Making access to health care more equal is a tough task, and a pandemic only makes the job tougher. To help, the UMKC Health Equity Institute is trying a new tool — mini-grants to university researchers and their community partners — to boost those efforts.
“We have about $12,000 to $15,000 to spend, and we think putting $1,000 to $2,000 in the right places could help eight to 10 projects move forward,” said Jannette Berkley-Patton, Ph.D., the director of the institute and a professor in the UMKC School of Medicine. “Sometimes help paying for study participants, software, consultants or other resources can make a real difference.”
Though small, the grants could be the seed money — or the Miracle-Gro® — needed to turn ideas into budding projects that encourage and measure the effectiveness of community health efforts.
The brief application for the mini-grant program is available now, and institute members are encouraging researchers and community groups to submit their joint applications. Applicants are strongly encouraged to attend a webinar Oct. 16 to learn information about the mini-grants. Important information, such as budget documents and the grant program overview, are available, as well.
Applicants will have until Nov. 9 to submit their proposals, after which finalists will be chosen. The finalists then will give short oral presentations and recipients will be chosen. The institute plans to have the funds available at the beginning of 2021.
“We’re hoping the mini-grants stimulate our researchers to be creative and to collaborate with community partners — or build relationships with new partners,” Berkley-Patton said. “The institute’s steering committee will evaluate the applications, and we hope to have applicants make a brief, but impactful, oral pitch for their proposals sometime this fall in a virtual presentation akin to “Shark Tank®.”
The idea behind the Health Equity Institute, an initiative Chancellor C. Mauli Agrawal started in April 2019, is to partner UMKC researchers with community groups, non-profits and government agencies in underserved areas on projects that aim to improve community health.
The institute, for example, is working with the Kansas City Area Transportation Authority to evaluate the impact of the city’s now-free bus service on health outcomes. The institute wants to understand whether their recruited residents’ health and overall well-being improve because they walk more and have better access to jobs and health care through the free transit system. The institute has also helped the Kansas City, Missouri, Health Department conduct COVID-19 drive-through testing by coordinating more than 90 student volunteers. The students helped with intake, traffic control and providing COVID-19 information to people seeking testing.
The institute also helped with formation of an interfaith ministers’ group, the Clergy Response Network,
founded to address COVID-19 inequities in Kansas City’s faith-based settings, and has created a church reopening checklist for clergy. The network recently received 30,000 face masks to distribute to congregations to help slow the spread of the coronavirus.
Berkley-Patton is a veteran of community-based health research, including studies that engage churches and other community-based organizations’ in efforts to combat health disparity issues such as HIV and other STDs, mental health, obesity and diabetes.
“We need more research projects that improve the health of people where they live, play, worship and work, and projects that can be sustained for the long haul after research shows they work,” Berkley-Patton said. “We think these mini-grants can get more projects like these up and running while engaging the community in research efforts that we hope will reduce disparities and improve health in Kansas City’s urban areas.”
Traci McDonald has joined the UMKC School of Medicine Office of Research Administration as a grants support specialist.
She comes to UMKC from Hallmark Cards, where she worked as a demand/inventory analyst. She was later promoted to product execution specialist. She has a bachelor’s degree from Ottawa University in Ottawa, Kansas.
McDonald enjoys crafts, party planning, wedding decorating, and shopping. She has two children.
The newest member of the Office of Research Administration says she is looking forward to working with researchers at the School of Medicine and School of Nursing and Health Studies, and with clinicians and residents who conduct research activities at Truman Medical Center.
The University of Missouri-Kansas City School of Pharmacy has been awarded a $1.5 million grant from the National Institutes of Health (NIH) to continue work on an important advancement to help treat the tens of millions of people who have diabetes.
The lifetime burden of constantly checking blood sugar and injecting insulin is significant. UMKC research has developed a way of delivering insulin to diabetics that eliminates pumps and most injections.
“We’re aiming to improve the lives of diabetics all over the world,” said UMKC pharmacy professor Simon Friedman, the principal investigator on the grant.
Normally, diabetics must inject themselves with insulin numerous times per day to enable the body to absorb blood sugar. The amount of insulin needed and timing vary with what an individual eats and their activity level. With blood glucose continuously varying, the insulin requirement parallels the amount of glucose in the blood.
The only clinically-used method to permit continuously variable delivery of therapeutic proteins like insulin is a pump. But they do so at a high cost: a physical connection to the outside of the patient, where the drug reservoir resides, and the inside of the patient, where drug absorption will ultimately take place. This connection in insulin pumps is a cannula — or needle — which can be dislodged, crimped, snagged, infected and most importantly, rapidly gets biofouled from moisture after implantation. This leads to variable and unpredictable delivery.
