World renowned leaders in medical ethics and simulation…..

At present most of our programs are in the primary care research areas of health services research and clinical epidemiology. Our faculty include national leaders in minority health, health services research and community based participatory research and we lead several large government and foundation sponsored projects in these areas. Among the specific diseases we focus of our research on are cardiovascular disease, cancer (breast, colon, cervical), hypertension, cholesterol, diabetes and HIV. Our faculty also include world renowned leaders in medical ethics and simulation research.

The Division of General Internal Medicine research faculty have a wide range of research interests in areas, such as minority health, health disparities, medical education and health services research. Among the specific diseases, we focus of our research on cardiovascular disease, cancer (breast, colon, cervical), hypertension, cholesterol, diabetes and HIV. Our faculty also include world renowned leaders in medical ethics and simulation research. Below is a description of a few of the major research programs being led by our faculty.

Increasing Uptake of Evidence Based Screening Services though a CHW-led multimodality program: The South Florida Center for Reducing Health Disparities

The mission of the University of Miami’s South Florida Center for Reducing Health Disparities (SUCCESS) is that through collaborative participatory research with we can improve the health of South Florida’s most vulnerable populations. Our conceptual approach has been to test innovative technology driven approaches to deliver early detection and prevention services among hard to reach populations within their local environment. We seek to further enhance and build on our existing research to test a Community Health Worker (CHW) led multi modality early detection and/or prevention strategy for four health priority conditions: HIV, Hepatitis C, colorectal cancer (CRC), and cervical cancer. Minority groups suffer disproportionately from conditions such as HIV, Hepatitis C, colorectal and cervical cancer. Strategies that can increase rates of screening for these conditions among minorities can help narrow such disparities. Community health workers will use recent advances in home testing technology to see if having these screenings services done at home leads to more screenings than simply referring persons to more traditional medical care.

PCORI- Partnership for Training Community Health Workers in PCOR (Patient Centered Outcomes Research)

The meaningful engagement of communities, patients and other stakeholders is key to patient centered outcomes research. One important stakeholder group in PCOR research are Community Health Workers (CHWs). Indeed at present, nearly half of all the projects funded by PCORI’s Addressing Disparities Program include interventions containing a CHW component. Over the past decade, consensus has rapidly emerged on process and procedures for standardized CHW training curricula and CHWs were also codified into the Affordable Care Act. However, there remains much less that has been developed around CHW research training and very limited materials for structured training of CHWs specifically in PCOR. Our stakeholder partnership has also identified a statewide need for a structured CHW training program in PCOR. In response to specific local stakeholder and national needs, Dr. Carrasquillo with Brendaly Rodriguez will develop and implement a structured training program in PCOR for CHWs that can be used in FL and for other PCOR stakeholders across the nation. This grant was awarded in 2015.

Proud to Be GIM

Awarded to Dr. Erin Marcus and the division of General Internal Medicine, The Society of General Internal Medicine conceived the ProudtobeGIM campaign as a way to educate early medical students about the importance and desirability of a career in general internal medicine (GIM). The ProudtobeGIM campaign has two tasks: educate medical students about a career in GIM and equip Society of General Internal Medicine (SGIM) members with the tools and confidence they need to be unofficial spokespeople for GIM as a field in academic interactions with trainees, formal conversations with deans and other curriculum decision-makers, and through online channels.

Hispanic Secondary Stroke Prevention Initiative (HisPPI)

Funded in 2014 by the National Institute on Minority Health and Health Disparities, HiSSPI is aimed at reducing the risk for a recurrent stroke. The focus of the study is on patients having had a stroke since they are at a higher risk for a recurrent and potentially much more debilitating stroke in the next five years. Our team is currently pursuing two important lines of research aimed at rigorously testing interventions to address disparities in a variety of other health conditions. One involves using Community Health Workers (CHW), which is a highly promising approach, and the second, a Pro-Mobile intervention to test mobile health solutions among minorities.

The Hispanic Secondary Stroke Prevention Initiative is a clinical trial of 300 Latino patients in our stroke registry admitted with an acute ischemic stroke and having a moderate disability or less at the time of discharge. The intervention will include CHW home visits, coaching phone calls, and group sessions.

