Health Systems Center

Current projects

Our staff work on a number of different projects which inform action around critical health issues. 

Evaluating a Partnership Between a Low-Income Housing Provider and a Managed Care Organization

Low-income populations are at increased risk for health disparities and social determinants of health may be important to health disparities. With funding support from Episcopal Health Foundation, this project evaluates a unique partnership between a large low-income housing provider in Texas and a large managed care organization that offered coverage to residents and on-site preventive services. Low-income residents with coverage by the managed care organization were compared to low-income residents without coverage and other matched individuals with coverage but not living on properties owned by the low-income housing provider on use of acute care services and cost-effectiveness. The results can shed light on unique housing-managed care models and new ways to address social determinants of health.

Project staff:
Jack Tsai, PhD
Suja Rajan, PhD
Cecilia Ganduglia Cazaban, PhD
Vanessa Schick, PhD
Cici Bauer, PhD

 

Strengthening Peer Accountable Healthcare Communities Navigation (SPAN)

The Accountable Health Communities (AHC) Model was designed to address the health-related social needs of CMS beneficiaries. Bridge organizations across the Model identified lack of technical assistance and peer planning as key gaps, particularly around patient navigation. The Strengthening Peer AHC Navigation (SPAN) study seeks to fill this gap by applying a novel framework for peer planning and technical assistance. The SPAN team works with Bridge Organizations using our framework to develop and test multi-level quality improvement protocols. We will evaluate the implementation and impact of our novel peer planning and technical assistance framework using a mixed methods design. Five national Bridge Organizations from across the US are participating in SPAN.

Project staff:
Linda Highfield, PhD
Gretchen Walton, JD, MPH
Vanessa Schick, PhD
Paige Wermuth, PhD
Gretchen Gemeinhardt, PhD
Gayla Ferguson, DrPH

 

Addressing Social Needs of High-Risk Patients Through Screening and Navigation to Community Social Service Organizations

The environments in which people live profoundly influence health outcomes. Harris County is one of the largest counties in the United States, with among the most diverse and underserved populations in the country. Health related social needs include rapidly increasing housing costs, frequent food insecurity, high rates of domestic violence, and limited public transportation. In this project, UT School of Public Health researchers are partnering with Harris Health System, Memorial Hermann Health System and UT Physicians to discover how screening for health-related social needs, referral and patient navigation of Medicare and Medicaid beneficiaries affect use of community services, healthcare costs, utilization and health outcomes.

Project staff:
Linda Highfield, PhD
Cecilia Ganduglia Cazaban, PhD
Robert Morgan, PhD
Gayla Ferguson, DrPH

 

National HIV Behavioral Surveillance (NHBS)

The Center for Disease Control and Prevention’s (CDC) Houston NHBS system collects behavioral surveillance data every year in three different populations at high-risk for HIV infection. The populations are men who have sex with men (MSM), persons who inject drugs (PWID), and high-risk heterosexuals (HET). During some cycles, we also work with additional populations including trans women and women who exchange sex. Houston is part of NHBS since 2003 and is one of 22 project areas with high prevalence of HIV that conduct NHBS. Our team collects data on demographics, sexual behaviors, alcohol and drug use, HIV & STI testing behaviors, use of prevention services, and health conditions. We use qualitative methods to conduct extensive formative research before each cycle. We use quantitative survey methods and collect biological specimens for HIV, gonorrhea, and chlamydia testing.  Project findings describe high-risk HIV populations, provide behavioral context for trends in the epidemic, and monitor the impact of the HIV National Strategic Plan.

Project Staff:
Paige Padgett Wermuth, PhD, MPH
Catherine Troisi, PhD
Trisha Amboree, PhD candidate

 

Health Communication Scripts for Trans Men and HIV Prevention

This is a Community Health Initiated Research Partnership (CHIRP) Fellowship Award to explore the effects of healthcare stereotype threat on health communication for trans men in Houston and create culturally competent communication tools. Trans men face significant health and social disparities including barriers to healthcare and HIV-related risks, but are often underrepresented in sexual health research. Healthcare stereotype threat occurs within the healthcare domain and may affect needed health communication. Our team is a collaboration with UTHealth SPH and Doctors For Change (DFC). We are working with community members to conduct focus groups and workshops to form communication products. These tools will contribute to better patient experiences, promote positive sexual health, and reduce health disparities.

