Current WREN Research Projects
PI: Edmond Ramly, PhD
Funding Agency: Agency for Healthcare Research & Quality (AHRQ)
What problem is this study trying to solve?
Following evidence-based guidelines to reverse cardiovascular disease (CVD) risk would prevent more than 50% of annual deaths in middle-aged US adults; however, guidelines are not uniformly implemented. Tailoring strategies to address local barriers has potential to improve adherence to guidelines, based on previous results such as increasing follow-up on blood pressure management and smoking cessation. Yet tailoring strategies is expensive and burdensome in practice and may be even less feasible given the expansion of telemedicine due to the pandemic.
What will be studied?
This 5-year Agency for Healthcare Research & Quality (AHRQ)-funded study will use configurable solutions to address local barriers without engaging in an expert-led individual tailoring process. Four CVD quality metrics will be targeted:
- Blood pressure control for patients with hypertension
- Aspirin, statins, and smoking cessation for patients with coronary artery disease
A configurable toolkit for CVD prevention will be developed using multi-stakeholder design and informed by large clinical data. The toolkit will be studied in a pragmatic, practice-based trial.
What could the study mean for clinicians and patients?
This project addresses challenges in consistent implementation of evidence-based CVD prevention guidelines, including new challenges related to the use of telemedicine. By using a configurable toolkit, implementation strategies can be matched to local barriers faced by primary care practices, which could result in improved patient outcomes.
PI: Art Walaszek, MD
Funding Agency: UW Madison – Institute for Clinical and Translational Research (UW ICTR)
What problem is this study trying to solve?
Approximately 90% of people with dementia have behavioral and psychological symptoms of dementia (BPSD), such as depression, agitation, or paranoia. BPSD can be distressing to patients and potentially dangerous to them and people around them. Primary care clinicians are often directly involved in managing BPSD, which can be complicated because of risks associated with pharmacological interventions. The project aims to use a clinician educational program to help improve the care of people with dementia.
What will be studied?
We aim to study two clinical/educational approaches to assisting healthcare professionals with managing BPSD: academic detailing and DICE. Academic detailing is an evidence-based approach to changing clinician behavior through brief educational encounters. DICE is an evidence-based framework for teaching people to use behavioral and environmental approaches to BPSD instead of medications. As part of our project, we will survey clinicians about their knowledge of and experience with BPSD and their interest in educational approaches to assisting their care. Academic detailing and DICE will be implemented in two primary care clinics in Wisconsin.
What could the study mean for clinicians and patients?
The survey will provide insights as to the educational needs of clinicians with regard to BPSD. Through academic detailing and DICE, we aim to support primary care clinicians with the goal of improving the care of people with BPSD.
PI(s): Sarina Schrager, MD, MS; Makeba Williams, MD, NCMP, FACOG; Mary Henningfield, PhD; Earlise Ward, PhD
Funding Agency: UW Madison Department of Family Medicine & Community Health
What problem is this study trying to solve?
African American women have more severe vasomotor symptoms, experience symptoms for longer durations than white women, and have more interrupted sleep. African American women also describe not being heard by members of the health care system. Thus, the menopausal care needs of African American women are doubly underserved.
What will be studied?
This project aims to explore African American women’s experiences with menopause and with the health care system. We will conduct focus groups and interviews with African American women to obtain a rich dataset of experiences to ensure that the perspectives of African American women are adequately heard.
What could the study mean for clinicians and patients?
This study will provide information that can help primary care clinicians better understand and treat African American women for their menopause symptoms.
PI: Daniel Merenstein, MD, Georgetown University
Madison Site PI: Bruce Barrett, MD, PhD
Funding Agency: Patient-Centered Outcomes Research Institute (PCORI)
What problem is this study trying to solve?
Every year in the U.S., one in seven adults is diagnosed with acute rhinosinusitis (ARS), totaling 30 million office visits. Although most patients with ARS do not benefit from antibiotics, they are still being prescribed in over 70% of ARS diagnoses. We want to know if there is a better way to treat patients and alleviate symptoms quicker and determine who truly benefits from antibiotics and should take them as soon as possible.
What will be studied?
Do antibiotics truly improve the course of symptoms for ARS, and for which patients? Are other approaches -watchful waiting, saline nasal irrigation, corticosteroid nasal sprays- or over-the-counter supportive treatments more effective?
What could the study mean for clinicians and patients?
The goal is to understand which treatment approaches are best at improving outcomes for patients. We hope the information we learn in this study can be used by providers and patients to determine the best way to treat their ARS.
PI: Heidi Brown, MD, MAS, FACOG
Funding Agency: Agency for Healthcare Research and Quality’s (AHRQ)
What problem is this study trying to solve?
Urinary Incontinence (UI) affects a large number of women. More than half of women over 20 years of age reported any urinary leakage. Overall, about 30% of older women in the US report moderate to severe UI, which can increase depression and work disability. What’s more, fewer than 50% of women seek care for UI symptoms. Finally, there is a significant gap between evidence-based care and actual practice. Fewer than 30% of women (> age 40) with UI report receiving any care for UI symptoms, despite available safe and effective non-surgical treatments for UI, according to a systematic review.
What will be studied?
This project builds on AHRQ’s EvidenceNOW Model, which previously showed that free practice facilitation for small- and medium-sized primary care practices supported improvements in the delivery of guideline-based care for heart disease. We aim to use the model to help primary care practices implement effective nonsurgical interventions for UI such as behavioral approaches, medications, and neuromodulation. By facilitating partnerships between primary care practices and community and subspecialist organizations, we hope to overcome barriers to increase the diagnosis and treatment of UI among women in primary care. This project aims to connect primary care practices to local and national resources through partnerships with the WI Institute for Healthy Aging, WI Department of Health Services, and the American Urogynecologic Society.
