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This project, funded by the Agency for Healthcare Research and Quality, (AHRQ) has been tasked to design and test a Heart Healthy Quality Improvement Project (QIP) focused on improving cardiovascular health and reducing disparities in CVD care using a unique co-design approach.
Four primary care practices have designed a Quality Improvement Project (QIP) under the leadership of co-design expert Richard Buchanan, PhD. The co-design period, which began in January 2021, completed the design of the quality improvement project in July, which will now be implemented in a step-fashion during the next phase of the project.
The Heart Healthy Project has now recruited fifty-two Ohio Primary Care Practices, including two UC Health academic practices and three rural ACRMC practices. These practices will be supported by QI experts as they implement the new QIP, focused on improvements in Hypertension control and Smoking Cessation rates. They will each attend four webinars over 12 months, to facilitate implementation and change will be guided by their clinical data. Practices will have access to the evidence-based resources developed by the Ohio Cardiovascular Health Collaborative and Cardi-OH.
The January 2022 Coronavirus Surge impacted the capacity of many practices to initiate new quality improvement projects. Because of this, the AHRQ HHIO project has rescheduled the Kick-Off for April 27 and the first cohort of the expansion will begin in May 2022.
For further information contact Dr. Saundra Regan, PhD at regansl@ucmail.uc.edu.
A statewide network of seven academic medical institutions, funded by the Ohio Department of Medicaid, was originally formed in 2017 with the goal of improving Cardiovascular health outcomes and eliminating disparities in Ohio's Medicaid population.
Physicians, nurses, pharmacists, and other allied healthcare professionals make up our working groups. Each year, these working groups create and disseminate new evidence-based materials. These free materials are available at a public access website: https://cardi-oh.org
The ECHO model, a unique method of sharing knowledge across disciplines, continues as a key method to expand our reach to Ohio Primary Care providers. The Spring 2023 ECHO Clinic will begin a new 12-week series in January 2023 on Innovations in Diabetes and Cardiovascular Health.
For further information, please visit https://cardi-oh.org or contact Mary Beth Vonder Meulen at marybeth.vondermeulen@uc.edu
In order to improve cervical cancer screening rates at a local community health center that provides primary care to LGBTQ+ adults, our team has paired with the population health nurse at Equitas Health. The 2020 American Cancer Society Cervical Cancer Screening guidelines recommends doing primary HPV testing rather than a pap smear with cytology and suggests that self-collection of a sample is reasonable in populations who otherwise would not be screened. Our team is using implementation science to guide implementation and evaluation of a quality improvement initiative that will introduce self-swab for HPV as a means of improving cervical cancer screening rates and will do a survey and interviews to assess acceptability of this method to LGBTQ+ individuals. We have developed a video for patient discussions their options and have begun data collection.
For further information, please contact Andi Christopher at anderson.christopher@uc.edu.
This project explored food insecurity of older adults in the Walnut Hills community (identified as Food Desert since 2017) during the height of the COVID pandemic. In 2020 we surveyed 48 adults, aged 55 or older, who live in Walnut Hills. The information was analyzed, and a healthy food cooking program was planned for Fall 2021 partnering with La Soupe, a program that takes food that would be tossed out and rescues it to prepare into healthy soups and other meals that are given to those who otherwise would go hungry. Unfortunately, the surges in Delta and Omicron Covid Pandemic led to cancellation of the in-person classes.
The project team met on February 24 to discuss the best way to re-engage with residents of the Alexandria, a Walnut Hills unit providing housing for elderly and disabled persons. Present at the meeting, led by UC DFCM faculty Anna Goroncy MD were four Family Medicine Resident Physicians, two UC Medical Students, three Community Organization representatives and the UC Family Medicine Research Director and Research Nurse.
At that meeting, the Food Insecurity Survey was updated, and the team devised a two-step plan to maximize participation in the survey. A free in-person dinner, with food donated by La Soupe, was held at the Alexandria on February 26. Residents were encouraged to complete the survey while enjoying dinner. An additional supply of the surveys, along with pre-paid return envelopes, were left in the Alexandria common areas. At the next meeting our team will be able to judge the success of this survey plan.
