Work

The Population Health Sciences Program launched in 2011 as an incubator for care delivery science initiatives within the Office of the Vice Chancellor for Health Affairs.

An initial investment of $370,000 yielded $21,600,000 in external funding to improve care at UI Health.

  • The Population Health Sciences Program solicited proposals featuring interprofessional models of care to support the needs of patients at UI Health.
  • The awardees —13 faculty across 6 of UIC’s 7 health sciences colleges—collaborated in proposing four projects (* noted below). Each project featured interprofessional models of care and involved faculty from 2 or more health sciences colleges.
  • Two of the projects, Bringing Care to Patients: A Patient-Centered Medical Home for Patients with Kidney Disease and Coordination of Healthcare for Complex Kids, subsequently received $2M from the Patient Centered Outcomes Research Institute (PCORI) and $19.6M from the CMS Innovation Center, respectively.

Since then, the Population Health Sciences Program has facilitated over $50 million in funding to study interprofessional models of care delivery.

Read more about our work below:

2011

Empowering Patient Interdisciplinary Care (EPiC)

Funding
PHSP award
2011–2015

Lead
Terry Vanden Hoek

EPIC is an individualized health management program for high-risk patients who are frequent visitors to the Emergency Department (ED) with the goal of enhancing quality of care, addressing the social determinants of health, improving health outcomes, and lowering Illinois Medicaid costs by reducing avoidable visits to the ED and hospitalizations. EPIC teams are now used in the Clinical Decision Unit at UI Health.

Bringing Care to Patients: A Patient-Centered Medical Home for Kidney Disease (PCMH-KD)

Funding
PHSP award
2011–2012

PCORI contract
#IH-12-11-5420
2013–2016

Award
PCORI $2.1M

PI
Denise Hynes

PCMH-KD compares a patient-centered medical home model with usual care in patients with end-stage renal disease and their caregivers. Patients receiving dialysis at participating centers receive an initial comprehensive care visit followed by ongoing care from a multispecialty provider team during the patients’ regularly scheduled dialysis visits.

Comprehensive Care Coordination for Chronically Ill Individuals at Risk for High Healthcare Utilization

Funding
PHSP award
2011–2012

Lead 
Cheryl Schraeder

CCC features an inter-professional care model designed to ensure high quality, evidence-based care for complex, chronically ill individuals. This patient/family-centered approach to care aims to improve health outcomes, quality of care, and lower healthcare expenditure.

Coordination of Healthcare for Complex Kids (CHECK)


Funding
PHSP award
2011–2012

Centers for Medicare and Medicaid Services (CMS)
Health Care Innovation Award
2014–2017

Award
CMS $19.6M

PI
Benjamin Van Voorhees

CHECK provides compressive, community-based care to Medicaid insured children and young adults in Cook County who have one or more chronic illnesses such as asthma, diabetes or sickle cell disease, or complications from premature birth. Designed to better manage the delivery of care with the goal of increasing patient engagement, and reducing urgent health resource utilization and missed school days, CHECK uses a “medical neighborhood” model where Community Health Workers help patients and families engage in the process of maintaining health and managing chronic illness.

Englewood Implementation

Funding
City of Chicago
2011–2013

Lead
Henry Taylor

The PHSP led a successful application to the City of Chicago Community Health Centers, resulting in the Mile Square Health Center at Englewood which extends the reach of UI Health to populations in need of high quality healthcare.

 

2012                                                                                                                                                                                            

Scientific Animations Without BOrders—UI Health

Funding
UI Health
2012–present

Lead
Barry Pittendrigh, University of Illinois Urbana-Champaign

Lower health literacy disproportionately affects populations served by UI Health. To address this issue, UI Health pioneered a collaboration with SAWBO to create health literacy-appropriate educational animations. SAWBO, a University of Illinois at Urbana Champaign-based program, transforms information on relevant topics such as agriculture, health and women’s empowerment, into 2D, 2.5D and 3D animations, which are then voice overlaid into a variety of languages from around the world.

