Introduction Automated colorectal cancer (CRC) screening programs often invite all age-eligible patients for fecal immunochemical testing (FIT), but providers may defer screening in clinically complex patients. However, such nuanced decisions are not captured by most automated systems. We evaluated whether International Classification of Diseases, Tenth Revision (ICD-10) codes are associated with variations in FIT ordering patterns beyond age-based outreach criteria. Methods In a retrospective observational study of 15,020 screening-eligible patients aged 50-75, we compared the frequency of ICD-10 codes between patients with and without a FIT order. We repeated the analysis restricted to those with a Charlson Comorbidity Index (CCI)<5. Results Overall, 4,833 (32.2%) patients did not have a FIT order. Of the 1,215 ICD-10 codes examined, 96 were significantly associated with the absence of a FIT order (p<0.05). These codes frequently indicated digestive diseases (e.g., colonic neoplasm, diverticular disease), advanced comorbidities (e.g., frailty, paralysis), and acute conditions (e.g., fractures, severe infections). Among the patients with CCI<5, 41 codes were associated with the absence of a FIT order (p<0.05), such as heart failure and chronic kidney disease. Conclusion Screening-eligible patients without a FIT order were more likely to have ICD-10 codes reflecting digestive diseases, chronic comorbidities, and acute conditions. These findings demonstrate that specific diagnostic profiles are associated with real-world FIT ordering patterns, highlighting the need for further investigation into how comorbidities and competing clinical priorities relate to CRC screening decisions.

Community health centers (CHCs) should be important partners in research with academic health centers (AHCs). While persistent barriers to CHC-AHC partnerships have been described, our understanding of the potential solutions to these barriers is limited. This study aims to identify recommendations to support sustainable research partnerships between CHCs and AHCs to advance community-engaged health research. We conducted a qualitative study using interviews with CHC-based participants from three community health care organizations and researchers from one AHC. Twenty-five participants completed 12 individual interviews and six small group interviews. Five specific barriers to operationalizing research partnerships between CHCs and AHCs were identified, along with several recommendations to address these barriers. Recommendations are categorized into two domains-the first set calls for practical steps for researchers to adopt when conducting research, while the second set calls for deliberate, and leadership-led activities that support the creation of systemwide research partnerships between CHCs and AHCs.

RATIONALE:Socioeconomically disadvantaged patients with asthma and/or chronic obstructive pulmonary disease (COPD) face barriers to evidence-based care that are difficult to overcome in health care settings with limited resources. OBJECTIVES:Evaluate the efficacy of a pulmonary-specialist-health coach consultation model (intervention) for patients with asthma and/or COPD, relative to usual care (control). METHODS:Randomized-controlled trial of 16 weeks of intervention versus control for adult English- or Spanish-speaking, low-income patients. Intervention: a lay health coach gathered information from the patient and medical record for remote review by a pulmonary specialist, who provided general recommendations to the primary care clinician. The coach supported implementation of recommendations. MEASUREMENTS:Primary outcomes were receipt of guideline-based care and medications. Secondary outcomes were receipt of chronic lung disease education, breathing-related quality of life and symptoms, patient-rated quality of care, and adherence to inhaler therapy. Longitudinal models for count data were used to estimate Intervention: Control relative rates. Parallel models for continuous data estimated relative means. MAIN RESULTS:165 intervention participants received 1.61-fold more guideline-based care than 163 control participants (relative ratio; CI: 1.37-1.90). They were not more likely to receive guideline-based medications in planned analysis using a pooled baseline rate, although post-hoc analysis using arm-specific baseline rates found significant improvement. Intervention patients received more chronic lung disease education and reported greater improvements in breathing-related quality of life, symptoms, and patient-reported quality of care. CONCLUSIONS:This intervention offers a scalable approach to improve uptake of clinical guidelines in resource-limited primary care practices managing most asthma and COPD care.

