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Center for Health Equity Research and Promotion

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CHERP Bulletin (August 2021)

CHERP Bulletin

The CHERP Bulletin features news about the VA HSR&D Center of Innovation in Health Equity Research and Promotion (CHERP) for our readers, including Veterans, researchers, health equity advocates, VA leaders, and more.

You can read about the accomplishments of VA COIN Investigators in Pittsburgh and Philadelphia, and learn more about our VA-funded research and implementation projects. We will highlight an individual investigator in each issue, as well as our partnerships with other VA centers across the country.

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Meet the Investigators

Ann-Marie Rosland, MD, MS
CHERP Investigator: Ann-Marie Rosland, MD, MS

Ann-Marie Rosland, MD, MS, is a CHERP COIN Investigator and Staff Physician at the VA Pittsburgh Healthcare System. Dr. Rosland’s research interests include advancing the ability of primary care teams to provide comprehensive, evidence-based care for VA patients with complex, high-risk chronic conditions.

Areas of Interest: Infomatics and machine learning, Family Support for Chronic Condition Care, Community-partnered Research

Location: Pittsburgh

Read more about Ann-Marie Rosland, MD, MS

Awards and Accomplishments

Sonya Borrero, MD, MS (PGH) received a Federal Executive Board 2020 Excellence in Government Award for her Outstanding Contributions to Medical Science.

Matthew Chinman, Ph.D. (PGH) received the 2020 Daniel Deykin Award for Outstanding Mentor from VA HSR&D. This award honors dedication and skill in mentoring the next generation of health services researchers. Dr. Chinman, who has served as a mentor to 41 mentees over his career to date, has focused his research on Peer Specialists and Implementation Science, working to improve mental health services for those with serious mental illnesses (SMI) through the use of Peer Specialists. As one of Dr. Chinman's mentees commented, "Beyond the traditional career counseling and education that characterizes most mentors, Matt mentors by example. His passion, professionalism, and respect for all persons is truly inspiring." Read the full story.

Utibe Essien, MD, MPH sitting while holding the 2021 Alumni Award at the Albert Einstein College of Medicine commencement ceremony

Utibe Essien, MD, MPH (PGH) received the Young Investigator Award from the American Diabetes Association (ADA). His abstract, "Diabetes Care among Older Adults Enrolled in Medicare Advantage vs. Traditional Medicare Fee-for-Service Plans: The Diabetes Collaborative Registry," was among the top scoring abstracts submitted for the upcoming ADA Virtual Scientific Sessions.

Albert Einstein College of Medicine recognized Dr. Essien with a 2021 Alumni Award — the Rising Star Clinical Practitioner Award — during the year's Commencement Ceremony.

Dr. Essien was also awarded the 2021 Larry E. Davis Award for Excellence in Race Research from the University of Pittsburgh Center on Race and Social Problems.

Leslie Hausmann, PhD (PGH) has been appointed Assistant Dean for Medical Students Research at the University of Pittsburgh. "Dr. Hausmann is an expert in Health Disparities and Equity and is a welcome addition to the team of Research Deans (Drs. Chang, DeFranco, DiCianno, Fowler, Hanmer, Hughey, Veldkamp) who provide mentoring and guidance for our medical student's scholarly projects," stated the University announcement.

Dr. Leslie Hausmann is CHERP COIN Investigator and Associate Professor of Medicine at the University of Pittsburgh. She directs the CHERP Equity Capacity Building Core, where she spearheads the development and dissemination of tools and education to support innovative health equity research and quality improvement. An experimental social psychologist by training, Dr. Hausmann's primary research focus is understanding how bias and discrimination contribute to health and health care disparities and her research has spanned the full continuum of health equity research designed to identify, understand, and reduce healthcare disparities. As a faculty member in the Institute for Clinical Research and Education at the University of Pittsburgh, Dr. Hausmann teaches courses on health equity research and team science. She is a certified facilitator of mentor training through the National Research Mentoring Network and mentors a diverse cadre of medical trainees and junior faculty interested in pursuing careers in clinical research.

David Oslin, MD, discussing an important topic.

David Oslin, MD (PHL) was presented with the 2020 John B. Barnwell Award as part of VA's 2021 National Research Week celebrations. Dr. Oslin's research focuses on two main areas: the development and implementation of measurement-based care practices and genetic research to bring precision mental health care to Veterans and others. As CMCVAMC Chief of Staff John Kelly, M.D., commented, Dr. Oslin "is a true triple threat as a clinician, an educator, and a researcher. The Barnwell Award recognizes his past and continuing contributions to the discipline of behavioral health for our nation's Veterans and by spread of innovation to the rest of the country." View a video produced by the CMCVAMC about Dr. Oslin (VA intranet only).

