Research Project Examples
Type 2 Translational Research solves problems in translating new and existing findings from efficacy studies into improvements in clinical practice and community health. Type 2 translational research often uses a collaborative approach that engages community members, organizations, and clinicians as partners in the research process.
Type 2 Translational Research includes research to determine whether interventions tested in efficacy studies are applicable or even used in typical community settings (e.g., determining whether and why major gaps exist in current practice). Examples might include determining the differences between recommended and actual practices for treating diabetes, reducing obesity, or screening for hypertension, along with determining the reasons for those gaps.
Type 2 Translational Research also includes studies that develop, evaluate, and disseminate interventions to improve practice (e.g., taking what we know and turning it into what we do). Interventions typically target individual behaviors (including patients, clinicians, families, and caregivers), organizational behaviors, or systems redesign. Examples include, but are not limited to, evaluating existing or piloting new programs such as (1) practice improvement programs that target greater adherence to guidelines, use of proven efficacious treatments, or efficiency in care delivery, (2) initiatives to increase preventive screening behaviors such as screening for breast, cervical, or colorectal cancer, (3) health promotion programs targeting individual behaviors such as quitting smoking or increasing exercise in community organizations or employer settings, (4) strategies to increase patient participation in decision making or support behavior change, or (5) patient safety initiatives targeting systems redesign in hospitals.
The following examples of Type 2 translational research are projects funded by the UW-Madison Institute for Clinical & Translational Research-Community Academic Partnerships Type 2 Pilot Program in 2008 and ideally provide a better understanding of the breadth and depth of this emerging area of research.
“Madison Area Collaborative Colonoscopy Improvement Project”
Dr. Mark Benson, UW School of Medicine and Public Health, Medicine & Clinical Oncology
Collaborators: Carla Alvarado, Pascale Carayon, UW College of Engineering; Patrick Pfau, Mark Reichelderfer, UW School of Medicine and Public Health; Christopher Rall, Marshfield Clinic Research Foundation
Most colon cancers begin as benign polyps, called adenomas. Removing adenomas during colonoscopy prevents colon cancer. Nonetheless, the ability to detect adenomas varies up to tenfold among clinicians performing the colonoscopy. This research will examine potential factors influencing the number of adenomas detected as a way to design a more effective colonoscopy.
“Treatment of Opioid Dependence in Drug Treatment Court”
Dr. Randall Brown, UW School of Medicine and Public Health, Family Medicine
Collaborators: Michael Fendrick, Michael Brondino, Lisa Berger, UW Milwaukee; Joseph Bluestein, Madison Health Services; James Swartz, University of Illinois-Chicago
The negative impact of substance abuse and misuse on public health and safety and individual and community well-being has been well-documented. “In one of the largest studies in the U.S., use of illicit drugs accounted for 500,000 emergency room visits, 1.3 million hospitalizations, and 39,000 deaths.” In order to turn the tide of this trend, we need to identify and support effective interventions for drug offenders that will significantly reduce drug use and its impact on personal and public health. This study will test a collaborative approach that introduces a “primary care” model into existing Drug Court interventions that if successful, could be further tested and introduced in communities throughout Wisconsin to strengthen their existing drug court programs through work with primary care providers.
“Adding Depression to a Primary Care Screening System”
Dr. Richard Brown, UW School of Medicine and Public Health, Family Medicine
Collaborators: Teresa Elaina Woods, David Katzelnick, UW School of Medicine and Public Health
The prevalence of depression among primary-care populations is estimated to be 10%, although almost one-half of these depressed patients receive no treatment because systematic screening and effective treatment are lacking. This study will examine whether health educators can improve depression outcomes in primary care clinic settings by providing an intervention of modest intensity.
