Poster Session



Students & Fellows Category

Title: SDOH Pathways: Adaptation of an Evidence-Based Community Care Coordination Model for a Primary Care CHW Program

Background: There is increasing recognition of the need to identify and address social determinants of health (SDOH) within health care settings, particularly in primary care. Community health workers (CHWs) are a unique workforce well-suited to address social needs, but there is little guidance in the literature on best practices for implementation in health care settings. This poster will outline the development and preliminary outcomes of SDOH Pathways, an adaptation of an evidence-based care coordination model to improve an ambulatory care-based CHW program through Dartmouth-Hitchcock (D-H) Population Health.

Authors: Meaghan Kennedy, MD, MPH (presenter); Susan Hanlon, MBA; Megan Colgan; Heather Carlos, MS; Bryan L’Heureux; Sally Kraft, MD, MPH

Title: Abstinence incentives with community treatment: impact on relapse among disadvantaged smokers with mental illness

Background: Relapse is common after cessation treatment ends. Abstinence incentives increase cessation among disadvantaged smokers with mental illness, but whether they protect smokers against relapse or worsen risk for relapse is unclear. We examined the impact of abstinence incentives on relapse among disadvantaged smokers with mental illness enrolled in a large community treatment study.

Authors: Minda A. Gowarty (presenter), Stacey C. Sigmon, Haiyi Xie, Rosemarie Wolfe, Sarah I. Pratt

Title: Addressing Human Trafficking and Domestic Violence in Rural New England

Background: One in three women and one in twenty men in New Hampshire (NH) will experience sexual violence in their lifetime and there is an overlapping relationship between domestic violence (DV), sexual abuse and human trafficking. Human trafficking is defined as using threat of force, fraud, or coercion for the purpose of subjecting a person to involuntary servitude, slave-like practices, or forced labor services. Trafficking can be divided into sex trafficking and labor trafficking, and trafficked persons can be found in multiple sectors of the economy: sex work, agriculture, resorts and spas, restaurants, construction, and domestic work. Traffickers manipulate trafficking victims so the only person the victim trusts is the trafficker, which creates an environment of extreme control and fear of seeking help. NH, Maine, and Vermont all have state task forces on human trafficking with Maine reporting 200-300 cases per year, NH reporting 70 cases per year, and Vermont reporting 50 cases per year; however, these numbers are all underestimated due to barriers associated with reporting.

Implementing screening in primary care clinics can help identify victims of trafficking and DV even though not all persons screening positive may be ready to seek help. The National Human Trafficking Resource Center has recommendations for addressing the needs of trafficked persons when they access healthcare: have protocol in place, assess safety, use a victim centered approach to care and avoid re-traumatization. Healthcare providers can encourage open communication about how to recognize when someone’s taking advantage of you and how to break the power the traffickers and abusers have over someone. By partnering with local service agencies and law enforcement, rural healthcare providers are in a unique position to increase surveillance, screening, and prevention of human trafficking in New England.

Author: Amanda St Ivany, PhD, RN

Title: Generalist Physician as Decision Consultant for Hospitalized Terminal Patients.

Background:  Uninformed aggressive end of life care has been broadly recognized as a major public health issue. This is most salient in hospital settings where busy physicians have limited time and training to address goals of care for patients with terminal illness. Palliative care specializes in inpatient serious illness conversations but they are scarce in community hospitals. Generalists with interest and training in decision support have potential to alleviate this problem, not just for their own patients but also as decision consultants for hospitalists. This prospective quality improvement intervention explores the use of a generalist decision consultant.

Authors: Fredrik Amell MD (presenter), James Stahl MD, Renato Mandanas MD, Paige Barker RN, Adriana Fitzpatrick RN, Kelly Pelletier BSN, Peter DeMillia MPH, Peter Scalia MS

Title: HIV-associated Myocardial Fibrosis Among Asymptomatic Outpatients in South Africa

Background: In South Africa (SA), HIV/AIDS and cardiovascular disease (CVD) are the two most common causes of death, with HIV prevalence being ~12%. Antiretroviral therapy (ART) has shifted the spectrum of morbidity and mortality to chronic complications that are managed in a primary care setting. Family medicine is a growing field in SA and is primed to undergo significant increases in patient volume due to HIV-related CVD.

Authors: Lye-Yeng Wong (Presenter); Justin Ackim Lumbamba; Tess Peterson; Jon Klaphake; Graeme Meintjes; Ntobeko Ntusi; Mpiko Ntsekhe; and Jason V. Baker


Title: The Current Method of Reporting Medical School Primary Care Output is Flawed

Background: Most medical schools in the United States report primary care rates based on graduate residency choice data. These data overestimate output, however, as many graduates who choose internal medicine later sub-specialize. In search of a more reliable statistic, we chose only to collect data from graduates three or more years after receipt of medical degree.

