September 2020
Project Spotlight
NC Program Can Reduce Pneumonia in Nursing Homes
A new paper published in The Journal of the American Medical Association (JAMA) Network Open highlights the importance of Sheps Center research conducted in North Carolina nursing homes. The paper shows that the Mouth Care Without a Battle staff training program, which promotes a practical program of tooth brushing, flossing and gum care, can significantly reduce pneumonia in nursing home residents.

After participating in the study for one year, nursing homes that implemented the Mouth Care Without a Battle program saw a 31% reduction of pneumonia cases compared to nursing homes that did not use the program. The research was led by two Sheps Center researchers -- Sheryl Zimmerman, Ph.D., Sheps Center program co-director and distinguished professor of social work and public health, and Philip Sloane, M.D., MPH, Sheps Center program co-director and distinguished professor of family medicine.

Poor mouth care causes as many as half the cases of pneumonia in nursing home residents and other people with physical and cognitive impairment. This is a significant problem, as there are more than two million episodes of nursing-home acquired pneumonia every year, many of which require hospitalization and result in death. The Sheps Center Program on Aging, Disability and Long-Term Care designed Mouth Care Without a Battle to remove common barriers to mouth care. In addition to learning about new products and techniques, staff learn individualized care practices that improve their confidence and the care they provide.

Research News
Research Shows Importance of Supporting
African-American Parents
Sheps Center research is paving the way for new strategies to help African-American families raising children with mental health conditions. A newly published paper developed from work with North Carolina families shows parents with greater knowledge, skills and confidence in managing their children's health are engaged with the healthcare system and their children are more likely to get mental health services.

These findings provide a rationale for investing in programs that teach parent activation skills and encourage practices to adopt strategies to reduce racial disparities in child mental health service use. As a result of this work, psychoeducational interventions have been implemented at UNC, led by Lin Sikich, now at Duke University, and also at El Futuro, Inc. in Durham, and beyond North Carolina.

The paper was published by The Permanente Journal, and authored by Leslie Adams, recent Sheps Training Program in Health Services Research Fellow, Joseph Morrissey, past director of the Mental Health Services Research Program, Kathleen Thomas, Sheps Center Senior Research Fellow and Associate Professor in the Division of Pharmaceutical Outcomes and Policy at the UNC Eshelman School of Pharmacy and co-authors outside Sheps.
NC Project to Study Impact of Maternity Unit Closures
A new project in partnership with the North Carolina Office of Rural Health will help to understand the impact of hospital-based maternity unit closures on maternal health outcomes. This project will engage rural North Carolinians and communities that have experienced maternity unit closures to shape future policies and interventions focused on increasing access to local maternity care services. Kathleen Knocke, PhD student in the Department of Health Policy and Management at the UNC-CH Gillings School of Global Public Health and graduate research assistant at the NC Rural Health Research Program, is leading the work.
Sheps Helps Address Unhealthy Alcohol Use
The STop UNhealthy (STUN) Alcohol Use Now trial is helping small-to-medium size primary care practices across North Carolina to identify and manage patients’ unhealthy alcohol use. Led by Dan Jonas, Sam Cykert, Darren DeWalt, Colleen Barclay, and Sean Riley, with web and database development by Brian Cass and Maria Tobin, STUN is one of 6 grantees in a $16 million initiative by the Agency for Healthcare Research and Quality (AHRQ) aiming to help primary care practices test and apply proven interventions to tackle the preventable problem of unhealthy alcohol use.     

North Carolina’s primary care practices, like many others around the country, often lack a formal process for screening and subsequent delivery of appropriate interventions. This is despite the large burden of illness caused by alcohol, the third leading cause of preventable deaths in the US and a key contributor to recent declines in US life expectancy. Partnering with NC AHEC and its trained practice support personnel, the project will provide quality improvement facilitation, electronic health records support, training, and practice coaching — now to be conducted virtually whenever possible — to all participating practices, as well as development of telehealth services for brief counseling to some practices.
Sheps Center Briefs
Fraher Delivers National Keynote

This past June, Erin Fraher, PhD, MPP, Director of Program on Health Workforce Research and Policy, delivered the keynote presentation at the National Forum of State Nursing Workforce Centers. Her presentation explored the power of data to illuminate challenges and opportunities facing the nursing workforce. She highlighted trends in LPN employment in North Carolina, the need to modernize LPN scope of practice, the pandemic’s impact on nursing workforce, burnout, and the possibilities of telehealth. Check out the presentation here.
Research Focuses on Patient Priorities Care

