Projects

More than 1 in 4 teens in a primary care waiting room are struggling with their mental health, with insufficient availability of mental healthcare providers/professional treatment options to meet the profound demand. This project identified new approaches to support teen mental health and wellness locally.

• Project Leads: Julie Balaban, MD and Kay Jankowski, PhD
• Multidisciplinary Team: Psychiatry, Pediatrics, School Social Worker, The Dartmouth Institute for Health Policy and Clinical Practice, Individual with Lived Experience
  
  See more about this project on their new website.

Heart failure is a source of substantial suffering, decreased quality of life, and caregiver burden, as well as one of the most common causes of hospitalization in older adults. This project created a provider- and patient- facing dashboard in the electronic medical record and implemented a pre-visit survey in order to improve symptom control, goal concordant care, and quality of life for patients living with advanced heart failure. In so doing, the team expects to reduce utilization of acute care settings, such as the hospital and emergency room, increase options for receiving medical care at home and in the community, and reduce patient and caregiver distress. 

• Project Lead: Katharine Manning, MD, MBE
• Multidisciplinary Team: Cardiology, Palliative Care, The Dartmouth Institute for Health Policy and Clinical Practice, Care Management, New England Life Care, Caregiver of Individual with Lived Experience

Certain communities in NH and VT experience higher rates of food insecurity and worse health outcomes compared to others. Unfortunately, many individuals eligible for WIC—an evidence-based, publicly funded nutrition program—do not enroll and therefore do not receive benefits that have been shown to improve health outcomes for birthing people and their children. This project developed community-healthcare partnerships to optimize referral streams and outreach strategies, and hopes to improve health outcomes for low-income children and pregnant people by increasing enrollment and participation in WIC.

• Project Leads: Chelsey Canavan, MSPH and Holly Gaspar, MEd, MPH
• Multidisciplinary Team: Population Health, Center for Advancing Rural Health Equity, Obstetrics & Gynecology, Pediatrics, The Dartmouth Institute for Health Policy and Clinical Practice, Community Action Program Belknap-Merrimack Counties, and Individuals with Lived Experience

Inflammatory bowel disease (IBD), consisting of Crohn’s disease and ulcerative colitis, is a medical condition characterized by chronic inflammation of the gastrointestinal tract. Suboptimal IBD care in adolescents and young adults (AYAs) can have life-altering impacts, increasing risk for hospitalization, surgery, opioid use disorder, and colorectal cancer. This project created a multidisciplinary, virtual clinic that engages AYAs in local gastroenterological care and promotes independent health management.

• Project Leads: Ellen Sejkora, PhD, MS and Michael Winter, MD
• Multidisciplinary Team: Psychiatry, Pediatrics, Gastroenterology, Tuck School of Business, Internal Medicine
  
  Learn more about this clinic at the new website and a recent grand rounds presentation.

Familial hypercholesterolemia (FH) is a genetic condition that causes high cholesterol. Left untreated, it leads to premature heart attacks, strokes, and death. FH is more common in Northern New England due to a well-documented  “founder effect” resulting from the high frequency of FH in French Canadians who emigrated during the industrial revolution. This project represents a joint collaboration between Dartmouth and the Family Heart Foundation and identified undiagnosed individuals with “probable” FH and engaged them in evaluation and treatment.

• Project Leads: Kerrilynn Hennessey, MD and Mary McGowan, MD
• Multidisciplinary Team: Cardiology, The Family Heart Foundation, Pediatrics, The Dartmouth Institute, Thayer School of Engineering, Epidemiology, Patient Representative
  
  Learn more about this project through the new website and a recent grand rounds presentation.

Ninety-five percent of incarcerated persons will reenter the community, yet most health systems are underprepared to support post-incarceration care transitions. During reentry, care is disrupted and delayed due to a variety of factors. This project developed a multidisciplinary re-entry planning team, utilizes peer support, and created facilitated, timely access to Primary Care at DH Concord.

• Project Lead: Milan Satcher, MD, MPH
• Multidisciplinary Team: Primary Care, Connected Care, The Dartmouth Institute, New Hampshire Department of Corrections, Patient Representatives
  
  Learn more about this project through a recent grand rounds presentation. and a recent publication: Community-Partnered Training in Trauma-Informed Primary Care for Patients Experiencing Reentry From Incarceration: A Pilot Training Study.

