Large Seed Grants:
CommunityRx-Family
Stacy Tessler Lindau, MD, MA (Professor of Medicine – Obstetrics and Gynecology)

The National Academies of Science, Engineering and Medicine (NASEM) recommends a “5 As” framework for integrating social care with healthcare delivery (“integrated care”), including awareness of and assistance for health-related social risks (HRSRs) [NASEM, 2019]. People with health-related social risks or needs (HRSR/Ns) often endorse feelings of shame, distrust, and fear that disclosing these conditions could exacerbate social risks such as removal of children from parental custody or discrimination in the healthcare setting (Barnidge et al., 2016; Cacioppo et al., 2023; Eder et al., 2021; Glasser et al., 2023; Palakshappa et al., 2017). Clinicians also worry about causing stigma or compromising satisfaction with care (Quiñones-Rivera et al., 2021) and are vulnerable to moral distress that comes with identifying social risks in the absence of meaningful assistance strategies (Robert Wood Johnson Foundation, 2011). New policy initiatives are motivating the rapid adoption of social care by children’s hospitals and others (Binger et al., 2023; Centers for Medicare and Medicaid Services, 2024; National Quality Forum, 2022; The Joint Commission, 2022). As the first step toward achieving family-centered social care at our children’s hospital, we are conducting an implementation science study engaging parents/caregivers and clinicians to examine the following:

1. Attitudes toward screening for social conditions in the pediatric hospital setting, preferences for timing and mode of assessment and assistance, and strategies to promote compassionate, trustworthy care and mitigate experiences of discrimination.
2. Perspectives on implementation determinants for integrated, family-centered social care programming in the pediatric hospital setting

We will apply the Implementation Research Logic Model (Smith et al., 2020), including Damschroder’s implementation determinants framework (Damschroder et al., 2022), Powell’s strategies framework (Powell et al., 2015) and Proctor’s outcomes framework (Proctor et al., 2011). Our planned experimental research will be refined with input from parents, caregivers, and clinicians, including nurses and child life specialists.

Small Seed Grants:
Impact of Functional Activity Strength Training (FAST) on Older Adults Outcomes After Surgery
Daniel Rubin, MD (Associate Professor of Anesthesia and Critical Care – Anesthesiology)

Up to one-third of older adults experience worsening disability after surgery, leading to increased complications, longer hospital stays, higher healthcare costs, and greater likelihood of nursing home discharge. Preoperative strength training has been shown to reduce these risks, but many older adults remain inactive due to barriers such as time constraints, lack of access to facilities, and limited insurance coverage. Functional Activity Strength Training (FAST) is a novel, brief, daily exercise program designed to address these barriers. FAST incorporates five simple exercises from the National Institute on Aging’s Go4Life program, requiring just 5 minutes per day. This program has demonstrated high adherence and effectiveness in improving physical function in community dwelling older adults with mobility disabilities.

This pilot study will assess the feasibility and preliminary efficacy of FAST in older adults (aged 60+) undergoing abdominal surgery. Ten participants will be randomized to either the 6-week FAST intervention or usual care. The program will continue during hospitalization and at home for one-month post-discharge. Feasibility will be evaluated using Bowen’s framework, and efficacy will be measured through improvements in 6-minute walk test distance, short physical performance battery scores, and reductions in disability (WHO Disability Assessment Schedule 2.0).

The study aims to determine the feasibility of FAST and identify barriers and facilitators to its implementation. Findings will guide future research to optimizing FAST to improve functional recovery and reduce post-surgical complications in older adults.

Risk Stratification by Sarcopenia and Frailty of Diabetes in Patients with Cirrhosis
Alan L. Hutchison, MD, PhD (Transplant Hepatology Fellow – Department of Medicine), Celeste C. Thomas, MD (Associate Professor of Medicine – Endocrinology), Mary E. Rinella, MD (Professor of Medicine – Gastroenterology, Hepatology)

Diabetes mellitus increases risk of heart attack, stroke, and mortality. While approaches to screen the general population for diabetes are well-established, these approaches are less effective in patients with chronic diseases. The most common biomarker, hemoglobin A1c, is known to be less effective in detecting diabetes in patients with chronic kidney disease or chronic liver disease. In this project, we work to optimize an efficient diagnostic pathway for patients with scarring of the liver, known as liver fibrosis, which in its most severe form is known as cirrhosis. Cirrhosis affects 112 million people worldwide and can be caused by obesity, viruses, auto-immune diseases, and excessive alcohol use. We are using additional biomarkers under-studied in cirrhosis as well as measures of body composition and frailty to help risk stratify patients, with comparison to the gold-standard test – the oral glucose tolerance test – which is difficult to employ as a universal screening test. We will develop an algorithm to help identify patients in whom the hemoglobin A1c is sufficiently accurate and those for whom additional testing would be warranted and help uncover undiagnosed diabetes. In this project we focus on patients with cirrhosis, but the framework established here can be applied to other chronic diseases as well.

