School of Medicine receives NIH grant to continue cardiovascular outcomes research program

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The UMKC School of Medicine has received a nearly $400,000 grant from the National Institutes of Health to continue and build upon a successful two-year training program in clinically oriented cardiovascular disease outcomes research through the Department of Biomedical and Health Informatics and UMKC’s new Healthcare Institute for Innovations in Quality (HI-IQ). The funding covers the first of five years of support through the National Heart, Lung and Blood Institute, bringing the total grant funding to just less than $2 million.

Immense research investments have improved the care of patients afflicted with cardiovascular disease, the leading cause of death and disability in the United States. But continued evaluation of patient-centered outcomes, including patient symptoms, function and quality of life and how to apply that knowledge in clinical settings is needed, said John Spertus, M.D., professor, clinical director and endowed chair in metabolic and vascular disease research.

“Collectively, our committed team will provide formal training, mentorship and research experiences for trainees to make significant contributions to the scientific literature, embark on successful academic careers, and improve the value and patient-centeredness of medical care,” Spertus said.

Hands-on research is one of the key components of the program that provides a basic foundation in clinical research, including a master’s degree in bioinformatics with a clinical research emphasis, and specialized skills for outcomes research, coupled with academic survival skills.

Hallmarks of the research experiences include multi-disciplinary group and individualized mentorship to meet each trainee’s needs, as well as access to numerous existing data. Clinical populations for primary data collection and implementation, training in entrepreneurship and highly experienced statistical support are provided to support trainees’ success.

Program enhancements are also planned that include a more robust collaboration with the University of Missouri system, increased engagement in clinical trial design and a growing focus on implementation science with access to HI-IQ’s multistakeholder collaboration of 19 regional hospitals.

School of Medicine recognizes first I-Ph.D. graduate

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Jeremy Provance was always interested in both health care and computers but wasn’t sure how to fit them together. The UMKC School of Medicine provided his answer.

As graduates of the School of Medicine took part in a commencement ceremony at Kansas City’s Kauffman Stadium on May 15 and 16, Provance became the first Ph.D. graduate from the medical school earning an interdisciplinary doctorate in biomedical and health informatics.

He describes the field as taking the enormous amount of health data that is generated every day and “making sense of all of those data points and telling the story about what is happening with our health.”

Provance didn’t know bioinformatics and data science existed until he found them as part of UMKC’s interdisciplinary Ph.D. program. The program allows students to work across disciplines to develop an individual academic plan geared to their specific interest.

Through collaboration with UMKC’s School of Graduate Studies, the School of Medicine started offering bioinformatics as a co-discipline in 2014 and as a primary discipline in 2017. Studying this emphasis, students like Provance primarily focus on biomedical data and knowledge, using that information in problem solving and decision making to develop technology and processes that will shape the future of health care.

Provance earned his master’s degree in bioinformatics at the School of Medicine in 2017.  He then continued in the I-Ph.D. program where he found several appealing factors during his studies, including the school’s quality of faculty, research opportunities and interdisciplinary aspect.

“My mentors were so critical to my success, and the faculty were such excellent people both in and out of the classroom. And bioinformatics is a such broad discipline – you can specialize in many different areas.”
– Jeremy Provance

“My mentors were so critical to my success, and the faculty were such excellent people both in and out of the classroom,” he said. “And bioinformatics is a such broad discipline – you can specialize in many different areas.” Provance’s studies focused primarily on cardiovascular outcomes research through the Mid America Heart Institute at Saint Luke’s Hospital.

Fostering collaborations with area institutions and corporations and across disciplinary boundaries are the program’s strengths, according to Jenifer Allsworth, Ph.D., and the bioinformatics department vice chair. “Through these partnerships, our students work with and alongside people from different organizations and backgrounds. We are training students to have the skills to best contribute in a rapidly evolving field.”

Provance says his overall goal is to understand “what we do well as individuals, doctors and health systems, and to encourage those practices and to identify areas for improvement to change them for the better.” Soon, he’ll be doing just that at the Yale School of Medicine, where he’s accepted a research position with its Vascular Medicine Outcomes Group.

“I would not have been successful without the guidance of my research advisor, Dr. Kim Smolderen, and my dissertation chair, Dr. John Spertus. And certainly there are so many others – brilliant researchers, administrators, clinicians, fellow students and more – that helped me find my way through this program,” he said.