Moral injury is defined as the psychological, behavioral, social, and spiritual sequelae of exposure to a moral transgression committed by oneself or others. Data across 28 months of the pandemic indicate that >75% of health care workers are experiencing routine exposure to moral dilemmas and morally injurious events, influencing emergent mental health disorders, eroded social connection, degraded healthcare quality, and increased intentions to leave the nursing workforce. This project developed interventions to re-establish healthy and supportive social networks that empower positive social meaning, service, and connection.

• Project Leads: Andrew Smith, PhD
• Multidisciplinary Team: Psychiatry, Family Medicine, Critical Care, Nursing, The Dartmouth Institute, Department of Veterans Affairs, Patient Representatives
  
  Learn more about this project through their grand rounds presentation and a recent publication: Building Social Support and Moral Healing on Nursing Units: Design and Implementation of a Culture Change Intervention.

For as many as half of people impacted by COVID-19, symptoms persist after having the virus. These symptoms can profoundly impact health and quality of life. This project developed peer-to-peer support and established a registry-enabled learning health system.

• Project Leads: Jeffrey Parsonnet, MD and Brant Oliver, PhD, MS, MPH, APRN-BC
• Multidisciplinary Team: Infectious Disease, Psychiatry, Medicine, Anthropology, The Dartmouth Institute, Tuck School of Business, Upper Valley Haven, Patient Representative
  
  Learn more about this project from their grand rounds presentation, the updated clinic website, and a recent publication: A Post-Acute COVID-19 Syndrome (PACS) Clinic in Rural New England.

Gastrointestinal problems can reduce quality of life and behavioral health interventions have been proven to reduce symptom burden. This project developed innovative workflows, content, delivery mechanisms that extended the reach of behavioral health services in GI.

• Project Leads: Jessica Salwen-Deremer, PhD
• Multidisciplinary Team: Psychiatry, Gastroenterology, Neuroscience, Patient Representative
  
  Learn more about this project from their grand rounds presentation, their publications: Redesigning a Gastroenterology Behavioral Health Program to Improve Patient Access, Patients’ experiences with virtual group gut-directed hypnotherapy: A qualitative study, and A Cross-Institution Protocol for Virtual, Transdiagnostic, Group Gut-Directed Hypnotherapy, and the team’s updated website.

Lung cancer screening is currently recommended for at-risk groups, yet is highly underutilized, especially among rural populations. This project evaluated and utilized novel strategies to increase lung-cancer screening in the DH catchment area.

• Project Leads: Rian Hasson, MD, MPH and Karen Schifferdecker, PhD, MPH
• Multidisciplinary Team: Thoracic Surgery, Radiology, The Dartmouth Center for Program Design and Evaluation, The Dartmouth Institute, Dartmouth Cancer Center, Little Rivers Health Care, Continuing Education, Tuck School of Business, Geisel School of Medicine, Patient Representatives
  
  Learn more about this project from their grand rounds presentation, a publication: Assessing and Identifying Improvements for Lung Cancer Screening in a Rural Population: A Human-Centered Design and Systems Approach, the clinic website, and a recent article in DH Geisel Giving: Lung cancer screening rates are low. This team is changing that.

Pediatric mental health patients awaiting transfer to inpatient treatment facilities are monitored for safety, but typically do not receive treatment during this time of boarding. This project redesigned care for pediatric patients experiencing acute mental distress by initiating treatment during the boarding period, providing a head start on recovery.

• Project Leads: JoAnna Leyenaar, MD, MPH, MSc and Robert Brady, PhD
• Multidisciplinary Team: Pediatrics, Psychiatry, The Dartmouth Institute, Hospital Medicine, West Central Behavioral Health, Patient Representative
  
  Learn more about this project from their grand rounds presentation and publications: Multistakeholder Perspectives on Interventions to Support youth During Mental Health Boarding, I-CARE: Feasibility, Acceptability, and Appropriateness of a Digital Health Intervention for Youth Experiencing Mental Health Boarding, and Human-Centered Design to Improve Care for Youths Experiencing Psychiatric Boarding.

Older adults undergoing surgical procedures are at higher risk for complications after surgery than younger adults. This project enhanced the surgical care experience for older adults by improving surgical education, ensuring goals of care discussions, promoting early identification of vulnerability for frailty and delirium, and strengthening support at home. As part of their Incubator work, this team is submitting for Geriatric Surgery Verification for DHMC by the American College of Surgeons.

