The purpose of this study is to enroll 200 families in a year-long, prospective cohort study to determine vaccine effectiveness without the limitation of missing vaccinated, non-sick children and families. By conducting this sub-study, we seek to build upon a long-standing school-based surveillance platform (2015) supplemented by a household surveillance sub-study component (2016) and a survey of parental attitudes towards and beliefs about the influenza vaccine (2018).
The outcome of interest for distinguishing ‘cases’ from ‘non-cases’ will be a positive, rT-PCR confirmed influenza result from the Wisconsin State Laboratory of Hygiene (WSLH). This outcome will be used to calculate the odds ratio of influenza infection for vaccinated and un-vaccinated participants.
The purpose of the proposed study is to examine the relationship between immediate and long-term changes in cortical functional connectivity and changes in cognitive flexibility and symptoms of depression following one dose of oral psilocybin.
Approximately 20% of people with depression do not respond to treatment and/or relapse. Recent clinical studies of psilocybin treatment have demonstrated dramatic and sustained reductions in depressive symptoms. However, changes in depressive symptomatology and functional connectivity specific to psilocybin are still unknown. The proposed work is a sub-study of a fully funded, industry-sponsored, multi-site trial evaluating psilocybin- assisted therapy for Major Depressive Disorder. This sub-study will add a series of 3 resting state and tasked-based functional magnetic resonance imaging scans to the existing protocol in order to evaluate functional connectivity pre- and post-administration of study drug. Resting state and task-based functional connectivity will be based previously established seed based and independent component analysis approaches and correlated with behavioral and clinical measures.
The proposed work has the potential to elucidate the neurobiological and cognitive mechanisms for an emerging line of new research and treatment approach for depression.
David Kiefer, MD – Exploration of the benefits of group medical visits
This small grant application proposes to use funding for staff support to facilitate the evaluation of two new group medical visits (GMVs) at the UW Center on Wellness at The American Center. The topics for the GMVs will be Healthy Sleep and Healthy Gut. Each GMV will be offered twice over a 12-month period to 10 patients with either mild-to-moderate insomnia (Healthy Sleep) or functional bowel disorder (irritable bowel syndrome; Health Gut). Several validated surveys will be used to quantify symptoms in each of the classes, and the survey results at the end of the GMV (time=1 month) and one month after GMV completion (time=2 months) will be compared to baseline using a paired t-test. The results of this project will be used to expand and improve the GMV initiative as well as search for external funding to further evaluate the outcomes.
Sean Duffy, MD – Enhancement of dissemination of mHealth technology for diabetes management in low-resource settings
The purpose of this study is to enhance the performance and capabilities of a successful clinical decision support tool for diabetes management in low-resource settings and facilitate the widespread adaptation of this tool in low- and middle-income countries.
Goals of the study are:
- Refine diabetes smartphone application and underlying clinical protocols based on data collected from 3 years of design and implementation experience to improve usability and performance
- Create English version of application to facilitate use outside of Latin America
- Develop an implementation toolkit for our task-shifting model of diabetes care
- Freely share the application under a Creative Commons license, accompanied by the implementation toolkit, on the CommCare Exchange and the mHealth Knowledge database, a repository of mHealth resources sponsored by USAID
- Develop clinical algorithms for diabetes diagnosis and antihypertensive medication initiation and titration by minimally-trained health workers
- Write research and grant proposal for implementation and evaluation of an enhanced smartphone application including diabetes diagnosis and hypertension management
Cristalyne Bell, BA – Household transmission of human Metapneumovirus within a community-based population
The project’s purpose is to develop accurate methods for the analysis of human milk. We also want to determine how milk composition may change based on BMI, freezer storage duration at milk banks, and exposure to pharmaceuticals during pregnancy.
