Sponsored Activities

Northern New England CO-OP Practice and Community Based Research Network

Director of Research: Maureen Boardman, MD
Email: Maureen.B.Boardman@Dartmouth.edu
Research Assistant: Zoe Daudier
Email: Zoe.M.Daudier@hitchcock.org
Telephone: (603) 653-6830
Homepage: https://geiselmed.dartmouth.edu/dcpbrn/


The NNE CO-OP PCBRN is sponsored by the Department of Community & Family Medicine at Dartmouth Health in collaboration with the University of Vermont, and Maine Medical Center. As a voluntary, cooperative network of independent clinical workers, the CO-OP has helped develop and refine a model for rapidly assessing and improving care since 1972. As the oldest PCBRN, our CO-OP members collaborate with academic researchers to improve patient outcomes, patient focus of care, and develop research and care methods that work in busy community-practice settings. The CO-OP demonstrates how to integrate the measurement of patient values, clinical improvement strategies, and research objectives into day-to-day health care delivery.

The goals of the NNE CO-OP PCBRN are to:

  • Provide professional stimulation and collegial communication and interaction among physicians, nurse practitioners, physician assistants, and researchers
  • Conduct cooperative research in primary care and family medicine
  • Improve primary care and family medicine services and office management techniques
  • Sponsor continuing education and training for healthcare professionals

Clinician & Patient Utilization of Expanded Age Range for the HPV Vaccine and Shared-Decision Making

Principal Investigator: Maureen Boardman, MSN, FNP-C
E-Mail: Maureen.B.Boardman@Dartmouth.edu
Contact Phone Number: (603) 653-6830

Project Summary: To assess the feasibility and acceptability among patients (Aim 1) and clinicians (Aim 2) of the expanded age range of the HPV vaccine as well as the effect of insurance coverage for the expanded age range ( Exploratory Aim 3 A) and shared decision-making facility among clinicians and patients (Exploratory Aim 3B) for increased HPV vaccination rates among the expanded age group.

We plan to survey clinicians at all rural Federally Qualified Health Centers across New Hampshire and Vermont who have different vaccine reimbursement options as well as rural versus urban FQHCs regarding clinician intent to meet the CDC’s guidelines for expanded-age HPV vaccination rates.

Using Redcap based survey to assess their perception of the need for HPV vaccination in this age group; the recommendation for shared decision-making prior to vaccination and if the need for shared decision-making is perceived as a barrier or a facilitator and other potential barriers to vaccination patients 27-45 including possible reimbursement barriers. We also plan to survey patients ages 27-45 from two Federally Qualified Health Centers; one in New Hampshire and one in Vermont to assess their perception of the expanded range for the HPV vaccine; patient awareness of the recommendation for shared decision-making prior to vaccination and if shared decision-making is perceived as a barrier or a facilitator to vaccination as well as other possible barriers patients believe may impact their ability to receive the HPV vaccine. We will compare HPV vaccination reimbursement of the expanded age population between New Hampshire and Vermont to see if there is a correlation between reimbursement and vaccination rates; indicating a relationship between out-of-pocket vaccine cost and patients’ willingness to be vaccinated.

T32 Northern New England Post-Doctorial Primary Care Research Training Program

Principal Investigator: Mary Brunette, Martha Bruce
E-Mail: Laurie.B.Emanuele@hitckcock.org
Contact Phone Number: (603) 653-6830


We propose to create an innovative, robust, and fully integrated T32 Northern New England Post-Doctorial Primary Care Research Training Program aimed at creating the next generation of investigators having the skills to address critical gaps in knowledge as needed to achieve the Quadruple Aim: enhancing patient experience, improving the health of individuals and the population, reducing overall health care costs, and increasing clinical staff resilience. The program will leverage the dedicated capacity for real-world health services research in a rural, three-state (New Hampshire, Vermont, Maine) primary-care research network, consisting of the new Academic Support Hub at Dartmouth and the long-established NNE CO-OP PCBRN. This research network is supported by faculty and programs in the Dartmouth Geisel School of Medicine, The Dartmouth Institute for Health Policy and Clinical Practice (TDI), and the Dartmouth Health clinical departments of Family Medicine, Internal Medicine, and Pediatrics. We will achieve this purpose by providing eight (8) trainees a 2–3-year program including mentored research opportunities and training in core research methods and skills.