Deidre Quinn, PhD, MS, MLitt, (PGH) is leading a demonstration project being deployed at the VA Pittsburgh Healthcare System and the VA Puget Sound Health Care System. Nearly half of women Veterans who use VA healthcare are of childbearing age and over one-third of their pregnancies are unintended. Consistent use of contraception is the most effective way to reduce the rate of unintended pregnancy; however, gaps in contraceptive coverage due to prescription refill delays are a major barrier to womens' correct and consistent contraceptive use. Through the new 'Birth Control on Demand' project led by Dr. Quinn with her mentor, Sonya Borrero, MD, MS (PGH), women Veterans at VAPHS and VA Puget Sound can access contraceptive counseling and prescriptions direct from a clinical pharmacist, and when clinically appropriate, will also have the (NEW!) option to receive a 12-month supply of birth control at one time.

Shari Rogal, MD, MPH standing, holding the Clinical Excellence Award.

Shari Rogal, MD, MPH (PGH) was selected to receive a Medical Student Research Mentoring Merit Award from the University of Pittsburgh School of Medicine. This prestigious award, initiated by medical student recommendations, is presented to a Longitudinal Research Project (LRP) mentor of a graduating Pitt Med student in recognition for outstanding mentoring over the course of the LRP

Dr. Rogal also received the July 2021 Clinical Excellence Award from the VA Pittsburgh Healthcare System. Dr. Rogal was nominated for the award by the June recipient, Dr. Amber Johnson.

Data show many individuals with diabetes count on a friend, relative or spouse in their everyday care. These supporters can help improve understanding of treatment recommendations and impact outcomes like medication taking, A1C and mental health. Ann-Marie Rosland, MD, MS (PGH) was interviewed for a podcast by the Association of Diabetes Care & Education Specialists (ADCES) about her latest research on the role of supporters in diabetes management, why you should incorporate them into your practice and tools you can use to get started.

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New VA Research Funding

Joshua Baker, MD, MSCE (PHL) serves as Site-Investigator on a new HSR&D Merit Award "Implementation Of Shared Decision Making In Rheumatoid Arthritis: A Stepped Wedge, Cluster-Randomized Trial" (PI: Jennifer Barton, MD, VA Portland Health Care System).

Robert E. Burke, MD, MS (PHL) received a new HSR&D Merit Award for his project "Improving Post-Acute Care Value for Veterans."

Robert E. Burke, MD and Mary E. Bowen, PhD, (PHL) lead a new project, "Implementing CAPABLE in the Department of Veterans Affairs" that supplements our currently funded QUERI Program Award (QUE 20-014) "Implementing the Age-Friendly Health System in VHA: Using Evidence Based Practice to Improve Outcomes In Older Adults." The Evidence-Based Practice (EBP) focuses on Mobility — adapting the home environment for older Veterans with impaired physical functions. This project is administered by the Philadelphia Research and Education Foundation (PREF) which is the CMCVAMC's research nonprofit corporation (NPC) and is funded by The Harry and Jeanette Weinberg Foundation.

Utibe Essien, MD, MPH, (PGH) leads a new Career Development Award, "Access, Quality and Equity of Anticoagulants in Veterans with Atrial Fibrillation."

Kevin Jenkins, PhD (PHL) received pilot funding from the VA Office of Health Equity (OHE) for his project "Implementing A Racism Focused Trauma Informed Approach in Nephrology Care."

Amol Navathe, MD, PhD (PHL) and S. Ryan Greysen, MD, MHS, MA (PHL) serve as Multiple PIs on the newly awarded HSR&D Merit Review "A Randomized Trial Of Behaviorally Designed Gamification and Social Incentives To Increase Physical Activity Among Overweight and Obese Veterans."

Dr. Navathe is also PI of the newly funded Service Directed Research (SDR), "Racial Bias in a VA Algorithm for High-Risk Veterans."

Deirdre Quinn, PhD, MS, MLitt (PGH) has a new Career Development Award, "Examining pre-pregnancy health and maternal outcomes among women Veterans."

Steven Weisbord, MD, MSc (PGH) leads a new Merit Review Project titled "Patterns, Processes, and Outcomes of Kidney and Liver Transplantation in an Era of Enhanced Community Care for Veterans."