Consensus on optimal prostate cancer screening remains elusive. Prostate-specific antigen (PSA) testing of patients in their 40–50 s is highly predictive of aggressive disease, yet remains underutilized; Black patients face excess mortality burden, particularly at younger ages. We describe a novel age and baseline PSA-stratified protocol to mitigate harms of overdiagnosis and reduce burden of disease, particularly for Black patients, with implementation by primary care providers (PCPs) in an academic healthcare system. We developed an evidence-based, age- and baseline PSA-stratified protocol and disseminated it to PCPs via talks and written materials beginning in 2016, with implementation as a health maintenance banner in the electronic health record (EHR) in 2019. EHR data were searched for rates of PSA screening within the prior 5 years in patients aged 40–90 from 2015 to 2021. We examined associations between age and race with receipt of PSA testing over time. Multivariable hierarchical mixed effects regression was performed to identify testing predictors, with clinic and provider included as nested random effects. Across 99,994 encounters, guideline-concordant PSA screening increased from 32.7 to 45.8

Background: Community health centers (CHCs) and those most burdened by disease are important partners in setting research agendas to address the needs of people who are medically underserved.Objectives: Identify and prioritize health equity-focused research priorities using a collaborative approach to community engagement of key informants.Methods: We used five stepwise phases from January 2021 to February 2023 to formulate and prioritize a set of health equity-focused research topics among CHC staff (leaders, clinicians), their key advisors (patients and community members), and researchers from academic medical centers in California. Phases included: (1) community advisory board formation, (2) key informant identification, (3) individual/small group interview guide development and administration, (4) initial health equity-focused topic categorization, and (5) in-person meeting with community advisors for final topic prioritization using nominal group technique.Results: Twenty individual or small group interviews were completed with 44 diverse participants, along with engagement from our community advisory board, which resulted in an initial list of 11 health equity-focused research topics. Ninety advisors including diverse community members, CHC staff/leaders, and researchers prioritized six overarching research topics. Final prioritized health-equity focused research topics include addressing mental health challenges, improving public's trust in healthcare and science, healthcare delivery models to increase access and utilization, build and sustain an anti-racist healthcare system, strategies and interventions to address health misinformation, and continuing and sustaining polices based on lessons learned from COVID-19.Conclusions: Results offer future direction for community-engaged research agendas to advance health equity among medically underserved and vulnerable patient populations.

OBJECTIVE:Community health centers (CHCs) are a vital safety net for under-resourced and medically underserved patients. As few studies have explored how they implemented broad-based organizational changes throughout the COVID-19 pandemic, we aimed to qualitatively examine CHCs' longitudinal, comprehensive pandemic response through the perspectives of staff, administrators, and researchers working in CHCs. METHODS:25 clinic leaders, staff, and researchers from three CHC networks and two academic medical centers in Northern California and the Central Valley of California participated in 18 focus groups and interviews between April and October 2022. We used thematic content analysis to identify key themes. RESULTS:Key themes emerged for three pandemic phases: shutdown, pivot, and recovery. During the shutdown, CHCs paused non-urgent services and in-person outreach while facing increased strain on staff capacity. Although CHCs were traditionally siloed, the pivot phase yielded efforts to build trust through information dissemination, partnerships with other health care organizations, and unprecedented innovations in care delivery. During recovery, CHCs re-prioritized preventive care but continued to face poor access to specialty care and socioeconomic resources for their patients. CONCLUSIONS:The COVID-19 pandemic magnified extant barriers within CHCs, including limitations in funding, staff capacity, and infrastructure for collaboration. CHC constituents highlight lessons learned through organization-wide adaptations and opportunities for the continuation and expansion of pandemic-related changes (e.g., investments in CHCs' workforce, care delivery infrastructure, and avenues for multidisciplinary collaboration) to better serve their communities in the post-COVID era.

