2018 Awarded Grants
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Name:  Hongmei Wang, PhD

Title:  Providing Legal and Social Services to Address the Needs of Health Care Super-Utilizers: Thinking Outside the Box

Funding Agency:  Robert Wood Johnson Foundation

The primary objective of the proposed study is to examine the effects of the provision of social and legal services on identified super-utilizers’ health care utilization, particularly ED visits and hospital admissions, and related medical expenditures. We expect that providing social and legal services to super-utilizers with unmet health harming social legal needs will help this population gain access to health care, gain cash benefits, improve living conditions, and thus improve their compliance of treatment and appropriate use of medical care services. In addition, we expect an incremental effects of legal services to social services. That is, super-utilizers receiving both social services through social workers and legal services from legal staff will have better results than those receiving services from social workers only. We specifically hypothesize that:

  1. Compared to those receiving no social or legal services provision through NM MLP, super-utilizers (a) assessed and provided with social and legal services through NM MLP or (b) assessed and provided with only social services will have fewer ED visits and inpatient admissions, lower annual medical care expenditure, better access to care, and better overall health.
  2. Compared to those receiving social services only, ED super-utilizers receiving both social and legal services will have fewer ED visits and inpatient admission, lower annual medical care expenditure, better access to care, and better overall health.

For more information contact Dr. Hongmei Wang at hongmeiwang@unmc.edu.

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Name:  Paul Estabrooks, PhD & Jennie Hill, PhD

Title:  An Evaluability Assessment of the One for Good Initiative 

Funding Agency:  Robert Wood Johnson Foundation

The Consumer Goods Forum (CGF), in partnership with Healthy Washington County, developed and are in the process of launching the One for Good Initiative, as a pilot in Hagerstown, MD. Four stores have been identified as pilot sites for the initiative—Martin’s, Target, Walgreens Boots Alliance, and Walmart—and the larger One for Good Partnership also includes partners such as Ahold Delhaize, Campbell’s, Colgate-Palmolive Company, Danone, General Mills, Johnson & Johnson, Mondelez International, Nestle, and Pepsico. 

The goal of One for Good is to support local stores in planning and implementing changes to encourage consumers to choose more healthful foods, improve employee wellness, and ultimately have a meaningful impact on community health. The One for Good Initiative is predicated on a small changes approach (e.g., small and sustainable steps towards better health at the consumer and collaborative levels) and will include a One for Good logo and messaging to promote healthier food and beverage choices within local retailers that may include social media, in-store promotions, and community advertising. The One for Good Partnership will also support community events that encourage healthy living. The development of One for Good strategies that will be used is locally driven and may vary by retail location and manufacturer products. There is also interest in developing evidence-based criteria for a healthy basket approach as part of the broader initiative moving forward.

Evaluation needs of the initiative include a better understanding of the: (1) strategies across retail locations and community events, (2) breadth and characteristics of community members who are intended to benefit from the initiative, (3) implementation processes that will speed the dissemination of strategies to other retailers and communities, (4) changes in purchasing and eating behaviors of residents that frequent the retailers, as well as across the broader community population, and (5) sustainability of initiative strategies and changes in community health. The One for Good partnership is also interested examining existing research and/or expert recommendations on developing a healthy basket. 

To begin to address these needs, we propose an evaluability assessment to determine the feasibility and appropriateness of providing a formative evaluation using the RE-AIM framework. An evaluability assessment is intended to (1) identify the objectives of an initiative across a broad group of stakeholders, (2) document planned and implemented activities associated with the initiative, (3) outline the operational changes associated with the initiative, and (4) provide a rating of the potential for evaluation and options for evaluation implementation. Evaluability assessments are conducted in a participatory fashion beginning with developing a shared vision for future evaluations between external evaluators and the One for Good Partnership—with the objective of providing actionable and relevant information related to the success of the initiative. This will include identifying the availability of data or feasibility of collecting data to assess initiative outcomes. The overarching goal is to ensure that the evaluability assessment meets the needs of the One for Good Partnership.

