June 2021
Research News
NEJM Publishes ADAPTABLE Results

The Sheps Center's work on the ADAPTABLE Aspirin Study was published this month in The New England Journal of Medicine. ADAPTABLE stands for Aspirin Dosing: A Patient-centric Trial Assessing Benefits and Long-Term Effectiveness. The purpose the study was to find the best dose of aspirin, 81 mg or 325 mg, for people with known or existing heart disease to prevent death or another heart attack or stroke. There were no differences in rates of death, hospitalization for a heart attack or stroke, and bleeding between participants who took 81 mg and those who took 325 mg.
From Spring 2017 to Fall 2020, the Sheps Center partnered with the School of Medicine and TraCS to participate in a large pragmatic clinical trial, funded by The Patient-Centered Outcomes Research Institute (PCORI), run by The Duke Clinical Research Institute (DCRI). Through TraCS, UNC is a part of PCORnet (the National Patient-Centered Clinical Research Network). ADAPTABLE was the first study conducted through PCORnet. Using the network, ADAPTABLE engaged 40 sites and recruited more than 15,000 participants. 
Under the leadership of Dr. Darren DeWalt, principal investigator, Sheps Research Fellow, and Chief, Division of General Medicine and Clinical Epidemiology, Sheps research assistants used four methods to recruit 585 participants from UNC Health. Most participants were recruited virtually (over the phone, by email, and through MyUNCChart messaging). Some participants were recruited in-person with the help of staff at the UNC Hospitals Center for Heart & Vascular Care at Meadowmont and at the UNC Internal Medicine Clinic. Staff at both clinics were key to the success of in-person recruitment. Staff at TraCS also provided invaluable support developing a computable phenotype to target eligible participants, helping to develop and maintain a REDCap database, performing frequent data queries, and inventing the programming that allowed us to recruit participants using MyUNCChart. 

Less exciting, but challenging was the Sheps Center's work in research administration to manage per participant payments, managing IRB and DUA approvals and modifications for a first-time study of this type at UNC, and coordinating with OIC, OSR, DCRI, TraCS, UNC Cardiology, UNC affiliate clinics, and participants. Kristie Thompson, Sheps Project Director, coordinated the teamwork between Sheps, TraCS, and the School of Medicine, to help us make a significant contribution to the method and outcomes found in the study.

NCNC Focuses on Practice-Based Research

The North Carolina Network Consortium (NCNC) is a group of practice-based research networks across North Carolina. These networks are centered at UNC, Duke, Atrium Health, ECU/Vidant Health, and the Mountain Area Health Education Center. We focus on advancing outcomes in highly prevalent diseases and perform this research in outpatient primary care practices. We include learners in our projects and provide hand-on experiences to develop the next generation of practice-based researchers. We are committed to designing, implementing, and disseminating our study findings with stakeholders who represent those impacted by our research areas.

Current NCNC projects include:
  • Which method for starting buprenorphine for patients with opioid use disorder works best?
  • COVID-19 impact on glucose monitoring in primary care patients with diabetes
  • De-adoption of daily monitoring of blood glucose for patients with non-insulin treated diabetes
  • Centering care for older patients with multiple chronic conditions around patient preferences and values
  • Cost of care for patients discharged to their homes after a stroke
  • Engaging youth stakeholders in advising primary care practice staff on best approaches to working with youth to avoid vaping and treating those who want to quit
  • Understanding the disease comorbidities and patient demographics among people in NC whose deaths were attributable to COVID-19
  • Novavax pediatric vaccine clinical trials
RTI-UNC Evidence-Based Practice Center Studies Health Care, Policy

The RTI-UNC Evidence-Based Practice Center (EPC) has been in existence since 1997. The EPC is a collaboration between UNC Chapel Hill and RTI International. The center is one of nine institutions funded by the Agency for Healthcare Research and Quality (AHRQ) to produce original research and update systematic reviews of the scientific evidence on a variety of health care and health policy topics.

