2017-18 CHSR Annual Report by UK Center for Health Services Research

Annual Report 2017 - 2018

Center for Health Services Research Applying Evidence to Optimize Health in Kentucky and BeyondÂŠ

Annual Report 2017 - 2018 JULY 2017 - JUNE 2018

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A Letter from the Director Observing and directing our team at the University of Kentucky’s Center for Health Services Research (CHSR) continues to astonish me as I witness the accomplishments and commitment of our team members to our mission of applying evidence to optimize health in Kentucky and beyond©. Guidance this year from our remarkable External Advisory Board (composed of nationally recognized experts in health services research, implementation science, quality improvement and academic medicine) led us to broaden our mission and refine our vision based on shifts in our efforts and the increasing emphasis on valuebased care and population health. Faster than I ever expected, the CHSR team is achieving our vision to become a national leader in advancing the science of health and health care delivery. I am thankful for our methodical approach to the strategic planning now guiding us. Integral to this approach was a SWOT analysis performed in the initial years of establishing our Center that led to identification of key initiatives aimed at achieving our targets and key milestones. Progress along the map of our strategic plan is delineated in the following pages of our Annual Report, detailing attainment of goals and work yet to be done. From my perspective, an essential ingredient contributing to our success is the culture of the Center. Growing from two people in January of 2014 to > 50 today could not have been accomplished without a supportive culture focused on results. One of my favorite books for team education is Patrick Lencioni’s The Five Dysfunctions of a Team. According to Lencioni, trust is foundational to successful teams. If team members trust each other, then they feel comfortable asking for help, assume the best intentions, admit mistakes and weaknesses, take risks offering feedback and assistance, offer and accept apologies, and focus time and energy on issues and not politics. When trust is absent, teams become dysfunctional with people failing

to recognize and tap into each other’s skills and experiences. Importantly, we do simple things such as using first names in the Center to flatten hierarchies to facilitate conversation and feedback. Why? It represents one component of factors that contribute to a climate of trust. And, an impactful personal experience early in my career introduced me to this approach. As every physician knows, residency training influences you powerfully and permanently. Mine started with a surprising question during the first five minutes of orientation by the program director. All the interns knew Dr. George Thibault’s reputation and revered him as an Editor of Harrison’s Textbook of Internal Medicine—our bible for training. With rapt attention, we listened silently to every morsel of wisdom escaping from him. After he welcomed us, he asked “What’s after everyone’s name in this room?” Dumbfounded, I was speechless. Dr. Thibault smiled, and commented “Come on, you’re smart medical school graduates and you got into this prestigious residency program. What’s after your name?” Someone whispered “MD?” eliciting a boisterous “YES” from Dr. Thibault. He then proceeded to tell us how we all were now physicians and he was not going to call us Dr. (insert last name) and neither should we call him Dr. Thibault. “We are colleagues.” Having grown up in the South with a retired Lt. Colonel as my father, these comments rolled off me like water on a newly waxed car. A few days later, things changed. George Thibault was my attending physician and I embarked on the experiential training integral to residency and transformative for me. Sleep deprived after my first night of call, I was presenting newly admitted patients. Quickly, my automatic reflexes addressed him as Dr. Thibault provoking an equally quick and kind response – “Mark, my name is George. Remember what I said during the orientation?” Another sympathetic reflex prompted me to immediately say “Yes Sir.” He

smiled, and I continued my case presentation soon to repeat the faux pas and respectfully address him as Dr. Thibault. He immediately corrected me and emphasized that I must use his first name, telling me that everyone on the team and those caring for the patient were colleagues. Flummoxed, I responded with another “Yes Sir!” Continuing with my patient presentations, a bit later I uttered ‘Dr. Thibault’ a third time. The reaction was swift and firm. With a serious tone, and look of consternation, he told me, “Mark, if you can’t figure this out, I’ll have to send you out of the room like an elementary student. Can you say George?” Panicked and dry mouthed, I rasped “Yes, George.” Later, I realized that using first names was symbolic of much more. While using first names was important at this hospital, it was supported by the expectation that we all learned from each other. Senior residents emphasized teamwork and frontline expertise by telling interns that if we were unsure about what to do, ask the nurse caring for the patient. And faculty pushed us to challenge standard clinical approaches throughout the residency. Confirmation comes from the multi-year Aristotle Project undertaken by Google which identified individuals’ psychological safety as the most important factor predicting successful teams.1 This expectation of seeking and sharing expertise among all health care team members pervades my approach to patient care and CHSR’s successful research on teamwork.2 Using first names fostered collegiality and collaboration then, and I strongly believe it remains relevant today. Please, call me Mark.

Mark V. Williams, MD, FACP, MHM Director, Center for Health Services Research Chief Quality & Transformation Officer Professor & Chief, Division of Hospital Medicine University of Kentucky and UK HealthCare

1 What Google Learned From Its Quest to Build the Perfect Team - The New York Times Magazine; 3/20/2016 2 Li J, Talari P, Kelly A, Latham B, Dotson SL, Manning K, Thornsberry L, Swartz CH, Williams MV. Inter-professional Teamwork Innovation Model (ITIM©) to Promote Communication and Patient-Centered, Coordinated Care. BMJ Qual Saf 2018 Feb 14. doi:10.1136/mjqs-2017-007369. PMID: 29444853

UK CHSR Annual Report 2017 - 2018

UK Center for Health Services Research The University of Kentucky Center for Health Services Research (UK CHSR) is an active contributor to the University for Kentucky’s focused efforts to become a national model for a thriving public, residential, research-intensive campus and to serve the health care needs of Kentucky and beyond to UK Healthcare’s® advances. The Center particularly focuses on how best to enhance the value of health care delivered by a well-integrated health delivery system to individuals, families, organizations, institutions, communities, and populations.

Vision Become a national leader in advancing the science of health and health care delivery.

Mission Applying evidence to optimize health in Kentucky and beyond©

Table of Contents 01

A Letter from the Director

UK CHSR Vision & Mission

Center Advancement

Advancing Health Services Research & Scholarship

Data, Analytics, & Statistical Core

Office for Value and Innovation in Healthcare Delivery

Education & Training

Noteworthy Accomplishments

Project ACHIEVE

Social Influences on Syringe Exchange

Center for Clinical & Translational Science

Kentucky Consortium for Accountable Health Communities

Faculty Development

Chief Quality & Transformation Officer

Staff Development

The Next Generation

CHSR-Led Proposals

Collaborative Proposals

50 Appendices

UK CHSR Annual Report 2017 - 2018

Center Advancement The CHSR’s strategic planning process is a dynamic undertaking guided by multiple levels of input and interactions, including: CHSR leadership, faculty and staff, a Steering Committee, and Internal and External Advisory Boards. The CHSR’s strategic plan serves as a guide for success integrated and aligned with institutional and UK HealthCare® initiatives. The iterative process development led to a comprehensive strategic vision for the Center for Health Services Research. Over the next five years, the Center’s leadership will use this Five-Year Strategic Plan to direct acquisition and investment of resources in faculty recruitment, seed grant development funding, space, and other mechanisms to promote health services research at UK.

Five-Year Strategic Plan Advance UK Health Services Research and the Science of Health Care Delivery 1. Grow Extramurally Funded Research Through Collaborative Efforts 2. Increase the Center’s Output of Peer-Reviewed Articles, Presentations and Briefs 3. Expand the Center’s Research Capacity, Expertise, and Output and Serve as a Connector

Catalyze the Transformation of UK HealthCare® into a Learning Health System 1. Support Operations, Process Improvement (PI), and Implementation Research Projects within UK Healthcare (UKHC) and Regionally 2. Enhance Health through the Translation and Dissemination of Evidence-Based Research and Practices, and Translate Quality Improvement Experiences into Scholarship

Create and Enhance Health Services and Value Care Education and Training 1. Contribute to Health Services Research Degree and/or Certificate Programs at UK 2. Communicate Latest Health Services Research (HSR) Developments 3. Enhance UK HealthCare Online Workplace Training Offerings 4. Develop Open-Source HSR Educational Tools, Disseminate Information, and Enhance the Visibility of the Center

Enhance the Center’s Capacity to Achieve its Mission by Ensuring Adequate Resources and Operational Effectiveness and Efficiency 1. Regularly Seek Feedback from Stakeholders to Guide the Direction and Communication of the Center 2. Partner with College Deans, Ensure the Center Has Sufficient Faculty Depth and Breadth to Support and Conduct High Quality Research 3. Grow Research and Quality Improvement Infrastructure 4. Enable Staff Professional Development

Center Advancement

Strategic Plan Accomplishments for FY18

ADVANCE HSR & HEALTH CARE DELIVERY 100%

CATALYZE UK HEALTHCARE 100%

HEALTH SERVICES/ CARE EDUCATION & TRAINING 100%

ENHANCE CENTERâ&#x20AC;&#x2122;S CAPACITY 94%

UK CHSR Annual Report 2017 - 2018

Advance HSR & Health Care Delivery Undertake, facilitate, and coordinate inter-professional collaborative research aimed at improving population health through delivering high value health care and community health, and provide leadership in the science of health care delivery and guidance across the University of Kentucky while engaging faculty and staff from the relevant Colleges.

RESEARCH 100%

FACULTY 100%

CAPACITY 100%

Research Grow Extramurally Funded Research through Collaborative Efforts 01 Submit ≥ 2 peer-reviewed, nationally competitive research applications per year to NIH, AHRQ, HRSA, PCORI, or CMMI 02 With guidance from senior faculty mentors, ≥ 1 Assistant Professors in the Center will submit a career award application to NIH or AHRQ within 3 years 03 ≥ 50% of full-time regular or research faculty members will receive nationally competitive research as a Co-Investigator within 3 years; ≥ 40% of faculty members will receive peer-reviewed, nationally competitive research funding as PI within 5 years Future Objectives 04 Establish partnerships with peer centers at 2 other institutes by 2019* *20% complete 100%

150%

167%

Center Advancement

Faculty Increase the Center’s Output of Peer-Reviewed Articles, Presentations, and Briefs 01 Each full-time faculty will publish ≥ 3 peer-reviewed manuscripts per year; ≥ 1 of the published articles will be as first or corresponding author 02 Each faculty will give 2 presentations per year at regional and national meetings

100%

260%

380%

Capacity Expand the Center’s Research Capacity, Expertise, and Output and Serve as a Connector 01 Increase collaborations with the 6 health colleges at UK and others (e.g., College of Arts and Sciences Departments of Sociology and Psychology, Communication and Information, Gatton College of Business, College of Engineering, College of Education, etc.) to develop research ideas/projects and grant submissions. Collaborate on ≥ 1 proposal submission for external funding per year 02 Host monthly Health Services Research (HSR) seminars and promote campus and external collaborations 03 Collaborate with ≥ 1 external partner on research project or proposal submission per year Future Objectives 04 Utilize Work-in-Progress (WIP) sessions to enable faculty communication and collaboration. Increase the frequency of WIP sessions to 2 per month by 2020* *80% complete

100%

200%

100%

UK CHSR Annual Report 2017 - 2018

Catalyze UK HealthCare Align with UK HealthCare’s (UKHC) strategic plan related to providing patient-centered care, growth in complex care, strengthening partnership networks, and value-based care and payment. Provide essential knowledge, skills, and resources needed for UKHC to become a learning health system as defined by the National Academy of Medicine and provide guidance to health care teams to optimize the value of care for patients by leveraging expertise in information technology, analytics, implementation science, survey methodology, decision making, and quality improvement.

DISSEMINATION 100%

OPERATIONS 100%

Dissemination Enhance Health through the Translation and Dissemination of Evidence-Based Research and Practices, and Translate Quality Improvement Experiences into Scholarship 01 Initiate ≥ 1 evidence-based practice implementation(s) at UKHC and affiliated organizations per year 02 Connect UKHC and affiliated organizations to regional or national translational and implementation projects 03 Translate ≥ 1 UKHC quality improvement project(s) into a peer-reviewed publication per year

100%

Center Advancement

Operations Support Operations, Process Improvement (PI), and Implementation Research Projects within UKHC and Regionally 01 Initiate and lead â&#x2030;Ľ 3 new improvement projects per year through the support of and collaboration with the Office for Value and Innovation in Healthcare Delivery (OVIHD) 02 Provide expert support and facilitate â&#x2030;Ľ 8 improvement projects for units and service lines within UKHC per year. Assist others seeking to undertake quality improvement (QI) and PI within UKHC 03 Provide QI/PI education and training to develop sustained PI capability and support infrastructure at UKHC Future Objectives 04 Secure funds from UKHC to continue support for OVIHD and host an annual symposium on contemporary health care delivery issues that involves participation by faculty, community stakeholders, professional associations, regional health systems, and representatives from state government by 2020* *20% complete

100%

02 03

138% 117%**

**OVIHD Trained >500 people in FOCUS-PDSA methodology and now supports >50 nurse/physician dyads across UKHC

UK CHSR Annual Report 2017 - 2018

Health Services/Care Education & Training Enhance the delivery of rigorous and cutting-edge academic and professional training that prepares current and future health services researchers to be leaders in the field.

