NFP-PRC Logic Model Consultation

The purpose of this project is to produce a logic model/theory of change that reflects current Nurse-Family Partnership practice and outcomes.

Bennet, Tell

Novel Pediatric Sepsis Criteria and Clinical Decision Support Tools

Sepsis is a life-threatening disease caused by an infection that affects many children around the world and can frequently result in the failure of organs in the human body (for example, the lungs, heart, or kidneys). The current criteria to identify children with sepsis are outdated and have many limitations. The aim of this project is to build a large database containing clinical information about children from both high-income countries and low- and middle-income countries to develop new criteria for sepsis in children using measures of organ function.

Tell Bennett

Pediatric COVID-19 Severity Dashboard During Delta Variant Circulation (R01 supplement)

Like sepsis, COVID-19 is a life-threatening disease caused by an infection that affects many children around the world and can frequently result in the failure of organs in the human body (for example, the lungs, heart, or kidneys). Detailed national data about the impact of COVID-19 on children over time are not readily available. In this Supplement, we will make information about the trajectories of pediatric COVID-19 hospitalization rates and disease severity readily available for national-level decision-making.

Kempe, Allison

2022-2674

This project will use the PhotoVoice method to engage youth aged 14 to 17 years to develop messaging on the importance of COVID-19 vaccination to their communities.

Kukreja, Janet

Patient Decision Making in Urinary Diversion after Radical Cystectomy

Bladder cancer is a prevalent malignancy representing the 4th most common cancer in men and the 6th most common cancer overall. At a very complex time in their life, patients with bladder cancer face a difficult process that is paramount to their quality of life after surgery for bladder removal. Bladder removal (radical cystectomy) is common and part of the standard treatment for many bladder cancers. When I see bladder cancer patients who will undergo bladder removal, the next step I have to undertake is helping them make a decision about how they want their urine to exit their body after radical cystectomy. This process of shared decision-making (shared decision-making) is where patients are informed about the complexities of each urinary diversion option, risks, and benefits leading to them ultimately making a decision that has a significant impact on their quality of life. It is incredibly important the patient is able to make a very difficult decision with major quality of life implications. This requires patient empowerment and dedication to the provider to provide the empowerment. The objectives of this project are to improve understanding of the overall patient experience and provide critical support for my academic career. We hypothesize patients undergoing radical cystectomy and urinary diversion for bladder cancer that utilizes the patient decision aid before and after surgery developed from this research will find it acceptable.

Matlock, Dan

The TRAjectories and Clinical ExpeRiences of ICD Therapy (TRACER-ICD) Study

Implantable cardioverter-defibrillators (ICDs) are commonly used in older patients with multiple co-morbidities. This project will use a multi-center cohort study to prospectively define the patient-centered experiences of older patients following ICD implantation. We will then apply these data to the shared decision-making process with individualized decision tools, evaluating the feasibility of a precision approach to ICD use.

Rao, Suchitra

Retrospective cohort study evaluating treatment pathways through care and potential adverse events in neonatal seizures

Rao, Suchitra

HERO: Healthcare Worker Exposure Response and Outcomes

Schilling, Lisa

CDS for CDC Opioid Guidelines

The purpose of this project is to provide support to the Office of the National Coordinator for Health IT (ONC) and the CDC for the refinement and development of electronic clinical decision support (CDS) to be used in and by electronic health records (EHRs) to incorporate recommendation statements from the CDC Opioid Prescribing Guideline and draft updates to that Guideline. The scope of this work will build on previously conducted work that supported the initial development of electronic CDS interventions.

 Russ Glasgow

 Russ Glasgow

Family Inclusive Childhood Obesity Treatment designed for Low Income and Hispanic Families

Childhood obesity is a major public health problem that disproportionately affects low-income Hispanic children. Hispanic families, especially Spanish Speakers, have been under-represented in studies of childhood obesity treatment, and existing interventions have not demonstrated effectiveness for this group. The goal of this project is to evaluate a novel family-inclusive childhood obesity treatment program designed for low-income and Hispanic, including Spanish Speaking, families.

