Investigator Spotlight

5 Questions for Researchers


Amy Huebschmann, MD, MSc, FACP

Associate Professor of Medicine, University of Colorado School of Medicine

Director, University of Colorado ACCORDS Dissemination and Implementation (D&I) Science Graduate Certificate

D&I science core lead, Center for American Indian and Alaskan Native Diabetes Translation Research

Immediate past-chair, Society of Behavioral Medicine’s Education, Training, and Career Development council

University of Colorado Center for Women’s Health Research - Lead Scientist for Community Education and Outreach


The overarching goal of Dr. Huebschmann’s independent line of research inquiry is to optimize the delivery of evidence-based interventions to improve the treatment and prevention of diabetes, asthma, cancer, and other chronic diseases in randomized-controlled trials, and to adapt those interventions to be feasible for delivery in real-world primary care and community-based settings.  These include serving as lead D&I co-investigator for one of only 7 NHLBI-funded UG3/UH3 dissemination trials to improve disparities in pediatric asthma care. Dr. Huebschmann is a primary care physician and Associate Professor at the University of Colorado School of Medicine with the Division of General Internal Medicine, Adult & Child Consortium for Outcomes Research and Delivery Science (ACCORDS), and the Center for Women’s Health Research.  She has had many leadership positions in research mentoring/training, including serving as: 1. founding Director of the Graduate Certificate in Dissemination and Implementation (D&I) science for the University of Colorado Graduate Program in Clinical Sciences; 2. co-Director of the Network and Outreach Unit for the Colorado Implementation Science Center for Cancer Control and Prevention (ISC3), 3. Co-Director of the Colorado NHLBI-funded D&I K12 training program; 4. immediate-past chair of the Education, Training, and Career Development Council for the Society of Behavioral Medicine. Dr. Huebschmann began her education at the University of Illinois at Urbana-Champaign, earning a BS in Environmental Engineering, then going on to earn her medical degree in 2000 from Vanderbilt University School of Medicine and complete her residency at the University of Colorado School of Medicine (2003). After her medical training, she completed the HRSA-funded Primary Care Health Services Research fellowship at the University of Colorado (2006-2009) that led her to successfully compete for a KL2 career development award from the Colorado Clinical and Translational Sciences Institute (CCTSI), followed by a NHLBI K23 career development award.


Why is your area of science important?

My work focuses on Dissemination and Implementation (D&I) science methods.  D&I science is important to the “scaling out” or dissemination of evidence-based interventions at a population level.  Without the use of D&I methods to actively promote dissemination, Balas and Boren published that only 14% of evidence-based interventions are ultimately translated into practice, and that it takes 17 years for even those few interventions to take root. A key premise of D&I science is that it is key to work with stakeholders to understand how best to tailor a specific evidence-based intervention to fit the specific contextual factors of their setting.  Without this type of tailoring, new settings will often decline to adopt/implement a beneficial intervention, even if it meets their priorities.

What was important in your Health Services Research training?

So many things!  I benefited greatly from my Primary Care Health Services Research fellowship that I completed from 2006-2009, when it was led by Dr. Allison Kempe, and I subsequently completed additional training through the CCTSI Clinical Faculty Scholars Program, the CCTSI KL2 award, and a NHLBI K23 award.  Thinking back over all of that training, I would call out 3 specific things that were important:

  1. primary research mentors who sought to help me develop my personal research goals rather than seeking to create a junior researcher who was stamped in their image;
  2. committed GIM Division chairs — Jean Kutner followed by Mark Earnest — who provided appropriate protected time for me to advance my independent research agenda;
  3. clearly identifying training goals to address during my K-award training that would allow me to advance my independent research goals to improve chronic disease prevention and management in primary care – in my case, that included training in behavioral science, community-engaged research, and D&I science.

 

What are the major take-home messages your current research provides?

I am working on a few different projects, but in focusing on the lessons learned from the take-home messages from my D2V pilot project that implemented an evidence-based program for improving diabetes care into 3 UCHealth primary care clinics, a few key take home messages were:

1. It’s critical for our implementation strategies to fit stakeholders’ priorities and workflow for diabetes care management. 

  • In terms of priorities, our UCHealth clinics are incentivized by our current value-based care contracts to improve/lower our rates of patients with certain thresholds of poor diabetes control, and it was important to match that threshold in the inclusion criteria of patients to include
  • In terms of working with clinic workflows, many UCHealth clinics rely on clinical pharmacists (PharmDs) to serve as a referral source for patients who are not meeting the clinic targets for diabetes and hypertension.  The clinics have standing protocols that allow them to titrate certain diabetes medications automatically, and they can also focus their entire encounter with a patient on a specific topic – diabetes, in this case.  Given this combination of factors, we found that clinical pharmacists were well-prepared to implement in programs for chronic disease management programs such as this one.

