Health Outcomes and Biomedical Informatics 2022

Integrating Patient Reported Outcomes for Patient-Centered Pain Care

Faculty Mentor’s Name: Dr. Christopher Harle
Email: charle@ufl.edu
Phone Number: (352) 294-5797
Project Category: Clinical
International Component or Travel: No

Research Project Description:

The U.S. faces dual public health crises of widespread chronic pain and opioid overdoses. Over 75,000 people die annually from opioid overdoses. Most patients with chronic pain first turn to primary care clinicians, who must decide among myriad treatment options based on relative risks and benefits, medical history, and patient goals. Unfortunately, primary care clinicians lack usable tools to help them partner with their patients in choosing pain treatment options that best meet their patients’ complex needs. Thus, primary care clinicians and patients would benefit from patient-centered clinical decision support (CDS) built into their Electronic Health Record (EHR). Such CDS systems can help organize and deliver the most relevant and useful information to busy clinicians, so that they can focus on collaboratively choosing the best treatment options with their patients.

The objective of this project is to study the implementation of an existing CDS tool for pain shared treatment decision making into UF Health primary care practices EHRs. Our specific aims are to: (1) Adapt the CDS tool (called Pain Manager), for implementation in eight UF Health primary care clinics (2): Evaluate the effect of tailored implementation support on Pain Manager’s use in shared decision making; and (3) Establish the feasibility and obtain preliminary data in preparation for a multi-site pragmatic trial targeting the effectiveness of Pain Manager and tailored implementation support on shared decision making and patient-reported pain and physical function.

Medical students’ involvement with the project will be geared towards their interests. Potential opportunities included assisting with interviews and training activities targeted toward both patients and primary care clinicians, contributing to qualitative and quantitative analysis of study results, and disseminating study findings at scientific meetings and in peer-reviewed publications. The student will be co-mentored by Dr. Christopher Harle and Dr. Ramzi Salloum.

Funding: Agency for Healthcare Research and Quality

Publications:
Militello LG, Hurley RW, Cook RL, Danielson EC, DiIulio J, Downs SM, Anders S, Harle CA. Primary care clinicians’ beliefs and strategies for managing chronic pain in an era of a national opioid epidemic. Journal of General Internal Medicine. 2020 35(12): 3442-3548.

Harle CA, Diiulio J, Downs SM, Danielson EC, Anders S, Cook RL, Hurley RW, Mamlin BW, Militello LG. Decision-Centered Design of Patient Information Visualizations to Support Chronic Pain Care. Applied Clinical Informatics. 2019 10(4): 719-7

Computable social factor phenotyping using EHR and HIE data

Faculty Mentor’s Name: Dr. Chris Harle
Email: charle@ufl.edu
Phone Number: (352) 294-5797
Project Category: Clinical
International Component or Travel: No

Research Project Description:

Social risk factors, such as transportation needs, housing needs, and food insecurity, increase healthcare utilization and negatively affect health outcomes. Especially as health systems become more financially responsible for outcomes, they can benefit from processes that identify patients’ social risk factors and connect patients to appropriate services. Today, most health systems attempt to measure patients’ social risk factors, but such data collection is typically fraught with operational and conceptual difficulties. Some health systems implement screening questionnaires in their electronic health records (EHRs). However, data collection represents an additional burden on healthcare providers and patients in the clinic, and patients may decline to answer sensitive questions. Both of these factors contribute to uncertainty surrounding the reliability and validity of these questionnaires.

Our specific aims are to: 1) Assess the validity and reliability of questionnaires, clinical notes, and structured EHR data for identifying social risk factors in individual patients compared to a validated reference measurement of social risk factors, and 2) Assess the ability of these separate methods for measuring social risk factors in predicting health outcomes, and 3) Compare potential bias across patient gender, race, ethnicity, and age in using questionnaires, clinical notes, and structured EHR data to assess social risk factors. We expect this project will lead to more valid and implementable approaches to patient social factor measurement. The proposed research is significant because it directly addresses the challenges organizations face in addressing patients’ social risks and will provide key inputs to support organizations efforts at achieving a learning health system.

Medical students’ involvement with the project can be geared towards their interests. Potential opportunities included assisting with primary data collection at CHFM UF Health primary care clinics, conducting annotation on clinic notes to identify the inclusion of social factors, contributing to qualitative analysis of study results, and disseminating study findings at scientific meetings and in peer-reviewed publications.

Defining Physician Workforce Need, Demand, and Supply for the State of Florida

Faculty Mentor’s Name: Dr. Christopher Cogle
Email: christopher.cogle@medicine.ufl.edu
Phone Number: (352) 273-7493
Project Category: Clinical
International Component or Travel: No

Research Project Description:

Florida is believed to be deficient in physician workforce number and geographic distribution. Academic medical centers are competing against each other for GME funding with little to no coordination of efforts. Unfortunately, no organization is using a scientific approach to labor mapping. However, the data and models exist. The goal of this project is to use information technology to construct a method of defining physician supply, demand, and need for Florida. Results will be made public for state planning. The algorithms will also be used as a proof-of-concept for a subsequent national effort. The ideal student for this project will have strong computational programming skills, such Python, R, SQL, and Tableau.

Reducing tobacco-associated lung cancer risk: A randomized clinical trial of AB-free kava

Faculty Mentor’s Name: Dr. Ramzi Salloum
Email: rsalloum@ufl.edu
Phone Number: (352) 294-4997
Project Category: Clinical
International Component or Travel: No

Research Project Description:

Tobacco use is the leading cause of many preventable diseases, particularly lung cancer. Based on the national cancer data in 2020, Florida has the highest lung cancer incidence with the most deaths among all the states in the U.S. Unfortunately, around 16% of Florida adults continue to smoke cigarettes due to its addictive nature and the limited success of current cessation strategies, partly because these cessation strategies have various adverse effects, such as suicide risk, anxiety, and insomnia. Therefore, there is an unmet and urgent need for novel interventions to improve the success of tobacco cessation. Kava is a traditional beverage consumed daily by residents of the South Pacific Islands to promote relaxation, socializing and to improve the quality of sleep. Kava has been available as a dietary supplement in the US for several decades to support calm and relaxation. Previous studies have suggested that kava supplementation may reduce tobacco use and dependence among addicted smokers. No withdraw or dependence has been observed in kava use in clinical trials or during its use as a beverage or a dietary supplement. The ultimate goal of this project is to develop a safe and effective kava-based intervention to enable tobacco cessation and reduce lung cancer risk, which will improve health. This study will use AB-free kava which is a new formulation that is expected to have a better safety profile than other kava supplements. This study will document AB-free kava use compliance, safety, evaluate reduction in tobacco dependence, and study AB-free kava’s potential benefits in reducing tobacco use and lung cancer risk.

The objective of this study is to characterize the compliance of AB-free kava use among addicted smokers, evaluate its potential to reduce tobacco use/dependence, and explore the reduction in lung carcinogenesis risk via a double-blind randomized, placebo controlled 4-week AB-free kava intervention trial. The potential of precision AB-free kava intervention will be explored as well.

Medical students’ involvement with the project will be geared towards their interests. Potential opportunities included assisting with participants recruitment, and dissemination of study at scientific meetings and in peer-reviewed publications.