Cancer is a leading cause of death in the Latino population. In 2021, California, Oregon, and Illinois amended their respective Medicaid programs to expand eligibility to adults regardless of immigration status; which could benefit 3.8 million Latinos. We propose to evaluate the impact of the Medicaid eligibility amendments implemented in California, Oregon, and Illinois on access to care and receipt of cancer preventive care among socioeconomically disadvantaged patients while taking into account a variety of social determinants of health.

Award PI: Nathalie Huguet, Ph.D.

Funder: American Cancer Society

Years: 2023 - 2026

Middle to older age Latina immigrants have a higher incidence of cervical cancer than non-Hispanic Whites. The goal of the proposed project is to partner with community research team members to develop a multi-level intervention that builds on the strengths of community health centers, where many underserved and marginalized individuals receive a wide range of preventive services. The results of this project will help community healthcare systems develop scalable interventions for marginalized patients with a particular emphasis on community-clinic partnerships to increase cervical cancer screenings, which do not involve a one-time behavior but rather require ongoing follow-up and monitoring to improve health outcomes.

Award PI: Cirila Estela Vasquez Guzman, Ph.D. 

Funder: NIH National Cancer Institute

Years: 2024 - 2029

The adverse effects of smoking on post-surgical complications has led to the implementation of policies requiring smoking cessation prior to elective surgery. The impact of these policies on socioeconomically disadvantaged patients, a population that experiences significant surgical- and smoking-related disparities, has not been evaluated. Our study fills this important gap by examining the impact of a policy implemented in Oregon in 2017 that requires Medicaid-insured patients to quit smoking prior to elective surgery on surgical- (referral rates, time to surgery, complications) and smoking-related outcomes (cessation assistance, cessation) among patients seen in community health centers.  

Award PI: Steffani Bailey, Ph.D. 

Funder: NIH National Institute on Minority Health and Health Disparities

Years: 2023 - 2028

To improve the delivery of tobacco cessation support to primary care patients, we unite the efforts of primary care clinics with outreach navigation to offer tobacco cessation assistance to individuals who use tobacco. We test two outreach strategies: 1) a person- vs. a technology-focused approach; both follow the same protocol to offer and connect patients to the tobacco cessation support services they choose, but differ in mode of delivery. We compare the two strategies on outcomes of whether patients receive tobacco cessation counseling and medications and whether 6 months later they report quitting tobacco; we also evaluate the cost effectiveness of the approaches.

Award PI: Sue Flocke, Ph.D. 

Funder: National Institute on Drug Abuse

Years: 2025 - 2030

Quitlines are effective, evidence-based smoking cessation interventions; yet, primary care referral rates to Quitlines remain low. A critical knowledge gap is how best to implement Quitline referral systems into health care settings to ensure maximum reach and effectiveness of cessation services, particularly among socioeconomically disadvantaged patients who smoke. This pragmatic study uses a cluster-randomized controlled trial (n=30 Oregon community health centers; n~15,000 smokers) to 1) examine smoking cessation assistance reach and effectiveness of implementation of a Quitline eReferral system with enhanced academic detailing (intervention condition) compared with implementation without enhanced academic detailing (comparison condition), and 2) evaluate the cost-effectiveness of the Quitline eReferral system, both with and without enhanced academic detailing.

Award PI: Steffani Bailey, Ph.D. 

Funder: NIH National Cancer Institute

Years: 2021 - 2027

 Latinos are more likely to have diabetes and hypertension and to face poor outcomes and complications from these diseases. The COVID-19 pandemic has shifted many primary care visits from face-to-face visits to telemedicine (telephone and video) visits, and it is uncertain how frequently Latino patients with diabetes and hypertension utilized (and continue to utilize) these types of visits, and how this may have affected the services they received for diabetes and hypertension. This project will use a highly innovative electronic health record database that contains telemedicine and in-person visit data to understand the quality of diabetes and hypertension care delivered via telemedicine among Latinos.

Award PI: Miguel Marino, Ph.D. 