The EPC has prepared reports and technology assessments for the U.S. Preventive Services Task Force (USPSTF), the AHRQ Effective Health Care (EHC) and Technology Assessment Programs, the Drug Effectiveness Review Project (DERP), the Washington State Health Technology Assessment (WA-HTA) Program, and other public and private health care organizations. 

Reports developed by the EPC have been used to inform and develop insurance coverage decisions, quality measures, educational materials and tools, practice guidelines, and research agendas. EPC staff and investigators have decades of experience in conducting systematic reviews and meta-analyses and have expertise in areas including internal medicine, family medicine, public health, epidemiology, pediatrics, psychiatry, and obstetrics and gynecology. Reports recently published by the EPC include Screening for Hearing Loss in Older Adults, Screening for Lung Cancer, Screening for Vitamin D Deficiency in Adults, and Mental Health Treatments in Pregnancy.
Okah Studies Intersection of Race and Medicine

Dr. Ebiere Okah is an NRSA Primary Care Research Fellow in the Department of Family Medicine. Dr. Okah's research interests include studying how physicians conceptualize and use race in their clinical care and evaluating the relationship between experiences of discrimination and blood pressure in Black Americans.

She's working on a project assessing the association between physicians' adherence to a colorblind racial ideology and their use of race in medical decision-making. Dr. Okah is also conducting a systematic review assessing physician characteristics and beliefs related to the use of race in clinical care. She's currently completing a book chapter on community-engaged research and working on two papers evaluating hypertension in Blacks. In addition to her research projects, Dr. Okah sees patients at the University of North Carolina's family medicine clinic and is completing a master's degree in clinical research.
Catching Up With...
This issue introduces a new feature "Catching Up With..." that will feature short interviews with prominent members of the Sheps community. Today, we are catching up with Gordon H. DeFriese, Ph.D., former director of the Sheps Center. Please note that the interview was lightly edited for content and style.
Catching Up With Gordon H. DeFriese, Ph.D.

Dr. Gordon DeFriese was the director of the Cecil G. Sheps Center for Health Services Research from 1973-2000. He also held appointments as Professor of Social Medicine and Professor of Medicine at the UNC-CH School of Medicine; Professor of Epidemiology and Health Policy and Administration in the UNC-CH School of Public Health; and Professor of Dental Ecology in the UNC-CH School of Dentistry. From 1986-2000 he served as Co-Director of the Robert Wood Johnson Clinical Scholars Program, co-sponsored by the UNC-CH School of Medicine and the Cecil G. Sheps Center for Health Services Research. From 1996-99 he served as the founding director of the UNC Institute on Aging.

His research interests have included studies in the areas of medical sociology, primary health care, rural health services, health services utilization behavior, child health services, dental care, medical technology assessment, medical self-care, health and aging, long-term care, health status measurement, cost-effectiveness and cost-benefit analysis, medical specialization, and health promotion/disease prevention.