Though he was familiar with bioinformatics through his master’s degree, Provance says it’s hard to anticipate doctoral work until you are going through it. His advice to others considering the I-Ph.D. program? Find a strong mentor and understand the importance of collaboration and networking. “It makes all the difference when you are identifying the path forward,” he said.

And though it was four years of hard work, overall, Provance says he’d do it all again. “But I’m glad I don’t have to!”

UMKC researcher helped lead studies published in New England Journal of Medicine

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UMKC School of Medicine researcher John Spertus, M.D., M.P.H., is part of two large NIH-funded clinical studies published in the New England Journal of Medicine, Monday, March 30. The studies indicate eliminating unnecessary revascularization treatments for cardiac patients could save the United States hundreds of millions of dollars annually.

Spertus serves as professor of medicine and Daniel J. Lauer, M.D., Endowed Chair in Metabolism and Vascular Disease Research at the School of Medicine, and Clinical Director of Outcomes Research at Saint Luke’s Hospital.

The studies looked specifically at coronary artery disease patients who had high-risk blockages with least 10 percent or more of the heart muscle being at risk. One focused on patients with preserved kidney function and the other targeted patients with end-stage kidney failure. That latter group has largely been excluded from almost all cardiovascular trials, despite having a high prevalence of coronary artery disease and death, Spertus said.

Both studies, conducted in unison, examined the most important outcomes for patients, clinical events (e.g. heart attacks, death) and patients’ symptoms, function and quality of life. Participants were randomized to undergo invasive angiography and revascularization with aggressive medical therapy or aggressive medical therapy alone. The goals of the medical treatment were cholesterol reduction, blood pressure control, aspirin and medications to treat chest pain.

The studies in patients with preserved kidney function showed that invasive medical procedures provided no reduction in clinical events, but did improve patients’ symptoms and quality of life, if they had chest pain within a month of entering the trial. These health status benefits were evident within three months and sustained out to four years.

“Importantly, this benefit was only observed in patients who had angina, chest pain, and not in asymptomatic patients,” Spertus said. “There is no indication for these procedures in patients whose symptoms are well-controlled with medications alone. If we avoided revascularization in asymptomatic patients, we could potentially save about $500 million to $750 million a year in the United States alone.”

Among patients with very severe kidney disease, there was no significant difference in clinical events or in patients’ symptoms and quality of life.

“While disappointing, this is a very ill patient population for whom an aggressive, invasive treatment strategy does not seem to offer much benefit,” Spertus said.

The NEJM is publishing four papers from these studies on March 30, one for each trial focusing on the clinical events and another for each trial focusing on the quality of life outcomes. Spertus was involved in writing all four and is the lead author on the two quality of life papers. He and his team designed, analyzed and led the health status, quality of life components of both trials.

Spertus is the author of the Seattle Angina Questionnaire (SAQ) that used in the studies. It is widely recognized throughout the world as the gold standard for quality of life measurement in cardiac medicine.

“Our group has led its use and analyses in multiple studies and quality improvement efforts,” Spertus said. “In light of these findings, the SAQ may start becoming a routine part of clinical care in cardiology.”

Research Study Can Help People Get Healthier

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Enhanced Lifestyles for Metabolic Syndrome trial will test group vs. self-directed approaches

UMKC is looking for participants.

Metabolic syndrome is a bundle of risk factors caused by common lifestyle choices that can lead to serious conditions such as diabetes, stroke, heart disease and cancer. Currently, one-third of Americans have metabolic syndrome, up from one-fourth a decade ago.

Over the next two years, with funding from the William G. McGowan Charitable Fund, the Enhanced Lifestyles for Metabolic Syndrome (ELM) Trial, developed at Rush University Medical Center in Chicago, aims to enroll 600 people who are at high-risk chronic disease and are interested in managing this risk by optimizing their lifestyle. In addition to UMKC at Truman Medical Centers in Kansas City, the other sites are Rush in Chicago; University of Colorado Denver; Geisinger Health System in Wilkes-Barre and Scranton, Pennsylvania; and Rochester Institute of Technology in New York.

The Kansas City study site is overseen by a prestigious UMKC School of Medicine team of principal investigators: endocrinologist Betty Drees, M.D., dean emeritus of the school and Jannette Berkley-Patton, Ph.D., director of the Health Equity Institute; and Matthew Lindquist, D.O.