EDUCATION 100%

COMMUNICATION 100%

TRAINING 100%

Education Contribute to Health Services Research (HSR) Degree and/or Certificate Programs at the University of Kentucky 01 Grow active e-learning and/or hybrid HSR courses supported by the Center 02 Center’s faculty give ≥ 2 guest lectures per year to relevant Master and/or PhD program courses offered by health and affiliated colleges 03 Further develop relationships with local and regional health systems to provide internships and practicum experiences on applied research Future Objectives

04 Collaborate in the development of a Health Services & Outcomes Master’s Degree Program at UK by 2022*

*40% complete

100%

01 02 03

100% 200% 350%

Center Advancement

Communication Communicate Latest HSR Developments 01 Communicate with our stakeholders on recent publications that are relevant to health services researchers and health policymakers 02 Evaluate social media strategies for optimization 03 Leverage information and communication technologies (CTs) for communicating HSR accomplishments

100%

300%

157% 105%

Training Enhance UK HealthCare Online Workplace Training Offerings 01 Expand and refine orientation of e-learning programs 02 Develop ≥ 2 web-based training offerings per year for clinicians, nurses, and other frontline staff

100%

150%

Visibility (Future Goal) Develop Open-Source HSR Educational Tools, Disseminate Information, and Enhance the Visibility of the Center 01 Develop a resources section on the Center’s website to support HSR professionals seeking direction in improving health services by 2019* 02 Develop podcast series on Center’s activities by 2019** 03 Develop a consistent brand for CHSR, aligning with UK brand standards and effectively communicating CHSR goals and expertise*** *70% complete **50% complete ***200% complete

UK CHSR Annual Report 2017 - 2018

Enhance the Centerâ&#x20AC;&#x2122;s Capacity Grow and develop the expertise needed for the Center to become a national leader in Health Services Research and for UK HealthCare to become a learning health system.

FEEDBACK 100%

INFRASTRUCTURE 83%

DEVELOPMENT 100%

Feedback Regularly Seek Feedback from Stakeholders to Guide the Direction and Communication of the Center 01 Utilize the Centerâ&#x20AC;&#x2122;s Steering Committee, Internal Advisory Board, and External Advisory Board to elicit feedback and guidance 02 Provide a feedback survey to Data, Analytics, and Statistical Core (DASC) Customers 03 Engage staff & faculty in an annual retreat to gain feedback on work environment and progress of the Center 04 Publish an annual report to be disseminated to stakeholders

100%

Center Advancement

Infrastructure Grow Research and Quality Improvement Infrastructure 01 Add technical capabilities for data intake, management, and analysis 02 Add the capability to perform de-identification of datasets by HIPAA expert determination methodology 03 Provide multimedia support for projects within UK and UKHC

100%

333%

50% 200%

Development Enable Staff Professional Development 01 Enable each staff memberâ&#x20AC;&#x2122;s development by supporting attendance at 1 conference, seminar, or other educational opportunity per year 02 Generate annual professional development plan for each staff

100%

275%

100%

Faculty (Future Goal) Ensure the Center Has Sufficient Faculty Depth and Breadth to Support and Conduct High Quality Research

01 Recruit 1 faculty member with expertise in qualitative research methods to better enable the Center to successfully compete for mixed-methods grants from PCORI, NIH, and AHRQ within the next 3 years* 02 Recruit 1 faculty member with expertise in organizational studies or implementation science to further enable the Center to successfully compete for implementation science awards from PCORI, AHRQ, and NIH within the next 3 years 03 Recruit 1 faculty member with expertise in health care finance and health delivery model evaluation to further enable the Center to successfully compete for grants from the state, HRSA, and CMMI within the next 3 years 04 Have â&#x2030;Ľ 1 adjunct faculty at each health college by 2020** 05 Create an endowed faculty position at the Center by 2017 *100% complete **50% complete

UK CHSR Annual Report 2017 - 2018

Strategic Plan Objectives for the Next Five Years

11 10 09 08 07 06 05 04 03 02 01

01 Research: Establish partnerships with peer centers at 2 other institutes by 2019, 20% complete 02 Capacity: Increase the frequency of WIP sessions to 2 per month by 2020, 80% complete 03 Operations: Secure funds from UKHC to continue support for OVIHD and host an annual symposium on contemporary health care delivery issues by 2020, 20% complete 04 Education: Collaborate in the development of a Health Services & Outcomes Master’s Degree Program

at UK by 2022, 40% complete 05 Visibility: Develop a resources section on the Center’s website to support HSR professionals seeking direction in improving health services by 2019, 70% complete 06 Visibility: Develop podcast series on Center’s activities by 2019, 50% complete 07 Faculty: Create an endowed faculty position at the Center by 2017, 0% complete 08 Faculty: Recruit 1 faculty member with expertise in qualitative research methods within the next 3

years, 100% complete 09 Faculty: Recruit 1 faculty member with expertise in organizational studies or implementation science within the next 3 years, 0% complete 10 Faculty: Recruit 1 faculty member with expertise in health care finance and health delivery model evaluation within the next 3 years, 0% complete 11 Faculty: Have ≥ 1 adjunct faculty at each health college by 2020, 50% complete

Center Advancement

Collaboration & Involvement Across the US The Center emphasizes collaborative partnerships with institutions* across the Commonwealth and nationally to conduct innovative research and improve patient care.

City or county with partnering institution

Boston Medical Center Brigham and Womenâ&#x20AC;&#x2122;s Hospital Caregiver Action Network Centers for Medicare & Medicaid Services Essential Health Institute Health Research & Educational Trust Kaiser Permanente

UK CHSR Annual Report 2017 - 2018

Kentucky Primary Care Association Louisiana State University Mayo Clinic National Association of Area Agencies on Aging Northwestern University Norton Healthcare Project Patient Care

St. Elizabethâ&#x20AC;&#x2122;s Hospital Telligen United Hospital Fund University of Pennsylvania Westat *Includes Project ACHIEVE Hospitals (42 active)

Value of Innovation to Implementation Program (VI2P) Coordinated by Jing Li, MD, MS (Associate Director of the CHSR and Director, OVIHD), the VI2P initiative reached its first sixth month milestone: on March 26th–VI2P researchers and colleagues presented their initial progress on their projects to the Dean of the College of Medicine. Some highlights from the reports are included below.

Kristin Ashford, RN, PhD (Principal Investigator on “Tobacco Use in Pregnancy Intervention for Cessation; ToPIC”) informed colleagues that the ToPIC team has conducted the planned provider focus groups and practice assessment survey. Three practice sites at UK HealthCare and Baptist Health Lexington are participating, and the project has started enrolling patients and delivering the intervention. The ToPIC project also provided opportunities to undergraduate interns to participate in various research activities including study planning, clinic engagement, and patient recruitment. James Keck, MD, MPH (Principal Investigator on “Partnership for Identification and Primary-care Based Enrollment to a Prevention Intervention for Diabetes; PIPE to Prevent Diabetes”)

presented findings from patient focus groups and a baseline survey of providers. The results indicated knowledge and awareness gaps and unmet needs among patients, while an evidence-practice gap was prevalent among providers. As of June 12th, 2018, more than 12,000 patients had been screened, with >1,000 deemed eligible to the Diabetes Prevention Program (DPP) referral. Jill Kolesar, PharmD, MS (Principal Investigator on “Implementing Oncology Precision Medicine in Kentucky”) conveyed findings from focus group and informant interviews her team conducted, which highlight the awareness gap of precision medicine and its benefits. A precision medicine continuing education event was held in Lexington in April 2018 and approximately 200 individuals attended the event. Essentially all patients

8 Conference Abstracts

Contributed $3.36 Million to Grants

interviewed were unaware of precision medicine and its benefits. Christina Studts, PhD, LCSW (Principal Investigator on “Adaptation and Pilot Implementation of the Family Check-up for Deaf and Hard of Hearing Children”) reported great stakeholder engagement in her study. Community Advisory Board (CAB) members strongly voiced the preference of having trained parents of deaf and hard of hearing children serve as the interventionist rather than social workers. With this input, the study team established a new partnership with Kentucky Hands & Voices and plans to train two parent coaches to deliver the intervention. The two parent interventionists have attended virtual training sessions on the Family Check-up program.

1 Manuscript

All VI2P researchers set impressive goals for the continuation of their studies, including R01 and R18 grant submissions, planned manuscripts, and conference presentations. To learn more about the VI2P program, visit https://chsr.med.uky.edu/vi2p.

Center Advancement

UK WINS The UK Workgroup for ImplementatioN Science (UK WINS) is a network of UK researchers with a common interest in dissemination and implementation science in health. The group meets bimonthly to coordinate and foster collaboration, funding, training and mentor/mentee opportunities. The UK WINS group offers a supportive, transdisciplinary opportunity for interactive conversation and feedback regarding specific projects. Members represent diverse research areas across UK–including healthrelated colleges (Colleges of Medicine, Nursing, Education, Public Health), Arts & Sciences and the UK Markey Cancer Center– with a common interest in Dissemination and Implementation (D&I) science in health. Another key activity is reviewing new funding opportunities and forging transdisciplinary teams to pursue extramural funding. UK WINS Vision Establish UK as a leader in implementation science to promote innovative research, bridge the gap between evidence and practice, and address complex health issues. UK WINS Focus • Create and support an internal UK community around implementation science • Enhance the capability of UK investigators to secure D&I science funding and training opportunities from NIH and other sources • Apply learning health system concepts and use UK HealthCare and affiliates as a laboratory to study D&I methods and interventions in order to advance research and optimize patient care UK WINS Accomplishments • Developed a database of faculty expertise in domains of D&I research so members can easily identify potential collaborators • Compiled available training programs and distributed to all interested researchers through the CHSR website and listserv • Serves as a support hub for development of transdisciplinary teams to pursue federal and other grant funding in D&I research

UK CHSR Annual Report 2017 - 2018

Advancing Health Services Research & Scholarship By the Numbers: Faculty and Staff Productivity in FY18 32 Peer-Reviewed Publications 31 Conference Presentations 2 Manuscripts in Review

Grant Funding Cumulative grant funding for the CHSR, FY14 - FY18

25m

$20.5 m

$21.6 m

20m

$15.7 m 15m

10m

$5.1 m 5m

$26,394 FY14

FY15

FY16

FY17

FY18

Advancing Health Services Research & Scholarship

The Center has collaborated with researchers within and outside the University of Kentucky to develop and submit 10 grant proposals to multiple funding agencies, including the National Institutes of Health (NIH), the Centers for Medicare and Medicaid Services (CMS), the Patient-Centered Outcomes Research Institute (PCORI), and the Gordon & Betty Moore Foundation. Values shown below are a depiction of proposals completed in FY18. A full list of CHSR and Collaborative Proposals can be found on pages 46-49.

GRANT PROPOSAL SUBMISSIONS

CHSR-LED PROPOSALS

FUNDED PROPOSALS

> $21.2 m

> $1.1 m

PROPOSALS IN REVIEW

FUNDING REQUESTED*

FUNDING RECEIVED*

*As of June 30, 2018

UK CHSR Annual Report 2017 - 2018

Data, Analytics & Statistical Core The CHSR Data, Analytics & Statistical Core (DASC) team provides analytical support to stakeholders across UK to meet their health services research and quality improvement data needs. This support includes data collection and management, extraction of data from clinical data management systems, survey development, program evaluation, study design and methodology, dashboard design, server support for datasets, and statistical analysis.

Development Prologue to the Year As an Agile Analytics group, DASCâ&#x20AC;&#x2122;s focus has shifted based on our strategic goals as well as reactions to demand and other external forces. Upon creation of the DASC team in fiscal year 2015, we immediately understood an effort to build relationships by providing analytic expertise, infrastructure staff, and support to those seeking data for quality improvement or research. We built processes for strong customer service with robust compliance standards with the Health Insurance Portability and Acountability Act of 1996 (HIPAA) and the Institutional Review Board (IRB). Additonally, customized agile principles focused around analytics and a continuous improvement cycle to

allow reflection and adaption within our unit. In fiscal years 2016 and 2017 we participated in the vendor selection and implementation of the new enterprise data warehouse (EDW), started building a collaborative community of data experts at UKHC across many organizational units, implemented intern programs for high school and college undergraduates interested in analytics, and made enhancements to our staff experience through workload management, development & training, and our six-month continuous improvement cycles. Accelerating and Scaling Analytics The DASC team worked to accelerate and scale analytics at UK and UKHC

Project Priority

through internal process improvement and external collaboration with other related units. We expect this work to continue into the following year allowing us to scale our output both as a unit and as an enterprise to enable research and UKHC quality improvement. We completed our full conversion to the new EDW platform, automated our recurring reports for the systems the EDW team has loaded so far, developed an analytics Wiki to assist the UKHC analytics community, shifted our project request and priority process to be able to better scale, and have started to implement a plan to further market DASC and share our successful strategies through talks and presentations in various settings.

156 Projects in FY18

25 % 44 %

High - Funded High - Leadership High - Old Request Mid - OVIHD and CHSR

8% 5%

Routine - Other 18 %

On-Going

Publications in FY18

In Review

Data, Analytics, & Statistical Core

Pharmacy

DASC Project Hours by Unit Maximum 50 Hours Worked High - Funded High - Leadership High - Old Request Mid - OVIHD and CHSR

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UK CHSR Annual Report 2017 - 2018

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DASC grew to 15 full-time staff and 3 interns and supported 156 projects and initiatives, a 57% increase over the previous year. The team provided data support to multiple extramurally funded grants and contracts; our 113 active Tableau dashboards support 242 non-DASC employees in their QI

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and research efforts and have had over 19,000 views. DASC staff were included as authors on 25 publications including posters, presentations, and manuscripts. We hosted monthly analytics open labs and analytics collaboration meetings, provided a guest lecture to Masters in Health Administration (MHA) graduate students, and analytic training modules during OVIHDâ&#x20AC;&#x2122;s UKHC True Blue training. DASC staff assisted faculty

in many grant applications and IRB submissions; the team produced multiple health-related infographics available on our website using publicly available data. Our programmers developed Android and iOS mobile apps, websites, and an application to support RFID data collection to support time/ movement studies at UKHC.