Maureen Goss and Jonathan Temte, MD, PhD – iKABOB (Influenza Knowledge, Attitudes and Beliefs in Oregon and Brooklyn)
The primary objective of this study is to ascertain the general influenza vaccination knowledge, attitudes, and beliefs (KABs) of parents whose children have recently participated in the ORegon CHild Absenteeism due to Respiratory Disease Study (ORCHARDS), an influenza surveillance study funded by the Centers for Disease Control and Prevention (CDC) and conducted by the University of Wisconsin Department of Family Medicine and Community Health (UW-DFMCH).
The proposed MCA (Mindful Climate Action) project will employ mindfulness-based practices to increase awareness of habitual or “mindless” behaviors that adversely impact both personal health and environmental sustainability. This will enhance health and stimulate carbon footprint reduction by increasing awareness, compassion, and connection to the environment. Mindfulness-based practices in our curriculum include personal centering, breath awareness, body scan and awareness of physical sensations, sitting meditation, mindful movement, gentle yoga, emotional state awareness, and empathy and compassion. Instructors will introduce each of these practices in tandem with science education on energy use, carbon footprints, and sustainability.
Larry Hanrahan, PhD, MS; Beth Klein, MS2; Guanhua Chen, PhD; and David Rebedew, MD – Use of herbal medicine to improve trust of Amish communities in western health care
The Amish are a significant patient population for health care providers in rural Wisconsin, but yet there is little understanding of their health care beliefs. Traditional Amish medicine includes chiropractic care, religious methods such as prayer, and perhaps most widely used: herbal medicine. The literature describing herbal medicine, especially Amish use of herbal medicine, is limited, and therefore the knowledge base of herbal medicine for western health care providers is also limited.
The goals of this project are to identify the herbal medicine practices used by the Amish communities in Southwestern Wisconsin, describe what is known about the herbs from previous research, and identify ways western health care providers could integrate herbal medicine into their practices in order to better serve their Amish patients.
In 2016, more than 42,000 opioid-related overdose deaths occurred in the United States—115 deaths per day. Misuse of prescription opioids and related harms have contributed substantially to negative health consequences and premature deaths among adolescents. Negative consequences of the opioid crisis for adolescents include serious medical outcomes, emergency department visits, and numerous hospitalizations. About 20% of adolescents prescribed opioids in the past year report misusing opioid medications.
Adolescents’ inadequate understanding of the safety risks associated with misusing prescribed opioids contributes to substance use disorders and there are limited mechanisms for adolescents to learn about appropriate use of prescription opioids. This study aims to understand perceptions of adolescents about opioid medication use, safety, and their preferred educational intervention.
Susan Wenker, PhD, MS – Survey development for the Advanced Certified Exercise for Aging Adults Course
Opioid misuse, use disorders, and overdose are epidemic and increasing, causing more than 15,000 deaths and costing the U.S. more than $60 billion annually. Use disorders, additionally, adversely affect outcomes of other chronic illnesses commonly managed in primary care settings, such as diabetes, hypertension, and a host of other mental and physical health conditions. Increasingly, patients with substance use disorders, including opioid use disorders (OUDs), are being seen in primary care and other non-specialty settings. As such, primary care providers are ideally positioned to coordinate care for patients with OUD.
Recent clinical studies at respected academic institutions, including our own, have demonstrated the safety of protocolized, supervised administration of psilocybin, and have shown dramatic, sustainable reductions in problematic substance use.
In this pilot study, we would administer psilocybin to 10 eligible and consenting participants with a history of opioid use disorder who have been in stable recovery on low-moderate dose buprenorphine (12 mg or less) for 6 months or more. The aims would be to demonstrate that:
- Co-administration of psilocybin and buprenorphine does not lead to adverse effects.
- The partial opioid agonist activity of buprenorphine doesn’t interfere with the therapeutic value of psilocybin.
- Secondarily, we would examine withdrawal symptoms, craving, self-efficacy, quality of life, and pain measures and discontinuation of OAT (opioid agonist therapies ) in the context of community-based OAT.