FY22 CHERP Pilot Projects

Lauren Sealy Krishnamurti, PhD, MA. (PGH) Mentor: Melissa E. Dichter, PhD, MSW Trajectories of patient care for women Veterans flagged for suicide risk: Observations from VHA Suicide Prevention Coordinators

Sameed Ahmed M. Khatana, MD, MPH (PHL) Mentor: Peter Groeneveld, MD, MS Cardiovascular care and outcomes for Veterans experiencing homelessness

Tiffany Purcell Pellathy, PhD, ACNP-BC (PGH) Mentor: Daniel Hall, MD, MDiv, MHSc Confirming the validity of the Risk Assessment Index to characterize frailty among hospitalized medical patients

Ashley Ritter, PhD, CRNP (PHL) Mentor: Helene J. Moriarty, PhD, RN Community-partnered rapid housing for Veterans at NewCourtland: A feasibility study

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Partnered Research

In partnership with the VA Office of Health Equity and VISN4, a team of CHERP colleagues led by Leslie Hausmann, PhD (PGH) sought to integrate equity into evidence-based quality improvement (QI) efforts by utilizing a user-centered interactive equity dashboard and population-specific interventions to drive QI. The equity dashboard project, VA HSR&D Equity and Quality Aligned (EQuAl), was funded by the VA Research to Impact for Veterans (RIVR) program. Early impacts include demonstration projects at three VAMCs that are using the dashboard to address disparities in statin adherence (VAPHS), hemoglobin A1c control (NJ VAMC), and hypertension management (Palo Alto VAMC).

Watch the video about the project below or via this link: Engaging Healthcare Teams to Eliminate Health Inequities.

CHERP colleagues, including Kelly Burkitt, PhD (PGH) (first author) and Leslie Hausmann, PhD (PGH) (PI), Michael Fine, MD, MSc, (PGH) Judith Long, MD, (PHL) Maria Mor, PhD (PGH), and Keri Rodriguez, PhD (PGH) published an article in Healthcare about their work with VA clinical and QI primary care leads from across VISN4 to reduce racial disparities in blood pressure control. Common QI strategies employed included provider education, frequent audit and feedback, and healthcare team change. Over 12 months this led to a statistically significant 1% decline in both Black veterans with severe hypertension and the disparity between Black and White veterans. Leslie Hausmann, the team leader, has now created a dashboard that allows VA QI leads across the state to drill down easily into their own data to look at disparities in QI metrics by race, gender, and location.

Also led by Leslie Hausmann, with funding from VA Research to Impact for Veterans (RIVR) program, the goal of CHERP's VA HSR&D Equity and Quality Aligned (EQuAl) — in partnership with the VA Office of Health Equity and VISN4 — is to integrate equity into evidence-based quality improvement (QI) efforts by utilizing a user-centered interactive equity dashboard and population-specific interventions to drive QI. Early impacts include demonstration projects at three VAMCs that are using the dashboard to address disparities in statin adherence (VAPHS), hemoglobin A1c control (NJ VAMC), and hypertension management (Palo Alto VAMC). See video on Engaging Healthcare Teams to Eliminate Health Inequities.

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Publications

A recent report from the National Academies of Sciences, Engineering, and Medicine on "Meeting the Challenge of Caring for Persons Living With Dementia and Their Care Partners and Caregivers," published in JAMA highlighted an editorial published by Lena Makaroun, MD, MS; Rachel Bachrach, PhD; and Ann-Marie Rosland, MD, MS (PGH) on "Elder Abuse in the Time of COVID-19-Increased Risks for Older Adults and Their Caregivers," published in the American Journal of Geriatric Psychiatry.

In the July Spotlight, VA HSR&D highlighted Caregiver SOS: An Intervention for Employed Caregivers, led by Shahrzad Mavandadi, PhD (PHL). Dr. Mavandadi and team anticipate that data from this study will fill knowledge gaps about work functioning and productivity among employed CGs caring for Veterans with behavioral health conditions, and will shed light on whether a program that specifically addresses caregiving — work balance is effective in improving CGs' wellbeing and work functioning — and the quality of Veterans' care.

Studying >100K Veterans with atrial fibrillation, Utibe Essien, MD, MPH (PGH), et al found major racial/ethnic disparities in anticoagulation use, controlling for clinical, provide, and socioeconomic status. As the largest national integrated health system, Veterans Health Administration (VHA) offers improved access to medications through a uniform national drug formulary, yet racial and ethnic disparities appear to persist in atrial fibrillation management. Disparities in Anticoagulant Therapy Initiation for Incident Atrial Fibrillation by Race/Ethnicity Among Patients in the Veterans Health Administration appears in the July 28 issue of JAMA Network Open.