For more information, contact Dr. Paul Estabrooks at paul.estabrooks@unmc.edu and/or Dr. Jennie Hill at jennie.hill@unmc.edu.

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Name:  Christine Arcari, PhD

Title:  Teaching Immunization for Medical Education Modules: Recommendations to Transition from Print-based Case-Studies to E-Learning Modules 

Funding Agency:  Association for Prevention, Teaching and Research

The Teaching Immunization for Medical Education (TIME) Project is a curriculum designed for use in medical schools to enhance immunization instruction.  Nine print‐based modules provide ready‐to‐use instructional materials that can be integrated into existing medical curricula and cover vaccine indications and contraindications, immunization schedules, and recommendations on efficient ways to increase vaccination levels.   The curricular goals of the nine modules are to: (1) increase learner knowledge about vaccine‐preventable diseases, vaccines, indications for vaccinations, and methods to increase vaccine coverage; (2) foster problem‐solving abilities; (3) stimulate learning in a clinical context; and (4) help learners gain familiarity with key references such as the recommendations of the Advisory Committee on Immunization Practices (ACIP). The purpose of this grant is to provide recommendations to transition the TIME print‐based case‐studies to e‐learning modules.  E‐Learning uses technology to access educational curriculum outside of a traditional classroom.

For more information contact Dr. Christine Arcari at christine.arcari@unmc.edu.

Gwenn Porter

Name:  Gwenn Porter, MS

Title:  Identifying, adapting, and testing weight loss programs in rural primary care 

Funding Agency:  American Heart Association

Eating healthful foods, engaging in regular physical activity, and maintaining a healthy body weight reduces the risk for cardiovascular and other chronic disease, improves quality of life, and reduces personal and public health costs. Unfortunately, the majority of American adults do not meet recommended guidelines for healthy eating or physical activity, and are overweight or obese. Further, rural communities that are disproportionally affected by obesity—perhaps due to the fact that many rural communities lack community recreation or fitness resources to promote physical activity and nutrition. The growing rate of obesity has prompted the development of numerous evidence-based weight management interventions for weight loss and weight loss maintenance. In preparation of this pre-doctoral fellowship Ms. Porter (Applicant) led a systematic review and meta-analysis of the impact of 53 rural weight loss interventions and found that a number of efficacious interventions exist for rural populations. However, these programs have lacked systematic and consistent translation in clinical practice or community services. In addition, information on intervention reach and cost is rarely reported.

To improve sustainability and reach, implementing weight loss programs with primary care settings show promise. In fact, individuals who use primary care are proportionally more obese than the general public. Primary care practices may be the only available services in many rural communities with the resources to support healthful eating, an active lifestyle, and weight management18. However, there is limited information related to physician and staff capacity to critically review the extant literature on efficacious weight loss strategies, identify an appropriate evidence-based approach, adapt it for local implementation, and develop screening and referral processes that engage a large proportion of their patient population—all while running a rural primary care practice. To address this, our proposal outlines a participatory process, guided by the RE-AIM framework, with the Nebraska Practice Based Research Network (PBRN) to identify, adapt, and complete a preliminary effectiveness and feasibility assessment of an evidence-based approach for rural weight management while concurrently testing new and integrated patient identification and referral structures to improve intervention reach.

Aim 1: Complete a participatory selection and adaptation of an evidence-based weight loss intervention with PBRN physicians, staff, office managers, and patients for local testing.

Aim 2: Conduct a limited effectiveness and feasibility (including cost) study to determine impact on weight loss of 100 overweight and obese patients. The proportion of participants who experience a clinically meaningful weight loss (i.e., ³5% initial body weight) at 6-months and cost per participant achieving this bench march will also be reported.