Jackie Gerhart, MD; Paul Bornemann, MD; Neil Jayasekera, MD; and Dwight Smith – Point of Care Ultrasound in Family Medicine: Creating a National Curriculum and a UWSMPH Ultrasound Program
Point-of-Care Ultrasound improves patient care and decreases time to diagnosis and treatment of many common medical diagnoses. This is well-known within the Emergency Medicine community, and it is now required that all residents and faculty in Emergency Medicine have point-of-care ultrasound training. It is a life-saving diagnostic tool, especially in rural communities and in global health. Increasingly, medical students are learning POCUS in their curriculums, and are looking for residency programs that provide training in ultrasound.
This is a one-year project to provide training in ultrasound and to prepare a curriculum for ultrasound.
Andrew McClintock, PhD; Aleksandra Zgierska, MD, PhD; Kenneth Kushner, PhD; Miroslav Backonja, MD; Eric Garland, MSW, PhD; Robert Edwards, PhD; and Robert Jamison, PhD – Brief Mindfulness-Based Intervention for Opioid-Treated Chronic Pain: A Pilot Randomized Clinical Trial
The goal of this project is to pilot-test the efficacy of a BMBI, relative to an education-based control, in the management of opioid-treated chronic pain.
The proposed study is designed as a pilot randomized clinical trial (RCT), in which participants will be randomized to one, 20-minute session of either: mindfulness training (BMBI) or nutrition education (Control). Following the session, participants will be encouraged to practice a technique associated with their intervention (i.e., practicing mindfulness technique in BMBI, preparing healthy meals in Control) 20 minutes/day for 4 consecutive weeks at home. Quantitative sensory testing (pain intensity and tolerance, using cold pressor test) will be conducted before and after the session, and self-reported outcome assessments will be conducted before and after the session and at 1-week and 4-week follow-ups.
The current project will look to explore both the continuation and expansion of the initial mindfulness curriculum developed in Academic Year 2016-2017. Specifically, this project will look at the following: 1) the feasibility of coordinating, implementing and evaluating an introductory mindful awareness curriculum for resident physicians across multiple departments within an academic institution; 2) the influence of mindfulness training on resident wellbeing in both medical and surgical specialties; and 3) the sustainability and potential for continued growth and quality instruction within such a program across departments.
Randy Brown, MD, PhD, FASAM – Opioid Overdose Prevention and Naloxone Use Survey
The primary goal of this study is to describe the circumstances related to opioid overdose, and the use of naloxone use by laypeople. As such, the study aims to conduct a survey of people who receive naloxone (the opioid overdose antidote) or who obtain clean injection equipment from one of two community resources that provide these services. By surveying opioid users directly about their first-hand experience with opioid overdose, the study team seeks to be able to develop and disseminate highly tailored educational materials and local policy advice based directly on the lived experience of this population.
Jennifer Edgoose, MD, MPH – Developing a Strategy to Increase Underrepresented-in-Medicine in the Wisconsin Healthcare Workforce
The purpose of this project is to identify undergraduate students from Wisconsin who are underrepresented in medicine and have an interest in pursuing a health professional career and ask them about past exposure to pipeline programs and mentorship related to healthcare professional careers and their views of the effectiveness of such interventions. The overall goal of this project is to gain a better understanding of how to increase diversity in the Wisconsin healthcare workforce.
The goal of this project is to launch an innovative, accessible database that provides residents of Wisconsin and the U.S. with reliable information about patients’ and caregivers’ experiences with a wide variety of health conditions. It deploys an internationally-recognized model for collecting and disseminating patients’ own perspectives on health and health care (Database of Patient Experiences, or DIPEx) and an award-winning user-friendly web platform (“healthtalkonline,” or HTO) that features representative audio and video clips of patients talking in their own voices.