“Treating Tobacco Dependence through Community Agencies”
Dr. Bruce Christiansen, UW School of Medicine and Public Health, General Internal Medicine
Collaborators: Kevin Reeder, The Salvation Army
Great gains have been made in reducing the numbers of smokers in the U.S.; but despite these reductions, tobacco use is still the primary cause of “preventable illness and premature death.” We also now know that of those who do still smoke, many have limited education and live in poverty. Because this population of smokers often has limited access to health insurance or primary care, it is more difficult to reach out to them to implement effective interventions. This study creates a partnership between the UW-Madison School of Medicine and Public Health and The Salvation Army and its staff to implement a program that may have greater success in reaching these populations. If successful, this research may illustrate how other community-based agencies can be valuable partners in our efforts to reduce tobacco dependence.
“Patient-Centered Care for Children with Chronic Disease”
Dr. Elizabeth Cox, UW School of Medicine and Public Health, Pediatrics
Collaborators: Betty Chewning, UW School of Pharmacy; Mary Bekx, Ellen Connor, Mark Moss, Michael Rock, UW School of Medicine and Public Health; Roger Brown, UW School of Nursing, UW School of Medicine and Public Health
Children with chronic disease face complicated self-management regimens, often with dismal adherence. Patient-centered care (formation of a physician-patient relationship and patient participation in self-management decisions) could improve adherence and ultimately health outcomes. Cox will modify tools she developed to gauge decision-making in the pediatric primary-care setting to assess participation in deliberation for families facing chronic disease management.
“Improving and Expanding Primary Care Treatment of Chronic Kidney Disease (CKD)”
Dr. David A. Feldstein, UW School of Medicine and Public Health, General Internal Medicine
Collaborators: Jonathan B Jaffrey, Medicine/SMPH; Richard E. Rieselback, Medicine/SMPH; Thomas C. Gabert, Marshfield Clinic; Douglas A. Wiegmann, School of Engineering; Linda B. Manwell, MPH; Paul D. Smith, WREN
Chronic Kidney Disease (CKD) is a worldwide epidemic with rapidly increasing rates in the United States and Wisconsin with significant impact on health care spending and quality of life. Early recognition and treatment of this disease can have significant health impacts, but often, primary care physicians may not have access to the best available research evidence. This study will develop and test an internet-based electronic patient management tool (PMT) given to 20 primary care physicians (from the Wisconsin Network for Health Research/WiNHR, and the Wisconsin Research and Education Network/WREN) that will include a CKD guideline checklist, educational modules, and electronic access to a nephrologist for consultation. The goal of this research is to give primary care physicians effective tools to best address the needs of their patients with CKD.
“Intervention for Adults with Obesity: Feasibility Study”
Dr. Sarah Khan, UW School of Medicine and Public Health, Family Medicine
Collaborators: David P Rakel, Bruce Barrett, Family Medicine/SMPH
Obesity is at epidemic levels in the United States and in Wisconsin. While programs to address weight loss abound, this feasibility study will combine elements of exercise, nutrition and a mindfulness component that targets sustained behavior modification. In addition, the program designed for this study brings together for both development and implementation a team of experts including a primary care doctor, nurse practitioner, nutritionist, exercise instructor and a mindfulness instructor. Results from this research will help us learn more about how to craft and apply successful weight reduction and lifestyle modification programs.
“Community and Family Influences on Healthy Eating in Rural American Indian Communities”
Dr. Tara LaRowe, UW School of Medicine and Public Health, Family Medicine
Collaborators: Alexandra Adams, UW School of Medicine and Public Health; Sam Dennis, UW College of Agriculture and Life Sciences; Scott Krueger, Menominee Tribal Clinic
There is little research on the impact of both environmental influences and family food-access issues on obesity prevention in rural communities, and in particular on American Indian reservations. The study will involve families with young children living on the Menominee, Wisconsin reservation and will examine dietary information, the location of food outlets, and food habits and attitudes. The information gathered will be used to identify ways to target community-based interventions for healthier nutrition.
