Funded Grant Projects - Improved Health Outcomes Program (iHOP)

Cycle IV (2010) iHOP Grant Summaries

1. Effects of Educational Intervention on Long-Term Outcomes of Hospitalized Children with Asthma.
   This study will assess the effectiveness of utilizing reinforced asthma education to improve care and reduce the health care costs that result from avoidable morbidity related to asthma in children 5-12 years of age. The main objectives are to: 1) to determine the retention rate of knowledge about asthma and 2) evaluate the clinical status, quality of life and healthcare costs of children with asthma following an educational intervention. A randomized control design will be utilized to assess standardized asthma education versus standard education with an enhanced reinforcement education intervention.
2. Cost Savings and Improved Access to Health Care with Guardianship.
   This objective of this study is to understand the extent to which guardianship services achieve cost savings and improved access to health care for Medicaid and uninsured populations in Passport Health Plan’s (PHP) Region 3. Project hypotheses are: 1) state guardianship services provided by the Division of Guardianship, Cabinet for Health and Family Services, achieve cost savings and improved access to health care for Medicaid and uninsured populations in PHP’s 16 Kentucky counties and 2) functionally disabled Medicaid and uninsured populations in PHP’s 16 counties without appropriate guardianship services increase costs and reduce access to care for this population. The study authors will analyze data from the Division of Guardianship to gather in-depth information regarding guardianship services available in PHP’s 16 counties. Additionally, the study team will calculate guardianship and Medicaid costs and cost savings to the state and quality of life improvements for the legally “disabled” persons served by the Division.
3. Disease Management Program for Depression.
   This study will pilot a disease management program for Medicaid insured patients with major depressive disorder (MDD) seen in primary care. Specific project aims are: 1) increase the frequency of use of an objective measure for diagnosing and monitoring outcome of patients with MDD treated by primary care clinicians; 2) increase the number of patients with MDD who receive appropriate and adequate treatment for this condition by primary care clinicians; 3) decrease the number of patients who are treated with antidepressants for non-indicated conditions; and 4) pilot use of health care costs as a measure of impact of a disease management program.
4. Improving Health Outcomes Through a Community Care Navigator.
   The aim of this project is to improve the health outcomes of residents in Region 3 with Passport, Passport Advantage, Medicaid, or no insurance through a disease management initiative designed to reduce 30-day readmissions to Jewish Hospital by 4% over a 12-month period. The demonstration project is modeled after the Coleman Care Transitions Intervention, an evidence-based four-week coaching process that empowers patients to assume greater responsibility and control over their self-care in the community. Improved adherence with prescribed treatment is expected to stabilize or curtail markers of participants’ disease and to minimize health care utilization. The project will provide a community care navigator to eligible patients who will serve as a health coach for each patient. The navigator, a registered nurse, will monitor the health status of each patient and work as a coach to improve their ability to manage medications, keep their personal health record, understand the indicators suggesting that their condition is worsening and how to respond, and facilitate follow-up care with primary care providers and specialists.
5. FIXIN ADDICTION: Improving the Treatment of Pregnant Opioid Addicts &Their Babies.
   The aims of this project are to: 1) educate OB/GYN residents and the community at large about the proper evaluation and treatment of opioid addiction; 2) provide an important alternative to long-term maintenance with Methadone and Suboxone for pregnant women who are addicted to opiates; and 3) reduce the severity and duration of neonatal abstinence syndrome (withdrawal) among infants born to addicted mother. Pregnant narcotic addicts will be indentified as they are referred to the U of L OG/GYN clinic, private practice or labor and delivery triage area. All pregnant narcotic addicts will be offered detoxification, comprehensive prenatal care and counseling via the University of Louisville OB/GYN service. The specific approach to detoxification, weaning or substitution and maintenance will be individualized based on whether or not the patient is already enrolled in a Methadone or Suboxone treatment program.