Mentored Research Opportunities will focus on establishing fundamental research skills, obtaining preliminary pilot data, writing first-authored manuscripts, and submitting a research project grant or career development award in one or more of Dartmouth Health’s strengths in health care delivery science including:

  1. Secondary Analysis of Population-based Data Sets, aimed at identifying best practices related to common, high-cost, and/or complex health conditions within primary care.
  2. Intervention Research in real-world primary care practices, developing and testing innovative models of care designed to improve health outcomes and reduce health care costs.
  3. Implementation Research testing innovative approaches to implementing best practices in rural primary care through systems engineering, decision science, and mobile health technologies.

Training in Early-Career Investigator Competencies in Primary Care Research will include:

  1. Individually Tailored Primary Care Research Mentoring Program
  2. Seminars in Health Care Delivery Science Methods and Statistics
  3. Seminars in Implementation Research, Clinical Research Informatics, Mobile Health Technology, and Human and Health Systems Engineering
  4. Potential for a Master's in Public Health (MPH) at TDI
  5. Participate in a Faculty Member’s Ongoing Research Project to develop skills in project management (e.g., IRB applications, subject recruitment and assessment, data management and analysis).

Northern New England Geriatric Workforce Enhancement Program

Principal Investigator: Ellen Flaherty, Ph.D., MSN, APRN
Email: Ellen.Flaherty@Hitchcock.org
Telephone: (603) 653-3458

The purpose of this proposal is to advance rural northern New England’s regional capacity to address the healthcare needs of older adults and to inform national geriatric workforce improvement by developing and evaluating the Northern New England Geriatric Education and Training Workforce Enhancement Learning Laboratory (NNE-GET WELL). We plan to achieve 5 goals:

  • Goal 1: Integrate
    Develop integrated geriatrics and rural primary care delivery teams providing clinical experiences for trainees with the goal of measurably improving health and health care for older adults. These teams will focus on efficient and effective implementation and training guided by quality improvement methods including performance “dashboards” and patient-reported outcome measures.
  • Goal 2: Partner
    Create partnerships between primary care providers and Aging Social Service Providers and with older adults and family caregivers in the “co-production of health” through collaborative geriatric care delivery.
  • Goal 3: Train
    Develop, implement, evaluate and disseminate didactic and experiential learning experiences for faculty, students, clinicians, allied health and community service providers, and direct training and programming for patients and families.
  • Goal 4: Disseminate
    Inform geriatric workforce development nationally through broad dissemination of resources, including a web-based “Practice Change Toolkit including a Curriculum Guide and Implementation Manual, a web-based Medicare Annual Wellness Visit Health Risk Assessment and Complex Care Management Assessment, and (c) a new “Dartmouth Atlas of Geriatric Health Care” documenting the quality of healthcare for older adults in regions across the nation.
  • Goal 5: Alzheimer’s Education and Training Provide education and support for systems transformation to manage Alzheimer’s and related Dementia is a complex condition for primary care providers in collaboration with Aging Social Service Providers and family caregivers.

Resources Services Administration (HRSA) Geriatric Workforce Enhancement Program

Principal Investigator: Ellen Flaherty, PhD, MSN, APRN
Email: Ellen.Flaherty@Hitchcock.org
Telephone: (603) 653-3458

The NNEGEC is one of 48 programs funded through the Health Resources and Services Administration’s Geriatrics Workforce Enhancement Program (GWEP) to the Dartmouth Centers for Health and Aging.

This work, in part, focuses on transforming systems of care through a model developed at Dartmouth called GITT-PC Geriatric Interprofessional Team Transformation in Primary Care. The model focuses on task reallocation and maximizing every team member's role on the team to implement 4 Medicare reimbursable services including the Medicare Annual Wellness Visit, Transitional Care Management, Advance Care planning codes, and Chronic Care Management.

