Currently Funded Research Projects
Do You Really Expect Me to get MST Care in a VA Where Everyone is Male? Innovative Delivery of Evidence Based Psychotherapy to Women with Military Sexual Trauma
Veterans who experience military sexual trauma (MST) are at heightened risk of developing psychiatric difficulties such as post-traumatic stress disorder (PTSD). Although the Veterans Health Administration (VHA) has identified MST positive Veterans as a high priority population, this group of Veterans may under-utilize evidence-based interventions for PTSD such as Prolonged Exposure (PE). Likely reasons for this under-utilization include unique barriers to care faced by MST survivors such as avoidance of VA medical facilities due to their potential to cue distressing memories and symptoms. The current study includes a randomized controlled study design comparing treatment engagement and clinical and quality of life outcomes between two groups: Veterans receiving PE for PTSD-related MST via homebased telehealth (PE-HBT) and Veterans receiving PE for PTSD-related MST via standard service delivery (PE-SD). The intervention component of the study is complemented by a qualitative component (i.e., patient interviews) designed to better understand Veterans’ reactions, preferences, difficulties, and suggestions for the intervention, as well as to solicit feedback about this patient population’s service needs and preferences more broadly. All Veterans enrolled in the study (i.e. Veterans in both groups) will benefit from receiving a well supported intervention for PTSD, Prolonged Exposure (PE), to address their MST-related symptoms. As such, all Veterans have the potential to experience significant symptom reduction related to their military sexual trauma post-intervention (i.e., within 12 weeks). However, women assigned to receive PE via home-based telehealth will have the particular advantage of being able to receive services from their home, thereby circumventing some of the traditional access to care barriers faced by this clinical population. It is anticipated that this advantage will result in increased session attendance and compliance, which in turn will result in better clinical and quality of life outcomes due to increased ‘dosing’ of the intervention. Thus, it is predicted that Veterans in PE-HBT will evidence better treatment engagement and more significant symptom improvement relative to Veterans in PE-SD. Treatment gains include a reduction of PTSD and other psychiatric symptoms such depression, as well as more global improvements in quality of life and social/occupational functioning. If, as anticipated, women in PE-HBT evidence improved outcomes relative to women in PE-SD, the current study findings can be used to establish an innovative service delivery model that will circumvent traditional barriers to care in an underserved, yet high risk patient population. Regardless of study outcomes, the proposed project stands to fill significant gaps in the literature with regard to how to optimally engage and retain MST positive Veterans in VA mental healthcare. Additionally however, there is only one PTSD treatment outcome study focused exclusively on female Veterans and no extant studies testing home-based telehealth for sexual assault victims. Thus, the proposed project also stands to make a significant contribution to mental health service delivery models for female Veterans and sexual assault victims more broadly.
Sponsor/Type: Sub with Veterans Education and Research Association of Michigan (VERAM)
The current research study aims to compare the effectiveness of two proven treatments for posttraumatic stress disorder (PTSD): Prolonged Exposure (PE), sertraline, and their combination. In addition, the investigators are examining predictors of response to these two treatments and how PTSD symptoms, thoughts, and biological factors may be changed by such treatments. In addition, the investigators will examine acceptability of each treatment and reasons for ending treatment.
Official title: Randomized Trial of Sertraline, Prolonged Exposure, and Their Combination for Post-traumatic Stress Disorder (PTSD) in Operation Enduring Freedom/Operation Iraqi Freedom (OEF/OIF).
Study design: Allocation: Randomized, Endpoint Classification: Safety/Efficacy Study, Intervention Model: Parallel Assignment, Masking: Double Blind (Subject, Investigator), Primary Purpose: Treatment
Primary outcome: Posttraumatic stress disorder (PTSD) symptoms as measured by the Clinician Administered Posttraumatic Stress Disorder Scale (CAPS)
Secondary outcome: Posttraumatic stress disorder (PTSD) related psychopathology, including depression, alcohol and substance abuse, and general anxiety
Mealtime Partnerships for People with Dementia in Respite Centers & at Home
The goal of this study is to test the efficacy of a mealtime intervention (Partners at Meals) in respite care centers (RCCs) that provide a social model of care for people with dementia living in the community and support for their caregivers. Largely staffed by long-time volunteers, these centers support caregivers’ ability to maintain their loved one in the home. Outcomes include improvements in: a) quality of life (QOL) and nutritional outcomes for people with dementia (PWD) and QOL outcomes for family caregivers (CGs); b) self-efficacy training outcomes for assessing and managing meals for the CGs and the RCC volunteers; and c) sustainability outcomes as determined by directors of the RCCs. Two large RCCs with a total of 5 sites of care in suburban and rural areas of SC will be the sites of this project; and 60 PWDs and 60 CGs will be recruited for this cluster-randomized trial, as well as potentially 60 staff and volunteers. Caregiving for PWDs is increasingly occurring in the community by persons who are often not prepared to assume this responsibility. Fortunately, RCCs evolved as a vital community-based resource that provide socialization, meaningful activities, respite for caregivers and at least one meal daily. Mealtime is a particular problem for PWDs because as this life-limiting disease progresses, they lose the functional ability to manage meals and display a variety of challenging behaviors all of which will eventually affect their ability to consume adequate calories and continue the social aspects of meals that connect them to others. A HIPAA-compliant telehealth system using simple ‘tablets’ will allow CGs to capture behaviors and environmental aspects of meals in the home at the time behaviors occur so that plans of care can be tailored to PWD needs. Using a train-the-trainer model, volunteers will be taught to assess the environment (Place), the interactions between the PWD and others (People), and the actions of the PWD (Person). They will then train the CGs to make those observations so they can tailor and change mealtimes in the home – the telehealth component supports this. Thus this project could be used in the community as a model for behavior modification for other dysfunctional behaviors in the home. This study proposes to examine the following aims: (Primary) Compared to participants in ‘enhanced usual care’ sites, PWD participants in the intervention sites will demonstrate improvement in nutritional status and dysfunctional behaviors, and QOL; (Secondary) a) CGs will report improve QOL and self-efficacy for managing meals, and decreased depression and burden; c) RCC volunteers will report improved self-efficacy for training and management of feeding issues; and d) Directors will report satisfaction with the program and willingness to continue the program post-funding. Additionally, hospitalizations and discharges related to nutrition-related issues among PWDs will be collected for future work.
RWJF Future of Nursing
This proposal requests support for two RWJ Future of Nursing Scholars for the MUSC Online PhD in Nursing program. Our program strives to take nursing science to the highest level in a culture of innovation, collaboration and accountability. We define nurse scientists as nurses who plan to pursue a research interest with a program of externally funded research using rigorous, well-designed methods that address a gap in the care of vulnerable populations. We demonstrate the resources, experience, and innovation to successfully mentor a focused student through the 45 semester-hour online program in three years. This program is streamlined to focus on the essential competencies to the developing nurse scientist yet include diverse opportunities for mentored and elective work in policy, teaching, research, and leadership.
Our experience in mentoring students in a distance format is reflected in our ranking as #2 among online graduate programs in US News and World Report. Mentoring and academic support services delivered in an online format are time tested and ready. We will supply these RWJ scholars with a senior peer, a faculty advisor, comprehensive academic support course, a writing specialist and link them to our 2014 RWJ Scholar during the summer before classes even begin. The scholars will be mentored and taught by a faculty that reached 17th in NIH funding, with 75% (12/16) of the educator-research faculty funded as PI’s on federally funded grants. In the past five years, we have obtained 7 NIH R01 awards and additional NIH training and pilot awards. PhD students played a strong role in the research funding effort, with 5 of the 26 submitted proposals initiated by students. We have faculty with experience in mentoring post docs and participation in T-32s. About 80% of our PhD alumni are working as faculty and a majority are employed in research intensive environments. We benchmark our program success through the publications and funded grants of our current students and alumni.