The weekly Friday Food + Fun outdoor event continues every Friday with food from La Soupe and the Healthy Harvest Mobile Market. Gary Dangel, from the Walnut Hills Redevelopment Foundation, will also be there to encourage neighborhood participation in the Walnut Hills fruit, vegetable, and flower gardens. More information may be found on the Foundation’s Facebook page at WH Redevelopment Foundation Facebook Page.
For further information, please contact Dr. Anna Goroncy at goroncar@ucmail.uc.edu.
This project utilizes a team of co-researchers to design a peer-led group stress management program, given that previous work with LU-SALUD (our partner CBPR group) has identified stress as a health priority for Cincinnati Latinos. Our co-researchers administered 121 surveys that they co-created and are planning a facilitated community conversation to share and get context for the survey results.
We have published a systematic literature review describing psychometric properties of scales measuring stress in US-based Latinx immigrants and are currently writing a systematic literature review describing psychometric properties of scales measuring resilience in Latinx immigrants. We held a community conversation with a Latinx church congregation to review and contextualize the results from our survey and are currently doing qualitative analysis of the transcript from this. Our next steps include implementing a YouTube video in Spanish about how to manage stress in partnership with Dr. Brittany Carter-Tidwell.
Public health data shows that Latinos in Cincinnati are disproportionately affected by latent tuberculosis infection. This project is an initiative with faculty from UCCOM Departments of Infectious Diseases and Family and Community Medicine, a social psychologist from CCHMC, community participatory research group Latinos Unidos Por la Salid (LU-Salud), and the Hamilton County Public Health Tuberculosis Control clinic. We have started community-based interviews with Cincinnati Latinos to assess their knowledge and beliefs about latent tuberculosis. We will then form a Community Advisory Board (CAB) with whom we will share the results. The CAB will invite public health, primary care, religious, and social service leaders to join LU-Salud co-researchers in designing an initiative aimed at improving screening rates, and treatment for, latent tuberculosis in Latinos in Cincinnati. We have completed twenty-five community-based interviews. We had three CAB meetings in 2022 and CAB members have already begun to share excellent ideas and strategies for addressing disparities.
Phase 1: We analyzed qualitative admissions data from two groups of 2010-2019 UC medical school graduates: students who matched to FM and a random comparison sample of non-FM matches. We used natural language modeling to recognize semantic patterns in the data, which guided a more traditional content analysis to generate themes. This work has been presented at multiple conferences, with a final presentation at the October 2021 Family Medicine Educational Consortium (FMEC) annual meeting. The manuscript was accepted by the journal, Family Medicine and will be published later this fall.
Phase 2: Using machine learning, we have developed an algorithm to inform prospective identification of incoming students who are likely to be future FM physicians. Students identified by the algorithm will be entered into a pipeline tracker to facilitate mentoring, peer-support, or additional family medicine experience earlier in their medical school training. The long-term objective of this study is to increase the number of medical students at UC who choose FM as their medical specialty. Using the results of Phase 1, we are evaluating an algorithm that is currently able to predict FM or non-FM residency selection with 80% accuracy.
For further information, contact Dr. Jackie Knapke at jackie.knapke@uc.edu.
The Cincy Homeless Resource Map app (available free in the Apple Store & Google Play) The app is intended to connect providers and community members to resources for those experiencing homelessness or at-risk for homelessness. This purpose of this project was to evaluate the Cincy Homeless Resource Map app by end users. We took the app to people experiencing homelessness, community service providers, and primary care providers who care for people who are homeless. We conducted surveys as well as a talk aloud evaluation as the participant used the app. Our next step is to analyze the data and publish the results.
For further information, please contact Harini Pallerla at harini.pallerla@uc.edu.
Transgender/gender expansive (TGGE) individuals are those whose gender identity does not align with society’s expectations of their sex designated at birth. Despite an increase in TGGE health research over the last ten years that has illustrated alarming health disparities, there are significant gaps in knowledge to fully inform healthcare practices and system level policies that address inequities.
The Healthcare Interprofessional Gender Health, Education and Research (HIGHER) Academy was developed as an adaptable, reproducible, sustainable year-long research course for interprofessional graduate students that is taught exclusively by TGGE individuals and cisgender women. Eligible disciplines include nursing, pharmacy, medicine, allied health, psychology, sociology, public health, social work, and counseling. The course focuses on health disparities, opportunities in the delivery of clinical care, and opportunities in research methodology and engage HIGHER scholars in interprofessional team-based collaboration to design a research proposal aimed at promoting TGGE health.