David L. Hahn, MD, MS – 2017 WREN convocation of Practices: How to get more joy out of your practice
The purpose of the overall project is to address burnout via an appreciative approach that emphasizes ways to increase joy in practice. The overall project goals are to plan for, implement, and evaluate a 2017 WREN Convocation of Practices during which appreciative approaches will be applied to (1) enhance clinician and team self-care (Whole Health self-enhancement training) and (2) provide practical ideas and strategies to increase team and patient well-being in specific clinical situations such as (i) creating more rewarding patient encounters; (ii) improving shared decision making (SDM) and (iii) creative strategies to help clinics achieve a Whole Health mindset and general approach to care and community engagement. We believe that practicing Whole Health approaches that enhance the meaningfulness of clinical encounters will improve both clinician and patient well-being (although in this project we will be measuring effects only on Convocation attendees, not on patients).
Adrienne R Hampton, MD – An individualized yoga program delivered in a group setting for the treatment of chronic pain in a low-income population: A feasibility study
This study will explore the therapeutic potential of a yoga program for the treatment of chronic pain which combines individual instruction with the efficiency of a group setting, in a community health center population. Future research directions could include larger prospective cohorts, or perhaps a randomized controlled trial to evaluate the effectiveness of an individualized yoga intervention delivered in a group setting in a low-income population.
Supriya Hayer, MD – Validating a Young Children’s Version of the Wisconsin Upper Respiratory Symptom Survey (WURSS-Kids/WURSS-K)
The scientific goal of this project is to validate a new patient-centered outcomes tool for assessing acute respiratory illness (ARI) in children. We also hope to help community collaborators understand how to effectively recognize acute respiratory infections early on, so as to take the appropriate preventive measures to enhance the health of the communities they each service. The information we disseminate through this study may serve as a tool for planning healthier community environments, tracking progress of public health programs, and advocating to state and federal levels for new policies and resources. The project is expected to result in a validated WURSS-Kids questionnaire and have substantial long-term effects. It will also be made available to other researchers nationally and internationally, furthering pediatric ARI research in general. Use of the instrument may facilitate the development and implementation of improved policy through the ability to accurately assess ARIs.
Daniel Jarzemsky, MD – Health Factor Outcomes for a Community-based Fitness and Nutrition Social Support Program (Empower)
This project plans to correlate significant outcome data from the electronic medical record with measurements and surveys from the Empower program. Our goal is to demonstrate physical activity and improved nutrition reduces obesity and is linked to improvements in Health Outcome Factors (hypertension, lipid disorders, diabetes, and quality of life).
Jennifer Lochner, MD – Care delivery changes associated with Primary Care Delivery Model Redesign (PCR)
The study will analyze the following Epic data from DFMCH clinics: primary care office visits per panel member per year; non face to face primary care clinic contacts per panel member per year; non primary care office visits per panel member per year including urgent care visits and specialty care visits. This data will be trended over time and overlaid with the timeline of the Primary Care Delivery Model Redesign (PCR) rollout to the clinics as well as the timing of the implementation of the new physician compensation plans. Analyses will involve an interrupted time series design allowing clear associations between changes in these outcomes and care model and compensation intervention changes.
Bobby Nourani, DO – Multiple modality integrative care for chronic low back pain: A quality improvement project
The overall goal of this quality improvement (QI) project is to evaluate the effectiveness of multi-modality integrative care for chronic low back pain (CLBP), among the most challenging conditions treated in primary care. Societal costs of CLBP are high and national organizations have called for new therapeutic options. The sources of pain in CLBP vary per patient; peripheral and central pain generators exist in different tissue types. No single therapy has proven generally effective. Therapeutic response may benefit from treating pain using a variety of approaches intended to address both neuropathic and nociceptive pain, therefore the use of multi-modality care has been advocated.
David Rabago, MD – Hypertonic dextrose injection therapy (prolotherapy) for painful knee osteoarthritis: An open label feasibility study of functional outcomes in support of extramural funding.
Research support to conduct an open-label feasibility study of objectively assessed functional measures after prolotherapy (PrT) for painful knee osteoarthritis (KOA), a necessary step in the preparation of future intra- and extra-mural grant applications.