Office for Value and Innovation in Healthcare Delivery The Office for Value and Innovation in Healthcare Delivery (OVIHD) is UK HealthCare’s internal department of experts in quality improvement and process engineering. OVIHD serves to build UK HealthCare’s operation as a Lean healthcare organization through coaching and training leaders and frontline staff on the application of quality and process improvement tools and methodologies, as well as the practice of problem solving and change management principles. The OVIHD team partners with operation and clinical leadership to identify opportunities for improvement by bringing technical expertise grounded in Lean management to support the improvement system and management system within UK HealthCare. Lean management is built on a foundation of respect for people and the relentless pursuit of reducing waste to drive organizations to continually add value in an effort to simultaneously improve quality, cost, and satisfaction.

Development Jing Li, MD, MS, Named Director of the Office for Value and Innovation in Healthcare Delivery (OVIHD) Dr. Jing Li was named associate director of the University of Kentucky Center for Health Services Research and the new director of the Office of Value and Innovation in Healthcare Delivery (OVIHD). Dr. Li graduated from Tianjin Medical University and completed residency training in anesthesiology and subsequent clinical research training at its hospital. In 2002, she completed a master’s degree in computer and information sciences at the University of Alabama at Birmingham (UAB). While at UAB, she helped provided research and analytic support to several multi-center studies including Coronary Artery Risk Development in Young Adults Study (CARDIA), National Lung Screening Trial (NLST), and Dental PracticeBased Research Network (PBRN) in the Division of Preventive Medicine at UAB. She then gained quality improvement, project management and program implementation and evaluation experience working for the Alabama Quality Improvement Organization, focusing on interdisciplinary teamwork, patient safety, care coordination, and best-practice adoption and implementation. Since arriving at UK

in 2014, she has co-authored 11 peerreviewed publications, collaborated on the submission of $96.3 million in grant and contract proposals and currently is principal or co-investigator on funded projects totaling $20 million awarded to the Center for Health Services Research. Additionally, she served as deputy director of OVIHD at its inception in April 2015, helping recruit and build its staff. Prior to coming to UK, Dr. Li co-developed and helped lead three statewide quality improvement programs, which were implemented in more than 60 hospitals in Illinois to promote system and culture change, optimize processes, and improve patient care. Prologue of the Year The mission of the OVIHD is to provide value-based care across our health system. By reengineering care delivery using expertise from industry, UK Health Care continues to undergo a transformation of its delivery system to optimize care coordination for patients. This past year we helped foster change by working with key stakeholders in areas including materials, procedural areas, inpatient units, and ambulatory. In these areas, we built processes to support an attitude of continuous improvement,

value creation, respect among staff, and visual tracking. We continue to collaborate with our DASC colleagues in utilizing their expertise in data and analytics to support project efforts to empower teams to improve processes using data. Our collaborations expand beyond UKHC including the College of Public Health, College of Health Sciences, and College of Medicine by supporting leaners in training and process improvement projects. These partnerships highlight the university’s commitment and willingness to drive process improvement as a skill set to grow staff and students professionally. Supporting Process Improvements with Innovative Tools The OVIHD team continues to improve its offerings by continuously improving and collaborating with other academic institutions including Cincinnati Children’s Hospital. We expect this work to grow and flourish to support the scale of quality improvement at UKHC. Process improvement efforts are supported by staff with a wide range of expertise including the aerospace industry, employee and patient safety, industrial engineering, clinical operational effectiveness, and organizational development. We continue to promote FOCUS

Office for Value and Innovation in Healthcare Delivery

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UK CHSR Annual Report 2017 - 2018

Trained and Educated in FOCUS PDSA

PDSA as UKHC’s problem solving methodology to ensure solid planning and usage of the scientific method to create sustainable change. Other tools leveraged by OVIHD to create transparency include workplace organization and standardization. Partnerships fostered by skilled facilitators have created an environment promoting staff satisfaction where dialogue is steered toward accomplishing a common goal.

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Act and Determine Next Steps

Testing is underway leveraging Reader Frequency Identification (RFID) to measure staff and room utilization. Time studies previously collected this information manually with human observers. RFID has provided the technical platform for

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utilizing readers and badges equipped with RFID to monitor movement within a clinic setting real-time. This partnership included assistance from the DASC team to create a mechanism to automate the data collection and summary. Partnerships with UKHC’s Building Efficiencies through Strategic Transformation (BEST) initiative have provided insights to providers on the effects of patient wait time throughout the day. This has benefited clinics in identifying process improvement opportunities including reducing patient wait times and improving staff and patient satisfaction. We project the volume in ambulatory time studies to increase over the upcoming months to support the implementation of the UKHC Quality Strategic Plan.

Staff and Students who used FOCUS PDSA in posters and presentations

FY18 Highlighted Outcomes and Figures OVIHD grew to 6 full time staff and 2 interns from the College of Public Health MHA Program; we supported 2 dozen projects and initiatives across UKHC; led FOCUS PDSA education and trained 100 people including participants from the Department of Anesthesiology, Department of Radiology, Great Lakes Transformation Network, College of Public Health, and College of Health Sciences; supported coaching for 12 staff and students leveraging FOCUS PDSA for poster presentations; and continually working with staff to drive change and improvement efforts using process improvement tools and methodology.

Education & Training Course Title

Teacher/Presenter

Date

CPH 755

Mark Williams, MD, Audrey Yates, MS Jing Li, MD, MS

Fall 2017

Dean’s Interprofessional Health Colloquium

Mark Williams, MD, FACP, MHM

Fall 2017 - Spring 2018

Dean’s Interprofessional Health Colloquium

Jean Edward, PhD, RN

Fall 2017 - Spring 2018

NUR 778 Guest Lecture

Jean Edward, PhD, RN

Fall 2017 - Spring 2018

NUR 790 Guest Lecture

Jean Edward, PhD, RN

Fall 2017

FM816/825 Guest Lecture

Brittany Smalls, PhD, MHSA

October 2017

CPH 476G Guest Lecture

Brittany Smalls, PhD, MHSA

October 2017

CPH 978 Guest Lecture

Jean Edward PhD, RN

Spring 2018

CCTS Career Development Series

Jing Li, MD

Spring 2018

PPS 620 Guest Lecture

Hilary Surratt, PhD

March 2018

CPH 782 Guest Lecture

Dan Cleland

April 2018

FOCUS PDSA

OVIHD Team

Quartely

CPH 755: Leading Change with Healthcare Teams This course focuses on developing the skills necessary to successfully facilitate teams to achieve sustainable change in health care systems. The course introduces the foundations of change management, key features of successful teams and factors that lead to team failures; and specific behaviors and communications that enhance effective team interaction. By the end of this course students have a better understanding of team dynamics and the tools of implementation with special emphasis on applications to improve health care quality, safety, satisfaction and efficiency.

Dean’s Interprofessional Health Colloquium: Introduction to Health Insurance Literacy This course has students participate in a project-based curriculum consisting of limited seminar instruction blended with small team interprofessional project development. Teams consider how collaborative practice can positively influence health + health care. NUR 778: Proseminar in Contemporary Health and Nursing Policy Issues This course focuses on a critical analysis of the development of policy related

to health and nursing. Attention is focused on the formation of a policy strategy to address major policy issues affecting health care and the discipline of nursing. In the fall of 2017, Jean Edward, PhD, RN was invited as a guest lecturer to speak on Contemporary Health and Nursing Policy Issues. NUR 790: Knowledge Development in Nursing - Examining Social Determinants of Healthcare Access This course focuses on the nature of nursing science and on approaches to the development of knowledge for use in nursing practice. Concepts and theories from philosophy of science and methods of theory development are

Education & Training

used to critically examine the process of knowledge development in nursing. Emphasis is placed on the role of logical analysis and critical thinking in the development of theory for nursing practice. Jean Edward, PhD, RN was invited back this year as a Guest Lecturer to speak on Examining Social Determinants of Health Care Access. FM815/825: Introduction to Global Health - Keys to Creating a Meaningful Global Health Initiative An elective for second year medical students interested in participating in global health. This course is designed to provide students with knowledge on how to engage communities, program evaluation, and how to conduct meaningful research and clinical initiatives in low-resourced environments. The course also invites guest lecturers to provide firsthand accounts of their global health challenges, successful initiatives, and lessons learned through their experiences. CPH 476G: Introductino to Global Health - Culture and Global Health: The Basis for Addressing Health Inequities The course is taken by undergraduate students seeking a Bachelor’s in Public Health. This course provides students with basic knowledge about the issues of global public health and its importance to all peoples of the globe. After receiving an introduction to the principles and goals of global public health, students will begin to acquire functional knowledge of the theoretical and methodological underpinnings of global public health practice. Key content areas such as health determinants, issues of health, education, and poverty, ethical and human rights concerns, the impact of culture on global public health, the burden of disease on the global human population, and other pertinent global public health topics will become focal points for class discussion. This course will emphasize theory-driven empirical investigation of key behavioral issues that influence the health and well-being

UK CHSR Annual Report 2017 - 2018

of people around the globe. Case studies of global public health issues will be utilized. CPH 978: Eliminating Racial and Ethnic Health Disparities - Racial and Ethnic Health Disparities in Healthcare This course focuses on understanding differences in minority populations in order to help build and lobby for the infrastructure needed to prevent excess disease and death among underserved populations. A special emphasis is placed on understanding the role of culture in influencing the adaptation of health attitudes, practices, and behaviors. In the spring of 2018, Jean Edward, PhD, RN was invited as a Guest Lecturer to speak on Racial and Ethnic Disparities in Healthcare. CCTS Career Development Series The Career Development Series is one of the support efforts the CCTS Career Development Office provides to prepare a diverse clinical and translational science workforce and foster collaborative and transdisciplinary career development. PPS 620: Substance Use Disorders - Health Implications, Policies, and Prevention Strategies This course provides an overview of the impact of alcohol, tobacco, and other drug use disorders on individuals and populations from the local, state, national and international perspectives. Topics include methods for measuring the impact of substance use disorders, risk and protective factors, prevention strategies and policies, “harm reduction”, and the relationship between substance use disorders and crime.

and emerging opportunities. The role of the healthcare manager in information system planning, selection and implementation is stressed. In April of 2018, Dan Cleland was invited to be a guest lecture to speak on big data in healthcare. FOCUS-PDSA The Office for Value and Innovation in Healthcare Delivery (OVIHD) has adapted its teaching style to the needs of the today’s learners. eLearning modules were developed to enable students interested in learning about UK HealthCare’s (UKHC) approach to FOCUS-PDSA problem solving. These Web Based Training (WBT) modules have been combined with didactic training, which provides students the added benefit of hands-on learning with an instructor. Hands-on learning includes working in teams and walking through a case study to reinforce process improvement learning concepts. Participants gain an appreciation of the basics of making problems transparent and utilizing a step-bystep methodology. Each module walks through each portion of the UKHC Storyboard providing the mechanics on how to successfully utilize FOCUSPDSA (Find, Organize & Clarify, Understand & Select, Plan, Do, Study, and Act). The WBTs are self-paced and serve as an introduction to the in-person workshop. The OVIHD Toolkitprovides additional tutorials to complement the training. Upon completion, staff will be prepared to work on projects individually or seek project assistance from OVIHD.

CPH 782: Information Systems in Healthcare This course provides an overview of information systems and their use in healthcare organizations. Topics include the history of IT use, recent developments, continuing challenges

CHSR Monthly Seminars CHSR Monthly Seminars provide an opportunity for UK faculty and staff to learn from nationally recognized researchers and experts in health services research. The seminars enhance dialogue and allow for the exchange ideas to foster research collaborations, communicate future research directions, and advance educational and professional development opportunities at UK. On occasion, CHSR monthly seminars are combined with Internal Medicine Grand Rounds to expand exposure to the health system and colleges.

Presentation Title

Visiting Professor

Institution

Transforming Health and Health Care & Partnering with the Community to Achieve the Healthiest Children in the Nation

Uma Kotagal, MBBS, MSC

Cincinnati Childrenâ&#x20AC;&#x2122;s Hospital Medical Center

Advancing Integrated Value-Based Models of Care through Interprofessional Education (IPE)

Janie Heath, PhD, APRNBC, FAAN

University of Kentucky, College of Nursing

Adaptation and Implementation of the Proactive Office Encounter Model in Health Systems in Appalachian Kentucky

Robin Vanderpool, DrPH, CHES

University of Kentucky, College of Public Health

Are You Ready to Act? The New Generation to Implement Evidence-based Practices

Mark Williams, MD

University of Kentucky, Center for Health Services Research

Moving to Value in Healthcare: Promise and Pitfalls of Current Strategies

Teresa Waters, PhD

University of Kentucky, College of Public Health

Implementing Lung Cancer Screening in Northeast Kentucky: A Study in Progress

Roberto Cardarelli, DO

University of Kentucky, College of Medicine

Behavioral Interventions for Smoking Cessation among People Living with HIV/AIDS (PLWH)

Seth Himelhoch, MD, MPH

University of Kentucky, Department of Psychiatry

From Variable to Valuable: Implementing Standard Care Models at an Academic Health Center

Sally A. Kraft, MD, MPH

University of Wisconsin, School of Medicine and Public Health

Tobacco Use and Mental Illness: Addressing a Hidden Epidemic

Chizimuzo Okoli, PhD, MPH, MSN, RN

University of Kentucky, College of Nursing

Education & Training

Work in Progress (WIP) Sessions CHSR created the Work In Progress (WIP) sessions to provide a forum for junior faculty to present their research and publication ideas, and receive feedback and mentorship from senior, research-active faculty. A variety of WIP sessions have been hosted to date, including faculty from UKâ&#x20AC;&#x2122;s Colleges of Medicine, Public Health, Communication and Information, Nursing, Design, and Arts & Sciences.

