Pilot Projects Program

Round 6 Pilot Project Awardees


Emily Belarmino, Ph.D.

University of Vermont

 

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Heterogeneity in Nutrition in Rural and Nonrural Areas of Northern New England

 

Poor diet quality is a leading risk factor for cardiometabolic diseases such as coronary heart disease, stroke, and type II diabetes. In the United States, rates of these conditions are higher among rural populations. Despite the clear associations between poor diet and cardiometabolic disease and the greater burden of these conditions on rural communities, limited population-level evidence exists on rural dietary patterns. The goal of the project was to contribute to filling this gap by comprehensively characterizing the diets of rural and nonrural populations in northern New England and identifying factors that contribute to differences in dietary quality across rural population subgroups. This was achieved through the collection and analysis of new qualitative data and econometric analyses of secondary data.

 Key nutrition and health stakeholders across rural Maine, New Hampshire, and Vermont were engaged in focus group discussions to generate hypotheses about factors that result in some rural communities achieving higher quality diets. The study also evaluated and compared the healthfulness of rural and nonrural diets in northern New England using household-level grocery store scanner data collected in the three states. The goal was to use quantitative and qualitative methods to identify characteristics of rural areas that are associated with measurable differences in dietary quality and food expenditure.


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A Comparison of Low Burden Data Collection Methods Using a Study on Primary Care Telehealth and Burnout

 

Primary Care Providers (PCPs), especially in rural communities, face high burnout rates. Recent literature has linked burnout to both electronic health record (EHR) burden and the COVID pandemic. One research methodology for collecting PCP perspectives in real time and at the point of care is the Codman card study. At the end of a visit, the PCP completes a card and places it in a box to be picked up by or mailed to researchers. To date, no one has compared the effectiveness of card studies using paper, a phone app, or EHR-embedded questions.

Therefore, each participating PCP completed a “card” after each encounter for two half-day sessions to gather data about characteristics of the visit and about the PCPs perception of the impact of the visit on their level of burnout. Additionally, the study compared the effectiveness of completing cards using paper, the phone app, or via the EHR.

"With an aging population of family medicine providers, we need to be doing as much as we can to understand what's happening in those communities."

Timothy Burdick, MD, MBA, MSc

Dartmouth Health

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Ling Cao, MD, Ph.D.

University of New England

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Identification of Gaps in Care for Patients With Chronic Pain Through the Establishment of a State-Wide Pain Registry in Maine

 

Chronic pain is a significant public health problem and generates a great burden to society worldwide. In this pilot project, Cao initiated a pain registry for the adult population across the state of Maine to further understanding of Maine’s chronic pain population and improve population-targeted pain care. Over time, the goal is to expand this registry to younger populations and to all of northern New England to help create an effective regional pain care network. Cao hypothesized that social determinants of health (such as racial/ethnicity groups, education, income, housing environment, etc.) significantly affect the characteristics of pain (such as daily functions and psychological conditions) and its management (such as opioid usage and types and access to primary providers). This pilot registry includes information on  patient demographics, pain characteristics, pain care information, and social determinants of health collected from each enrolled individual.

 Potential population-based strategies can be identified based on the results and tested further in future studies. The eventual establishment of a region-wide pain registry is a significant undertaking, but it has unique potential to improve understanding of the unique characteristics of the chronic pain population in our region.

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Adapting Boot Camp Translation Methods to Engage Rural Communities in Lung Cancer Screening

 

Lung cancer is the second most common malignancy and the leading cause of cancer death in the U.S. In Maine, the burden of lung cancer is particularly great, with incidence and mortality rates significantly higher than national averages. While these rates are due in part to high levels of tobacco use and environmental radon, Maine also has a large population of low-income, rural residents who experience systemic barriers to accessing life-saving early detection services, like low-dose CT (LDCT) screening.

Among high-risk individuals, LDCT screening has been shown to reduce lung cancer mortality rates by as much as 20%. Effective engagement in early detection of lung cancer is the critical first step in optimizing medical intervention and reducing mortality. However, screening rates in Maine remain considerably lower than other states in New England.

To address this discrepancy, Scharnetzki used Boot Camp Translation (BCT) methodology to develop and assess a communication-based intervention for lung cancer screening awareness in a high-need rural Maine community. BCT an innovative community-based participatory research methodology in which clinicians, communities and researchers work collaboratively to translate scientific, evidence-based health information into actionable messages that are locally and culturally relevant. This was the first study to adapt BCT methods to lung cancer screening.

Elizabeth Scharnetzki, Ph.D.

MaineHealth 

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Seth Frietz, Ph.D.

University of Vermont

Characterization of CDK12 As a Breast Cancer Therapeutic Target

 

Seth Frietz’s team hypothesizes that their research may pave the way for the development of new therapeutic approaches for human cancer. Cyclin-dependent kinases (CDKs) are vital components of the cell cycle control system and transcription, and their deregulation has been associated with various aspects of tumorigenesis including cancer cell proliferation and metastasis. Selective inhibitors targeting CDKs modulate the cell cycle and have been demonstrated as effective anti-cancer agents. However, the biological functions and therapeutic potential of several CDKs in breast cancer remain uncharacterized. In this study, Frietz’s team tested the hypothesis that CDK12, a kinase involved in transcription and gene splicing, represents a potential therapeutic target in HER2+ breast cancer cells.

The research represents a new and substantive departure from current research because technological breakthroughs have allowed researchers to directly study the functional characteristics of CDK12 proteins for the first time, thus allowing a description of specific interactions of CDK12 at the molecular level and characterization of how the cellular function(s) of CDK12 support(s) HER2+ cancer cell growth.

 

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Opioid Prescribing Patterns and Analysis of Secular Trends

 

The majority of opioid pain medications are prescribed by primary care providers (PCPs) in the management of chronic pain, yet these PCPs may lack knowledge and experience regarding when and how to taper pain medications.

One effective method to support PCPs is with data summarizing their own prescribing along with benchmarking and peer comparison. The goal of this proposal is to demonstrate the feasibility of collecting data from state-level Prescription Drug Monitoring Programs (PDMPs)  along with matched electronic health record data, to support quality improvement interventions in primary care.

This project demonstrates the feasibility of using these data to improve the treatment of patients with chronic pain and to reduce risk of opioid misuse. This approach will support practice-level quality improvement programming to optimize controlled substance prescribing in primary care, and will support future research efforts.

 

Constance van Eeghen DrPH MHSA MBA

University of Vermont