2017 Funded CCRI Projects

Section 1

Estimating the operationalization of Clinical Nurse Leader practice model domains/components in diverse health systems: a criterion validation study

Project Team:

Miriam Bender, PhD; UCI School of Nursing

Darla Banks, RN; Texas Health Resources

Project Description:

This program of research directly addresses the need for evidence-based care delivery models to achieve national quality mandates. Clinical Nurse Leader (CNL) integrated care delivery is a nursing-led care model that has been identified by numerous policy organizations as an innovative strategy to improve microsystem care delivery. It has a growing track record of adoption in health systems across the nation, but lacks a rigorous evidence base, in part because of diversity in CNL initiatives reported across the literature. To address this gap, the PI, as part of a stakeholder-engaged research collaborative, developed and validated a conceptual model of CNL practice, providing a solid foundation for evidence-generating hypothesis testing.  Confirmatory factor analysis and structural equation modeling (SEM) was used to validate the measurement (CNL Practice Survey) and model structure. Community stakeholders in a current CCRI-funded capacity building study tagged the survey as a potentially robust evidence-generating instrument, but not without further validation. The purpose of this pilot study is to test the criterion-related validity of the CNL Practice Survey. The study will determine if the survey instrument can accurately estimate the operationalization intensity and integrity of CNL Practice Model components in diverse health systems with CNL initiatives. Results will be used to refine the measurement instrument, if necessary. The instrument will then be utilized in a national-level multi-site study that aims to quantify and causally link levels of CNL implementation and practice to quality and safety outcomes in a diverse sample of healthcare organizations with CNL initiatives, as part of a systematic program of research to generate actionable evidence about how this care delivery model functions to achieve positive outcomes for patient populations with acute and chronic disease care needs.

Community engagement in water quality monitoring using rapid E. coli quantification chip

Project Team:

Sunny Jiang, PhD; UCI Civil and Environmental Engineering

Ray Hiemstra; Orange County Coastkeeper

Project Description:

In this pilot project, we will test a rapid pathogen quantification chip for recreational water quality monitoring in collaboration with Orange County Coastkeeper. There is a critical need for a near real time pathogen quantification method to protect surfers and swimmers from exposure to contamination in recreational waters. Currently water quality is monitored by public health agencies using culture-based methods, which takes 1-2 days to go from sample to results. This delay affects the ability to make timely decisions that can protect surfers and swimmers from exposure to contaminated water. Molecular biology based methods, such as quantitative polymerase chain reaction (qPCR) or droplet digital PCR, require expensive laboratory equipment and clean facilities as well technical expertise, which makes onsite testing difficult. We have developed a “Lab-on-chip” (LOC) method for detection of E. coli in water using loop-mediated isothermal amplification (LAMP) assay combined with nano-droplet generation by a syringe pump. In this project, we will test the field application of this LOC method using beach waters collected from various recreational beaches in southern California. The project will address the suitability of the LOC technology for protecting humans against exposure to pathogens during beach recreational activities. Through the involvement of OC Coastkeeper and its network of environmental activists, the project will have the opportunity to train local surfers and swimmers to test the water quality onsite. This practice will address the potential of translating this bench-scale research into a real-world application that can reduce the public health risk from exposure to pathogens in recreational water.

Dementia Care for Underserved Asian American Communities in Orange County: A Pilot Education Intervention and Qualitative Needs Assessment

Project Team:

Jung-Ah Lee, PhD; UCI School of Nursing

Tricia Nguyen; Vietnamese Community of Orange County

Wendy Yoo; Orange County Korean American Health Information and Education Center

Project Description:

Research has documented significant barriers to dementia care for underserved Asian Americans in California, including lack of health insurance, low income, limited English language, stigma surrounding dementia, and low health literacy;1 in fact, many Asian Americans continue to believe that dementia is a normal part of aging.2 They avoid diagnosis and treatment for dementia until late-stage, and underutilize available public health services. 2 Orange County (OC) has a diverse population of older adults including 66% Caucasian, 14% Hispanic, and 17.5% Asian.3 In some areas (e.g., Westminster and Garden Grove), the Asian population constitutes 50-60% of residents.4 OC has the largest numbers of Vietnamese Americans living outside of Vietnam, and more than 30% of Korean Americans live in southern California. These two groups have the highest rates of poverty (12% and 17%, respectively) of all ethnic minorities ages 65+. 4 In OC, the Asian population is 62% foreign-born and the fastest growing ethnic population. Tragically, death rate of Alzheimer’s disease in OC increased 36%, which is higher than the CA or national rates.5 Therefore, we aim to address the disparities in dementia care and provide targeted, culturally tailored dementia education interventions for underserved immigrant Asian families and their caregivers. As a collaborative group between UCI Nursing Science and Family Medicine, we work together to enhance geriatric education and healthcare services for aging population; we are committed to educating the future healthcare and primary care workforce in partnership with individuals, families and their communities to improve wellbeing. While developing key research questions addressing the healthcare needs of underserved ethnic minority families struggling with dementia care, we will create state and nationwide models for health care programs to directly link with community groups in a sustainable model of care and health education. We will partner closely with the Vietnamese and Korean Community centers in OC.