Research and Scholarship

The National Network to Innovate for COVID-19 and Adult Vaccine Equity (NNICE) is a partnership of Michigan State University, Michigan Public Health Institute, the Community Foundation of Greater Flint and Community Campus Partnerships for Health. These organizations reflect the ‘pillars’ for a network of organizations that represent four important sectors of society, including: 1) academic institutions; 2) the national network of Public Health Institutes that support public health practice and translation; 3) local community foundations/philanthropy (whose legacy and mission is to lead local fund raising, grant-making and sustainability efforts); and 4) grass roots community organizations. The bringing together of these four pillars to form a network of partners to mitigate the disparate impact of COVID-19 and boost confidence in and receipt of COVID-19 and other adult vaccinations, is timely and relevant to the current pandemic and adult vaccine disparities and inequities more broadly in the nation.

Cardiovascular disease (CVD) complications are the leading cause of diabetes mellitus (DM)-related morbidity and mortality, creating a significant burden on the public health system. This burden is in part attributable to poor medication adherence, with 21-42% of patients failing to properly adhere to their care. Importantly, this issue is especially pronounced in minority and low-income populations, which show higher rates of chronic illness and lower medication adherence. Interventions that foster and reinforce patient-centered communication between clinicians and patients show promise in improving health outcomes. However, they have not been widely implemented, in part due to a lack of compelling evidence for their effectiveness in real primary care settings. Project Objective: We propose to evaluate the impact of our patient activation program: Office Guidelines Applied to Practice (Office-GAP) combined with mobile phone text messaging reinforcement (Care4life) on medication adherence, in minority and low-income patients with DM compared to mobile texting alone. Office-GAP incorporates shared decision-making and a decision/support checklist to be completed during office visits, to foster patients’ investment in their own care. Care4life is a cell phone messaging service that informs and encourages patients to adhere to goals and improve communication. Our long-term goal is to develop a model that can reliably improve and sustain adherence and can be successfully implemented in primary care clinics to close the morbidity and mortality gap for minority/low-income DM patients. We hypothesize that the combined face-to-face patient activation and mobile phone delivered reinforcement methods will facilitate communication between patients and care providers, improving the frequency, accuracy, and timeliness of communication while reinforcing shared goals and engendering mutual respect more than mobile phone texting alone. Improved communication between patients and physicians may improve medication adherence, blood sugar, cholesterol, blood pressure control, and patient satisfaction with providers, and ultimately decrease burden of illness. Research Strategy: We will conduct a randomized community-based clinical trial in Federally-Qualified Health Clinics (FQHCs) in Michigan. We will enroll 378 patients in 16 teams in clinics serving low-income and minority patients. All patients will receive usual care and medication for DM and CVD prevention. Eight teams will be randomly chosen to use mobile phone texting alone, and 8 teams will combine Office-GAP with Care4life. We will evaluate the impact of these shared decision-making strategies for patients and providers in the clinics. Impact: If successfully translated to clinical practice, these interventions have the potential to significantly impact patient care in FQHCs, improving outcomes for DM and CVD. This research also paves the way for shifting clinical practice across a spectrum of chronic disease where medication non-adherence is an issue.

Both colorectal (CRC) and cervical cancers are major causes of death in the US; colorectal cancer is the third leading cause of cancer deaths among men and women in Michigan; while deaths from cervical cancer in Michigan have been declining, in 2019, the ACS estimated 360 new cases, despite an effective vaccine against HPV, the primary cause of cervical cancer. Both cancers have effective screening approaches (colonoscopy, the gold standard for colorectal cancer), and clinician-directed speculum exam (the gold standard for cervical cancer). Follow-up after a positive screening test is key to survival from both cancers; there is consistent evidence that time to follow-up diagnostic testing after a positive screen is suboptimal, and unequally distributed. Thus, both cancers are still likely to be diagnosed after symptoms develop. The initial diagnosis is most likely to take place in the primary care setting. With both types of cancer, residents in rural areas experience a higher incidence of these cancers than urban residents. Multi-level screening approaches—with individuals, clinical teams, and health care institutions—have been found effective in increasing screening for both cancers, but are rarely implemented conjointly for CRC and cervical cancer screening in the primary care setting. The goal of the project is to advance understanding of the multi-level healthcare policy, institution, provider team, and patient factors that contribute to colorectal and cervical cancer-related health disparities in incidence and mortality among rural populations, and the implications of these inequities. One of our specific aims is to recruit 40 primary care sites from networks serving rural patients, yielding letters of support or MOU’s for the long-term conduct of long-term research within these settings. The project, a planned center grant application (P01), will contain four novel R01’s, one focused on practice-level shared decision-making and patient navigation interventions, another, implementing an SMS-based program at the healthcare and patient levels, a third, on self-screening for cervical cancer at the provider workflow and patient levels, and a fourth, on disseminating multilevel HPV vaccination approaches to rural primary care practices.