Kempe, Allison

T3242016

ACCORDS Primary Care Research Fellowship

The Adult and Child Consortium for Health Outcomes Research and Delivery Science (ACCORDS) Fellowship in Primary Care will be a collaborative training program between the University of Colorado Anschutz Medical Campus as well as affiliated institutions Kaiser Permanente of Colorado and Denver Health. The goal of the Fellowship is to train post-doctoral professionals to become primary care research leaders to address the nation’s primary care health delivery challenges. The Fellowship is built upon the extensive mentorship experience of the Director and the mentorship team, a curriculum developed over many years of successfully training primary care researchers, and strong methodological expertise in 5 key proposed areas of emphasis: 1. dissemination and implementation (D&I) science, 2. economic analysis to assess value-based care, 3. community-based participatory research (CBPR), 4. health equity, and 5. mixed methods/qualitative methods.

Rao, Suchitra

Establishment of the National Evaluation System for Health Technology Coordinating Center (NESTcc) - Comparative Effectiveness of Alternative Approaches for Wound Closure

The mission of the National Evaluation System for health Technology Coordinating Center (NESTcc) is to catalyze the timely, reliable, and cost-effective development of real-world evidence (RWE) to enhance regulatory, clinical, and coverage decision-making throughout the total product lifecycle (TPLC) of a medical device. NESTcc enables research using real-world data (RWD), serves as a Collaborative Community for ecosystem-wide initiatives, and develops capabilities in Active Surveillance for medical device safety. NESTcc provides the infrastructure and expertise to lead the development of RWE research and surveillance activities.

Rao, Suchitra

Pharmacokinetics and Exposure Outcome in Neonates Administered Lacosamide

Seizures are one of the most common neurologic emergencies in neonates, arising in ~3/1,000 term live births and are associated with significant mortality and neuro-developmental disability. In contrast to seizures in older children, most neonatal seizures result from acute symptomatic etiologies rather than epilepsy. Treatment is largely guided by physician preference and tradition, due to a lack of data from well-designed clinical studies. Based on these factors, UCB Biopharma SRL (UCB) has decided to set up an epidemiological neonatal seizure study evaluating pharmacokinetics (PK) and effectiveness outcome to support development of a clinical study and provide evidence for the clinical and patient community. The study will include all neonates initially exposed to iv Lacosamide (LCM) in PEDSnet and PCORnet.

Stevens-Lapsley, Jennifer

Advancing Rehabilitation Paradigms for Older Adults in Skilled Nursing Facilities

In the U.S., 8.37 million adults over age 65 will experience a hospital stay during the next year, which often has serious and long-lasting consequences including profound deterioration in physical function. Following a hospital stay, around 1.35 million patients with deconditioning require rehabilitation in a skilled nursing facility (SNF) each year to address the deleterious musculoskeletal and functional deficits from deconditioning. Unfortunately, current rehabilitation paradigms in SNFs do not adequately restore physical function, which directly contributes to poor community discharge rates. Strikingly, only 52% of all patients admitted to SNFs are discharged to a community setting (e.g., home), which suggests a paradigm shift is required to optimize rehabilitation within SNFs. Currently, usual care rehabilitation in SNFs consists of low-intensity rehabilitation interventions, which are physiologically inadequate to induce meaningful changes in skeletal muscle strength and physical function. To address these pitfalls, a high-intensity resistance rehabilitation paradigm has been shown to improve outcomes including better physical function, increased community discharge rates, and cost-effective reductions in length of stay. The proposed pragmatic study seeks to apply this rehabilitation paradigm to multiple SNFs to further evaluate the effectiveness of high-intensity resistance rehabilitation (Aim 1), while evaluating processes, mechanisms, and determinants of successful implementation (Aim 2).