Objective Community health centers (CHCs) are a vital safety net for under-resourced and medically underserved patients. As few studies have explored how they implemented broad-based organizational changes throughout the COVID-19 pandemic, we aimed to qualitatively examine CHCs’ longitudinal, comprehensive pandemic response through the perspectives of staff, administrators, and researchers working in CHCs. Methods 25 clinic leaders, staff, and researchers from three CHC networks and two academic medical centers in Northern California and the Central Valley of California participated in 18 focus groups and interviews between April and October 2022. We used thematic content analysis to identify key themes. Results Key themes emerged for three pandemic phases: shutdown, pivot, and recovery. During the shutdown, CHCs paused non-urgent services and in-person outreach while facing increased strain on staff capacity. Although CHCs were traditionally siloed, the pivot phase yielded efforts to build trust through information dissemination, partnerships with other health care organizations, and unprecedented innovations in care delivery. During recovery, CHCs re-prioritized preventive care but continued to face poor access to specialty care and socioeconomic resources for their patients. Conclusions The COVID-19 pandemic magnified extant barriers within CHCs, including limitations in funding, staff capacity, and infrastructure for collaboration. CHC constituents highlight lessons learned through organization-wide adaptations and opportunities for the continuation and expansion of pandemic-related changes (e.g., investments in CHCs’ workforce, care delivery infrastructure, and avenues for multidisciplinary collaboration) to better serve their communities in the post-COVID era.

PURPOSE:We estimated the 5-year overall, age at diagnosis- and stage-specific colorectal cancer survival in patients treated through their coverage with Seguro Popular. METHODS:We conducted a retrospective study using a dataset that included 1418 colorectal cancer patients covered by Seguro Popular (Mexico's public health insurance system covering 60 % of the population) between 2013 and 2016. Deaths were identified using the Epidemiologic Death Statistics Subsystem registry, with a specialized algorithm for record linkage. The Kaplan-Meier method was used to estimate overall survival curves and the proportion of patients alive at various follow-up time points. We compared survival curves across subgroups using the log-rank test. RESULTS:In this study the average age at diagnosis was 56 years with 31.9 % of patients diagnosed before the age of 50. Most cases (78.1 %) were diagnosed in advanced stages (i.e., III and IV), with nearly half of the cases originating in the rectum. The overall 5-year survival was 50 %, with higher survival (74 %) for patients with stage I-II and lower survival for those with stage III (58 %) and IV (33 %). While age at diagnosis was not associated with survival for early-stage colorectal cancer, younger patients with metastatic disease had a worse prognosis compared to older patients. CONCLUSION:The 5-year overall colorectal cancer survival was 50 %, with variation by clinical stage. Almost 80 % of the population was diagnosed with advanced stages, underscoring the need for screening programs. Younger patients with metastatic disease exhibited a worse prognosis, highlighting the need for targeted interventions.

BACKGROUND:Adverse childhood experiences (ACEs) are stressful or traumatic events prior to age 18 that are known to have a lasting impact on individuals' health and well-being. There is a gap in understanding the relationship between ACEs and Other Life Stressors and health status for adults with sickle cell disease (SCD). We examined the impact of adversities within clinical and behavioral health domains that have been associated with ACEs for other populations. PROCEDURE:Sociodemographics; medical history; patient-reported outcomes, including pain and emotional distress; and reports of de-identified ACEs and Other Life Stressors, were collected from n = 553 participants enrolled in the Sickle Cell Disease Implementation Consortium Registry. RESULTS:Participants were a median age of 28 years; 57% female; 95% Black/African American; 55% annual household income ≤$25,000; primarily diagnosed with sickle cell anemia (SS or Sβ0 thalassemia: 69.6%). Adults with SCD evidenced a high prevalence of exposure to adversity (28.3% reporting four or more ACEs), significantly higher than general or Black/African American populations (p < 0.001). Adjusting for age, gender, SCD genotype, annual household income, and disease-modifying therapy, we found a graded effect for categories of original ACEs (one to three, and four or more), with progressively greater odds of being diagnosed with asthma with increasing ACEs (p <0.0001), as well as for "ever been treated for depression" (p < 0.05). CONCLUSIONS:Our findings support the need for consistent screening for ACEs in adults with SCD and highlight the importance of trauma-informed care approaches to improve clinical and behavioral outcomes and quality of life.