Project Staff:
Paige Padgett Wermuth, PhD, MPH
Lou Weaver

 

Muslim Community-Based Health Organizations

Muslim Community-Based Health Organizations (MCBHOs) represent a new wave of nonprofit organizations outside of mosques and Islamic community centers. We analyzed survey, maps, tax filings, and strategic plans to examine MCBHOs’ finances, strategy, and structure. Philanthropy’s central and historically enduring role was present among MCBHOs, with contributions and grants constituting 76% of their annual revenue. MCBHO managers were concerned about raising financial and human capital to sustain health and social care delivery in low-income communities, often with large Muslim populations. We did not find strong endorsements of the Muslim faith as part of MCBHO identity. Current extensions of this research include examining how MCBHO managers develop capabilities to meet patient demand, particularly for psychosocial interventions.

Project staff:
Gordon Shen, PhD, SM
Lance Laird, PhD

 

Training Advanced Practice Registered Nurses to Implement Comparative Effectiveness Research Findings In Primary Care Settings

There is a widening divide between the field of implementation science and implementation practice, that is perpetuated by the lack of training and mentoring programs focused on stakeholder engagement, working in context and application of pragmatic implementation approaches, strategies and methods to build practitioner capacity to apply findings from comparative effectiveness research studies in the real-world. To address this gap, training for practitioners that includes pragmatic designs, team science and interprofessional practice have been suggested as an alternative approach to create implementation practice skills. Our team is working with a diverse set of stakeholders to develop an IP training curriculum which will be delivered to APRNs across Texas focused on implementation of CER findings in primary care practices.

Project staff:
Linda Highfield, PhD
Gayla Ferguson, DrPH

 

Training Maternal and Child Health Leaders in Adaptive Change and Systems Integration

A central function of the Health Resources and Services Administration's Maternal and Child Health Bureau (HRSA MCHB) Title V Block Grant is convening across systems. As the UTSPH subcontract lead for the National Maternal and Child Workforce Development Center, Dr. Wells trains Title V leader in adaptive change management and systems integration. This includes using tools such as causal loop diagramming and network analysis. In addition, Dr. Wells publishes work for maternal and child health practitioners on using systems science methods to advance public health.

Project staff:
Rebecca Wells, PhD, MHA

 

The Risk of Developing Alzheimer’s Disease and Related Dementias Associated with Hypertension, Diabetes, and Drug Therapies for Cancer: Up to 30-year Follow-up for Older Medicare Beneficiaries

The goals of this proposed study are to examine the trends in the prevalence and incidence of Alzheimer’s disease and related dementias (ADRDs) over the past 30 years (1991-2020) and to determine whether, and to what extent, the risk of ADRD is affected by anticancer, antihypertensive and antidiabetic drug therapies.

Project Staff:
Xianglin L. Du, PhD
Paul E. Schulz, MD
Hua Xu, PhD
Wenyaw Chan, PhD

 

Long-term Benefits & Harms of Antihypertensive Drugs in the Elderly: Up to 22-year Follow-Up of ALLHAT Trial Participants

This project aims to link the data of ALLHAT (Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial) participants with their Medicare data up to 2016, making the total follow-up time to 22 years (including 8-year in-trial and 14-year post-trial follow-up). We will mainly determine if there are any long-term benefits for the reduced risk of coronary heart disease (CHD), cardiovascular disease (CVD), stroke, and mortality in those receiving diuretics as compared to those receiving other antihypertensive drugs into next 14-year post-trial surveillance period after taking into consideration post-trial antihypertensive medication usage from Medicare Part-D pharmacy data; and if long-term side effects, such as cancer and depression which are identifiable from post-marketing surveillance of Medicare claims, are similar among the 3 arms of antihypertensive drugs.

