Research

iTEQC program directors Dana Mukamel and Dara Sorkin received a $10.2 million contract from the California Mental Health Services Authority (CalMHSA) to perform the statewide evaluation of the Help at Hand Evaluation Project.

This five-year demonstration project is funded and directed by the following counties in California: Los Angeles County, Orange County, Kern County, Modoc County, and Mono County, Inyo County, Marin County, Monterey County, Riverside County, San Francisco County, San Mateo County, Santa Barbara County, Tehama County and Tri-City County and the City of Berkeley.

The California statewide collaborative project is designed to bring interactive technology-based mental health solutions into the public mental health system through a highly innovative set, or “suite”, of mobile applications. The counties have adopted and tested several mental health apps including Prevail, Headspace, Minstrong and others. The counties also engaged in many activities designed to lower barriers to adoption of these technologies, targeted in particular towards vulnerable populations such as the elderly, low socio-economic groups, individuals with low digital literacy, LGBTQ and TAY. To reach these groups, the counties have employed Peers, developing different models of Peers engagement. 

The objectives of the project are to: 

• Detect and acknowledge mental health symptoms sooner; 
• Reduce the stigma associated with mental illness by promoting mental wellness;
• Increase access to the appropriate level of support and care;
• Increase the purpose, belonging, and social connectedness of individuals served; and 
• Analyze and collect data to improve mental health needs assessment and service deliver 

The evaluation conducted by iTEQC involved a large team of faculty and researchers from several schools and departments at UCI and UC San Diego. The iTEQC team worked closely with the Help & Hand county, using a Formative Evaluation model that allowed implementation of lessons learned during the project, as the evaluation was implemented. Quarterly and annual reports were provided to the counties, which included learning briefs and lessons learned specific to each county and encouraged learning across counties throughout the collaborative. 

Year one evaluation report

Year two evaluation report

Year three evaluation report

NHCPlus is a $1 million project funded by the U.S. Agency for Healthcare Research and Quality (AHRQ) to create a sophisticated, personalized decision-making aid for hospital inpatients who are being discharged to nursing homes. 

Building on the federal Nursing Home Compare (NHC), currently called Care Compare Nursing Homes quality report card which is published on the web, NHCPlus assists patients in determining what dimensions of quality are important to them in a nursing home. It then directs them to nursing homes that best match their preferences.  

The NHCPlus team was a multi-institution, interdisciplinary group consisting of an economist, a psychologist, a specialist in preference elicitation, a clinician and a NASA consultant who specialized in building user friendly apps. After building NHCPlus, the team then tested it in an Randomized Controlled Trial (RCT) in the departments of medicine and surgery at the UCI Medical Center. The findings from the RCT showed that using NHCPlus compared to the usual discharge process leads to higher patient satisfaction, discharge to better quality nursing homes and shorter hospital stay and lower costs. 

Publications

Award winning paper: Best in Arm. Mukamel DB, Amin A, Weimer DL, Ladd H, Sharit J, Schwarzkopf R, Sorkin DH. “Personalizing Nursing Home Compare and the Discharge from Hospitals to Nursing Homes” Health Services Research 2016 Dec; 51(6):2076-2094. DOI: 10.1111/1475-6773.12588. Epub 2016 Oct 24. PMID: 27778333; PMCID: PMC5134132.  

Mukamel DB, Amin A, Weimer DL, Sharit J, Ladd H, Sorkin DH. “When Patients Customize Nursing Home Ratings, Choices and Rankings Differ from The Government’s Version” Health Affairs 2016, Apr 1; 35(4):714-9. DOI: 10.1377/hlthaff.2015.1340. PMCID: PMC4818159. 

uORACLE: Understanding Online Reactions to and Attitudes Concerning Lipid-Lowering Medication is a pilot study funded by a $25,000 grant from the UCI School of Medicine's Department of Medicine to test a hypothesis about the search patterns of patients seeking information in the era of the internet and widespread use of social media.