Presentation Title

Speaker/Panel

College/Department

Simplifying Complex Medication Regimens: Impact of Label Instructions

Clark Kebodeaux, PharmD, BCACP

University of Kentucky, College of Pharmacy

Mental Health Literacy as Theory: Current Challenges and Future Directions

Joseph H. Hammer, PhD & Doug Spiker, M.A.

University of Kentucky, Department of Educational, School, and Counseling Psychology

Optimizing Telemedicine Diabetic Retinopathy Screening in Appalachia: An Implementation Study

Ana Bastos de Carvalho, MD

University of Kentucky, College of Medicine

Asthma in an Appalachian Coal-Mining Community: Findings from the Mountain Air Project

W. Jay Christian, PhD, MPH

University of Kentucky, College of Public Health

Health Disparities in the Kentucky Appalachian Region

Brandi M. White, PhD, MPH

University of Kentucky, College of Health Sciences

Preterm birth prevention in Appalachian Adopting a Dissemination and Implementation Science Approach

Niraj R. Chavan, MD, MPH, FACOG

University of Kentucky, College of Medicine

Mining Biomedical Data with an Emphasis on Exploratory Analysis

Qiang Cheng, PhD

University of Kentucky, Department of Computer Science

Defining and Assessing Environmental Health Literacy in Kentucky: Early Steps in an Emerging Field

Anna Goodman Hoover, PhD

University of Kentucky, College of Public Health

UK CHSR Annual Report 2017 - 2018

Noteworthy Accomplishments Smalls Presented at U.S. - Hong Kong 2018 Conference Congratulations to Dr. Brittany Smalls for her abstract entitled “Phenotype of the Rural Caregiver: Implications for Aging America” being selected for the U.S.-Hong Kong 2018 Conference with the theme “Aging across Time and Contexts”. Dr. Smalls’ abstract was selected amongst an impressive number of abstracts from countries such as China, Israel, Switzerland, and Brazil. Dr. Smalls presented her abstract at the conference held in Hong Kong in May. Edward Selected as a UK Center for Appalachian Research in Environmental Sciences (UK-CARES) Fellow in Science Communication Congratulations to Jean Edward, PhD on being selected into the first cohort of UK-CARES Fellows in Science Communication. This program is designed to provide early career faculty with skills training for communicating science to a broader audience, leading to an enhanced capability for outreach and success in research, teaching, and service. Dr. Edward will be provided with a year-long training program and follow-up, beginning with attendance at an on-campus workshop by the acclaimed Alda Center for Science Communication. Additional training will include three on-site workshops, and online training modules provided by Dr. Beverly Delidow, PhD, Marshall University. Participants will develop their own goals for the training and will be expected to attend all meetings and complete assignments for individual feedback. Dr. Edward was chosen from an elite group of faculty at UK who will comprise the first cohort of 10 fellows.

Williams Invited as Visiting Professor to John Hopkins Bayview Center Director Mark Williams traveled to Baltimore, MD, on April 3rd and served as a visiting professor at Johns Hopkins Bayview Hospital. In addition to meeting with hospitalist faculty, he gave a grand rounds lecture on “Building a Learning Health System – What is Your Role?” Smalls Accepted to the 2018 Summer Institute on Randomized Behavioral Clinical Trials The NIH Office of Behavioral and Social Sciences Research (OBSSR) in collaboration with the National Heart, Lung, and Blood Institute (NHLBI), held the Eighteenth Annual Summer Institute on Randomized Behavioral Clinical Trials in July 2018. Dr. Smalls was accepted to this prestigious training program which provides thorough grounding in the conduct of randomized clinical trials through developing competence in the planning, design, and execution of randomized clinical trials involving behavioral interventions. Williams Honored as a University Research Professor Dr. Williams was among 13 other UK faculty who were presented with the 2018-19 University Research Professorship Award. This award was presented to faculty who have demonstrated excellence in research and creative work that address scientific, social, cultural, economic, and health challenges in Kentucky and around the world. Surratt Interviewed by WUKY Radio on Rural Needle Exchange Programs in Kentucky Dr. Greg Davis from UK’s local NPR station (WUKY), interviewed Hilary Surratt, PhD, associate professor in the

Center for Health Services Research, and principal investigator of the study, “Examining Social Influences on Syringe Exchange Uptake among Rural PWID at Risk for HIV.” Rates of opioid use disorder and injection drug use have risen significantly in Kentucky, especially in rural communities. The serious health consequences of injection drug use include the spread of the Hepatitis C Virus (HCV) and HIV infection. Kentucky is home to eight of the 10 counties in the nation that the Centers for Disease Control and Prevention have identified as most vulnerable to an outbreak of HIV. CHSR’s focus on community-engaged health disparities research in underserved communities aligned closely with an NIH funding opportunity to examine structural level interventions among people who inject drugs. In this interview, Dr. Surratt discusses this recently awarded two-year National Institute on Drug Abuse (NIDA)-funded study designed to reach vulnerable injection drug users in Appalachia to understand the multi-level barriers to access syringe exchange programs and to identify priority intervention targets and strategies to increase uptake. This data will inform changes to policies and practices of syringe exchange programs and the development of multi-level prevention strategies to enhance access and utilization of rurally located syringe exchange programs. The study aims to enhance HIV and HCV prevention efforts and delivery of treatment addressing critical disparities in accessibility among rural communities. Williams Presents at the 2018 AcademyHealth National Policy Conference In February 2018, Mark V. Williams, MD, FACP, MHM and Glen Mays, PhD, MPH from the Project ACHIEVE research team participated in a 90-minute policy roundtable at the 2018 AcademyHealth National Health

Noteworthy Accomplishments

Policy Conference in Washington, DC. Specifically, they reported on the prevalence of transitional care (TC) strategy adoption at 380 hospitals across the country as well as the associations of various combinations of TC strategies (i.e., clusters) with 30-day readmissions at those hospitals. The preliminary analysis presented by Drs. Williams and Mays suggests that hospitals tend to adopt TC strategies in five main clusters, and do so preferentially based on high baseline readmission rates. Further, hospitals adopting TC clusters experienced larger readmission reductions than non-adopters. Data analysis is ongoing and final results will be submitted for publication in Fall 2018. Fugazzi Participates in the UK Women’s Forum Annie Fugazzi, CHSR’s administrative services assistant, is a member of the University of Kentucky Women’s Forum. The UK Women’s Forum is an organization for all employees of the University — faculty and staff. Its mission is to exert a leadership role in empowering, validating, informing, including and celebrating all women employed at the University of Kentucky by addressing the challenges, communicating issues, and recognizing successes within the context of the workplace. Otachi Selected to Participate in the UK SciVal Implementation Initiative Janet Otachi, MA, project coordinator for the CHSR Tracking and Evaluation Core of the CCTS, was selected to participate on the Implementation Team for the University of Kentucky’s SciVal implementation initiative. SciVal is a research evaluation and bibliometric analysis tool that offers quick, easy access to visualize research performance, benchmarking relative to peers, the ability to develop collaborative partnerships, and analyze

UK CHSR Annual Report 2017 - 2018

research trends. Led by the University of Kentucky Office of the Vice President for Research, SciVal implementation will improve measurement of quality and impact of research projects at the institutional level. Williams Featured in Vizient Panel The 2017 Vizient Health Innovation and Implementation Network (HIIN) Community Knowledge Network Education Series features CHSR Director, Mark Williams. This program continues the examination of an ongoing and crucial issue for healthcare providers and patients, reducing unnecessary utilization. Decreasing unnecessary utilization is not only important for cost-containment but also for patient safety, and it is a success factor for organizations moving into a value-based reimbursement environment. “Webcast #3: Choosing Wisely” highlights the recommendations of the national Choosing Wisely Initiative led by the American Board of Internal Medicine Foundation in partnership with Consumer Reports, and how these recommendations encourage shared decision-making between clinicians and patients. It also features examples of health care organizations successfully carrying out ‘Choosing Wisely’. Smalls Selected as a PRIDE-AHD Scholar

in grantsmanship, scientific writing strategies, epidemiological/ bio-statistical methods and more. PRIDE was established to provide junior faculty, from backgrounds underrepresented in biomedical research, with opportunities to gain the knowledge they need to carry out independent and meaningful research and advance their careers. Li Participates in KY Performance Measure Alignment Subcommittee The Kentucky Performance Measures Alignment Committee (PMAC) is a public-private partnership between the Kentucky Department of Medicaid Services (KDMS) and the Kentuckiana Health Collaborative (KHC). Members of PMAC help form recommendations for measure prioritization in key areas of focus. The final measures chosen are included on the Kentucky Core Healthcare Measure Set (KCHMS). Ultimately, the expectation is for KCHMS to be adopted by public and private organizations to better focus improvement efforts toward shared areas. As a member of the Acute and Chronic Care Subcommittee, Dr. Li attended 4 meetings from November 2017 to March 2018 with the goal of establishing broadly agreed upon core quality measures that improve the quality and value of care, reduce provider reporting complexity, and align Kentucky’s healthcare organizations.

Dr. Brittany Smalls was selected as a Scholar in the 2017-2018 Programs to Increase Diversity among Individuals Engaged in Health-Related Research Advanced Health Disparities Research Training program (PRIDE-AHD). As a scholar for this program, Smalls is receiving advanced training in an interprofessional environment that facilitates successful team science career development and contributes to decreases in health disparities through impactful research. This year-long mentoring experience offers training that includes experiential skill development

Project ACHIEVE Project ACHIEVE (Achieving Patient-Centered Care and Optimized Health In Care Transitions by Evaluating the Value of Evidence) is a 5-year, $15.5 million national study funded by the Patient Centered Outcomes Research Institute (PCORI) that focuses on transitional care (TC)—or the coordination of care when patients transition from the hospital to home or other care settings. Project ACHIEVE is comprised of two phases. Phase I consisted of focus groups and key informant interviews with patients, family caregivers, and providers; development and cognitive testing of patient, caregiver and provider surveys; and pilot-testing a protocol for visiting hospital sites to garner in-depth information about their transitional care efforts. Phase II is comprised of 1) site visits to participating hospitals, 2) surveys of patients and caregivers discharged from those hospitals, and 3) surveys of providers involved in the TC process at those hospitals in order to provide an in-depth understanding of the TC strategies employed by hospitals and their process of implementation. The research team will link data from Phase II with patient Medicare claims data to evaluate the comparative effectiveness of the multi-component TC programs employed by hospitals.

Completion of Data Collection Hospital Site Visits

Provider Surveys

In Phase II, 29* hospital site visits were conducted to verify which transitional care (TC) strategies are employed at each hospital site and to describe the contextual factors that influence their implementation and success. Each site visit consisted of five to six group interviews with key stakeholders involved in the hospital’s transitional care efforts. Each session was audio recorded, transcribed, quality checked, and analyzed by two independent coders. Twelve site visits were performed during the 2017-2018 fiscal year and qualitative analysis is ongoing.

Web-based surveys (N=977) were administered to hospital, downstream, and community health care providers involved in each participating hospital’s TC efforts from October 2017-April 2018 to assess the facilitators and barriers to implementing TC strategies.

* Although there are 42 active hospitals in Project ACHIEVE, the Kaiser health system participated in the Phase I site visits and were not included in Phase II.

centered health outcomes. Ultimately, across 42 hospital sites nationwide: • 17,769 patients were recruited, resulting in 10,143 completed patient surveys. • 5,150 family caregivers were recruited, resulting in 2,965 completed caregiver surveys.

Patient/Caregiver Surveys In April 2018, recruitment ended for Project ACHIEVE’s patient and family caregiver surveys and data collection ended July 23, 2018. Through these surveys, patients/family caregivers provided information about recent care transition experiences that will be linked to patients’ Medicare claims data to evaluate which TC strategies are most effective at improving patient-

1000 People recruited for survey Patients Family Caregivers Completed Survey

Project ACHIEVE

Dissemination of Research Findings Phase I Site visits: Findings from the Phase I hospital site visits (N=22) were published in The Joint Commission Journal on Quality and Patient Safety and featured as its lead article for the September 2017 issue. The article, titled “Understanding Facilitators and Barriers to Care Transitions: Insights from Project ACHIEVE Site Visits,” reports on the facilitators and barriers to care transitions described by participating hospitals, concluding that effective transitional care partnerships require true community partnership, high-quality communication, patient and family engagement, and ongoing evaluation & adaptation.

Peer-Reviewed Manuscripts Phase I patient and caregiver qualitative interviews: Findings from Phase I focus groups and key informant interviews conducted with 248 patients and family caregivers were published in the May 2018 issue of Annals of Family Medicine. The article, “Care Transitions from Patient and Caregiver Perspectives” reports that when undergoing a care transition from hospital to home, patients and family caregivers desired: 1) to feel prepared and capable of implementing care plans, 2) unambiguous accountability from the healthcare system, and 3) to feel cared for and cared about by medical providers. The article also describes five provider behaviors that link to these desired component (see figure below).

Hospital Site Visit Reports Hospitals that hosted site visits will receive a report summarizing the findings from the visit that can inform quality improvement and transitional care efforts. These 5-6 page site-specific documents provide an overview of the TC strategies and programs employed

Links to the article and one-page summaries of the article targeting various stakeholders are available on the UK ACHIEVE website: http://achieve. med.uky.edu/news.