The CON faculty is known for a range of funded work and populations that extends from population-based interventions to the physiological investigation of caring for chronic and acute illness. Our Office of Research highlights four stepwise mechanisms to help students with proposal development and implementation, and is supported by pre- and post-award support personnel and systems.
Our approach to diversity and inclusiveness is evidenced in our diverse student profile and high retention. We have 25 - 50% minority students any given year and an 89% rate of graduation. Our commitment to health equity, vulnerable populations, and diversity is reflected in every course. This same content is integrated into rich community based research opportunities with minority and vulnerable populations. CON faculty play key leadership roles in the NIH funded MUSC South Carolina Clinical and Translational Institute (SCTR). The South Carolina Clinical & Translation Research Center for Community Health Partnerships (SCTR/CCHP),dedicated to engaging community members and academic partners in all aspects of the research process to promote health, reduce the risk of illness and disease, and build community resilience to help transform health care and eliminate health disparities. Other intra-institutional research collaborations include the Center for Health Disparities Research, Hollings Cancer Center, College of Medicine, College of Dental Medicine, and College of Health Professions, and the VA. The RWJ scholar will participate and observe the working mechanism of these interdisciplinary SCTR cores, as well as assist in the academic products that result from them.
We are able to comply with all program requests and will meet the matching contribution required by the grant as detailed in the narrative.
Reducing Hospital Readmission Rates by Implementing an Inpatient Tobacco Cessation Service Driven by Interactive-Voice Recognition Technology
There is good reason to believe that providing tobacco cessation services to patients while hospitalized can improve clinical outcomes for patients. Smoking increases a patient’s risk for a host of negative clinical outcomes, including treatment-related toxicities and complications, medication side effects, and reduced performance status. Intervening with patients while hospitalized offers several advantages. First, patients are not permitted to smoke while in the hospital and temporary smoking abstinence may serve as a catalyst to help them remain tobacco free after discharge. Second, the illness that brought patients to the hospital may serve to motivate them to refrain from smoking. Third, hospitalized smokers have access to medical professionals and medications to assist in refraining from smoking. Thus, the Joint Commission (JC) has recommended that hospitals screen all patients for tobacco use and offer cessation services and follow up support within 1 month of discharge. Unfortunately, few hospitals implement the JC tobacco treatment standards in part because the services require extra costs, the standards are voluntary, and the financial benefits to hospitals and insurers have yet to be documented. In the future, national health policy changes may incentivize hospitals and insurers to explore how smoking cessation services may help to control healthcare costs. For example, the Centers for Medicare and Medicaid will penalize hospitals whose 30-day readmission rates exceed allowable limits for 5 conditions: 1) acute MI, 2) heart failure, 3) pneumonia, 4) COPD and 5) hip/knee replacement). The Medical University of South Carolina recently implemented an automated in-hospital smoking cessation program using IVR technology to follow-up with patients post-discharge in accordance with JC standards. This study takes advantage of in-place data capture mechanisms that allow efficient linkage between hospital clinical system, cessation program and statewide healthcare utilization datasets to examine hospital readmission and cost outcomes. The proposed study will use an interrupted time series design to examine monthly trends in readmission rates before (01/01/13-12/31/13) and after (02/01/14-01/31/15) program implementation, allowing us to test the hypothesis that an automated inpatient smoking cessation program will reduce unplanned readmissions and healthcare costs. This study provides an efficient way to examine whether investing in tobacco cessation services can help hospitals to avoid readmission penalties and reduce healthcare costs via secondary data analyses.
Components of Team Science Implementation-What Contributes to Success?
This project will generate pilot data through a qualitative inquiry with front line caregivers and administrators to contribute to the knowledge base of team science in order to close the gap of a lack of rich information and perspectives from essential stakeholders in team training. The study team will interview approximately 40 participants including all types of caregivers and relevant administrators with open ended questions regarding past and/or current experiences with team training to determine multidisciplinary perspectives. By analyzing the data qualitatively using an implementation science framework, the Consolidated Framework for Implementation Research, themes will be identified that can impact team science knowledge relating to team training that may contribute to practical clinical outcomes. In this way, the team will contribute towards progress with integrative and cumulative changes in collaborative behaviors by examining the “why” and “how” perspectives from stakeholders on the front lines of patient care and organizational decision making regarding team training. An Engaging Teams for Improved Outcomes Framework will be developed for future use in developing team training at MUSC and beyond.
Taking Student Learning Higher with Simulation Collaboration
This project seeks to advance the science of simulation in nursing education by (a) developing a unique statewide alliance with student involvement to promote collaboration; (b) developing evidence-based simulation pedagogy and simulation regulation recommendations; and (c) implementing a reliable and valid outcomes based measurement system for simulation users. At the present time, there is a lack of opportunity for student involvement in advancing simulation science in nursing education, a lack of clear, consistent and evidence based pedagogy guidelines for simulation, and inconsistency in outcomes measurement quality and implementation. The present project is designed to address each of these deficits.
This project will accomplish several important objectives for improving nursing education in South Carolina and beyond. Collaboration across the state with faculty and student involvement will occur through the formation of the South Carolina Simulation Alliance. A steering committee with members from each region of the state-- Low country, Midlands, and the Upstate will guide the development process. Through collaboration with the Medical University of South Carolina Medical Center, there is access to experts in all specialties available for providing input into the latest evidence-based practices for simulation scenario development.
Sharing will occur via teleconference, in-person meetings, conference calls, and culminate in a simulation conference created by alliance members with rewards for excellence in simulation presented at the student and faculty level. The implications for healthcare and practice are far-reaching as a team of nurse educator simulation experts will be developed allowing for input into regulatory processes for simulation in nursing education, collaboration, and multi-site research opportunities. The South Carolina Simulation Alliance will also provide opportunities for student involvement in the areas of simulation participation and scenario development. Additionally, with the support of the Promise of Nursing School Grant, there is an opportunity for enhanced student learning with the sharing of resources and content experts via three mobile video conferencing robots.
1) Develop and maintain a South Carolina Simulation Alliance to improve, coordinate, and expand the use of simulation in nursing education.
2) Collaborate with students to adopt advanced technology that enables access to resources and experiences not otherwise available (video-conferencing robots).
3) Develop a set of evidence-based practices that expand the science of simulation in nursing education as measured by increased measurement of outcomes with valid and reliable instruments.
Expanding the Reach of a Novel Mental Health Service for Traumatic Injury Patients
Our primary aim is to implement Trauma/Telehealth Resilience and Recovery Program (TRRP) in three partnering Level I-II trauma centers in South Carolina. TRRP activities include provision of in-hospital education after traumatic injury (Step 1), enrollment in our text-message service to monitor emotional recovery (Step 2), 30-day telephone mental health screen (Step 3), and provision of mental health treatment or referral (Step 4). We will initiate this process with each center by working closely with hospital leadership (i.e., trauma medical director, trauma program manager) and key personnel (e.g., social workers) to determine the optimal approach toward implementing TRRP and identify, record, and address barriers to integration. Most of this planning will focus on optimal procedures supporting the initial brief (i.e., 10 min) educational encounter because all other levels of our service will be provided via various forms of technology. We will document barriers and solutions to implementation at each site to inform future dissemination initiatives.
