General Internal Medicine & Clinical Innovation Research Focus Areas
Key research areas in the Division of General Internal Medicine and Clinical Innovation, part of NYU Langone’s Department of Medicine, include improving care for patients with 2019 coronavirus disease (COVID-19), developing interventions for obesity and weight management, reducing diabetes care disparities, expanding virtual healthcare, making pre-exposure prophylaxis more accessible to prevent HIV, and advancing medical education and training.
Researchers in our division also conduct clinical trials, participate in Program for Medical Education Innovations and Research projects, and spearhead hospitalist quality improvement and safety initiatives.
At the height of the COVID-19 pandemic, healthcare professionals were inundated with new information on a daily basis. General internal medicine and clinical innovation faculty played a major role in distilling this information and implementing solutions to improve the quality of care that patients received.
Risk Factors for Progression to Critical Illness and Mortality
Christopher M. Petrilli, MD, Luke F. O’Donnell, MD, Leora Horwitz, MD, and colleagues conducted a prospective cohort study of the demographics, risk factors, and outcomes of patients with COVID-19 who were admitted for treatment at NYU Langone Health.
They determined that being older than 75, having a body mass index (BMI) greater than 40, and having a history of heart failure were significant factors associated with increased risk of progression to critical illness (requiring intensive care unit [ICU]–level care or ventilator support and mortality) for hospitalized patients. However, elevated initial laboratory inflammatory markers and low oxygen saturation were the strongest predictors of worse outcomes.
Risk of critical illness and mortality decreased significantly over the study period, suggesting that care may have improved during the study period.
Post-Discharge Outcomes in Patients Treated for Severe COVID-19 Disease
Studying the long-term effects of COVID-19 is critical for understanding the cumulative impact of this disease beyond hospitalization and mortality. Himali M. Weerahandi, MD, Katherine Hochman, MD, Leora Horwitz, MD, and colleagues, are conducting a prospective cohort study to evaluate the overall health status and the physical and mental health of patients discharged home after being hospitalized for severe COVID-19.
Initial findings demonstrate that although most patients admitted to NYU Langone began with overall health that was slightly better than the United States average, one month after discharge overall health, as well as physical and mental health, were significantly worse (approximately seven to nine weeks after disease onset). Three quarters of patients reported persistent shortness of breath and more than one in eight required oxygen. In the future, our researchers plan to examine objective functional outcomes and longer-term outcomes.
Using Predictive Analytics to Determine Safe Discharge After Hospitalization
As part of their work in the Predictive Analytics Unit at NYU Langone’s Tisch Hospital and Kimmel Pavilion, Jonathan S. Austrian, MD, and Yin Aphinyanaphongs, MD, PhD, developed and implemented an innovative algorithm to help inpatient care teams determine whether patients with COVID-19 might be medically ready for discharge.
The algorithm calculates the likelihood that a patient with COVID-19 will experience no adverse events in the 96 hours after the prediction time. Adverse events include ICU transfer, intubation, mortality, hospice discharge, readmission to the emergency department, and oxygen requirements that exceed nasal cannula at 6 L/min.
A multidisciplinary team of researchers under the leadership of Melanie R. Jay, MD, and Jeannette M. Beasley, PhD, MPH, RD, seeks innovative and sustainable ways to address obesity-related health challenges and to improve health outcomes and quality of life. Our goal is to investigate ways to integrate innovative, evidence-based practices for the treatment and prevention of obesity into primary care, particularly for veterans and underserved patients, including minorities and those with mental illnesses.
The Goals for Eating and Moving Study
At the Managing Obesity Through Interventions and Effectiveness (MOTIVATE) Research Lab, Dr. Jay, co-director of NYU Langone’s Comprehensive Program on Obesity, and her team are assessing the efficacy of technology-assisted health coaching as an obesity weight management tool in primary care settings as part of the Goals for Eating and Moving (GEM) study, a cluster-randomized trial that involves patients from the VA NY Harbor Healthcare System and Montefiore Medical Center.
The researchers hope the initiative increases utilization of existing weight management services at these institutions. The study is funded by a National Institutes of Health (NIH) R01 grant.
Financial Incentives for Weight Reduction
Led by Dr. Jay, the Financial Incentives for Weight Reduction (FIReWoRk) study, is a multi-institutional effort to compare the effectiveness of two financial incentive interventions for weight management—goal-directed and outcomes-based financial incentives versus standard care—in low-income primary care patients.
