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ECDOI Health Services Research

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Diabetes and Obesity Research at ECU

Health Services Research in ECU Family Medicine in Partnership With Health Disparities Center and Diabetes & Obesity Institute

Geographic and Racial Disparities in BP Control and Stroke Care

  1. Heart Healthy Lenoir Project: Collaborative $10M NIH-funded clinical trial (UNC-CH-prime) to examine innovative community-based participatory research strategies to engage local citizens and providers to improve blood pressure (BP) control in rural impoverished community. Overall, the study examined impact on 525 patients (>60% African American) and demonstrated engagement successes, important improvements in BP control, as well as the lack of inherent racial bias in treatment intensification patterns.
  2. Southeastern Consortium for BP Control: Rigorous $9.8M prospective cluster-randomized NIH funded clinical trial in partnership with University of Alabama-Birmingham(prime), UNC-CH, and Weill-Cornell Medical Center to examine systems-based vs. patient-focused interventions to improve BP control in rural African-Americans with uncontrolled BP. Study will utilize 80 practices and enroll 2000 patients.
  3. COMPASS: Pragmatic cluster-randomized prospective PCORI-funded ($14M) trial in partnership with Wake Forest University (prime) and UNC-CH to examine innovative transitions in care strategies for patients following an acute stroke, to improve functional ability, and minimize risk of 2nd stroke. 40 hospitals engaged; 6000 patients anticipated to be enrolled.

Improving Diabetes Care in Type 2 Diabetes

  1. Redesigning Diabetes Care in Rural Practices: This RWJ-funded ($300K) clinical trial examined the efficacy of using a circuit-rider model to deliver state of the art diabetes care in rural underserved communities. Glycemic control (A1c) and SBP were improved in patients (n = 727) receiving this care.
  2. EMPOWER: This BMS Foundation-funded ($300K) randomized clinical trial examined the effectiveness of a community-health worker delivered small-changes lifestyle intervention in 200 African American women with uncontrolled Type 2 diabetes in rural areas. While glycemic control was only modestly improved, weight loss was significantly greater in the intervention group.
  3. COMRADE: This BMS Foundation-funded ($450K) randomized clinical trial examines the effectiveness of a cognitive-behavioral intervention in 144 African American and white patients with uncontrolled Type 2 diabetes and co-morbid depression or distress. Results will be available spring 2017.
  4. TeleTEAM: This prospective trial ($800K) evaluated the effectiveness of delivering team-based diabetes care (nutritionist, pharmacist, behavioral health, diabetologists) to patients via telemedicine in 15 remote rural primary care practice sites compared to the care delivered in the academic medical center. We have shown that we can deliver comparable care over large distances to remote patients using telemedicine.
  5. Screening to Prevent Blindness from Diabetes: This project, funded by the Duke Endowment ($300K), examined the utility of a telemedicine-enabled system in which digital retinal images were collected in patients with diabetes and transmitted to a remote ophthalmologist at UNC-CH for reading. Reports were transmitted back to ECU within 24 hours. The project identified approximately 16% of our patients who had some level of diabetic retinal disease.
  6. Role of Vitamin B12 in patients with diabetes who take Metformin: This pilot project, led by Nutrition Sciences, will examine the impact of taking metformin (causes the body to not absorb B12 as well) on Vitamin B12 levels and on the incidence of complications (retinal, neuropathy, nephropathy) from diabetes.
  7. Reducing the incidence of hypoglycemia in hospitalized patients with diabetes: This project, in partnership with Vidant Medical Center, examined the utility of a computer-guided dosing protocol for insulin administration and monitoring in hospitalized patients with diabetes. Implementation of this new protocol substantially reduced the risk of hypoglycemia.
  8. Comparison of DPP-4 inhibitors vs. sulfonylurea diabetes medications: This meta-analysis, working with diabetes fellow, examined the relative efficacy and safety of two commonly prescribed classes of diabetes medications following both short and long-term administration.
  9. HRSA Integrated Care Center Project: This project ($750K) established an integrated care delivery system with embedded behavioral health providers and learners in the Family Medicine Center for patients with diabetes and other chronic illnesses who have co-morbid behavioral challenges.

School Health in Rural Areas

  1. School-based Telehealth: New ORHP funded ($1.2M) demonstration project to examine how telehealth connections in rural school districts can be used to improve access to care for children with asthma, obesity/diabetes, oral health, behavioral health problems, etc.

Evaluating Sports-related Concussions and Return to Play Guidelines

  1. BioSway - This pilot study is examining the potential utility of the BioSway instrument which measures the amount of sway/balance deviation that occurs following sports-related concussion and whether improvement in this measure is predictive of when the athlete can return to full play.
  2. Fish Oil and Concussion Recovery: Animal data suggests that high dose fish oil supplementation may reduce inflammation and damage following brain injury. Our pilot study will be the only randomized trial examining the role of fish oil supplementation in athletes following concussion to track symptom response. A second pilot is also examining the impact of fish oil supplementation on immune response.

Educational and Health Policy Research

  1. Quality Improvement Training: There is increased emphasis on monitoring the quality of care and ECU Family Medicine, in concert with Pediatrics and the Dean's office are evaluating innovative strategies (HRSA Training Grant, $2.5M) to train medical, nursing, PA, and behavioral health learners in the knowledge and skills needed to improve systems of health care delivery using rapid cycle improvement.
  2. Rural Access to Care: Several studies have been conducted examining the competition between federally funded health centers and private practices and physician placement; regarding generational differences in practice site selection among graduated of residency; and about driving distances to rural practice locations.