University of Illinois Community Assessment of Health Needs (UI-CAN)


Funding
UI Health
2012-present

Lead
Nicole Kazee

As part of the Patient Protection and Affordable Care Act (ACA), every three years all  non-profit hospitals are required to prepare a Community Health Needs Assessment (CHNA) and an Implementation Plan outlining how the hospital proposes to address the needs identified. UI Health has completed two Community Assessments of Health Needs: 2013 UI-CAN and 2016 UI-CAN. UI-CAN systematically evaluates the health-related needs of the UI Health primary service area, which includes some of the poorest communities in Chicago. The accompanying implementation plans set a clear path for strategically deploying resources in ways that stay closely linked to UI Health’s mission.

Warfarin Pharmacogenetics Consult Service


Funding
UI Health
2012–2013

American Society of Health Systems Pharmacists Research & Education Foundation

Lead
Edith Nutescu

To improve safety and reduce complications related to anticoagulationt therapy, UI Health was the first hospital in the nation to implement a pharmacogenetics service to provide genotype-guided warfarin dosing and personalized anticoagulation management. This service aimed to better estimate and personalize dosing for patients newly initiated on warfarin while hospitalized. The novel pharmacogenetic consult program showed reduced complications, improved patient safety and clinical and health-care utilization outcomes with significant cost savings. Receiving national accolades, the program was recognized as one of 3 US Health-System finalists with the Medication Use Safety Excellence Award by the American Society of Health Systems Pharmacists Research and Education Foundation.

 

2013                                                                                                                                                                                                      

PATient Navigators to rEduce Readmissions (PArTNER)

Funding
PCORI contract
#IH-12-11-4365
2013–2016

Award
$2.0M

PI
Jerry Krishnan

PArTNER is a patient-centered intervention tailored to meeting the needs of patients and caregivers who have been hospitalized at UI Health. An innovative study, PArTNER tests a care delivery model that combines a community health worker (lay patient advocate, acting as a “Patient Navigator”) and a peer-led telephone support line to improve the patient experience during transitions from the hospital to home with the goal of increasing social support, reducing anxiety and avoidable hospital readmissions.

Comparative effectiveness of a PEer-Led O2 Infoline for patients and CAregivers (PELICAN)

Funding
PCORI contract
#CE-1304-6490
2013–2016

Award
$2.0M

PI
Jerry Krishnan

PELICAn is a broad-based collaboration with patients and caregivers, advocacy groups, and a national O2 supplier with the goal of testing whether a patient-centered PEer-Led o2 Info-line for patients and CAregivers (PELICAn) will increase adherence and improve health. Through the engagement of patients and caregivers to identify gaps in knowledge and self-management skills, PELICAn is testing the effectiveness of a proactive intervention (peer coaches contact and deliver intervention) vs. reactive intervention (peer coaches deliver intervention when contacted by participants) vs. usual care.

University of Illinois Survey On Neighborhood Health (UNISON)

Funding
UI Health
2013–present

Lead
Nicole Kazee

UNISON Health is an in-person community health needs assessment of about 900 individuals living in 24 community areas served by UI Health. This scientifically rigorous examination collects patient-reported information about health behaviors, health care access and utilization, prevalence of disease conditions, quality of life indicators, knowledge of the Affordable Care Act and basic biometric screenings. The goal is to understand the health needs of the diverse community served by UI Health and to use this information to improve health care for those who need it the most. The Survey Research Lab with the College of Urban Planning and Public Affairs co-designed the UNISON Health survey and home assessments.

 

2014                                                                                                                                                                                                               

The Coordinated Healthcare Interventions for Childhood Asthma Gaps in Outcomes (CHICAGO) Plan

Funding
PCORI contract
#AS-1307-05420
2014–2017

Award
$4.0M

PI
Jerry Krishnan

CHICAGO Plan is a collaboration between 13 Chicago-based institutions, including UI Health, Cook County Health and Hospitals System, Sinai Health System, Rush University Medical Center, Lurie Children’s Hospital, University of Chicago, Chicago Department of Public Health, Respiratory Health Association, Chicago Asthma Consortium, and the Illinois Institute of Technology, as well as caregivers and patients with asthma. CHICAGO Plan tests both provider- and patient-level interventions to improve clinically meaningful outcomes in a minority pediatric population with uncontrolled asthma in the Emergency Department.