Aim 3: To determine if weight loss program reach increases using a 2X2 randomized recruitment design (in-visit referral vs electronic health record screening and mailed referral; active vs passive follow-up) within participating PBRN clinics.

The completion of these aims has the potential to affect the health of rural Nebraskans and influence future efforts to translate evidence-based weight management programs into rural primary-care practice.

For more information contact Gwenn Porter at gwenndolyn.porter@unmc.edu.

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Name:  Paul Estabrooks, PhD

Title:  Rural Patient and Stakeholder Engagement in Research 

Funding Agency:  Patient Centered Outcome Research Institute (PCORI)

Although national research agendas highlight both rural health disparities and emphasize the need for patient-centered outcomes, tools and resources employed to promote effective rural patient and stakeholder engagement in research have not been well documented. Rural populations experience unique challenges in accessing all levels of healthcare. This limited access occurs in the context of an increasingly diverse, older population with lower income, less education and limitations in digital communications infrastructure compared to suburban and urban populations. Rural patients and stakeholders engagement in research is necessary to ensure their voices are included in patient-centered outcomes and that research findings can be effectively translated into rural practice. However, consideration of the effectiveness of current tools and resources in rural communities is needed.

We propose to identify and implement rural patient and stakeholder engagement tools and resources built upon PCORI best practices, our experiences with community-engagement, and perspectives of rural patients, stakeholders, and researchers. A 3-tiered project structure with collaborative decision making among equal partners will be used. Co-Leads include a researcher, a patient, a physician, and a process facilitator that will manage the project. A Steering Committee, composed of 2 researchers, 2 patients, and 2 stakeholders, are sponsors. The steering committees will identify 10 research teams of approximately 5 members representing rural patients, scientists, and community or clinical delivery organizations using current research or healthcare connections. Research teams will be convened to support decision making on patient-engagement tools, recommend tool adaptations, and pilot tools and resources identified.

Our overall objective is to develop and test tools and resources for engagement of rural patients and stakeholders in research (planning through dissemination). Our long term objective is to ensure rural patient and stakeholder engagement in research. We aim to:

Aim 1: Prepare and engage rural patient, community, and provider stakeholders in the evaluation and modification of current best practices for rural patient and stakeholder engagement.

Aim 2: Identify, refine, and test tools and resources to support rural patient, community, and stakeholder engagement in research (e.g., policies and procedures; strategies; guides; technology evaluation).

Aim 3: Continue evaluation of findings through implementation in independent rural patient and stakeholder-engaged research project(s).

Aim 4: With patients, community organizations, and stakeholders, disseminate findings to others interested in rural, patient-engaged research and plan for sustainability

For more information contact Dr. Paul Estabrooks at paul.estabrooks@unmc.edu.

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Name:  Hongying (Daisy) Dai, PhD

Title:  Effects of FDA Compliance Inspections of Tobacco Retailers on Youth E-cigarette and Cigar Use: A National Study 

Funding Agency:  NIH/NCI

The purpose of this proposal is to conduct a quasi-experimental design to assess the impacts of the FDA retail compliance inspections on youth cigar and e-cigarette use behaviors (e.g., ever, current, and frequency of use). Results from this study are expected to inform appropriate retail compliance inspection strategies and further expand our knowledge of the potential impacts of regulatory actions on youth e-cigarette and cigar use behaviors.

Aim 1: Develop propensity models to identify areas with high risk of violation for underage sales of cigars and e-cigarettes.

Aim 2: Assess the association between FDA inspection intensity and youth cigar and e-cigarette use.

For more information contact Dr. Hongying Dai at daisy.dai@unmc.edu.