Funder: NIH National Institute of Diabetes and Digestive and Kidney Diseases

Years: 2023 - 2028

Foreign-born Latinos in the United States are at risk for poor health outcomes, including poor outcomes for cancer. It is uncertain whether or not they receive fewer prevention services for cancer, and if so, which specific factors may be most responsible for the lower receipt of these services. This project will use a highly innovative electronic health record database that contains country of birth information and is linked to community information in order provide policy makers and healthcare providers better information about what cancer prevention services their patients or community members are most at risk for underutilizing.

Award PI: John D. Heintzman, M.D., M.P.H.

Funder: NIH National Cancer Institute

Years: 2022 - 2026

The Tilikum Summer Health Experience is a free 5-week hybrid summer enrichment program specifically designed for American Indian/Alaska Native (AI/AN) freshman and sophomore college students. Through a combination of virtual learning and in-person experiences, students will receive academic training, mentorship, and hands-on exposure to the health professions, all while staying connected to their cultural identity. The Tilikum Summer Health Experience is part of the AAMC’s Minority Serving Institutions Pathway Initiative (MSIPI).

Award PI: Erik Brodt, M.D.

Funder: Association of American Medical Colleges (AAMC)

Years: 2024 - 2025

The Northwest Native American Center of Excellence (NNACoE) at Oregon Health & Science University (OHSU) works to sustainably address the health care needs of all people by increasing the number of American Indians and Alaska Natives (AI/ANs) in the health professions workforce. We accomplish this through a continuum of health professions initiatives from high school through early faculty level. NNACoE is Native-led, and grounded in Indigenous values that strengthen our programmatic approaches to recruit, train, and retain future AI/AN healthcare leaders.  

Award PI: Erik Brodt, M.D.

Funder: Health Resources and Services Administration (HRSA) Bureau of Health Professions

Years: 2022 - 2027

Substance use during pregnancy is associated with negative maternal and infant health outcomes and numerous barriers impede delivery of well-coordinated and high-quality pregnancy and postpartum care for pregnant women with substance use disorder. In a recent pilot study, Project Nurture, a clinical model designed to combine maternity care, substance use disorder treatment, peer / doula support and case management in a single setting, was associated with reductions in child maltreatment, placement of children in foster care, and increases in both prenatal visits and maternal lengths-of-stay in the hospital. This proposal leverages Oregon's expansion of Project Nurture to five rural / frontier and underserved counties, offering an ideal opportunity to assess the effectiveness of this promising clinical and to identify how it is implemented in order to foster replication to other regions and states.

Award PI: Deborah J. Cohen, Ph.D.

Funder: NIH National Institute of Child Health & Human Development

Years: 2021-2026

Establish a new center that will incorporate information about Latino populations in the study of health inequities; build capacity in this area of research by developing an ethnically diverse workforce; and work to ensure the center’s approach aligns with community needs.

Award PI: Miguel Marino, Ph.D. 

Funder: OHSU Foundation Faculty Excellent and Innovation Award, funded by the Silver Family Innovation Fund

Years: 2023 - 2025

This study describes the workforce configurations (functions, tasks, professionals who do those tasks) and the per member per month costs to support these configurations among 12 purposively selected primary care practices with robust team-based interdisciplinary primary care models. This grant builds on work conducted by the Agency for Healthcare Research and Quality and by our team at Oregon Health & Science University by expanding the types and regional distribution of primary care practices examined, and by better addressing recent changes in non-visit-based care, and in team-based roles and functions.

Award PI: Deborah J. Cohen, Ph.D.

Funders: Co-funded by Commonwealth Fund and Healing Works Foundation

Years: 2024 - 2026

Our study evaluates the effects of major Medicaid initiative designed to integrate mental and physical health care in Washington state’s Medicaid program. This study will provide critical information on policy approaches currently under consideration for Medicaid and the potential public health benefits and impacts on the value of the program.

Project PI: Deborah J. Cohen, Ph.D.