For several years, Friedman and his lab associates have been developing a method in which a single injection of a material called a PAD (photo-activated depot) can take the place of multiple normal insulin injections and allow for minute-by-minute automatic updating of insulin release. The material is injected into the skin like insulin, but lies dormant until a beam of light stimulates release of insulin, in response to blood sugar information.
The new grant will help make the technology more reliable for someone to use and easier to manage.
“With the improvements, we anticipate creating a new and revolutionary approach to continuously variable protein delivery, one that minimizes invasiveness and maximizes the close matching of therapeutic with patient requirements,” Friedman said.
Karen Kover, associate professor of pediatrics at the UMKC School of Medicine and Children’s Mercy, has been an integral member of the research team for years, and Friedman is grateful for her collaboration.
Reviewers of the grant application praised the work, and Friedman, who has won previous NIH funding, said this was his highest rated grant award.
“We are grateful for the enthusiastic response from the NIH study section, given the very competitive nature of funding at this time during the pandemic,” said UMKC Vice Chancellor for Research Chris Liu.
The project is supported by the National Institute of Diabetes and Digestive and Kidney Diseases at the NIH.
In people with type 1 diabetes, the pancreas no longer makes insulin. Patients need insulin to process sugar from meals.
People with type 2 diabetes make insulin, but their bodies don’t respond well to it. At first the pancreas produces extra insulin to make up for it. But over time it isn’t able to keep up and can’t make enough insulin to keep blood sugar at normal levels.
About 34.2 million children and adults in the U.S. — 10.5% of the population — have diabetes, according to the Centers for Disease Control and Prevention. More than 25 percent use insulin shots. About 86 million people ages 20 and older in the U.S. have prediabetes.
Complications from diabetes include heart disease and stroke, high blood pressure, blindness, kidney disease, nervous system damage and amputation.
People with diabetes risk more serious complications from COVID-19 than others who do not have the disease.
“Through research at UMKC, we strive to improve the health of not just our community but our entire population,” said Chancellor Mauli Agrawal. “We are proud of Dr. Friedman and his team’s innovation, which could significantly benefit people around the world.”
The event brings together members of the UMKC health sciences community in a forum that highlights the research being conducted by students. It also fosters research collaborations across disciplines and schools to produce economic, health, education and quality of life benefits for the Kansas City community.
Students were invited to either present a poster or give an oral PowerPoint presentation of their research findings. A panel of judges selected the top three in both graduate student and undergraduate divisions.
Judges were from the School of Medicine, School of Pharmacy, School of Nursing and Health Sciences, School of Biological and Chemical Sciences, Truman Medical Centers, Children’s Mercy Kansas City Hospital and the Kansas City Veterans Administration Medical Center.
This year’s research summit drew 66 participants, including 51 medical students, eight pharmacy students, two from the School of Biological and Chemical Sciences and two from master’s programs.
Graduate Clinical Poster Presentations (BA/MD and MD Year 5 and 6 medical students, master’s students, Pharm.D. students and medical residents)
1st Place: Mark Gray, master’s student SBCS: Bone Strain Alters Cardiac Function. Mentor: Michael Wacker, SOM
2nd Place: Suma Ancha, SOM MS VI: Electronic Health Record Functionality: Medical Students’ Perspective.