Project Staff:
Xianglin L. Du, PhD
Barry R. Davis, MD, PhD
Lara Simpson, PhD

 

Blood Pressure Control and Antihypertensive Drugs in ALLHAT Trial Participants and the Risk of Alzheimer’s Disease and Related Dementias

The goal of this Alzheimer’s-focused Administrative Supplement will determine whether blood pressure control and antihypertensive drugs are associated with the decreased risk of Alzheimer’s disease (AD) and related dementias (ADRD) during a long follow-up of up to 23 years from 1994 to 2017 in the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT) participants.

Project Staff:
Xianglin L. Du, PhD
Barry R. Davis, MD, PhD
Lara Simpson, PhD

 

Community Information Now (CI:Now)

Based in the UT School of Public Health San Antonio, CI:Now is a 501(c)(3) nonprofit that turns public and private data into information local government, nonprofits, and others in south central Texas use to improve community conditions. CI:Now makes local data available through reports and infographics, such as for the City of San Antonio’s Racial Equity Indicator Report, online data tools such as estimates of neighborhood-level correlations with life expectancy, and data support, such as for the San Antonio United Way’s four Impact Councils’ Results-Based Accountability process. CI:Now has gained national attention as an exemplar of how to make data useful to local decision makers.

Project staff:
Laura McKieran, PhD

 

COVID-19 Contact Tracing for the City of San Antonio

Coronavirus Disease 2019 (COVID-19) became a major epidemic that impacted cities around the U.S. including the city of San Antonio. With funding support of $7 million from the local health department, we hired, trained, and deployed 150 staff to lead COVID-19 case investigation and contact tracing for the City of San Antonio over a 1.5 year period. Our team handled thousands of COVID-19 cases per day. From the project, we have also collected longitudinal data on COVID-19 cases to understand their long-term physical health, mental health, and social needs. 

Project staff:
Jack Tsai, PhD
David Gimeno, PhD
John Herbold, PhD
Belinda Hernandez, PhD
Laura Aubree Shay, PhD

 

Telemental Health Adoption Amidst COVID-19

Health care organizations in the US adopted telehealth in the wake of the COVID-19 pandemic. Telemental health, more specifically, is the delivery of mental health services remotely through the use of communications technology. Mental health is an invisible bell curve that overlaps with the COVID-19 curve. One premise is that telehealth is a panacea in mitigating the behavioral health consequences of the pandemic and concomitant financial crisis through the provision of psychotherapy virtually. Yet, there are preexisting barriers in customizing technology to suit the needs of health care providers and patients. We are seizing this opportunity to examine telehealth as an enabling tool for providers to continue to provide mental health care in the throes of COVID-19. We conducted semi-structured interviews with 27 psychologists and psychiatrists who are affiliated with UTHealth. Our continued work uses a provider-centered approach to optimize technology in the treatment of people with serious mental illness.

Project staff:
Gordon Shen, PhD, SM
Lokesh Shahani, MD
Scott Lane, PhD

 

External Evaluation of Texas Child Health Mental Health Consortium Initiatives

Comprehensive and program-specific participatory evaluation approach to assess three mental initiatives of Texas Child Mental Health Care Consortium (the TCMHCC). Our collaborative team of evaluators at UTHealth School of Public Health and Rice University’s Baker Institute for Public Policy will apply a mixed-methods approach to conducting formative, process, and outcome evaluations of the Child Psychiatry Access Network (CPAN), Texas Child Health Access Through Telemedicine (TCHATT), and Psychiatry Workforce Expansion (Community Psychiatry Workforce Expansion (CPWE) and Child and Adolescent Psychiatry (CAP) Fellowship) initiatives.  Our role is to assist UTSPH colleagues Drs. Savas and Peskin by conducting the cost and cost-effectiveness analyses of the programs.

Project staff:
David Lairson, PhD
Yijiong Yang, PhD candidate

 

Clay Hunt Suicide Prevention for American Veterans (SAV) Act Evaluation: Agile Delivery of VA Imminent Strategic and Operational Requirements (ADVISOR)

Serve as a subject matter (economic evaluation of mental health programs in the Veteran’s Health Administration) expert and consult for the VA on the ADVISOR program.  Work primarily involves providing advice and review on how to conduct economic evaluation on several VA mental health programs.  A comprehensive report is submitted annually to the U.S. Congress. Currently working on the 3^rd annual report.