Processes of Care (Provider Behaviors)

at the site, the contextual factors influencing their implementation, and recommendations from the ACHIEVE team. Project ACHIEVE in The Washington Post Kaiser Health News reported on findings from Project ACHIEVE’s patient and caregiver focus groups and interviews regarding the importance of attending to patient/caregiver needs and desires during care transitions from the hospital to home. The article features interviews with ACHIEVE research team members and stakeholders and was picked up by The Washington Post as well as nearly 40 other media outlets nationwide including CNN’s Spanish-language news site (CNN Español). Read The Washington Post article here: https://wapo.st/2P0zCUF.

Care Transition Outcomes (Patient and Family Caregiver Desires)

Uninterrupted Care

Provide Actionable Information

Unambiguous Accountability

Feeling Cared For and Cared About by Health Professionals

Communicate with Compassion and Empathy Anticipate Needs Patients Caregivers

Feeling Prepared and Confident

Collaborative Discharge Planning Patients Caregivers

UK CHSR Annual Report 2017 - 2018

Social Influences on Syringe Exchange Uptake The Center for Health Services Research received grant funding from the National Institutes of Health in September 2017 to study the uptake of syringe exchange programs (SEPs) among people who inject drugs (PWID) in rural Appalachian Kentucky. Opioid abuse and injection are critical public health problems nationally, and serious health consequences associated with opioid injection are at crisis levels in Kentucky. The Centers for Disease Control and Prevention recently identified eight counties in Appalachian Kentucky as among the nationâ&#x20AC;&#x2122;s top 10 most vulnerable to HIV and Hepatitis C among PWID. The significant public health impact of the study is indicated by the potential to understand SEP uptake patterns in rural, resource poor areas, and to develop complementary intervention strategies for enhancing access to evidence-based structural HIV prevention interventions for highly vulnerable rural PWID. This study is providing some of the first systematic data on SEP uptake and social drivers of risk among highly vulnerable rural PWID who are understudied with regard to structural HIV prevention. The two-year study is designed to reach vulnerable PWID in Clark, Owsley, and Knox Counties to understand the multi-level barriers to SEP utilization, and to identify priority intervention targets and strategies to enhance uptake of SEPs among rural PWID. This collaborative effort involves a robust partnership with the Health Departments in Clark, Owsley, Knox and Pike Counties. The research will engage directly with community stakeholders, gathering data and input from PWID, health department directors and SEP staff, substance abuse treatment providers, law enforcement, and other community stakeholders, to inform the continued refinement of SEP policies and practices for vulnerable rural PWID and to develop multilevel prevention strategies to enhance access and utilization of rurally located SEPs. The study will enhance HIV/

HCV prevention efforts and treatment services delivery by addressing critical disparities in service accessibility among rural PWID. Major Activities and Objectives The focus of activity in Year 1 of the study was on start-up of the quantitative component related to study AIM 1. Start-up of the quantitative study involved identifying and training additional members of the study team, including research interviewers, establishing presence in and building relationships with participating county health departments (HDs), exploring additional appropriate recruitment sites in the respective target communities, developing study forms, recruitment materials and respondent-driven sampling cards, and the finalization of materials related to participant screening and data collection. A major activity involved the development of the study data collection instrument. As intended, we reviewed relevant measurement domains and conducted an environmental scan to identify other candidate items for potential inclusion in the structured data collection instrument. Once finalized, the study instrument was piloted with two PWID SEP participants in Clark County HD in January 2018 and revised to its final form. Significant Results Intake for the quantitative component of the study began on February 2, 2018. As of July 6, 2018, 93 participants, 27% of our quantitative AIM 1 sample had been enrolled into the study. Thus far the quantitative sample has a median age of 36 years, is 52.2% male, and in terms of race/ethnicity is 96.7% White. Eighty-Seven and eight tenths percent of participants report current medical insurance, of which 85.7% is Medicaid, largely due to Kentuckyâ&#x20AC;&#x2122;s position as an expansion state. Thirty-three and three tenths percent considered themselves homeless in the month prior to the

interview. As intended, the sample is comprised entirely of PWID; thus far, we have focused on the enrollment of SEP utilizers. Participants report serious levels of drug involvement: injecting a median of 90 times in the past month; knowing a median of 25 other individuals who inject drugs; injecting with a median of five people in past three months. Thirty-five and six tenths percent report needlesharing behaviors in past three months; 45% reported sharing of cookers, cotton, or rinse water in the same time period. Drugs injected most often are: suboxone (36.7%); crystal meth (34.4%); and, heroin (23.3%). Forty-one and one tenth percent report a personal overdose history, 68% have witnessed an overdose, and 14.4% report current access to naloxone. Nearly one-quarter report being in some type of substance use treatment program in the past month; 21.1% are currently prescribed buprenorphine. Among our sample of SEP utilizers thus far, 60% report no barriers associated with using the SEP; the primary barrier mentioned was transportation at 15.6%. Twentysix and four tenths percent report being worried about potential law enforcement activity when utilizing the SEP, but indicated that this concern did not deter their use of the programs. Kentucky is now among the top states in the nation in numbers of SEPs, with more than 40 operational exchanges as of June 2018. Characterizing the rural social ecology relevant to SEP uptake, within the layered context of SEP operational policies and practices that are potentially access-limiting, will be a key outcome of this study at completion. Multi-level SE data will identify clear targets for intervention to improve services delivery. Identifying the social drivers of rural SEP uptake has the potential to enhance HIV/HCV prevention and treatment services delivery among rural PWID and reduce critical disparities in SEP and harm reduction services for rural PWID relative to their urban counterparts.

Social Influences on Syringe Exchange

54 Kentucky Counties with Increased Vulnerability to Rapid Dissemination of HIV/HCV Infections Among People who Inject Drugs and Preventive Syringe Exchange Programs

Vulnerable Areas Operating Syringe Exchanges as of July 6th, 2018 (Counties in Bold) Counties Participating in the Study: Clark Knox Owsley

Kentucky Countiesâ&#x20AC;&#x2122; National Rank of Vulnerability 1 Wolfe 3 Breathitt 4 Perry 5 Clay 6 Bell 8 Leslie 9 Knox 10 Floyd 11 Clinton 12 Owsley 14 Whitley 15 Powell 17 Knott 21 Pike 23 Magoffin 25 Estill 30 Lee 31 Menifee

UK CHSR Annual Report 2017 - 2018

34 Martin 35 Boyle 39 Lawrence 40 Rockcastle 45 Harlan 48 McCreary 50 Letcher 53 Johnson 54 Russell 56 Elliot 65 Laurel 67 Carroll 75 Taylor 77 Grant 93 Adair 97 Lincoln 99 Wayne 101 Cumberland

108 Gallatin 125 Bath 126 Grayson 129 Greenup 132 Green 153 Casey 154 Carter 163 Monroe 167 Garrard 175 Robertson 178 Lewis 179 Edmonson 180 Allen 187 Boyd 191 Hickman 202 Breckinridge 212 Campbell 214 Mercer

Center for Clinical & Translational Science In September 2016, CHSR was selected to lead the Tracking & Evaluation Core of UK’s Center for Clinical and Translational Science (CCTS). Directed by Dr. Phil Kern, the UK CCTS champions innovation across the spectrum of clinical and translational research, promotes team science, and educates the translational workforce of the future.

Tracking & Evaluation of UK’s CCTS CHSR leads the Tracking & Evaluation (T&E) Core of UK’s Center for Clinical and Translational Science (CCTS). Directed by Dr. Phil Kern, the UK CCTS is part of a national network of more than 50 medical research institutions with Clinical and Translational Science Award (CTSA) Program funding. The CTSA Consortium, led by the National Center for Advancing Translational Sciences (NCATS), is charged improve the quality and speed of clinical research in the CTSA Program network, with the ultimate goal of bringing more evidence-based treatments to more patients more quickly. The T&E Core is implementing a concurrent two-armed process and outcome evaluation model, using a mixed-methods approach. The mixedmethods approach is well-suited for capturing the full complexity of CCTS activities and providing evidence to determine whether the CCTS is progressing toward its intended goals. A major focus of the T&E effort is the systematic analysis of proximal outcomes that are both antecedent to and necessary for achieving long-term impact on community health. Specific Aims The Specific Aims of the T&E Core are to: 1) Develop core-specific evaluation plans (metrics, processes and timelines) to assess outcomes of key Core activities,

2) Support the implementation and ongoing application of NCATS Common Metrics, 3) Establish a data infrastructure to support systematic and efficient collection, analysis and reporting of metrics and other key outputs, 4) Examine the impact of CCTS activities on key translational science outcomes, including scholarship, collaboration, and health benefits, 5) Synthesize and disseminate evaluation findings to CCTS stakeholders for quality improvement and strategic management purposes. In Program Year 2, T&E activities focused principally on the implementation phase of evaluation. The construction of formal operational guidelines was completed for the large universe of metrics that span CCTS Core, in order to define all of the required elements of metric collection with precision including: the specific sources of data, quality of and quantity of available data, timing and infrastructure needed to gather metric data routinely, and the ownership and responsibility for data-gathering tasks. When priority metrics were identified that had no existing data source, new data collection tools were constructed to gather this information. These activities were undertaken to enhance the utility and accuracy of our evaluation results; to ensure that we selected the most robust, valid and reliable data sources; to fully describe the attributes of these

information sources; and to establish clear procedures to collect high-quality information. Significant efforts were also devoted to the development of a relational database architecture and the development of institutional tools to support the routine integration of multiple sources of metric data for reporting purposes. Milestones The T&E Core achieved a number of major milestones in PY2. These include: • Ongoing implementation of the NCATS Common Metrics initiative. • Facilitating CCTS Strategic Planning process culminating in FY2018FY2023 CCTS Strategic Plan. • Initiation of new data collection on impact, including: pilot program data on anticipated translational science benefit models (TSBM) of awarded projects; REDCap workflow data on CCTS support for studies with special populations and priority disease foci; and REDCap survey for retrospective data collection on TSBM among CCTS-supported investigators. • Creation of a Pilot Relational Database (PRDB) to be used for efficient scholarship tracking and report generation for CCTS pilot program awardees. • Systematic scoping scholarship tracking platforms. Participation on the institutional implementation team for the roll out of SciVal for scholarship tracking. • Initiated construction of a relational

Center for Clinical & Translational Science

database (RDB) to streamline capture and reporting of the universe of metrics from multiple data sources across Cores. • Development of a CCTS membership model. • Development of 11 original survey tools for new metric data capture. • Design and development of Utilization reports for CCTS services. • Compiling institutional data sources, including financial systems and sponsored programs proposal/award data to construct CCTS utilization reports. • Interfacing institutionally to develop and implement robust tools to better examine external proposal support

provided by CCTS, as well as grant awards related to CCTS support.

newly developed Translational Science Benefits Model (Luke et al. 2017). A targeted data collection effort was undertaken to examine the benefits of CCTS-supported research in the clinical and medical domain (e.g., procedures and guidelines, tools and products), community and public health domain (e.g., health services and resources, health care accessibility and delivery, health promotion), economic domain (e.g., license agreements, patents, cost savings), and policy and legislative benefits (e.g., advisory activities, new legislation).

Metrics Our outcome monitoring is largely metric-based, in line with the objectives of the CCTS. Our standardized, robust implementation of a metricsbased evaluation allows us to make significant inroads into examining the key proximal outcomes of the CCTS, which ultimately tie to health impacts in the longer-term. In addition to the focus on scientific activities and outputs, the T&E Core is undertaking a special initiative to develop metrics that assess health and societal impacts of translational research, in line with the

Percent of Respondents Indicating Impact Area of CCTS-Managed Pilot Research (Based on Translational Science Benefits Model)

26.6 % Health Activities and Products 42.6 % Tools and Products

46.8 % Procedures and Guidelines

Clinical and Medical

2.1 % Commercial Products

26.6 % Financial Savings and Benefits

Economic

UK CHSR Annual Report 2017 - 2018

26.6 % Health Care Characteristics

44.7 % Health Promotion

Community and Public Health

6.4 % Policies and Legislation

43.6 % Advisory Activities

Policy and Legislative

Kentucky Consortium for Accountable Health Communities KC-AHC Convenes First Advisory Board Meeting for Five-Year Project UK’s Center for Health Services Research convened their first Kentucky Consortium for Accountable Health Communities (KCAHC) Advisory Board meeting at an in-person meeting on Monday, March 19th. In addition to the UK project team, 33 members from various stakeholder organizations–including the Cabinet for Health and Family Services (Medicaid, Public Health, and Behavioral Health), regional/local health departments, Managed Care Organizations (MCOs), clinical delivery sites (CDSs), community services providers, other community-based organizations and patient and family caregiver representatives–attended the meeting at Hazard Community and Technical College. The meeting was co-chaired by Dr. Gil Liu, Medical Director of the Kentucky Department for Medicaid Services and Sandi Curd, the Promise Zone Coordinator at Kentucky Highlands Investment Corporation. After the CHSR KC-AHC team provided major project accomplishments and updates, the Advisory Board members separated into small groups to discuss community social service needs and gaps in regards to transportation, food, housing, utilities, safety, and family and community support; community priorities; assets and capacity building; and potential strategies. The rich discussion identified several overarching factors that have contributed to service gaps prevalent in the KC-AHC geographic target area and pinpointed specific opportunities in the community service landscape. Systems change, economic mobility, resource sharing, and community planning were among the many strategies identified to alleviate these gaps by the advisory board.

