Funded by the Agency for Healthcare Research and Quality (AHRQ)

Over a third of American adults engage in unhealthy substance use (USU), which includes a spectrum ranging from any illicit drug use or alcohol consumption above guideline-recommended levels through more severe substance use disorder. USU results in increased mortality through overdose and substantial morbidity including reduced functioning, poorer chronic disease outcomes and increased health care utilization. A broad range of biological, psychological and social factors contribute to USU. However, while primary care clinicians frequently encounter patients with USU, they rarely screen for, diagnose, or treat USU using a comprehensive approach that would account for all these factors. Furthermore, existing strategies and models to improve USU care frequently fail to consider practice and community context, and thus have not been widely disseminated. In our study, we propose to engage primary care practices and individuals with lived USU experience in codesigning a whole person USU intervention and collaboratively test the implementation of the intervention in primary care practices.

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Funded by the Patient-Centered Outcomes Research Institute (PCORI)

Acute rhinosinusitis (ARS) is a leading cause of antibiotic use in primary care settings and are prescribed in over 70% of outpatient ARS visits in the United States. In the U.S., one in seven adults (a total of 30 million office visits) every year are diagnosed with ARS, resulting in one in five antibiotics prescribed to adults. However, most patients do not benefit from antibiotics as their symptoms are caused by a viral infection. In addition to antibiotics, nasal sprays such as intranasal corticosteroids (INCS), over-the-counter supportive treatment, or saline nasal irrigation (SNI) may help improve symptoms. Our goal is to improve outcomes for patients with ARS by understanding for whom antibiotics, INCS, supportive care, or watchful waiting are most likely to provide benefit. We hope the information we learn in this study can be used by providers and patients to figure out what is the best way to treat ARS.

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Funded by the National Cancer Institute (NCI)

New cancer screening technologies with great promise for reducing cancer death are emerging. These technologies require large-scale controlled clinical trials to evaluate their effectiveness and assess the feasibility of adopting and implementing them into routine practice if effective. Furthermore, the National Academy of Medicine and US Preventive Services Task Force have identified dozens of evidence gaps in current cancer screening approaches that will need similar large scale randomized controlled trials and longitudinal studies. To address this, the National Cancer Institute (NCI) is creating a Cancer Screening Research Network (CSRN) with a network of Accrual, Enrollment, and Screening Site (ACCESS) Hubs capable of conducting clinical trials and longitudinal studies, a central Statistics and Data Management Center, and a central Coordinating and Communication Center. We propose to create the Virginia CSRN ACCESS Hub from long-standing, inter-institutional partnerships to assist in this important national effort.

Funded by the Agency for Healthcare Research and Quality (AHRQ)

Primary care consolidation under health system ownership is increasing, but it is unclear how this will impact clinicians’ ability to achieve the National Academy of Medicine’s vision of High- Quality Primary Care and Whole Health. We will use multimedia elicitation surveys and focus group interviews to assess the impact of ownership on the delivery of high-quality care and to describe how contextual factors may help or hinder care. This information will inform national efforts and practice interventions to advance high-quality primary care and whole health.

Funded by the National Institute of Nursing Research (NINR)

This study is a collaboration between the National Institute of Nursing Research and the VCU Department of Family Medicine to assess the state of interprofessional team-based care in Virginia. We will conduct practice interviews to understand how interprofessional team-based care is defined across Virginia, the contextual variables that shape the composition and function of care teams, and the influence of team-based care on practices’ ability to deliver high quality primary care.

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Funded by the Medical Society of Virginia (MSV)

In partnership with the Virginia Mental Health Access Program, we are using the Virginia All-Payer Claims Database to identify characteristics of mental health care in the Commonwealth and inform training to strengthen the ability of primary care providers (PCPs) to manage the behavioral health needs of their pediatric patients. We are also helping to evaluate the reach of the program to guide future directions.

Funded by the C. Kenneth and Dianne Wright Center for Clinical and Translational Research

In partnership with the Wright Center at VCU, we are working with the Opioid Abatement Authority, the Virginia Society of Addiction Medicine, and cities and counties across Virginia to develop an Opioid Abatement Toolkit. This Toolkit will be an online evidence-based resource for the use of cities and counties across Virginia to support their OAA-funded abatement efforts. We will carry this out through community outreach and engagement efforts to obtain input from Virginia cities and counties on their needs, consultation with subject matter experts, vetting of resources, and creating, rolling out, and continuously updating the Toolkit. In addition, we will provide expert ongoing consultation to communities on how to use the Toolkit and offer guidance on evidence-based practices.

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Funded by the Agency for Healthcare Research and Quality (AHRQ)

Many patients with poorly controlled chronic conditions also have unhealthy behaviors, mental health challenges, and unmet social needs. Medical management may have limited benefit if patients are struggling to address these basic life needs. In a randomized controlled trial, we are testing whether enhanced care planning to address these root causes of poor health will better help to control chronic conditions. These enhanced care plans will be supported by support from patient navigators, community health workers, and clinical-community linkages to address health behaviors, mental health, and social risks.

