General Internal Medicine Research

Research from investigators in the Section of General Internal Medicine represents a wide range of topics including: Medical Education, Epidemiology, Health Care Outcomes, Patient Satisfaction and Safety, Technology Implementation and Medical Errors, HIV Care, Equity and Diversity, Substance Use Disorders and Tobacco Research.

The total research funding for the section of General Internal Medicine currently exceeds $8 million. The majority of this research funding comes from the NIH (i.e., R01s, T-32s, K-12 awards) and the Health Resources and Services Administration (HRSA). Additionally, we have a nationally renowned Center for Tobacco Research and Intervention (PI: Fiore).

The faculty members actively involved in research include:

• David Feldstein, MD, Assistant Professor (CHS) (Evidence-Based Medicine and Medical Education Research)
• Michael Fiore, MD, Professor (Tobacco Research)
• Khin Mae Hla, MD, Professor (CHS) (Sleep-Disordered Breathing and Cardiovascular Consequences, Medical Education)
• Douglas Jorenby, PhD, Associate Professor (Psychosocial Aspects of Health Care, Smoking Cessation)
• Christie Seibert, MD, Associate Professor (Medical Education)
• Stevens Smith, PhD, Assistant Professor (Psychosocial Aspects of Health Care, Smoking Cessation)
• James Sosman, MD, Associate Professor (CHS) (Hepatitis B and C Care, HIV Care, HPV Care)
• Elizabeth Trowbridge, MD, Assistant Professor (Education Innovations)
• Tosha Wetterneck, MD, Associate Professor (CHS) (Technology Implementation, Medication Errors, Error Prevention and Recovery, Physician Job Satisfaction, Hospital Medicine)

Provided below is a brief description of major research programs sponsored by the Section of General Internal Medicine:

Understanding and Treating Tobacco Dependence. The University of Wisconsin Center for Tobacco Research and Intervention (UW-CTRI), a campus-wide program housed within the Section of General Internal Medicine has a wide-ranging research program with an active outreach component to translate research into practice. The UW-CTRI is lead by GIM Professor Michael Fiore, MD, MPH. Additionally, Associate Professor Douglas Jorenby, Ph.D. and Assistant Professor Stevens Smith, Ph.D. are accomplished and active members of the UW-CTRI research team. Currently, the UW-CTRI has a research and intervention portfolio of approximately $6 million per year with more than sixty full-time staff, and includes a large NIH P50 Center grant: Tobacco Dependence: Treatment and Outcomes. In that Center grant, over 2,800 smokers from Madison and Milwaukee will be recruited into a cessation trial designed to develop evidence-based treatment algorithms as well as to assess long-term psychological and physical outcomes for those who successfully quit versus those who continue to smoke. This program will examine how smoking and quitting impact people's mental and physical health, their social interactions and their lifestyle.

New Tobacco Dependence Treatments. The Center for Tobacco Research and Intervention not only studies ways to optimize existing tobacco dependence treatments, but is also involved in the development of new treatments. Douglas Jorenby, Ph.D., is currently evaluating varenicline (a novel cholinergic α4β2 partial agonist) in populations with cardiovascular disease and conducting a Phase III study of a nicotine vaccine.

Cardiovascular consequences of Sleep-Disordered breathing. Khin Mae Hla, MD, is currently involved in studying cardiovascular outcomes in sleep-disordered breathing including 24-hour BP monitoring and preclinical cardiovascular risk markers such as carotid artery intimal media thickness in the Wisconsin Sleep Cohort population. This epidemiologic study will help answer important questions regarding the mechanism of sleep apnea in cardiovascular diseases. Dr. Hla is also Co-Director of the HRSA funded Primary Care Faculty Development Program (PCFDP) and Director of the EBM curriculum for the PCFDP: research in this area involves assessing the impact of the program on primary care faculty's skills on teaching, EBM and technology skills using objective evaluation tools.

Partnerships in Health: BASIC Training in Medicine. With a team of curriculum leaders and co-investigators, Dr. Christie Seibert will develop, implement and evaluate a new curriculum for medical students that integrates behavioral and social sciences into more traditional medical student training. The curriculum will include 6 content domains: mind-body interactions, patient behavior, physician role and behaviors, physician-patient interactions, social and cultural issues in medical care and health policy and economics.

Treatment Adherence Intervention for Incarcerated Persons Living with HIV. Under the leadership of James Sosman, MD, this three-year study will develop and test a behavioral intervention to improve antiretroviral treatment adherence for HIV-infected inmates.

Transition from Prison to Community: A Pilot Intervention of Adherence Support. James Sosman, MD, is also developing a behavioral intervention model to improve antiretroviral treatment adherence for HIV-infected inmates as they transition to the community.

Multi-center Hospitalist Study. Under the leadership of Tosha Wetterneck, MD, the major findings of this two-year multi-center study conclude that hospitalists in the academic setting improve length of stay and costs early on in the program's life but the benefits return to baseline - with the control group being general internists and subspecialists on the wards. The lack of the difference in patient care outcomes between the hospitalists and non-hospitalists group are partially explained by spillover effects of residents who have worked with hospitalists. Outcomes regarding end-of-life care, disease-based care (congestive heart failure, pneumonia), readmissions and mortality forthcoming. This study will further the knowledge base in learning by doing or how much experience a physician needs with a disease state to become really good at it. It also gives information about the worklife of students, residents and attendings on the medical wards that will be useful for the profession.

CPOE in ICUs. This observational study evaluates the effects of computerized order entry and electronic health records on medication errors, nurse and physician job tasks, and quality of working life in four intensive care units (adult medical—surgical, cardiac, pediatric and neonatal) and also explores the usability of the technology and the effects of prospectively evaluating the effects on technology implementation. Tosha Wetterneck, MD, is participating in the medication error evaluation in the adult medical-surgical and cardiac intensive care units and studying the impact of the technology on error recovery and team communication.

Medication Administration Technologies and Error Reduction. Under the leadership of Tosha Wetterneck, MD, this study evaluated the effects of bar code medication administration technology and the implementation of Smart IV pumps on medication errors, nurse quality of working life and job tasks. It also explored the use of prospective risk analysis before and after the implementation of the technologies. This study ended December 2004 with data analysis still ongoing.