Cycle III (2009) iHOP Grant Summaries

1. Aqui Es Donde Nos Encontramos (Here is Where We Meet) Project
   The goal of this project is to develop, implement, and evaluate a community-focused, digital storytelling tool and method, which will enhance ongoing efforts to engage community members developing plans to eliminate health inequities. The specific aims to achieve this objective for the Latino populations served by two neighborhood community centers are:
   1. Recruit and train 10 facilitators in using PlaceStories, a digital storytelling methodology, to encourage, support and sustain the Health Equity Dialogue process with these populations;
   2. Implement and test the effectiveness of using this specific tool and methodology in expanding the engagement of Latino populations in action planning focused on addressing the social determinants currently limiting their access to prevention and clinical services and on decreasing their exposure to negative systemic issues; and
   3. Collect, analyze and share relevant information about the community's perception of priority issues regarding health inequities and proposed best practices for addressing these priorities.
2. Kangaroo Care Expanded
   This project proposes to increases breastfeeding rates in sixteen Kentucky counties by training healthcare providers to implement Kangaroo Care (KC) at the ten birthing hospitals served by Passport Health Plan. The primary goal is to increase breastfeeding rates in the ten hospitals in the Passport Area from an average of 49% to an average of 55% in 12 months.
3. Wholesale "Central Fill" Pharmacy System
   The aim of this study is to determine the effects of a Wholesale "Central Fill" Pharmacy system on the Access to an Indigent Prescription Replenishment Program; Kentucky Physician's Care (KCP) Program. The related hypothesis is that by implementing a Wholesale "Central Fill" Pharmacy System an increase will be demonstrated in:
   1. The number of participating pharmacies;
   2. The speed which participating pharmacies receive their replenished pharmaceuticals; and
   3. The number of participating pharmaceutical companies.
4. Improve use of health services by teen mothers with symptoms of depression through a public health, social marketing intervention.
   The aim of this study is to determine the acceptability, feasibility, and efficacy of a public health, social marketing intervention to improve health care use of teen mothers with symptoms of depression. Exploratory research questions will be utilized to define the market (understand how teen mothers use social media; where they receive health information; who they prefer to receive health information from), in message development (obtain the opinions of teen mothers concerning what the message should be, the image of the message, and how message should be delivered such as Facebook or text message, etc.), and in concept and message testing (pilot testing of the message with teen mothers). Then outcomes related to the public health, social marketing intervention will be measured.
5. E.A.R.S.: Leading to a better understanding of the educational needs, access issues, resources and satisfaction with care for high risk pregnant women who participate in the Prenatal Task Force Mother's Day Out Program.
   The aims of the project are to lead to a better understanding of the needs and access issues for pregnant, low income women; examine the Mother's Day Out Program (MDO) to improve the satisfaction with care; and explore the unique collaboration and community based partnerships that MDO offers to improve the care for this population.

Cycle II (2008) iHOP Grant Summaries

1. Clinical Skills for Early Detection of Oropharyngeal Carcinomas in High-Risk Urban African American Population: Development of a Novel Educational Intervention and Educational Assessment Strategy. 
   The study objective is to develop and test an educational intervention aimed at oral health practitioners' ability to improve recognition of early-stage oropharyngeal cancers. Thirty Louisville-based oral health practitioners will be targeted to participate in a continuing education program on oral health utilizing standardized patients. Following this work shop standardized patients will visit the oral health practitioners practice for unannounced new patient visits to determine the effectiveness of the training at fixed intervals (3, 6, and 9 months) post intervention and education session.
2. The Effects of Motivational Interviewing on Type 2 Diabetes Management in African American Adults: A Pilot Study.
   The study objective is to determine the effects of a motivational interviewing intervention on adherence to prescribing treatment regimens, diabetes markers, and number of unscheduled health care visits among African Americans with type 2 diabetes mellitus. This study is a randomized, controlled trial with a planned enrollment of 30 participants to the intervention group and 30 participants to a usual care group. 
3. A Community Coalition to Help Parents Raise Healthy Confident Children.
   The study objective is to form a community coalition to fight childhood and adolescent obesity through a year long interdisciplinary program. Three components of the program include: 1) physical activity, 2) dietary management and nutritional education, and 3) confidence and self-esteem boosting counseling sessions. Fifty obese children, ranging 5-12 years of age with a commitment of at least 1 parent, will be selected to participate in the program. 
4. Louisville Metro EMS PSIAM Pilot Program.
   Study goals are: 1) to implement a pilot program for the alternate triage of patients assessing the 911 emergency medical services system (EMS) for low-acuity medical concerns; and 2) to evaluate the specificity of a 911 call-processing algorithm for indentifying low-priority 911 medical patients, and for the timely and safe referral of these patients to alternative non-acute sources of medical care.
   911 emergency calls categorized as "low-priority" by the MetroSafe 911 Communications Center will be secondarily triaged by a trained nurse utilizing the pilot PSIAM call-processing algorithm. The nurse will access a database to determine the appropriate and safe alternative referral to existing community resources rather than the emergency dispatch of a 911 ambulance. 
   The PSIAM call-processing algorithm is currently being piloted in London, England; Richmond, Virginia; Houston, Texas; and Oklahoma City, Oklahoma. 
5. Intra-uterine device placement: a randomized, controlled trial.
   This study is a randomized, controlled trial comparing typical placement of IUD's at six week's postpartum or later and immediate post-placental placement with regards to the rate of success, complications, and patient satisfaction.

