Message from the Vice Chair for Research
Clinical research is the name of the game for May - I’m pleased to highlight research from our largest division, that, besides embracing clinical responsibility for hospital and ambulatory medicine, has a long history of investigation in health services research, clinical epidemiology, clinical decision-making research, disparities research, and prevention. Specific areas of expertise include heart disease prevention, care of vulnerable patients with chronic conditions, and HIV care, and they thus collaborate widely across the campus and with the Agency for Healthcare Research and Quality (AHRQ), Centers for Disease Control and Prevention (CDC), and others nationally. Five Division researchers are profiled here, and a Chair's Corner podcast will feature a conversation with Dr. Cykert, coming up later this month.
Janet Rubin, MD
Vice Chair for Research
Samuel Cykert, MD
Dr. Cykert’s research career has emphasized access to care, resolution of health disparities in cancer care, and primary care practice improvement including cancer prevention and informatics. He is Clinical Director of the North Carolina Regional Extension Center for Health Information Technology and Director of UNC’s Program on Health and Clinical Informatics. The latter, a collaborative initiative by the School of Medicine and the North Carolina Translational and Clinical Sciences Institute, will train future clinicians and researchers to use informatics tools such as electronic health records and mobile devices to improve clinical care, extend patient outreach, and affect the health of whole communities.
Demonstrating how clinical practice disparities can be addressed with the help of IT, Dr. Cykert responded to the results of a study in JAMA, in which he and other investigators reported lower rates of surgery for African American patients with newly diagnosed early-stage lung cancer, by creating a system for tracking patients after diagnosis and alerting providers to missed milestones in care.
This attention to the intersection of informatics, access to care, and population health was recently instrumental in bringing a $15 M award to UNC through AHRQ’s EvidenceNOW initiative. As principal investigator for the Heart Health Now! Project, Dr. Cykert will oversee a multidisciplinary team using public-private partnerships to improve cardiovascular care in close to 300 small primary care practices in North Carolina. The project offers an unprecedented opportunity, through practice coaching and use of sophisticated practice-based analytics, to improve cardiovascular outcomes by introducing risk stratification and population management approaches to every day practice. This work has the potential to quickly reduce the risk, of heart attack, stroke, and related deaths for tens of thousands of North Carolina adults.
Dr. Cykert’s multi-faceted career clearly illustrates the challenges and opportunities of being a generalist, a role he describes in a recent video for the Society of General Internal Medicine (SGIM) as akin to being the “captain of the medical ship.” The video, in which he appears along with 3 other physicians, was released as part of a national SGIM communications campaign titled “Proud to Be GIM.”
Carol Golin, MDDr. Golin has made a substantial contribution to the areas of HIV prevention, treatment adherence, and care access during her career in health services and behavior. As Director of the UNC Center for AIDS Research Social and Behavioral Core, she brings her expertise in working with vulnerable populations and development of theory-based interventions to an ever-growing body of work on one of the foremost health issues of our time. She was principal investigator of the PACT, SafeTalk and imPACT (Co-PI) randomized, controlled trials of motivational interviewing based interventions to improve HIV health outcomes as well as for the UNC and Wake sites of the HIV Prevention Trials Network study, which estimated the overall HIV-1 incidence rate in a prospective observational cohort of women from 10 geographic areas in the U.S. with high HIV prevalence and poverty.
She is currently PI or co-investigator on projects to engage a public housing community’s stakeholders in the design and implementation of HIV prevention programs; to conduct a trial of a program for improving treatment adherence and care access for newly released HIV-infected prisoners; to understand HIV-positive inmates’ barriers to entering and staying in care and achieving treatment milestones; and to test a program to support patients’ motivation and self-care skills in the year following HIV care entry at multiple sites.
Dr. Golin has authored over 150 publications over the course of her career. These include a longitudinal study on the impact of SafeTalk, a multicomponent motivational interviewing-based safer sex program, which reduced unprotected sex acts among HIV-infected patients receiving the intervention (compared with controls). Another study found poverty and depression to be the factors most strongly associated with sexual risk behaviors during the 6 months before prison entry in a cohort of incarcerated African American men who were in committed relationships with women. Dr. Golin and co-investigators explored, in another study, barriers and facilitators to HIV viral load monitoring, reported by providers in 5 anti-retroviral treatment (ART) clinics in Malawi; the insights provided may help scale-up efforts in resource-constrained settings on the front lines of the global HIV epidemic.
Crystal Wiley Cené, MD, MPH, FAHADr. Cené’s research interests include the influence of social networks and support, especially within families, on health behaviors and outcomes in patients with or at risk of cardiovascular disease. In a secondary analysis of data from the Atherosclerosis Risk in Communities (ARIC) study, published in the European Journal of Heart Failure, Dr. Cené and co-investigators found that social isolation independently predicted incident heart failure among a nationally representative sample of middle-aged adults. In another study led by Dr. Cené, heart failure patients who were more frequently accompanied by family members into the examining room during medical visits had higher self-care management and maintenance scores. She is currently co-investigator on awards from NIH and AHRQ testing peer-coaching or practice facilitation interventions to improve and reduce racial/ethnic disparities in hypertension control.
