Center for Transformation of Internal Medicine (CENTRI)

Mission

The Center for the Transformation of Internal Medicine (CENTRI) in the Division of General Internal Medicine (DGIM) was established in 2021 by a transformative gift to advance the care of every patient, promote the career satisfaction of general internists, and advance workforce enrichment and engagement in primary care. CENTRI is designed to evaluate innovative clinical or educational programs in primary care, with a particular focus on projects that address social determinants of health, vulnerable populations, or virtual care and digital health. Its goal is to expand research support for the DGIM educators and innovators, who do not have formal research training, to help them develop better evidence to support clinical practice and to support the work of researchers to develop evidence to inform practice. It is focused on four pillars of innovation: care frontiers, patient-centered care, data-driven care, and care innovation.

Four Guiding Pillars of Innovation

CENTRI is focused on four pillars of innovation: care frontiers, patient-centered care, data-driven care, and care innovation.

Faculty & Staff

Jennifer S. Haas, MD, MSc
Peter L. Gross, MD, Chair in Primary Care
Director of Research & Research Education, Division of General Internal Medicine, Massachusetts General Hospital
Professor of Medicine, Harvard Medical School
Professor of Social & Behavioral Sciences, Harvard T.H. Chan School of Public Health

 

Suzanne Brodney, PhD
Investigator, Division of General Internal Medicine, Massachusetts General Hospital

Yuchiao Chang, PhD
Associate Professor of Medicine, Division of General Internal Medicine, Massachusetts General Hospital

Sue Regan, PhD
Investigator, Division of General Internal Medicine, Massachusetts General Hospital

Meghan Rieu-Werden
Senior Systems Analyst, Division of General Internal Medicine, Massachusetts General Hospital

Jacquelyn Lykken, PhD
Senior System Analyst, Division of General Internal Medicine, Massachusetts General Hospital

Jessica Pham-Stephens, MHA, SHRM-CP
Grant Administrator, Division of General Internal Medicine, Massachusetts General Hospital

 

 

Katherine Gallagher, BS
Clinical Research Coordinator II, Division of General Internal Medicine, Massachusetts General Hospital

 

 

Caylin Marotta, MPH
Senior Clinical Research Coordinator, Division of General Internal Medicine, Massachusetts General Hospital

 

Current CENTRI Projects

Flex Nutrition Services

Team Members: Sarah Matathia, MD, MPH; Anne Thorndike, MD, MPH; Saja Alani, MPH; Kristen Risley PMP, MSW, Sue Regan, PhD; David Cheng, PhD; Suzanne Brodney, PhD; Katherine Gallagher
Years: 2022-2024

As part of the Medicaid Accountable Care Organization (ACO) Flexible Services Program, members with a health needs-based criteria who are experiencing food insecurity can receive nutritional support through the Flex Nutrition Program. We will randomize eligible members into three cohorts. Cohort A will receive high intensity proactive outreach via phone, Cohort B will receive low-intensity outreach via letter, and Cohort C will receive usual care with no proactive outreach. We seek to understand if proactive outreach to eligible patients increases enrollment into and utilization of the Medicaid ACO Flex Nutrition Program. Data collection was completed in March 2024 and the analysis was completed in June 2024. A manuscript will be submitted in early 2025.

Nurse-Led Diabetes Education Sessions

Team Members: Kerri A. Pagliuca, RN; Lisa M. Brugnoli-Semeta, RN; Julie B. Marden, CNP; Jennifer Haas, MD; Suzanne Brodney, PhD; Katherine Gallagher; Meghan Rieu-Werden
Years: 2022-2024

The objective of this project is to implement and evaluate a 3-session, nurse-led diabetes management education program with peer support for nurses to help patients in primary care with uncontrolled type 2 diabetes better manage their condition. The nursing team will implement the clinical program in five primary care practices and the program includes an initial phone call and three in-person or virtual visits that will be conducted over four months. The research project will survey nurses at baseline, 4 months and 8 months to evaluate if the program improves nurse’s confidence with managing patients with uncontrolled diabetes. We hypothesize that engaging and supporting nurses to educate patients with uncontrolled diabetes through structured educational and goal setting visits will improve nursing confidence in providing diabetes education, improve patient A1C levels and improve patient engagement. Data collection will be completed in January 2025 and a manuscript submitted in early 2025.

