Opioid Abuse & Viral Infections: UW SMPH Support of Rural Prevention Programs

As an Associate Professor of Medicine and Population Health Sciences, Ryan Westergaard, MD, PhD, MPH, is an infectious disease physician and epidemiologist who specializes in the treatment of HIV and viral hepatitis. He has a particular focus and passion to improve treatment of HIV in vulnerable, underserved populations.

Notably, drug abuse from injecting heroin and other opioids is commonly complicated by HIV or viral hepatitis infection. This risk is especially high in rural communities lacking adequate public health infrastructure, medical homes, and/or effective prevention programs. In Wisconsin, treatment admissions for heroin and other opioids tripled between 2005 and 2014 and Hepatitis C virus (HCV) infections increased at the same time.

Since 2011, Westergaard and his interdisciplinary team have created a research program to evaluate the role of non-clinical settings in coordinating delivery of essential prevention services. The team particularly concentrates on six contiguous rural counties of Wisconsin with peak opioid injection and HIV/HCV infection rates. With an NIH R01 award in 2016, the team began implementing and evaluating a novel community response model to support prevention services for high risk clients. Westergaard comments,

Ryan WestergaardOur project, the Client Centered Prevention Home model, reflects a partnership with the Aids Resource Center of Wisconsin. Much of our work is done through their field sites in northern Wisconsin and we observed that a considerable number of Native American participants were enrolling. We knew we wanted to explore a collaboration with one or more of the tribal communities.

Because our work is so community focused, we have received a lot of support over time via the UW Community Academic Partnerships core and the Collaborative Center for Health Equity (CCHE). So we knew who to turn to for advice.

Westergaard and Assistant Scientist, Wajiha Akhtar, PhD, contacted CCHE Administrative Director, Sarah Esmond, to introduce the research and explore how best to raise visibility about the project with tribal leaders. She promptly connected with Gail Nahwahquaw, Wisconsin Department of Health Services Office of the Secretary and Tribal Affairs Director. Nahwahquaw confirmed time for the project team to present at the next Wisconsin Tribal Health Directors meeting. Esmond then notified Melissa Metoxen, a community and academic support coordinator with the UW Native American Center for Health Professions (NACHP). As a member of the Oneida Nation, Metoxen was able to provide insight about how to prepare the team for their presentation to the Directors. Metoxen notes,

Melissa MetoxenWestergaard worked with NACHP to seek knowledge around working and pursuing partnerships with tribal communities. We appreciated his awareness in knowing that our communities are unique, especially given we are sovereign nations. Working with our communities often means working with tribal leadership, tribal governance bodies, and more. We were happy to assist in this effort and look forward to Westergaard creating sustainable relationships with some of our communities.

Esmond adds,

Sarah EsmondWestergaard’s work with NACHP and CCHE is an exciting case study of the efficiencies and partnerships that can result when investigators are willing to prepare for working in community settings in advance. This approach is always important when creating trusting community-academic partnerships, but is particularly significant when projects involve sensitive topics, stigmatizing behaviors, and/or engage communities from which individuals have been underrepresented in or treated poorly as part of research.

Another important step will be to establish collaboratively with our tribal partners how to share the research data with communities. For Westergaard’s project, tribal clinic staff and health directors will have a strong interest in understanding the data and strategizing how to use it to advance positive community health outcomes.

Westergaard’s work would not be possible without ICTR support. The project received an ICTR Type 2 Pilot Award in 2013, and expert guidance from the Community Academic Partnerships core and the Collaborative Center for Health Equity, which both promote work that strives for health equity through community partnership. His projects also use the services of the ICTR Scientific Review Committee, as part of review by the UW Institutional Review Boards.

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Spotlight: Engaging Patients and Their Families in Family-Centered Care

Health Services Research | Elizabeth Cox

Elizabeth Cox, MD, PhD
Elizabeth Cox

Goal: To engage the voices of children and families to deliver safer, higher quality pediatric care.

ICTR Support: In addition to receiving ICTR Pilot Awards in 2008 and 2013 to support her research, Dr. Cox’s work was strengthened through a variety of collaborations with program partners within the ICTR Community Academic Partnerships core, assistance from biostatisticians, the Office of Clinical Trials, and scientific editing. Cox also received competitive ICTR-CAP supplemental funding to create state-of-the-art resources to support researchers wishing to conduct patient and other stakeholder engaged research.

Outcomes: Cox’s 2008 Pilot Award, Patient-Centered Care for Children with Chronic Disease, led to an AHRQ R18 which generated evidence to support adoption of the family-centered rounds approach to care in hospital settings. UW Health has incorporated this approach within the pediatrics service. The resultant Family-Centered Rounds (FCR) Toolkit has been widely disseminated and accessed by users in 44 states, Washington DC, and 11 countries.