A Sheps Center study is working to align clinical decision making to reflect older patients’ care priorities. Crystal Wiley Cené, MD, MPH, FAHA, director of the Program on Health Disparities at the Sheps Center, in collaboration with Drs. Darren DeWalt (UNC Medicine), Arlene Chung (UNC Medicine), Jacquie Halladay (UNC Family Medicine), and researchers from Yale have begun the second year of their 5-year study entitled, ‘Implementation and Evaluation of Patient Priorities Care-North Carolina for Older Adults with Multiple Chronic Conditions.’ The objective of the study is to implement and evaluate Patient Priorities Care (PPC) in eight primary care practices in North Carolina.

In response to practice feedback, recruitment has been paused until the pandemic begins to ease.
INSPIRE Trial Addresses Chronic Pain

Integrated Services for Pain: Interventions to Reduce Pain Effectively (INSPIRE) study aims to help people living with chronic pain by comparing two behavioral interventions, shared decision-making and cognitive behavioral therapy. The study is funded by the Patient-Centered Outcomes Research Institute and led by RTI International. UNC is one of three research sites along with Duke and Vanderbilt, and the Principal Investigator is Paul Chelminski, MD, MPH, FACP.

People in the shared decision-making program will see a specially trained health care provider and focus on the risks and benefits of using opioids and treatment options. Those in the cognitive behavioral therapy program will get eight weekly group sessions and a one-on-one visit with a therapist to learn coping skills. The study’s key outcomes are opioid dose reduction, physical functioning level, and pain scores.
Upcoming Events
Three seminar series focused on Sheps Center research and funded by Carolina Seminars are starting this Fall. Full details are included below.

Rural Health Research Seminar Series

We are excited to begin the 2020-2021 rural health research seminar series at UNC, funded by Carolina Seminars. This seminar is designed to unite researchers from across the university whose work pertains to the study of rural health and health care. Excellent research is already being conducted at the university in multiple disciplines, from health services research to nutrition, and from public policy to journalism, so this seminar series is designed to raise awareness of the ongoing work and to encourage connection and collaboration among the individuals and teams currently studying rural health.

Our first meeting will be on Wednesday, September 16th at 11 a.m. over Zoom. The speaker will be Dr. Mark Holmes, PhD, Director of the UNC Sheps Center for Health Services Research and federally funded national rural health research center. Dr. Holmes with give an overview of current issues in rural health along with an overview of some of the key stakeholders at UNC and in North Carolina. For more information and to register, please visit the website.

The Program in Health Disparities (“PriHD”) is organizing two seminar series this year, with slightly different foci.

Interdisciplinary Seminar in Health Disparities: Healthcare Delivery in the Age of COVID-19

This interdisciplinary Seminar will hold intensive and collaborative sessions focused on health outcome and health delivery problems resulting from the COVID-19 pandemic. Our main research topic is health disparities in healthcare delivery and how the COVID-19 pandemic shapes systems and impacts resources, including human resources. Our main product from these collaborative interdisciplinary and multi-organizational work groups of health disparities researchers and students will be a focused grant proposal aimed at examining the impact that the COVID-19 pandemic has had on care delivery and home health caregivers’ own health outcomes. All seminars will be virtual and will have accompanying information and resources provided through Sakai.

The first meeting will be Tuesday, October 20th from 2 p.m. to 3 p.m. The speaker will be Robert Espinoza, Vice President of Policy at PHI. The session will raise awareness and interest in issues related to home health/care workers during the COVID-19 pandemic.

For more information on seminar dates or to join the PriHD listserv, please see our webpage and/or send an email to our program at healthdisparities@email.unc.edu.

Interdisciplinary Seminar in Health Equity

This is the second academic year of funding for this seminar. Our previous year goals will carry forward this year with some additions and improvements. We still aim to become acquainted with researchers and students who are involved in or interested in health disparities; to understand how to build and refine a Program on Health Disparities for the Sheps Center based on interaction with seminar attendees and their identified needs; and to provide a space for researchers and students to present (and solicit feedback) on past and current research to a group of peers. All seminars will be virtual and will have accompanying information and resources provided through Sakai.

For more information on seminar dates or to join the PriHD listserv, please see our webpage and/or send an email to our program at healthdisparities@email.unc.edu.
Sheps In the News