PURPOSEColorectal cancer burden is increasing in Mexico. Population-based screening programs will be needed to address this public health challenge. Our objective was to explore the feasibility of offering colorectal cancer screening (CRCS) with a fecal immunochemical test (FIT) kit in the context of an existing door-to-door vaccination program in Mexico City.METHODSThe study was conducted in Mexico City in 2019-2020, before and during the onset of the COVID-19 pandemic. Design of the intervention was informed by focus group interviews with average-risk adults age 50-75 years served by a door-to-door vaccination program and interviews with primary care clinic and hospital staff serving this community. The intervention involved offering FIT to household members age 50-75 years during routine door-to-door immunization campaigns, with follow-up colonoscopy for those with abnormal results. Feasibility and acceptability of the intervention was evaluated through analysis of patient participation, clinical outcomes, and surveys.RESULTSA total of 132/178 (74.2%) eligible community participants accepted a FIT kit after receiving information from a trained health promoter. Mean age of participants was 62.0 (±6.8) years, and most were women (n = 84, 63.6%). Among participants, 94 (71.2%) returned FIT for testing. Of these, 20 (21.3%) had an abnormal FIT result (≥20 ngHg/mL) and were offered colonoscopy. Of these, 10 (50%) completed the colonoscopy. Recruitment was halted due to the COVID-19 pandemic, which also became a barrier to colonoscopy completion.CONCLUSIONOffering CRCS with FIT during door-to-door vaccination activities was feasible and acceptable to outreach workers and patients. Further studies are needed to determine interventions and implementation strategies necessary for scale-up and the effectiveness within integrated health systems.

You have accessJournal of UrologyProstate Cancer: Detection & Screening II (PD19)1 May 2024PD19-05 SMARTER SCREENING AND TREATMENT (S3T): MITIGATING HARM VIA AGE- & BASELINE-PROSTATE SPECIFIC ANTIGEN-STRATIFIED SCREENING James Nie, Nynikka R. Palmer, Rena J. Pasick, Maria Byron, Claire M. de la Calle, Samuel L. Washington, Coleen Kivlahan, Michael B. Potter, and Matthew Cooperberg James NieJames Nie , Nynikka R. PalmerNynikka R. Palmer , Rena J. PasickRena J. Pasick , Maria ByronMaria Byron , Claire M. de la CalleClaire M. de la Calle , Samuel L. WashingtonSamuel L. Washington , Coleen KivlahanColeen Kivlahan , Michael B. PotterMichael B. Potter , and Matthew CooperbergMatthew Cooperberg View All Author Informationhttps://doi.org/10.1097/01.JU.0001009448.41537.64.05AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Consensus on optimal prostate cancer screening to reduce over and under treatment remains elusive. Prostate-specific antigen (PSA) testing of men in their 40s and 50s is highly predictive of aggressive disease, yet is underutilized. Black men, particularly those under 50, face excess mortality burden. We describe: i) a novel age & baseline PSA stratified protocol to mitigate harms of overdiagnosis and reduce burden of disease for Black men, in particular; ii) implementation by primary care providers (PCPs) in an academic health system. METHODS: An evidence-based age & baseline-PSA stratified protocol was developed by a multidisciplinary task force and disseminated to PCPs via continuing medical education. In July 2019, the protocol was implemented as a health maintenance banner in the electronic health record (EHR). EHR data were searched for rates of PSA screening by PCPs in men aged 40-90 by provider and clinic setting from 2015-2021. We examined associations between age and race with receipt of PSA testing over time. Multivariable hierarchical regression was performed to identify testing predictors, with clinic and provider included as nested random effects. RESULTS: Across 18,203 patients, PSA screening increased from 29.1% in 2015 to 39.6% in 2021 (p<0.001) and was noted across all age groups and despite COVID-19. Notably, PSA screening among Black men increased from 29.7% in 2015 to 52.8% in 2021, with younger Black men exhibiting the following gains: 40-44 (4.4% to 7.0%), 45-49 (38.5% to 56.1%), 50-54 (44.7% to 58.6%). In a mixed effects model, Black men were more likely to undergo PSA screening (OR 1.39, 95% CI 1.34-1.44). Screening was less likely in geriatric clinics and there was a wide range in screening (0 to 75%) across individual PCPs in all departments. CONCLUSIONS: Increased PSA screening can be obtained for younger men and Black men following multidisciplinary collaboration, PCP outreach, and an EHR-based intervention. Significant provider variation in screening rates persist, suggesting the need for continued conversation with PCPs. Download PPTDownload PPT Source of Funding: San Francisco Cancer Initiative Prostate Cancer Task Force, UCSF Helen Diller Family Comprehensive Cancer Center © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e441 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information James Nie More articles by this author Nynikka R. Palmer More articles by this author Rena J. Pasick More articles by this author Maria Byron More articles by this author Claire M. de la Calle More articles by this author Samuel L. Washington More articles by this author Coleen Kivlahan More articles by this author Michael B. Potter More articles by this author Matthew Cooperberg More articles by this author Expand All Advertisement PDF downloadLoading ...