Content development for the course and the formation of the Community-Academic Advisory Board (CAAB) is currently underway. The CAAB is essential to the HIGHER Academy in the development of content for the course. It is formed from both community and academic members who have relevant lived and/or professional experience. The CAAB meets every other month and will annually be comprised of about 15 individuals, including representatives from Equitas Health and University of Cincinnati Medical Center.
For further information, please contact Dan Hargraves at dan.hargraves@uc.edu.
UC DFCM has have received grants from the CCTST and Office of Research to do several projects in partnership with the Immigrant & Refugee Law Center (IRLC). In summer 2021 we worked with an IRLC client to use Group Level Assessment to describe the health needs, priorities, and barriers of local immigrants and refugees being served by IRLC. We had 15 IRLC clients join two virtual sessions, one in English and the other in Spanish. A medical student updated a local resource guide and will assist with Health Navigation to connect IRLC clients without a regular source of care to local health services. Our co-researcher, who is a client at IRLC, designed a phone survey that our research assistant has done with nine clients.
Additionally, we have done medical evaluations of three IRLC clients to assist their lawyers with their cases.
Finally, in a feasibility study we have the following aims 1) the demand for forensic medical evaluations amongst IRLC clients, 2) the demand for participating in a medico-legal partnership serving immigrants/refugees amongst UC medical and law students, and 3) the impact of volunteering with IRLC on the career intentions of involved students.
To address Aim 1, we are auditing IRLC intakes to determine the demand for medical evaluations, and providing valuable information to them on their volume, the demographics of people seeking their services, and the types of relief people are seeking from them. To address Aim 2, we have collected data from UC medical students and residents in pediatrics, family medicine, psychiatry, internal medicine, and emergency medicine on their interest in participating in the partnership and will be doing a quantitative evaluation soon. Lastly, to address Aim 3, we have been interviewing students who previously collaborated with us to deter-mine the impact of their participation on future career plans. We are exploring opportunities to work with ado-lescents looking for Special Immigrant Juvenile Status cases.
UC College of Medicine (COM) has been chosen by ODM to serve as a Regional Quality Improvement (QI) Hub. The goal of the QI Hub will be to translate best-evidenced care more reliably into clinical practice, offering structure to collectively support health improvements that can be measured at the level of Ohio’s populations. Single institution efforts focusing on chronic conditions such as hypertension and diabetes have already been successful in achieving significant improvements in health status as well as closing disparity gaps for the Medicaid population. A “Hub and Spoke” model offers greater scale as well as choice of clinical practice areas ripe for improvement. The six Regional QI Hubs will be comprised of an Ohio College of Medicine and select hospital partners to serve as the central ‘hub,’ with other interested practices acting as ‘spokes.’ The Government Resource Center (GRC) will provide project management to the participating Colleges of Medicine. UC’s Dept of Family and Community Medicine is leading this grant in partnership with faculty from the UC Dept of General Internal Medicine (GIM), the UC Dept of GIM and Pediatrics with QI Leadership from UC Health.
For further information, please contact Asia Harris at asia.harris@uc.edu.
The University of Cincinnati Department of Family and Community Medicine (UC DFCM) has partnered with Wuqu’Kawoq and the Universidad del Valle de Guatemala (UVG) to pilot Project ECHO as a format to provide mental health education to Guatemalan primary care physicians as well as Guatemalan medical students, nursing students, and psychology students who are on their rural health rotations. Faculty from UC DFCM, UC Department of Psychiatry and Behavioral Neurosciences, and UVG provide interdisciplinary expertise and discuss cases submitted by students based on their clinical work. Our team implemented and evaluated a five-session pilot program in April-May 2021 and shared preliminary results which show trends towards improved attitudes and self-efficacy at a national conference. We are currently working with our team to draft manuscripts of our results.
UC DFCM has partnered with Refuge Collaborative and Cincinnati Public Schools (CPS) to evaluate a health literacy curriculum developed by Refuge for refugee adolescents. A two-stage pilot program has been completed. Our undergraduate researchers presented data from the pilot program at the UC Undergraduate Research Symposium at the international North American Refugee Health Care Conference. We have recently received a generous grant from the CCTST to partner with a student who participated in the pilot program to revise our curriculum, expand our reach, and more robustly evaluate our program. We have selected a student who participated in the pilot program to come onto the te as a co-researcher. We are now preparing to start teaching at Withrow High School.