Peer-Assisted Lifestyle Intervention
Dr. Jay and her team are evaluating an obesity intervention that utilizes trained coaches in the Peer-Assisted Lifestyle (PAL) Intervention. The intervention involves training veteran peer coaches to deliver weight management counseling and motivational interviewing at primary care medical homes. This study is funded by a U.S. Department of Veterans Affairs Health Services Research and Development Merit Review Award.
Bariatric Surgery Weight Loss Outcomes
Dr. Jay serves as the principal investigator on a longitudinal study to predict weight loss outcomes in people who undergo bariatric surgery, which is being conducted as part of NYU Langone’s Comprehensive Program on Obesity.
Long-Term Effects of Food Policies on Cardiovascular Disease
Dr. Beasley and a team of researchers that includes experts in cardiovascular disease, nutrition, public health, health economics, health policy, and computer simulation modeling are analyzing the effects of food policies and programs on cardiovascular disease–related health outcomes and healthcare costs for adults.
The goal is to identify realistic pathways for improving dietary behaviors. We are partnering with the New York City Department of Health and Mental Hygiene and a broad range of community-based organizations across the city to select and implement the most cost-effective, neighborhood-specific food policies and programs to improve population health. This study is funded by the NIH.
Dietary Screening and Counseling
Dr. Beasley is assessing the impact of an office-based dietary screening program to improve dietary counseling and patient health outcomes. The short dietary screener could be implemented by a wide range of clinicians to guide referrals for patients with diet-related diseases, such as cardiovascular disease, to registered dieticians for more targeted interventions. This study is funded by NYU Langone’s Center for Healthcare Innovation and Delivery Science.
Our researchers investigate disparities in diabetes treatment and develop innovative ways to overcome barriers to care.
Enhanced Primary Care for Patients with Diabetes and Dementia
Many older people who have diabetes and Alzheimer’s disease or related dementias encounter challenges with self-managing their conditions and often experience hypoglycemia. It is not uncommon for this group to rely heavily on the healthcare system, or to feel burdened by illness.
Under the direction of Eric R. Goldberg, MD, Sondra R. Zabar, MD, and Caroline S. Blaum, MD, researchers at NYU Langone Internal Medicine Associates and the Division of Geriatric Medicine and Palliative Care are conducting the Enhanced Quality in Primary Care for Elders with Diabetes and Alzheimer’s Disease or Related Dementias (EQUIPED-ADRD) study.
The EQUIPED-ADRD study links people with diabetes and Alzheimer’s disease or related dementias and their caregivers to primary care and psychosocial support resources, both at NYU Langone and in the community.
The research team has developed and distributed a clinical guideline specific to adults with these conditions, the first of its kind in the country. There are plans to implement the guidelines at NYU Langone primary care outpatient locations and the Family Health Centers at NYU Langone. This research is funded by the NIH.
Diabetes Prevention Program for Geriatric Populations
Jeannette M. Beasley, PhD, MPH, RD, and a team of researchers are examining the feasibility of implementing a virtual adaptation of the National Diabetes Prevention Program, which is currently covered under Medicare and other health insurers, into New York City senior centers.
A virtual National Diabetes Prevention Program has the potential to reduce health disparities in underserved, high-risk populations who are served by the nationwide congregate meals program and could result in considerable public health benefits. This project, the Bringing the Diabetes Prevention Program to Geriatric Populations (BRIDGE) study, is funded by the New York Regional Center for Diabetes Translation Research at Albert Einstein College of Medicine.
Diabetes and Hypertension Health Disparities in Asian Americans
In collaboration with the NYU Center for the Study of Asian American Health and the Department of Population Health, Jeannette M. Beasley, PhD, MPH, RD, and Nadia S. Islam, PhD, are seeking to replicate and scale a previously tested, efficacious community health worker model as an intervention to address comorbid hypertension and diabetes among Asian Americans in the southeastern United States.
The culturally tailored intervention relies on community health workers, builds on a national network of community partners, and is transforming care in the community. The researchers are in the process of establishing a formal partnership with Emory University School of Medicine to maximize impact and reach across southeastern regions, which have growing concentrations of south Asian populations. This project receives funding from the NIH.