Screening for and treating anal squamous intraepithelial lesions (ASIL) in persons living with HIV (PLWH) prevents anal cancer but has not been widely implemented, especially in low-and-middle income countries. We conducted semi-structured qualitative interviews with providers and staff affiliated with two clinics from the Mexico City HIV program to understand barriers and facilitators to the implementation of a permanent anal cancer screening program. A limited program for anal cancer was already in place at these clinics as part of an international research collaboration. Interviews in Spanish were conducted in person or by video conference, audio-recorded, transcribed and thematically analyzed using domains from the Consolidated Framework for Implementation Research. Between October 2023 and January 2024, we conducted 17 interviews, of which 9 were with nurses or physicians who were part of the existing screening research program and 8 were with referring physicians or administrators. Interviewees agreed that establishing a permanent screening program was necessary given documented high rates of ASIL. The most significant barriers were related to resources required to sustain a program, especially infrastructure for collecting and processing pathology specimens. The clinics’ current participation in a research collaboration was recognized as a facilitator that could help overcome barriers related to procurement of anoscopes and training staff. Some interviewees believed that given resource limitations, screening would have to be scaled up in a stepwise process, requiring the creation of triage strategies to identify and prioritize high risk patients for screening. Barriers related to patient participation included lack of patient knowledge and, particularly among cis-women, stigmatization and logistical challenges to attending appointments. The clinics’ patient-centered culture and existing educational and clinical workflows promoting preventive health were facilitators that could help overcome patient-level barriers. Staff believed that establishing a permanent anal cancer screening program was necessary and possible but acknowledged that it would require additional external resources. In the next phase of data collection, we will interview PLWH who receive care at the clinics.

OBJECTIVES/GOALS: Community-based residency programs often lack formal training in research scholarship required by ACGME. To address this need, UCSF’s CTSI collaborated with residency leaders to implement a self-paced online curriculum for residents called Training in Practice Based Research (TIPR). We describe characteristics of the initial trainee cohort. METHODS/STUDY POPULATION: In the 2022-23 academic year, TIPR was offered to 10 UCSF-affiliated family medicine residency programs across Northern California and the Central Valley, and 8 chose to participate. An additional community-based psychiatry residency independently contacted our team and was also granted permission to participate. We conducted baseline surveys with participants to understand their prior research experience and motivation to join TIPR. Descriptive data for demographics of trainees and their prior research experience were collected using Qualtrics. Thematic analyses were conducted on qualitative responses. RESULTS/ANTICIPATED RESULTS: Of 32 participants, 29 completed the survey (91%). Learners identified as 40% non-Hispanic White, 28% Asian, 16% Hispanic, 9% non-Hispanic Black, and 15% non-Hispanic other. 28% were motivated to participate in the program because it was a residency requirement, 31% wanted to improve their scholarly skills and confidence, 16% were interested in career development, and 6% were interested in networking. 19% reported no research experience. Participants are currently working on scholarly projects designed during the first year of TIPR. In 2023-2024, with the addition of two new family medicine residency programs, an additional 40 residents have enrolled in TIPR. In April 2024, we will present data on projects completed, and demographics of the full cohort. DISCUSSION/SIGNIFICANCE: With CTSI support, TIPR has reached a large cohort of ethnically diverse physician trainees in community-based settings. Future evaluation will focus on whether TIPR increases the quantity and quality of practice-based research within residency training programs served by this program.

