CIIS supports investigators and projects with rigorous methods to evaluate safety net interventions. Some of our current projects include:
Defining the Transition from New to Normal: A Qualitative Investigation of the Clinical Change Process
Clinical practice has been unable to keep up with the overwhelming volume and pace of changing care guidelines and evidence-based interventions. Identifying indicators of change to know when a practice change becomes standardized is important to foster successful and sustained implementation efforts. We are analyzing qualitative interviews with clinical leaders in implementation or quality improvement within health systems to explore strategies utilized to facilitate practice change and understand how participants define when a successful practice change has occurred.
A Mixed Methods Exploration of Diabetes Management Strategies, Barriers, and Facilitators Experienced by Black and Latino People with Diabetes in a Safety Net Hospital Setting
Diabetes is increasingly prevalent and disproportionately burdens minoritized communities. Among populations who experience high rates of adverse social determinants of health, data are limited regarding patient self-reported challenges to diabetes management and preferences for healthcare system-based interventions to address them. We are conducting a mixed-methods study to explore self-reported diabetes management strategies and barriers to care to identify intervention targets for future implementation science research and quality improvement programs.
Decades of Devotion: A Qualitative Exploration of Framingham Heart Study Participant Engagement
The Framingham Heart Study (FHS) has experienced declines in participant engagement. This study aims to qualitatively understand participant experiences with the FHS through exploring motivators and challenges to ongoing engagement, investigating preferences for being recruited for ancillary studies, and elicit recommendations to improve the experience or lessen the burden. Ultimately, we aim to identify actionable suggestions to mediate barriers to improve FHS retention.
The TIDE Trial
Hospital discharge is a vulnerable time for all patients, but especially those with LEP given the importance of communication in preparing patients for self-management and transition home. Tools to Improve Discharge Equity (TIDE) is a type 1 hybrid randomized controlled trial to test a package of linguistically concordant discharge teaching tools for patients with LEP: a translated medication calendar, pictographic illustration of return precautions, and an audio recording of discharge teaching. The mixed methods evaluation will assess key implementation outcomes (acceptability, adoption, appropriateness, and feasibility) and its impact on clinical outcomes (medication adherence, hospital re-utilization), patient satisfaction, and health care worker perspectives.
Understanding Discharge Preference of Patients with Limited English Proficiency
Hospital readmissions are costly to the health care system and dangerous to patients. While many interventions have been shown to decrease readmissions, nearly all have excluded patients with LEP. Understanding the preferences of this demographic is key to successfully adapting one of these evidence-based interventions to be effectively implemented in this new target group. To do so, we are conducting a discrete choice experiment—a quantitative means to measure implicit preferences in health care —with Spanish and Haitian-Creole speaking participants. Results will be used as part of a formal adaptation process to modify Project RED—an evidence-based transitional care intervention—to the needs and preference of patients with LEP in the safety net setting.
Barriers and Facilitators to Uptake of Healthcare-Based Food Assistance Programs
Healthcare-based food assistance programs have previously found positive impacts on food security, overall health, and healthcare spending. However, there is a lack of guidance on creating, staffing, and funding of healthcare-based food assistance programs, which is a significant barrier to the availability, accessibility, and continuation of this important resource for patients who experience food insecurity. To address the evidence-practice gap, we sought to identify barriers and facilitators to implementation and sustainability of these programs. To do so, we conducted a sequential mixed methods evaluation, guided by the Practical, Robust Implementation and Sustainability Model (PRISM) framework, of an exemplar healthcare based food assistance program. Participants reported that facilitators to use of the market included financial need, simple registration processes, a centralized location, and comfort and familiarity with the health center; barriers to use include impaired mobility and lack of communication regarding market dates. Analysis of medical record and market attendance data indicate that cardiometabolic disease (e.g., type 2 diabetes and cardiovascular disease) is not associated with use of the market. Publications are forthcoming.
Primary Care and Endocrine Clinician Knowledge and Perspectives on Screening for NAFLD
Recent clinical practice guidelines1,2 have expanded indications for non-alcoholic fatty liver disease (NAFLD) risk stratification and evaluation to include obesity, prediabetes, and type 2 diabetes. These are conditions common in safety-net primary care clinics and highly prevalent in endocrinology clinics. Safety-net clinician knowledge and perspectives on screening for NAFLD are unclear. We are conducting a sequential explanatory mixed-methods study to explore the implementation context in anticipation of an initiative to test an electronic health record (EHR) tool to increase NAFLD screening in primary care and endocrinology clinics.
Clarifying Lung Cancer Screening Eligibility Through Patient Engagement with the Electronic Health Record
Tobacco smoking is an important risk factor for disease, but inaccurate smoking history data in the electronic health record limits the reach of lung cancer screening and tobacco cessation interventions. Patient-generated health data is a novel approach to documenting smoking history; however, the comparative effectiveness of different approaches is unclear. We are conducting a pragmatic randomized trial to evaluate the effectiveness of portal questionnaires compared to text message-based surveys, to compare message frames, and to evaluate the completeness of patient-generated smoking histories. Additional, we are conducting qualitative interviews with patients to understand their experience with the survey.