One full-time coordinator will be hired at each Center to provide TRRP services using funds from The Duke Endowment and MUSC Health Center for Telehealth. Coordinators will complete a 2-week intensive training in TRRP operations at MUSC. Training will include orientation to program goals and procedures, guided reading and discussion, and hands-on supervised experience in the first (in-hospital education) and third (telephone mental health screen) step of TRRP. MUSC staff will provide all support for the second (text messaging) and fourth (mental health treatment) steps of TRRP. Best practice treatment will be offered directly or by referral based, in part, on our capacity and patient preference. We will continue to provide oversight to coordinators throughout the award period and will travel to each site on a quarterly basis to work with hospital leadership and provide booster training. Site coordinators will maintain daily contact with the MUSC team to support program operations.
Behavioral Health Workforce Education and Training (BHWET) Program
This application requests funds to support innovative interdisciplinary academic-practice partnerships to prepare psychiatric mental health nurse practitioner (PMHNP) students in the MSN and DNP at MUSC CON for the professional track. The purpose of this project is to expand lifespan behavioral health workforce through increased longitudinal placements and provide interprofessional training in collaborative practice for students, faculty, and preceptors (field placement supervisors). The BHWET project will provide stipends to PMHNP students who commit to completing their field placement and plan to pursue employment in rural, vulnerable, and/or medically underserved areas (MUA). MUSC CON opened a PMHNP BSN to MSN/DNP program in Fall 2016 and enrolled 11 PMHNP students and 10 new students will be matriculating for Fall 2017. The CON graduated 68 primary care nurse practitioner students during 07/01/16-06/30/17. 100% of graduates from the previous year (07/01/2015 – 06/30/2016) are employed in rural, underserved and public health practice settings with 51% being classified as a HPSAs and 91% as a MUAs. Thus, demonstrating our historical support of these populations. We are requesting special funding consideration based upon the CON’s significant contribution to meeting the needs of the rural and underserved in SC.
The Goals/Objectives for the BHWET grant include:
1. Provide stipend support to eligible PMHNP students completing final field placement.
2. Expand community partnerships to increase longitudinal field placements while developing recruitment strategies with AHEC to increase employment for PMHNP students post-graduation in rural, vulnerable, and /or medically underserved areas.
3. Implement and provide interprofessional collaborative practice training to CON students, faculty and preceptors using enhanced didactic and experiential activities integrating behavioral health and team-based care to increase competencies.
4. Communicate with other BHWET Program grant recipients to share successes and problem solve any challenges or barriers to ensure optimal program outcomes as part of ongoing quality improvement and evaluation.
Processes and evaluation for the BHWET program will occur as follows:
Objective 1: PMHNP students will be eligible to apply in the final year of full-time or final two years for part-time study. A rubric will be used to rank and fund the top students. Priority points will be awarded to disadvantaged and/or diverse students, and students who live or have clinical rotations in rural areas, MUAs or HPSAs. Students must remain in good standing each semester. All BHWET students will sign a commitment letter (Attachment 8) each funded year. Longitudinal data collected includes post-graduation position placement.
Objective 2: Innovative community partnerships will be expanded.
Objective 3: Didactic and experiential training using the Interprofessional Core Competencies will occur with students, faculty and preceptors.
Objective 4: As part of ongoing project quality improvement, we commit to participating in email, blog and/or HRSA interactive phone conferences to ensure best program outcomes. An annual performance report and final report will be submitted as required.
The Choose Well Initiative
Choose Well is a statewide initiative of the New Morning Foundation, whose goal is to substantially and measurably reduce unintended pregnancy among women and teens in South Carolina over a 4-year period (2017-2020). This collective impact initiative will involve a wide range of partners, including state agencies and coalitions, health care services, schools and colleges of nursing and medicine, and community-based and community-serving organizations, whose individual and collaborative work will result in better access to highly effective contraceptive methods and a decrease in unintended pregnancy.
Building the Healthcare Workforce to Serve the Underserved
The goal of this proposal is to develop a model of integrated clinical experiences for interprofessional teams of students within the safety net delivery systems to establish a network of teaching community health centers. This proposal builds on the momentum established by the AHEC Institute for Primary Care, a collaboration between the Medical University of South Carolina (MUSC) and East Cooper Community Outreach (ECCO) to provide care to the uninsured, and an interest by Fetter Health Care Network (FHCN), a Federally Qualified Health Center, to build a pipeline of primary care providers to serve the underserved.
Elder Abuse Assessment Training and Mental Health Services Program
(1) Health care personnel and other professionals such as professional caregivers (CNAs, PCAs) etc., are in a pivotal position to help victims of elder mistreatment because they see virtually every adult over age 60 each year. However, they frequently fail to do so because 1) they are not trained to consistently recognize, assess, and refer to services and (2) evidence based counseling services are not readily available, particularly to rural elder abuse victims.
Solution: We have already designed and now propose to implement a low-cost, easily disseminated and highly sustainable elder abuse identification, intervention, and referral training program designed for (a) health care professionals already in practice, and (b) healthcare professional students in training in academic settings. In conducting this (a) training and (b) services program, we will not only reach victims currently under the care of providers, but will reach future victims treated by future healthcare providers, thereby assuring the program’s reach and sustainability. In addition, we propose to greatly expand the number of medical and health care personnel this program reaches by incorporating a "train the trainer" component, during which health care providers with interests in addressing the issue of elder abuse will be trained to provide these screening, intervention, and referral trainings to other health care personnel.
Specifically, this is a training and services project. With respect to training: we propose to offer a brief training program to identify and intervene in cases of elder mistreatment. This program is specifically designed to be easily integrated into (a) existing practice sites, particularly those serving low income and minority populations, where risk of elder mistreatment is greatest such as our partners represented by ECCO, Harvest Free Clinic, and State wide as represented by the SC Office for Rural Health (see letters of support). In addition, these training protocols are amenable to being delivered to (b) nursing, medical, and physician assistant students as part of their classroom instruction. Finally, we propose to train nurse practitioners, residents and junior level healthcare providers to deliver these elder abuse training programs to other health care personnel in their clinical settings.
Components of the training program include: (1) a complete, practice-ready elder abuse screening and intervention protocol designed for active clinics, particularly those healthcare settings serving minority populations as well as clinics facing budgetary and time constraints; (2) a brief, pragmatic, and integrated training program in how to use the elder abuse screening and intervention protocol in real practice settings, (3) a complementary training program for nursing, medical, and physician assistant students to conduct sensitive and comprehensive assessments for elder abuse, including elder DV, (4) a train the trainer component where program components are reviewed in depth, and training parameters conveyed to new cadres of providers with interests in addressing elder abuse.
1. Training health care providers in clinics across the tri-county area to screen, intervene and refer victims of elder abuse, with an emphasis on clinics and providers that serve minority populations, for which elder abuse rates are higher.
2. Training other community based agency personnel about elder mistreatment prevalence, risk factors, and how to screen, intervene, and refer for services for elder abuse, particularly in minority populations.
3. Provide group and individual counseling services in the community and via telehealth to both rural and urban older adult victims of abuse (psychological, physical, sexual, neglectful and financial).
To recruit a team of highly motivated volunteers.
