Welcome to our inaugural newsletter for the FCM Research Group! This newsletter covers happenings during January - April 2023.

Spring is always a pretty busy time - First year students are deciding on their project topics and designing their studies, and the more senior students are preparing their year-end reports. We've also had several grant deadlines that keep us on our toes. And Carilion Clinic Research Day! 

Presentations

• Jamie Turner (PhD-1) presented The Impact of the COVID-19 Pandemic on Opioid Prescribing Rates in Virginia at the Translational Biology Medicine and Health (TBMH) poster session in March. 

• Brianna Chang (M-1) and Isaiah Yim (M-1) joined FCMRG and presented their research proposals to VTCSOM evaluators. Brianna is planning to study the intersection of multiple chronic conditions and sludge in cancer screening and Isaiah is working on a data science study to investigate impacts of switching from chronic opioids to chronic NSAIDs on kidney function in a national dataset. 

• Matthew Vinson (M-2) and Nancy Wu (M-2) presented their research progress to VTCSOM evaluators. Matthew is evaluating the impact of a brief original patient education video focused on potential harms of OTC NSAIDs on intent to reduce NSAIDs use and Nancy is evaluating Community Health Workers' efforts with patients who have hypertension and diabetes. 

• Michelle Rockwell (FCM Faculty) presented Reallocating Low-Value Care to Cover High-Value Follow-up Care at the Low Value Care Task Force Spring Meeting in April. 

Papers

• Rockwell, Michelle; Cox, Emily; Locklear, Tonja; Hodges, Brandy; Mulkey, Stacey; Evans, Brandon; Epling, John; Stavola, Anthony. Implementation of a Multimodal Heart Failure Management Protocol in a Skilled Nursing Facility. Gerontology and Geriatric Medicine. February 2023.

• Krist, Alex; Villalobos, Gabriella; Rockwell, Michelle. Improving Screening for Unhealthy Alcohol Use: Lessons from the Field. JAMA Internal Medicine. February 2023.

• Rockwell, Michelle; Armbruster, Shannon; Perkins, Karen; Capucao, Jillian; Rockwell, John; Russell, Kyle; Mafi, John; Fendrick, A. Mark. Reallocating Low-Value Cervical Cancer Screening from Low- to High-Value Clinical Scenarios. Cancer Prevention Research. March 2023.

Impact

Alcohol use disorders: We continue to try to multiply the work we've done in the Unhealthy Alcohol Use project (with our VCU colleagues) to strengthen the work of the Carilion Clinic Addiction Task Force. We have planned a continuing education session for the Carilion Clinic nutrition staff and for an additional primary care practice, we are adding an Alcohol Use Disorder Smart Order Set to our EMR, and are looking  for new ways to spread the word about the increasing problem of risky drinking and alcohol use disorder. 

Low-value back pain imaging: As a result of our project with Smarter Care Virginia in trying to reduce unnecessary imaging in the management of acute low back pain, we have updated a reminder prompt in the lumbar spine x-ray order that reminds the ordering clinician of well-accepted guidelines on imaging for acute low back pain.

Sludge is sticky!: As we talk about our work on sludge (unnecessary and burdensome administrative frictions) in colorectal cancer screening, people seem to find the concept of sluge very intuitive and, dare we say it, sticky. We hear the term used in the halls and on the calls nowadays to describe a variety of thorny administrative problems - hopefully this can lead to efforts to reduce it wherever we find it!

Ongoing Research...

• February marked the kick-off of our 1-year iThriv pilot award period for Patients' Experiences with Sludge in the Colorectal Cancer Screening Pathway. The first step in our project involved engaging community advisors (patients) in the design of the study through Community Engagement Studios. Their invaluable insight has informed our next steps.

• We continue our work on training clinicians to discuss self management techniques to their patients with Chronic Obstructive Pulmonary Disease, and seeing if that training affects clinical practice as well as unnecessary hospitalization and emergency department use.

• We are just finishing up a collaborative national survey of family practice clinicians with the American Academy of Family Physicians Research Network. This survey looks at an aspect of how clinicians make decisions and attempts to understand how that impacts their decision making in certain clinical scenarios. We can be more detailed about the findings once the survey and analysis is completed! 

Pictures of (many of) the research group above...We continue to strive to work on interesting problems that can help clinicians and patients do what must be done to improve health...and have some fun along the way.