Low-cost air sensors offer tremendous opportunities for researchers and community members to better understand air pollution exposures at neighborhood, indoor, and personal levels. Though these devices are often marketed as easy-to-use, users face multiple challenges including maintenance, calibration, data management, and data visualization. These issues often lead residents and researchers to form community-academic partnerships within a community-engaged research (CEnR) framework. However, successful community-academic partnerships require time and training to set expectations, identify team member roles, develop team processes and shared mental models, and design a project that balances the needs of a community with the expectations of academic researchers.
In recognition of both the opportunities and challenges of using low-cost sensors in CEnR, we propose an innovative program to foster successful community-academic partnerships and equip research teams with the technical skills and knowledge to successfully utilize low-cost sensors in environmental justice (EJ) communities. Our program, entitled Research Innovations using Sensor Technology in Environmental Justice Communities (RISE Communities), will accomplish three specific aims using a combination of in-person training, experiential learning, and a social learning community. We will recruit community-academic teams (5 per year) from throughout the US and provide these teams with dedicated time and training to build trust, set expectations, enhance sustainability, and engage in evaluation (Aim 1). In addition, experts in the use of low-cost sensors and their application in EJ communities will provide in-person courses, workshops, and hands-on training on their use.
This training will equip teams with the requisite foundational knowledge in research methods employing low-cost sensors including how to select the appropriate sensor(s) for their research questions, deploy them in their own communities, and translate the data to action (Aim 2). Throughout the program we will cultivate a community of practice to facilitate continued interaction among participants and program faculty and extend the learning beyond the in-person training (Aim 3). Collectively, these aims address the urgent need in environmental health research to foster successful community-academic partnerships to address disparities in air quality experienced by residents of EJ communities. In addition, the RISE Communities program will promote the use of sensor technology in EJ communities to encourage data-driven action to improve public health. This R25 proposal was awarded in September 2022 with Drs. Jackie Knapke and Patrick Ryan as MPIs.
For further information, please contact Dan Hargraves at daniel.hargraves@uc.edu.
The purpose of this evaluation is to measure the impact of the training program Serving At-risk youth Fellowship Experience – specialty Training (SAFE-T), that trains social work (SW), mental health counseling (MHC), and psychiatric-mental health nurse practitioner (PMHNP) students to provide culturally competent opiate use disorders (OUD) and substance use disorder (SUD) prevention, treatment, and recovery services as members of integrated healthcare teams that collaborate with DATA-waived medication assisted treatment (MAT) prescribers. The evaluation will include perspectives from fellows, faculty, and site supervisors from community field placement sites that provide OUD and SUD services. We are in Year 3 of this program.For further information, please contact Harini Pallerla at harini.pallerla@uc.edu.
The UC CON and the UC COM DFCM received a grant from the Ohio Department of Medicaid to create online patient experiences of underserved patients. The patients will include a chronically homeless patient with severe mental illness, a transgender patient, and a patient with intellectual and developmental disabilities and the patient’s caregiver. These scenarios will be used as educational tools for Medicaid providers in Ohio.
The research team has completed interviews with patients and their care providers (when appropriate). A Qualitative analysis of the interviews with patients and care providers was used to inform draft scripts. The scripts were edited by physicians who were expert in the clinical areas. The final scripts were approved by the Government Resource Center (GRC) in December 2021.
The UC Center for Simulations and Virtual Environments Research Team have been programming the three scenarios into interactive simulations. The leadership and core development teams review and rebuild the scenes and characters, working towards final simulations. The three web-based simulations have gone through multiple iterations of reviews by Ohio Medicaid and the GRC. In August we conducted an alpha test of the current versions with UC healthcare personnel.
To view these simulations, please see the links listed below:
Description: This simulation features, Sharon Taylor, a 58-year-old female, who has been homeless for 1 year. The patient has comorbidities including schizophrenia and chronic obstructive pulmonary disease (COPD). Sharon is experiencing paranoid delusions and auditory hallucinations. During the simulation participants will play as Sharon and her healthcare provider.