Dr. DeFriese has been involved with many national and international organizations and initiatives. He retired from UNC in 2005 but remains active in health research. He is currently the Acting Director of the Health Promotion Institute of the AARP and the American Federation for Aging Research (AFAR), based in Washington, DC and New York, NY, which focuses on the translation and dissemination of scientific health information affecting older adults. The Gordon H. DeFriese Lecture on Health Services Research is named in his honor, and the Gordon H. DeFriese Career Development in Aging Research Awards were established in recognition of his distinguished 40-year career.
What is your favorite Sheps-related memory?
My favorite memory from my 27+ years as Director of the Center is the day I took a photo of six women, most of whom were employees of the Center. Each was working full-time with children still at home, who received PhDs (or DrPHs) on the same day and all sitting on the same row at graduation (See photo below). We had so many outstanding people in those days, but these women were most impressive. There were certainly many remarkable people who worked with us, but I was always impressed by what that cohort of women managed to get done every day! They each have achieved widespread recognition for their scholarly work and careers.
What is your current hobby/interest at the moment?
Until recently, during the pandemic, I was still working at a reduced level with a private consulting firm. But, primarily, I spend my time doing woodworking, mainly woodturning, and a little bit of music, particularly playing New Orleans-style traditional jazz on clarinet and soprano sax. I taught a course on that subject in the Duke OLLI Program two or three years ago. Live performance music has taken a backseat lately, but it will return before long, but probably without some of us.
What is the best thing about retirement?
I am not sure there is a “best thing” about retirement. My advice to others: Don’t retire FROM something; retire TO something, but just get up a little later each morning. One good thing is having the time to read two or more newspapers each day, and my stack of un-read New Yorker and Atlantic magazines is shorter.
Picture taken in 1994: Lucy Savitz, PhD, MBA; Marcia Herman-Giddens, DrPH; Victoria Freeman, DrPH, RN; Rebecca Slifkin, PhD; Shula Bernard, PhD; and Jane Stein, DrPH
Upcoming Events
AcademyHealth 2021 Annual Research Meeting
June 14-17, 2021

An important annual milestone for the community, the ARM is AcademyHealth’s biggest and most popular meeting of the year, offering an irreplaceable forum for connection, recognition, reflection, learning and professional networking opportunities. Find Sheps Center faculty, students, trainees and alumni at presentations throughout the event.

How Inequality Kills: Equity as a Health System Imperative
Presented by the UNC Office of Health Equity & Cecil G. Sheps Center for Health Services
June 22, 2021, 3 p.m. to 4 p.m.

Speaker: Dr. David A. Ansell, MD, MPH
Michael E. Kelly Presidential Professor of Internal Medicine, SVP for Community Health Equity for Rush University Medical Center, Associate Provost for Community Affairs for Rush University

Ansell is a 1978 graduate of SUNY Upstate Medical College. He did his medical training at Cook County Hospital in Chicago. He spent 13 years at Cook County as an attending physician and ultimately was appointed Chief of the Division of General Internal Medicine at Cook County Hospital. From 1995 to 2005 he was Chairman of Internal Medicine at Mount Sinai Chicago. He was recruited to Rush University Medical Center as its inaugural Chief Medical Officer in 2005, a position he held until 2015. His research and advocacy has been focused on eliminating health inequities. In 2011 he published a memoir of his times at County Hospital, County: Life, Death and Politics at Chicago’s Public Hospital His latest book, The Death Gap: How Inequality Kills, was published in 2017. 
Sheps In the News
Recent Publications
Erinosho T, Treadway C, Wretman CJ, Hales D, Blitstein JL, Ward DS. 
Fam Community Health. 2021 Jul-Sep 01;44(3):206-214. doi: 10.1097/FCH.0000000000000303. PMID: 33999885
Paynter RA, Fiordalisi C, Stoeger E, Erinoff E, Featherstone R, Voisin C, Adam GP.
Rockville (MD): Agency for Healthcare Research and Quality (US); 2021 Mar. Report No.: 21-EHC008. PMID: 33755394
Allison BA, Walters EM, Butler BW, Perry MF. 
Jt Comm J Qual Patient Saf. 2021 Apr 28:S1553-7250(21)00099-4. doi: 10.1016/j.jcjq.2021.04.006. Epub ahead of print. PMID: 34074609
Allison BA, Widman L, Stewart JL, Evans R, Perry M.
J Adolesc Health. 2021 May 28:S1054-139X(21)00169-5. doi: 10.1016/j.jadohealth.2021.04.001. Epub ahead of print. PMID: 34059426
Neutze D, Hodge B, Steinbacher E, Carter C, Donahue KE, Carek PJ.
Fam Med. 2021 May 10. doi: 10.22454/FamMed.2021.154874. Epub ahead of print. PMID: 33970470
To see more publications by the Sheps community, visit the PubMed query here.