PROF-PATH Yearlong Fellows

2016-2017 Fellows

 

Emilio Galán

Project Title: Understanding Pay-for-Performance Programs: A Study of the Current Use of P4P from Public and Private Quality Measures and Claims Data

Mentor(s): Dr. R. Adams Dudley

Pathway: Health & Society

Project Description: With the passage of the Patient Protection and Affordable Care Act (ACA), the Center for Medicare & Medicaid Services (CMS) rolled out two pay-for-performance programs (P4P) entitled “Value-Based Purchasing” (VBP) and the “Hospital Readmissions Reduction Program” (HRRP), each of which adjusted payments according to quality performance evaluations. This project will use various datasets to look at a timely topic: whether Pay-for-Performance (P4P) programs sponsored by both private insurers and public government programs are associated with hospitals’ clinical performance. The study has real potential to add to the national discussion of payment models by generating an update on the current prevalence of P4P programs and how P4P programs are being structured in private insurance and Mediciad programs and by updating our current understanding of the association of payment with quality.

 

Steven Garcia

Project Title: Therapeutic Potential of Transplanted Human Skeletal Muscle Stem Cells as a Foundation for Novel Treatment Modalities for Degenerative Muscle Diseases

Mentor(s): Dr. Jason Pomerantz

Pathway: Molecular Medicine

Project Description: There is an unmet need in the treatment of degenerative muscle conditions that affect isolated small muscles and traumatic injuries to peripheral nerves and muscles, which when all combined leave over one million people in the U.S. with significant morbidity and disability. Reconstructive surgeons are tasked with restoring function to these damaged nerves and muscles which is often impossible and lends itself to additional risks. Satellite cells are a population of muscle progenitor and stem cells which provide muscles with the ability to regenerate. Upon muscle injury, satellite cells are activated from their quiescent state, proliferate, and migrate to repair damaged muscle. There exists a population of satellite stem cells, a subpopulation of satellite cells, which are capable of self-renewal and have been demonstrated to possess superior regenerative potential. Identification of this population in human satellite cells is necessary to develop translational therapies for muscle disorders such as muscle dystrophies and sarcopenia, which alter normal satellite cell function. I am interested in characterizing this population of satellite cells through transplantion of human satellite cells into mouse skeletal muscle in order to determine the therapeutic potential of satellite cells as a novel treatment modality for degenerative muscle diseases.

 

Jesse Ikeme

Project Title: Examining Vascular Cerebro-Renal Associations to Elucidate Potential Mechanisms of Renal Injury: Post-Hoc Analyses of the SPS3 Randomized Trial

Mentor(s): Dr. Carmen Peralta

Pathway: Clinical & Translational Research

Project Description: For my yearlong project I will be investigating renal outcomes in the The Secondary Prevention of Small Subcortical Strokes (SPS3) Trial, a trial of dual anti platelet therapay versus aspirin alone in patients after lacunar stroke. I will be looking at cerebral white matter disease as a predictor of renal function decline after stroke. Such an investigation could demonstrate shared patterns of injury between the brain and the kidney underlied by similar vascular pathology. I will also be looking at randomization to aspirin plus clopidogrel versus aspirin alone after lacunar stroke as a predictor of renal function decline. While kidney disease is a growing global burden associated with significant cardiovascular risk, there are few evidence-based therapies to protect the kidneys from chronic injury. However, there is some evidence in experimental models suggesting clopidogrel may have some renoprotective properties. This study will help evaluate clopidogrel as a novel candidate for renoprotective therapy in a high risk population.

I am excited to study renal disease first-hand after spending a year in Nephrology clinic with my mentor. I hope to build a foundation of skills that will be useful in the future as a clinician and a clinical researcher. Hopefully, this project will be able to explore possibilities of improved care for my future patients.

 

Fabiola Molina

Project Title: A Decision Aid’s Impact on Latina Women’s Preferences for Shared Decision-Making

Mentor(s): Dr. Miriam Kuppermann 

Pathway: Health & Society

Project Description: Although the shared-decision making (SDM) model has been endorsed for some clinical contexts in OB/GYN, there is a gap in the literature assessing the impact of a decision aid on shared decision-making and other aspects of the decision-making process among Latina women, particularly those with limited English proficiency in the field of obstetrics. My project has two aims, utilizing two clinical trials.  Aim 1 will be a retrospective analysis of decision-making metrics including desire for SDM among Latina women that participated in a recently published RCT assessing the impact of a decision aid on decisions for prenatal genetic testing. Aim 2 will assess how a decision aid developed for an ongoing RCT can improve Latina women’s decision self-efficacy and increase desire to participate in SDM when deciding on mode of delivery after a prior cesarean. By better understanding decision-making preferences among Latina women and how a decision tool impacts them, we may be able to facilitate care that is consistent with values important to Latina women. 