3rd Place Tie: Brooke Jacobson, PharmD YR4: Development of a Cystic Fibrosis Specific Antibiogram. Mentor: Claire Elson, CMH
3rd Place Tie: Rachna Talluri, SOM MS V: The influence of maturity on the relationship between the triglyceride/HDL ratio and vascular health in children and adolescents with dyslipidemia. Mentor: Geetha Raghuveer, CMH
3rd Place Tie: Brandon Wesche, SOM MS VI: Transcriptome Changes after Glucocorticoids for Bronchopulmonary Dysplasia. Mentor: Paula Monaghan Nichols, SOM
Graduate Oral PowerPoint Presentations (BA/MD and MD Year 5 and 6 medical students, master’s students, Pharm.D. students, and medical residents)
1st Place: Darya Tajfiroozeh, SOM MS VI: Immune profiling of dexamethasone response in treatment of bronchopulmonary dysplasia. Mentor: Paula Monaghan Nichols, SOM
2nd Place: Andrew Peterson, SOM MS V: Development and Validation of the Nasal Outcome Score for Epistaxis in Hereditary Hemorrhagic Telangiectasia (NOSE HHT). Mentor: Jay Piccirillo, Washington University-St. Louis
3rd Place: Emily Boschert, SOM MS VI: 22 Years of Pediatric Musculoskeletal Firearm Injuries: The Carnage Continues. Mentor: Richard Schwend, CMH
Undergraduate Poster Presentations (BA/MD and MD Years 1 to 4 medical students, School of Biological and Chemical Sciences students)
1st Place: Adnan Islam, SOM MS IV: rfaZ’s Role in Escherichia coli Neonatal Sepsis: In-Vitro Bacterial Growth. Mentor: Susana Chavez-Bueno, CMH
2nd Place: Som P. Singh, SOM MS III: Mental Health Outcomes of Early-Entrance to College Students: A Cross Sectional Study. Mentor: Jianwei Jiao, SOM
3rd Place: Shil Shah, MS III: The Effects of Necrotizing Enterocolitis on Cytoskeletal Genes in Gut Epithelium. Mentor: Paula Monaghan Nichols, SOM
Undergraduate Oral PowerPoint Presentations (BA/MD and MD Years 1 to 4 Medical students, School of Biological and Chemical Sciences students)
1st Place: Madhavi Murali, SOM MS IV: Challenges of interpreting Naranjo causality assessment of pediatric adverse drug reactions. Mentor: Jennifer Goldman, CMH
2nd Place: Aarya Ramprasad, SOM MS II:Contributions to Health Disparities Observed in the COVID19 Pandemic. Mentor: Bridgette Jones, SOM
3rd Place: Victoria Shi, SOM MS II: Transcriptome Analysis of Patients with Bronchopulmonary Dysplasia. Mentor: Paula Monaghan-Nichols, SOM
When Chancellor C. Mauli Agrawal needed someone to head the new UMKC Health Equity Institute, he didn’t have to look far. The School of Medicine’s Jannette Berkley-Patton is a leader in community health research — just the right person to direct the institute, which is charged with combining the university’s research strengths with community groups’ grass-roots involvement to identify, quantify and reduce health care gaps.
Berkley-Patton, Ph.D., a professor in the school’s Department of Biomedical and Health Informatics, might be best known for her Taking It to the Pews project, an outreach effort through local churches that gets people tested for HIV. She also is director of the UMKC Community Health Research Group, putting her in an ideal position to bring together the university’s research programs and Kansas City social services groups and agencies.
In the year since Agrawal announced the institute, Berkley-Patton has made sure it got off to a running start. The institute has helped new projects large and small, with the goal of lasting improvements in health across social and economic classes. Anything that might improve health — from providing better transportation and more-affordable care to encouraging better eating and exercise — could be involved.
“We spend billions on health care but are still one of the unhealthiest countries in the world,” said Berkley-Patton, who has degrees in engineering, human development and family life, and child and developmental psychology. “Large federal grants can help create effective programs, but we need sustainable improvements that continue when the grants end.”
Berkley-Patton also is determined to keep the institute’s momentum moving forward, despite the COVID19 disruptions to health care and the wider economy.
“In fact,” she said, “the Health Equity Institute is even more important than ever given that these underserved folks who historically have had more challenges in accessing health care services are likely to be hurt the most by the disruptions.
Get on the bus
One big project for the institute will be tracking how free bus service affects people’s health. This year, Kansas City, Missouri, plans to become the first large city with free public transit — dropping bus fares to zero to match the city’s streetcars, which already are fare-free.
The institute, recognizing a golden opportunity to measure the benefits of free public transit, has drawn up a multi-step research plan and submitted ambitious applications for grants from the National Institutes of Health and the Centers for Disease Control.
The CDC grant calls for research into “a natural experiment,” Berkley-Patton said, “and if ever there was a natural experiment, offering free transit is it.”
She continued, “We know from other research that people who use public transit tend to get 5 to 15 minutes more physical activity than non-riders, just getting to and from public transit. So if free bus service increases ridership, we hope to also see improvements in the health of people in low-income areas.”
The institute will start by gathering baseline data, both from comparable cities’ transit systems and from 500 current riders. The plan for identifying those people and getting data from them has been approved by UMKC’s Institutional Review Board, which ensures that research subjects are treated ethically. That data gathering is on hold over COVID-19 concerns, but the institute is ready to go when the situation improves.