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Name:  John Lowe, PhD

Title:  Surveillance of Pathogens Causing Severe Infections and Associated Antimicrobial Resistance 

Funding Agency:  National Strategic Research Institute

The 2014 West African Ebola virus disease (EVD) outbreak and subsequent outbreaks have demonstrated the threat of infectious diseases to both US and global security and the importance of establishing a robust bio-preparedness posture. Global coordination ultimately resulted in the control of the outbreak; however, the severity of the disease, the geographic spread of the epidemic and the potential dissemination to regional and international partner countries highlighted critical vulnerabilities of concern to the US military medical enterprise. Paramount among the areas in need of immediate attention is the lack of adequate surveillance capabilities in the developing world. Greater upfront investments in surveillance systems and enhanced diagnostic capabilities to detect both known and unknown pathogens in affected countries could have yielded more farsighted preparation for and subsequent response to the outbreak.

The feasibility of any surveillance system for infectious disease incidence and etiology relies on diagnostic capabilities. In many of the EVD-affected or -at-risk countries, even the most rudimentary diagnostic microbiology capabilities are unavailable, making the identification of common causes of severe infection impractical and early identification of emerging threats particularly challenging. In Liberia, where the most EVD deaths occurred, clinical microbiology was non-existent throughout in the country for decades. But even where microbiologic tools such as blood cultures do exist, they are often deemed too rudimentary or unreliable to adequately inform clinical decisions. Additionally, physicians often do not understand how to collect or interpret the results resulting in a low perceived benefit of these tests. These limitations pose challenges to building or enhancing surveillance systems in resource-constrained settings. However, strategic development of diagnostic capabilities in key areas of developing countries’ public health systems can have an impact on preparedness of the entire region.

Through this task order, NU/NSRI, NMRC/Austere environments Consortium for Enhanced Sepsis Outcomes (ACESO), Naval Medical Research Unit – 2 (NAMRU-2), Naval Medical Research Unit – 3 Ghana Detachment (NAMRU-3G), and WRAIR/Military HIV Research Program (MHRP) will partner to improve surveillance through increased detection, timely reporting, and antimicrobial resistance characterization of pathogens causing both sepsis and acute febrile illness in developing and tropical OCONUS locations with strategic relevance for US military force health protection (including but not limited to Liberia, Ghana, Nigeria, and Cambodia). The primary aim of this task order is to advance the understanding of pathogens causing severe infections and enable health protection decision-making, promoting Global Health Security Agenda aims as well as interests of US Africa Command (AFRICOM) and US Pacific Command (PACOM). Under this TO, NU/NSRI will provide the Nation with research efforts centered on Core Competency: #4 Consequence Management, including innovative solutions to avoid or mitigate the effects of a Weapons of Mass Destruction event on personnel and infrastructure through detection, technology development, modeling and simulation, protocols, and design; Visualization and simulation of critical infrastructure vulnerabilities: Disaster preparation and response, and human behavior patterns; Computer-based surrogates of real world systems for training, analysis of alternatives, experimentation and exploration of system vulnerabilities; and Decision-making support tools to analyze complex data, assess risk, analyze exposure, and visualize impacts. Consequence management includes providing solutions to the challenges of protecting, responding, and restoring personnel health and infrastructure after a chemical, biological, cyber, radiological, or nuclear incident triggered by human or natural disaster.

For more information contact Dr. John Lowe at jjlowe@unmc.edu.

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Name:  Michael Wiley, PhD

Title:  Target Acquisition of Reference Materials Augmenting Capabilities (TARMAC) Initiative Next Generation Sequencing (NGS) Research Support 

Funding Agency:  National Strategic Research Institute

Task 1: Expansion of TARMAC Laboratory Network

As needs arise UNMC/NSRI will expand the laboratory network but placing equipment and providing next-generation sequencing training in strategic places throughout the world.

In the event of a disease outbreak, UNMC/NSRI can deploy a rapid response team capable of sequencing samples to aid in outbreak response.

Task 2: Sustain and Support Data Generation within the TARMAC Laboratory Network

UNMC/NSRI will support the TARMAC Laboratory Network with reagents and training to ensure data generation and dissemination is occurring.