Evaluating the Acceptability and Clinical Impact of a Preventive Genetic Counseling Service

Team Members: Leland Hull, MD, MPH; Jennifer Haas, MD, MSc; Sue Regan, PhD; Suzanne Brodney, PhD; Caylin Marotta, MPH
Years: 2023-2024

Given the high demand for preventative genetics services, limited access to genetic subspecialists, and the logistical barriers to screening, this study will evaluate the implementation of a “fast track” genetics screening service. The new genetics screening workflow would include an EPIC referral being placed by a clinician, a pre-visit phone call to collect personal and family medical history, and a streamlined visit with a genetics counselor. This study will examine whether the clinical model is acceptable to key stakeholder groups by collecting and analyzing qualitative and survey data. Moreover, this study will seek to characterize the patients and providers referred to the clinical service and their outcomes via analysis of electronic health record data and medical notes. Quantitative and qualitative data collection have been completed and an analysis will be completed in December 2024. A manuscript will be submitted in early 2025.

Integration of a Colorectal Cancer Screening Decision Support Tool Primary Care

Team Members: Karen Blumenthal, MD; Karen Sepucha, PhD; Katherine D. Rose, MD; Maria Eliopoulos, RPH; Moshe A. Rancier, MD; Lauren Leavitt; Meghan Rieu-Werden; Yuchiao Chang, PhD; Suzanne Brodney, PhD; Caylin Marotta, MPH, Katherine Gallagher
Years: 2023-2026

This project will test if a CRC screening decision support tool that is part of the Annual Visit Primary Care Screening Bundle, offered in advance of a primary care visit, increases CRC screening completion rates. The decision tool was developed by MGB and has been integrated into Epic. Primary care practices have been randomized to receive the decision support tool or usual care. Patients aged 45-75 years complete the tool on Patient Gateway prior to the visit or via an iPad at the visit. CRC completion rates will be assessed 12 months after the intervention period. To better understand decision making and preference concordance around CRC screening discussions, a follow-up project is surveying 1000 patients who were either assigned the CRC screening decision support tool (intervention) or the patient was eligible for the bundle, but not assigned (control). 300 primary care providers from the MGB primary care practices where the bundle was assigned will also be surveyed about their experience.

Cross-sectional Population Study of Patients with Substance Use Disorders at the MGH Health Centers

Team Members: Wei Sum Li, MD, James Morrill, MD, PhD; Danielle Fine, MD, MSc; Meghan Rieu-Werden; Suzanne Brodney, PhD; Caylin Marotta, MPH
Years: 2023-2024

Since initiation of the MGH Substance Use Disorders Initiative in 2014, the MGH Health Centers have developed a robust set of services to care for a large population of patients with Substance Use Disorders (SUD), including medication for SUD, OBAT (office-based addiction treatment) Nursing, SUD-focused behavioral health care, multidisciplinary risk rounds, and Recovery Coaching. However, the scope and characteristics of the patient population being managed has not been assessed. We propose conducting a cross-sectional study of patients treated for SUD at the MGH health centers to describe the patient population, medical comorbidity, and the cascade of SUD care. Data analysis will be completed in December 2024 and a manuscript submitted in early 2025.

Identifying Mental Health Needs for Patients with Sickle Cell Disease (SCD) at MGH’s SCD Treatment Clinic

Team Members: Jennifer Hong, MD; Adaugo Amobi, MD, MPH; Aisha James, MD, MEd; Sharl Azar, MD; Meghan Rieu-Werden; Suzanne Brodney, PhD; Caylin Marotta, MPH
Years: 2023-2024

SCD is a multi-organ disease process that requires multidisciplinary care for optimal continuity care. Primary care is the central anchor for many chronic diseases, of which SCD is no exception. The goal of this project is to develop a data registry of patients with SCD to determine screening, treatment, and referral practices for other conditions that patients with SCD may have or develop as a result of SCD. An analysis describing the emergency department presentation, inpatient admissions and preventative health screens has been completed. Data analysis will be completed in December 2024 and a manuscript submitted in early 2025.

