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 diversity of the work force 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

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

Suzanne Brodney, PhD
Investigator, 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

Current CENTRI Projects

Flex Nutrition Services

Team Members: Sarah Matathia, MD, MPH; Anne Thorndike, MD, MPH
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 is expected in June 2024.

Nurse-Led Diabetes Education Sessions

Team Members: Kerri A. Pagliuca, RN; Lisa M. Brugnoli-Semeta, RN; Julie B. Marden, CNP
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 July 2024.

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

Team Members: Leland Hull, MD, MPH; Jennifer Haas, MD, MSc
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. Survey data collection started in August 2023 and qualitative data collection will begin in April 2024.

Integration of a Best Practice Alert to Support Preventive Screening in Primary Care

Team Members: Karen Sepucha, PhD; Katherine D. Rose, MD; Maria Eliopoulos, RPH; Moshe A. Rancier, MD; Despina Garalis
Years: 2022-2024

This project seeks to develop and refine an interactive best practice alert (BPA) for primary care clinicians (PCPs) to use with patients to support preventive screening. This project is in development.

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; MD; Lori Hooley, RN
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 currently being treated for SUD at the MGH health centers to describe the patient population, medical comorbidity, and the cascade of SUD care. Data analysis will begin in May 2024.

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
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. The first analysis will describe the demographics and care utilization patterns of patients with sickle cell disease (SCD) at MGB. Data analysis will begin in May 2024.

Transgender Health Cohort

Team Members: Jenny Siegel, MD; Michael Barry, MD; Alex McDowell, PhD, MPH, MSN, RN
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 will begin in May 2024.

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 is under review.

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. A manuscript has been accepted by the American Journal of Lifestyle Medicine. A second manuscript is under review.

For more details about this research project, please click here. 

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 be CITI certified 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. Prior CENTRI supported projects include a practice-level equity dashboard study, virtual group visit patient satisfaction and preferences study, and a flex nutrition program outreach study.

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?

Salary support is not available through CENTRI.

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).