Abstract

Opioid use disorder has reached epidemic proportions in the United States. Opioid misuse is especially alarming among women of reproductive age. There has been a dramatic increase in maternal opioid use and neonatal abstinence syndrome, a treatable central and autonomic nervous system dysfunction in newborns. Women with opioid use disorders have high rates of unintended pregnancies, low rates of contraceptive use, and more lifetime pregnancies than comparison women. Women of reproductive age in treatment for opioid use disorders often have significant unmet needs with regards to their reproductive health.

To begin to address this complex problem, the proposed research aims are: (1) To assess the extent to which evidence-based sexual health education and reproductive health services for women of reproductive age are currently incorporated into public opioid treatment programs in North Carolina; (2) To assess the feasibility of integrating evidence-based sexual health education and reproductive health services for women of reproductive age in public opioid treatment programs in North Carolina.

We will employ a mixed methods approach: quantitative survey (Aim 1) and in-depth qualitative interviews (Aim 2). Study results will be used as demonstration data to (1) design and pilot-test an evidenced-based sexual health education and reproductive health services intervention in a sample of opioid treatment programs in North Carolina; and (2) to identify efficacious components of implementation strategies through assessment of existing sexual health education and reproductive health programs and unmet needs of women of reproductive age within North Carolina opioid treatment programs.

Funded through the Pilot Program of the NC TraCS Institute and supported by the National Center for Advancing Translational Sciences (NCATS), National Institutes of Health, through Grant Award Number UL1TR001111.

Abstract

For the nearly 15 million cancer survivors in the United States, follow-up care is often poor. Follow-up care and health outcomes improve when cancer care providers develop treatment summaries (TS) – written documents containing information regarding cancer diagnosis, treatment, short- and long-term health effects – and deliver TS to survivors and their primary care providers (PCPs). However, cancer care providers often do not develop TS in practice; when developed, TS frequently omit guideline-recommended content and/or are not delivered to survivors or PCPs. Successful TS implementation involves developing TS with recommended content and delivering TS to survivors and PCPs. Successful TS implementation may be limited by the lack of evidence-based strategies for developing and delivering TS.

Promoting successful TS implementation requires understanding current patterns of use, and identifying and testing strategies to address the barriers cancer care providers face developing and delivering TS in practice. As such, we propose a mixed-methods study to identify variation in TS development and delivery and strategies associated with successful implementation of TS in the 600+ cancer programs participating in the Quality Oncology Practice Initiative. In Aim 1, we will use logistic regression to assess variation in TS development and delivery across cancer program characteristics (e.g., location). In Aim 2, we will identify strategies associated with successful TS implementation using qualitative comparative analysis. Data will be gathered through interviews with cancer care providers who develop and deliver TS. Findings will be leveraged to develop TS implementation interventions to be assessed in a comparative effectiveness trial.

Funded through the Pilot Program of the NC TraCS Institute and supported by the National Center for Advancing Translational Sciences (NCATS), National Institutes of Health, through Grant Award Number UL1TR001111.

Abstract

Adolescent risky behaviors (e.g., substance use, sexual activity, firearm injuries) are highly prevalent, often lead to chronic and costly illnesses, and greatly burden healthcare systems. An NIH R01 (Ridenour, Lead CoPI) is documenting the effectiveness of an evidence-based Screening, Brief Intervention, and Referral to Treatment (SBIRT) for pediatric well-child check-ups in which (a) nurses and pediatricians screen for propensity of risky behaviors and (b) high-risk 9- to 13-year-olds are referred for family-based preventive intervention. Preliminary data demonstrated that Pittsburgh-area, African-American and Caucasian patients, parents, and practitioners support this approach. However, there is tremendous need for this SBIRT in North Carolina, nationwide, and in all racial/ethnic groups.

This TraCS project will acquire preliminary data to support two federal proposals to test SBIRT implementation strategies in NC and then nationwide. Specific Aims are to: 1- Document need for the SBIRT in that standard healthcare procedures fail to detect youth risky behaviors but expend much effort and funds to treat their consequences; and 2- Document the demand, acceptability, practicality, and implementation needs for the SBIRT among NC pediatricians and family therapists. CoPIs Coyne-Beasley (UNC) and Ridenour (RTI) and their multidisciplinary team have the skills to conduct the proposal. However, Implementation of an SBIRT to prevent risky behaviors represents a new research direction for them. Thus, they will consult an advisory board of practitioners and a resident implementation scientist. The research design consists of basic analyses of four large datasets of North Carolinians and primary data collection from pediatricians and family therapists.