“Metabolic syndrome is a serious condition because it is so common, and it can silently increase risk of heart disease and stroke without early warning symptoms,” Drees said. “Research into how to stop it early and keep it controlled is very important in preventing heart disease in individuals and in the population as a whole.”

Starting in January, participants will engage in the program for six months, and then will be followed for an additional 18 months, to allow for an assessment of how well they have been able to sustain the good habits they developed and the health benefits they received.

“We know that making these small lifestyle changes can have a big impact on people who have health issues that indicate they may have metabolic syndrome. Plus, everyone who participates will receive a free Fitbit. Other lifestyle-change programs can cost upwards of $500, but ELM will be free to our participants, which is awesome.” – Jannette Berkley-Patton

photo of vegetables and free weights

The ELM program provides tools, methods and support for healthier eating, increased physical activity and stress management. Guidelines include making vegetables half of every lunch and dinner, exercising for at least 30 minutes on most days, and learning to be less reactive to stressors.

The Rush team has been studying a group-based version of ELM for nearly a decade. The group approach, which has been shown to be effective, requires participants to attend meetings. While those can be helpful, they’re time-consuming and may be inconvenient; from a public-health standpoint, groups are expensive and labor-intensive. So researchers want to know: Can we simplify this treatment? Can participants get the same or better health results under their own direction, with only minimal contact with the program?

“Metabolic syndrome is a serious condition because it is so common, and it can silently increase risk of heart disease and stroke without early warning symptoms. Research into how to stop it early and keep it controlled is very important in preventing heart disease in individuals and in the population as a whole.” – Betty Drees

For this study, a “self-directed” program will be compared to a group-based program, with the best lifestyle information available in clinical practice today provided in both..

Everyone in the self-directed arm will be assigned to a coordinator, and will receive a Fitbit activity tracker, access to the program’s website and monthly tip sheets for six months.

In the group-based program, participants will get most of those things, too. But instead of the tip sheet, group members will meet for an hour and a half weekly for three months, biweekly for an additional three months, and monthly for 18 months after that. They will also have access to the ELM website. They will learn, for example, to distinguish when they are eating because they are hungry from when they turn to food because it is available or they are bored or sad.

Participants in both arms of the program will report for three follow-up visits so their progress can be assessed. They will receive lab results and physical measures after each visit.

“We are hoping we can learn how self-guided and group support programs can help people eat healthier and move more,” Berkley-Patton said. “We know that making these small lifestyle changes can have a big impact on people who have health issues that indicate they may have metabolic syndrome. Plus, everyone who participates will receive a free Fitbit. Other lifestyle-change programs can cost upwards of $500, but ELM will be free to our participants, which is awesome.”

How to participate

Participants in the study must be ages 18 years or older, not have diabetes, speak English, be willing to commit to a healthy lifestyle and have at least three of metabolic syndrome’s five risk factors:

  • Central fat (waist circumference of 40 inches or more for men, 35 inches or more for women)
  • High blood pressure
  • High blood sugar
  • Low HDL cholesterol
  • Elevated triglycerides

A condition of enrollment is a willingness to participate in either arm of the trial. Participants will not get to choose. To participate in the Kansas City area, email ELMtrial@tmcmed.org or call Alex Lyon at (816) 404-4418.

A woman in an exercise class

Spertus involved in big stent study

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A leading UMKC and Saint Luke’s Health System researcher, John Spertus, M.D., M.P.H., was heavily involved in important heart-procedure research that was published earlier this month and presented at the annual conference of the American Heart Association.

You can read an interview with Spertus about the research here.

A Washington Post story said the study, called ISCHEMIA, found that invasive procedures to unclog blocked arteries — in most cases, the insertion of a stent, a tiny mesh tube that props open a blood vessel after artery-clearing angioplasty — were no better at preventing heart attacks and death in patients with stable heart disease than were pills and improvements in diet and exercise. Overall, the study results suggest that invasive procedures, stents and bypass surgery, should be used more sparingly in patients with stable heart disease and the decision to use them should be less rushed, experts said.