Administration on Community Living (ACL) Falls Prevention

Principal Investigator: Ellen Flaherty, Ph.D., MSN, APRN
Email: Ellen.Flaherty@Hitchcock.org
Telephone: (603) 653-3458

The Dartmouth Falls Prevention Training Program was developed with funding from ACL, a program within the National Council on Aging. This current grant is the third grant of this kind awarded to The Centers. This training program has built capacity for 2 evidence-based falls prevention programs (Matter of Balance and Tai Chi Quan: Moving for Better Balance) in 5 States. Currently, we are working with 2 HRSA-funded GWEPs (Baystate in MA and the University of RI) to bring together primary care practices and community-based organizations around fall prevention.

Charles Hamlin Medical Students POLST Project

Principal Investigator: Ellen Flaherty, Ph.D., MSN, APRN
Email: Ellen.Flaherty@Hitchcock.org
Telephone: (603) 653-3458

Starting in April, The Dartmouth Centers for Health & Aging trained 8 Geisel medical students to conduct phone conversations with patient surrogates at the Sullivan County Nursing Home and complete Physician Orders for Life-Sustaining Treatment (POLST) forms. Eighty patients with dementia and a surrogate decision-maker at the facility did not have a POLST form documented at the beginning of our program. After extensive coaching from mentors, medical students were able to speak with 59 surrogates resulting in 39 POLST documents entered into the medical record outlining care preferences. The Hamlin fund will enable us to expand this program in additional nursing homes, initially in New Hampshire and then across New England. Dr. Hamlin’s interest and work in end-of-life care and his passion for medical students and Geisel make this a perfect fit for this fund.

Next Generation Learning Health System for Multiple Sclerosis: Next Gen-MS

Principal Investigator: Brant Oliver, Ph.D., MS, MPH, APRN-BC
E-Mail: Brant.J.Oliver@hitchcock.org
Contact Phone Number: (603) 653-6869

Objective: A three-year, prospective, cluster-randomized study to assess the quality of life and functional impairment outcomes in people with multiple sclerosis (MS) followed by MS care centers randomized to the effect of a quality-improvement intervention informed by learning health system feed-forward patient-reported measures compared to usual care controls.

Crohn's and Colitis Foundation IBD Qorus Collaborative

Principal Investigator: Brant Oliver, Ph.D., MS, MPH, APRN-BC
E-Mail: Brant.J.Oliver@hitchcock.org
Contact Phone Number: (603) 653-6869

Objective: This is a 3-year award (2021-2023) in which I serve as the national improvement advisor and scientist guiding the work of a large multicenter improvement collaborative for adult IBD care including 54 IBD centers across the U.S. My role also includes supervising the design and development of a comprehensive learning health system data pathway to accelerate QI and research efforts, and oversight of a team at TDI (sub-award) which will focus on the development and facilitation of a comprehensive quality improvement training curriculum to build front line capability for improvement.

COVID Compass Project

Principal Investigator: Brant Oliver, Ph.D., MS, MPH, APRN-BC
E-Mail: Brant.J.Oliver@hitchcock.org
Contact Phone Number: (603) 653-6869

Objective: This project is a collaboration between TDI, the Dartmouth Atlas, and the Brody School of Medicine at East Carolina University (ECU) in North Carolina. This is a study funded by the State of North Carolina and focused on developing a "smart epidemiology" approach to monitoring the incidence, mortality, and societal impact using small area variation methods (Dartmouth Atlas), real-time regression adjusted statistical process analytics (TDI) and high-level mathematical modeling approaches (ECU) to "visualize" the behavior of the pandemic using a balanced measurement approach unlike other monitoring systems currently available. This project aims to inform public health leaders making time-sensitive decisions about COVID management and research efforts to understand the relationships between policy, behavior, and outcomes. I serve as Co-Investigator on the project and specifically oversee the statistical process control analytics component of the project. Gene Nelson is the PI. Sally Kraft is also on the project as a population health advisor.