2016 Funded CCRI

Section 1

Developing capacity to conduct large-scale testing of an explanatory model of clinical nurse leader integrated care delivery: leveraging health system stakeholders

Project Team

Miriam Bender, PhD; UCI School of Nursing

LeeAnna Spiva, PhD, RN; Wellstar Health System

Marjory Williams, PhD, RN; Central Texas Veterans Health Care System

Project Description

The purpose of this study is to leverage existing community-stakeholder and scientific connections to establish the research capacity to conduct multi-site studies designed to test an explanatory model of Clinical Nurse Leader (CNL) integrated care delivery. This capacity building phase will identify and address challenges inherent in measuring and comparing models of nursing care delivery across diverse care settings and linking them to improved patient quality and safety outcomes. Numerous policy bodies have determined that redesigning nursing care delivery is essential for improving care quality and safety.  However, the science of care delivery is in its infancy, and evidence to guide effective care delivery is limited. Many health systems have addressed this evidence gap by developing their own nursing care delivery innovations in response to economic and policy mandates for improved quality and safety. Nurses comprise the largest sector of the healthcare workforce and are in a vital position to shape clinical settings into spaces where the multi-professional healthcare team work together to deliver high quality patient care.  Clinical nurse leader (CNL) integrated care delivery is one example of a promising nursing innovation. The CNL is a Master’s prepared registered nurse educated to apply advanced competencies in clinical leadership, clinical outcomes management, and care environment management to enhance the effectiveness with which care is delivered across the entire healthcare team. CNLintegrated care delivery is a systems-oriented healthcare innovation with a promising track record of success, but lacks a generalizable evidence base.  To generate this evidence, it is necessary to build infrastructure that connects healthcare innovators with care delivery researchers and leverage their combined knowledge and experience to develop a program of research that is feasible, scalable, and capable of translating care delivery innovations into reliable and usable evidence for practice. 

Experiences, Knowledge, and Attitudes of Parents involved in the Dependency Process: Targeting Parents to Intervene on Behalf of Children and Families

Project Team

Jodi A. Quas, PhD; UCI Department of Psychology & Social Behavior; 

Gene Howard; Orange County Alliance for Children and Families

Project Description

The dependency branch of the juvenile justice system handles cases of alleged child maltreatment. Involvement in such cases is life-changing for children, but also for their entire families. To be reunited, parents are typically required to complete court-mandated services, regularly return to court, check in with social service and legal professionals, and follow strict orders concerning interactions with their children. When parents fail to complete these activities, the assumption is, most often, that the parents are not sufficiently motivated to comply. Yet, for some parents, another reason is equally plausible. They may not understand the requirements, their role, or the judicial process sufficiently well to be able to follow through.  Researchers in the fields of criminal and juvenile justice and psychology and law have long recognized the importance of individuals’ understanding toward the legal system for their compliance with court orders (Grisso et al., 2003), and considerable effort has been devoted to augmenting these individuals’ understanding. Virtually nothing, however, is known about such understanding, and its links to compliance, among parents in dependency cases. Such knowledge is imperative if, as a society, we want to identify the best ways of intervening to improve the lives of children—and their entire families—when involved in dependency proceedings. The overarching purpose of the proposed pilot project, to be carried out via an exciting new partnership with the Orange County Alliance for Children and Families (OC ACF), is to provide this knowledge. Main questions to be addressed are threefold: How well do parents involved in ongoing dependency cases understand the dependency process in general and their case in particular? Does parents’ understanding vary depending on socio-economic status, race/ethnicity, and prior contact with the system? And does parents’ understanding predict their subsequent willingness to follow court orders mandated for reunification. 

Developing a saliva-based oral cancer risk test for underserved populations in a community-based settingPetra Wilder-Smith, DMD, PhD (Cherie Wink)

Project Team

Petra Wilder-Smith, DMD, PhD; UCI Beckman Laser Institute

Cherie Wink, RDH; Concorde College of Dental Hygiene

Project Description

The proposed study is a collaboration between the low-cost clinic for underserved populations at Concorde College of Dental Hygiene School (CCDH) in Garden Grove, and the Wilder-Smith group at UCI. Our goal is to develop a non-surgical tool based on salivary transcriptomic biomarkers for diagnosing dysplasia, as well as monitoring oral premalignancy and ensuing cancer risk in underserved patients with leuko- and erythroplakia. Using high-throughput sequencing techniques, the dynamic features of salivary transcriptome have been highlighted and are evolving rapidly. Upregulation of specific salivary transcriptomes has been demonstrated in OSCC patients; however, this concept remains unexplored for oral dysplasia. Targeting dysplasia potentially provides greater benefits by identifying RISK of malignant change and PROGRESSION towards OSCC, so that treatment can be instituted BEFORE OSCC becomes established and metastasizes. 

Specific Aims of this pilot study: (1) identify salivary transcriptomes that are involved in dysregulation of cell proliferation and inherent death mechanisms using quantitative polymerase chain reaction and microarray-based gene profiling in patients with leukoplakia and erythroplakia (2) evaluate the downregulation/upregulation of determined transcriptomes at different stages of oral dysplasia, (3) identify potential salivary biomarkers of dysplasia and progression that will provide the basis for future extensive studies.