• Project Leads: Stacie Deiner, MD, MS and Alexandra Briggs, MD
• Multidisciplinary Team: Anesthesiology, Aging Resource Center, Trauma Surgery, Geriatrics, Care Management, Hanover Terrace Health and Rehabilitation, Visiting Nurse and Hospice of VT & NH, DALI Lab, Patient Representative
  
  Learn more about this project from their grand rounds presentation and a publication: Cognitive Impairment and Frailty Screening in Older Surgical Patients: A Rural Tertiary Care Centre Experience.

Stigma, cost, and access issues cause individuals with viral hepatitis, sexually transmitted infections, and HIV to be poorly connected to traditional healthcare systems. This project utilizes novel peer support strategies and telemedicine to redesign access to testing and care for people at risk for these conditions.

• Project Lead: David deGijsel, MD, MSc, MPH
• Multidisciplinary Team: Infectious Disease, Geisel Students for Harm Reduction, HIV and HCV Resource Center, DH HIV Program, Better Life Partners, Anthropology, Patient Representatives
  
  Learn more about this project from the recording of their Innovation Grand Rounds presentation (starts at minute 3:15) and a recent publication: Coproduction of Low-Barrier Hepatitis C Virus and HIV Care for People Who Use Drugs in a Rural Community: Brief Qualitative Report.

Patients with multiple comorbidities and hospital stays of 5+ days have high rates of readmission to the hospital. This project designed an inter-professional transitional care management model that increases the likelihood that patients see their own DH primary care provider less than 7 days from discharge, which literature has shown reduces rates of re-admission.

• Project Leads: Tim Burdick, MD, MBA, MSc and Justin Montgomery, DNP, APRN-C
• Multidisciplinary Team: Community & Family Medicine, Heater Road Primary Care, The Dartmouth Institute, Tuck School of Business, Visiting Nurse and Hospice of VT & NH, Patient Representative
  
  Learn more about this project from the recording of their Innovation Grand Rounds presentation.

Many preterm babies stay in intensive care nurseries (ICN) after medical care only to gain weight and be fed via nasogastric tube. Data suggest that extended ICN stays can harm infant development and create financial burden. This project redesigned care for stable preterm infants by transitioning their feeding from the hospital to the home with extensive medical support and monitoring.

• Project Lead: Tyler Hartman, MD
• Multidisciplinary Team: Neonatology, Connected Care, Telemedicine, Film & Media Studies, Patient Representatives
  
  Learn more about this project from the recording of their Innovation Grand Rounds presentation and a publication: Redesigning Care to Support Earlier Discharge from a Neonatal Intensive Care Unit: A Design Thinking Informed Pilot.

People who inject drugs are often excluded from outpatient parenteral antibiotic therapy (OPAT). Data suggest the use of peripherally inserted central catheters and OPAT is safe in these patients when they also receive treatment for substance use disorder (SUD). This project designed a new care model that developed individualized treatment plans integrating infectious disease, SUD, and OPAT treatment.

• Project Lead: Colleen Kershaw, MD and Christine Finn, MD
• Multidisciplinary Team: Infectious Disease, Internal Medicine, Opioid Addiction Treatment Collaborative, Care Management, Hospital Medicine, Transitions Care, Behavioral Intervention Team, New England Life Care Partnership, Visiting Nurse and Hospice of VT & NH, Patient Representative
  
  Learn more about this project from the recording of their Innovation Grand Rounds presentation and a publication: Improving care for individuals with serious infections who inject drugs.

Patients with advanced heart failure are frequently admitted for IV diuresis. This project created DHMC’s first IV diuresis clinic and outpatient management program, which includes transitioning diuresis to local community health centers and the home with the support of visiting nurses.

• Project Leads: Susan D’Anna, MSN, APRN and Lauren Gilstrap, MD, MPH
• Multidisciplinary Team: Cardiology, Nursing, Care Management, Emergency Medicine, Internal Medicine, Patient Representative
  
  Learn more about this project from the recording of their Innovation Grand Rounds presentation and a publication: Outpatient Intravenous Diuresis in a Rural Setting: Safety, Efficacy, and Outcomes.