Stille, Christopher

The SARS-CoV-2 pandemic has manifested in children with a wide spectrum of clinical presentations ranging from asymptomatic infection to devastating acute respiratory symptoms, appendicitis (often with rupture), and Multisystem Inflammatory Syndrome in Children (MIS-C), a serious inflammatory condition presenting several weeks after exposure to or infection with the virus. These presentations overlap in their clinical severity while maintaining distinct clinical profiles. Public health and clinical approaches will benefit from an improved understanding of the spectrum of illness associated with SARS CoV-2 and from the capacity to integrate data to achieve two goals: (i) to identify the clinical, social, and biological variables that predict severe COVID-19 and MIS-C, and (ii) to target those populations and individuals at greatest risk for harm from the virus. We propose the COVID-19 Network of Networks Expanding Clinical and Translational approaches to Predict Severe Illness in Children (CONNECT to Predict SIck Children) comprising eight partners providing access to data on >15 million children. Our network will systematically integrate social, epidemiological, genetic, immunological, and computational approaches to identify both population- and individual-level risk factors for severe illness. Our underlying hypothesis is that a combination of multidimensional data – clinical, sociodemographic, epidemiologic, and biological – can be integrated to predict which children are at greatest risk to have severe consequences from SARS-CoV-2 infection.

Studts, Christina

Implementing an Evidence-Based mHealth Diet and Activity Intervention: Make Better Choices 2 for Rural Appalachians

We propose a type 1 hybrid effectiveness-implementation study to test an adapted evidence-based intervention and explore critical implementation issues, including feasibility, acceptability, and costs, that influence scale-up and sustainment. We will focus this adaptation, effectiveness, and implementation study on underserved rural residents, a population that maintains extremely high rates of suboptimal diet and sedentary behaviors, placing them at elevated risk for cardiovascular disease, obesity, diabetes, cancer, and other chronic conditions. Within the vulnerable low socioeconomic status population of rural residents, Appalachian Kentuckians experience even worse health outcomes, including among the highest rates of morbidity and mortality in the nation. Such adversity is exacerbated by and associated with inadequate community resources. Increasingly, however, Appalachian residents and other vulnerable populations are gaining access to modalities that may be useful in addressing these health challenges, including internet connectivity and nearly ubiquitous cell phone use. Despite this accelerating technology use, the evidence base on personal technology-associated interventions (mHealth) in a rural, high need population remains sparse. We propose finalizing adaptation and testing of an evidence-based multicomponent mHealth intervention, Make Better Choices 2 (MBC2), a behavioral program consisting of personalized health coaching, an app, accelerometer, and financial incentives.

Developing a Novel Decision Aid for Tracheostomy to Support Shared Decision-Making in the Intensive Care Unit

Tracheostomy utilization is increasing in the United States but evidence suggests patients and their decision- makers experience substantial decisional conflict and regret exists as they feel uninformed about prognosis and feel that their values and preferences were not considered. In order to better improve the patient centeredness of care, align treatments with patient values, reduce unwanted procedures, and reduce healthcare costs, multiple societies strongly recommend the use of shared decision-making in the intensive care unit which can often be facilitated with decision aids. Our proposal seeks to combine qualitative value assessments with long-term outcome predictions for patients with tracheostomy in order to create a personalized web based tracheostomy decision aid that we hypothesize will reduce decisional conflict and regret as well as better align patient care with underlying values and expectations.

Szefler, Stanley

Reducing Asthma Attacks in Disadvantaged School Children with Asthma

(Diversity Supplement - postdoctoral support for Udoko Mfonobong) Asthma is a leading cause of children’s hospitalizations, missed school days and caregivers’ missed work days that has a significant impact on low income families. We seek to increase asthma control for children with uncontrolled asthma and health disparities, in order to improve the outcomes of activity, symptoms, and reduce asthma exacerbations. We will evaluate whether two interventions, an evidence-based school asthma program and an assessment of social determinants of health (with the aid of an asthma navigator and school nurse champion) can be disseminated and implemented in other school settings to reduce the risk of asthma attacks.

