A major focus of the Department of Community and Family Medicine has been in primary care research. The Department's primary care research spans many centers and departments, such as:
- Centers (Geriatric Center of Excellence, Dartmouth Cancer Center, and The Dartmouth Institute)
- Population Health
We collaborate within the community through the Dartmouth Northern New England Primary Care Cooperative CO-OP) and the Practice-based Research Network (Dartmouth CO-OP PBRN)
We support new researchers through the Academic Support Hub, where we work with early-career clinician-researchers in developing, testing, and implementing new approaches to health care delivery.
Learn more about our sponsored research projects listed below:
- Administration on Community Living (ACL) Falls Prevention
- Charles Hamlin Medical Students POLST Project
- Clinician & Patient Utilization of Expanded Age Range for the HPV Vaccine and Shared-Decision Making
- COVID Compass Project
- Crohn's and Colitis Foundation IBD Qorus Collaborative
- Dartmouth Northern New England Primary Care Cooperative (CO-OP) Practice-based Research Network
- Goal-Oriented, Innovative Technology and Team-Based Care to Reduce Readmissions, ED Visits and Length of Stay (GITT RREAL) – A Levy Incubator Project
- Harvard Pilgrim Adapted Serious Illness Conversation Training
- Next Generation Learning Health System for Multiple Sclerosis: Next Gen-MS
- Northern New England Geriatric Workforce Enhancement Program
- Northern New England Post-Doctorial Primary Care Research Training Program
- Resources Services Administration (HRSA) Geriatric Workforce Enhancement Program
- Rural Primary Care Perspectives on the Impact of the COVID-19 Pandemic on Food Insecurity
- Smoking Cessation in the Digital Age: Evaluating the Usability and Appeal of Two Cessation Apps Among Young Adults With Serious Mental Illness
Administration on Community Living (ACL) Falls Prevention
The Dartmouth Falls Prevention Training Program was developed with funding from ACL, a program within the National Council on Aging. This current grant is the third grant of this kind awarded to The Centers. This training program has built capacity for 2 evidence based falls prevention programs (Matter of Balance and Tai Chi Quan: Moving for Better Balance) in 5 States. Currently, we are working with 2 HRSA funded GWEPs (Baystate in MA and University of RI) to bring together primary care practices and community based organizations around falls prevention.
Charles Hamlin Medical Students POLST Project
Starting in April, The Geriatric Center of Excellence trained 8 Geisel medical students to conduct phone conversations with patient surrogates at the Sullivan County Nursing Home and complete Physician Orders for Life-Sustaining Treatment (POLST) forms. Eighty patients with dementia and a surrogate decision-maker at the facility did not have a POLST form documented at the beginning of our program. After extensive coaching from mentors, medical students were able to speak with 59 surrogates resulting in 39 POLST documents entered into the medical record outlining care preferences. The Hamlin fund will enable us to expand this program in additional nursing homes, initially in New Hampshire and then across New England. Dr. Hamlin's interest and work in end-of-life care and his passion around medical students and Geisel make this a perfect fit for this fund.
Clinician & Patient Utilization of Expanded Age Range for the HPV Vaccine and Shared-Decision Making
To assess the feasibility and acceptability among patients (Aim 1) and clinicians (Aim 2) of the expanded age range of the HPV vaccine as well as the effect of insurance coverage for the expanded age range ( Exploratory Aim 3 A) and shared decision-making facility among clinicians and patients (Exploratory Aim 3B) for increased HPV vaccination rates among the expanded age group.
We plan to survey clinicians at all rural Federally Qualified Health Centers across New Hampshire and Vermont who have different vaccine reimbursement options as well as rural versus urban FQHCs regarding clinician intent to meet the CDC's guidelines for expanded-age HPV vaccination rates.
Using Redcap based survey to assess their perception of the need for HPV vaccination in this age group; the recommendation for shared decision making prior to vaccination and if the need for shared decision making is perceived as a barrier or a facilitator and other potential barriers to vaccination patients 27-45 including possible reimbursement barriers. We also plan to survey patients ages 27-45 from two Federally Qualified Health Centers; one in New Hampshire and one in Vermont to assess their perception of the expanded range for the HPV vaccine; patient awareness of the recommendation for shared decision-making prior to vaccination and if shared decision-making is perceived as a barrier or a facilitator to vaccination as well as other possible barriers patients believe may impact their ability to receive the HPV vaccine. We will compare HPV vaccination reimbursement of the expanded age population between New Hampshire and Vermont to see if there is a correlation of reimbursement and vaccinations rates; indicating a relationship between out-of-pocket vaccine cost and patients' willingness to be vaccinated.
COVID Compass Project
Objective: This project is a collaboration between TDI, the Dartmouth Atlas, and the Bordy School of Medicine at East Carolina University (ECU) in North Carolina. This is a study funded by the State of North Carolina and focused on developing a "smart epidemiology" approach to monitoring the incidence, mortality, and societal impact using small area variation methods (Dartmouth Atlas), real time regression adjusted statistical process analytics (TDI) and high level mathematical modeling approaches (ECU) to "visualize" the behavior of the pandemic using a balanced measurement approach unlike other monitoring systems currently available. This project aims to inform public health leaders making time sensitive decisions about COVID management and research efforts to understand relationships between policy, behavior, and outcomes. I serve as Co-Investigator on the project and specifically oversee the statistical process control analytics component of the project. Gene Nelson is the PI. Sally Kraft is also on the project as a population health advisor.