Background The prevalence of functional impairment is increasing among middle-aged adults and is associated with adverse health outcomes. Primary care providers (PCPs) and geriatricians may have important insights about optimal approaches to caring for these patients, but little is known about their perspectives. Objective To examine PCPs’ and geriatricians’ perspectives on clinical needs and optimal approaches to care for middle-aged patients with functional impairment. Design Qualitative study using semi-structured interviews. Participants PCPs and geriatricians from outpatient practices in the San Francisco Bay area. Approach Interviews focused on characteristics and care needs of middle-aged patients with functional impairment and models of care to address these needs. We analyzed interviews using hybrid deductive-inductive qualitative thematic analysis. Key Results Clinicians (14 PCPs, 15 geriatricians) described distinct characteristics of functional impairment in middle-aged versus older adults, such as different rates of onset, but similar clinical needs. Despite these similar needs, clinicians identified age-specific barriers to delivering optimal care to middle-aged patients. These included system-level challenges such as limited access to insurance and social services; practice- and clinician-level barriers including inadequate clinician training; and patient-level factors including less access to family caregivers and perceptions of stigma. To overcome these challenges, clinicians suggested clinical approaches including addressing health-related social needs within healthcare systems; implementing practice-based models that are multi-disciplinary, team-based, and coordinated; training clinicians to effectively manage functional impairment; and expanding community-based services and supports to help patients navigate the medical system. Identified needs, challenges, and solutions were generally similar across geriatricians and PCPs. Conclusions Clinicians face challenges in delivering optimal care to middle-aged patients who have functional impairments similar to their older counterparts but lack access to services and supports available to older people. These findings suggest the importance of increasing access to care models that address functional impairment regardless of age.

Purpose: Colorectal cancer (CRC) screening is recommended starting at age 45, but there has been little research on strategies to promote screening among patients younger than 50. This study assessed the effect of a multicomponent intervention on screening completion in this age group. Methods: The intervention consisted of outreach to patients aged 45 to 49 (n = 3,873) via mailed fecal immunochemical test (FIT) (sent to 46%), text (84%), e-mail (53%), and the extension to this age group of an existing standing order protocol allowing primary care nurses and medical assistants to order FIT at primary care clinics in an urban safety-net system. We used segmented linear regression to assess changes in CRC screening completion trends. Patients aged 51 to 55 were included as a comparison group (n = 3,943). Data were extracted from the EHR. Results: The percentage of patients aged 45 to 49 who were up-to-date with CRC screening (colonoscopy in 10 years or FIT in last year) increased an average of 0.4% (95% CI 0.3, 0.6)) every 30 days before intervention rollout and 2.8% (95% CI 2.5, 3.1) after (slope difference 2.3% [95% CI 2.0, 2.7]). This difference persisted after accounting for small changes in the outcome observed in the comparison group (slope difference 1.7% [95% CI 1.2, 2.2]). Conclusions: These results suggest that the intervention increased CRC screening completion among patients 45 to 49. Health care systems seeking to improve CRC screening participation among patients aged 45 to 49 should consider implementing similar interventions. ( J Am Board Fam Med 2024;37:660-670.)