Sponsor/Type: NIH/NINR - R21
Monitoring and managing newly healed chronic leg and foot ulcer skin temperature: a cooling intervention (MUSTCOOL) to prevent ulcer recurrence
The goal of this randomized control trial is to test a patient directed self-monitoring and self-management intervention aimed at preventing the recurrence of chronic venous leg and diabetic foot ulcers using skin temperature and cryotherapy (cooling). We propose MUSTCOOL, a novel ulcer prevention strategy for patients at highest risk for developing chronic ulcers; those with a previous history. We aim to compare a cooling treatment to a placebo to determine the outcomes on ulcer recurrence, pain, physical activity and quality of life.
Individuals with newly healed chronic ulcers will be invited to participate in MUSTCOOL’s two component intervention: 1) self monitoring skin temperature over targeted “hot spots” daily with an infrared thermometer; and 2) maintenance cooling with a cooling pack (or placebo pack) placed over the “hot spot” three times each week for 30 minutes. If the temperature of the “hot spot” becomes elevated 2°F above baseline (average of 30 days of daily temperature readings) for 2 days in a row, a bolus regimen of 5 consecutive daily, 30 minute applications of the cooling or placebo pack will be implemented. We will monitor safety and side effects, however, there have been no reported adverse events reported in our previous cryotherapy studies.
We designed this chronic ulcer prevention intervention that targets the remodeling phase, the final repair process of healing after chronic ulcer closure. The skin environment is particularly vulnerable to ulcer recurrence due to a persistent aberrant inflammatory state. Our previous research has demonstrated that cooling this skin reduces the abnormal metabolic activity, protecting it against ulcer recurrence. Recent advancements in infrared technology allow us to take images of the affect skin to identify the area that has the highest temperature or vulnerable “hot spot”. These “hot spots” will be self monitored by patients with newly healed ulcers in the home with an infrared thermometer that date and time stamps each reading. The study’s outcomes on physical activity will be evaluated with an accelerometer. We hypothesize that by improving the skin environment and reducing pain, patients will more likely be physically active and have better quality of life, all measurable goals for this study.
We will evaluate this prevention strategy over six months in 180 patients, 90 of whom will be randomized to receive the cooling pack and 90 the placebo. Our goal is to test this non-pharmacological, non-invasive clinical intervention as a tailored self-management strategy to prevent chronic ulcer recurrence. It will also determine alleviation of symptoms such as pain, and the debilitating effects on physical activity and quality of life.
Technology Enhanced Self-Management Interventions for Fatigue and Pain: The Symptoms Self-Management Center
The overall goal of the Symptoms Self Management Center is to build a critical mass of research thematically focused on targeting symptoms of fatigue and pain through complementary, synergistic research activities. Toward this end, the National Institute on Nursing Research-funded (NINR-P20) Symptom Self Management Center (SSMC) at the College of Nursing, Medical University of South Carolina, provides the infrastructure and context for nurse scientists who will:
Community-based Intervention under Nurse Guidance after Stroke (CINGS)
Stroke is the leading cause of severe disability in Americans, and African Americans (AA) are at the highest risk for stroke with rates approximately twice those of Whites. Also concerning, stroke in AA occur at younger age, and with higher severity than whites. Despite being affected at younger ages, AAs are less likely than whites to return to equivalent functional status and are more likely to die following stroke. This disparity cannot be explained by access to acute care or rehabilitation, but may relate to other personal, familial, and community factors that remain understudied. Because diabetes and hypertension are more prevalent among AA relative to Whites, and because both are significant risk factors for stroke, complex factors underlying these chronic diseases very likely also contribute to increased rate and relatively poor outcome of stroke found in AA. To address these complex issues, an innovative, coordinated approach is required that considers patient, family, and community level factors, both to explain disparate stroke recovery rates and to design and implement efficacious interventions for post stroke recovery in community residing AA patients. We have designed and successfully implemented precisely such an approach with Diabetes Belt communities and propose to do so for Stroke Belt communities as well through the Community-based Intervention under Nurse Guidance after Stroke (CINGS), a 12 week, nurse-coordinated, community health worker-delivered home-based intervention. Therefore, we propose to (1) Identify primary barriers and facilitators of post-stroke recovery for AA in the US Stroke Belt Buckle of SC through formative qualitative research (i.e., interviews, focus groups) with AA patients with stroke, their families, community leaders, and public health practitioners. (2) Develop CINGS intervention components to improve AA stroke recovery and community participation in stroke recovery activities by integrating evidence-based guidelines and AA community generated evidence to address factors that perpetuate disparity in stroke recovery. And (3) Subject CINGS to a pilot RCT with approximately 60 patients obtain variability estimates, measure preliminary effects, and explore potential relationships with mediators/moderators. We hypothesize that the intervention group will significantly improve along impact and outcome measures of interest as compared with the usual care group.
Accessible Care: Utilizing Telehealth to Manage Chronic Respiratory Disease in an Underserved, Rural Setting
Chronic lower respiratory disease is currently the third leading cause of death in the United States. These diseases, such as chronic obstructive pulmonary disease and asthma, are associated with dyspnea, activity avoidance, and functional impairment, all of which combine to reduce quality of life and self-efficacy. Mobility limitations, enhanced by perceived symptom burden, create barriers for those with chronic respiratory disease, making it difficult to attend medical appointments, rehabilitation, and seek preventative health care. Lack of transportation (inadequate/unreliable public transportation, depending on a caregiver to take time off of work) is an additional barrier in rural localities. Consequences of disease are often felt most by higher risk populations, such as families of lower socioeconomic backgrounds and minority race and ethnicity. Thus, we propose address these barriers by evaluating technology-enabled symptom tracking and telehealth-delivered care to patients with chronic respiratory disease in an underserved, rural setting. This collaborative, patient-centered, accessible therapy delivery will serve to improve access to health services for patients classified as a member of a "vulnerable population," including those with economic and transportation-related (e.g. residing in a rural or highly rural locality) barriers, as well as those self-identified as belonging to a racial or ethnic minority group. It is our hope that increasing the availability of care and provider access, along with technology-enabled symptom tracking, will offer patients an opportunity to increase their active management of their disease and in turn, increase self-efficacy, decrease perceived symptom burden and disease exacerbations.
Innovative Treatment for Female Victims of Military Sexual Trauma (MST) and PTSD
Female members of our Armed Forces experience sexual trauma (MST-Military Sexual Trauma) at a rate 400% that of female civilians. Social Withdrawal leading to depression and other psychological problems is a major problem following MST. Treatment programs for these women are housed in VA Medical Centers, where patients and counselors are predominantly male and services are thus predominantly male oriented. As such, greater than 95% of all identified female victims of Military Sexual Trauma Veterans DO NOT receive any services from the VA for the psychological effects of their MST experience.
1. The MUSC College of Nursing will collaborate with the non-profit 501c3, Veterans on Deck, to provide evidence based counseling services for Military Sexual Trauma and combine these with mastery and empowerment experiences specifically designed to the counter-act Social Withdrawal common in Military Sexual Trauma victims. These experiences will make use of the Veterans On Deck sailing vessels and Veterans on Deck volunteer psychologists and social work counselors, and will include team building, mastery, and empowerment training during sometimes challenging conditions found on sailing vessels.
2. The Project will include Spanish speaking and African American counselors and trainers during empowerment and mastery sailing sessions.
3. The College of Nursing will collaborate with the Veterans on Deck non-profit and with the Charleston VA Medical Center, PTSD Clinical Team (PCT). The PCT will refer women identified as victims of Military Sexual Trauma to this program. Note, the Director of the current project is a collaborates with the VA PCT team on multiple projects, thereby assuring referral flow and inter-agency cooperation.