 

Maria Patanwala

Project Title: A Population-based Cross-sectional Study of the Prevalence, Severity, and Factors Associated with Somatic Symptoms Among Older Homeless Adults

Mentor(s): Dr. Margot Kushel 

Pathway: Clinical and Translational Research

Project Description: ​The median age of the adult homeless population is now over 50.  It has been shown that older homeless adults have a prevalence of chronic disease and geriatric conditions similar to that of the general population 15-20 years older than them suggesting that they are aging faster than the general population. Increased somatic symptom burdens have been associated with lower health status and increased health care utilization, but currently, little is known regarding somatic symptom profile and burden among older homeless adults.  As individuals remain homeless for longer and develop chronic diseases while homeless, there is a need to better understand the life experiences of these older adults as well as to characterize the factors associated with health status within this population.

During the upcoming year, I will be delving into both quantitative and qualitative methods to describe the life and health experiences of older homeless adults in Oakland, CA. My primary study will examine the prevalence, severity, and factors associated with somatic symptoms among homeless adults aged 50 and older using data gathered from an NIH-funded longitudinal cohort study of aging among the homeless: Health Outcomes in People Experiencing Homelessness in Older Middle Age (HOPE-HOME) (PI Kushel). I am very excited to gain experience and skills in various research methods as well as to learn how research can spark change through advocacy and evidence-based practices. I believe the yearlong fellowship will help me develop knowledge and career goals that will allow me to better serve as an advocate and ally for my community in the future as a primary care physician. I am particularly honored to be able to learn from the stories of our generous participants in the study in order to help create a foundation of research that may help guide policy change and service provision to improve the lives of older homeless adults. 

 

David Ramirez

Project Title: Eye Health Among Farm Workers in California

Mentor(s): Dr. Jeremy Keenan

Pathway: Health & Society

Project Description: ​Limited data exist describing the burden of eye disease in United States farm workers. The prevalence of eye injury has been examined by the Healthcare Cost and Utilization Project (HCUP), with roughly 636,000 ED visits related to eye injuries in 2008 alone. Several cross-sectional studies have investigated the burden of eye disease specifically among farm workers as well; in the 1999 California Agricultural Workers Health Survey, at least 21% of workers reported eye irritation, and at least 10% of workers reported blurry or clouded vision as a result of hired farm work.

In general, the magnitude of eye disease and the specific causes of eye trauma among farm workers have not been well studied, with only a handful of papers reporting prevalence and mechanism of injury. Our study aims to examine whether individuals working in agricultural jobs have an increased risk of eye injury, and specifically, which risk factors are the most salient predictors of eye trauma among farm workers. If we find a high prevalence of eye trauma, our hope is that this research will identify clear risk factors, eventually leading to interventions to prevent eye trauma among this group.

This project is perfectly in line with my goals for my PROF-PATH Yearlong Fellowship project: working with an underserved, primarily Spanish-speaking community and having the primary role in overseeing my study develop from beginning to end. With this work, and with excellent mentorship, I will gain incredible experience in directing clinical research. While I understand becoming an expert researcher takes many years of trial and experience, this project will give me the skills I need for the beginning of a career in clinical research with underserved communities.

 

Griselda Velasquez

Project Title: Contraception Initiation at Three Versus Six Weeks Postpartum: A Serial Cohort Study

Mentor(s): Dr. Kate Shaw and Dr. Jennifer Kerns

Pathway: Clinical & Translational Research

Project Description: ​My project will focus on looking at differences in rates of short interval pregnancy and effects of initiating contraception at 3 weeks vs. 6 weeks postpartum. We hypothesize that there will be lower rates of subsequent short interval pregnancy for participants in the 3 week group vs. 6 week group. 

My intention is to use this opportunity to focus on gaining tools to conduct research that can be used to improve interventions as a future provider. I am passionate about contributing to advances in family planning and deeply motivated to improve access, family planning services, and care for women. 

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