Over the last 5 years, the COERE has supported, in whole or in part, 8 pilot projects. In order to move toward a more efficient Learning Healthcare System, and to improve collaborations between COERE investigators and the UAB Health System as well as meet our benchmarks of increasing OER/HSR funding at UAB, this year the COERE, along with the other members of the UAB University-Wide Interdisciplinary Research Centers (UWIRCS) program will participate in a joint/coordinated pilot RFA(s) program. Funding opportunities and application due dates will be announced shortly.

View our pilot funding opportunity here.

View our pilot project template here.

Huifeng Yun, PhD

Huifeng Yun, PhD
About Huifeng
Dr. Yun is an associate professor in the department of Epidemiology at the University of Alabama at Birmingham (UAB). After working as a statistician/epidemiologist, she have accumulated more than 10 years of experience in the study design, analysis, and methodological development using a variety of data system, including electronic medical records, Medicare, Medicaid, SEER, commercial administrative data, and patient surveys. In 2012, I received an Agency for Healthcare Research and Quality (AHRQ) funded K12 research career award in patient centered outcomes research focusing on the safety and effectiveness of biologic disease-modifying anti rheumatic drugs using Medicare data linked to Consortium of Rheumatology Researchers of North America (CORRONA) registry data for patients with rheumatoid arthritis and spondyloarthritis.

Her Pilot: “Fracture Risk and Post-operative Complications in Patients Who Receive Epidural Steroid Injections”
Over 2.3 million epidural steroid injections (ESI) are performed annually in the US. There is substantial geographic variation in use of ESI, with the highest use in the Deep South2. Alabama has the highest rate of ESI use of any state in the US, with rates 8 times higher compared to Hawaii, the state with the lowest use. While ESI are an effective treatment for many causes of low back pain, these injections may have harmful consequences, including both local and systemic bone loss as a potential major issue. Data on the relationship between ESI use and fracture is limited, but critical to obtain given the high prevalence of their use. Moreover, patients who have persistent pain after ESI often go on to have spinal surgery as the definitive treatment for their symptoms. ESIs may weaken bone locally causing hardware instability and increasing the likelihood of a complication after spinal surgery. The relationship between ESI and outcomes after surgery is particularly relevant in the Southern US, where higher rates of ESI are associated with higher rates of subsequent lumbar surgery, and there is a shorter duration between ESI and surgery compared with other regions. Prior studies investigating the skeletal consequences of ESI have included very few Black or Hispanic subjects. This pilot project will collect critical data on the adverse skeletal effects of ESI in these populations in whom they are so commonly prescribed, through a population-based health investigation that will utilize Medicare data reflective of the actual racial and ethnic composition of the elderly population To our knowledge, this pilot study it will provide the first estimate on the relationship between ESI and bone outcomes in these underrepresented groups. This research will address population health, health challenges among the elderly, and health disparities with a clear pathway to an intervention to improve patient care.

Melanie Morris, MD

Melanie Morris, MD
About Melanie
Dr. Morris joined the faculty as an associate professor of surgery in 2010. In 2016, she was named the chief of general surgery for the Birmingham VA hospital. A native of Tennessee, she completed her undergraduate degree at Vanderbilt University and her medical degree at the University of Tennessee Health Science Center. She completed her surgical residency in general surgery at Oregon Health and Science University and a colon and rectal surgery fellowship at the University of Texas Health Science Center at Houston. Dr. Morris is a specialist in colon and rectal surgery who is dedicated to improving surgical outcomes and surgical education. She is the National Surgical Quality Improvement Project surgeon champion for UAB Hospital and actively improved in quality improvement projects to ensure the safest surgical care possible is delivered to our patients. She serves as an associate program director for our General Surgery Residency Program and mentors many residents and students.

​ ​ Her Pilot: “Pilot Evaluation of the Virtual Acute Care for Elders Program for Older Adults Having Complex Gastrointestinal Surgery”
​The current approach to postoperative care for older patients fails to optimize either short-term or long-term recovery after surgery. Over 150,000 Americans aged 65 years and older will have major gastrointestinal surgery annually, and these patients frequently experience functional and cognitive decline, leading to reduced quality of life and diminished survival. Additionally, 20-50% of older patients are unable to return home after surgery and are discharged to nursing homes and other facilities. Clinical outcomes in older patients are significantly improved when hospitals utilize an Acute Care for Elders (ACE) treatment model in which older patients are placed in specialized units where geriatricians lead multidisciplinary teams that follow evidence-based practices for geriatric care. Unfortunately, dissemination of the ACE model for surgical patients has been limited because there is a shortage of geriatric-trained physicians, and hospitals lack the financial resources to create dedicated ACE units. There is an urgent need to develop better methods to widely disseminate and implement the ACE model because this can improve postoperative recovery, enhance quality of life, and decrease healthcare costs for older surgical patients.

Our team of geriatricians and surgeons implemented a modified version of the ACE model (Virtual ACE) at our institution, that showed promising effects on patient mobility and incidence of delirium (see Preliminary Data), and was well-received by staff. Virtual ACE capitalizes on a novel combination of information technology and engagement with nursing staff to deliver ACE quality care without requiring specialized geriatric units, and with minimal need for formal geriatric consultations. Nurses on a Virtual ACE unit are trained to routinely conduct brief assessments of cognitive function, mobility, and pain. We developed software that compiles this information to generate a Virtual ACE dashboard on desktop computers that highlights high-risk patients who have poor mobility, decline in cognitive function, or inadequate pain control. Nurses and physicians are trained to collaboratively act on evidence-based geriatric care protocols for these patients, with care guided and coordinated by the dashboard. This enables non-geriatric specialists to manage most routine care issues, limiting formal geriatric consultation to only the most complex older patients. Enhancing use of geriatric care principles is especially important for gastrointestinal surgery patients, because surgery causes multiple functional deficits and surgeons frequently fail to adjust postoperative care to the unique needs of older patients.

Understanding barriers and facilitators to implementation is critical in order to enhance adoption and effectiveness. Consequently, the goal of this proposal is to conduct a stepped wedge randomized trial of the Virtual ACE program to evaluate effectiveness for older surgical patients, and to better understand the implementation process. We hypothesize that Virtual ACE can be successfully implemented in surgical units at multiple institutions, and will improve postoperative care for older gastrointestinal surgery patients.