Chronic Disease Management
Members in this research area focus on improving implementation of evidence, reducing disparities, and improving delivery of care to patients with a variety of chronic conditions, including diabetes, hypertension, obesity and heart failure.
Active Projects
Multi-Ethnic Study of Atherosclerosis - Field Center
The Multi-Ethnic Study of Atherosclerosis (MESA) is a study of the correlates, predictors, and progression of subclinical cardiovascular disease (CVD) in a diverse population-based sample of men and women aged 45-84 who had no evidence of clinical CVD at baseline.
Dementia Risk Pooling Project (DRPP)
The Dementia Risk Pooling Project harmonizes 11 prospective, natural history cohorts of diverse middle and older age adults, recruited across multiple sites with multiple in-person assessments of clinical, genetic and behavioral risk factors, follow-up of greater than 10 years, and ongoing ADRD ascertainment. The DRPP will be made available to researchers via a cloud-based computing platform. We will develop and validate an accurate and personalized, dynamic dementia risk prediction model which incorporates longitudinal risk factor measurements and updates as new measurements are accrued. This tool can be used clinically to guide treatment decisions and will be made available to clinicians.
Computer-guided Action Planning to Support Physical Activity (CAPPA) for Employees with Chronic Knee Symptoms
CAPPA is a physical activity intervention for employees with chronic knee pain, which is being tested in a developmental randomized controlled trial at two partnering worksites in the Midwest. CAPPA is assessing whether an action planning intervention supporting physical activity can increase and sustain physical activity in employees with chronic knee pain. The goal of this program is to develop and assess a low resource physical activity coaching intervention to large groups of employees at risk for knee osteoarthritis.
Charlesnika Tyon Evans, PhD, MPH
Cook County Clinical Research Site (CC_CRS) of the MACS/WIHS Combined Cohort Study (MW_CCS)
Despite the availability of potent antiretroviral therapy, HIV-infected men and women continue to suffer from premature morbidity and mortality, including cardiovascular and pulmonary disease, neurocognitive dysfunction and malignancies. The goal of the Chicago Cook County Clinical Research Site of the MACS/WIHS Combined Cohort Study is to investigate the mechanisms of HIV-associated co-morbidities in order to inform interventions that will ultimately improve the quality of life and prevent premature disability and death of people living with HIV.
Variable Intensive Early Walking post-Stroke (VIEWS)
The proposed research will evaluate the individual and combined effects of task-specificity and intensity of rehabilitation interventions on locomotor function, community mobility and quality of life in patients with subacute (1-6 months) post-stroke. The primary hypothesis is that practice of specific walking tasks early post- stroke at very high intensities will maximize health and function.
Health Equity and Access to Leverage Technology for Improved Diabetic Retinopathy Outcomes (HEAL-DR)
The Health Equity and Access to Leverage Technology for Improved DR Outcomes (HEAL-DR) study seeks to understand the association of optical coherence tomography and CMT, laboratory, and clinical measures for racial and ethnic minority patients for reducing visual impairment using an innovative strategy that incorporates data from the Sight OUtcomes Research CollaborativE (SOURCE). This research will have high impact by providing the health sector and other stakeholders research that will enhance visual risk assessment to better identify minority people at greatest risk for vision loss from undetected and/or worsening disease on a population level to enhance clinical guidelines for high-risk minority populations.
Health Disparities in Utilization, Quality, and Outcomes for Three Common Ocular Conditions (HealthDOC)
The Health Disparities in Utilization, Quality, and Outcomes for Three Common Ocular Conditions (HealthDOC) study seeks to understand the association of the social determinants on National Quality Forum and clinically meaningful measures, and mortality for racial and ethnic minority patients using an innovative strategy that incorporates data from the Sight OUtcomes Research CollaborativE (SOURCE). This research will have high impact by providing the health sector and other stakeholders with essential information about the quality of ocular care, which is needed for informed interventions aimed at reducing health disparities and improving quality.
5-Cog battery to improve detection of cognitive impairment and dementia: pragmatic clinical trial
Early detection of cognitive impairment in primary care settings is a recognized healthcare priority in the United States. To overcome the technical, cultural and logistic barriers of current cognitive screens in primary care settings, we developed the 5-Cog paradigm, which is a brief cognitive assessment paired with a clinical decision-making support that is simple to use, standardized, takes <5 minutes and does not require informants. The proposed study focuses on this low-cost electronic medical record embedded cognitive assessment and decision support that is applicable and appealing for uptake in everyday primary care settings in the United States.
Healthy Hearts in Manufacturing: Improving Cardiovascular Care in Worksite Health Clinics
Heart disease is the leading cause of death in the U.S., and manufacturing workers and communities have high rates of heart disease and its risk factors (e.g., smoking, obesity, physical inactivity, and diabetes). The proposed Healthy Hearts in Manufacturing (HHM) study will introduce evidence-based interventions for hypertension and tobacco cessation in worksite clinics that serve manufacturing workers and their families. We will evaluate whether HHM is associated with improved hypertension control and tobacco screening and cessation intervention, and estimate the health care savings for the companies and Medicare.
Mixed Methods Study on Impact and Implementation of Social Needs Screening and Referral on Hypertension Outcomes
Achievement of ideal blood pressure (BP) among people with hypertension (PHTN) remains an important clinical and public health challenge. The purpose of the study is to evaluate how social needs screening and referral (SNSR) programs impact hypertension outcomes, specifically blood pressure control, by examining SNSR implementation among people with hypertension, assessing patient and community-based organization (CBO) interactions, and identifying strategies to optimize SNSR programs within a health system.
Adaption, Implementation and Testing of a Telehealth Diabetes Discharge Intervention to Improve Transitions of Care
There is a clear need for improvement in the diabetes mellitus (DM) transitions of care from the hospital to home. This research focuses on adapting, integrating, implementing, and testing, through a clinical trial, a telehealth diabetes discharge toolkit designed to improve glucose control, safety, and diabetes self-care, and psychosocial measures following discharge from the hospital for those new to DM medications and requiring additional diabetes education. This intervention has the potential to be generalized to DM care in other care settings (e.g., emergency department, outpatient clinic) for DM patients.
Accelerate AHEAD Study: Evaluating Diabetes Technology Use in Primary Care
The purpose of the study is to identify care gaps and barriers to adopting telehealth and diabetes technologies, such as continuous glucose monitoring, in underserved populations with diabetes, and to develop strategies to accelerate the implementation of these technologies to improve diabetes care and reduce health disparities in real-world primary care settings.