This K23 award will provide an opportunity for Dr. Cecere to achieve her long-term goal of transitioning to an independently-funded physician-scientist with a focus on improving outcomes for patients with chronic lung diseases. The proposed project builds on her previous work investigating the effects of patient health behaviors and characteristics on health outcomes for patients with COPD and studying heterogeneity in delivered COPD care. Through this project, Dr. Cecere will achieve her immediate goals of attaining expertise in clustered and correlated data analysis, qualitative research methods, and designing and conducting intervention trials. This will be accomplished through an integrated career development plan consisting of formal coursework, guidance from highly skilled mentors, and protected time to gain practical research experience. Environment: The rich academic environment at the University of Washington (UW) is an ideal place for Dr. Cecere's continued training. The UW Division of Pulmonary and Critical Care Medicine Clinical Research Training Track prides itself on a collegial environment in which investigators are encouraged to collaborate with one another. The UW also offers a broad range of educational and research resources, including the School of Public Health and Community Medicine and the Institute of Translational Health Sciences (the UW's Clinical and Translational Science Awards (CTSA) institution). In addition, Dr. Cecere has assembled a mentoring team with expertise in health delivery and quality improvement interventions, strong records of funding and publication, and success in training early-investigators who have gone on to have careers as physician-scientists at major academic medical centers. Research: In this patient-oriented research proposal, Dr. Cecere will identify specific patient and provider characteristics associated with best-practice COPD care and intervene to improve delivery of that care in the outpatient setting. To accomplish this, she has identified a cohort of COPD patients and their providers at the two internal medicine clinics associated with the University of Washington Medical Center in Seattle. Dr. Cecere will: 1) conduct a cross-sectional study to determine patient and provider characteristics associated with adherence to evidence-based best-practice guidelines for COPD management;2) perform a qualitative study to better understand patient and provider perspectives influencing the delivery of recommended care for patients with COPD;and 3) test the efficacy of a multi-faceted intervention for providers designed to improve the delivery of best practice care to COPD patients in the primary care setting, using a quasi-experimental clinical trial design. The proposed project is innovative in that it explores the interface between Phase 2 (T2) and Phase 3 (T3) research by examining the efficacy of an intervention designed to disseminate and implement evidence-based guidelines into clinical practice as a means of improving quality of care. This study has the potential to lead to additional intervention and dissemination studies designed to improve health outcomes for the growing population of patients with COPD. This model can also be translated to improve outcomes for patients with other chronic diseases.

Public Health Relevance

Despite well-established treatment guidelines, a significant number of the more than 12 million Americans with chronic obstructive pulmonary disease (COPD) receive care that is not consistent with accepted best practice. This project will aid in a better understanding of patient and provider factors influencing quality of COPD care and evaluate an intervention to improve the delivery of best-practice care in the outpatient setting. Knowledge gained from this study will serve as the basis for future studies designed to improve health outcomes, such as decreasing hospitalization and improving health-related quality of life, for patients with COPD.

National Institute of Health (NIH)
National Heart, Lung, and Blood Institute (NHLBI)
Mentored Patient-Oriented Research Career Development Award (K23)
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Special Emphasis Panel (ZHL1)
Program Officer
Tigno, Xenia
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University of Washington
Internal Medicine/Medicine
Schools of Medicine
United States
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Reinke, Lynn F; Feemster, Laura C; McDowell, Jennifer et al. (2017) The long term impact of an end-of-life communication intervention among veterans with COPD. Heart Lung 46:30-34
Feemster, Laura C; Lyons, Patrick G; Chatterjee, Rohini S et al. (2017) Summary for Clinicians: Lymphangioleiomyomatosis Diagnosis and Management Clinical Practice Guideline. Ann Am Thorac Soc 14:1073-1075
Melzer, Anne C; Feemster, Laura C; Collins, Margaret P et al. (2016) Predictors of Pharmacotherapy for Tobacco Use Among Veterans Admitted for COPD: The Role of Disparities and Tobacco Control Processes. J Gen Intern Med 31:623-9
Reinke, Lynn F; Feemster, Laura C; Backhus, Leah M et al. (2016) Assessment and Management of Symptoms for Outpatients Newly Diagnosed With Lung Cancer. Am J Hosp Palliat Care 33:178-83
Lindenauer, Peter K; Stefan, Mihaela S; Feemster, Laura C et al. (2016) Use of Antibiotics Among Patients Hospitalized for Exacerbations of Asthma. JAMA Intern Med 176:1397-400
Melzer, Anne C; Feemster, Laura C; Crothers, Kristina et al. (2016) Respiratory and Bronchitic Symptoms Predict Intention to Quit Smoking among Current Smokers with, and at Risk for, Chronic Obstructive Pulmonary Disease. Ann Am Thorac Soc 13:1490-6
Feemster, Laura C; Curtis, J Randall (2016) ""We Understand the Prognosis, but We Live with Our Heads in the Clouds"": Understanding Patient and Family Outcome Expectations and Their Influence on Shared Decision Making. Am J Respir Crit Care Med 193:239-41
Kahn, Jeremy M; Feemster, Laura C; Fruci, Carolyn M et al. (2015) Attitudes of Pulmonary and Critical Care Training Program Directors toward Quality Improvement Education. Ann Am Thorac Soc 12:587-90
Feemster, Laura C; Cooke, Colin R; Rubenfeld, Gordon D et al. (2015) The influence of hospitalization or intensive care unit admission on declines in health-related quality of life. Ann Am Thorac Soc 12:35-45
Attia, Engi F; McGinnis, Kathleen A; Feemster, Laura C et al. (2015) Association of COPD With Risk for Pulmonary Infections Requiring Hospitalization in HIV-Infected Veterans. J Acquir Immune Defic Syndr 70:280-8

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