Current WREN Research Projects
PIs: Sarina Schrager MD, MS; Mary Henningfield, PhD; Earlise Ward, PhD
Funding Agency: 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 ten 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.
The American Diabetes Association® (ADA) has announced the formation of the Diabetes Primary Care Alliance (the Alliance), made possible through a new partnership between the ADA and the DARTNet Institute. The Alliance is a growing national network of primary care practices focused on improving health outcomes of people with diabetes.
The Alliance will promote the adoption of evidence-based standards of care in diabetes in clinical practice and will work in concert with the educational and policy initiatives of the ADA’s Primary Care Council. The Alliance will engage nationally recognized primary care thought leaders and leading academic and health care institutions as early adopters of evidence-based improvements. The goal is to accelerate the integration of the latest advances in diabetes care by primary care practices across the country.
The project grant awarded the DARTNet Institute by the ADA is intended to expand work in primary care and quality improvement initiatives. Given that more than 90% of people with type 2 diabetes care receive care in primary care settings, the initiatives will focus primarily on the effective prevention and treatment of type 2 diabetes and comorbidities, including cardiovascular disease, chronic kidney disease, eye health, weight management, and peripheral vascular disease.
The Wisconsin Research and Education Network (WREN) will assist with the development of the American Diabetes Association DARTNet Institute Alliance for Diabetes (ADA DIAD) which will include practice-based research networks to potentially deliver diabetes focused activities.
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 to 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
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
The Wisconsin Research and Education Network (WREN) at the University of Wisconsin Department of Family Medicine and Community Health (DFMCH) is now part of a groundbreaking pilot program developed by the National Institutes of Health (NIH). The Communities Advancing Research Equity (CARE) for Health™ initiative aims to integrate research into clinical care and community settings, striving to improve health outcomes for all regardless of race, ethnicity, income, or zip code.
The CARE for Health™ award designates WREN as one of three primary care research network hubs nationwide. This initiative seeks to expand the network, integrate innovative research with routine clinical care, support primary care-based clinical research, engage underrepresented communities, and implement suitable study designs for primary care settings. Initial awards are focused on serving rural communities.
“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 clinic 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, associate director of WREN.
PI: Eric Simpson, MD, MCR
UW Madison Site PI: Sarina Schrager, MD, MS
Funding Agency: 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 not only negatively effects 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, multi-site, randomized community-based trial will enroll dyads of a parent or legal guardian (“parent”) 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 healthcare 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, if positive, treated with antibiotics. 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 patients care across other diseases.
PI: Thomas Chelimsky, MD
Funding Agency: Agency for Healthcare Research & Quality (AHRQ)
What problem is this study trying to solve?
The study is trying to solve the major gap that separates the current approach to chronic pain in the community and the current state of the science. The new evidence-based tools and paradigm transform this sometimes-frustrating part of medical practice into a much more satisfying and successful experience.
What will be studied?
We will study 4PCP (Primary Practice Practitioner Program for Chronic Pain), an intensive curriculum that trains community teams of PCP’s, PT’s and behaviorists in the biobehavioral approach to chronic pain. We will determine if practitioners are more satisfied with care, patient outcomes improve, and fewer opioids are prescribed.
What could the study mean for clinicians and patients?
The long-term aim is to transform how chronic pain is managed nationally with 3 results: (1) practitioners no longer experience “heart-sink” when someone with chronic pain on that day’s schedule, patients recover from their chronic pain syndromes to more normal function, and fewer opioids are needed.
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 vs usual care among in rural healthcare 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 ultimate 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 healthcare system. In this project, we aim to reach out to women who are not already engaged with the healthcare 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: UW 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 healthcare settings. In addition to psychosocial consequences such as depression, anxiety, decreased social involvement, and increased allostatic load, weight bias from healthcare 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 healthcare 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 felted 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 their clinic culture can either alienate or advocate for patients in larger bodies.
Meta-Network Affiliations
Funding Agency: Agency for Healthcare Research and Quality
Workshop: Multi-Network Research Collaboration: Steps to Success
Recent Publications
Schrager S, Williams M, Ward E, Henningfield MF, Yuroff A, Johnson G, Sullivan-Wade L, Hawkins J, Turnquist A. African American women’s experiences of menopause: A focus group study. Maturitas. 2024;187:108043.
Zgierska AE, Edwards RR, Barrett B, et al. Mindfulness vs Cognitive Behavioral Therapy for Chronic Low Back Pain Treated With Opioids: A Randomized Clinical Trial. JAMA Netw Open. 2025;8(4):e253204. Published 2025 Apr 1. doi:10.1001/jamanetworkopen.2025.3204