Promoting High-value Inpatient Delirium Management with an Integrated Best Practice Advisory and Order Set
Robin Z. Ji, BA (Class of 2027, Pritzker School of Medicine), Lauren Gleason, MD, MPH (Associate Professor of Medicine – Geriatric Medicine)

This project explores the impact of integrating clinical decision support within the electronic medical record (EMR) to enhance evidence-based delirium management in hospitalized older adults at the University of Chicago Medicine (UCM).

Delirium, associated with increased morbidity, mortality, and healthcare costs, often leads to extended hospital stays and resource overutilization. EMR-embedded clinical decision support offers potential to improve adherence to evidence-based clinical practices.

Our team implemented a Best Practice Advisory (BPA), triggered by positive delirium screening results from the 4 A’s Test, alongside an evidence-based order set, with the goal of reducing inappropriate antipsychotic use and promoting high-value care within UCM’s Mitchell Hospital and Center for Care and Discovery (CCD).

Through support from the I-CARE Program Mini Grant, we aim to measure the impact of this intervention by comparing pre- and post-implementation data, focusing on reductions in antipsychotic and benzodiazepine use, restraint utilization, standing bowel regimen orders, and head CT imaging rates. Additionally, provider responses to BPA activation will be analyzed, including whether new orders were placed, the order set was opened without orders, or the BPA was disregarded.

Overall, our study seeks to determine whether EMR-based decision support can improve adherence to best practices, reduce unnecessary interventions, and ultimately enhance patient outcomes in managing delirium among high-risk older adults.

The Utility of Aromatherapy for the Improvement of Comfort, Satisfaction, and Pain in Adult Patients with Sickle Cell Disease Being Treated for an Acute Sickle Cell Pain Episode
Nabil Abou-Baker, MD (Assistant Professor of Medicine – Internal Medicine/Pediatrics)

Sickle Cell Disease (SCD) is estimated to affect nearly 100,000 Americans, occurring in 1 of every 365 African American births (CDC, 2023). The most common complication for patients with SCD is pain, which is primarily managed with conventional multimodal pain medications such as oral or intravenous opioids, nonsteroidal anti-inflammatory drugs (NSAIDs), gabapentinoids, serotonin and norepinephrine reuptake inhibitors (SNRIs), acetaminophen, topical analgesic medications, and ketamine infusions. Essentials oils (EO) have been evaluated for their ability to be used as an adjunctive therapy for patients with pain. Multiple studies support the use of aromatherapy as a tool to successfully manage pain when combined with conventional treatments (Brown et al., 2023; Lakhan et al., 2016; Sattayakhom et al., 2023; Scuteri et al., 2021). In addition to analgesia, anti-stress, anti-anxiety, cognitive, and autonomic effects can be seen (Sattayakhom et al., 2023). We hypothesize that admitted adult patients with SCD being managed for an acute vaso-occlusive pain episode/event (VOE) who utilize EO inhalation aromatherapy as a multi-modal, integrative, and complementary pain management modality will have improved emotional comfort, satisfaction, and pain levels, as measured by a pre/post-intervention survey. Patients who voluntarily agree to the intervention after education on the potential benefits, safety considerations, and proper usage techniques will be offered pre-manufactured, hospital-grade, clip-on inhalation aromatherapy devices that will provide inhaled EO aromatherapy for up to two-weeks. Two Advanced Practice Providers on the sickle cell inpatient consult service will perform direct patient engagement, including education, management of EO devices, patient monitoring, and implementation of pre/post-intervention surveys. Integrative and complementary medicine techniques are often under-utilized and under-studied in the SCD population. The goal of this intervention is to improve outcomes for SCD patients suffering from a VOE, specifically satisfaction, emotional comfort, and pain.