Chicago Area Patient Centered Outcomes Research Network (CAPriCORN)

Funding
PCORI contract
#CDRN-1306-04737
2014–2015

Award
$7.0M

PI
Terry Mazany, Chicago Community Trust

Led by the Chicago Community Trust, CAPriCORN is a collaboration with academic medical centers in Chicago, the Illinois Medical District Commission, payers, patient advocacy organizations, and other Chicago-based groups. CAPriCORN is intended to leverage health system clinical and administrative data at UI Health to support state-of-the-art patient-centered outcomes research.

 

2015                                                                                                                                                                            

Coordinated Healthcare Interventions for Childhood Asthma Gaps in Outcomes (CHICAGO) Collaboration II

Funding
NHLBI Grant
#U34 HL130787
2015–2016

Award
$322K

PI
Kate McMahon, Respiratory Health Association

CHICAGO Collaboration II builds off the work started on the 2014 CHICAGO Plan comparative effectiveness trail. CHICAGO Collaboration II engages a diverse group of stakeholders to conduct a comprehensive community-based needs assessment (CNA) to identify resources, gaps in resources, and specific barriers to implementing evidence-based care in communities disproportionately affected by asthma. Stakeholders will then use the findings of the CNA to refine an Asthma Care Implementation Program aimed at improving asthma for children across four sectors; medical care, family, home and community.

Achieving Patient-Centered Care & Optimized Health In Care Transitions by Evaluating the Value of Experience (ACHIEVE)

Funding
PCORI contract
#ETC-1403-14049
2015–2017

Award
$15M

PI
Mark Williams, University of Kentucky

UI Health is collaborating in a national program to evaluate the effectiveness of care transitions programs. The project seeks to develop evidence-based recommendations on best practices for patient-centered care transitions. UI Health’s team is leading the stakeholder engagement efforts for Project ACHIEVE.

 

2016                                                                                                                                                                              

Improving Sickle cell care in Adolescents and Adults in Chicago (ISAAC)

Funding
NHLBI grant
2016–2022

Award
$4.4M

PI
Victor Gordeuk, UI Health

Despite the availability of effective treatments for patients with Sickle Cell Disease (SCD, patients may not receive the care they need. The 6-year ISAAC project aims to improve the health and lives of patients with SCD by helping patients receive longitudinal care, use hydroxyurea, and receive appropriate pain management in the Emergency Department and hospitals. The ISAAC project is a collaboration between UI Health and the Sinai Health System.

Community Health And eMPowerment through Integration Of Neighborhood-specific Strategies (CHAMPIONS)

Funding
Pritzker Traubert Family Foundation
2016–2018

Award
$250K

PI
Marina Del Rios

CHAMPIONS NETWork uses innovations in health education and technology to empower high school students to become health advocates  in their communities. Students attend a six-week health intensive internship where they shadow health professionals and serve as health liaisons to their community, conducting health screenings with family, friends, and neighbors, and helping at-risk individuals navigate the health system. The program’s goals are to develop successful education and mentorship opportunities for high school students, create a tech-savvy workforce in healthcare that is sustainable and empowers communities, create effective pathways for supporting students to graduate from college and move into health-related careers, and to disseminate health information, resources, and knowledge, creating a culture of health in underrepresented communities.

George H. Miller Health Science Student Research Awards

Funding
UI Health
2016–2017

Leads
Evaluation of inpatient rounding practices
Mary Buzzard, College of Applied Health Sciences
Joanna Abraham, Mentor

Joanna Jaros, College of Medicine
Karl Kochendorfer, Mentor

Making long-acting reversible contraception available in UIC School-Based Health Centers

Molly Murphy, School of Public Health
Kristin Rankin, Mentor

Katrina Stumbras, College of Medicine
Sadia Haider, Mentor

Out-of-hospital complications in adult patients with sickle cell disease

Keesha Roach, College of Nursing
Crystal Patil, Mentor

Frank Zadravecz, College of Medicine
Robert Molokie, Mentor

Interdisciplinary models of care are needed to address the multiple health-related needs of complex medical patients. The goal of the George H. Miller Memorial Fund Health Science Student Mentored Research Award is to promote mentored interprofessional research by students enrolled in health science colleges at the University of Illinois at Chicago. Three one-year mentored research projects were selected to receive awards. Each proposed stakeholder engagement activities necessary to develop interdisciplinary care models tailored to specific high-risk populations served by UI Health.

 

2017