1. Formal agreements for sail training and counseling of Military Sexual Trauma Victims will be made between the non-profit Veterans on Deck and MUSC.
2. Formal volunteer rosters of counselors trained to treat sexual trauma and Military Sexual Trauma will be finalized.
Female victims of Military Sexual Trauma will receive counseling services via on the water training.
A Virtual Learning Collaborative for Alcohol Screening, Brief Intervention and Treatment in Primary Care
This application builds upon previous studies by investigators at Medical University of South Carolina (MUSC) that resulted in significant improvements in alcohol screening and brief interventions, and modest improvements in adoption of pharmacotherapy for alcohol disorders in primary care practices across the United States. While PPRNet accomplished these improvements in a crossover randomized trial, effective strategies are still needed to more widely disseminate findings and approaches practices used, and develop mechanisms to make a larger national impact in the adoption of and effective implementation of the NIAAA recommended clinical guidelines. The proposed R25 education program implements an innovative virtual learning collaborative (VLC) approach to disseminating evidence, guidelines and strategies for implementation of screening, brief intervention, and referral to treatment (SBIRT) to primary care clinicians, nurses and other clinical staff nationwide that participate in PPRNet, a practice based research network with 15 years of experience in translating research into practice (TRIP). The proposed project tests the comparative effectiveness of participating in ALC-TRIP (Alcohol Learning Collaborative–Translating Research into Practice) compared to practices that have not participated in this VLC. This study will be the first use of an innovative VLC that involves learner participation in web-based discussions/planning to improve alcohol screening and intervention in primary care, with the potential to reach a large number of primary care practices throughout the US. The primary aims of this alcohol education project proposal are to: 1) Develop and implement ALC-TRIP, a multi-component VLC designed to educate primary care staff and clinicians to develop practice approaches to improve alcohol screening, brief intervention and alcohol pharmacotherapy for alcohol use disorders; 2) Compare the effectiveness of practice participation in ALC-TRIP on alcohol screening, brief intervention and use of alcohol pharmacotherapy to non-participation in this learning collaborative, in a nationwide sample of 10 practices in each group; and 3) Conduct a process evaluation of this learning collaborative to examine the strengths, weaknesses, opportunities and threats related to this approach from the perspective of the stakeholders. Findings from this project will advance the educational mission of the NIAAA and inform future dissemination and implementation programs for alcohol SBIRT. If ALC-TRIP is more effective than passive dissemination of guidelines through an educational webinar and quarterly practice reports, VLCs might play a critical role in primary care-focused alcohol and illicit drug use initiatives.
For more information contact Dr. Nemeth at email@example.com
PHOENIX: Development of a Spinal Cord Injury Peer-Supported Self-Management Intervention
The goal of this 2-phase, 3-year proposal is to develop and pilot test, in partnership with the South Carolina Spinal Cord Injury (SCI) Association, a SCI Peer Navigator intervention for implementation across South Carolina, integrating online and telehealth platforms. Our Peer-supported Health Outreach, Education, aNd Information eXchange (PHOENIX) intervention, which builds on our pilot Peer Navigator study, is specifically designed to promote self-management after SCI. The broad goals of PHOENIX are to improve participants’ community participation and quality of life (QOL) and decrease subjective impact and occurrence of secondary conditions and rehospitalization after SCI. During Phase 1, we will complete translation of our existing in-person SCI Peer Navigation program for online and telehealth delivery. Key objectives of Phase 1 include: 1) integration of mobile technology to improve access and reach of PHOENIX, and 2) development of additional multimedia online educational content. During Phase 2, we will conduct a randomized waitlisted pilot trial to identify potential logistical and methodological issues of both intervention implementation and study procedures in preparation for conducting a future full scale, randomized controlled trial. Key objectives of Phase 2 include: 1) evaluation of feasibility, acceptability, and fidelity of intervention implementation and study design and procedures, and 2) obtaining estimates of variability of relevant outcome measures. The expected outcomes are that PHOENIX will be feasible and acceptable to participants and stakeholders, and we will observe increased levels of community participation and QOL, and decreased subjective impact and incidence of medically serious secondary conditions and rehospitalizations. The expected products are Peer Navigator training and PHOENIX curriculum housed in the online iTunes U platform.
For more information contact Dr. Newman at firstname.lastname@example.org
Nurse-led Education and Engagement for Diabetes Care in Sub-Saharan Africa (NEEDS)
Study Goals: The overall objective of the Nurse-led Education and Engagement in Diabetes care in Sub-Saharan African (NEEDS) study is to characterize the burden of Type 2 Diabetes (T2DM) patients in SSA, and explore and prioritize preferences of patients with T2DM, caregivers, and health providers in the development of a theoretical, multi-level, culturally tailored nurse-led diabetes management intervention that incorporates mobile health (mHealth) technology to increase adherence, improve outcomes, and reduce the burden of diabetes in SSA, that will be subsequently tested in a future trial. Our hypothesis is that a multi-level, culturally situated assessment of diabetes can lead to the development of a nurse-led intervention enhanced by the use of mHealth to address diabetes education and care management.
Specific Aims: Guided by a social ecological model (SEM)22, community based participatory research23, and NIH best practices for mixed methods research24, the Medical University of South Carolina (MUSC) and Ghanaian partner will conduct a mixed methods study with the following aims:
Aim #1: Assess the characteristics, including contextual factors, beliefs, practices, and self-management behaviors, of patients with T2DM in SSA.
Aim #2: Assess the characteristics, beliefs, knowledge levels, access and familiarity to technology of patients with T2DM in SSA, as well as the barriers and facilitators influencing diabetes care and its potential influence on outcomes, at the various levels of the SEM: a) individual, b) family/significant other/caregiver, c) healthcare organizations, and d) community. Using focused ethnography25, 26, the following research questions will be addressed:
Aim #3: Triangulate quantitative data (Aim 1) with qualitative data (Aim 2) to guide the design of a theory, driven, multimodal nurse-led intervention incorporating technology for diabetes management for testing in a future trial.
Long-term Goal: To develop a practical, collaborative, effective, and sustainable diabetes prevention and management program for patients with T2DM in SSA and improve access to care through task shifting and use of technology.
For more information contact Dr. Nichols at email@example.com
Survive to Thrive: Living Well with Stroke
Comparative Effectiveness Research (CER) Transition into Letter of Intent (LOI) Proposal
Building on our prior work from Tiers I & II, our group will continue to refine our CER questions with the goal of developing a Letter of Intent and full proposal for submission to a PCORI Broad-based Pragmatic Clinical Study announcement. Our group, named consistent with our Tier III Project Name, Survive to Thrive: Living Well with Stroke, initially convened during Tier I and further evolved during Tier II. Based on input from stroke survivors and their caregivers/care partners, the group adopted this expanded name (adding on Living Well with Stroke) to be representative of patient/family member experiences and goals. Community partners identified the inconsistencies between current health systems and care models focused on acute and immediate post-acute discharge on stroke recovery and the realization that stroke is a life altering experience that results in a lifetime of adaptation to a new norm, often amidst a paucity of resources and programs for long-term support and services. In Tier III, we will continue to strengthen and expand our partnerships while refining our comparative effectiveness research questions and developing a research plan for subsequent grant funding.
Through our Tier II efforts, shared experiences from our community partners shaped our current CER questions and highlighted the need to address the long-term unmet needs of stroke survivors and their caregivers. We collaboratively developed two CER questions that allow further exploration in these areas:
1) Do stroke survivors and caretakers receive optimal longer-term care when post-discharge follow up consultations with stroke specialists are conducted in clinic versus telehealth?