2. Implementing online tools and coaching for patients with uncontrolled diabetes in primary care can work very well if there is the proper technical assistance in place to get patients set up with those tools.   However, in our study, we learned that clinic staff don’t have enough bandwidth to do this on their own, and need support.  I am excited to be working now with UCHealth on a new Diabetes Home and Remote Care program that provides this type of technical assistance to set up patients with type 2 diabetes with Bluetooth-enabled glucometers and mobile phone apps.

What are your goals or areas for future research?

Generally, my goals continue to be to conduct research that improves how primary care practices can prevent/treat chronic diseases for their patients.  Giving one specific example, I am excited for our newly funded NHLBI DECIPHeR UG3/UH3 grant that seeks to reduce disparities in pediatric asthma care by disseminating an evidence-based intervention that leverages partnerships with primary/specialist asthma care, school nurses, asthma navigators, and public health.

 

What advice do you have for researchers who want to work in this area?  OR  What is the most important advice you have received from your mentors?

When you are designing studies as a junior investigator, listen well to your stakeholders, and to input from your mentors to guide the approach.  If there are differences of opinion on how to proceed, try to hold discussions with the key thought leaders from each side, in order to come to consensus.  If you can’t build a complete consensus, then you need to trust your instincts on which way to go as the PI.


Stan Szefler

Stanley J. Szefler, MD

Professor of Pediatrics, University of Colorado School of Medicine

Research Medical Director and Director, Pediatric Asthma Research Program - The Breathing Institute

Interim Medical Director, Research Institute - Children's Hospital Colorado

Dr. Stanley Szefler is currently the Research Medical Director and Director of the Pediatric Asthma Research Program in the Breathing Institute of the Pediatric Pulmonary and Sleep Medicine Section and interim Medical Director for the Research Institute at Children’s Hospital Colorado. He is also Professor of Pediatrics at the University of Colorado School of Medicine, Anschutz Medical Campus.

Dr. Szefler’s major contributions are directed toward the individualized use of asthma therapy.  He has identified biomarkers and asthma characteristics that are associated with asthma exacerbations and response to asthma therapy. He is the Co-Principal Investigator for the Denver site of the NHLBI PrecISE Network that is focused on precision medicine for severe asthma.

For the past fifteen years, he has directed a school-centered asthma program (AsthmaCOMP) funded by the Colorado Department of Public Health and Environment Cancer, Cardiovascular and Pulmonary Disease Program for the State of Colorado. This program identifies students most significantly affected by asthma and then establishes lines of communication between schools, primary care physicians, and specialists to assure that these children have consistent medical care.


Why is your area of science important? 

My area of focus is childhood asthma, especially in relation to my school-centered asthma program. It started 15 years ago from a community-based participatory research approach to a current grant that is focused on dissemination and implementation. I became interested in population health including public health as part of my work with our program. While we have been effective in improving asthma outcomes in children with health disparities, a population at great risk for asthma morbidity and mortality, we have also taken the opportunity to address social determinants of health.

 

 

What was important in your Health Services Research training? 

In my early career days, research training was more of an apprenticeship than formal training. I benefitted from working with great mentors on research projects. Nowadays, I see early career investigators in medicine benefit from a fellowship centered on research training with formal courses and strong multidisciplinary mentorship teams. They often seek either a PhD or Master’s in Clinical Science as part of their training. You have to seek that formal training nowadays to be competitive for grant funding. Personally, I continue to learn from working with great collaborators at ACCORDS for my health services research work.

 

What are the major take-home messages your current research provides?

The major ingredient for our success is building visibility and trust in our community, especially with the school nurses in the six public school districts that we work with in the Denver Metropolitan Area. Our collaboration works from a win-win approach. We learn what the community needs are and then collaborate to bring the necessary resources to address those main issues.

 

What are your goals or areas for future research? 

We were recently awarded a grant from the National Heart, Lung and Blood Institute to participate in a UG3 DECIPHeR Alliance. DECIPHeR stands for “Disparities Elimination through Coordinated Interventions to Prevent and Control Heart and Lung Disease Risk”. Our grant is entitled ”Reducing Asthma Attacks in Disadvantaged School Children with Asthma”. Our goal is to take the model we developed for the school-centered asthma program in the Denver urban setting and see if we can replicate this model in Colorado rural and mid-sized cities outside the Denver area. 

 

What advice do you have for researchers who want to work in this area?  OR  What is the most important advice you have received from your mentors?

The most important advice that I have for those who want to do research in the community is to be a good listener. Identify the community needs and attempt to fill those gaps with resources. There is a great need in the community in the area of health disparities. Our school communities have limited resources. If you can bring expertise and resources to the community to address important issues, such as addressing social determinants of health, that is very much appreciated and very rewarding.