Funder: NIH National Institute of Mental Health

Years: 2020 - 2025

Atrial fibrillation is a common heart rhythm disorder, and it is responsible for up to 1.2 million Emergency Department (ED) visits per year, with an estimated cost of $6.65 billion per year in the United States. In appropriately selected patients per professional guidelines, oral anticoagulants (OACs) prevent strokes, yet clinicians rarely prescribe OACs during an ED visit, leading to delayed and fragmented care. By implementing a clinical decision support tool consistent with evidence-based guidelines and optimizing the tool through feedback from clinicians and patients, this research plan has the potential to improve both the transition of care for ED patients with AF and long-term clinical outcomes. 

Project PI: Deborah J. Cohen, Ph.D.

Funder: NIH National Heart, Lung, and Blood Institute

Years: 2021 - 2026

The proposed research will provide critical information about effective Medicaid policies to improve health care utilization of Medicaid enrollees with opioid use disorder (OUD) and reduce the number of opioid-related overdoses among them. This knowledge will help inform state Medicaid policymakers who are seeking effective approaches in improving treatment for OUD among their Medicaid enrollees.

Project PI: Deborah J. Cohen, Ph.D.

Funder: NIH National Institute on Drug Abuse

Years: 2021 - 2026

Medicaid Transformation Project (MTP) is Washington State's five-year Section 1115 Medicaid demonstration waiver between the Health Care Authority and Centers for Medicare & Medicaid Services. MTP allows Washington to create and continue to develop projects, activities, and services that are designed improve Washington’s health care system. This mixed methods evaluation will assess Washington state’s approach to expanding coverage and access to care, advancing whole-person primary, preventive, and home- and community-based care, and accelerating care delivery and payment innovation focused on health-related social needs.

Project PI: Deborah J. Cohen, Ph.D.

Funder: Washington State Health Care Authority

Years: 2024 - 2026

Our study evaluates the effects of state Medicaid waivers focused on improving crisis care and expanding inpatient treatment for adults with serious mental illness (SMI) and children with serious emotional disturbances (SED). This study will provide critical information on policy approaches currently under consideration for Medicaid, the effects on acute episodes and crisis care, and the potential impacts on emergency department use, mental health services, and suicide and suicide-related behaviors.

Project PI: Deborah J. Cohen, Ph.D.

Funder: NIH National Institute of Mental Health

Years: 2023 - 2027

Medicaid is an important source of health insurance for people with substance use disorder (SUD), but many Medicaid enrollees with SUD do not receive optimal health care. Most states now contract with Managed Care Organizations (MCO) to deliver care for their SUD Medicaid population. The proposed research will provide important information on how states can further improve their Medicaid program by starting, renewing or to ending contracts with MCOs.

Project PI: Deborah J. Cohen, Ph.D.

Funder: NIH National Institute on Drug Abuse

Years: 2024 - 2028

Low rates of Medicaid participation among mental health providers have compounded growing service gaps for the one in three enrollees diagnosed with a mental health condition, and states are actively implementing policies to address this critical problem. In this proposal, we use national Medicaid claims data, coupled with in- depth qualitative interviews, to evaluate the effects of mental health reimbursement increases on Medicaid participation among psychiatrists and psychiatric mental health nurse practitioners, and on health care utilization, quality, and clinical outcomes for enrollees. Findings from this study will generate new, actionable information for states seeking to expand the Medicaid mental health workforce, a key proposed lever to improve access to mental health services.

Project PI: Deborah J. Cohen, Ph.D.

Funder: NIH National Institute of Mental Health

Years: 2025 - 2029

Changes in telehealth policies for care delivery have the potential to increase access to primary care-based treatment for opioid use disorder, which is critical to reducing opioid overdose rates. This study uses data from a large network of community health centers (CHCs) to 1) examine rates of opioid use disorder care before, during, and after telehealth expansion, 2) examine rates of opioid use disorder care by visit modality (in-person, telephone, video) over time, and 3) identify patient- and community-level factors that moderate the associations between visit modality and opioid use disorder care over time. Study findings are critical to informing future federal, state and local telehealth policies and clinical guidelines related to opioid use disorder care, and to determining if interventions are needed within CHC settings to ensure access to treatment for all individuals in need.

Award PI: Steffani Bailey, Ph.D. 

Funder: NIH National Institute on Drug Abuse

Years: 2025 - 2030