Crohn's and Colitis Foundation IBD Qorus Collaborative
Objective: This is a 3-year award (2021-2023) in which I serve as the national improvement advisor and scientist guiding the work of a large multicenter improvement collaborative for adult IBD care including 54 IBD centers across the U.S. My role also includes supervising the design and development of a comprehensive learning health system data pathway to accelerate QI and research efforts, and oversight of a team at TDI (sub-award) which will focusses on development and facilitation of a comprehensive quality improvement training curriculum to build front line capability for improvement.
Dartmouth Northern New England Primary Care Cooperative (CO-OP) Practice-based Research Network
The Dartmouth NNE COOP is sponsored by the Department of Community & Family Medicine at Dartmouth Hitchcock Medical Center, the University of Vermont, and Maine Medical Center. As a voluntary, cooperative network of independent clinicians (community-based), The COOP has helped develop and refine a model for rapidly assessing and improving care. COOP members collaborate with academic researchers to improve the outcomes focus of care and develop methods that work in busy community-practice settings. The COOP demonstrates how to integrate the measurement of patient values, clinical improvement strategies, and research objectives into day-to-day health care delivery.
The goals of the Dartmouth NNE COOP are to:
- Provide professional stimulation and collegial communication and interaction among physicians, nurse practitioners, physician assistants, and PhD researchers
- Conduct cooperative research in primary care
- Improve primary care services and office management techniques
- Sponsor continuing education and training for health professionals
Goal-Oriented, Innovative Technology and Team-Based Care to Reduce Readmissions, ED Visits, and Length of Stay (GITT RREAL) – A Levy Incubator Project
Patients being discharged from the hospital face a high chance of returning to the ED or being readmitted within 30 days, for several reasons. In the end, patients lack adequate systems to reintegrate back into their homes. Within a few days of returning home, patients often feel alone and face a moment of realization that they cannot manage their care. They see miscommunication between clinical teams resulting in conflicting advice. Perhaps they can't use technology effectively. Personal goals may not align with the treatment plan. Patients may not have a meaningful emergency plan to cope with unexpected events. These system failures may stem from the lack of involvement of the patient in developing and executing the treatment plan. As one patient stated, "I want to know that the team is talking to each other, that the community is looking out for me, and that I know who to call when I need help."
Among patients hospitalized for five or more days for cardiometabolic disease, we aim to improve their ability to get well in their home (i.e., skilled nursing facility, assisted living facility, personal home, etc.) following discharge. We are working with various stakeholders across Dartmouth Health and the Upper Valley community to identify high-yield strategies to this end.
Harvard Pilgrim Adapted Serious Illness Conversation Training
We are working with New London Hospital, a Dartmouth Health member, to pilot a model aimed at increasing the percentage of patients with a serious illness (defined as a prognosis of two years or less) who have end-of-life care preferences clearly documented in their medical record. Participating healthcare staff will be trained to use an adapted version of Harvard's Ariadne Lab 20-Minute Serious Illness Conversation Guide to facilitate the completion of Provider Orders for Life-Sustaining Treatment (POLST) forms. We believe this initiative could lead to patient care that more clearly aligns with the individual's goals, values, and wishes for end-of-life care, improve competencies of healthcare personnel and prompt a significant reduction in costs associated with unwanted hospitalization.
Next Generation Learning Health System for Multiple Sclerosis: Next Gen-MS
Objective: A three-year, prospective, cluster-randomized study to assess the quality of life and functional impairment outcomes in people with multiple sclerosis (MS) followed by MS care centers randomized to the effect of a quality-improvement intervention informed by learning health system feed-forward patient-reported measures compared to usual care controls.
Northern New England Geriatric Workforce Enhancement Program
The purpose of this proposal is to advance rural northern New England's regional capacity to address the healthcare needs of older adults and to inform national geriatric workforce improvement by developing and evaluating the Northern New England Geriatric Education and Training Workforce Enhancement Learning Laboratory (NNE-GETWELL). We plan to achieve 5 goals
Goal 1: Integrate
Develop integrated geriatrics and rural primary care delivery teams providing clinical experiences for trainees with the goal of measurably improving health and health care for older adults. These teams will focus on efficient and effective implementation and training guided by quality improvement methods including performance "dashboards" and patient-reported outcome measures.
Goal 2: Partner
Create partnerships between primary care providers and Aging Social Service Providers and with older adults and family caregivers in the "co-production of health" by collaborative geriatric care delivery.
Goal 3: Train
Develop, implement, evaluate and disseminate didactic and experiential learning experiences for faculty, students, clinicians, allied health and community service providers and direct training and programming for patients and families.
