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Division of General Medicine and Clinical Epidemiology

We are nationally and internationally recognized for research in the areas of clinical epidemiology, health services delivery, practice-based research, social determinants of health, disparities, clinical decision-making, health care payment models, and prevention. Clinical areas of expertise include heart disease prevention, diabetes, heart failure, hypertension, cancer prevention, care of vulnerable patients with chronic conditions, unhealthy alcohol use, and HIV care.

Our faculty collaborate with researchers in all other schools on campus including schools of public health, nursing, pharmacy, dentistry, social work, business, and arts and sciences.  UNC is known for widespread collaboration across campus without clear research silos.  Additionally, UNC hosts several content related Centers that facilitate interdisciplinary research.  Our faculty often work out of the Cecil G. Sheps Center for Health Services Research, the Center for Health Promotion and Disease Prevention, and the Lineberger Comprehensive Cancer Center.

Focus Areas

  1. Social Determinants of Health

Members of the division have made seminal contributions that have advanced our understanding of and interventions for social determinants of health.  Specifically, we have studied food insecurity and are currently conducting several clinical trials of strategies to ameliorate food insecurity.  Several of our investigators study health disparities and are actively engaged in trials to mitigate disparities by race/ethnicity or other markers of vulnerability.  We have a long history of studying health literacy in a variety of contexts and designed and tested interventions that improve outcomes for patients with low literacy skills.

Investigators working in this area: Seth Berkowitz, Allison Brenner, Giselle Corbie, Gaurav Dave, Darren DeWalt, Tom Keyserling, Dan Reuland.

  1. Prevention and Shared Decision Making

For many years our division has been at the forefront of understanding several aspects of screening and shared decision making with an emphasis on cancer screening modalities and cardiovascular disease.  In the past 15 years we have had two division members serve on the USPSTF and have consistently performed the systematic reviews for USPSTF.  Our faculty have studied screening for colorectal cancer, prostate cancer, and lung cancer with ongoing trials of methods to reach vulnerable populations for screening programs.  We have studied screening and shared decision-making for cardiovascular risk reduction.

Investigators working in this area: Allison Brenner, Carol Golin, Dan Reuland

  1. Nutrition and Physical Activity

Our division investigators have designed and led several community-based and medical intervention studies to improve nutrition and physical activity with an emphasis on vulnerable populations and disparities.  Work by our investigators and their colleagues led to the “MedSouth” diet that has adapted the Mediterranean Diet to southern tastes and cuisine.  Moreover, they have studied various ways to support people in adopting a health diet and lifestyle.  More recently, this line of work has merged with efforts to ameliorate food insecurity leading to creative and healthy solutions.

Investigators working in this area: Seth Berkowitz, Tom Keyserling

  1. Evidence-based Practice Center

Our division participates in the RTI-UNC Evidence Based Practice Center. Through this center we have participated in or led several systematic reviews for AHRQ, USPSTF, and other organizations.  This center is run out of the Cecil G. Sheps Center for Health Services Research.

Investigators working in this area: Cindy Feltner

  1. Practice Based Research

Members of our division have been leaders in practice based research and, more specifically, large scale quality improvement across ambulatory practices.  In the early 2000’s our faculty helped to develop Improving            Performance In Practice which established cooperatives in 7 states to improve chronic illness care delivery.  This program led to the AHEC Practice Support program that provides practice facilitators for independent practices across North Carolina.  We have had a series of AHRQ grants supporting implementation of primary care transformation infrastructure, implementation of cardiovascular disease treatment and prevention, and alcohol use screening and treatment across hundreds of practices in North Carolina. We have also conducted smaller practice based studies to reduce disparities and to implement new models of care.

Investigators working in this area: Allison Brenner, Darren DeWalt, Crystal Wiley Cene, Dan Reuland

  1. Health Care Payment and Value Based Care

In the past 2 decades, we have seen the emergence of quality metrics and the concept of value-based care.  In the past decade, we have seen dramatic expansion of new payment models including ACOs, bundled  payments, and primary care capitation. Members of our division have worked to design and implement new payment models in collaboration with the Centers for Medicare and Medicaid Services and private payers. Many members of the division are actively involved in activities with UNC Health to improve our health system’s approach to alternative payment models.

Investigators working in this area: Seth Berkowitz, Darren DeWalt

  1. Evaluation

Our division has been involved in planning and supporting evaluation for several major projects including the Center for Translational Science Institute (TraCS). This work has led to establishment of Abacus which can provide consultation and investigator services for setting up evaluation of programs.