While the internet offers seemingly unlimited information about disease and treatment options, not all of it is evidence-based, and some of the information is misleading. Specifically with hyperlipidemia, much of the available information is reliable, valid and based on scientific evidence. However, a considerable amount of information on the internet is anecdotal and non-representative.

When advised by physicians to start a statin, patients often seek additional information about cholesterol medication from other sources and may choose not to follow their physician’s recommendations. This study is designed to investigate patients’ search for information and the impact that information has on their decision whether or not to take statins for cholesterol treatment, as well as to evaluate the quality of the information viewed in their internet searches.

The Early Pathogen Identification project, funded by a $341,838 grant, is designed to explore the value of the timely identification of pathogens in patient settings.

Called "A Single-Center Observational Study to Assess the Use of PCR in Pathogen Identification Compared to Culture-Based Test Methods and the Potential Impact of Antimicrobial Treatment, Clinical Outcomes and Hospital Charges in Patients with Skin and Soft Tissue Infections," this study uses Millennium Health’s molecular diagnostic test on specimens obtained from infections of the skin and soft tissues as compared to the current standard of care.

The hypothesis is that this innovative technology, which uses polymerase chain reaction (PCR), will enable earlier identification of pathogens and help treat patients faster as well as reduce the chance of antibiotic resistance.

The Cost of Home Health and Health Outcomes project, funded with $2.6 million from the National Institutes of Health (NIH), is designed to answer the question of: How much does it cost to improve the quality of home care, not only in the aggregate but also in specific health trajectories?

For example, how much does it cost at the margin to improve the performance of a home health agency by 10 percentage points on a scale measuring the percentage of patients with skin sores. This project is being conducted in partnership with the National Association of Home Health Agencies (NAHC) and will include a national survey of 12,000 agencies.

The Neural and Behavioral Changes in Weight-Loss Regimens project examines baseline and longitudinal differences in behavioral inhibitory responses and brain circuitry in a sample of Latina women participating in an individual versus dyadic weight loss intervention. Funded by a $25,000 grant from UCI School of Medicine's Department of Medicine, this pilot study is designed to examine neural activity associated with the longitudinal development of self-regulation to high calorie, high fat foods in the context of a dyadic weight-loss intervention.

Inherent in the success of any weight-loss program is the fundamental change in health behaviors that occur by adopting self-regulatory eating behaviors that result in weight loss, such as shifting from impulsive food choices to controlled decision-making, inhibition and delayed gratification (e.g., portion control, reducing intake of sweets and high-fat foods, meal planning and preparation). Furthermore, we hypothesize that the support of a partner, with shared genetic and environmental health risks, would further bolster motivation and self-regulation in order to make significant, lasting behavioral changes.

To our knowledge, this is the first study to examine longitudinal neural activity associated with behavioral change and weight loss in the context of a behavioral intervention that is specifically designed to test the influence of interpersonal processes on weight loss and healthy weight maintenance.

Mi Salud, Mi Vida: A Self-Discovery Tool for Latina Breast Cancer Survivors is a mobile application project designed to promote health behavior change among Latina breast cancer survivors. The project, funded by a $100,000 grant from the National Institutes of Health (NIH) and the National Cancer Institute (NCI), is being conducted in partnership with a faculty member at the Cal State Fullerton School of Nursing.

The smartphone-based system enables breast cancer survivors to keep a record of their food intake, weight, exercise, fatigue, mood, pain and sleep, and choose from an additional set of functions to get personalized information about the relationship between their actions and/or mood states and their health behaviors.

The intent is to promote health behavior changes tailored to a woman's own preferences, thus increasing the likelihood of sustainability. In other words, in addition to providing general health knowledge, Mi Salud, Mi Vida is intended to promote the development of knowledge that is personalized for each woman.

