YCCI Scholars Engaged in Community-Based Research

Approximately 20 percent of the junior faculty selected for the YCCI Scholar Program are conducting community-based research. Moreover, 15 percent (or nearly $7 million) of the total external grants awarded to YCCI Scholars are for community-based projects. Many of these Scholars work with the Robert Wood Johnson Foundation Clinical Scholars Program and other partners in developing and performing their projects. Below are highlights of some YCCI Scholars who have conducted community-engaged research:

2007 YCCI Scholar

In his role as Chief of Medicine at Cornell Scott-Hill Health Center, Douglas Bruce, M.D., M.A., M.S., uses research to help drive improvements in patient care. “It’s exciting to apply research and a focus on evidence-based care to the health center,” he said.

Dr. Bruce’s research has focused on the intersection of substance dependence and infectious diseases. Early on, the Scholar program offered mentorship from faculty members across the university, an experience that he found to be valuable. “It provided me with access to additional relationships that made my work much easier,” he said. He also found that the exposure to other researchers through the bi-monthly Research in Progress meetings afforded a change in perspective that helped inform his work.

He conducted research for his Scholar project on integrating hepatitis C treatment with methadone maintenance therapy at South Central Rehabilitation Center, one of the Cornell Scott-Hill Health Center clinics, his first foray into public health in New Haven. This paved the way to additional work integrating infectious disease and substance abuse treatment, which eventually led to a series of projects in the international arena where he modified what he had learned in Connecticut.

A desire to help create an evidence-public health center prompted his full-time move to the Center, which has 36,000 patients and six major sites in addition to satellite clinics. He maintains ties with Yale and continues to conduct research that informs evidence-based performance improvements. One example is an initiative to photograph the retinas of diabetes patients, facilitate speedy review by an ophthalmologist, and collect data to determine if it’s worthwhile to invest in the program.

Dr. Bruce serves on YCCI’s T3 working groups for asthma and obesity/diabetes and is also exploring funding and other opportunities with Yale that are a win-win for everyone. “The skills I developed at Yale have honed my ability to help move the needle on performance and in doing that I think we can see positive outcomes,” he said. He relishes the ability to work on a larger scale and believes that his efforts can help other health systems in Connecticut and nationally to improve quality and access to health care.

For more on Dr. Bruce, click here.

Chronic cocaine users may think they’re getting a good night’s sleep, but they are often deficient in “slow wave” sleep, the deep, restorative sleep that helps build physical and mental energy. Peter Morgan, M.D., Ph.D., used his Scholar award to study whether the stimulant modafinil could help reset the homeostatic sleep response – the inner clock that regulates sleep and wakefulness.

His Scholar award became the basis of an R01, allowing him to show that those who respond better to the medication abstain longer from using cocaine. Those who started treatment as inpatients, a setting that ensures both abstinence and a structured sleep schedule – had the highest rate of success. “There are no FDA-approved medications for the treatment of cocaine dependence, so we’re hoping that studies like this one will encourage people to start using it as a treatment,” he said.

Dr. Morgan conducts his research at the Connecticut Mental Health Center (CMHC), one of the oldest community mental health centers in the country that is a collaboration between the State of Connecticut Department of Mental Health & Addiction and the Yale University Department of Psychiatry. CMHC provides recovery-oriented mental health services for thousands of people in the New Haven area each year.

At CMHC, he also conducts research on insomnia in patients with chronic mental illness. He is testing a computer-based intervention that uses cognitive behavioral therapy to help improve sleep for these individuals. “Our clients may be on a number of medications that may affect sleep, so it’s an open question as to whether an intervention that doesn’t involve medication might help them sleep,” he said.

Without the initial award from YCCI, Dr. Morgan would have found it difficult to begin the patient-oriented research that is allowing him to help patients today. “I don’t know what I would have done without that support,” he said. “It really launched my career to start my own research.”

For more on Dr. Morgan, click here.