“Talking about Medication in Assertive Community Treatment”
Dr. Colleen A. Mahoney, UW School of Social Work
Collaborators: Betty A. Chewning, School of Pharmacy. Ronald J. Diamond, Mental Health Center of Dane County
Mental illness is a significant health issue for millions of Americans and has serious and widely-recognized implications for the individual dealing with the illness, their friends, family and the larger community. Within this population, medication management, in particular the risks of not taking medication, is a significant problem. Managing medication use has often been addressed by an approach called Assertive Community Treatment, designed to improve client medication adherence through assertive participation of a case manager/ACT provider. This study will look at patient-provider communication within this model and at how movement towards greater shared decision-making may impact medication management.
“Authoritative Parenting: Could it reduce teen weight?”
Dr. Susan Riesch, UW School of Nursing
Collaborators: Dr. Bradford Brown, School of Education; Dr. Aaron L. Carrel, UW Pediatric Fitness Clinic; Dr. Carmen R. Valdez, Dept. of Counseling Psychology; Dr. Whitney P. Witt, Dept. of Population Health
Obesity in youth and adults has been linked to cardio-vascular disease, diabetes, hypertension among many other ailments that impact an individual’s quality of life and put a strain on our health care system. While there are many factors that can lead to childhood overweight and obesity, this study will look at the impact of parenting style on a child’s eating and exercise habits. Specifically, an interdisciplinary team of health, social and behavioral scientists will research, design and test an intervention for parents of overweight teenagers that focuses on setting firm and fair limits conveyed in an affectionate manner.
“Optimizing Management of Ventilator-associated Pneumonia in the ICU”
Dr. Nasia Safdar, UW School of Medicine and Public Health, Medicine
Collaborators: Pascale Carayon, School of Engineering; Kenneth E Wood, SMPH; Matthew C Hall, Marshfield Clinic
Estimates suggest that as many as one hospital patient in ten acquires a nosocomial infection, otherwise known as a hospital-acquired infection, each year. The most common of these found in the intensive care unit (ICU) is called ventilator-associated pneumonia (VAP) with research showing that 10-20% of patients receiving over 48 hours of mechanical ventilation develop this pneumonia. This is of special concern to those critically ill patients who come to the ICU for whom the added burden of VAP can prove fatal. While national guidelines outline steps for diagnosing and treating VAP to improve patient health, not all ICUs follow these guidelines for reasons we do not yet fully understand. In partnership with the UW School of Engineering the researchers hope to identify and understand barriers to the implementation of these guidelines…”[The] long-term goal is to improve adherence to the guidelines by developing methods to reduce barriers where possible and assist healthcare workers in working around others.”
“Wisconsin Model of Family-Centered Genetic Counseling”
Dr. Audrey Tluczek, UW School of Nursing
Collaborators: Michael Rock, UW School of Medicine and Public Health; Bradley Sullivan, Marshfield Clinic Research Foundation; Diana Quintero, Children's Hospital of Wisconsin
This study is unique for its application of the patient/family-centered models to the context of genetic counseling for newborn screening, innovatively using mental health clinical skills to address parents' emotional needs as well as their cognitive styles. The research team will compare this family-centered counseling approach with the traditional patient-education model in families with infants screening positive for cystic fibrosis.
“Remote Assessment of Communication Ability in Adults with Traumatic Brain Injury"
Dr. Lyn Turkstra, UW College of Letters and Science
Collaborators: Marilyn Workinger, Maura Quinn-Padron, Marshfield Clinic Research Foundation
Chronic communication problems are common in those with traumatic brain injury (TBI), which can lead to other difficulties, such as depression, social isolation, and unemployment. For those with limited access to long-term services because of geographic isolation, telemedicine offers remote assessment of potential communication difficulties. This work will compare remote and direct assessment of conversations in individuals with TBI to refine clinical practice guidelines.