2) Do stroke survivors and caretakers receive optimal longer-term care by using community-based stroke care coordinators or by attending in-clinic consultations with stroke specialists?
Understanding the need within Tier III to build upon prior work to lead to our LOI and proposal development, we have structured our Tier III Proposal Opportunity Plan development to afford a shared partnership between academic researchers (Nichols, Woodbury, & Magwood) and Co-Lead (Roper team), with regular involvement from community partners. The Project Co-Leads will work directly on refining the research questions, developing a research proposal plan, preparing a Letter of Intent (LOI), and compiling all necessary requirements for successful completion of a research grant application over the 12-month Tier III P2P project period.
For more information contact Dr. Nichols at firstname.lastname@example.org
Bounce Back Now: A Low-Cost Intervention to Facilitate Post-Disaster Recovery
Improving Quality of Care in Child Mental Health Service Settings
Assuring children access to the highest quality mental health care is a top national priority. Yet, quality of care continues to be highly variable in traditional service settings. Novel, scalable solutions are needed to address modifiable quality-of-care indicators in sustainable ways. To this end, provider fidelity and children’s engagement are key correlates of clinical outcome and practical targets for intervention. There is tremendous opportunity to address both through technology. Studies in child education show that interactive games, touch-screen learning, and demonstration videos enhance engagement, knowledge, motivation, and learning. These benefits also may extend to the therapeutic context, where strategic integration of technology-based activities may enhance children’s learning, strengthen the therapeutic alliance, and keep providers on protocol. We are in the final stages of an NIMH R34 in which we piloted a patient- and provider-informed tablet-based toolkit designed to facilitate delivery of Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) – a treatment that was selected because it addresses a wide range of symptoms using techniques shared by other treatments for emotional and behavioral disorders. The tablet-based toolkit consists of numerous components (e.g., videos, interactive games, drawing applications) that are designed to facilitate provider-patient interactions in a way that enhances children’s engagement and supports adherence to the treatment model. The tablet-based toolkit was very well received by children, caregivers, and providers in our pilot work. Moreover, all benchmarks for feasibility outlined in our NIMH R34 application were met or exceeded. We now propose to conduct a hybrid effectiveness-implementation trial to examine the extent to which the tablet intervention may improve fidelity, engagement, and children’s mental health outcomes. We will conduct a randomized controlled trial with 120 mental health providers and 360 families in partnership with dozens of clinics in the Carolinas and Florida. Providers will be assigned randomly to tablet-facilitated vs. standard TF-CBT. Youth aged 8-16 years with clinically elevated symptoms of PTSD will be recruited. Baseline and 3-, 6-, 9-, and 12-month post-baseline assessments will be conducted by independent, blind evaluators. Sessions will be video recorded for observational coding of engagement and fidelity by independent raters blind to study hypotheses. We will also examine costs and conduct semi-structured interviews with families, providers, supervisors, and agency leaders to inform future dissemination and implementation initiatives. Technology-based resources that are scalable, easy to use, and designed for efficient integration into everyday practice may have sustained national impact. The return on investment of these initiatives will ultimately rest on their potential to improve the spread of best-practice treatments and the quality with which they are delivered to the children who need them.
Mobile Web Resources to Support Spouses and Family Members of Fire Service Personnel
Earlier studies showed that, after critical incidents and occupational stressors, 19% of firefighters looked to peers for support but four times as many (74%) turned to spouses and family members. Later studies have emphasized even further that family members are often the first to recognize the need for help. This shows a critical need for resources that can help firefighter families to: (1) understand and identify common firefighter stressors and behavioral reactions; (2) identify their own stressors and behaviors (e.g., worry, anxiety, distress, marital discord) when they occur; (3) learn about evidence-based self-care, peer/social support, and communication strategies; (4) build skills to recognize warning signs and take action; and (5) know how to seek help through local and online resources. We were asked by the National Fallen Firefighters Foundation to create such a resource to add into our fire service portfolio. This project will develop and evaluate these resources.
The National Fallen Firefighters Foundation (NFFF) solicited our participation in the consensus groups that originally identified and designed comprehensive behavioral health projects for Firefighter Life Safety Initiative 13, and we have been partners ever since. Our team is internationally recognized for expertise in developing web- and smartphone-based screening, assessment, self-help, and provider training resources in behavioral health. The projects we have been asked to develop for this initiative, including the spouse and family resources proposed here, have been identified in consensus sessions as high priority needs with designs based on the best evidence-supported approaches.
Our work on behalf of America's firefighters has become a passion and a commitment for our staff and our program. Our first FPS supported project involved the launch of our Helping Heroes training course to teach providers how to effectively deliver the best treatments to firefighters for posttraumatic stress and depression. More than 5,000 health care providers successfully acquired these critical skills to date, and their endorsement of its utility and contribution has been extraordinary.
Our second FPS grant supported development and launch of a smartphone app, RIT Tools for Firefighter Suicide Prevention. The app develops fire service peers' ability to recognize suicide risk and use effective motivational techniques to get at-risk firefighters to sources of effective help. We have worked with NFFF to disseminate and maximize uptake of the app. Our third FPS grant supported development of Firefighters Helping Firefighters, a video peer education intervention that features the personal stories of over 20 firefighters to address mental health stigma and improve readiness to seek behavioral health care among firefighters who need it. Our fourth grant was a web-based screening, assessment, and educational resource for firefighters and behavioral health professionals working with firefighters after a critical incident. Our fifth, and current, grant is a smartphone screening, brief intervention, and referral resource for firefighters and behavioral health professionals to address alcohol abuse in the fire service. We have fully developed this content and are on schedule for successful launch.
For all resources launched by our team, all major tasks were completed according to timelines proposed, including focus groups, content development, production and editing of videos, and input from fire service groups at NFFF-sponsored meetings. We have successfully completed a number of other projects very similar in scope to the one here proposed, including development, testing, launch, extensive evaluation, and ongoing maintenance of numerous web- and smartphone-based resources. Each was completed on time and within budget, and each has met and exceeded its development and dissemination objectives as demonstrated through detailed evaluation and study.
Addressing Mental Health Needs in SC by Primary Care Nurse Practitioners
The MUSC College of Nursing (CON) outcomes obtained because of BSBSSCF's 2012 grant funding are powerful, however, there is much more work to be done! Additional advanced competencies are needed by CON DNP graduates in the fluctuating health care environment in order to best serve South Carolina's (SC) future health needs. SC has significant challenges with chronic illnesses such as asthma, cancer, diabetes, and heart disease, as well as comorbid mental health conditions. There are no SC DNP programs preparing nurses for certification in mental health care in the primary care setting at this time. This proposed project would provide outcomes that meet the BCBSSCF focus areas through increasing the number of frontline health care professionals and supporting innovative approaches to knowledge and skills development. The project activities, timetable and outcomes will include:
Further growth in information technology and technology support to ensure relevancy in online programming, teaching and clinical supervision for students in collaboration in monthly meetings with CON IT staff. Outcome: curriculum map, program evaluation. Grant funding will enable the development and implementation of an innovative program that will educate critically needed primary care nurse practitioners in psychiatric-mental health care to meet the complex health care needs of South Carolina.
