Current Research

Evaluating Primary Care’s Capacity to Care for New Medicaid Beneficiaries
Principal Investigator: Alex Krist, M.D., M.P.H.
Sponsor: Division of Medicaid Assistance Services
Start Date: August 2018

Description: As part of Virginia’s recent decision to expand Medicaid, the Department of Family Medicine will evaluate the capacity of primary care to care for new Medicaid beneficiaries. The evaluation will include assessing the range of services can provide 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.


Evaluating the Impact of MyHealthfinder on Wellness Care
Principal Investigator: Alex Krist, M.D., M.P.H.
Sponsor: Office of Disease Prevention and Health Promotion
Start Date: November 2017

Description: This study tests whether providing patients a “prescription” to view MyHealthfinder prior to a wellness visit will better to engage patients in care, improve patient-clinician communication, and increase the delivery of evidence based preventive care. 800 patients from 20 clinicians throughout the state will be randomized to receive the prescription or receive usual care (no pre-visit instructions).


Diabetes Engagement and Activation Program
Principal Investigator: Alex Krist, M.D., M.P.H.
Sponsor: Agency for Healthcare Research and Quality
Start Date: October 2017

Description: Despite evidence that diabetes education programs improve health outcomes, few patients receive formal education. We have developed a virtual diabetes education program, adapted from the American Association of Diabetes Educators, and delivered to patients through their patient portal. It includes print material, videos, and questions to assess confidence and knowledge. In this pilot project, we are randomizing 160 patients with an A1c above 8 to receive this virtual education versus usual care.


Understanding Health System, Practice, Clinician and Patient Factors Associated with the Implementation of New Clinical Practice Guidelines
Principal Investigator: Sebastian Tong, M.D., M.P.H.
Sponsor: Agency for Healthcare Research and Quality
Start Date: September 2016

Description: Trusted clinical practice guidelines are an important tool that can help patients and clinicians understand the best evidence about care. In practice, there have been varied responses to new guideline revisions with some guidelines being widely adopted and others being largely ignored. Using data from nearly 250,000 patients from 56 practices from 3 practice-based research networks across the country, this study seeks to understand the relative importance of patient, clinician, practice and health system factors on the implementation of guideline changes.


Identifying Gaps in Well Child Care Attendance among Primary Care Clinics Serving Low-Income Families
Principal Investigator: Elizabeth Wolf, M.D., M.P.H.
Sponsor: Academic Pediatric Association
Start Date: April 2016

Description: It is estimated that children 0-6 years of age miss about a quarter of their recommended well child-care visits. Children from low-income families miss an even greater proportion. Deficient well-child care is associated with increased emergency department utilization and hospitalizations. This study aims to determine what age’s well-child visits are most likely to be missed and what preventive services are lacking in these children.   We will also explore patient- and provider- reported causes for gaps in well-child care to help inform the development of future interventions to improve receipt of preventive services in children.


Community Vital Signs: Integrating Community Data with Primary Care
Principal Investigators: Winston Liaw, M.D., M.P.H.; Alex Krist, M.D., M.P.H.
Sponsor: VCU Center for Clinical and Translational Research
Start Date: June 2015

Description: Clinicians lack a road map for integrating public health and primary care. In this project, we will combine clinical data from primary care clinics with publicly available data about patients’ communities (community vital signs). Following this integration, we aim to identify patients living in cold spots (resource poor communities), determine whether living in cold spots is associated with worse outcomes, and explore how practices could use community vital signs for population care.


Restoring Primary Care in Virginia: Patient-Centered Outcomes Research Learning as a Pathway to Value
Principal Investigator: Anton Kuzel, M.D., M.H.P.E.
Sponsor: Agency for Healthcare Research and Quality
Start Date: May 2015 

Description: Most care for chronic conditions is provided by primary care clinicians. Although Virginia ranks 4th among the 50 states in average income, it ranks 27th in mortality due to heart attacks and strokes. The scope and focus of this project will materially improve the rates of screening and treatment of risk factors for heart attacks and strokes, and will give primary care clinicians the tools and training to improve the care of other chronic illnesses and the delivery of preventive services.


Supporting Practices to Adopt Registry-Based Care (SPARC)
Principal Investigator: Rebecca Etz, Ph.D.
Sponsor: National Institute of Diabetes and Digestive & Kidney Diseases
Start Date: October 2013

Description: The purpose of this study is to test the effectiveness, and cost-effectiveness, of a low resource, low impact process for initiating improvement in the primary care management of patients with type 2 diabetes through implementation of a diabetes registry. Using a self-assessment tool, a milestones document and area-based peer mentors, we help practices to adopt registries responsive to their community context and the people they serve.


Implementing Personal Health Records to Promoting Evidence-Based Cancer Screening
Principal Investigator: Alex Krist, M.D., M.P.H.
Sponsor: National Cancer Institute
Start Date: September 2013

Description: This study is based on the concept that patient-centered personal health records with higher levels of functionality, combined with practice redesign to make use of these functions, can help patients obtain recommended cancer screening tests by linking them to their doctor’s records, explaining information in lay language, displaying tailored recommendations and educational resources, providing logistical support and tools to stimulate action, and generating reminders. This project will measure whether making these resources available to primary care practices and patients promotes shared decision-making and increases the delivery of cancer screening compared to existing information systems.


An Interactive Preventive Health Record to Increase Colorectal Cancer Screening
Principal Investigator: Resa Jones, Ph.D.
Sponsor: National Cancer Institute
Start Date: August 2013

Description: To develop a novel, web-based, tailored decision aid tool embedded within personal health record systems to promote informed decisions and increase colorectal cancer screening.