The CDC funds Special Interest Projects (SIPs) to focus on a topic of interest or a gap in scientific evidence. SIP grants are competitively awarded only to investigators affiliated with one of the 26 Prevention Research Centers in the national network. During this funding cycle, Emory has been awarded six SIP grants – two in 2020 and four in 2019.
Both mental and physical health are consistently reported to be worse in people with systemic lupus erythematosus (SLE) compared to those with diabetes, heart disease, and other chronic conditions, in large part due to the systemic involvement, challenging diagnosis and management, and multiple comorbidities that often come with having SLE. This is exacerbated in Black individuals by their disproportionate burden of SLE prevalence, poor outcomes, comorbidities, and poor health-related quality of life. Successful self-management of SLE requires having the skills to engage in effective daily activities, which often comes from having access to up-to-date health education and self-management support. Currently, there are no widely available, evidence-based, SLE-specific self-management resources.
Our proposal leverages two on-going Centers for Disease Control and Prevention (CDC) supported efforts with synergy in resources and timing to uniquely and powerfully achieve our aims. The CDC–supported, population-based Georgians Organized Against Lupus (GOAL) Cohort is a prospective cohort of validated and consented individuals with SLE that reflects “real world” lupus in the community in and around Atlanta, Georgia. The Lupus Foundation of America was supported by the CDC to develop an online lupus self-management program based on the Transtheoretical Model of Behavior Change called Strategies to Embrace Living with Lupus Fearlessly (SELF), which helps users adopt key self- management behaviors. We propose two aims over a two-year period. Aim 1 will examine behavioral and psychosocial factors and their association with patient reported outcomes using already collected data from the GOAL Cohort. Aim 2 will examine changes in patient reported outcomes after being exposed to SELF in the GOAL Cohort.
Overall survival for childhood cancer is over 85%, however childhood cancer survivors are at an increased risk of premature mortality. The Institute of Medicine (IOM) recommends all cancer survivors (of both childhood and adult cancers) receive a personalized survivorship care plan (SCP) that includes a summary of treatment received and surveillance recommendations to mitigate late effects. Since the initial IOM guidance, there have been concerns that heterogeneous construction and dissemination of SCPs may limit their ability to improve the quality of cancer survivorship care. In childhood cancer survivors, the development of a SCP is guided by the evidence-based Children’s Oncology Group (COG) Long-Term Follow-up (LTFU) Guidelines. These guidelines recommend specific surveillance for late effects based on therapeutic exposures. However, very few studies have examined the impact of SCPs on adherence to COG-recommended surveillance and the associated impact on reducing premature mortality using a population-based approach.
We will study a cohort of over 4,000 childhood and adolescent cancer survivors diagnosed before the age of 20 and treated between 2002-2016 at Children’s Healthcare of Atlanta (CHOA). More than 91% of all cases of childhood cancer in the state of Georgia are treated at CHOA, thus we will be able to generate statewide estimates of the impact of SCPs for survivors with all types of childhood cancers and a diverse racial/ethnic background. We also have documentation that approximately 70% of this cohort of survivors has received of a SCP.Our study aims are to:
Within CHOA, we have systematically been providing all survivors seen in the Cancer Survivor Program their SCP utilizing the COG LTFU Guideline recommendations since 2005. Each SCP provided to a survivor contains a summary of their cancer diagnosis and treatment, their late effect risk profile, and their recommend surveillance. Importantly, our reporting to and linking with the Georgia Cancer Registry will allow us to easily trace mortality and determine cause of death in this cohort of survivors. A subset (47%) of this CHOA cohort, representing a population that is the most vulnerable and underserved in the U.S, will also be linked to longitudinal Medicaid data to evaluate screening adherence for key drivers of premature mortality.
Estimates of the burden of disease are useful for evaluating the potential benefits of biomedical research, interventions, and treatments. Nearly 3 million adults in the US currently live with active epilepsy. We will use large claim and survey datasets to estimate the impact of epilepsy on labor force participation, quality of life, health care use, and outcomes among nursing home patients.
The Managing Epilepsy Well (MEW) network is a thematic research network designed to address gaps in knowledge and programs related to improving epilepsy self-management and quality of life for people with epilepsy. Our current funding cycle is comprised of several collaborating centers: Emory Prevention Research Center, Dartmouth-Hitchcock Medical Center, Arizona Prevention Research Center, University of Texas, NYU-CUNY Prevention Research Center, University of Washington Health Promotion Research Center, Case Western Reserve University, and Prevention Research Center for Rural Health at the University of Iowa. The MEW Network also closely collaborates with the Epilepsy Foundation, American Epilepsy Society, and other community epilepsy organizations.
The mission of the MEW Network is to advance the science related to epilepsy self-management by facilitating and implementing research, conducting research in collaboration with network members and community stakeholders, and broadly disseminating research findings. Emory is currently replicating a study called HOBSCOTCH, which was developed by Dartmouth-Hitchcock. The study aims to improve the quality of life for people with epilepsy by helping them gain skills to improve their memory and cognitive abilities. HOBSCOTCH is a virtual program, delivered by a coach via one-on-one telephone sessions for 8 weeks. Our goal for this funding cycle is to enroll 100 people with epilepsy through clinic and community recruitment for the replication trial. For more information, visit the Managing Epilepsy Well Network website.
The goal of this project is to translate evidence-based interventions for cancer and to evaluate a multi-level intervention for HPV vaccination uptake among clinics in Southwest Georgia. Cultivate and strengthen partnerships with communities, public health agencies, community-based organizations, and cancer control research and practice networks to promote community-based participatory approaches to preventing cancer and reducing health disparities. Conduct national and local trainings to build capacity on adoption and implementation of evidence-based approaches in collaboration with our Southwest GA partners and regional cancer coalitions. Assess factors related to HPV vaccination using the P3 (Practice, Provider, and Patient-Level) model to inform intervention development through a qualitative study in Southwest Georgia. Evaluate a multi-level intervention employing implementation strategies of mini-grants and technical assistance on HPV vaccine series initiation and completion among clinical and community organizations in SW Georgia. Assess implementation outcomes and factors related to implementation success.
The goal of this project is to evaluate community-clinical linkage (CCL) interventions in the National Breast and Cervical Cancer Early Detection Program (NBCCEDP). The evaluation will include a robust mixed methods design to evaluate the implementation, cost, cost-effectiveness and scalability of CCL interventions funded by NBCCEDP to increase cancer screening completion among medically underserved women. Guided by the AHRQ Clinical-Community Evaluation Roadmap, we will collect qualitative, quantitative, process, costs and outcome data to determine the effectiveness of clinical-community relationships for improving cancer screening completion among hard-to-reach and unscreened women. Findings from these efforts and a cost-effectiveness analysis will also be used to identify and describe the strategies for scaling up each intervention studied.
The primary aims of this evaluation are 1) to assess facilitators and barriers to implementation of selected CCL interventions; 2) to determine the cost and cost-effectiveness of select CCL interventions; and 3) to assess the potential for scalability of each CCL interventions. Findings from this evaluation can be used for program monitoring, enhancement of the CCL interventions and the development of strategies to scale programs to reach broader, hard-to-reach populations.
Estimates of the cost and burden of metastatic disease are critical for assessing the value of interventions to prevent, detect, and treat prostate cancer. Yet, existing estimates of the cost and burden of metastatic disease are out of date or are based on small, non-representative patient samples. We will develop a comprehensive assessment of the burden of metastatic prostate cancer, including quality of life and caregiver costs, using large survey and claims databases.