Cycle I (2007) iHOP Grant Summaries

1. Health Needs and Experiences of Immigrants and Refugees in South-Central Louisville
   Louisville is experiencing a rapid growth in its immigrant and refugee population many of whom are residing in South Central Louisville.  Refugees and immigrants often face barriers to accessing health care such as language, culture, feat and confusion about the medical system, past trauma, victimization, poverty, and social isolation that often preclude access and acquisition of care.  This study sought to learn the health care needs, experiences with the existing health care system, and determine barriers that prevent health care access for refugee and immigrants, including both personal and environmental challenges faced when attempting to obtain health care and achieve wellness.
2. Improving Access to Mental Health Care in Young Postpartum Women with Symptoms of Depression.
   The aims of this project included determining the feasibility, acceptability, and efficacy of New Mother Program, a telephone based depression care management program) in postpartum adolescents 13-18 years of age with symptoms of depression.  This program is screening adolescents 13-18 years of age for symptoms of postpartum depression, with those registering a positive depression at baseline being enrolled into the New Mother Program. Potential outcomes include enrolling adolescents in the New Mother Program and entering depression treatment in a timely manner, as well as satisfaction with telephone based depression care management intervention.
3. Access to Early Dental Care - An Initial Step to Dental Health
   The objectives of this project were to improve access to preventive dental care in the first two years of life and to reduce the risk of early childhood caries.  This project was conducted at the Children and Youth Project of the Department of Pediatrics, University of Louisville.  The C&Y Project provides comprehensive health care to children, including medical, dental, nursing, nutrition, speech, and social services.  Dental preventive services were scheduled at the same time as medical preventive visits. 
4. Chronic Care Coordination Project
   The goal of this project was to improve clinical outcomes for Passport Health Plan members and underinsured individuals with chronic illnesses, with a focus on diabetes, through the implementation of an on-site chronic care coordinator at the University of Louisville Family Medicine-Ambulatory Care Building.  Potential outcomes included: improving clinical outcomes for patients with chronic illnesses with a focus on diabetes; providing coordination of patient care using a multidisciplinary team approach to include Passport Health Plan Disease Managers and community resources;  implementing self-management support strategies to empower patients to become more actively involved in managing their own care, and analyzing outcome data continuously.
5. Kangaroo Care
   The goal of this project was to implement a program titled, "Kangaroo Care" in the newborn nursery at University Hospital to positively impact mother-infant outcomes and demonstrate a statistically significant increase in the number of newborn infants' breastfeed.  Kangaroo care, also know as "skin-to-skin" are, is a special way a mother holds her newborn infant with contact starting at birth and continuing after discharge.  This method of care, involving placing the infant on a mother's bare chest immediately after birth or within the first 24-hours of life provides benefits to both the mother and child.