Appalachian Region

Promise Zone

Participating Counties: Adair Bell Casey Clay Clinton Cumberland Estill Floyd Green

Harlan Hart Jackson Knox Lee Leslie Letcher Madison Magoffin

Martin McCreary Monroe Owsley Perry Pike Russell Wayne Whitney

Kentucky Consortium for Accountable Health Communities

CARE KY Launched The Kentucky Consortium for Accountable Health Communities (KC-AHC) project team developed a free, crowd-sourced website called the Community Asset Registry for the Empowerment of Kentucky, or CARE KY. This site houses a database of nearly 1,000 community resources among 27 counties in Eastern Kentucky.

Users can search for resources in the domains of food, housing, utility assistance, transportation, safety, and family and community support. There also is a mechanism for users to submit information for either additional programs/services or correction of program information. Although the site currently features resources in

counties that are taking part in the project, the team plans to expand the site to encompass all 120 counties in the Commonwealth. The KC-AHC team hopes that CARE KY can ensure a lasting effect on the Commonwealth far beyond the duration of the Accountable Health Communities project. Visit CARE KY today at CARE-KY.org.

CARE KY

UK CHSR Annual Report 2017 - 2018

Center Development The Center aims to address significant issues in health care including value, quality, safety, delivery of appropriate care, and health outcomes with the ultimate goal of improving the health of individuals and populations. The Center focuses on creating, testing and scaling innovative solutions for health and health care delivery to accelerate the discovery and implementation of new knowledge applicable to clinical care and community health, particularly for rural and limited-resource settings.

CATALYZE collaborations to improve population health and build healthy communities

CONNECT colleagues across UK, the Commonwealth of Kentucky and beyond

ENABLING CULTURE

CREATE innovative approaches to deliver value-based care and improve health

Faculty Development

Chief Quality & Transformation Officer

In May 2018, UK HealthCare’s (UKHC) Executive Vice President for Health Affairs, Mark Newman, MD, appointed Mark V. Williams, MD, FACP, MHM, as UKHC’s Chief Quality & Transformation Officer (CQTO). In this new position, Dr. Williams will work with Dr. Newman and other members of the Executive Quality Committee

to provide leadership in ensuring that quality is UKHC’s chief goal as an institution. Dr. Newman considers this new role as a first and important step in UKHC’s journey to becoming a premier “learning health system.” The CQTO will coordinate UKHC’s efforts to become one of the top academic medical centers in quality. Leveraging

resources in the Center for Health Services Research including the Data, Analytics & Statistical Core (DASC) and Office for Value & Innovation in Healthcare Delivery (OVIHD), Mark will be working to provide resources to everyone at UKHC to be successful as champions for quality.

“He brings stellar credentials to this new role, one that I consider a first and important step in our journey to being a premier ‘learning health system.’ In this position, Mark will coordinate our efforts as we aim to be one of the top academic medical centers in quality. This, and other actions I am taking to develop our infrastructure for quality improvement, are the first steps to ensure our growth in high-quality care delivery matches our growth in other aspects.” - Mark Newman, MD, UK Executive Vice President for Health Affairs

UK CHSR Annual Report 2017 - 2018

Faculty and Staff Development The Center for Health Services Research seeks to help its team members to develop skills and capabilities that advance organizational, unit, and personal growth. To assist with the facilitation of staff and faculty development, CHSR provides both faculty and staff the opportunity to attend and participate in workshops and/or trainings throughout the year that will enhance their professional and personal development. This year we held our first Employee Retreat, which included a professional development workshop called “Understanding DISC” that focused on interpersonal skills. In addition to the employee development workshop provided during the annual retreat, our staff and faculty also had the opportunities to attended and/or participate in “Legal 101 training” (Office of Legal Counsel) and “Using your Time Wisely” workshop. At CHSR we see the importance of investing in our faculty and staff, to help fill skill gaps and keep the Center moving forward successfully and running effectively. For this reason, we typically try to organize and provide at least 2-3 workshops per year. This is in addition to any individual trainings that staff or faculty may sign up for. By building up the skills of our faculty and staff within the Center will essentially improve the Center’s bottom line of our vision to “become a national leader in advancing the science of health and health delivery” and our mission to “apply evidence to optimize health in Kentucky and beyond.”

First Annual CHSR Retreat The first Center for Health Services Research retreat on June 13th was a successful day of activities, discussion, and team building. Employees created a roadmap displaying the Center’s goals for the 2019-2022 fiscal years while also celebrating the Center’s accomplishments during its first four years. Employees had the chance to

display posters showing their work and milestone updates on several Center projects and departments, such as Project ACHIEVE, OVIHD, and CCTS Tracking and Evaluation. Special guests Dean Robert DiPaula and Vice President of Research Lisa Cassis, both from the College of Medicine, stopped by to discuss the Center’s future at UK. Debra

Graham, from the UKHR Professional Development Office, led a DISC personality workshop with employees. This was a time to discuss the Center’s major accomplishments and how we can continue working as team to achieve more success as we move forward.

Staff Development

The Next Generation–Educational Initiative The Center recently established an Educational Initiative Committee with the overall goal of establishing a centralized education program consisting of clear leadership, procedures, and types of roles students can fill. The committee has defined several roles housed within the Educational Initiative: credit-seeking interns, paid interns, research assistants and students seeking dissertation or practicum credit. The committee has also drafted detailed procedures and a task matrix for each role, clearly identifying who is responsible for each task through our Educational Initiative. In addition to constructing an organized Education program, committee members will continue to attend job and internship fairs to inform UK students about current and upcoming opportunities at the Center.

Supporting Student Development & Opportunity Credit-seeking and Paid Interns

Practicum/Dissertation

Credit-seeking and paid interns come to the Center to gain work experience while also completing their education at UK. Prior to their internship, creditseeking interns complete a learning contract with a faculty or staff member from the Center. Learning contracts outline the hours they are expected to work, anticipated projects, skills they want to develop, and tasks they will be asked to complete. Through a collaboration with the Office of Experiential Learning, the student will be enrolled in an “Experiential Education” or “Experiential Fieldwork” course for credit hours. Paid interns complete similar tasks, but receive an hourly wage rather than course credit as compensation for their work.

Similar to a research assistant, students seeking practicum credit or dissertation experience come to the Center with interest in a specific project or faculty member’s research portfolio. Practicum or dissertation students are typically Master’s or PhD candidates who are required to complete a number of fieldwork hours within their area of focus such as epidemiology or health literacy. Practicum and dissertation students complete a learning contract before their experience begins, clearly outlining their expectations, hours they will devote to the specific project, and anticipated deliverables. Students seeking dissertation experience will likely be working with a specific faculty member who may be a member or chair of their dissertation committee.

Research Assistantships Research assistants come to the Center to work on a specific grant or project and are typically graduatelevel students. Most research assistants work 15-20 hours per week in the field, gaining valuable experience that can be applied to their graduate studies and future research projects. Research assistants have the opportunity to work closely with faculty and staff, contribute to analysis and dissemination efforts, and present on their research findings and experience at Center meetings or conferences.

UK CHSR Annual Report 2017 - 2018

DASC Student Internships The Data, Analytics, and Statistical Core (DASC) within the CHSR provides internship opportunities for students interested in analytics. DASC participated in the Gill Junior Researchers program to provide internships to economically disadvantaged high school students who are interested in health care careers. These Gill Junior Researcher positions, as well as undergraduate internships, are providing opportunities for students to get hands-on experience with

survey development, data extraction and integration, reporting, dashboard development, and statistical analysis in UKHC. Students also acquire skills in agile analytics development, customer service, effective communication, information security, and a wide variety of technologies. OVIHD Student Internships Since April 2015, the Office for Value & Innovation in Healthcare Delivery (OVIHD) has collaborated and provided year-long internship opportunities for MHA students from the College of Public Health. Recognized as a popular internship opportunity, OVIHD receives around a dozen applicants for two positions that start early Spring each year. Students are selected for their interest in learning a skill set that will challenge their ability to facilitate teams and grow their leadership capacity in process improvement. Interns receive extensive training in FOCUS-PDSA and work alongside a senior health systems engineer who serves as their preceptor. Interns embark on a process improvement project where they have the opportunity to work alongside a team comprised of clinicians, leaders, and staff. They gradually develop their skill set for conducting productive meetings including meeting preparation, presentation building, and team facilitation.

Gill Junior Research Program Continues at CHSR This is the second year that CHSR has participated in sponsoring a high school student through the Gill Junior Research Program at the University of Kentucky. This program provides opportunities for underserved minority students who are interested in the health care professions to explore related career paths and guide their educational trajectories. This year, Bryan Station High School student Eayly Ly, was selected as a mentee in the Center for Health Services Research, as part of our Data Analytics and Statistical Core team. Eayly is currently a Junior at Bryan Station who wishes to pursue a career in medicine. Eayly shares her reflections on the Gill Junior Research Program, and her experiences at CHSR:

“For many Cambodians, becoming a physician is just a dream. For me, it is not only my dream, but something that is achievable. Growing up in Kentucky, there are currently no Cambodian-American physicians around the area and so that leads to a lack of representation from the Cambodian community in the medical field. If you wanted to be a doctor, there was no advice that close relatives or many Cambodian-Americans doctors could give because there weren’t many out there. I had to seek opportunities on my own in the medical field which meant volunteering every summer at UK and Cardinal Hill hoping to eventually find a mentor.

I met Dr. Winkler last summer when I was volunteering in the gift shop. He quickly became my mentor and has provided me with numerous opportunities that many high school students do not get to have. Junior Researchers has allowed me to grow as an individual and as a student. Being able to shadow someone who I can see myself becoming one day, not only inspires me, but makes me become even more motivated and determined to become a physician. Becoming a physician is not just about being a part of something ‘great’ but so I can be more than just someone whose name is Eayly.

One of the opportunities that I have been given is an internship at CHSR. This would not have happened without Junior Researchers. Being an intern has challenged me and forced me to get out of my comfort zone. I now have plans to pursue a degree in computer science at UK in the fall because of my experience here at CHSR. Since this is my first job, it has helped me transition into adulthood and work life. Dr. Winkler and the Junior Researcher’s program has jump started my future. I am extremely grateful and hope to pay it forward by continuing to help with the program in the future.”

The Next Generation

Research Assistantships Robin Thompson My name is Robin Thompson and I’m a third-year Doctor of Public Health (DrPH) student concentrating in epidemiology. Additionally, I’m a trainee of the Central Appalachian Research and Education Centers (CARERC) in the occupational epidemiology core. I started working as a research assistant for Dr. Hillary Surratt in February of 2018 on her R21 study, “Examining Social Influences on Syringe Exchange Uptake among Rural PWID at Risk for HIV”. This study involves interviewing injection drug users who utilize syringe exchange programs (SEPs) across rural Kentucky as well as those that inject drugs who do not use the SEPs. The goal is to identify priority intervention targets and develop interventions to increase uptake of SEPs among people who inject drugs residing in rural areas. So far, working within the Center for Health Services Research (CHSR) with Dr. Surratt has been an incredibly growing experience. The research team Dr. Surratt has constructed for the R21 project, is made up of a wonderful group of talented, motivated, and supportive individuals that all share a passion for making a difference through research. Also, I cannot say enough about Dr. Surratt as a mentor; she truly cares about her mentees and providing opportunities for us to grow and develop our research skillset. She is also one of the kindest people I have ever had the pleasure to get to know. All in all, my experience working at the CHSR has been excellent. I truly appreciate the opportunity I’ve been afforded thus far working with Dr. Surratt and look forward to continuing to support her research and learn from her.

Timothy Williams I am a third-year Doctor of Public Health (DrPH) student in the Health Management and Policy program in UK’s College of Public Health. I began working in the Center for Health Services Research (CHSR) in April, 2018 as a Research Assistant for Dr. Hilary Surratt on her National Institutes of Health-funded “Examining Social Influences on Syringe Exchange Uptake” study. For this study I and the other members of the research team travel to rural Kentucky counties that have established syringe exchange programs (SEPs) in their local health departments. We then interview people in these communities who inject drugs who either do or do not use the SEPs. The purpose of this project is to gather information regarding things like the frequency with which people use SEPs, how they find out about them, what other health-related services they receive from them, and, particularly in the case of people who do not use the SEPs, what barriers there are to utilizing them. My experience on this study and in working for CHSR has been an overwhelmingly positive one thus far. Dr. Surratt has not only been a fantastic supervisor, but a mentor as well who constantly encourages me to grow as a student and as a public health professional. My direct involvement in primary data collection as given me invaluable research experience and improved my understanding of the unique health challenges faced by an essentially marginalized population. Having the opportunity to work with professionals of varied backgrounds who have vast knowledge of their respective fields has also been a privilege that would undoubtedly be difficult to find elsewhere.

UK CHSR Annual Report 2017 - 2018

Jada Biggers I started working as a research assistant here at the Center for Health Services Research during my junior/senior year of high school in 2016. I have since returned after completing my first year of college at the University of Louisville where I am pursuing a Bachelor’s of Science in Biology. During my time here, I have had the privilege of assisting the staff and faculty on various tasks ranging from scheduling meetings to coding and building dashboards. I am currently working on building a dashboard for the OVIHD department that displays the patient experience data from HCAHPS, which is very important for quality improvement here at UK healthcare. The tasks that I have worked on for the department and those outside of the department have helped me gain skills with Tableau, Aqua Data Studio, Excel and allowed me to be added to multiple IRBs. My goal is to become a physician and I believe my exposure to the patient experience aspect, focusing on quality improvement and seeing the complexity of the data behind healthcare has helped me gain a better understanding of the career I am pursuing. Becoming a part of this team during my high school career helped me gain knowledge and skills that I otherwise would not have adopted had I continued with my old job working in fast food like most high school students.