Marlon Mundt, PhD – Team Communication Networks in Electronic Health Records (EHR) and Quality of Care for Patients with Cardiovascular Disease in Primary Care
This study will provide a unique opportunity to evaluate EHR communication network structures within primary care teams in relation to CVD patient outcomes extracted from the EHR. The study will promote better primary care team performance in a pursuit of improved care for patients with CVD. This evaluation would allow developing analytical techniques to conduct future primary care evaluations with no additional burden or disruption for the health care providers in clinics.
Angela Black, PhD – Mindfulness and Black Women: What’s Cultural Relevance Got to Do With It?
The larger goal of the proposed study is to develop a culturally-relevant mindfulness-based intervention pilot for stressed black women across the lifespan. To accomplish this, focus groups will be conducted in the community that explore black women’s thoughts, beliefs, and reactions to select themes pertaining to mindfulness meditation, mindful movement, and mind-body awareness. Additionally, the proposed study intends to offer the focus groups in an informational, workshop style format that promotes stress reduction and mind-body awareness as wellness resources to Black women living in Madison.
Randy Brown, MD, PhD, FASAM – Trauma and responsible opioid use study
In order to generate pilot data supportive of future NIH funding applications, the current study seeks to survey American trauma centers regarding current alcohol use screening practices, current opioid misuse risk screening practices, and barriers/facilitators to expanding current alcohol screening practices to include opioid misuse risk. These results will be used to support a future NIH R34application which will seek to pilot an opioid misuse screening protocol at a level I trauma center. The future R34-fundedclinical trial planning study would also develop and pilot test an intervention to prevent opioid misuse and progression to addiction. This intervention would subsequently be tested in an NIH-R01 funded, multi-site, randomized clinical trial.
David Hahn, MD – INSTTEPP2: Creating and Sustaining Clinic-Patient Teams for Self-Management Support.
WREN recently participated in an AHRQ-funded P30 (Meta LARC) SMS toolkit evaluation called INSTTEPP that included patient advisors, clinicians and care managers at four WREN clinics (and at 12 other Meta-LARC sites). The purpose of INSTTEPP2 is for WREN to work with two of the four INSTTEPP clinics to create and sustain SMS work groups within clinics to pursue the following aims: (1) Explore the SMS needs of each clinic (what are our needs? How could this group fill that need? What’s the idea for our clinic?); (2) Define the membership and roles/responsibilities for a clinic SMS workgroup; (3) Find resources to sustain the group and (4) Create and pilot at least one SMS project within the initial 9-month period.
Randy Brown, MD, PhD, FASAM – Survey of opioid misuse screening practices in Wisconsin pharmacies
The proposed project seeks to expand upon existing survey results and specifically target Wisconsin pharmacies in an effort to begin development of screening and brief intervention (SBI) procedures practical for administration in pharmacies. In addition to facilitators of and barriers to opioid misuse risk screening, pharmacist knowledge about and comfort with opioid overdose prevention education and naloxone distribution to laypeople will be explored. (Distribution of naloxone, the opioid overdose antidote, to laypeople, was made legal in Wisconsin in the spring of 2014 with the passage of the Heroin Overdose Prevention and Education legislative package.)
David Hahn, MD – Stakeholder Engagement: Practice-Based Research from the Practice Participant Perspective
The purpose of this study is to perform a qualitative study into the experience of clinic teams who’ve participated in Wisconsin Research and Education Network (WREN) Practice Based Research studies. WREN will conduct focus groups (clinicians, staff and administrators, if present) surrounding the question “How has participation in practice-based projects impacted you and/or your practice?”
Jonas Lee, MD – African American Appreciative Inquiry
Appreciative Inquiry is a change model used by organizations and communities that avoids focusing on problems, but instead identifies what is already working well, envisioning a future state built upon the assets of an organization or community. Research will be conducted through` a series of focus groups and individual interviews with residents to discover the ways in which local health care providers and systems have positively impacted engagement in personal health care, promoted healthier lifestyles, and mitigated the effects of institutional racism in our health care system. Through qualitative analysis of these interviews, we can hear the voice of our community as a first step in designing effective solutions to address health disparities.