Advanced Nursing Education Workforce (ANEW) Program
This application requests $1.4 million in funds to support innovative academic-practice partnerships to prepare primary care APRN students in the MSN and DNP at MUSC CON. The purpose of this project is to increase the longitudinal clinical immersive training experiences with rural and/or underserved population for selected primary care APRN students, develop a clinical preceptor education and support program, and facilitate post-graduate employment in rural and HPSA and/or MUA in three nurse practitioner roles: AGNP, FNP, and PNP. The ANEW project will provide traineeships to 14-16 students who commit to at least two years of primary care work in a rural and HPSA and/or MUA after graduation. MUSC CON graduated 55 primary care nurse practitioner students during 07/01/15-06/30/16, and 100% are employed in rural, underserved and public health practice settings of which 51% are employed in HPSAs and 49% in MUAs (Data Form Table 1 Part A & B). Since 2012, a total of 110 students have received AENT (n=80) and ANEE (n=30) HRSA funding; currently 74% of their practice sites can be classified a HPSA, 77% as a MUA, and 25% as a rural, underserved area. We are requesting special funding consideration based upon the CON’s significant contribution to meeting the needs of the rural and underserved in SC.
The objectives for the ANEW grant include:
Processes and evaluation for the ANEW program will occur as follows:
Objective 1. Full-time APRN students at any program point and part-time students in the last year will be eligible to apply. A rubric will be used to rank and fund the top students. Priority points will be awarded to disadvantaged and/or diverse students, and students who live or have clinical rotations in rural areas, MUAs or HPSAs. Students will be tracked for success and registered each semester. Students will sign a commitment letter (see Work Plan & Budget Narrative) each funded semester. Longitudinal data collected includes post-graduation position placement. An annual performance report and final report will be submitted as required.
Nurse Faculty Loan Program
This application is a request for financial loan support for students enrolled in a Doctor of Philosophy in Nursing (PhD) degree program and the post-Master’s Doctorate of Nursing Practice Program (DNP) at the College of Nursing (CON), Medical University of South Carolina (MUSC) with a career goal to serve as nurse faculty upon graduation. The CON DNP program is fully accredited by the Commission of Collegiate Nursing Education (CCNE) through June 30, 2016, and MUSC is an accredited university by the Southern Association of Colleges and Schools Commission on Colleges (SACSCOC).
The objectives for this program are as follows:
Increase the number of graduate doctoral students in the BSN-DNP, post MSN-DNP, BSN-PhD and MSN-PHD programs who are prepared to become qualified nurse faculty upon program completion by:
Processes and evaluation for the program will occur as follows:
Program completion, reports and post-graduation follow-up. Students will be followed at the end of each semester to ensure successful completion of the courses. Longitudinal data will include collection of teaching program level for each NFLP graduate completed by the coordinators for the DNP and PhD program at 6 months post-graduation and every year for four years. Bi-annual reports for HRSA will be completed and submitted, (January & July) as required, by the Associate Dean of Academics.
Screening, Brief Intervention, and Referral to Treatment (SBIRT) Health Professions Student Training (SBIRT- Student Training)
Substance abuse ruins lives, destroys families, and increases health care costs. South Carolina is a state with significant chronic illness, including substance use paired with a large medically disenfranchised population (NACHC, 2007). The goal of this project is to improve and enhance the training of health professions students (undergraduate and graduate nursing students, and medical students) to provide competent screening, brief intervention and referral to treatment for persons who have or are at-risk for substance use disorder (SUD). With Screening, Brief Intervention and Referral to Treatment (SBIRT) training, the pool of nursing and medical professionals at every level of education and in every clinical setting will have the knowledge and skill to improve the assessment and intervention provided to active or at-risk individuals of SUD and negative sequelae. A proactive approach identifying those active or at-risk of SUD will lead to improved health, decreased health costs and poor outcomes. The basics of SBIRT are the same regardless of setting. All patients in hospitals, emergency rooms, primary health clinics, community health centers, schools, or other health care venues undergo a quick screening to assess alcohol and drug use. If they have or are at risk of developing a serious problem, they receive a brief intervention that focuses on raising their awareness of substance abuse with motivation to change their behavior. Patients who need more extensive treatment receive referrals to specialty care. SBIRT is a simple, evidence-based approach to incorporate screening for and intervention in one of our largest public health problems – substance abuse.
This project at the Medical University of South Carolina (MUSC) will implement a unique strategy to address the unmet detection and treatment needs of the underserved and active or at-risk population for SUD by: 1) educating all educator/clinical faculty at the College of Nursing (CON) and College of Medicine (COM) in the use of SBIRT (approximately 90 faculty in the first year); 2) integrating SBIRT training into existing courses in the undergraduate and graduate nursing and medicine curricula to promote competency of all nursing and medical graduates in using SBIRT (training 440 new students each year); 3) creating simulations, videos and online teaching modules, online resource library, and competency evaluations to facilitate the mastery of SBIRT for use by students; 4) enhancing the cultural and linguistic competencies of students in utilizing SBIRT; and 5) providing local and state-wide trainings through MUSC initiatives, AHEC, and health professional organizations. Health care providers have highlighted the need for specific knowledge and skills training to provide interventions for those active or at-risk of SUD. Embedding this training into the core curricula assures its implementation and sustainability. More importantly, this training program represents educating nurses, advanced practice nurses and physicians for the future of health care, in which physical and mental health systems of care will be integrated allowing intervention for patients experiencing both medical and behavioral health problems.
Increasing Treatment Seeking Among At-Risk Service Members Returning from Warzones
Dr. Stecker was awarded a five year trial (W81XWH-13-2-0032) entitled Increasing Treatment Seeking Among At-Risk Service Members Returning from Warzones by the Department of Defense. The goal of this research is to evaluate the effectiveness of the cognitive-behavioral intervention to increase behavioral health treatment seeking among military personnel at-risk for suicide. Reducing suicide is a national priority and an urgent concern within the Department of Defense and the Department of Veterans Affairs. Indeed, rates of suicide among active duty service members and Veterans have increased dramatically since 2005, with an average of 20 Veterans completing suicide per day. The vast majority of service members and Veterans at-risk for suicide do not seek help.
This is a randomized controlled clinical trial of 1,200 military service members who are at increased risk for suicide but not currently in behavioral health treatment for the purpose of determining if a brief intervention improves the initiation of treatment. Participants assigned to the treatment condition receive an individualized cognitive-behavioral intervention administered by phone. The intervention has been shown to promote treatment-seeking in preliminary studies of OEF/OIF Veterans with elevated posttraumatic stress disorder (PTSD) symptoms. Participants are assessed at baseline and at 1-month, 3-month, 6-month, and 12-month follow-up.
Jonas Nurse Leaders Scholar Program
The goal of the program is to increase the number of doctorally-prepared faculty available to teach in nursing schools nationwide, as advocated by the Institute of Medicine’s recent report, The Future of Nursing: Leading Change, Advancing Health. Supported by the Jonas Family Fund at the Jewish Communal Fund, the program will provide financial assistance, leadership development, and mentoring support to expand the pipeline of future nurse faculty into research-focused and practice-focused doctoral nursing programs.