INTRODUCTION:Previous research has found an association between low health literacy and poor clinical outcomes in type 2 Diabetes Mellitus (T2DM) patients. We sought to determine if this association can be mitigated by a self-management support (SMS) program provided by trained health workers using a technology assisted menu driven program, called Connection to Health (CTH). METHODS:This study is a secondary analysis from a randomized trial of 2 similar versions of CTH implemented in 12 Northern California community health centers. As part of this, each participant completed a single validated question to assess health literacy. We used unadjusted and adjusted linear regression analyses to determine the extent to which baseline health literacy was predictive of prepost changes in hemoglobin A1c (HbA1c). RESULTS:Of 365 participants for whom prepost HbA1c data were available, HbA1c concentrations declined by an average of 0.76% (from 9.9% to 9.2%, 95% CI (0.53%-1.0%). Almost 114 (31.2%) of the participants had low health literacy, but there was no significant association between health literacy and the reduction in HbA1c concentrations in either the unadjusted or adjusted models, nor did baseline health literacy predict prepost changes in body mass index, medication adherence, exercise, or diet. DISCUSSION:The study found that implementing the CTH program in 2 versions via a randomized clinical trial improved HbA1c concentrations without increasing disparities between participants with high and low health literacy. This suggests CTH-like programs can enhance diabetes outcomes in community health centers without exacerbating inequities for those with low health literacy.

Introduction: Traditionally, research institutions have valued individual achievements such as principal investigator and lead authorship status as primary indicators in the academic promotions process. However, the scientific process increasingly requires collaboration by teams of researchers across multiple disciplines, sometimes including experts outside academia, often referred to as “team science.” We sought to determine whether there is agreement about what constitutes team science at our academic institution and whether current promotion processes sufficiently incentivize faculty participation in team science. Methods: We conducted 20 qualitative interviews with academic leaders ( N = 24) at the University of California, San Francisco (UCSF) who supervise faculty promotions processes. Participants were asked to share their definitions of team science and the extent to which faculty receive credit for engaging in these activities during the promotions process. A subset of participants also completed a brief survey in which they ranked the importance of participation in team science relative to other factors that are traditionally valued in the promotions process. Interview data were examined by two analysts using structural coding. Descriptive analyses were conducted of survey responses. Results: Though team science is valued at UCSF, definitions of team science and the approach to assigning credit for team science in academic promotions processes varied widely. Participants suggested opportunities to bolster support for team science. Conclusions: Efforts to define and provide transparent faculty incentives for team science should be prioritized at institutions, like UCSF, seeking to advance faculty engagement in collaborative research.

BACKGROUND:Cigarette smoking rates remain disproportionately high among low income populations with unmet social and behavioral health needs. To address this problem, we sought to develop and evaluate the feasibility, acceptability, and preliminary effectiveness of a novel smoking cessation program for community health centers that serve these populations.METHODS:We implemented a randomized pilot trial of two smoking cessation programs in three county operated community health center (CHC) sites: (1) a systematic assessment of smoking habits and standard tools to assist with smoking cessation counseling ("Enhanced Standard Program" or ESP), and (2) another that added a structured assessment of social and behavioral barriers to smoking cessation, ("Connection to Health for Smokers" or CTHS). Clinical outcomes were evaluated between 10 to 16 weeks, supplemented with interviews of patient participants and health care team members.RESULTS:141 adults were randomized and 123 completed the intervention (61 in ESP, 62 in CTHS). At follow-up, over half of participants reported ≥1 quit attempts (59.7% ESP and 56.5% CTHS; adjusted p = .66) while more in ESP (24.6% vs. 12.9%) were documented as not smoking in the last 7 days (adjusted p = 0.03). In addition to being in ESP, predictors of smoking cessation included higher baseline confidence in ability to quit (p = 0.02) and more quit attempts during the study (p = 0.04). Health care teams, however, generally preferred the more comprehensive approach of CTHS.CONCLUSION:Lessons learned from this pilot study may inform the development of effective smoking cessation programs for CHCs that combine elements of both interventions.