Graduate Internships Olivia Colliver I began my graduate internship with the Office for Value and Innovation in Healthcare Delivery (OVIHD) in May of 2018. I’m currently pursuing a Master’s in Health Administration, on track to graduate in May of 2019. I have been very fortunate to sit in on and work on a variety of projects just in these past few months. Two main projects I have had the opportunity to contribute to are with the Ear, Nose, and Throat Clinic, and the PICU. The Ear, Nose, and Throat Clinic reached out to OVIHD in hopes of improving their standardized process for scheduling and registration. Not only is it a standardized work project, but the Clinic was relocating to a different and bigger space, so juggling these different aspects of a project all within one clinic has been very exciting. The PICU is implementing a new rounding tool in a bundle format, to ensure patient safety and experience, as well as decreasing length of stay. Because this is a very clinical-based project, OVIHD has acted as a facilitator and guide for how this project should be approached, as well as set milestones and timelines that would be very beneficial to the full implementation and effectiveness of this bundle. Adam Mardis I am a graduate student at the University of Kentucky currently pursuing a Master’s Degree in Health Administration. This past spring I was fortunate enough to be invited to join the Office for Value and Innovation in Healthcare Delivery (OVIHD) as a summer intern. Since the start of my internship, I have been involved in different projects that have expended my outlook on the healthcare industry. For example, I am currently working with the staff in Adolescent Medicine and Developmental Behavioral Pediatrics to analyze how they are utilizing their space in order to find new ways to decrease patient wait times and, ultimately, improve patient-centeredness within the departments. Earlier in the summer I had the pleasure to work with the insurance authorization teams to construct a Service Level Agreement (SLA) which clarified the roles and responsibilities of the staff within clinics enterprise-wide to decrease the amount of authorization denials. I believe those two examples alone show how wide the projects of the OVIHD team can vary, and I look forward to the projects to come.

The Next Generation

DASC Student Internships Caroline Smith I am a recent graduate from the University of Kentucky and recently completed a year long data analysis internship with the Data, Analytics, and Statistical Core (DASC) at the University of Kentucky Center for Health Services Research (CHSR). During my time with the DASC team, I gained invaluable experience in health care data analytics and further developed numerous skills such as computer programming, data visualization, and database management and analysis. I worked on many projects that showed how complex and vital data analysis is in the healthcare industry. For example, I worked with a clinician from the Ophthalmology Department, analyzing whether Endocarditis patients were unneededly receiving ophthalmologist consults, costing patients unnecessary money and stress. I also had the opportunity to work with veteran staff on creating and updating the Call Back Dashboard, which analyzed and visualized survey results to the Call Back Note initiative within UK Healthcare. Additionally, I worked with a pharmacist on creating a report of vasopressor use in the Medical Intensive Care Unit (MICU), revealing how impactful this work is in maintaining regulation and introspection inside UK Healthcare. Among other projects I completed and assisted with included analyzing and visualizing UK Healthcare Referrals, working with the Neurology Department to analyze a cohort of neurological conditions and patients, assisting with an MICU Census, and assisting research and analysis on the upcoming Emergency Department Risk Stratification Project. Working and learning from the brilliant people within the DASC team and at CHSR gave me experience, skills, and relationships that I will value and learn from throughout my career.

Other Opportunities

Phillip Combs I began my time at the Center for Health Services in May of 2018. I was hired on as the student graphic artist for the Center. I chose this opportunity to grow my professional experience within my career aspirations of design. I am currently pursuing my Bachelors of Arts in Architecture at the University of Kentucky with plans of graduating in December. My duties at the Center have included making the Spring Newsletter and Monthly Monitors to provide Center news, event information, and employee birthdays and anniversaries. I helped the Office for Value and Innovation in Healthcare Delivery create the work books for their TrueBlue training programs and updating their SharePoint website. I keep the main CHSR website maintained and updated and have helped in creating a new website for Health Literacy Kentucky. I worked alongside DASC to design their team icon, CARE-KY to design the icon for their new webpage and app, and Project ACHIEVE to design thier research brief template. I began my experience at the Center to expose myself more to design, and within design software (Photoshop, Illustrator and InDesign), to add more variety to my portfolio when applying to future architecture jobs or for applications to graduate programs. The Center has provided every opportunity to help me accomplish these goals, and I have been very grateful to be a part of the Center and their work.

UK CHSR Annual Report 2017 - 2018

CHSR-Led Proposals *Funding Status as of June 30, 2018

2017

2018

September

October

December

January

Examining Social Influences on Syringe Exchange Uptake among Rural Persons Who Inject Drugs (PWID) at Risk for HIV

Developing a multicomponent, Multilevel Implementation Strategy for Syncope OptimalCare through eNgagement (Project Mission)

Evaluating the Relationship Between Social Networks and Social Support to Reduce Cardiovascular Risk in Older Adults with T2DM

Reducing Unsafe Opioid Prescribing in Appalachia

Funding Agency: National Institutes of Health (NIH)

Funding Agency: American Heart Association (AHA)

Status: Funded

Funding Agency: National Heart, Lung, and Blood Institute (NHLBI)

Amount: $409,718

Status: Pending* (Funded August 2018)

Amount: $231,000

Principal Investigator: Hilary L. Surratt, PhD

Amount: $1.02 million

Principal Investigator: Brittany Smalls, PhD, MHSA

Status: Not Funded

Funding Agency: Patient Centered Outcomes Research Institute (PCORI) Status: Pending Amount: $4 million Principal Investigators: Hilary L. Surratt, PhD; Jing Li, MS, MD

Principal Investigator: Jing Li, MS, MD February Identifying Critical Geriatric Syndrome Risk Factors and Their Relationship with Hospital Admissions for Older Adults with Diabetes Mellitus Type 2 (T2DM) Funding Agency: University of Kentucky Center for Clinical Transitional Science (UK CCTS) Status: Not Funded Amount: $24,399 Principal Investigator: Brittany Smalls, PhD, MHSA

CHSR Led Proposals

March

April

May

June

Social Network Analysis and Social Support Intervention for Rural Dwelling Older Adults with Diabetes Mellitus Type 2 (T2DM)

Partnership to Improve Availability of Self-Care Education in Older Adults Living in Rural Appalachia

Examining Health Insurance Literacy Needs of Rural Appalachian Kentucky

Project Cardiac REHAB - Implementing Cardiac Rehabilitation Evidence into Practice Helping All Beneficiaries

Funding Agency: National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) Status: Pending Amount: $610,052 Principal Investigator: Brittany Smalls, PhD, MHSA

Funding Agency: Department of Health and Human Services/Administration on Aging Status: Pending Amount: $896,436 Principal Investigator: Brittany Smalls, PhD, MHSA

Funding Agency: University of Kentucky Center for Clinical Transitional Science (UK CCTS) Status: Not Funded Amount: $25,000 Principal Investigator: Jean Edward, PhD, RN

March

April

May

Developing and Testing the HILE3T Program-Health Insurance Literacy: Educate, Engage, Empower Training

Examining Availability of Health System and Community-based Programs Aimed at Improving Health Insurance Literacy and Informed Healthcare Decision Making among Rural, Appalachian Consumers

Determine the Effectiveness of a Comprehensive Lifestyle Modification Intervention for Pediatric NAFLD/ NASH Patients Using MRE and AMRAÂŽ Quantification Technology to Determine Disease Severity

Funding Agency: Agency for Healthcare Research and Quality (AHRQ) Status: Pending Amount: $758,728 Principal Investigator: Jean Edward, PhD, RN

Funding Agency: College of Nursing (CON) Pilot Research Program Status: Pending Amount: $15,000 Principal Investigator: Jean Edward, PhD, RN

UK CHSR Annual Report 2017 - 2018

Funding Agency: National Heart, Lung, and Blood Institute (NHLBI) Status: Pending Amount: $2.67 million Principal Investigators: Jing Li, MS, MD; Mark Williams, MD, FACP, MHM

Funding Agency: Univesity of Kentucky Status: Not Funded Amount: $32,088 Principal Investigator: Brittany Smalls, PhD, MHSA

Collaborative Proposals *Funding Status as of June 30, 2018

2017 August

September

October

Community to Clinic Navigation to Improve Diabetes Outcomes

Social Media HIV Prevention Intervention for Rural Women Drug Users

Tufts Clinical and Translational Research Institute

Funding Agency: National Institutues of Health/ National Institute for Diabetes and Digestive and Kidney Disease

Funding Agency: National Institute on Drug Use (NIDA)

Funding Agency: Tufts Institute

PATHways: Comparative Effectiveness Study of Peripartum Opioid Use Disorder in Rural Kentucky

Status: Funded

Funding Agency: Patient Centered Outcomes Research Institute (PCORI)

Amount: $560,760

Amount: $22,531

Status: Pending* (Funded August 2018)

Principal Investigator: Michele Staton, PhD, University of Kentucky

Principal Investigator: Philip Kern, MD, University of Kentucky

Amount: $4.9 million

Co-Investigator: Hilary Surratt, PhD

Status: Funded Amount: $2.6 million Principal Investigator: Nancy Schoenberg, PhD University of Kentucky Co-Investigator: Brittany Smalls, PhD

Principal Investigator: Agatha Critchfield, MD, College of Medicine Co-Investigator: Hilary Surratt, PhD

Collaborative Proposals

2018 November

January

May

June

Leveraging Innovative Academic, Industry and Transcelerate Partnerships to Promote Acceleration of Science to Improve Health

Pediatric non-alcoholic fatty liver disease (NAFLD) and non-alcoholic steatohepatitis (NASH): The role of MR Elastography and AMRA fat quantification technology to determine disease severity

Reducing Opioid-Related Hospitalizations and Overdose Deaths among Older Adults

R01-Pharmacist Assisted Stop Smoking (PASS) Trial with Medicaid Recipients in Appalachia

Funding Agency: National Institutes of Health (NIH)

Funding Agency: National Cancer Institute

Funding Agency: Childrenâ&#x20AC;&#x2122;s Miracle Network

Status: Pending

Amount: $ 1.5 million

Amount: $3.754 million

Principal Investigator: Khary Rigg, PhD University of South Florida

Principal Investigators: Ellen Hahn PhD, RN, FAAN, College of Nursing; Patricia Freeman, PhD, College of Pharmacy

Funding Agency: Yale University Status: Pending Amount: $133,406 Principal Investigator: Jamie Studts, PhD, College of Medicine Co-Investigator: Jean Edward, PhD, RN

UK CHSR Annual Report 2017 - 2018

Status: Not Funded Amount: $43,000 Principal Investigator: Sylvia Ofei, MD, MPH, University of Kentucky Co-Investigator: Brittany Smalls, PhD

Co-Investigator: Hilary Surratt, PhD

Co-Investigator: Jean Edward, PhD, RN

Appendices Peer-Reviewed Publications Barsuk JH, Cohen ER, Williams MV, Scher J, Jones SF, Feinglass J, McGahie WC, O’Hara K, Wayne DB. 2018. Simulation-based Mastery Learning for Thoracentesis Skills Improves Patient Outcomes: A Randomized Trial. Acad Med; in press doi: 10.1097/ ACM.0000000000001965. Clouser JM, Bush A, Gan W et al. Associations of Work Stress, Supervisor Unfairness, and Supervisor Inability to Speak Spanish with Occupational Injury among Latino Farmworkers. J Immigrant Minority Health (2018) 20: 894. https:// doi.org/10.1007/s10903-017-0617-1 Dave K, Thompson-Bastin M, Flannery A, Morris P, Kelly A, & Cassity E (2018). Evaluation of Stress Ulcer Prophylaxis Indications at a Large Academic Medical Center. Critical Care Medicine, 46(1), 507. doi:10.1097/01. ccm.0000529053.05101.4b Edward J, Carreon L, Williams MV, Glassman S, Li J. 2017. The Importance and Impact of Patients’ Health Literacy on Low Back Pain Management. The Spine Journal. [Epub ahead of print]. Edward J, Mir N, Monti D, Shacham E, Politi M. 2018. Exploring Characteristics and Health Care Utilization Trends among Individuals who fall in the Health Insurance Assistance Gap in a Medicaid Non-expansion State. Policy, Politics and Nursing Practice. [Epub ahead of print]. Edward J, Morris S, Mataoui F, Granberry P, Williams MV, Torres I. 2018. The Impact of Health and Health Insurance Literacy on Access to Care for Hispanic/Latino communities. Public Health Nursing. [Epub ahead of print].