Simulation 1 Pre-test
Simulation 1 Interactive Video
Description: This simulation features Crysta Epps, a transgender woman. Crysta is seeking healthcare after being without a physician for a few years. The physician assesses Crysta’s health needs and creates a plan of care. During the simulation participants will play as Crysta and her physician.
Simulation 2 Pre-test
Simulation 2 Interactive Video
Description: This simulation features, Brian, a 19-year-old male with cerebral palsy, intellectual disability, OCD, epilepsy, generalized anxiety disorder, and autism spectrum disorder. His mother, Debbie, who is a single parent, is also featured in the simulation. During the simulation, participants will play as Brian, his mother, and the healthcare provider.
Simulation 3 Pre-Test
Simulation 3 Interactive Video
The UC Department of Family and Community Medicine faculty members are working with UC Communication Sciences and Disorders faculty Dr. V. McKenna to develop a national survey that will assess the relationship between vocal congruence, wellness, and social determinants of health in gender-diverse individuals. The survey had over two hundred participants. In addition, our colleagues in CSD are longitudinally assessing wellness during gender-affirming vocal therapy and its relationship to measurable vocal changes.
Qualitative data from a series of workshop breakout sessions and open-text survey questions were analyzed to explore the complex issues at play when developing high-quality recruitment, retention, onboarding, and continuing education opportunities for diverse CRPs at academic health centers.
Results suggest there are several barriers to providing training to the CRP workforce, including: balancing foundational onboarding with role-based training, managing logistical challenges and institutional contexts, the need for champions, assessing competency, and providing high-quality mentorship. Several of these themes are inter-related. One common thread that is present throughout all these themes is the challenge of effective communication.
While certain institutions have set benchmarks for best practices in job titles and descriptions, standardization remains lacking across CTSA hubs. Significant hiring needs have reached exponential proportions across hubs, unable to meet current and projected clinical research goals.
Data confirmed an urgent need for closing gaps in clinical research workforce at AMCs, especially for improving diversity and equity of personnel. Improved salary scales and retention benefits were suggested strategies, as well as outreach to community colleges to raise awareness of the professional pathways for CRPs. Several posters and manuscripts have resulted from this project.
For further information, please contact Dr. Jackie Knapke at jackie.knapke@uc.edu.
The UC Bear-CAT program aims to increase the number of prepared graduate-level behavioral health clinicians entering and continuing practice with at-risk children, adolescents, and transitional-age youth in the Greater Cincinnati region. Program participants receive financial support, behavioral health training specific to the child, adolescent and transitional-age youth population, with additional training focused on team-based care in integrated behavioral health and primary care settings, and tele-behavioral health. Drs. Regan and Knapke, and Harini Pallerla serve as evaluators. The second year of the grant began in Fall 2022.
For more information, please contact Harini Pallerla at harini.pallerla@uc.edu.
In early 2022, the DFCM submitted an R25 application to the National Institute of Aging entitled the University of Cincinnati Undergraduate Program in Geriatric Research to Accelerate Workforce Diversity and Community Equity Outcomes (UC UPGRADE). Drs. Jackie Knapke and Hyacinth Hyacinth (Department of Neurology and Rehabilitation Medicine) is the MPIs. This program would be the first aging-focused summer undergraduate research fellowship (SURF) program in Cincinnati. We developed an innovative approach to offering mentored research experiences and training to support undergraduates on the path to a graduate degree related to aging research, and we are uniquely poised to implement our plan given the successes of our existing SURF program. This program builds on SURF in critical ways to specifically address the unique needs of a culturally competent research workforce spanning the aging research continuum, particularly into local, urban, and underserved communities at greatest risk of health inequities.
All of these factors make us ideally suited to foster underrepresented minority and disadvantaged or disabled (URM/DA) students towards a successful career in aging research. The overarching objective of this application is to support diverse scholars’ pursuit of research careers in aging by preparing them for application into biomedical graduate and professional programs.
The goals of the CTSA Community Engagement Core are to improve relationships between academic researchers and community members; to engage community physicians in research and translation of evidence-based practice; and to train researchers in community-engaged research and educate community members in order to build capacity and an understanding of the benefits and risks of research involvement. The Community Engagement Core of the CTSA seeks to broaden and strengthen collaborations between the Academic Health Center and the community to produce research initiated with, supported by, carried out through and benefiting the community.
For further information, please contact Mary Beth Vonder Meulen at marybethvondermeulen@uc.edu
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