Goal 4: Disseminate
Inform geriatric workforce development nationally through broad dissemination of resources, including a web-based "Practice Change Toolkit including a Curriculum Guide and Implementation Manual, a web-based Medicare Annual Wellness Visit Health Risk Assessment and Complex Care Management Assessment, and (c) a new "Dartmouth Atlas of Geriatric Health Care" documenting the quality of healthcare for older adults in regions across the nation.
Goal 5: Alzheimer's Education and Training
Provide education and support for systems transformation to manage Alzheimer's and Related Dementias as a complex condition for primary care providers in collaboration with Aging Social Service Providers and family caregivers.
Northern New England Post-Doctorial Primary Care Research Training Program
Principle Investigator: Cathleen E. Morrow
Co-Investigators: Mary Brunette, Martha Bruce
We propose to create an innovative, robust, and fully integrated Northern New England Postdoctoral Primary Care Research Training Program aimed at creating the next generation of investigators having the skills to address critical gaps in knowledge as needed to achieve the Quadruple Aim: enhancing patient experience, improving the health of individuals and the population, reducing overall health care costs, and increasing clinical staff resilience. The program will leverage the dedicated capacity for real-world health services research in a rural, three-state (New Hampshire, Vermont, Maine) primary-care research network, consisting of the new Academic Support Hub at Dartmouth and the long-established Dartmouth CO-OP Primary Care Practice-based Research Network. This research network is supported by faculty and programs in the Dartmouth Geisel School of Medicine, The Dartmouth Institute for Health Policy and Clinical Practice (TDI), Dartmouth's SYNERGY Clinical and Translational Research Institute, and the Dartmouth Hitchcock Medical Center clinical departments of Family Medicine, Internal Medicine, and Pediatrics. We will achieve this purpose by providing eight (8) trainees a 2–3-year program including mentored research opportunities and training in core research methods and skills.
Mentored Research Opportunities will focus on establishing fundamental research skills, obtaining preliminary pilot data, writing first-authored manuscripts, and submitting a research project grant or career development award in one or more of Dartmouth's strengths in health care delivery science including:
- Secondary Analysis of Population-based Data Sets, aimed at identifying best practices related to common, high-cost, and/or complex health conditions within primary care.
- Intervention Research in real-world primary care practices, developing and testing innovative models of care designed to health improve health outcomes and reduce health care costs.
- Implementation Research testing innovative approaches to implementing best practices in rural primary care through systems engineering, decision science, and mobile health technologies.
Training in Early-Career Investigator Competencies In Primary Care Research will include:
- Individually Tailored Primary Care Research Mentoring Program
- Seminars in Health Care Delivery Science Methods and Statistics
- Seminars in Implementation Research, Clinical Research Informatics, Mobile Health Technology, and Human and Health Systems Engineering
- Potential for a Masters in Public Health (MPH) at TDI
- Participate in a Faculty Member's Ongoing Research Project to develop skills in project management (e.g., IRB applications, subject recruitment and assessment, data management and analysis).
Resources Services Administration (HRSA) Geriatric Workforce Enhancement Program
The NNEGEC is one of 48 programs funded through the Health Resources and Services Administration's Geriatrics Workforce Enhancement Program (GWEP) to the Geriatric Center of Excellence.
This work, in part, focuses on transforming systems of care through a model developed at Dartmouth called GITT-PC Geriatric Interprofessional Team Transformation in Primary Care. The model focuses on task reallocation and maximizing every team members role on the team to implement 4 Medicare reimbursable services including: the Medicare Annual Wellness Visit, Transitional Care Management, Advance Care planning codes and Chronic Care Management.
Rural Primary Care Perspectives on the Impact of the COVID-19 Pandemic on Food Insecurity
Principle Investigators: Kayla Hatchell (Geisel MS4); Meaghan Kennedy, MD, MPH; Maureen Boardman MSN, FNP-C; Chelsea Canavan, MSPH
Kayla Hatchell is a medical student at the Geisel School of Medicine at Dartmouth and a research assistant in the Department of Community and Family Medicine. Kayla received funding from Rural PREP to conduct a micro research study. The study consists of surveys and interviews that assess practice-based screening procedures and interventions that address food insecurity and how both have been impacted by the COVID-19 pandemic. The study will engage primary care practices in the Dartmouth NNE CO-OP Practice-Based Research Network, and surveys will later be sent to members of the North American Primary Care Research Group (NAPCRG) to gather national data. Preliminary results will be disseminated at the CO-OP Annual Meeting in January 2021.
Smoking Cessation in the Digital Age: Evaluating the Usability and Appeal of Two Cessation Apps Among Young Adults With Serious Mental Illness
Principle Investigators: Minda Gowarty, MD
Dr. Gowarty is a T-32 Postdoctoral Research Fellow in the Department of Community & Family Medicine. Dr. Gowarty received funding from the Center for Technology and Behavioral Health (CTBH) to conduct a mixed-methods pilot study in a population of young adult smokers with serious mental illness to evaluate attitudes toward mobile applications for smoking cessation, and the acceptability and usability of the National Cancer Institute's two widely available smoking cessation apps.