“Development of a Tool for Diabetes Risk Assessment in Children"
Dr. Todd Varness, UW School of Medicine and Public Health, Pediatrics
Collaborators: Aaron Carrel, David B. Allen, Jens Eickhoff
Translating measurements that can be readily obtained in the community to a reliable indicator of the risk of developing type 2 diabetes would be of great importance for community-based interventions for childhood obesity and diabetes prevention. The specific aim of this project is to develop and validate a cost-effective and feasible field-based tool for diabetes risk assessment in children. This project engages schools, children, and parents as partners in the research process.
“Utilizing Novel Interventions to Prevent Diabetes in Youth (UNITY)”
Dr. Eva Marie Vivian, UW School of Pharmacy
Collaborators: Patricia Kokotailo, SMPH; Kenneth Loving, Access Community Health Center; Naomi Wedel, Dean West Clinic; Pamela Myhre, School of Nursing
National reports have cautioned that one in three children born in the year 2000 would develop type 2 diabetes. According to the American Diabetes Association, Type 2 diabetes is more common in African Americas, Latinos, Native Americans and Asian Americans/Pacific Islanders and those with type 2 diabetes have a higher risk of heart disease, blindness, nerve and kidney damage. A vital component of treating type 2 diabetes is screening for and addressing this disease in younger populations. This research study is designed to determine if a community-based, family-centered diabetes prevention program with a peer component might increase the success rate of identifying teens with or at risk of developing type 2 diabetes and teach us more about some of the problems children and families face when trying to lead a healthy lifestyle.
“The Oh Happy Day Depression and Alcohol Intervention (OHDDA)”
Dr. Earlise Ward, UW School of Nursing
Collaborators: Michael Fleming, Molly Carnes, UW School of Medicine and Public Health; Susan Heidrich, UW School of Nursing
African-Americans across the United States face significant disparities in mental health and receipt of health care. Ward developed the OHDDA intervention in response to her research showing this population preferred obtaining counseling in community settings such as churches and community centers. This study will test feasibility and acceptability of the intervention, as well as the effectiveness of using pastoral staff to refer individuals for counseling.
“Primary care provider barriers to colon cancer screening”
Dr. Jennifer Weiss, UW Hospital, Medicine & Clinical Oncology
Collaborators: Patrick Pfau, Medicine/SMPH; Sally Kraft, Medicine/SMPH; Maureen Smith, Population Health/SMPH; Michael Lucey, Gastroenterology/Hepatology/SMPH
Colorectal cancer (also called colon cancer or large bowel cancer) is the third most common form of cancer and the second leading cause of cancer-related death in the Western world. Current screening techniques that identify and remove the polyps that can turn into colorectal cancer are widely available and can decrease chances of death by up to 75-90%. However, there is significant variability in screening rates, even when health insurance coverage is not a barrier. This research pilot will survey primary care clinics and providers to better understand attitudes toward and training in colorectal cancer screening, cancer screening beliefs and practices and system-related issues to determine whether barriers to screening as seen by providers explain differences in rates of screening.
“Improving Cardiac Surgical Care: A Work System Approach”
Dr. Douglas A. Wiegmann, UW Department of Industrial and Systems Engineering/UW School of Medicine and Public Health, Surgery
Collaborators: Niloo Edwards, Surgery/SMPH; Hope Maki, Marshfield Clinic; Thoralf Sundt, Mayo Clinic
Heart surgery is one of the most common surgeries performed in hospital operating rooms (OR) and while we have witnessed significant improvement in survival rates over the past 50 years, there is still a great deal of variability in surgical outcomes across surgeons and across institutions. Whereas part of this variability can possibly be associated with individual surgeon skill, other factors may play a role as well. This research study will look at cardiac surgery from a “work systems” approach and try to identify and explain how other variables—such as staffing, equipment reliability, team familiarity, workload—contribute to surgical performance. “The long term goal of this research is to further improve cardiac surgical care by enhancing or re-engineering the surgical care process.”