Project staff:
David Lairson, PhD
Lou DeNino, PhD

  

Health in the Workplace

Entrepreneurs’ mental health and well-being (MWB) and small business performance are intrinsically linked. Owners of small businesses experience chronic stress and poor mental health. Moreover, Black, Indigenous, People of Color (BIPOC) and immigrant entrepreneurs face respective hardships stemming from structural racism and xenophobia, which are root causes of health inequities in the US. Few low cost, highly effective mental health interventions have been proven for owners of small businesses. At the same time, there is a recent boom in venture capital investments in mental health startups. In partnering with start-ups, we are proposing to conduct randomized controlled trials to test the effectiveness of different app-based MWB interventions. The delivery of MWB interventions through apps is expected to overcome the stigma associated with mental illness in BIPOC and immigrant communities. Gaining this knowledge would allow the private sector and government to holistically understand and support entrepreneurships.

Project staff:
Gordon Shen, PhD, SM
Asia McClearly-Gaddy, PhD
Anabel Rodriguez, PhD, MPH
David Gimeno Ruize de Porras, PhD
David Douphrate, PhD, MPT, MBA, CPE, CSP
Jack Tsai, PhD
Rebecca Wells, PhD, MHSA

 

Economic Evaluation of Telehealth Programs on Health Outcomes in Rural Mississippi

The aim of this research is to study the economic costs and benefits of telehealth services relative to usual care. Economic analyses of telehealth interventions are important since the main reasons programs of this nature are being implemented is as a means to:  reduce costs for delivery health care, allow for more efficient use of healthcare workforce, improve timeliness of care and increase access to care.

The goal is for the economic evaluation of telehealth to inform decision makers on whether or not expanding telehealth services across clinical programs is cost-effective. This research is relevant to public health because the findings from the cost-effectiveness analysis may ultimately impact patient-centered policies by increasing access to needed services, as well as ultimately improving patients’ quality of life. Considering recommendations from the Taskforce on Telehealth Policy, costs to patients and family caregivers, clinicians and other providers will be incorporated.

Project staff:
J M Swint, PhD
Maria Pena, PhD student

 

Evaluating the Impact of a Comprehensive D2C Telehealth Program on Maternal Health Outcomes in Rural Mississippi

We will work with the University Medical School study team to achieve project goals. These include enhancement of access to antepartum and postpartum care for rural Mississippians by educating our partners in the use of telehealth and promoting patients’ visits with their primary care providers and obstetricians; incorporating patients’ social determinants of health into their care by connecting them to available community resources and providing direct-to-consumer care by the Mississippi Telehealth Center of Excellence Behavioral Health Team; assessing the cost-effectiveness of antepartum and postpartum telehealth care for patients, providers, and payors.

Project staff:
J M Swint, PhD
Maria Pena, PhD student

 

Economic Evaluation of DSRIP Projects

We are working with UT Physicians’ Healthcare Transformation Initiatives on evaluating Delivery Reform Incentive Payment Program (DSRIP) and Network Access Improvement Programs. We are involved in community-focused economic evaluation of DSRIP interventions targeting vulnerable Harris County populations. These include economic evaluations projects, including such projects as a Community Health and Wellness Center, an Expansion of Primary Care Clinics project, Integrated Behavioral Care for Adults, Integrated Behavioral Care for Children, Maternal & Neonatal Care, a Medication Therapy Management program, a Medical Home project, a Teen Medical Home project, a Patient Navigation Program, etc.

Project staff:
Tong Han Chung, PhD
Linh Nguyen, PhD
J M Swint, PhD
Lincy Lal, PharmD, PhD (Adjunct MPACH faculty)

 

Harnessing Big Data for Identifying Geographic Clusters of Low-income Children with Poor HPV Vaccination Rates

Human papillomavirus (HPV) vaccine uptake is suboptimal among low-income children and adolescents in Texas. This project will utilize state-of-the-art data mining techniques to determine area-level HPV vaccination rates, will implement geospatial approaches to identify hotspots of poor HPV vaccination rates, and will disseminate evidence-based resources for improving HPV vaccination rates. The long-term goal of this project is to increase the HPV vaccination rates among low-income children and adolescents to reduce HPV-associated cancer disparities.