CHERP VA OAA Postdoctoral Fellow Kim Waddell, PhD, OTR/L (PHL) was a co-author on an article in JAMA Network Open, reporting results from the VA Career Development Award study by former CHERP Investigator Mitesh Patel, MD, MS. Findings showed that with overweight veterans, step counts increased in an arm with gamification and loss framed financial incentives compared to usual care but did not increase in those just getting gamification as an intervention. The trial was designed to test behavior during the intervention, not for sustaining behavior. A newly-funded VA HSR&D Merit Award, IIR 20-120 A Randomized Trial of Behaviorally Designed Gamification and Social Incentives to Increase Physical Activity Among Overweight and Obese Veterans will test longer-term term sustainment.

Rachel Werner, MD, PhD (PHL) and colleagues published a paper in JAMA Network Open looking at factors associated with differences in mortality rates among Blacks and Whites with COVID-19 Infection. In this analysis of Medicare patients, they found that almost all the difference in mortality between Black and White patients with COVID could be explained by the hospitals in which these patients were admitted, showing that disparities in COVID deaths could be explained by the hospitals in which people were seen. They followed this by a Washington Post Opinion Piece describing the forces current and historical that have contributed to segregation in the US including redlining, property taxes, and poor local investment which limits prosperity and consequently the payor mix of patients in hospitals located in segregated neighborhoods. They argue that for these hospitals to perform better they need more resources and one way to address this would be for Medicaid to pay rates similar to Medicare and to increase Disproportionate Share Hospital (DSH) payments.

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Welcome to CHERP

New COIN Investigators

Ryan Greysen, MD, MHS, MA Ryan Greysen, MD, MHS, MA (PHL)
is a CMCVAMC Hospitalist and Associate Professor of General Internal Medicine at the University of Pennsylvania.

Yuvaram Reddy, MBBS, MPH Yuvaram Reddy, MBBS, MPH (PHL)
is a CMCVAMC Nephrologist spearheading the medical center's efforts to implement a home dialysis program, and will also pursue a VA Career Development Award studying Chronic Kidney Disease (CKD).

Ravy Vajravelu, MD, MSCE (PGH)
is a gastroenterologist who evaluates multiple medication exposures using large data sets.

New Staff Members

Adeyinka Adejumo, MD (PGH)
is a new T32 research fellow working with Shari Rogal, MD, MPH (PGH)

Alison Brecher, MPH (PHL)
works on the SAGE QUERI project (Safer Aging through Geriatrics-informed Evidence-based Practices), focused on implementation and process methods.

Diana DeFelice, BS (PHL)
is Project Coordinator for Continuing the Conversation: A Multi-site RCT Using Narrative Communication to Support Hypertension Self-Management among African-Americans, CIRB Study with PI Judith Long, MD (PHL).

Marybeth Groot, MS (PHL)
is project coordinator on merit review led by Shahrzad Mavandadi, PhD (PHL) Caregiver SOS: An Intervention for Employed Caregivers.

Monica Merante, MPH (PGH)
has joined Dr. Shari Rogal's QUERI Partnered Evaluation Initiative team.

Lindsay Pelcher, MPH Lindsay Pelcher, MPH (PGH)
is a new Research Assistant for the SAGE QUERI, working with Dan Hall, MD, MDiv, MHSc (PGH) on the Surgical Pause practice implementation.

Anne-Marie Shields, MSN (PGH)
has returned to CHERP to coordinate Dr. Steve Weisbord's new Merit Review project.

Madeline (Maddie) Rigatti, MSW (PGH)
is the Program Manager for the new High Risk Veterans (RIVET) QUERI Center directed by Ann-Marie Rosland, MD, MS.

Alina Tudose, MA, MS (PHL)
is project coordinator on Dr. Steven Sayers' merit review, A Randomized Controlled Trial Of Coaching Into Care With VA-CRAFT To Promote Veteran Engagement In PTSD Care.

Kelvin Tran, PharmD, MS (PGH)
is our new post-doctoral fellow in Medication Safety and Pharmaceutical Outcomes.

Connor Warren, OTR/L (PHL)
is an occupational therapist and coordinator of the Community Aging in Place: Advancing Better Living for Elders (CAPABLE) Evidence-Based Practice of the SAGE QUERI (Safer Aging through Geriatrics-Informed Evidence-based Practices)

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