Enhancing Maternal/Birth-Outcomes Research by Advancing Culturally-Informed Engagement

In the United States, Black women (BW) experience severe maternal morbidity and mortality at a notably higher rate than their non-Black counterparts. Recent population-based data analyses have found that non-Hispanic BW are 3.4 times more likely to experience pregnancy-related mortality than non-Hispanic White women. In addition, across the country, BW bear the greatest burden of severe pregnancy-related complications such as hemorrhage, eclampsia, and stroke, among others. Disparities in severe maternal morbidity and mortality can result from patient, community/neighborhood, provider, or healthcare system factors occurring at any level of maternal care (preconception to postpartum). While patient-level factors may contribute to differences in maternal health care and outcomes, evidence suggests that provider- and system-level factors are strong contributors to negative maternal health outcomes experienced by BW. Regionally, the impact of each of these factors on maternal health outcomes for BW vary. To date, much patient-centered outcomes research (PCOR) related to severe maternal morbidity and mortality is being conducted in regions in which there is a significant Black population. Similarly, the development of and evaluation of resources to improve outcomes for this population are becoming increasingly accessible in those areas. However, similar disparities in maternal morbidity and mortality are observed across states and communities, regardless of demographic distribution. In Colorado, non-Hispanic Black people make up less than 5% of the overall population and only 5.4% of births are to BW; however, this population accounts for nearly 10% of Colorado’s maternal deaths. The top severe maternal morbidity events leading to pregnancy-related death in Colorado include cardiovascular conditions (e.g., cardiomyopathy), infection, and hemorrhage.

​Matlock, Daniel

01062185 (Prime - 5R01AG065311-02)

A Conversation Aid on Mammography Screening to Support Shared Decision Making between Clinicians and Women Aged 75 and Older

Since the utility of breast cancer screening in later life varies according to women's life expectancy, risk of breast cancer, and preferences, experts and guidelines recommend that primary care clinicians engage women aged 75 and older in shared decision making around mammography screening (meaning that primary care clinicians inform women of the possible benefits and harms of screening, elicit patient values and preferences, and together decide on a course of action); however, primary care clinicians report feeling ill- prepared and request support for these conversations. Therefore, with help from primary care clinicians, women aged 75 and older, their family members, medical assistants, and other expert stakeholders, we aim to develop and test in diverse “real-world” primary care practices an easy-to-use, flexible, and adaptable, interactive web-based conversation aid that will provide personalized estimates of the benefits and harms of mammography screening for older women using the most up-to-date data and simulation modeling methods. We anticipate that use of our conversation aid will allow primary care clinicians to feel more supported and prepared to engage older women in shared decision making around mammography screening and as a result older women will make more informed decisions around mammography screening consistent with their values.

Rao, Suchitra

COVID-19 Electronic Health Data Initiative

The COVID-19 electronic healthcare data initiative project will demonstrate PCORnet sites' ability to collect information on COVID data through the implementation of a nationally distributed data infrastructure. The collection of these COVID-19 data will help to answer critical questions to assist in the emergency response to the COVID-19 pandemic.

Scherer, Laura

Understanding Affective Processing of Scientific Evidence to Promote Informed Choice for Breast Cancer Screening

Given past health messages that strongly promoted mammography screening, recent revisions to guidelines that promote informed choice constitute a health message reversal that can be difficult for many women to accept. This research will employ nationally representative and longitudinal surveys of women 40-49 that aim to understand women’s affective reactions to screening evidence and the consequences of those reactions for screening preferences and shared decision making with a primary care provider. This research will directly inform how to more effectively communicate about breast cancer screening to maintain credibility and trust when health messages change.

Schilling, Lisa

Childhood Obesity Data Initiative (CODI) @ CHORDS

The purpose of the Childhood Obesity Data Initiative (CODI) is to facilitate access to integrated multi-sector data from pediatric care and weight management programs (WMPs) based in clinical or community settings. The project seeks to build data capacity for research that assesses strategies to prevent and treat childhood obesity and to integrate with the CHORDS data network infrastructure.