Project staff:
Kalyani Sonawane, PhD
Xianglin L. Du, PhD
Maria E Fernandez, PhD
Ashish A Deshmukh, PhD
Ruosha Li, PhD
Ana Giuliano, PhD

 

Acceptance and Commitment Therapy for Fear of Recurrence in Breast Cancer Survivors (BCS)

The primary objective of this 3-arm phase III RCT is to test the impact and estimate the cost-effectiveness of our Acceptance Commitment Therapy (ACT) intervention on fear of cancer recurrence (FCR). We will randomly assign up to 400 early-stage BCS who have completed primary cancer treatment and report clinically significant FCR to: (1) group-based ACT (6 weekly 1.5-hour videoconference sessions), (2) group-based cognitive behavioral therapy (CBT) (6 weekly 1.5-hour videoconference sessions), or (3) education usual care (EUC) (a single 90-minute videoconference coaching session with self-administered readings). Costs and behavioral outcomes will be measured at baseline and 4 additional times over a 12-month follow-up period. Results will be modelled over the expected lifetime in a secondary analysis.

Project staff:
David Lairson, PhD
Ashish Deshmukh, PhD
Ravi Datt, MS

 

University of Texas Prevention Research Center

The UTPRC’s five-year goal is to decrease cancer-related morbidity and mortality and health disparities among African Americans and Hispanics in urban and rural settings in Texas by increasing the use of evidence-based Cancer control interventions, policies, and guidelines in communities and healthcare settings. Assisting primarily in the role of evaluation of interventions, including cost-effectiveness analysis.

Project staff:
David Lairson, PhD
Yaxeni Valero

Request a speaker

Our faculty are experts in a variety of fields. They are available to speak to community groups on the following subjects. 

Faculty	Subject matter
Carol Galeener	Behavioral Economics
Cecilia Ganduglia Cazaban	Claims / Administrative / Clinical Health Care Utilization Outcomes Research
Trudy Krause	Behavioral Health Claims / Administrative / Clinical Cost-Effectiveness Health Care Utilization Health Information Technology Hospital / Health Plan Administration Occupational Health Outcomes Research Physician Costs Policy Evaluation Qualitative Methods US Healthcare Policy
David Lairson	Analysis of Healthcare Interventions Cost-Effectiveness Economics of Cancer Prevention
Stephen Linder	1332 Waiver (ACA) Climate Change Cumulative Risk Data for Communities Diabetes Prevention Environmental Issues Ethics Health Disparities Needs Assessment Policymaking Regulatory Process Social Determinants of Health The  Texas Medical Center
Suja S. Rajan	Behavioral Health and Behavioral Economics Breast Cancer Cancer Screening (especially mammography and pap smears) Comparative Effectiveness Econometrics Economics Economics Evaluation and Cost Analysis Health Economics Health Outcomes Research Health Services Research Healthcare Disparity – Racial and Gender Disparities Impact of obesity on health risk, treatment utilization, and costs Large database analysis – Claims data analysis Managerial Economics (mostly with reference to healthcare management) Medicaid and Medicare (CMS) data use for health services research Regression analysis Statistics Women’s Health
Pauline Rosenau	Policy Evaluation International Policy US Health Care Policy Affordable Care Act Medicaid / Safety Net Medicare Private Insurance Health System Reform
Paul Rowan	Integrated care Mental illness Postpartum Depression/Peripartum Mental Health
Catherine Troisi	Immunizations Infectious diseases
Melissa Valerio	Health Literacy Community Engagement Community-Based Participatory Research Research methods Chronic Disease Management Translational Research Evaluation Building Partnerships
Rebecca Wells	Network analyses to facilitate cooperative initiatives

Contact us

Rebecca Wells, PhD, MHSA
Center Director
713 500-9184
Rebecca.S.Wells@uth.tmc.edu