OBJECTIVES/GOALS: The CTSI Research Infrastructure Network (RIN) expands CTSI’s reach into the regional health systems to provide our services to a broad and diverse translational science community. We create and support research collaborations that span multiple geographies and patient populations and serve as a bridge between the affiliate sites and CTSI programs. METHODS/STUDY POPULATION: We conducted needs assessments at each site (n=6) via in-depth, semi-structured interviews with key stakeholders. Informants (n=40) included investigators, study personnel, and research administrators. Investigators were selected across a variety of departments and career stages. Interview transcripts and notes were analyzed using matrix-based qualitative methods to identify both the common and unique research infrastructure needs of each site. Individualized support plans were shared with each site and a comprehensive summary report was presented to CTSI leadership. RIN met with UCSF’s Comprehensive Cancer Center, which conducts clinical trials at 2 sites, to coordinator our effort and services. When possible, RIN addressed service requests in real time that arose during interviews. RESULTS/ANTICIPATED RESULTS: We identified heterogeneous needs across multiple sites. However, among the community health systems with non-academic clinicians, there were common needs for research training, consultations in biostatistics/study design, and finding academic collaborators. The needs of sites with UCSF academic faculty differed from those of community sites and mainly included improved awareness and access to CTSI programs, ease of use of data extraction services, training programs, and assistance with regulatory approvals. Site needs are best addressed with individual plans created with CTSI Program leaders. A developing governance structure will include representation on a CTSI advisory committee and an annual conference to facilitate the sharing of best practices and foster collaboration across member sites. DISCUSSION/SIGNIFICANCE: Providing an individualized, site-specific approach to expanding CTSI services to regional health systems, will increase research collaborations across Northern California through building relationships, addressing unique infrastructure needs and sharing best practices throughout the network.

Context: Type 2 diabetes (T2DM) self-management support (SMS) programs can yield improved clinical outcomes but may be limited in application or impact without considering individuals’ unique social and personal challenges that may impede successful diabetes outcomes. Objective: To 1) determine whether adding a patient engagement protocol to an evidence-based SMS program to address unique patient challenges further improves behavioral, social, psychological and diabetes outcomes, and 2) explore whether improvement in behavioral, social, and psychological measures is associated with improvement in diabetes outcomes. Study Design and Analysis: Cluster randomized trial. Primary analyses used generalized linear mixed effects models to examine change in social, behavioral, psychological, and clinical outcomes by study arm and as potential mediators of change in clinical outcomes Setting or Dataset: 12 Community Health Center (CHC) sites affiliated with the San Francisco Bay Collaborative Research Network in California. Population Studied: 734 CHC patients with type 2 diabetes Intervention/Instrument: Clinics randomized to 1) Connection to Health (CTH; 6 sites), including a health survey and collaborative action planning, or 2) Enhanced Engagement CTH (EE-CTH; 6 sites), including all features of CTH plus additional relationship building training/support. Outcome Measures: Selected behavioral self-management (medication taking), psychological (health distress), modifiable social risks (food security, utilities), and clinical outcomes (HbA1c) from baseline to one year post-enrollment. Results: At 6-12 months post-enrollment, individuals in both programs reported significant improvements missed medications, health-related distress, social risks (p < .05), and HbA1c (p<.01). Compared to CTH, individuals in EE-CTH reported greater decreases in health-related distress (p < .05). Improvement in behavioral, social, and clinical outcomes did not differ by study arm (p>.05). Overall, reductions in missed medications and health distress (but not social risks) were independently associated with reductions in HgA1c (both p<.01). Conclusions: CTH and EE-CTH demonstrated positive behavioral, psychological and social risk impacts for T2DM in CHCs when delivered within existing clinical workflows. Improvements in SMS and psychological outcomes may mediate reductions in HbA1c, emphasizing the importance of addressing patient context and challenges within SMS programs.