meaningful data.

By starting here, we aim to build a deeper understanding of how civic life intersects with health — and how engaging patients beyond the exam room may open new avenues for healing and connection.

What could this mean for patients/communities?

Reframing civic engagement as an upstream driver of health could offer a powerful new lens for tackling long-standing inequities. By recognizing its influence on more traditional social determinants — like housing, education, and employment — we can strengthen ongoing efforts to confront the structural and environmental challenges many patients face every day.

PI: Miena Meek Hall, MD, IBCLC

Funding Agency: University of Wisconsin Department of Family Medicine and Community Health

What problem is this study trying to solve?

Lactation insufficiency (LI) impacts an estimated 5–15% of breastfeeding pairs, and one of the strongest indicators is poor breast growth during pregnancy — a sign that often correlates with low milk production. Currently, a diagnosis of insufficient glandular tissue (IGT) is typically made after the fact when a baby fails to gain weight despite proper breastfeeding support, and the parent notes minimal breast changes during pregnancy.

Our proposed feasibility study aims to shift that timeline forward. What if we could predict low milk production before a baby is born? We plan to explore whether prenatal imaging of breast fibroglandular tissue (FGT) could be a reliable early indicator. Using ultrasound and MRI (the gold standard for quantifying FGT), we’ll track fibroglandular development during pregnancy and see if it holds predictive power.

How will this be achieved?

In this study, we’re setting out to explore three key questions. First, can ultrasound and MRI reliably track changes in FGT throughout pregnancy? Second, how well do imaging biomarkers from ultrasound align with those captured by MRI? And third, can those changes in FGT help us predict how much milk someone will produce in the early postpartum period?

To answer these questions, we’ll perform ultrasound and MRI scans on multiparous participants at two time points during pregnancy, analyzing how FGT changes over time and comparing the two imaging methods. Then, at four weeks postpartum, we’ll measure milk output over a 24-hour period and correlate that data with imaging features from earlier during pregnancy.

The findings from this feasibility study will laythe groundwork for a future pilot trial, helping us plan a larger investigation and generate preliminary data for upcoming grant proposals. Our ultimate vision? To develop and validate early screening protocols that identify individuals at risk of IGT so we can offer targeted lactation support and improve outcomes for breastfeeding dyads from the very beginning.

What could this mean for patients/communities?

When milk production falls short, the consequences can be serious. Infants are placed at risk for conditions like hyperbilirubinemia, hypernatremia, and hypoglycemia. For parents, the impact is often emotional as well, ranging from distress and anxiety to postpartum depression. Over the long term, insufficient milk can contribute to failure-to-thrive, kernicterus, and developmental delays in infants, while parents may face increased risks of breast cancer, mood disorders, and disrupted bonding.

To prevent these outcomes, we urgently need validated screening tools that identify at-risk individuals early in pregnancy. With the right information, parents can receive proactive guidance, set realistic feeding expectations, and access clinical support, empowering them to navigate the lactation journey with greater confidence and care.

PI: Yao Liu, MD, MS

Funding Agency: National Institutes of Health/National Eye Institute

What problem is this study trying to solve?

Diabetic retinopathy is an eye condition that can cause vision loss and blindness in people who have diabetes. Early detection of diabetic retinopathy is essential to effective treatments to prevent vision loss or blindness. Teleophthalmology is a validated method for diabetic eye screening that is underutilized in primary care clinics in the US. Teleophthalmology could provide eye screenings to underserved and remote rural patient populations who otherwise may not have access to specialized eye care.

What will be studied?

This project will test the effectiveness of teleophthalmology versus usual care in rural health care systems across six states. Practice facilitation will help clinics implement teleophthalmology. Factors that distinguish high and low teleophthalmology-use health systems following I-SITE implementation will be measured.

What could the study mean for patients?

The goal of this work is to facilitate early detection of diabetic eye disease through increased use of teleophthalmology in primary care settings. Early detection of diabetic eye disease could help prevent vision loss and blindness by allowing earlier treatment with available effective treatments.

PI: Earlise Ward, PhD; Co-PI: Sarina Schrager, MD, MS

Funding Agency: University of Wisconsin–Madison Carbone Cancer Center

What problem is this study trying to address?

Breast cancer continues to be a leading cause of cancer death among women. Early detection of breast cancer through screening mammography is one way to help improve patient outcomes, but rates of breast cancer screening are lower among women living in rural areas.

What will be studied? 

Results of a previous collaboration between Prairie Ridge Health and the University of Wisconsin–Madison showed that participants who answered a survey about mammography were already engaged with a health care system. In this project, we aim to reach out to women who are not already engaged with the health care system to collect their views about mammography and why they do not routinely get a mammogram.

What could the study mean for patients?

Understanding and addressing barriers to screening mammography has the potential to increase early detection of breast cancer. Detecting breast cancer early, when treatments tend to be more effective, offers the best chance to improve survival.

PI: Sarina Schrager MD, MS

Funding Agency: Oscar Rennebohm Foundation

What problem is this project trying to address?

This project addresses loneliness and social isolation, which can lead to mental and physical health problems like anxiety, depression, and heart disease.

How will this be achieved?

The project starts by creating training for clinicians on loneliness and social isolation, based on a review of existing information. We focus on primary care because it’s where most people get their health care.

Next, steps will be developed to screen for loneliness in UW Health primary care clinics using the UCLA 3-Item Loneliness Scale, a reliable tool with three simple questions.

Finally, a “social prescribing” approach will be tested for people identified as lonely through screening. Research is needed to confirm whether this method effectively reduces loneliness and social isolation in older adults in the community.

What could this mean for older adults?

The goal is to improve the overall well-being of community-dwelling older adults by screening for loneliness and testing the use of social prescribing to reduce loneliness in UW Health primary care clinics in Dane County.

PI: Aimée Wattiaux, MD, MPH

Funding Agency: University of Wisconsin Madison Department of Family Medicine and Community Health

What problem is this study trying to solve?

Weight bias is a highly prevalent and under-recognized issue in health care settings. In addition to psychosocial consequences such as depression, anxiety, decreased social involvement, and increased allostatic load, weight bias from health care professionals results in frequent misdiagnosis and alienation of patients. People in larger bodies intentionally delay or avoid care to protect themselves from the bias and stigma they face in health care settings. For a field that strives to do no harm, it is essential that we re-examine our approach to the care of patients in larger bodies.

What will be studied? 

This focus group study will explore the perspectives of larger-bodied patients at Wingra Family Medical Center on the care they have received in clinic. The focus group questions will solicit both positive and negative experiences patients have had — the ways they have felt safe and respected in clinic as well as the ways they have felt judged and unwelcome. Participants will also be invited to share their recommendations on ways to make Wingra Clinic more size inclusive.

What could the study mean for clinicians and patients?

By identifying the ways that Wingra patients experience weight bias in clinic and exploring potential interventions to improve care, the information gathered in this study will be used to offer specific recommendations on how Wingra and similar clinics can better serve their larger-bodied population. This study will challenge clinicians to recognize how weight bias manifests in their own practice and how clinic culture can either alienate or advocate for patients in larger bodies.

Project Summary: Creation of research and learning consortium to accelerate the conduct of PBRN research through a common infrastructure enabling the efficient conduct of research. The consortium will promote continuous learning across networks and practices for evidence dissemination and knowledge transfer.

Funding Agency: Agency for Healthcare Research and Quality

Workshop: Multi-Network Research Collaboration: Steps to Success