Gillings researchers are using big data and evidence-based interventions to improve health equity and patient outcomes in N.C. by addressing health disparities.
Implementation science is the study of methods to promote the adoption and integration of evidence-based practices, interventions and policies into routine health-care and public health settings. But it takes too long — 17 years on average — to put evidence-based research into practice. Even then, only half the evidence-based practices are widely used in clinical and community settings.
Translating Science into Practice: Doing great public health research means putting study results to work. Whether examining molecular-level data or facilitating large-scale organizational changes, we’re Gillings. We’re on it! Gillings faculty go beyond the literature and the lab to make real changes in health-care practice and policies — and real differences for patients.
From creating personalized health interventions to helping large health-care organizations implement widespread changes, UNC Gillings School of Global Public Health researchers are working to bring about meaningful results for patients, providers and communities throughout North Carolina.
For Stephanie Wheeler, PhD, MPH, professor of health policy and management, those results hinge on using big data to identify key underserved populations or regions where evidence-based interventions should be adapted and implemented to improve health equity.
In one series of studies, Wheeler and her colleagues linked insurance claims, cancer registry data, surveys and interviews to look for ways to address the financial strain of costly cancer treatments. They found that financial navigators — oncology support staff trained to support patients and reduce hardship related to treatment costs — were one effective solution: Patients at UNC’s Cancer Hospital who worked with navigators reported lower levels of out-of-pocket cost burden and less worry about their finances.
The National Cancer Institute (NCI) has awarded Wheeler and Don Rosenstein, MD, professor of psychiatry and director of the Comprehensive Cancer Support Program, a five-year R01 grant to embed trained navigators in five rural oncology clinics across the state. “We’ve seen how this works at a large academic medical center,” Wheeler says. “The next step is adapting and implementing it in rural clinics.”
Wheeler has received another five-year R01 grant from the NCI to explore whether an evidence-based intervention to improve medication adherence — whether a patient continues to receive recommended treatment — among patients with chronic diseases like diabetes and cardiovascular disease can be adapted and used to improve endocrine therapy adherence in racially diverse breast cancer patients.
Wheeler and Katie Reeder-Hayes, MD, MBA, MSc, assistant professor of medicine, initially tested motivational interviewing, a counseling technique used in other health studies but not in cancer research, to see if it would help patients continue their treatment. It did. Adherence was high among participants, and so was patients’ confidence in sticking with their medication. The second NCI grant will scale-up the counseling intervention, adding a text messaging reminder, to be delivered remotely to more than 1,200 cancer survivors to understand how well it works in different settings and different sub-groups identified by race and age. This could revolutionize survivorship care for women who have had breast cancer and reduce inequities in health-care access and outcomes.
While Wheeler has focused on implementing innovative patient-focused interventions in medically underserved populations, Chris Shea, PhD, associate professor of health policy and management, studies implementation of organizational changes, many of which involve new technologies.
Shea has examined how technology has transformed health-care organizations over the years. This includes the adoption of electronic health records (EHRs), which increased about a decade ago with the introduction of the Centers for Medicare & Medicaid Services’ Meaningful Use program. This program gives providers financial incentives to promote adoption of EHRs and other technology-based care tools. Shea’s study of the UNC Health Care system’s readiness to implement Meaningful Use in ambulatory settings suggests the need for different implementation strategies for various roles and sites within a health system.
For example, Shea found that physicians were less willing than nurses and physician assistants to change their own work practices to meet Meaningful Use requirements. They were also less confident in their clinic’s ability to solve implementation problems. Additionally, practitioners in specialty clinics were more concerned than primary care practitioners about Meaningful Use activities diverting attention away from other important patient care activities.
In another study, Shea found that success in meeting the program’s requirements was highest when efforts were led by quality improvement teams, which are teams of diverse clinic staff who are charged with carrying out improvement efforts for that practice. “It’s important to integrate health technology implementation with quality improvement infrastructure and processes,” he says, “to connect those changes to ongoing efforts within the practice that clinicians think are important.”
“It’s important to integrate health technology implementation with quality improvement infrastructure and processes.”
Chris Shea, PhD
Associate Professor of Health Policy and Management
EHR data have potential benefits beyond the patient encounter, such as assisting with health system planning and predictive analytics. Health systems also are trying to determine how much to invest in novel approaches, such as machine learning.
Although new technology is a driver of many organizational changes in health care, changes that are not tech-driven also can affect how clinicians and administrative staff share information and do their work, Shea says. “We’re moving toward more information-oriented and technology-enabled health systems. It’s important to keep in mind that this movement may not affect all stakeholders the same way. We can’t lose sight of the implications for clinicians, patients and communities.”
Did you know? Cancer treatment is one of the most frequent causes of bankruptcy in the country, according to the President’s Cancer Panel. In 2015, new cancer drugs ranged in price from $7,484 to $21,834 per patient per month.
