Current Research
Every year we help clinicians formulate their research questions, translate them into research projects, and help them implement and analyze the data. Below is a list of our current on-going research within the NNE CO-OP PCBRN.
Assessing the State of Climate-Informed Health Care in Northern New England
PI: Christine Vatovec, PhD
This project aims to address the unique climate-related health challenges faced by rural and aging populations in Northern New England (NNE). Given the region’s susceptibility to extreme weather events, poor air quality, and vector-borne diseases, there is a critical need to understand and improve how primary care clinicians (PCCs) address these issues. Through surveys and interviews with both residents and PCCs across Maine, New Hampshire, and Vermont, the project seeks to assess climate-related health needs and identify gaps in clinician knowledge and resources. The findings will guide the development of targeted interventions and region-specific tools to enhance climate-informed primary care, ultimately improving health outcomes and resilience in these vulnerable communities.
A Comparison of Low-burden Data Collection Methods Using a Study on Primary Care Telehealth and Burnout
PI: Timothy Burdick, MD, MBA, MSc
Telehealth is a common tool for delivering primary care services yet the differential impact on clinician perceived stress, based on setting and experience, requires study. By comparing low burden data collection methods on primary care telehealth and burnout and incorporating different surveys to assess primary care provider (PCP) perceptions this card study will investigate the relationship between telehealth modality (clinic, phone, video) and PCP stress perception. As the first card study it will be used to evaluate the card study methods for conducting a card study by surveying all participating PCPs. In comparing different methods of delivering point-of-care observational surveys (Card-studies) and evaluating the impact on PCP burnout in the context of telehealth, this study will recognize the burden, benefits, and potential improvements for future card studies, ultimately enhancing engagement and relevance.
A Study of Long COVID in Primary Care with the Northern New England CO-OP PCBRN
PI: Darlene Peterson, MD
Studies have estimated that Long COVID prevalence ranges from 10% to 50%. Despite Primary Care’s crucial role managing these patients, Long COVID is especially understudied in primary care. This pilot study seeks to fill this gap by employing a low burden point-of-care clinical encounter survey (Card Study) and through this innovative approach, collect data from sixty primary care providers across CO-OP practices in the Northern New England (NNE) region. By characterizing Long COVID as it manifests in primary care and examining Long COVID’s prevalence, symptoms, impairment level, and management approaches, we will help spur more advanced research studies that enhance patient care, guide treatment, and engage other NNE CO-OP members to investigate Long COVID in primary care.
COVID-19 Vaccine and Booster Hesitancy Perception Study
PI: Maureen Boardman, MSN, FNP-C, FAANP
COVID-19 vaccine hesitancy was highest in rural communities in 2021 with 21% of all rural US residents saying that they would “definitely not” be immunized against COVID-19 compared with 10% of urban residents. As of 2021, only 58.5% of people in rural areas had the first dosage of the primary vaccination series compared to 75.4% of urban counties. We created this study to explore the why behind COVID-19 hesitancy disparities of rural and urban populations. We’ve distributed patient surveys to three federally qualified health care centers in Maine, New Hampshire, and Vermont. These surveys ask about hesitancy for COVID-19 vaccination series, booster series, and overall vaccine hesitancy. Primary care clinicians are also being surveyed in the three states to understand what their perceptions of their patient population’s hesitancy beliefs are and first hand experiences.
HPV Vaccine Expanded Age Range
PI: Maureen Boardman, MSN, FNP-C, FAANP
In 2019 the CDC updated 2006 guidelines on HPV vaccine eligibility by expanding the age range of individuals that qualify. Currently, unvaccinated or inadequately vaccinated individuals between the age of 27- 45 can be vaccinated for HPV based on risk and clinical shared decision making. However, we know little about patient and clinician perspectives on the new age expansion and the shared-decision making process for HPV vaccination eligibility which is why we proposed a study to evaluate patient and clinician perspectives. Two surveys were created to evaluate patient and clinician perceptions and perceived barriers for HPV vaccination and shared decision-making. Our first survey focused on patients between 27- 45 at three clinic sites in Vermont and three clinic sites in New Hampshire while our second survey focused on clinicians who see patients between the ages of 27- 45 in Vermont or New Hampshire. Our goal is to get a total of 300 completed surveys from patients and 300 from clinicians.