Her 2013 ICTR Patient Centered Outcomes Research (PCOR) Pilot Award, Engaging Stakeholders to Deliver Family-Centered Diabetes Self-Management Resources, and a PCORI-funded study have engaged children with type 1 diabetes and their parents to tailor diabetes self-management resources to the unique needs of each child and family. In addition, the Children’s Hospital of Wisconsin explored the development of group-based chronic disease management visits that would utilize Cox’s scheduling models, needs assessment tools, and content.

With support from the 2013 PCOR award and other ICTR resources, Cox has co-authored three toolkits to support patient and other stakeholder engagement including the Toolkit on Patient Partner Engagement in Research (TOPPER), Hard-to-Reach Patient Stakeholders (HARPS): An Engagement Guide, and Sustaining Engagement of Blended Stakeholder Boards Across the Research Trajectory. Collectively, these toolkits have been accessed by over 200 individuals world-wide.

Cox has become a leader in patient-centered outcomes research, and has been instrumental in developing local and national resources to support investigators wishing to conduct high-quality patient and other stakeholder engaged research.

Cox ED, et al. A Family-Centered Rounds Checklist, Family Engagement, and Patient Safety: A Randomized Trial. Pediatrics. 2017. Apr 25. 139(5): e20161688. doi: 10.1542/peds.2016-1688.

More: Does a Personalized Approach Help Young People Manage Type 1 Diabetes?

Spotlight: Promoting STEMM Career Development for Underrepresented Groups

Angela Byars-Winston

Workforce Development & Higher Education | Angela Byars-Winston

Goal: To examine the cultural influences on career development, especially for racial and ethnic minorities and women in the sciences, engineering, and medicine.

ICTR Support: Her KL2 Scholar Award provided protected time, mentoring, and introductions to UW collaborators in mentoring research.

Outcome: As a local & national leader related to the field of mentor & mentee training and its potential to influence the commitment of women and underrepresented ethnic minorities to careers in STEMM, she was named a White House Champion of Change in 2011. More recently, she was appointed to the Board on Higher Education and Workforce (BHEW) at the National Academies of Sciences, Engineering, and Medicine. Currently a UW Department of Medicine associate professor & co-investigator in the UW-Madison Mentor Training core of the National Research Mentoring Network.

Byars-Winston, A, et al. New Measures Assessing Predictors of Academic Persistence for Historically Underrepresented Racial/Ethnic Undergraduates in Science. CBE-Life Sciences Education. 2016. 16(3).

Dept of Medicine News: National Workshop Focuses on Effective Mentoring Strategies in STEMM Fields

Spotlight: Reducing Hypertension in Young Adults

Physician using a stethescope to examine a a patient..

Research Dissemination to the Community | Heather Johnson

Goal: Young adults with hypertension are less likely to be diagnosed or treated compared to other age groups. Johnson’s MyHEART (My Hypertension Education And Reaching Target) program is an intervention for young adults to help them live healthier lives, lower their blood pressure and prevent heart disease

ICTR Support: In adddition to receiving a Dissemination Supplement Award and D&I consultations, she collaborated with the CARDS® group from the Wisconsin Network for Research Support and the Health Innovation program, both affiliates of the  Community Academic Partnerships core.

Outcome: A new MyHEART (My Hypertension Education And Reaching Target) website for young adults with hypertension was developed and launched in early 2017. In addition, Johnson is disseminating an online toolkit for use by healthcare providers, community outreach workers/volunteers, and health organizations. The toolkit explains the MyHeart website and provides customizable brochures and social media communication drafts.

Johnson HM, et al. MyHEART: A Non Randomized Feasibility Study of a Young Adult Hypertension Intervention. J Hypertens Manag. 2016;2(2). pii: 016.

Spotlight: Quality Improvement Framework for Colorectal Cancer Screening

Health Professional palpating a patients stomach.

Health Systems Research | Jennifer Weiss

Jennifer Weiss

Goal: UW Health quality improvement ranked colorectal cancer screening performance at 11 out of 20 reporting groups, despite the demonstrated importance of early screening to cancer detection and treatment.

ICTR Support: Pilot award, KL2 scholar, CAP consultations

Outcome: An quality improvement framework was developed to drive large scale change in the UW Health organization. Enhanced work systems increased colorectal cancer screening at UW Health from 63% to 81%, resulting in 11,000 additional patients screened each year.

Kraft S, Carayon P, Weiss J, Pandhi N. A simple framework for complex system improvement. American Journal of Medical Quality: The Official Journal of the American College of Medical Quality. May 2015;30(3):223-231.

Spotlight: Community Based Falls Prevention Programs

Elderly man using a walker.

Community-Engaged Research | Jane Mahoney

Goal: As falls are a significant source of morbidity and mortality for older adults, there was a need for effective, community-based falls prevention programs for community-dwelling older adults.

ICTR Support: D&I Pilot award, CAP consultations

Outcome: An evidence-based program to prevent falls was implemented in 19 states across the country, reducing the risk of falls by 31% in over 7,000 elderly adults. This program is being adapted to address culturally diverse populations.

Mahoney JE. “Stepping on:” stepping over the chasm from research to practice. Frontiers in Public Health. 2014;2:148.