Authors: James Durham (presenter), Devin Van Dyke (presenter), Shawn O'Leary

Title:An Examination of Body Dissatisfaction in Obese Adolescents and Psycho-Social Correlates

Background: Obesity during adolescence is a worldwide public health problem and despite efforts to decrease childhood obesity, disparities still exist and disproportionately affects certain communities. Obesity has been associated with negative psychological outcomes potentially mediated by body dissatisfaction. Individuals with body dissatisfaction are shown to be less likely to engage in healthy weight management behaviors and are at risk for weight gain and poorer over-all health. Research linking obesity to poor psychosocial outcomes mediated by body dissatisfaction has been conflicting and often failed to look at adolescents, a population at risk for higher rates of body dissatisfaction as well as increased expression and intensity of psychopathology.

Author: Olutosin Ojugbele


General Category

Title:The impact of warm hand-offs on patient engagement with integrated behavioral health services in primary care

Background: Although an integrated model (combining behavioral health services within a primary care setting) is gaining momentum in healthcare, there is a dearth of research supporting the benefits of warm handoffs. A warm handoff is a formal introduction to a behavioral health clinician by another health professional, often facilitated in the exam room during the medical visit. Pace et al. (2018) found that patients who received a warm handoff were no more likely to attend an initial on-site psychotherapy visit than patients who did not receive a warm handoff. This study examined correlations between warm handoffs and initial and subsequent visit rates in a rural New England primary care practice. Results from this study (N = 93) align with the Pace study, suggesting that warm handoffs do not significantly influence the rate of attendance of initial psychotherapy appointments. However, a significant positive correlation was found between warm handoffs and the rate of ongoing attendance to psychotherapy sessions

Author: Daniel Mitchell, MD

Title: Community Engaged Research in Rural Maine: A Collaborative Approach to Identify Priorities and Foster Research

Background: Rural populations face challenges related to healthcare access and are often underrepresented in clinical trials and health services research activities. In Maine, the average distance from one of the sixteen counties to Maine Medical Center (MMC) is 116 miles. In July 2017, MMC and the University of Vermont jointly received a 5-year grant from the National Institutes of Health (NIH) called the Northern New England Clinical and Translational Research (NNE-CTR) Network to build research infrastructure across northern New England. The NNE-CTR Rural Core was developed to address research gaps in rural areas and facilitate connections between MMC and clinicians working in rural hospitals or practices, as well as the communities they serve. The NNE-CTR Rural Core in Maine has decided to utilize community engaged research (CER). CER is a strategy in which local clinicians, patients, their families, and other local stakeholders work together with researchers on relevant research projects, with all members involved in the process from designing the study through disseminating results. In June 2018, a Community Engaged Research Symposium was held in South Paris, Maine, a rural community located in Oxford County near Stephens Memorial Hospital/Western Maine Health (WMH). Forty persons attended including 13 researchers from MMC, 10 community members, 5 clinicians from WMH, 9 other stakeholders, and 3 speakers experienced in community engaged research. The symposium set the stage for future collaborative research; next steps included additional meetings with local clinicians and community members to identify a list of research topics to work on together, with adverse childhood experiences (ACEs) identified as a top priority. Efforts are currently underway to design a research study within this community focused on ACEs and resiliency-building. Due to its collaborative and community-integrated nature, community engaged research is a strategy that can effectively translate research to practice and can impact health in rural settings across Maine.


Authors: Neil Korsen, MD, MS; Lisbeth Wierda, MPH; and Kerri Barton, MPH (presenting)

Title:A multilevel model of organizational change capacity in primary care

Background: Transformation initiatives in primary care develop in stages, involve multiple organizations, and often need to be brought to scale. Clinics and their partners (e.g. specialists, payers, community organizations, hospitals) have varying levels of success—individually and collectively—in executing these initiatives. Understanding why some groups tend to succeed, while others struggle, is vital to the success of transformation efforts and improving the field of primary care as a whole.

Authors: Georges Potworowski, PhD (presenting); Norain A. Siddiqui, MPH; Olivia McMullen, MPH;

Maine Lung Cancer Coalition

Background: The Maine Lung Cancer Coalition (MLCC) is a four year, grant funded, statewide effort to decrease lung cancer incidence and mortality through a variety of activities to understand the current situation, test new ideas and innovations, and spread best practices through education, media and policy. The specific aims of the MLCC are:
1) engaging and educating the general public, patients, health care providers, health care payers,
and policymakers about evidence-based lung cancer prevention and screening practices;
2) developing and testing innovative community-based strategies to engage high-risk individuals in rural underserved areas of the state in smoking cessation and lung cancer screening services; and
3) developing, implementing, and disseminating innovative programs to increase access to evidence-based lung cancer screening and treatment services to the entire Maine population, including residents of rural underserved areas.

