Patient-Based Projects

We conduct projects on how to measure and improve patients' experience of health care.  

PCORI pipeline to proposal

Now in Tier II of funding, CPPE staff have convened a multi-stakeholder team of community members, community health workers, a health plan leader, and a facilitator as a core visioning team to plan future, participatory, patient-centered research projects. The group is self-named “Quorum: Reimagining health and wellness through community connection.” The team has identified four areas of shared passion: (i) patient/family-centered care, (ii) reform in Medicaid, (iii) living with multiple chronic conditions especially mental illness and substance use disorder, (iv) the impact of unstable housing on health.


Factors Affecting Safety-Net Medical Home Care Quality for Patients with Comorbid Diabetes

Through a career development award from the University of Minnesota’s Clinical and Translational Science Institute, this project aims to identify HCMC patient and clinic factors that influence patient workload and capacity, and are associated with diabetes care quality, for patients with comorbid type 2 diabetes. These results will inform future development of a primary care-based intervention to individualize and optimize care delivery in patients with comorbid type 2 diabetes.


BoT PETS: Burden of Treatment

For this study Burden of treatment (BoT) is defined as the “workload of health care and its impact on patient functioning and well-being.” Workload consists of the demands of treatment and self-management (e.g., taking multiple medications, maintaining medical appointments, diet).

This study in partnership with the Mayo Clinic developed the first comprehensive, multi-domain, multi-item measure of patient Burden of Treatment (BoT). The Patient Experience with Treatment and Self-care (PETS) is a general measure of patient-reported treatment and medical self-care burden. It can be used for any disease or treatment regimen; hence, it is appropriate for use in people with multiple chronic diseases (MCCs). CPPE staff, in collaboration with the primary team from the Mayo Clinic, will conduct a comprehensive validation test of the PETS measure across three settings in which patient-reported outcomes are used: clinical research, performance measurement, and clinical practice. The aims of this study are designed to accelerate implementation of the PETS in a variety of settings.


Somali Healthy Heart

This federally funded grant, in partnership with HealthPartners and WellShare International is designed:

  1. To study heart disease and diabetes risks among Somali people in the Twin Cities
  2. To estimate effects of those risks on health behaviors and health results among Somali people in the Twin Cities
  3. To suggest the best public health interventions for preventing and treating   heart disease and diabetes among Somali people in the Twin Cities


UCare Med-Psych project

This project started when the Departments of Psychiatry and Medicine at HCMC articulated a vision and began to implement a program for providing integrated medical and psychiatric care for patients with co-morbid medical and psychiatric conditions. The Medical Psychiatry program integrated psychiatric and medical care for the thousands of medical and psychiatric inpatients and outpatients seen at HCMC annually. The project included:

  • The Comprehensive Cardiovascular Prevention Program (C2P2) in outpatient day treatment program. 
  • A Quality Improvement (QI) program in shared decision making in psychiatric medication therapy, presented at the Minnesota Health Services Research Conference.
  • A QI/research program based in our psychiatric inpatient service addressing  medication management and falls. 
  • A research endeavor in the engagement and medical outcomes of psychiatric patients after they are discharged from HCMC. 


Shared Decision Making

Shared decision making for AFIB: This federally funded study (R0-1 supported by the National Heart, Lung, and Blood Institute) about patients with non-valvular atrial fibrillation (AFIB) is a collaboration with the primary investigators at the Mayo Clinic and partners at Park Nicollet. The goal is to determine the extent to which an anticoagulation choice tool promotes shared decision making (SDM) and impacts anticoagulation uptake and adherence when compared to standard care without this tool. The anticoagulation choice tool is a decision aid designed to support the recommendation for shared decision making for anticoagulation in AF and was created using a user-centered design process.

TRICEP: Translating Information on Comparative Effectiveness into Practice (TRICEP) was a federally-funded multi-site shared decision making study conducted in collaboration with our Mayo Clinic colleagues that looked at shared decision making surrounding diabetes medication choices.

iADAPT:  Translation of comparative effectiveness of depression medications into practice was also a federally funded multisite shared decision making study conducted in collaboration with the Mayo Clinic that looked at shared decision making surrounding depression medication choices.

Community Transformation Grant: This CDC-funded initiative, in partnership with Hennepin County Human Services and Public Health, came to an end in 2014. Over three years, we promoted chronically ill patient engagement, documented patient goal setting, and provided opportunities for care team collaboration. The project took place at the Medicine Clinic, Richfield Clinic, and Coordinated Care Center.


Digital Storytelling

Diabetic outcome and Process Measures with Limited English Proficiency: Partially funded by the Mayo Clinic, this retrospective cohort study of patients with type 2 diabetes took place in two large primary care networks in Minnesota. We compared diabetic process and outcome measures for English speaking and low English speaking patients, finding that solutions are needed to bridge the gap from process to outcomes.

Digital Storytelling for Reduction of Diabetes-Related Health Disparities: With funding from the Mayo Clinic, we pilot tested a community-designed set of digital storytelling videos among Spanish and Somali-speaking patients for acceptability and feasibility to inform the application for a R01 application