Patient Centered Health Technology Medication Adherence Program for African American Hypertensives
Efforts to improve medication non-adherence (MNA) and blood pressure (BP) control in patients with hypertension (HTN) have met with limited success. Innovative approaches are needed that are acceptable, sustainable, efficacious, and easily disseminated. There have been no randomized controlled trials (RCTs) evaluating the application of theory-driven, patient centered, mobile health (mHealth) technology programs among African Americans (AAs) with MNA and uncontrolled HTN. The proposed research will test and refine the Smart phone Medication Adherence Stops Hypertension (SMASH) program. SMASH includes multi-level components: 1) automated reminders from an electronic medication tray; 2) tailored text message/voice mail motivational feedback and reinforcement guided by self-determination theory and based upon adherence to daily medication and BP monitoring and 3) automated summary reports and direct alerts to providers. A 6-month, 2-arm (SMASH vs. enhanced Standard Care [SC]) efficacy RCT will be conducted in 192 AAs (21-59 years old) with electronic monitor derived MNA and repeated clinic and 24hr BP verified uncontrolled HTN. Evaluations will occur at baseline, months 3 and 6, and post-trial follow-ups at months 12 and 18. Specific aims are to test the hypotheses that, compared to the enhanced SC cohort, the SMASH cohort will demonstrate significantly improved and sustained changes in: 1) Primary Outcome Variables: a) Medication adherence: % with electronic monitor-derived adherence scores >0.90; b) BP control: % meeting JNC8 guidelines for BP control (resting BP <140/90 mmHg). 2) Secondary Outcome Variables: a) % reaching and sustaining 24-hr ambulatory BP<130/80 mmHg; b) % of provider adherence to JNC8 guidelines as measured by timing of medication changes and c) patient changes in Self-Determination Theory constructs (e.g., competence and autonomous motivation). 3) Exploratory Outcomes: a) moderators (e.g., gender, age, income) and mediators (e.g., perceived severity of disease, med side effects, depression symptoms, etc.) of medication adherence and BP control; b) cost effectiveness and c) physical risk factor changes (cholesterol, LDL, HgA1c, blood glucose). After final follow-up evaluations, focus groups with random sample of SMASH subjects (total n=32) and healthcare providers (total n=~12) will assess key user reactions including acceptability, usability, salience and aids/barriers to sustainability. Data from RCT and focus groups will be triangulated to further refine and optimize SMASH and prepare for a multi-site effectiveness RCT. Our long-term objective is to reduce premature mortality among AAs by developing effective and sustainable mHealth chronic disease medical regimen self-management programs including medication adherence, bio-function monitoring (e.g., BP) and timely bidirectional contact with healthcare providers.
Smartphone Delivered Meditation for BP Control among Prehypertensives
Stage 2 pre essential hypertension (preEH; 130-139/<90 mmHg) entails a 3-fold risk of developing EH and 2-fold risk of cardiovascular disease (CVD) events compared to those with optimal blood pressure (<120/80 mmHg). Prevention programs are needed which can be sustained by preEHs and readily disseminated by healthcare providers. Psychological stress is a risk factor for future EH and CVD. Stress reduction via meditation has shown promise in reducing blood pressure (BP) but adult studies have not determined optimal dosage level nor evaluated dosage adherence objectively. Multiple underlying biobehavioral mechanisms linking meditation with BP reduction also require additional scrutiny. The proposed research will address these issues by further developing and optimizing a smart phone breathing awareness meditation program (Tension Tamer:TT). Stage 2 preEH 21-50 year old African Americans and Whites balanced by geographical locale (urban vs. rural) and healthcare providers from 12 practice sites (6 urban/6 rural with 12,843 stage 2 preEHs) within the OQUIN practice based research network will be enrolled.
The 3 stage process of intervention development specified in PA-11-063 will involve:
1) Optimization of TT content and delivery formats guided by behavioral and technological theories using 6 focus groups of OQUIN healthcare providers and 6 focus groups with preEHs (8 preEHs per group);
2) 6 month TT proof of concept study (n=60 stage 2 preEHs) to establish dosage tolerability and impact upon resting and 24 hour SBP and biobehavioral mechanisms: worry, rumination, anxiety, hostility, mindfulness, sleep, physical activity, sympathetic nervous system (SNS) and hypothalamic pituitary adrenal axis (HPA) activity;
12 month 2-arm randomized control trial (RCT; TT vs enhanced standard of care smart phone health education program; total n=80) to generate estimates needed for design of a large scale RCT. This series of iterative studies, implemented and guided by healthcare providers and their preEH patients, will result in an intervention acceptable to multiple racial/ethnic groups in both urban and rural settings, feasible to conduct in clinical practice settings, effective in reducing SBP in a pilot RCT and ready for a large scale RCT.
Increasing Aging in Place Through Increased Physical Activity
This project will utilize (1) the existing telemedicine equipment to obtain baseline and weekly BP, HR, and weights on participants by interprofessional teams of nursing and physical therapy (PT) students, under supervision of MUSC faculty and the primary investigator; (2) this project would support tailored software (app) implementation that would allow us to leverage our existing telemedicine investment by (a) incorporating wearable activity monitors that allow participants and providers to monitor PA, in real time as part of integrated programs to increase daily PA levels. In addition, this project will allow us to leverage telemedicine technology to (b) enhance interprofessional training so PT students could provide televideo instruction and lead PA programs to participating residents in the complex.
Boosting Our Barrio: A Community Based Intervention to Improve School Preparedness for At-Risk ChildrenSponsor/Type: Duke Endowment
Boosting Our Barrio is a care model focused on early childhood development, early intervention when necessary and access to culturally appropriate care that can decrease health care and school costs in the long term. This project will narrow the gap of health disparities within the Latino community by increased community engagement via use of the extant promotores model with PASOs, thus increasing sustainability and maximizing use of current supports and trusted agencies.
EQUIP: Excellence and Quality Using Interprofessional Practice
The goal of EQUIP (Excellence and Quality Using Interprofessional Practice) is to create an innovative and sustainable interprofessional collaborative practice (IPCP) to improve patient and population health outcomes within a network of Federally Qualified Health Centers (FQHCs) in South Carolina. Objective 1: Modify and tailor the infrastructure (personnel/IT) within a network of FQHCs to implement a model in which nurses and other health care professionals are competent in IPCP and systems level QI processes. Objective 2: Incorporate an innovative coaching model leveraging collaboration between an FQHC and academic partners to create an IPCP environment where high-functioning diverse professionals collaborate and communicate effectively to improve patient outcomes within the FQHC network. Objective 3: Institute a team-based quality improvement (QI) training program within the FQHC’s network followed by the identification and implementation of quality improvement initiatives based on practice metrics. Objective 4: Implement a model academic/FQHC partnership for student training that helps the student develop competencies in IPCP.
The Fetter Health Care Network (FHCN) and the Medical University of South Carolina (MUSC) will work together to leverage and expand nursing leadership within the FHCN to direct quality improvement (QI) processes utilizing an interprofessional (IP) collaborative team approach. These teams will include existing FHCN health care professionals (physicians, nurse practitioners, physician assistants, pharmacists, nurses, and front desk clerks), the addition of nurse case managers and community health workers to the FHCN, as well as new partners in nutrition and biomedical informatics. Quality improvement priorities will be based on team-identified assessment and practice metrics, and evidence-based strategies will be identified and implemented to address them. The project will begin July 2014, with IPCP team training and pre-implementation QI coaching, followed by clinical implementation December 1, 2014. Innovations of EQUIP include: 1) implementation of systems based QI initiative in a IPCP framework 2) the creation of a data dashboard tracking patient, practice and network improvements; 3) the development of an Academic/ Community Health Center interprofessional student training partnership, and 4) the use of telehealth for service delivery in remote locations. FHCN has 7 sites in 5 rural and 2 urban communities serving over18,500 patients of which 80% are African American and 8% are Hispanic. This diverse patient population is characterized by high rates of poverty, low educational attainment, and significant disparities in health outcomes. In addition, a funding preference is requested as this project will substantially benefit both rural and underserved populations, as the project will be implemented throughout a network of Federally Qualified Community Health Centers.