Elkins K, Bellamy L, Guo J, & Dobbs MR (2017). Small Rural Hospitals Have a Harder Time Achieving Success in Continuous Quality Improvement: An Example From a Stroke Care Network. Quality Management in Healthcare, 26(3), 165-170. doi:10.1097/ qmh.0000000000000144 Flannery, A, Bissell, B, Owen, G, Moran, P, Kelly, A, & Thompson Bastin, M (2018). Assessing the Impact of Albumin Use on Vasopressor Duration and Mortality in Septic Shock Patients. Critical Care Medicine, 46(1), 687. doi:10.1097/01. ccm.0000529408.83036.0d Graham KL, Auerbach AA, Schnipper JL, Sehgal N, Flanders SA, Kim CS, Robinson EJ, Ruhnke GW, Thomas L, Kripalani S, Vasilevskis EE, Lindenauer PK, Williams MV, Metlay JP, Davis R, Yang J, Marcantonio ER, Herzig SJ. Preventability of Early vs. Late Readmissions in a National Cohort of General Medicine Patients. Ann Int Med; in press 2018. Hall AM, Chadha R, Romond J, Bailey P, Kelly A, & Williams MV (2018). Patient-Centered Morning Blood Collections. Am J Med Qual, 33(4), 449. doi:10.1177/1062860617748740 Hatton K, Lamping O, Fischer B, Cook A, Kelly A, & Fraser J (2018). Compliance with Sepsis Guidelines in Patients with Aneurysmal Subarachnoid Hemorrhage. Critical Care Medicine, 46(1), 589. doi:10.1097/01.ccm.0000529214.35494.a8 Ickes MJ, Wiggins A, Rayens MK, Edward J, Hahn EJ. (2018). Employee adherence to a tobacco-free executive order in Kentucky. American Journal of Health Promotion. In Press. Labuhn J, Almeter P, McLaughlin C, Fields P, and Turner B. Supply Chain Optimization at an Academic Medical Center. American Journal of HealthSystem Pharmacy August 2017, 74 (15) 1184-1190; DOI: https://doi.org/10.2146/ ajhp160774

Lawental M, Surratt HL, Buttram ME, Kurtz SP. 2018. Serious Mental Illness among Young Adult Women who Use Drugs in the Club Scene: Co-Occurring Biopsychosocial Factors. Psychology, Health, and Medicine, 23(1):82-88. Levi-Minzi MA, Surratt HL, O’Grady CE, Kurtz SP. 2017. Examining the Relationship between Social Context and Prescription Opioid Initiation Routes among Young Adults Entering Medical Detoxification. J Alcohol Drug Depend, 5:6. Li J, Talari P, Kelly A, Latham B, Dotson S, Manning K, Thornsberry L, Swartz C, Williams MV. Inter-professional Teamwork Innovation Model (ITIM©) to Promote Communication and PatientCentered, Coordinated Care. BMJ Qual Saf. Epub ahead of print, doi:10.1136/ mjqs-2017-007369. PMID: 29444853 Li J, Williams MV. Hospitalist Value in an ACO World. J Hosp Med. 2018 Apr; 13(4):272-276. PMID: 29624190 Lilley EJ, Scott JW, Goldberg JE, Cauley CE, Temel JS, Epstein AS, Lipsitz SR, Smalls BL, Haider AH, Bader AM, Weissman JS, Cooper Z. Survival, healthcare utilization, and end-of-life care among older adults with malignancy-associated bowel obstruction: comparative study of surgery, venting gastrostomy, or medical management. Annals of Surgery. 2017; doi: 10.1097/ SLA.0000000000002164. Lowman J, Stone LT, & Guo J (2018). Effects of Interactive Book Reading for Increasing Children’s Knowledge of Instructional Verbs. Communication Disorders Quarterly, 39(4), 477-489. doi:10.1177/1525740117745639 Mitchell SE, Laurens V, Weigel G, Hirschman K, Scott Gordon A, Nguyen HQ, Martin J, Laird L, Levine C, Davis TC, Gass B, Shaid E, Li J, Williams MV, Jack BW. Experiencing Care Transitions from Patient and Caregiver Perspectives. Ann Fam Med. 2018 May;16(3):255-231. PMID: 29760026

Appendices

Mulready-Schick J, Edward J & Sitthisongkram S. 2018. Developing Local Evidence about Faculty Written Exam Questions: Asian ESL Nursing Student Perceptions about Linguistic Modification. Nursing Education Perspectives. In Press O’Leary KO, Johnson JK, Manojlovich M, Gastik GJ, Williams MV. Use of Unitbased Interventions to Improve the Quality of Care for Hospitalized Medical Patients: A National Survey. The Joint Commission Journal on Quality and Patient Safety; in press. Remy LS, Scherer J, Guimarães L, Surratt HL, Kurtz SP, Pechansky F, Kessler F. 2017. Anxiety and depression symptoms in Brazilian sexual minority ecstasy and LSD users. Trends in Psychiatry and Psychotherapy, 39(4):239-246. Scott AM, Li J, Oyewole-Eletu S, Nguyen H, Gass B, Hirschman K, Mitchell S, Hudson S, Williams MV. Understanding Facilitators and Barriers to Care Transitions: Insights from Project ACHIEVE Site Visits. Jt Comm J Qual Patient Saf. 2017 Sep;43(9):433-447. PMID: 28844229. Shawler C, Edward J, Ling J, Crawford T, Rayens MK. 2018. Effects of MotherDaughter Relationship on Hypertension Self-Management and Quality of Life: Testing Dyadic Dynamics Using the ActorPartner Independence Model. Journal of Cardiovascular Nursing. [Epub ahead of print]. Shen E, Alem A, Khang P, Watson HL, Li J, Nguyen HQ. Completion of an outpatient visit after skilled nursing facility discharge and readmission risk. JAMDA (in press). Smalls BL, Aroh A, McQuerry K, Adegboyega A, Schoenberg N, Hatcher J. Social support and breast cancer screening in rural Appalachia. PyschoOncology, 2018; doi: 10.1002/pon.482.

UK CHSR Annual Report 2017 - 2018

Surratt HL, Kurtz SP, Buttram ME, Levi-Minzi M, Pagano ME, & Cicero TJ. (2017) Heroin Use Onset among Nonmedical Prescription Opioid Users in the Club Scene. Drug and Alcohol Dependence. 179:131-138.

Surratt HL, Cowley A, Lockard AS, Gulley J, Otachi J, Rains R, Thompson R, Williams T. Methamphetamine injection rising in Appalachia amidst the opioid epidemic– Kentucky, 2018. Morbidity and Mortality Weekly Report.

Surratt HL, Staton CM, Leukefeld CG, Oser CB, and Webster M. Patterns of buprenorphine use and risk for re-arrest among highly vulnerable opioid-involved women released from jails in rural Appalachia. Journal of Addictive Diseases. In press.

Presentations

Swanberg JE, Nichols HM, Clouser JM, Check P, Edwards L, Bush AM, Padilla Y, & Betz G. A Systematic Review of Community Health Workers’ Role in Occupational Safety and Health Research. J Immigrant and Minority Health. 2018. E-pub ahead of print. doi: 10.1007/ s10903-018-0711-z. Sweigart JR, Aymond D, Burger A, Kelly A, Marzano N, McIlraith T, Morris P, Williams MV, Siegal EM. Characterizing Hospitalist Practice and Perceptions of Critical Care Delivery. J Hosp Med 2017; in press. Woolum J, Thompson Bastin M, Kelly A, & Flannery A (2018). Association of Thiamine Administration With Outcomes in Septic Shock Patients. Critical Care Medicine, 46(1), 711. doi:10.1097/01.ccm.0000529456.68839.45 Manuscripts in Review Corrêa de Magalhães Narvaez J, Remy L, Bagatin Bermudez M, Nichterwitz Scherer J, Ornell F, Surratt HL, Kurtz SP, Pechansky F. Re-traumatization: Sexual Abuse, Post-Traumatic Stress Disorder and Sexual Risk Behaviors among Club Drug Users. Child Abuse & Neglect.

Chaaban S, Cassity E, Kelly A, Dhar S, & Morris PE (2018). “Increased Mortality in Idiopathic Pulmonary Fibrosis Patients When Admitted to the Intensive Care Unit with Mechanical Ventilation.” Poster presented at the American Thoracic Society 2018 International Conference, San Diego, CA. Dave K, Dhar S, Cassity E, Kelly A, & Morris PE (2018). “ICU Cost and Mortality Outcomes by Decade of Life.” Poster presented at the American Thoracic Society 2018 International Conference. Donaldson, K, Rudy, M, Cleland, D, Du, G, Huaman, M, Thornton, A, Neyra, J (2017). “Incidence and Costs of AKI in Hospitalized Patients with Infective Endocarditis.” Poster presented at the American Society of Nephrology Kidney Week, New Orleans, LA. Li J, Mays G, Du G, Stromberg A, Williams MV. “Impacting HRRP— Transitional Care Strategies, Achieve More by Doing Less?”W 2018 AcademyHealth Annual Research Meeting. Seattle, WA. June 2018. Li J, Mays G, Du G, Stromberg A, Williams MV. “Project ACHIEVE Achieving Patient-Centered Care and Optimized Health in Care Transitions by Evaluating the Value of Evidence.” 10th Annual Conference on the Science of Dissemination and Implementation. Washington, DC. December 2017.

Edward J, “Examining Relationships between Presence of Wisdom Teeth, Periodontal Disease, and C-Reactive Protein in the U.S. Adults Population.” Eastern Nursing Research Society Conference. Newark, NJ, April, 2018. Edward J, “Grand Rounds. Promoting Health Literacy & Equity in Access to Healthcare for Underserved Communities” Baptist Health Madisonville. Madisonville, KY. August 2017. Edward J, “Health Benefit Literacy Panel Presentation.” Kentuckiana Health Collaborative Health Literacy Forum. Louisville, KY, December 2017. Edward J, “Health Insurance Literacy and Decision Making in Cancer Prevention.” Kentucky Health Communication Conference. Lexington, KY, April 2018. Edward J, “Health Insurance Literacy and Informed Consumer Healthcare Decision-Making.” Kentucky Public Health Association. Lexington, KY, May 2018. Edward J, “Health Insurance Literacy Tools and Resources for Community Health Workers.” Kentucky Community Health Workers Conference. Lexington, KY, September 2017. Edward J, “Identifying culturally and linguistically appropriate methods to measure health insurance literacy in Spanish-speaking communities.” American Public Health Association’s Annual Meeting and Expo. Atlanta, GA, November 2017. Kurtz SP, Buttram M, Pagano ME, Surratt HL, “A Randomized Trial of Brief Assessment Interventions to Reduce HIV/STI Sexual Risk and Drug Use among Young Adults who Use Drugs in the Club Scene.” 9th IAS Conference on HIV Science. Paris, France, July 2326, 2017.

Lippert W, Gray A, Kelly A, McAdams M, & Bailey P (2018). “A novel algorithm for the management of inpatient asymptomatic hypertension.” Poster presented at the Society of Hospital Medicine Annual Conference, Orlando, FL. Levi-Minzi M, Surratt HL, “Factors Related to Prescription Opioid Misuse among HIV Positive Substance Users: Understanding the Role of Substance Use, Mental Health Problems and ARV Adherence.” The College on Problems of Drug Dependence Eightieth Annual Meeting, San Diego, CA, June 9-14, 2018. Li J, Williams MV, Page C, Cofield R, Cassis L, Kern PA, DiPaola RS. “The value of innovation to implementation program (VI2P): A strategic approach to aligning and leveraging academic research and clinical care missions.” 10th Annual Conference on the Science of Dissemination and Implementation. Washington, DC. December 2017. Mays G, Williams MV, “Classifying and Comparing Hospital Care Transition Strategies in Real-World Settings: Project ACHIEVE’s Retrospective Analysis.” 2018 AcademyHealth National Health Policy Conference. Washington, DC. February 2018. Pasha S, Kelly A, Cassity E, & Morris PE (2018). “The Prognosis of Patients Admitted to the Intensive Care Unit with Hepatitis C Infection as a Comorbidity.” Poster presented at the American Thoracic Society 2018 International Conference, San Diego, CA. Smalls B, “Barriers to colorectal cancer screening in rural Appalachia communities in Kentucky.” American Society of Prevention Oncology. New York, NY, March 2018

Smalls B, “Diet and Physical Activity in an Indigenous Poplulation in Panama.” International Diabetes Federation. Abu Dhabi, UAE, December 2017. Smalls B, “Evaluating modifiable CVD risk factors in rural Appalachia Residents with and without Diabetes.” AcademyHealth. Seattle, WA, June 2018. Smalls B, “Incorporating Social Determinants of Health in Diabetes Intervention Development for Indigenous People in Panama.” International Diabetes Federation. Abu Dhabi, UAE, December 2017. Smalls B, “Phenotype of Rural Caregiver: Implications for Aging in America.” US-Hong Kong Aging Conference. Hong Kong, May 2018. Smalls B, “Prevalence of Diabetes and Cardiovascular Risk Factors in Indigenous Populations.” International Diabetes Federation. Abu Dhabi, UAE, December 2017. Smalls B, “The Burden of Aging with Diabetes and the Impact of Cognitive Decline.” American Diabetes Association Orlando, FL, June 2018. Surratt HL, Staton M, Leukefeld C, Oser C, Webster M, “Patterns of Buprenorphine Use and Risk for Rapid Re-arrest among Highly Vulnerable Opioid-involved Women Released from Jails in Rural Appalachia.” The College on Problems of Drug Dependence Eightieth Annual Meeting, San Diego, CA, June 9-14, 2018. Surratt HL, “Kentucky Consortium for Accountable Health Communities Overview.” 2018 Kentucky Primary Care Association Spring Conference. Lexington, KY, May 14-15, 2018.

Smalls B, “Cost Burden of and Mortality in Rural Emergency General Surgery Transfer Patients.” Academic Surgical Congress. Jacksonville, FL, January 2018.

Appendices

Swartz C, Williams MV, “TeamworkAn ITIM of Necessity: The Interprofessional Team Innovation Model (ITIM).” Closing Plenary of the Doctoral Education Conference: Collaborations to Improve Health; American Association of Colleges of Nursing. Naples, FL, January 2018. Williams MV, “Secrets and Misperceptions of Teamwork-One Day Seminar.” SHM Leadership Academy. Scottsdale, AZ, October 2017. Yee S, Cassity E, Kelly A, Pasha S, Dave K, Kalema A, Morris P (2018). “Magnitude of Fluid Positive Balance on Post-Shock Day 1 Correlates with the Number of Subsequent Ventilator Days.” Paper presented at the American Thoracic Society 2018 International Conference, San Diego, CA

UK CHSR Annual Report 2017 - 2018

chsr.med.uky.edu Phone: 859.218.1037 Fax: 859.257.0521 Center for Health Services Research University of Kentucky 740 South Limestone J525 Kentucky Clinic Lexington, KY 40536-0284