Cell phone based interactions will include blood pressure monitoring and tailored education messages. Our goal is to determine if the proposed intervention results in improving the most important recurrent stroke risk factor which is systolic blood pressure (SBP). We will also examine other risk factors including cholesterol, medication adherence, and among diabetic patients, glycemic control.

The strength of our study is that it will leverage existing resources, including those of our recently funded stroke disparities program and our Clinical Translational Science Award (CTSA). We expect that our translational research project will provide new insights on potential approaches to treatment that can transform medical practice to improve health outcomes in Latino stroke populations.

South Florida Center for Reducing Cancer Disparities (SUCCESS)

Caribbean immigrants (both Hispanics and blacks from Haiti) as well as low income African-American women are less likely to be screened for cervical cancer than the general population. Community Health Worker are a promising approach in increasing cervical cancer screening among such groups. Yet even in rigorous well-structured CHW interventions, many women remain unscreened. Our group has shown that use of an emerging technology, HPV self-sampling devices, through home based CHW visits greatly facilitate the acceptability and ability to conduct cervical cancer screenings in our communities.

The vision of the South Florida Center for Reducing Cancer Disparities (SUCCESS) is that through increased cervical cancer screening we could eliminate cervical cancer health disparities in our local community. By doing so, we would also be contributing nationally towards our nation’s ongoing effort towards the reduction and ultimate elimination of cancer health disparities.

With the support of NIH, our study is conducting a randomized CBPR study among 600 women in three underserved communities in Miami-Dade County to determine optimal approaches to increase cervical cancer screening among Caribbean and other underserved women. The study is a three arm study with 200 women randomized at each site over 3 years. Women in the control group would be exposed to NCI approved culturally and linguistically appropriate outreach and educational materials on cervical cancer screening.

Our two specific aims are: 1) to determine if as compared to our control group, women randomized to the community health worker intervention group consisting one on one health education and facilitation of referrals to existing screening programs, results in increase proportion of women who are screened and 2) to determine if as compared to the CHW group, women randomized to a CHW intervention with the addition of a home based self-sampling strategy, results in an additional increase in proportion of women who are screened versus the CHW group without HPV sampling. Secondary outcomes include comparisons of a) measures of access to care (health insurance, having a usual source of care, and visit to provider in six months); b) cost of providing the intervention in order to determine the cost of recruiting an individual woman into screening and c) among women having abnormal screens, time to follow-up and further testing.

Miami Healthy Heart Initiative (MMHI)

MHHI was a NHLBI sponsored RCT of Latinos with poorly controlled diabetes that we completed in 2014. Community health workers (CHWs), lay peers trained to provide culturally-relevant health education and support, as well as accompaniment to clinical and social service appointments, have emerged as one of the most successful strategies to address racial disparities in chronic diseases. However, evidence from randomized studies on the effectiveness of CHWS on health outcomes is limited. Our objective was to determine if a CHW intervention is superior to usual care at improving outcomes among Latinos with poorly controlled diabetes.

We conducted a clinical trial among 300 Latino with diabetes, between the ages of 35-70 whose diabetes was not well controlled. Participants randomized to the intervention group (aka CARIÑO), received a 12 months of personalized support from a CHW focused on social support, patient navigation, advocacy and peer health education on diabetes and cardiovascular disease risk factor management. CHWs also conducted group-level activities addressing diabetes, such as workshops, support circles, and exercise sessions. Participants randomized into the control group received linguistically and culturally appropriate educational materials via the mail several times during the 12-month period. Our primary outcomes measures were changes in systolic blood pressure, LDL cholesterol and blood sugar control (HgA1C). We used validated instruments to measure medication adherence, medication intensification, physical activity and nutritional intake. MHHI also examined confidence in overall diabetes management, patient-provider communication, and lifestyle changes. We found that patients randomized to the intervention arm had a statistically significant reduction is SBP (5mmHG), A1C (0.5%) and a trend in LDL reduction (9mg/dl).