The CDC grant the institute seeks calls for data on 10,000 people, which defies individual recruitment. “So, we’re proposing to collaborate with the Truman Medical Centers,” Berkley-Patton said. “We have identified 11 low-income ZIP codes, and TMC has data on thousands of people that can serve as a measure of the health of those areas.”
Of those patients, the institute hopes to have 4,000 take a brief survey, to gauge some basics about them such as income and incidence of health problems including diabetes and obesity.
The institute also plans to recruit 200 occasional bus riders to track, to see whether free service turns them into regular riders, and whether that improves their health.
Berkley-Patton says the elimination of fares should be a good incentive, saving a regular rider an estimated $1,500 in transit costs. And the research should identify other possible benefits, such as having access to more and better jobs.
“We’ve had lots of collaboration on this already to design research and make our grant proposals,” Berkley-Patton said, ticking off allies from Children’s Mercy, the Kansas City Area Transportation Authority and Public Works Department, UMKC Departments of Economics and Psychology, and the Schools of Dentistry, Medicine, and Nursing and Health Studies.
Now the institute must wait — on whether it gets CDC and NIH money to go full bore on its plans, and on when people can resume more normal living and head to jobs, doctor’s appointments and other activities.
‘They miss recess’
Another project is Youth Engagement in Sports, or YES, led by Joey Lightner and Amanda Grimes, UMKC assistant professors in the School of Nursing and Health Studies. When their proposal received an $800,000 grant from the U.S. Department of Health and Human Services, Grimes described the need to increase activity in middle school students.
“The evidence is very clear that American youth suffer from high rates of obesity, inactivity and poor nutrition,” said Grimes, who has a master’s degree in health science and a doctorate in community health.
“Adolescence seems to be a critical time in a child’s life where behaviors are learned or reinforced. Girls are particularly prone to low rates of physical activity during adolescence.”
The YES program will help students at two Kansas City middle schools, Central and Northeast, said Lightner, who has a master’s in public health with an emphasis in physical activity, and a Ph.D. in kinesiology.
According to Lightner, sixth- through eighth-graders are in a tough place between elementary and high school. “In talking with them, we found out they miss recess. They don’t get to play anymore. And they’re suddenly supposed to be adults, often without all the information they need on health and nutrition.”
One goal of the institute is to come up with innovative programs, and YES is certainly that.
“So after school, we’re going to give them a big, healthy snack and then there’s a physical activity intervention — they get to play,” Lightner said. “We’re going to offer competitive and non-competitive games, because we’ve found that some students gravitate to one kind of sport or another.”
By reaching out to the students and their schools, the program also embodies the institute’s emphasis on community engagement. And it draws heavily on another institute strength — collaboration.
TMC’s Mobile Market, which brings healthy foods to underserved areas, will give students a weekly bag of produce along with recipes. Children’s Mercy consulted on the program, providing its expertise with young people’s health. The Kansas City Department of Parks and Recreation will help with the sports activities.
And Lightner, as director of the UMKC Public Health Program and a new bachelor’s degree under it, has recruited undergraduate students to help gather data — and get first-hand experience in devising and tracking the sorts of programs that could become integral in their careers.
The program’s aim is to help at least 300 students at the schools in summer sessions, and then again in the fall. Of course, the level of disruption and other unknowns caused by COVID-19 make it hard to plan. But when school is back in full swing, Lightner wants YES to be making a difference.
“We know this is a pivotal time for students, especially girls,” Lightner said. “Peer groups are really important; there’s a mentality of, ‘If my friends are doing it, I’ll do it.’ So if we get them engaged in physical activity with their friends at this age, they’re likely to continue. And so many benefits, from physical and mental health to staying in school and achieving academically, have been demonstrated.”
Seeding other efforts
Another goal of the institute is to communicate across the university and among hospitals, government health agencies and community groups. A database is being compiled for training and other resources, along with opportunities to collaborate.
The institute’s new website will be a clearinghouse for everything from health indicators to grant opportunities and processes. That could help community groups connect, for example, with the Health Forward Foundation, a Kansas City fund that promotes healthy communities.
The institute also will be awarding mini-grants, with the aim of giving several community groups a few hundred dollars each for health-related training, software, added staff help and other basics.
Overcoming health disparities is a huge task, made more daunting by the COVID-19 disruptions. But BerkleyPatton and other Health Equity Institute partners have had success in the past and will keep looking for new ways to reshape access to health care.
“It will be a while before we know how much damage the pandemic has done,” she said. “But we do know that research programs that involve people in improving their own health can make a real difference, and it’s going to take all the innovative, collaborative efforts we can build to help those most affected.