The Real-Time Referral Program, funded by a $795,350 grant from the UC Office of the President Center for Health Quality and Innovation, is designed to improve access to specialty care services by enhancing communication between primary care and specialty care providers and facilitating electronic consultation.

The Real-Time Referral program includes an electronic health record platform based on structured electronic referrals (eReferral), allowing bi-directional communication and presenting decision support and expectations from the specialty practice to the referring provider at the moment of referral.

The platform is also intended to facilitate efficient communication of key clinical information and expectations from the referring provider. In appropriate cases, it also allows primary care physicians to request specialist input electronically (eConsult), in place of an office referral.

PCOA is a $1.5 million project funded by the U.S. Patient-Centered Outcomes Research Institute (PCORI) that is designed to help women diagnosed with late-stage ovarian cancer evaluate and choose the best treatment options for their individual needs.

Ovarian cancer patients are often faced with a difficult choice between a more toxic treatment — and hence, a lower quality of life — that promises longer survival, or traditional and less toxic treatments. PCOA helps patients understand all the options available to them, and to help them think through their personal preferences and needs to reach the best decision for their situation.

This is done in a shared decision-making model with the patient's healthcare provider.

With a $30,000 award from Cardinal Health Foundation's E3 grant program, we will develop a culturally appropriate and age-sensitive patient-centered mobile app to improve patient satisfaction with, and adherence to, anti-coagulation therapy. The ultimate goal is to reduce hospital readmissions related to adverse events from anticoagulation therapy.

Improving the Delivery of Mental Healthcare into Primary Care using Health Information Technology, a $1.1 million project funded by the National Institute of Mental Health (NIMH), is designed to use health information technology (HIT) to address high rates of under-diagnosed and under-treated mental health concerns among under-resourced, limited-English proficient (LEP) patients, for whom the rate of depression in primary-care settings is high.

Primary care providers serve as the initial point of contact for the majority of patients with depression, yet about 50 percent of cases are believed to go unrecognized. The under-diagnosis of depression may be further exacerbated in limited English-language proficient (LEP) populations. Language barriers may result in less discussion of patients’ mental health needs and fewer referrals to mental health services, particularly given competing priorities of other medical conditions and providers’ time pressures.

Recent advances in HIT may facilitate novel ways to screen for depression in LEP populations. iTEQC has developed a multi-component approach to delivering culturally competent mental healthcare that includes:

• Web-based provider training
• Multimedia electronic screening of depression and PTSD in the patients’ primary language
• Computer-generated risk assessment scores delivered directly to the provider
• Clinical decision support

Study outcomes include assessing the potential of the HIT intervention to improve screening rates, clinical detection, provider initiation of treatment and patient outcomes for depression and PTSD among LEP Cambodian refugees, a population that experienced war atrocities and trauma under the Khmer Rouge during the late 1970s. This technology has the potential to be adapted for any LEP population to facilitate mental health screening and treatment in a primary-care setting.

Mobile Health Technology Among Elderly Hispanics on Anti-Coagulation Therapy is a project designed to develop a theory-based, culturally appropriate, elder-centered, interactive mobile health technology to improve self-care in older Hispanic adults who need anti-coagulation therapy. It also aims to test the feasibility and acceptability of the study protocol in preparation for a randomized clinical trial.

The project is funded by a $40,000 grant from UCLA's Center for Health Improvement of Minority Elderly (CHIME), which is a Resource Center for Minority Aging Research (RCMAR) funded by the National Institute of Health/National Institute of Aging and UC Irvine's Institute for Clinical and Translational Science (ICTS).

A Technology-Driven Safety Intervention for Older Adults on Oral Anti-Coagulation Therapy is a focus-group study to identify older adults’ attitudes and preferences regarding health technology aids and health-related games that will improve their anti-coagulation therapy self-management skills.

Findings from this qualitative study will be used to develop an elder-sensitive health technology for older adults on anti-coagulation therapy. The study is funded by a $27,500 grant from UCI's Institute for Clinical and Translational Science (ICTS).