The rapid implementation of virtual healthcare visits during the COVID-19 pandemic has made way for a future where virtual care is the new normal. We conducted a needs assessment among faculty to understand how telemedicine influences quality of care and to determine the best use cases for managing chronic disease, increasing patient access, and strengthening patient relationships.
Eric R. Goldberg, MD, Sondra R. Zabar, MD, and Andrew B. Wallach, MD, are working with Devin Mann, MD, in NYU Langone’s Healthcare Innovation Bridging Research, Informatics, and Design (HiBRID) Lab to examine the opportunities that home monitoring brings the future of virtual healthcare.
The unique communication skills needed for telemedicine require an investment in medical education across all levels of learners. At Tish Hospital, Kimmel Pavilion, and NYU Langone Hospital—Brooklyn, we are piloting a new transitions of care management initiative that consists of scheduling a virtual appointment for all patients with their hospital team in the two days after discharge. The goal is to improve patient follow-up, satisfaction, care outcomes, and resident telecommunication skills. Patients also have a video visit with the ambulatory doctor who is managing their post-discharge care.
Richard E. Greene, MD, MHPE, and Robert A. Pitts, MD, have developed a sexual health dashboard in collaboration with the Department of Population Health to improve treatment for sexually transmitted infections (STIs), specifically HIV and AIDS, at Bellevue.
The goal is to track STI testing throughout the hospital to ensure that patients who are eligible for pre-exposure prophylaxis (PrEP) for HIV are offered treatment, complete the full 28-day course of PrEP medication, and are connected with PrEP resources and other preventative services for HIV and AIDS. This research is funded by NYU Langone’s Clinical and Translational Science Institute.
Our faculty conduct influential research in the field of medical education and participate in curriculum development and program evaluation across the medical education continuum.
Clinical reasoning refers to the cognitive process clinicians use to diagnose and manage patients. Although it is considered a core competency for medical students and residents, faculty confidence in teaching clinical reasoning skills is low.
To address this need, Verity E. Schaye, MD, MHPE, and Division of General Internal Medicine and Clinical Innovation researchers have developed clinical reasoning workshops to train faculty in this important area of medical education. They found that training not only increases the likelihood that faculty members teach these skills, but also boosts faculty confidence and increases the quality of instruction on this topic.
As part of this initiative, the research team also incorporated a workplace-based clinical reasoning education intervention for residents, using dual-process theory and script theory. They measured the efficacy of the residency intervention using patient outcomes data and found fewer diagnostic errors after residents took part in the intervention.
This research was funded by a Program for Medical Education Innovations and Research Innovation Grant.
LGBTQ+ Health Disparities
Richard E. Greene, MD, MHPE, director of gender and health education at NYU Grossman School of Medicine, has created and implemented a fully integrated LGBTQ+ health curriculum for medical students, residents, and faculty that includes didactics, case-based learning, and simulation activities. The curriculum, which is one of the most robust in the country, incorporates and enhances elements of cultural competencies in NYU Grossman School of Medicine’s MD degree curriculum, Internal Medicine Residency and primary care residency track, and continuing medical education (CME) courses.
As a Macy Faculty Scholar, Dr. Greene continues to develop curricula at the intersection of health disparities, clinician bias, and structural competence across the undergraduate and graduate medical education spectrum, as well as assessment models to evaluate the development of knowledge and skills in these areas.
Patient-Centered Communication Skills
Patient-centered communication skills are a core value at NYU Langone, and we understand that everyone plays a part. Designed by Sondra R. Zabar, MD, Andrew B. Wallach, MD, Katherine Hochman, MD, and Eric R. Goldberg, MD, Can We Talk? is a unique experiential onboarding program that provides healthcare providers with actionable, behaviorally specific feedback from the perspective of patients. The program, which is part of our division’s faculty mentoring and professional development services, establishes expectations and standards for communication skills across our hospitals and ambulatory care practices.
We have developed the integrated sonography competency (I-Scan) program, to teach clinicians how to perform point-of-care ultrasonography (POCUS) in accordance with Society of Hospital Medicine standards. Using POCUS at the bedside reduces patient exposure to radiation and helps doctors make faster diagnoses and decisions about treatment. We offer the I-Scan program as part of our faculty mentoring and professional development services.