Spertus is a UMKC professor of medicine and Daniel J. Lauer Endowed Chair in Metabolism and Vascular Disease Research. At Saint Luke’s Mid America Heart Institute, as clinical director of outcomes research, he developed technology that guides physicians and patients in medical-decision making by using models to measure and predict the risk factors of various procedures. Many experts cite two tools he created — the Seattle Angina Questionnaire and the Kansas City Cardiomyopathy Questionnaire — as the gold standards for measuring symptoms, function and quality of life in treating coronary artery disease and heart failure. Both have been translated into more than 95 languages.

A year ago he received the American Heart Association’s 2018 Distinguished Scientist Award. He previously received the association’s Lifetime Achievement Award in 2015 and the Council on Quality of Care and Outcomes Research Distinguished Achievement Award in 2013.

 

Health for all remains an elusive goal

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From left: Rex Archer, Mary Anne Jackson, Eric Williams, D. Rashaan Gilmore and Bridget McCandless.

Community leaders discuss UMKC efforts to close gaps

Health equity is a broad concept that encompasses differences in disease and mortality rates, and in access to healthcare services, among different population groups. It also includes differences in social determinants of health, such as poverty, exposure to toxins and access to healthy food.

UMKC leadership quantifying and addressing these differences was the focal point of the UMKC Engagement Showcase, the university’s signature event celebrating Engagement Week – a special week of engaged leadership, partnership and learning hosted by UMKC and the UM System.

The event included a demonstration of the System’s new online Engagement Portal and a panel discussion on health equity led by the director of the new UMKC Health Equity Institute, Jannette Berkley-Patton, Ph.D., of the UMKC School of Medicine.

Engagement with community partners by the UM System and its four universities is hardly a new phenomenon. Curt Crespino, UMKC vice chancellor for external relations and constituent engagement, noted that UMKC history is rooted in an enduring city-campus partnership.

Marshall Stewart, chief engagement officer for the UM System, said what’s new is a more systematic and coordinated approach to engagement, including a transformation of the system’s Extension programs, designed to expand engagement beyond Extension’s original rural focus to forge engagement partnerships in every community and corner of the state.

“Urban and rural communities are facing very similar issues across Missouri. Our mission is to work together with all of our stakeholders to expand our impact by using our research to help transform lives,” said UMKC Chancellor Mauli Agrawal. “That spirit of connection to the city and engagement with our community was woven into the origin story of UMKC. And we are excited to take those efforts to the next level in collaboration with the efforts being led by the system.”

Following are excerpted highlights of the health equity panel.

Jannette Berkley-Patton, director, UMKC Health Equity Institute:

“We spend billions on healthcare but are still one of the unhealthiest countries in the world.” The burden of health disparities rests primarily on groups outside the mainstream, including people of color, rural communities, veterans and seniors. Large federal grants allow for the creation of effective programs, “but what happens when the grant ends? Everything goes away. We need to figure out how to take the Cadillacs we create with these million-dollar grants and turn them into Pintos.”

Rex Archer, director, Kansas City Health Department:

“We need to change the structural issues that create the (health equity) problem.” These include issues with disparities in housing, poverty, education, safety and more.

Mary Anne Jackson, interim dean, UMKC School of Medicine:

In 2014, the Kansas City area had to contend with a large outbreak of a serious respiratory illness among school-age children. Researchers were notified early enough to identify the virus responsible and contain the outbreak. “We were able to address this in time because of the strong connections we have with people in the community who brought it to our attention.”

Eric Williams, pastor, Calvary Temple Baptist Church:

Conducting funerals for victims of gang violence and AIDS led Williams to involvement in public health. “Conversations about HIV were happening, but it was all on the down-low. (Berkley-Patton) helped us to understand that some of the things we were already doing were working” to change behaviors.

Rashaan Gilmore, founder and director, BlaqOut:

BlaqOut surveyed gay African Americans about their health care priorities, and the top response was health care access. “It was because they didn’t feel welcomed by traditional providers. We asked them to recommend strategies to address that, and we developed interventions based on those results.”

Bridget McCandless, former president and CEO, Health Forward Foundation:

After 15 years working in a free health clinic, she changed her approach from providing care to impacting policy “because I saw that policy could be far more effective.” Citing a sampling of dramatic health disparities between local white and black populations, she said “there’s no excuse for us to have disparities like that.” Data analysis can empower highly effective strategies if we act on the findings. “We’re getting smart enough to figure this out. (Data-driven policy) can be the new germ theory; it can revolutionize the delivery and effectiveness of health care.”