Funded through the Pilot Program of the NC TraCS Institute and supported by the National Center for Advancing Translational Sciences (NCATS), National Institutes of Health, through Grant Award Number UL1TR001111.

Abstract

Recently, primary care practices are more commonly integrating behavioral health services, such as screening and treatment for depression, as they seek Patient-Centered Medical Home Accreditation. This shift has created a need for evidence-based implementation approaches for depression screening and treatment that consider resource, staffing, and time constraints.

The purpose of this study is to 1) measure practice capacity and provider readiness to implement an evidence-based depression toolkit among a sample of primary care clinics, 2) develop a menu of implementation options for that toolkit, and 3) assess the feasibility and acceptability of that menu of implementation options by conducting focus groups with stakeholders. Data collection methods for the study include a survey of organizational readiness to adopt the depression toolkit, focus groups to assess current capacity, and additional focus groups to determine the preferred implementation strategies for each clinic environment. The ultimate goal of the pilot project is to improve patients’ mental health outcomes by understanding effective ways to increase consistent screening and evidence-based treatment of depression in primary care.

Funded through the Pilot Program of the NC TraCS Institute and supported by the National Center for Advancing Translational Sciences (NCATS), National Institutes of Health, through Grant Award Number UL1TR001111.

Abstract

79 million Americans have pre-diabetes, but only 11 percent are aware of their condition. This lack of awareness translates to missed opportunities to prevent new cases of diabetes. Based on trials of structured lifestyle intervention programs, there is strong evidence that half of new diabetes cases could be avoided if people with pre-diabetes changed their lifestyle habits to lose a modest amount of body weight. Though the use of community health workers (CHWs), for example, has proven to be an effective and efficient approach to delivering these lifestyle interventions, this and other EBIs are still not being sufficiently used on a national level. Cost acts as a major barrier to the adoption of EBIs by organizations as well as the enrollment of community members into such programs. In order to address this barrier, research is needed on the perceived value and demand for diabetes prevention programs (and for employing CHWs in program delivery), from the perspectives of both potential recipients (adults at high risk for/ diagnosed with pre-diabetes) as well as decision-makers in healthcare and public health delivery.

The purpose of this study is 1) to assess the demand (actual use, intention to use, and perceived demand) for diabetes prevention EBIs and the potential delivery role of CHWs, and 2) to use demand-based pricing methods to determine perceived value and willingness to pay for diabetes prevention programs (including delivery by CHWs). Using a mixed-methods approach, this study will target both the potential recipients of prevention EBIs as well as the decision-makers in healthcare.

Funded through the Pilot Program of the NC TraCS Institute and supported by the National Center for Advancing Translational Sciences (NCATS), National Institutes of Health, through Grant Award Number UL1TR001111.

Abstract

Significant health-related barriers have historically hindered employment for women in welfare-to-work programs. For the first time, however, an evidence-based intervention (EBI) using public health nurse (PHN) case management is available to address these barriers and potentially reduce health disparities. Unfortunately, this EBI and others have seen low rates of adoption, largely due to poorly-regarded dissemination approaches that fail to increase adoption interest of welfare-to-work and PHN managers. Research drawing upon Roger’s Dissemination and Innovation Theory suggests that dissemination approaches with a more customer-oriented marketing perspective would be more effective in increasing adoption interest for EBI’s.

The purpose of this study is to explore whether a new, graphics-rich, simulation-based approach would more effectively disseminate the PHN case management EBI to welfare-to-work and PHN managers than a standard, description-oriented approach. This new dissemination approach, developed by applying dynamic modeling and using software to create rich graphic representation, will simulate the effect that adopting EBI’s would have on the specific populations each manager is responsible for. The study will use a survey methodology to examine EBI adoption-related characteristics of welfare-to-work and PHN managers in 50 North Carolina counties. The study will then assess the effect the simulation-based approach has on EBI appraisal and adoption interest, compared to the effect the standard description-based approach has on these two factors.

Funded through the Pilot Program of the NC TraCS Institute and supported by the National Center for Advancing Translational Sciences (NCATS), National Institutes of Health, through Grant Award Number UL1TR001111.