Transgender Health Cohort

Team Members: Jenny Siegel, MD; Michael Barry, MD; Alex McDowell, PhD, MPH, MSN, RN; Meghan Rieu-Werden; Suzanne Brodney, PhD; Caylin Marotta, MPH
Years: 2023-2024

The goal of this project is to clarify and refine methods used to identify patients such that there is user-friendly dataset that can be analyzed to address key questions and hypotheses pertaining to the health needs of transgender and gender diverse persons. Once the data set is optimized for analysis, it could be used for a descriptive study of the health care epidemiology for people in this cohort to better understand where and with what frequency individuals received care across our system. Data analysis has been completed and a manuscript will be submitted in early 2025.

Pharmacist referrals in primary care: A descriptive study

Team Members: Karen Blumenthal MD, MPH; Jennifer Haas, MD; Anthony Ishak, PHARMD; Yuchiao Chang, PhD; Meghan Rieu-Werden, TuTran Nguyen, RPH; Caylin Marotta, MPH; Suzanne Brodney, PhD
Years: 2023-2025

The goal of this project is to evaluate a clinical program by describing the outcomes of the referrals to the clinical pharmacist and then comparing blood pressure control for those who worked with the pharmacist to a matched cohort who did not work with a pharmacist. MGB has integrated a dedicated, experienced, full-time academic ambulatory pharmacist in primary care and this pharmacist is working with Bulfinch Medical Group and MGH Chelsea Health Center Adult Primary Care.

Medications for alcohol use disorder in hospitalized patients: A medical center's experience and analysis

Team Members: Daniel Liauw, MD; Michael Barry, MD; Eugene Lambert, MD; Susan Regan, PhD; Caylin Marotta, MPH; Suzanne Brodney, PhD
Years: 2024-2025

The purpose of this study is to perform a retrospective cohort study of adult alcohol-related hospitalizations at Massachusetts General Hospital from April 2017 through September 2024. The analysis examined the cohort of hospitalized patients with AUD with an alcohol withdrawal syndrome diagnosis to characterize medication for AUD prescribing on discharge. Data analysis has been completed and a manuscript is in preparation.

VIBE: Emulating a Stepped Wedge Trial Design to Assess the Impact of Virtual AI-Based Scribes on Primary Care Providers

Team Members: Lidia Maria Moura MD, PhD; Jennifer Haas, MD; Meghan Rieu-Werden; Yuchiao Chang, PhD; Katherine Gallagher; Suzanne Brodney, PhD
Years: 2024-2025

This research is exploring whether using virtual AI-based scribes can make it easier and faster for primary care doctors to complete their patient documentation, which is the written summary of each patient visit. We also want to find out if this technology can help reduce burnout among doctors, especially those with complex patient needs or a high number of non-English-speaking patients. This analysis will be completed in Q1 2025.

Prescriptions for Weight Loss Medication and Referrals for Lifestyle Interventions and Bariatric Surgery in Primary Care at Mass General Brigham

Team Members: Ksenia Blinnikova, MD, MPH; Suzanne Brodney, PhD; Jennifer Haas, MD; Jacquelyn Lydden, PhD; Yuchiao Chang, PhD; Katherine Gallagher
Years: 2024-2025

The objective of this project is to describe the patient, provider and clinic characteristics of patients with obesity who were sent an initial prescription for weight loss medication and describe referrals for lifestyle interventions and bariatric surgery in MGB primary care practices. A second phase of this project will conduct semi-structured interviews with primary care physicians to understand the barriers and facilitators that influence decision making about treating obesity with weight loss medication and referrals to lifestyle interventions and bariatric surgery. This analysis is expected to be completed in Q1 2025.