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Funded by the Agency for Healthcare Research and Quality (AHRQ)

Unhealthy alcohol use is the third most preventable cause of death. Screening and counseling for unhealthy alcohol use is recommended by the USPSTF. Primary care clinicians can deliver this preventive service very effectively with brief interventions, but few patients in need receive care. As part of a national initiative directed by the Surgeon General, we are one six centers funded to provide practice facilitation to 150 primary care practices throughout Virginia to better implement this preventive service.

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Funded by the Virginia Department of Medical Assistance Services (DMAS)

As part of Virginia’s recent decision to expand Medicaid, DMAS has contracted the Department of Family Medicine to evaluate the capacity of primary care to care for new Medicaid beneficiaries. The evaluation will include assessing the range of services practices can provide to new beneficiaries, intent to accept new beneficiaries, and barriers to caring for more beneficiaries. Information will directly inform the state to help ensure the success of Medicaid expansion.

Funded by Virginia Commonwealth University

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HealthLandscape Virginia is a suite of web-based interactive mapping tools and interactive databases to understand the intersection of healthcare delivery and socioecological factors that drive community health and wellbeing. HLVA contains data from the Virginia All-Payer Claims Database, American Community Survey, derived workforce data, derived health outcomes data, and dozens of indicators about the social determinants of health. Data is displayed and downloadable at the census tract, zip code, county, and congressional district levels. These tools allow health professionals, policy makers, researchers, learners, and planners to combine, analyze and display information in ways that promote a better understanding of health and the social determinants that affect it.

Funded by the Virginia Department of Medical Assistance Services (DMAS)

This project aims to identify communities with positive outcomes with regard to opioid use disorder. We will review a variety of key metrics, including fatal opioid overdoses, community level factors, prescriptions for opioids, outpatient and emergency room visits for opioid use disorder, and access to medication assisted treatment. This project will develop a model to identify outlier communities that have positive outcomes despite risk factors. This project will inform a future initiative, which involves performing qualitative interviews to identify effective strategies and best practices that could inform interventions in other communities.

Funded by the National Center for Advancing Translational Sciences (NCATS)

Low-value care, or the provision of care without net benefit, is associated with patient harm and billions of dollars in unnecessary medical costs. Low-value care continues to affect one in ten children every year. We are using the Virginia All-Payers Claims Database to understand patterns of low-value care in children and how best to reduce unnecessary and potentially harmful services. Our goal is to optimize the quality and value of care being delivered to children.

Funded by the National Cancer Institute (NCI), Agency for Healthcare Research and Quality (AHRQ), and Patient-Centered Outcomes Research Institute (PCORI)

MyPreventiveCare is a patient-centered application embedded within patient portals to help make health information more actionable for patients. MyPreventiveCare combines patient reported information with clinical data from electronic health records, applies the data to robust algorithms from a dozen preventive care and chronic care guidelines, explains information in lay language to patients, displays tailored recommendations and educational resources, provides logistical support and tools to stimulate action for patients and clinicians, and generates recurring reminders as care becomes due again. Originally developed in 2008 through an AHRQ funded RCT, it was shown to increase the delivery of USPSTF recommended preventive services by 5-20%. Advanced through a PCORI study (2010-2014), MyPreventiveCare was programmed to anticipate decisions and guide patients through the decision-making process prior to clinical encounters. In an NCI trial (2015-2019), content was modified and tested for marginalized and medically underserved patients. Now with support from AHRQ, MyPreventiveCare is being modified to use FHIR-based data transfers and CDS hooks to integrate in a widely disseminatable manner with any certified electronic health record and patient portal.

Funded by the American Board of Family Medicine (ABFM) Foundation

This project will evaluate the association between quality of care and board certification status of Family Physicians in Virginia. Using the All-Payer Claims Database, the national provider enumeration system, and the ABFM Diplomate data, we are comparing board-certified physicians and non-board-certified physicians in their achievement of five overuse/low value metrics including imaging in acute low back pain, labs and imaging prior to low-risk surgery, brain imaging for simple syncope, and reflux medications for infants. In the future, we will compare attrition of board certification and rates of low value care to identify early intervention points for FPs.

Funded by the C. Kenneth and Dianne Wright Center for Clinical and Translational Research

Choosing Wisely has defined metrics for overuse, care that does not improve health and exposes patients to unnecessary and possibly harmful services. Overuse is better understood in adults. We plan to assess 24 metrics of overuse in the pediatric population and factors associated with greater overuse.

Funded by the C. Kenneth and Dianne Wright Center for Clinical and Translational Research

This is a three-part study examining risk factors for missed preventive visits of women and children, identifying hot-spots, and engaging the community to develop solutions.

Funded by the Children’s Hospital Foundation, Children’s Hospital of Richmond at VCU

This is a retrospective cohort study using the All-Payer Claims Database of children 0-4 years of age with and without opioid exposure. We will examine if utilization of primary care, child protection, and therapies differs between children exposed to opioids in utero compared to non-exposed children. We will also analyze whether children exposed to opioids in utero living in rural areas get less specialty care than those living in urban areas.