Abstract

An absence of reliable measures hinders researchers from evaluating the effectiveness of strategies to build practitioners’ capacity. To address this need for reliable measures, we propose to develop and test a theory-derived measure of practitioner capacity. This study will utilize an interdisciplinary team of UNC faculty and RTI investigators to:

1. identify and, as needed, create survey items that address central theoretical constructs (capability, motivation, and opportunity to plan, implement, and sustain P&E interventions),
2. refine theoretical constructs and identify a final set of survey items via card sorting,
3. refine survey items via cognitive interview methods, and assess the instruments factor structure, reliability, and validity via a field study with public health and community-based practitioners.

Funded through the Pilot Program of the NC TraCS Institute and supported by the National Center for Advancing Translational Sciences (NCATS), National Institutes of Health, through Grant Award Number UL1TR001111.

Project Description

Integration of palliative care (PC) concurrently with cancer treatment is associated with improved health outcomes and cost savings. Despite the known benefits, many hospitalized cancer patients do not receive PC.  The implementation of predetermined clinical criteria (i.e., metastatic disease with uncontrolled symptoms) for identifying cancer inpatients who need PC improves quality of cancer care.  Yet, no standard process exists to automatically identify cancer inpatients who meet PC criteria using the electronic health record (EHR). The vast majority of this clinical information exists in free-text notes, requiring time-consuming and costly manual abstraction. This pilot project addresses an urgent need to develop technological solutions that leverage unstructured data to identify cancer inpatients who need PC.  The long-term goal is to develop innovative strategies for improving PC integration in oncology.  The study objective is to develop a natural language processing (NLP) algorithm using EHR data to identify cancer inpatients who need PC.  Our aims are to: 1) identify optimum data elements for the algorithm by examining clinicians’ documentation process through semi-structured interviews with stakeholders (e.g., oncologists, PC physicians); and 2) develop an NLP algorithm and evaluate the model in comparison to a “gold standard” (chart review).  Our research is innovative in that few studies have examined the use of machine learning methods to identify cancer inpatients who need PC.  Our research is significant in that it will generate an algorithm that could potentially be incorporated into a clinical decision support tool, thereby tailoring PC access and services to match patient needs.

Project Description

Funded through the U24/Cooperative Agreement mechanism from the NHLBI and NIMHD

Advances in care delivery and treatment have more than doubled the life expectancy of individuals with sickle cell disease (SCD) since 1972. Beginning in the 1970s, measures such as newborn screening and prophylactic administration of penicillin decreased complications and morbidity, increasing the length and quality of life of children with SCD. More recently, the use of hydroxyurea as a therapeutic agent to increase fetal hemoglobin has been shown to further reduce the debilitating symptoms of and improve survival in SCD. However, many of these advances have not translated into an increase in longevity or quality of life for adolescents and adults because of disparities in access to routine primary health care.

NHLBI and NIMHD are cosponsoring the Sickle Cell Disease Implementation Consortium (SCDIC) to improve the health and well-being of adolescents and adults with SCD by addressing the barriers to health care that exist at multiple levels in the United States. As the DCC for the SCDIC, RTI will facilitate scientific collaboration to achieve the program objectives by providing logistical, data management, and statistical support; by contributing to the design, development, and management of the needs assessment, the SCD Registry, and individual implementation research protocols; and by establishing study operations to efficiently monitor studies and to collect, manage, analyze, report, and disseminate the resulting data.

RTI’s specific aims as the DCC are as follows:

Aim 1: Enhance Consortium Efficiency and Productivity by Providing Logistical and Operational Support, Scientific Expertise, and Sound Advice.

Aim 2: Identify Gaps and Barriers to Care and Strategies to Improve Access to Care by Providing Needs Assessment Support.

Aim 3: Develop and Sustain a SCD Registry that Provides Patients for Implementation Research and Data on Patient and Provider Outcomes.

Aim 4: Test Interventions and Clinical and Behavioral Outcomes by Providing Support for Implementation Research Studies.

The planned SCDIC research program will join implementation science, a newly emerging field that tests interventions under real-world or usual conditions, with clinical care practices and the patient community. If our proposed aims are met, the end products of this research will identify barriers to care and evidence-based practices that will improve patient access to care, sustainability of care, and quality of life. By sponsoring this research, NHLBI and NIMHD are taking a huge step toward addressing the health care needs of the SCD patient community and, ultimately, improving their health outcomes.