Like many young, aspiring athletes, Som Singh saw his football career end early with an injury during high school. Yet, his love for sports never waned. Now, it could be taking the fourth-year UMKC medical student to the European College of Sports Science in Spain next fall to present as lead author of a research project on rugby player injuries.
His work is part of a project affiliated with the Hospital for Special Surgery in New York and the Rugby Research and Injury Prevention Group (RRIPG) that has been monitoring U.S. Rugby Club-Sevens player injuries and performance.
“The culture of sports has always had an impact on me and I wanted to stay around sports,” Singh said.
When he first came to the School of Medicine, Singh used what free time he had to help as a volunteer assistant football coach at a local high school. While coaching, he realized the hunger to be connected to sports still burned.
“Coaching players was cool, teaching, talking to the players,” Singh said. “That aspect of teaching sports was unique and it led me to seek out other things I could do to combine sports and medicine.”
About a year ago, a national rugby tournament came to Kansas City. Dr. Victor Lopez Jr., founder and executive director of the RRIPG in New York, arrived as well to study the players on the field, monitoring their injuries and the effects on their performance. Lopez was also looking for medical students and residents to help with his project. A UMKC orthopaedic surgery resident who knew both Lopez and Singh introduced the two.
Singh began working on the sidelines in the medical tents and soon became the assistant national study coordinator for the group, attending countless rugby matches and collecting injury data.
His report, which was based on a five-year analysis of medical costs related to player injuries sustained in U.S. Rugby-Sevens regional tournaments, caught the eye of the European College of Sports Sciences.
He said his findings could serve as a profile of the financial impact that sports injuries have on both men and women players. Much like the National Football League has done in developing its concussion protocols, Singh said his data could also serve as a tool for national U.S. Rugby-Sevens to improve player welfare and safety.
“It is a growing collision sport,” Singh said of rugby.
Singh also is co-author of two other group abstracts that were selected for presentation at the international conference in Seville, Spain – assuming limitations brought by the novel coronavirus are lifted and allow the conference to take place.
In addition to Lopez, the project has Singh working closely with Dr. Richard Ma, Gregory L. and Ann L. Hummel Distinguished Professor in Orthopaedic Surgery Missouri Orthopaedic Institute at the University of Missouri-Columbia, and Dr. Answorth Allen, an orthopedic surgeon at the Hospital for Special Surgery in New York and team doctor for the NBA’s New York Knicks.
Singh said he doesn’t plan to let up on his injury prevention research with the group anytime soon.
“We have plenty of studies coming up,” he said. “I’m booked for the next couple of years. We’re continuing to grow and understand more about sports injuries.”
Driven. Creative. Optimistic. Curious. Determined. Smart. Happy. These are common traits found in successful entrepreneurs. All of them are found in Fahad Qureshi.
A third-year medical student at UMKC, Qureshi took third place in the UM System Entrepreneurship Quest Pitch Competition, where 20 student teams from across the four campuses presented innovative business ventures.
Qureshi is the founder and creator of Vest Heroes, which uses a system of pulleys and levers in the operating room to relieve surgeons from bearing weighted lead X-ray skirts and vests during long procedures. Wearing the vests are required by law and protect health care professionals from radioactive exposure. But they are heavy – between 30 and 69 pounds – and can hinder mobility.
Qureshi wasn’t nervous during the final rounds of competition, as he’s had the idea for a long time and knows the product well. In fact, his invention is patent-pending, and he’s launched a company to fulfill orders for 100 vests that will be used throughout the country. “I strongly believe in the idea,” he said, “and it was great to get affirmation from the judges. To know it’s real and it’s working – I feel good about that.”
As a child, Qureshi had a good friend who died during an operation following a bad accident. He heard the surgeon say that wearing his 60-pound vest made it hard for him to make movements during his friend’s operation – and that’s something he never forgot.
While finding a way to reduce the weight of these vests has been in his head for a long time – “10 to 12 years, maybe more” – he didn’t have the background needed to solve it … until medical school.
Once at UMKC, he gained academic understanding, expanded his medical knowledge, got into the operating room and participated in an engineering apprenticeship, completely independent of the School of Medicine.
“Just because you are practicing medicine doesn’t mean you can’t do anything else,” he said. “I wasn’t looking for credit, I was looking for knowledge.”
He also found a local engineering firm to help out.
“When you have an interdisciplinary approach, that’s when you can really solve problems. Without medicine, I wouldn’t know what to build,” he said. “Without engineering, I wouldn’t know how to build it.”
