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:  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.

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: 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: 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.

PI: Mary Henningfield, PhD

Funding Agency: UW Madison Department of Family Medicine and Community Health

What problem is this study addressing?

Loneliness and social isolation represent serious public health risks and have been associated with poor mental and physical health, such as risk for dementia in older adults.

What will be studied? 

The project will look at the use of the UCLA 3-item Loneliness Scale by UW Health primary care clinics. The UCLA 3-item Loneliness Scale is a simple, three-question instrument to screen people for loneliness. We aim to understand how the results of screening for loneliness were used by primary care clinicians and what actions were taken to address loneliness in their patients.

What could the study mean for clinicians and patients?

Data collected in this pilot study will be used to design larger studies to determine ways to address loneliness in primary care. The overall long-term goal is to improve patient outcomes through effective interventions for loneliness.

Meta-Network Affiliations

Project Summary: Creation of research and learning consortium of 6 PBRNs: Oregon, Colorado, Wisconsin, Iowa, and Quebec to accelerate the conduct of PBRN research through a common infrastructure enabling the efficient conduct of research. The consortium will promote continuous learning across networks and practices for evidence dissemination and knowledge transfer.

Funding Agency: Agency for Healthcare Research and Quality

Workshop: Multi-Network Research Collaboration: Steps to Success

Wisconsin Research & Education Network (WREN)

Recent Publications

Hagen SJ, Henningfield MF. Health at every size principles: Clinician perspectives to limit weight stigma in medical care. WMJ. 2023; 122(4):277-279.

Williams M, Richard-Davis G, Weickert A, Christensen L, Ward E, Schrager S. A review of African American women’s experiences in menopauseMenopause. 2022;29(11):1331-1337. doi:10.1097/GME.0000000000002060