K12 IMPACT Update

April 2022

The K12 IMPACT (IMPlementation to Achieve Clinical Transformation) Program in Dissemination and Implementation (D&I) science, in its final year of funding from NHLBI, is a two-year career development program that prepares a diverse group of post-doctorate scholars for careers in T4 translational research with an emphasis on heart, lung, blood, and sleep (HLBS) disorders. As we prepare for the program’s conclusion, we’d like to celebrate the competitive impact scores that Drs. Katy Trinkley (NHLBI K23) and Nicole Wanger (NIDA K01) from our 2020 cohort received their individual career development award submissions. Both scholars are collaborating with their respective program officers and currently working on documents for their Just-In-Time request, which refers to the application timeframe requiring applicants to send updated information to the NIH if an award is likely. They are also waiting for council review to assess the budget and funding.  Please read on for a brief summary of their K23/K01 project proposals:

Dr. Katy Trinkley’s project centers on the consideration of contextual factors and minimization of irrelevant information to improve clinical decision support (CDS) tools within electronic health records. She notes that currently existing, ‘traditional CDS’ are often designed to be patient-specific, but are not tailored to clinician needs. She proposes a new approach to CDS in which prescribing patterns could be used to determine whether prescribing misconceptions might exist and then conditionally present information within a ‘personalized CDS’ to address a specific clinician’s misconceptions. Dr. Trinkley argues that this approach would both minimize irrelevance and alert fatigue, and could substantially improve the effectiveness of CDS tools to improve the translation of evidence into practice. For her K23, she specifically aims to improve guideline-directed management and therapy (GDMT) for the many suboptimally treated patients with heart failure and reduced ejection fraction (HFrEF). Her award submission presents the following three specific aims: 1) design and build prototypes of traditional and personalized CDS to address common misconceptions of GDMT for HFrEF; 2) pilot the traditional and personalized CDS tools in real-world care settings; and 3) compare the traditional and personalized CDS in a pragmatic, randomized controlled trial. The significance of this research lies in its potential to substantially improve GDMT and outcomes for high-risk patients with HFrEF. Further, its innovative, personalized CDS challenges the status quo of “one size fits all” CDS by individualizing these tools to both patients and clinicians. Dr. Trinkley expects that this paradigm shift will have a far-reaching influence on CDS development and expedite evidence to practice.

Dr. Nicole Wagner’s proposal stems from the 30% increase in opioid overdose deaths in the last year and how current naloxone distribution strategies in the US are missing individuals at high risk of opioid overdose that could be prevented with access to this medication. Vending machines are an emerging harm reduction strategy for naloxone distribution in the United States shown to increase the reach of harm reduction services in Europe in populations not otherwise engaged with harm reduction services. However, current agencies implementing vending machines for naloxone distribution have difficulty navigating stakeholder approvals leading to implementation in locations that may not attend to the needs of the underserved populations. Dr. Wagner thus proposes studying a community-initiated, stakeholder (including populations misusing opioids) engaged adaptation of naloxone distribution, VEnding machine Naloxone Distribution for Your community (VENDY), to increase the reach of naloxone in underserved populations at risk of opioid overdose. Specifically, her award submission proposed the following three aims:1) to refine the VENDY program in three underserved communities (two urban and one rural) using an iterative user-centered design (UCD) implementation strategy and stakeholder engagement to increase reach, implementation, and sustainability; 2) to conduct a six-month pilot assessment of the VENDY program in the aforementioned communities; and 3) to identify factors in the social and built environment contributing to reach and implementation of the VENDY program using Our Voice Discovery Tool evaluations with organization implementers and community members currently using opioids. Given community-based approaches such as VENDY are essential for reaching opioid users not currently engaged with health systems, the adaptation of effective interventions addressing substance use to better reach underserved populations and to produce sustainable implementation models is of paramount importance.

The K12 IMPACT Program’s Co-Directors congratulate Drs. Katy Trinkley and Nicole Wagner on their competitive individual career development award scores, and excitedly wait for more information on funding decisions from NHLBI  and NIDA on their invaluable work using D&I science! To learn more about our scholars and the K12 IMPACT Program, we invite you to visit our website.