Growing up in St. Thomas, U.S. Virgin Islands, a health professional shortage area, Marcella Nunez-Smith, MD, MHS, remembers countless stories of loved ones and members of her community who struggled with their health or died prematurely. That experience led her to pursue a career in medicine and conduct research that focuses on vulnerable populations and their interactions with healthcare systems.

Ever since her arrival at Yale as a fellow in the Robert Wood Johnson Foundation Clinical Scholars Program (CSP), Dr. Nunez-Smith has been on a mission to develop ways of addressing health and healthcare inequities wherever they are found: in patient settings, in the healthcare workforce, and in medical education. As a 2006 YCCI Scholar, she gathered preliminary data for what is now known as PreDict (Patient-Reported Experiences of Discrimination in Care Tool). PreDict is a tool that assesses the patient care experience and measures hospital performance with the goal of improving the quality of care delivery. “The Scholar award was tremendously helpful because it allowed me to launch a line of inquiry that was new and then provided me with the resources to complete the preliminary work that allowed us to be competitive for major NIH grants,” she said.

Dr. Nunez-Smith went on to develop the Eastern Caribbean Health Outcomes Research Network (ECHORN), a collaborative multi-million dollar research study funded by the National Institute for Minority Health Disparities (NIMHD). ECHORN examines the risk factors and prevalence of cancer, diabetes, and heart disease in the Eastern Caribbean, a region for which such data are lacking.

Both ECHORN and PreDict – which has spurred several related projects undertaken by her mentees – are now incorporated into the Equity Research and Innovation Center (ERIC), for which Dr. Nunez-Smith serves as director. ERIC builds on the local, national, and global experience of Dr. Nunez-Smith and 60 team members that are involved in research aimed at narrowing health and healthcare inequities, as well as disparities in the healthcare workforce and medical education.

As a former YCCI Scholar, Dr. Nunez-Smith appreciates the benefits of mentorship and serves as academic advisor to Yale School of Medicine students. She also continues her involvement with the CSP as a core faculty member of the Scholars Program and co-director of Community Research Initiatives. “I’m working towards synergy across all of these programs so they’re not siloed,” she said. “The idea is to think about core elements of knowledge for our faculty for population health and health equity and engage stakeholders in our work.”

For more on Dr. Nunez-Smith, click here.

2012 YCCI Scholar

Most older adults who experience fragility fractures don’t typically have osteoporosis; most of the fractures they experience are the result of a fall. Most of the HIV infected patients that Julie Womack, M.A., M.S.N., Ph.D., works with are in their mid 50s or younger, yet this population also experiences fragility fractures.

This led her to study falls in HIV-infected patients at the Yale AIDS Program’s Nathan Smith Clinic and the VA Connecticut Healthcare System. Her Scholar award allowed her to collect quantitative and qualitative data to explore risk factors and ways to prevent falls in these patients.

The award was especially helpful in allowing her to use natural language processing to identify falls in clinical progress notes and radiology reports and conduct patient interviews at the clinic for the qualitative analysis. She learned that interventions designed to prevent falls among the elderly may not translate to the HIV population because of population differences between the elderly, who have been the focus of most falls studies, and younger, HIV infected patients. For example, while antipsychotic use, and drug and alcohol use have not, thus far, been common in elderly populations, they are important concerns among HIV infected groups. She also found that the qualitative research she was able to conduct was a great opportunity to get input from patients regarding the issues they face. She is now starting to identify modifiable risk factors for falls, as well as interventions.

Combining informatics and qualitative analysis allowed Dr.Womack to achieve a balanced view of the problem at hand. Big data sets, particularly in clinical epidemiology, provide invaluable information, but don’t tell the whole story. “I think there’s a lot that you miss if you just look at the numbers,” she said.

As a Scholar, she was interested in learning about research being conducted by other Scholars at the Research in Progress meetings and appreciated being able to delve into her research in a new way. “I couldn’t have done my research without it,” she said.

For more on Dr. Womack, click here.