UNMC/NSRI will uses Laboratory Network partners to help test new technologies in real-world settings

Task 3: Establish US-based NGS Laboratory Training Site

In collaboration with TARMAC, NU/NSRI will establish a genomics laboratory capable of training US and non-US personnel. The existence of this training site will allow for long-term stays of visiting scientists in the US to learn new NGS skills.

For more information contact Dr. Michael Wiley at mike.wiley@unmc.edu.

DejunSu

Name:  Dejun Su, PhD

Title:  Listen to My Story

Funding Agency:  Nebraska Arts Council

On January 31, 2018 the Center for Reducing Health Disparities, with the partnership of Kaneko and local artists, offered to the public a stage presentation entitled, Listen to My Story: Stories from African-American mothers and male offenders on violence in Omaha.

The purpose of the presentation is two-fold. First, through a format that rests on creativity in collaboration with academia, the audience members will listen in captivation to the real-life stories of individuals who live in a community stricken with violence, which will help the audience realize the context behind violence and its dramatic consequences. Second, the composition of the audience will bring together community-based organization who work daily to reduce violence and others who may be able to support their efforts.

For more information contact Dr. Dejun Su at dejun.su@unmc.edu.

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Name:  David Dzewaltowski, PhD

Title:  Whole-of-Community Systems Intervention for Youth Population Physical Activity 

Funding Agency:  National Cancer Institute, National Institutes of Health

The underlying conditions where youth live are associated with population health outcomes, with rural communities facing under-studied challenges. Youth physical activity (PA), a key risk factor linked to later cancer occurrence, is an outcome of community conditions. The proposed work will address a critical public health need by evaluating the impact of a whole-of-community multi-level adaptive systems intervention on implementation of community change and youth population PA. Our intervention, Wellscapes, is based on a hierarchical patch dynamics paradigm, given that communities are “wellness landscapes” of spatially heterogeneous geographic areas, characterized by a patchwork of interacting organization and activity settings. The intervention will establish a multi-level system infrastructure (Community Hub, Organization Wellness Teams, Activity Setting/Leaders) and provide training and support for population health quality improvement cycle processes targeting two evidence-based practices (EBPs): (1) stacking time segments of PA episodes within an organization’s daily routine, and (2) improving the quality of PA episodes (% time in PA). Our omnibus hypothesis is that intervention communities (plus organizations and leaders nested within) will have synergy and capacity to implement EBPs, adapting to continuously changing local system drivers to create a whole-of-community ecosystem of diverse and equitable youth PA opportunities. Building on local health department partnerships, we will conduct a two-wave staggered-start community randomized trial with four volunteer rural communities (each having nested school, after-school, scouting/4-H club, youth sport organizations) randomly assigned to intervention or standard public health practice. For baseline and intervention years, one day per month in the fall (3 days) and spring (3 days), organization activity settings (e.g., classrooms, teams) that house 480 children in 3rd through 6th grades will be assessed, resulting in observed community condition data, PA accelerometer data, and setting reach data (children % attendance by gender, ethnicity, free/reduced lunch status, and grade). We will also obtain estimates of population level PA with the use of the calibrated Youth Activity Profile, as well as community system qualitative data. The specific aims are to: (1) Determine the impact of the intervention on multi-level community system outcomes; and (2) Determine the implementation system drivers of multi-level youth population PA. We will use “big data” multi- level modeling methods for this effectiveness-implementation hybrid design, because there is a dual focus on testing an implementation strategy while simultaneously evaluating youth population PA impact. The research is significant because it evaluates a method for improving population health, theory-based systems, and behavior change processes in low-resource rural communities. The proposed research is novel because the adaptive patch dynamics approach builds capacity for both equitable collaboration and EBPs implementation across multiple local systems that are individually and collectively, dynamic and unpredictable.

For more information contact Dr. David Dzewaltowski at david.dzewaltowski@unmc.edu.