In addition, Qureshi reached out to various physicians to get their opinions – how to improve the vest, how to grow consumer interest, what did and didn’t work well. His biggest support has come from Bogdan Derylo, M.D., a nephrologist from his hometown of Chicago and Akin Cil, M.D., UMKC professor and the Franklin D. Dickson/Missouri Endowed Chair in orthopaedic surgery.
“All of the feedback received was terrific,” Qureshi said. “The final model is a culmination of all the suggestions they provided.”
Qureshi, who worked minimum-wage jobs to fund the company so he can retain full equity, says mass distribution is his ultimate goal. He’s currently working with a Chinese manufacturer to help produce large numbers of the Vest Heroes, although that is sidelined now due to the coronavirus pandemic.
“Any doctor or health care professional that uses radiation has a need for this,” he said. “There’s really no downside to using it – it’s a necessity, as I see it.”
There’s no doubt that Qureshi’s entrepreneurial spirit motivates him, but he sees health care connecting it all. As for his future, he plans “100 percent to practice medicine.” And part of that plan includes research, his company and teaching the next generation of doctors.
“When you choose what you do every day, it should be something that makes you happy. Going to work shouldn’t be scary or dreaded. If your work makes you happy, you’re doing something right.”
In addition to Qureshi, the UMKC teams presenting pitches during the final competition were Greyson Twist, Ph.D., bioinformatics and computer science major presenting his Genalytic project; and Kyle McAllister, business administration graduate student presenting his company Compost Collective KC.
The National Institutes of Health awarded a $3.3 million grant to Jannette Berkley-Patton, professor, at the University of Missouri-Kansas City School of Medicine, to help improve diabetes prevention outcomes with African Americans.
“This is an extension of what we’ve been doing in the School of Medicine with Project FIT, which stands for Faith Influencing Transformation” says Berkley-Patton, Ph.D., director of the UMKC Health Equity Institute and the Community Health Research Group. With Project FIT, nearly 900 people have participated in the program and more than 200 medical, physician assistant, nursing and health studies and psychology students have been trained as FIT health coaches to help deliver the program.
At UMKC, Berkley-Patton has won other significant grants that focus on improving the health of African Americans, and each centers on health inequities and community-engaged research with African American community-based organizations, including places of worship because of their cultural importance. This new five-year grant, which starts on April 1, will include similar strategies. To date, Berkley-Patton’s work has been supported by more than $10 million in federal grants over the past 14 years.
The grant will tailor the Centers for Disease Control and Prevention’s National Diabetes Prevention Program, an evidence-based lifestyle change intervention, with 360 African American pre-diabetic participants recruited from Truman Medical Centers. The program includes 22 group sessions that take place over one year and primarily focuses on eating healthier and exercising regularly.
Preventing diabetes can help stave off other associated chronic health issues including blindness, kidney failure and heart disease.
People who participate in the CDC program aim to lose 5 to 7 percent of their body weight and exercise 150 minutes per week, which have been shown to reduce the risk of diabetes by up to 60 percent. The program has also been found to outperform pre-diabetes drugs such as Metformin.
However, African Americans typically don’t fare as well, especially women and those with low incomes. Some of the issues include barriers such as cost of the program, transportation, childcare, access to healthy food and places to exercise. These barriers are often referred to as social determinants of health.
“With the grant, we’re trying to address every barrier related to social determinants,” Berkley-Patton said. “The most successful outcomes are correlated with attending the sessions – the more sessions attended, the better the outcomes.”
The grant will support linking Truman Medical Centers patients to FIT Diabetes Prevention Program classes in their home communities via church, community center or neighborhood association settings. The program will be culturally-tailored for African American adults. The program is at no cost to the participant – typically it costs $450 per year. In addition to Truman Medical Centers, program partners include several urban Kansas City churches, Calvary Outreach Network, YMCA, Chestnut Resource Center, KC Care Health Center, Children’s Mercy and the University of Kansas.
Although the grant begins this week during a pandemic that has Americans sheltering in place and working from home, the first year of the grant is a planning year.
“With this grant, we are looking forward to further refining our current Project FIT program to have trained UMKC students and community members working side-by-side as FIT coaches,” says Carole Bowe Thompson, project director, UMKC Community Health Research Group.
The program will be launched by this time next year.
“We are looking forward to getting started,” Berkley-Patton said. “We want to show participants that here’s a premiere program designed just for you.”
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.”
“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.”