In future research Dr. Cené intends to develop and test more theory-driven, practice-based interventions addressing social determinants of health and healthcare utilization in order to improve cardiovascular risk behaviors and outcomes, and to continue her contributions to dissemination and implementation science with a focus on Community-Based Participatory Research.
A series of faculty development awards, including the UNC Simmons Scholar Program Award in 2014 and the RTI University Scholars Program in 2016, has been both a result of and a springboard for Dr. Cené’s promising research career. The Simmons Award, providing salary support, structured mentorship, and career and leadership development opportunities, is available to SOM faculty members from populations underrepresented in medicine. The RTI University Scholars program provides support for distinguished academic researchers to spend scholarly leave time at RTI International, actively partnering with their experts. Dr. Cené has led or contributed to work resulting in more than 20 publications in the past 4 years, and continues to build upon an early foundation of excellent training and mentorship.
Dan Reuland, MD, MPH
is a general internist and health services researcher with a longstanding interest in improving health for diverse vulnerable populations. He worked for four years with the US Indian Health Service at a remote hospital on the Navajo reservation in Arizona before joining the UNC faculty in 1998. During his first eight years at UNC, he served as the director of the Chapel Hill North Medical Center, taught medical students and residents, and developed an innovative medical Spanish curriculum for medical students, Dr. ReulandComprehensive Advanced Medical Program of Spanish (CAMPOS.)
He began his formal research career in 2006 after a total of 12 years in clinical practice, when he completed a Primary Care Research Fellowship at UNC’s Sheps Center for Health Services Research. His research interests fall into two main categories: 1) improving cancer screening in primary care practice and health systems, which includes addressing problems of both underuse and overuse of cancer screening; 2) reducing health disparities for diverse, vulnerable populations, with a particular focus on improving care for Latino populations.
His current research projects include leading an American Cancer Society-funded multi-site, randomized controlled trial of a colon cancer screening intervention in primary care clinics serving diverse populations in North Carolina and New Mexico. He also leads a multi-disciplinary initiative called Supporting Appropriate Implementation of Lung Cancer Screening (SAILS) at UNC. With funding from NC TraCS, the Institute for Healthcare Quality Improvement, and Lineberger, the SAILS initiative aims to develop and test tools and processes for the responsible implementation of lung cancer screening using Low Dose Computed Tomography, which was recently recommended by the US Preventive Services Task Force. Finally, he directs the Expanding Networks for Latinos though Community Engagement (ENLaCE) initiative within NC TraCS. ENLaCE aims to promote translational research in Latino populations and communities.
In addition to his main projects, he also enjoys the role of collaborator on other multi-disciplinary endeavors along with investigators from the Sheps and Lineberger Centers, as well as UNC Departments of Health Policy and Management, Medicine, Genetics, Radiology, Psychiatry, and Nutrition.
Outside of work he enjoys watching and playing soccer, traveling with his family, playing guitar, and gardening.
Dan Jonas, MD, MPHAs UNC’s Director of the RTI-UNC Evidence-based Practice Center (EPC), Dr. Jonas leads a team of investigators and staff to produce rigorous systematic reviews and meta-analyses that inform clinical practice, guidelines and recommendations, and healthcare policy. The EPC is currently focused on working with the US Preventive Services Task Force (USPSTF), but has also supported the Agency for Healthcare Research and Quality’s (AHRQ) Effective Healthcare Program, the Centers for Medicare and Medicaid Services (CMS), and others. Over almost 20 years, the EPC has generated numerous publications in high-impact medical journals, covering a wide range of topics, including prevention, screening, mental health, comparative effectiveness of treatments, and chronic disease management. Under new awards from AHRQ to support the USPSTF, Dr. Jonas and the EPC investigators will publish Evidence Reports for the USPSTF in JAMA.
Dr. Jonas’ research interests include unhealthy alcohol use and pharmacogenomics. He has published on screening and behavioral counseling for unhealthy alcohol use in Annals of Internal Medicine, and on medications for alcohol use disorders in JAMA. Alcohol is the 3rd leading cause of preventable death and our system currently lacks a process for screening and subsequent delivery of appropriate interventions for primary care patients. To this end, Dr. Jonas is currently initiating quality improvement work to implement a systematic approach to screening and interventions for unhealthy alcohol use in primary care. The work is supported by UNC’s Institute for Healthcare Quality Improvement and Healthwise.
As the Clinical Operations in Pharmacogenomics Lead for UNC’s multidisciplinary Center for Pharmacogenomics and Individualized Therapy (CPIT), he has focused on the primary care perspective. He was the principle investigator on an RCT evaluating genotype-guided warfarin therapy and also a contributor to a meta-analysis and other articles on the same topic. He has worked with UNC’s Center for Genomics and Society to evaluate the potential harms and benefits of screening healthy adults for certain genetic variants that are associated with an increased risk of adverse health outcomes. He has also published on methods for evaluating genetic tests, and on the effect of genetic polymorphisms on response to medications for alcohol use disorders.