Ildi Martonffy, MD – How Doctors Birth: How our experiences shape our practice
The project aims to explore physicians’ own choices in their pregnancies and birth processes, and how these choices may or may not inform the care of patients. Physicians’ birthing narratives will be coupled with quantitative data consisting of information on medical training and family development history. Female Family Medicine physicians and Obstetricians from Dane County who have received training in labor and delivery will be asked to participate in the study.
Tanya Schlam, PhD – Can Smartphone Games Help Smokers Quit?
The objective of the research project is to determine whether smartphone games can help smokers distract themselves, suppress their cravings, and increase their chances of quitting. The proposed research will determine whether smartphone games add to a standard of care smoking treatment (pharmacotherapy plus counseling) by further suppressing craving and enhancing cessation success.
This project intends to 1) Distribute a practice management curriculum survey to family medicine residency graduates (2010-2012) to identify which practice management topics are being covered during residency, how effectively they are being taught, and opportunities to cover topics not previously covered; 2) Interpret and publish survey results to inform residency programs how to improve development of future practice management curricula.
Brian Arndt, MD – Engaging in community conversations, developing partnerships in health
This project aims to perform a stakeholder analysis/community needs assessment related to obesity involving residents, faculty, and community partners. Funding from the small grant will support Verona residents and faculty to work with community members to identify collaborative strategies to help community members lose weight and become healthier.
John Beasley, MD – Improving PrimAry Care Through Industrial and Systems Engineering (I-PrACTISE) Development
This project intends to a) secure resources to re-convene national experts in 2014 to continue the development of a national I-PrACTISE agenda; b) increase collaboration between primary care and Industrial and Systems Engineering that results in funded projects locally; and c) find and implement funding mechanisms to sustain these activities.
Randy Brown, MD, PhD, FASAM – Pharmacotherapeutic intervention to improve treatment engagement among alcohol-dependent veterans after hospital discharge
Dr. Brown was awarded an ICTR Type-2 grant in fall 2012 to fund a research project for inpatient veterans at the William S. Middleton VA with alcohol dependence/ abuse. The over-arching goal of the ICTR pilot feasibility study is to understand the impact of medication adherence upon engagement in behavioral treatment for alcohol use disorders. The specific objective of the ICTR study is to conduct a pilot randomized study of prescribed oral naltrexone (taken orally once daily) vs. long-acting injectable naltrexone (30-day duration of action) administered prior to hospital discharge. The ICTR budget of $50,000 did not allow room for subject compensation for study participation. The purpose of this grant is to provide financial incentives for study participants following each study visit. The financial incentives will play a key role in increasing subject recruitment.
Sandy Kamnetz, MD – Influences of the Primary Care Clinic Environment on Patients and Staff
The goal of this project is to explore how different primary care clinic environments affect the following processes outside of the examination room: (1) patient experience, (2) staff-patient interaction, (3) and staff interaction. The study will conduct a comparative case study analysis of three community family medicine clinics with different environmental designs using observations and focus groups.
Jonas Lee, MD – Patient Activation Measure in High Utilizers
The Patient Activation Measure (PAM) is a validated tool measuring patient involvement in self management. Like the Stages of Change model, specific strategies can be employed to different stages of patient activation in order to encourage self management of health issues. The level of patient activation has been directly correlated with outcomes in several chronic diseases. However, there have been no studies examining the relationship of patient activation to inappropriately high utilization of health care services. This study seeks to examine if a correlation exists between utilization of healthcare services to patients sense of self efficacy in healthcare. A DFM Small Grant would be used to pay the fee for utilization of the PAM. The project will also be part of the Summer Student Research and Clinical Assistantship program.
Maggie Wallace, PharmD – Case study analysis of successful development of inter-professional education in US health professional programs
This project is designed to evaluate the common steps to successful implementation of Interprofessional Education (IPE) programs at universities with successful IPE programs. Key staff from each of the identified IPE programs will be interviewed using a semi structured interview design to collect information on each of the IPE programs. A multisite case study approach will be used to describe key common themes.