Authors: Paul Han, MD, MPH; Leo Waterston, MA; Susan Leeds, MOT; Neil Korsen, MD, MS (presenting)

Title: MOms in Recovery (MORE) Study: defining optimal care for pregnant women and infants

Background: Northern New England has among the highest rates of opioid dependence in the U.S, with prevalence highest and growing among those aged 18-35 years. Regional rates of perinatal opioid use disorders (OUD) reflect this public health crisis; Northern New England region has the highest incidence of opioid-related births in the nation. Perinatal opioid use disorders impact 5-8% of pregnancies in Maine, New Hampshire, and Vermont, three states that have been severely impacted by the current opioid epidemic. Consequences of inadequately treated OUD include premature delivery and other perinatal complications, prolonged newborn hospitalization for neonatal abstinence (NAS), and maternal morbidity and mortality from infectious disease and overdose. In 2013, costs associated with NAS treatment in the U.S. reached $1.5 billion. The epidemic has grown multifold since 2013.

Authors: Sarah Lord, PhD (presenter); Daisy Goodman, CNM, DNP, MPH; Deborah Johnson, MHA

Title: Resilience-Informed Collaboration with Head Start to Integrate Care for Early Childhood Stress

Background: This poster describes ongoing collaboration between a pediatric practice, Head Start center, and mental health provider to accomplish better health, healthcare, and healthcare cost; serving families of children at risk for toxic effects of chronic early childhood stress. The team began in 2016 as one of about 16 projects nationwide within the Early Childhood Education - Medical Home Learning Collaborative, facilitated by AAP National Center on Childhood Health and Wellness. The poster illustrates family resilience-building activities, integrated care workflow, parent feedback, evaluation data, a case example, and a format (adapted from Edmonton Obesity Staging System for Pediatrics) for stratifying, communicating and integrating information and plans about medical (e.g. well child and chronic child conditions), mental health (e.g. trauma, resilience), milieu (e.g. social determinants of health, family wellness and adversity), metabolic (e.g. inflammation, neuroendocrineimmune complications), and developmental domains.

Authors: Mark Rains, PhD (Vienna Mtn Consulting; Presenter)
Lara Walsh, MD, Lynn Jackson, RJ Tantaco (Kennebec Pediatrics)
Cristina Salois, Lynn Richards, Susan Emmerling (Southern Kennebec Child Development Corporation)

Title: Dialysis: A successful model for healthcare reform in other areas?

Background: Dialysis mortality is the lowest ever at 16% per year (USRDS 2018 Annual Data Report) and with the consolidation of the industry, only two large dialysis provider companies remain profitable despite declining reimbursement and a highly regulated environment. We attempt to examine the reasons for this success and whether there are lessons that may be applicable to other areas in healthcare. The research is an ongoing project using participant observation working as a Dialysis Patient Care Technician (PTC) at a rural Fresenius Kidney Care hemodialysis clinic, surveys of randomly selected nephrologists, PCTs, nurses, patients, and Fresenius Kidney Care management employees, and a literature review.

Most chronic dialysis patients typically have multiple serious comorbidities and are ravaged by the top leading causes of death in America: heart disease, diabetes, and infection. Dialysis patients are faced with growing personal, psychological, and financial challenges due to increasing rates of multiple emergency department visits and hospital readmissions, polypharmacy, poor treatment outcomes, poor communication, and discontentment. Managing the care of chronic dialysis patients is complex and often dreaded by primary care physicians and other specialty providers. What lessons can be learned from the successes of the dialysis industry that keep these patients alive?


Author: Valentina Sedlacek

Title: A New Pathway to Clinical and Translational Research Success: Establishing a Catalyst Certificate Program

Background: Opening opportunities for scientists and physicians to pursue careers in team-based biomedical research is a national priority. The Professional Development Core of the Northern New England Clinical and Translational Research (NNE-CTR) Network is currently developing a unique Research Catalyst Certificate Program to train scientists to collaboratively facilitate clinical and translational biomedical research in an interdisciplinary team environment. This innovative one-year program blends didactic courses and experiential rotations with a part-time Research Catalyst internship. Participants start with the online National Institutes of Health course titled Introduction to the Principles and Practice of Clinical Research. The curriculum includes course work in study design, epidemiology, and applied biostatistics, as well as elective courses to fill knowledge base gaps. In addition, the curriculum includes a catalyst internship, and rotations in our Regulatory/Compliance office, in Financial Management, and in our Clinical Trials Office. These rotating modules are designed to gradually increase the participant’s level of independence over the course of the year such that graduates of the program will emerge as fully trained Research Catalysts. We are currently in the pilot phase of this program, with our first postdoctoral fellow completing a Research Catalyst practicum as a part-time research coordinator for the Trauma Surgery department. Most elements of this curriculum would be suitable training for interested providers of all levels to increase their research capacity. We are highly enthusiastic about this model and eager to engage with the Dartmouth COOP PBRN community for input and to share it with the wider scientific community.


Authors: Carolyne Falank, Sarah Peterson, Kimberly Luebbers, Donald St. Germain, and Ivette Emery (presenter)