What could this study mean for patients?
By supporting the implementation and maintenance of non-surgical interventions for women with UI being seen in primary care, we hope to improve outcomes and symptoms that can threaten daily functioning.
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.
PI: Annette Totten, PhD
UW Madison Site PI: Sarina Schrager, MD, MS
Funding Agency: Patient-Centered Outcomes Research Institute (PCORI)
What problem is this study trying to solve?
Advance Care Planning (ACP) is not routinely used in primary care settings. Primary care practices are ideally suited for ACP; however, barriers such as time constraints often impair the ability of clinicians to complete ACP conversations with their patients.
What will be studied?
This project is designed to study use of a serious illness conversation (SIC) guide for conversations between patients and either their physician or their healthcare team. The SIC provides questions to enable clinicians to understand their patients’ values and preferences. The study will measure how well the care received by patients aligned with the goals they discussed in ACP conversations.
What could the study mean for patients and their families?
Patients, caregivers, and their families could benefit from ACP conversations by helping to ensure that their wishes are known and implemented. In addition, ACP conversations can help increase the satisfaction of patients and clinicians with their communication and relationship.
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: Jennifer Weiss, MD, MS
Funding Agency: American Cancer Society
What problem is the study trying to solve?
Colorectal cancer (CRC) is the third leading cause of cancer-related deaths for men and women in the United States claiming nearly 50,000 lives annually. CRC is the most preventable, yet least prevented cancer because of low rates of CRC screening. Screening rates are especially low in rural communities (vs urban) where more than 24 million persons are eligible for CRC screening.
What will be studied?
This project will examine and characterize the system and clinic factors that distinguish high- from lower-performing rural clinics. Successful CRC screening strategies in high-performing clinics, including strategies that are successful for subgroups with disproportionately low CRC screening (Medicaid, racial/ethnic minorities), will be identified.
What could the study mean for patients?
The results will provide a compendium of strategies to increase CRC screening in rural communities, thus helping to prevent diagnosis at later stages and reduce deaths from CRC.
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: Rachel Grob, PhD
Funding Agency: UW Madison – Institute for Clinical and Translational Research (UW ICTR)
What problem is this study trying to address?
Long COVID has emerged as a significant health care issue with millions of Americans reported to be experiencing long-COVID symptoms. Minority groups have been disproportionately affected by SARS-CoV-2 infections, hospitalizations, and deaths. Post-COVID conditions represent a wide array of symptoms and best practices to care for patients with long COVID have not been fully defined. This study aims to use information about patient experiences of long COVID to create education materials for use by primary care clinics to effectively care for patients with long COVID and address health care inequities.
What will this study accomplish?
This study will use a community-partnered approach to learning together to effectively address long COVID in primary care. We will create, pilot, and evaluate the impact of an educational intervention comprised of a catalyst film of clips from audio- or video-recorded patient interviews and an accompanying toolkit of actionable approaches to care.
What could the study mean for clinicians and patients?
Learning from patients and community advocates will help inform best practices for an indication with uncertainty about best practices for clinical care and few known interventions. The project will explore the needs of historically underserved patients to address inequities faced by those suffering from long COVID.
PI(s): Mary Henningfield, PhD
Funding Agency: UW Madison Department of Family Medicine and Community Health
What problem is this study trying to solve?
The COVID-19 pandemic has had a significant impact on health care systems and effects on rural primary care physicians have been especially impactful. Available research tends to focus on negative aspects of the pandemic (ie, burnout among clinicians) with limited work on understanding the impact on relationships with their patients, physician colleagues, staff, and communities. This pilot study seeks to fill the information gap by documenting the experiences of 10 to 15 rural clinicians during the pandemic through 1:1 interviews.
What will be studied?
This pilot project will interview rural primary care physicians to understand the impact of the pandemic on relationships as well as their well-being. Strategies that helped physicians and their clinic staff cope with the impact of the pandemic will be recorded.
What could the study mean for clinicians and patients?
This study will provide insights into the unique experiences of physicians practicing in rural areas. By documenting real experiences and identifying strategies that supported clinicians practicing in rural areas, we aim to inform future efforts to address pandemics and preserve knowledge assets to provide care to patients in rural areas.
PI: Aleksandra Zgierska, MD, PhD
UW Madison Site PI: Bruce Barrett, MD, PhD
UW Madison Site Co-PI: Mary Henningfield PhD
Collaborators:
The University of Utah – Site PI: Eric Garland
Harvard Medical School/Brigham & Women’s Hospital – Site PI: Robert Edwards
Funding Agency: Patient-Centered Outcomes Research Institute (PCORI)
What problem is this study trying to solve?
Chronic low-back pain has no known effective treatment. Although often treated with long-term opioid therapy, opioids do not work well for many patients and can cause serious side effects, including addiction, poorer mental health, and overdose death. Alternatives to opioids and the development of tools to help patients manage their chronic pain are needed.
What will be studied?
This study will compare Mindfulness Meditation and Cognitive Behavioral Therapy for improving health and quality-of-life for adults with opioid-treated chronic low back pain.
What could the study mean for patients?
The results of this trial will help to determine which therapy is viewed as useful by patients for managing their chronic low back pain, increasing physical function, improving quality-of-life, and decreasing daily opioid dose.
Meta-Network Affiliations
Funding Agency: Agency for Healthcare Research and Quality
Workshop: Multi-Network Research Collaboration: Steps to Success
Recent Publications
Stewart TP, Sesto ME, Haine JE, et al. Results of Engineering, Primary Care, Oncology Collaborative Regarding a Survey of Primary Care on a Re-Engineered Survivorship Care Plan. J Cancer Educ. 2022;37(1):23-29. doi:10.1007/s13187-020-01776-4