Completed CENTRI Projects

Primary Care Equity Initiative

Team Members: Andrew Hwang, MD, MPH; Sarah Matathia, MD, MPH; Michael Barry, MD; Vanessa Adjei; Aisha James, MD, MEd; Victoria Nixon; Yuchiao Chang PhD;  Meghan Rieu-Werden 
Years: 2021 – 2023

As part of the Mass General Brigham United Against Racism (UAR) initiative, primary care launched a practice-level equity dashboard that displays ambulatory quality outcome metrics stratified by race and language. Five practices were assigned to the UAR initiative, and 10 practices are serving as controls. All practices have equity huddles led by population health coordinators, but the five UAR practices also have community health workers who can outreach to patients to provide additional hypertension support. We used a stepped-wedge design to randomize the timing of when physicians and their patients would receive the intervention. This approach was chosen so that the resources would be distributed equitably. Data collection was completed in September 2023 and the manuscript was published.

Hwang AS, Chang Y, Matathia S, Brodney S, Barry MJ, Horn DM. Effectiveness of a Population Health Intervention on Disparities in Hypertension Control: A Stepped Wedge Cluster Randomized Clinical Trial. J Gen Intern Med. 2024 Nov;39(15):3028-3034. doi: 10.1007/s11606-024-08839-y. Epub 2024 Jun 12. PMID: 3886500.

A second manuscript is under development.

Virtual Group Visits

Team Members: Jacob Mirsky, MD;  Anne Thorndike, MD, MPH
Years: 2021-2022

Virtual Group Visits (VGV) support patients in making lifestyle behavior changes, and it holds promise as a primary care delivery tool for preventing and managing chronic diseases. This project is evaluating VGV invitees’ satisfaction with and preferences for VGVs at the Mass General Revere HealthCare Center. Patients who attended a visit during the prior year were surveyed and asked for their input. Results from this project were published in two manuscripts: one describing patient attendance and perceived benefits:
Mirsky J, Brodney S, Boratyn V, Thorndike AN. Lifestyle Medicine Virtual Group Visits: Patient Attendance and Perceived Benefits. American Journal of Lifestyle Medicine. 2023;0(0). doi:10.1177/15598276231208164)
and the other describing patient perspectives on VGV appointments:
Vigue D, Mirsky J, Brodney S, Thorndike AN. Patient Perspectives on Lifestyle Medicine Virtual Group Visits. Am J Lifestyle Med. 2024 Sep 2:15598276241274233. doi: 10.1177/15598276241274233. Epub ahead of print. PMID: 39554912

Frequently Asked Questions

How do I know if CENTRI is the right opportunity for me?

This opportunity is right for you if you are:

• Interested in research and evaluation but need some extra support to develop your idea
• Motivated to take a lead role in the research project and welcome the opportunity to present your results at a scientific meeting and write up your results for publication
• Feeling you are at a time in your career when you want to try something new

Does the project have to focus on primary care?

All projects funded by CENTRI must have a focus within primary care delivery.

Can I apply if I’ve never done research?

Prior research experience is not required. A central initiative of CENTRI is to expand research support for DGIM educators and innovators, who do not have formal research training to help them develop better evidence to support clinical practice.

Please note, all applicants must complete the MGB Human Research Trainings prior to the award/start of the proposed project.

What types of projects do you fund?

A core pillar of the CENTRI program is to promote the delivery of patient-centered primary care by supporting the evaluation of care innovation. Please see the list of current and completed CENTRI projects.

What type of assistance do you offer?

The program is designed to evaluate interesting clinical or educational innovations. CENTRI can provide support for project management, data collection, and data analysis. Projects should be very focused and have a timeline of 12 months or less.

When are applications due?

The call for proposal applications is announced in January or February each year. Of note, CENTRI applications are continuously open to provide timely support of innovative research ideas. Please contact Jessica Pham-Stephens at jpham-stephens@mgb.org to learn more about the application process and/or request an application.

What does the application include?

The CENTRI Proposal Application form includes:

• A paragraph overview of the goals, design and scientific hypothesis to be tested/evaluated
• A paragraph explanation of how support from CENTRI would influence the quality of care that you deliver
• The expertise provided by the application team
• The expertise requested from CENTRI

Do you fund salary?

CENTRI will now support the time of each pilot project Principal Investigator for up to 0.1 FTE for one year. This will provide the PI with the opportunity to fully participate and be successful in leading the pilot project.

Who do I contact if I have an idea or want to learn more?

To learn more about CENTRI or submit an idea for a CENTRI proposal, please contact Jessica Pham-Stephens (jpham-stephens@mgb.org).