Increasing Epilepsy Self-Management Access by Embracing a HUB and Spoke Model
PI: Elaine Kiriakopoulos, MD, MPH, MSc
Despite mounting evidence of the benefits of epilepsy self-management (ESM) programs, the matter of bringing self-management programs to clinical centers has been challenging. Dartmouth Health’s HOme-Based Self-management and COgnitive Training CHanges lives (HOBSCOTCH) Institute for Cognitive Health and Well-Being has made measurable progress of addressing neurocognitive difficulties and improving the quality of life in people with epilepsy with a central support and an intervention that is telehealth delivered by trained Cognitive Coaches. This implementation science project will build upon the success of the HOBSCOTCH program by proposing partnerships with primary care practices, to integrate the HOBSCOTCH Institute’s resources and streamline the referral process for PWE to access ESM support. Over the course of 5 years, 53 clinical sites, including CO-OP practices, will be recruited to receive the learning sessions that provide the evidence-based resources for ESM and in doing so, will support epilepsy care for patients and contribute to the development of a comprehensive replicable model for community and family practice systems nationwide. This project (2023-2028) is supported by Cooperative Agreement grant funding from the Centers for Disease Control and Prevention (1-NU58DP007541-01-00).
Northern New England Provider Insights Participatory Engagement (NNE PIPE) Survey
PI: Meagan E. Stabler, Ph.D. CHES
The Northern New England Provider Insights and Participatory Engagement (NNE PIPE) Survey is designed to gather valuable insights from rural primary care providers across Maine, New Hampshire, and Vermont. This initiative offers NNE CO-OP PCBRN members a unique professional development opportunity to directly engage in research. By submitting survey questions, members can contribute to meaningful community-driven research, with selected questions providing the foundation for publications, preliminary data for grant proposals, and presentations at conferences. Members whose questions are selected will also have the chance to present their findings at the 45th NNE CO-OP PCBRN Annual Meeting in January 2025. This platform will showcase their work and facilitate collaboration within the network and beyond. The purpose of the NNE PIPE Survey is to deepen understanding of current practices, evaluate the impact of clinical interventions and policies, and highlight areas in need of quality improvement and innovative research. The survey will help streamline research efforts by consolidating questions submitted by clinicians, academics, and researchers, fostering a collaborative research environment. The inaugural NNE PIPE Survey will be released in October 2024, with support from the NNE Clinical and Translational Network and the NNE Clinical Translational Research Network (NNE-CTR) Pilot Project Program (U54GM115516).
Opioid Prescribing Patterns and Analysis of Secular Trends
PI: Constance van Eeghen, DrPH, MBA
Primary care providers are increasingly called upon to treat chronic pain patients at risk of addiction yet prescribing practices require robust study. A pilot study is a necessary first step to study the feasibility of data collection in primary care for future effectiveness studies related to opioid prescribing patterns. Since state-wide standardization and ability to capture prescriptions that were filled, rather than prescribed, are in prescription drug monitoring program (PDMP) data, PDMP will provide a reliable source for measuring adherence to required and best practices prescribing opioids. Four rural primary care clinics in Northern New England were recruited to collect opioid prescribing data from state PDMPs and electronic health records to evaluate key indicators of adherence to best practices to improve treatment of patients with chronic pain and reduce risk of opioid misuse.
Quality Improvement of HCV Screening Among Perinatally Exposed Infants and Children in Primary Care: A Real-World Pilot
PI: Meagan E. Stabler, Ph.D. CHES
This project addresses the significant gap in screening and treatment for Hepatitis C virus (HCV), particularly among people who are pregnant and perinatally exposed infants in northern
New England, where HCV and opioid use disorder co-occur at high rates. The team will assess historical baseline data via a large retrospective chart review across multiple birthing hospitals and clinics. CDC’s updated 2023 evidence-based screening protocols will then be implemented
in primary care practices, via co-developed processes to increase compliance and follow-up care. Groundwork is underway with interdisciplinary collaboration among experts in OBGYN, family medicine, public health, and infectious disease, with plans to integrate the voice of
patients. This project is supported by the Dartmouth Learning Health System (LHS) Embedded Scientist Training and Research Center (ESTaR).
Past Research
The CO-OP has over 40 years of research including our widely used Charts. Below is a selected list of our completed projects in recent years.
- Adverse Childhood Experiences (ACE) – PI: Patricia Glowa, MD
- Cervical Cancer Screenings – PI: Maureen Boardman MSN, FNP, FAANP & Joyce Cappiello, ARNP
- Colonoscopy Screening – PI: Audrey Calderwood, MD, MS
- Food Security for Pregnant People – PI Chelsey Canavan, MSPH
- Lung Cancer Screening – PI: Tracy Onega, PhD, MPAS & Jenna Schiffelbein, MPH, RD, LD, CHES
- Sexual Education– PI: Rebecca Yukica, DO
- Smoke-free Moms – PI: Ardis Olson, MD
- VA Dual Care Pi: James Schlosser, MD & Donald Kollisch, MD
- Warm Handoff – PI: Daniel Mitchell, PhD