The Behavioral Health Clinical Program uses research to continually improve the care provided to patients with mental health conditions. Through research, this clinical program determined the need to expand the integration of mental health care within the primary care setting in order to improve specialty clinical efficiencies and provide the necessary continuum of support to patients. The Behavioral Health Clinical Program works collaboratively with the Primary Care Clinical Program to implement its mental health integration evidence-based best practices.

Key Project: Mental Health Integration

Most patients with mental health conditions, such as depression, receive care from a primary care physician (PCP). This approach, however, presents challenges for the PCP such as (1) the need for consultation with a mental health specialist; (2) the time constraints of a PCP; (3) the complicated nature of recognizing depression; (4) the barriers to reimbursement and compensation; and (5) associated medical and social comorbidities.

To overcome these challenges and improve care, Intermountain Healthcare researched and developed a team-based approach—known as mental health integration (MHI)—to care for patients with mental health conditions. The team includes the PCPs and their staff and integrates mental health professionals, community resources, care management, and the patient and his or her family.

The integration model goes far beyond co-location in its team-based approach; it is operationalized at the clinic, thereby improving both physician and staff satisfaction. Patients treated in MHI clinics also show improved satisfaction, lower costs, and better quality outcomes. The MHI program is financially sustainable in routinized clinics without subsidies. MHI is a successful approach to improving care for patients with mental health conditions in the primary care setting.

References:

Reiss-Brennan B, Briot PC, Savitz LA, Cannon W, Staheli R. Cost and quality impact of Intermountain’s mental health integration program. J Healthc Manag. 2010;55(2):97-113.

Research led by the Cardiovascular Clinical Program at the Intermountain Heart Institute at Intermountain Medical Center is guided by three primary goals:

• To improve its understanding of the mechanisms of cardiovascular disease
• To discover improved ways to predict, detect, treat, and cure cardiovascular disease
• To apply new knowledge to clinical practice to shape prevention and treatment solutions individualized to each unique patient

Learn more about the current research and clinical trials.

Key Projects

The Intermountain Heart Institute at Intermountain Medical Center research team, consisting of physicians, coordinators, epidemiologists, and regulatory specialists, has developed a national reputation for conducting quality research and developing innovative approaches to improving healthcare delivery. Currently, they are working on over 100 individual research projects, each aimed at understanding, preventing, and/or treating heart disease.  

This research team participates in multicenter clinical trails, develops and tests their own research ideas, and conducts an extensive amount of laboratory work to better understand how heart disease develops and progresses. Two current clinical projects include:

Intermountain INSPIRE Registry

The Intermountain INSPIRE Registry, also called the Intermountain Healthcare Biological Samples Collection Project and Investigational Registry for the On-Going Study of Disease Origin, Progression, and Treatment, is original research from the Intermountain Heart Institute at Intermountain Medical Center. Through this registry, Intermountain researchers are trying to discover the underlying factors of heart disease. Specifically, researchers are looking to identify the exact role of genetics and other biological influences on the progression of disease. Over the past 17 years, more than 30,000 DNA samples have been collected from heart disease patients at LDS Hospital and Intermountain Medical Center. The use of this registry resulted in the publication of more than 40 research papers in the past three years, all of which were published in major international scientific journals.

Systolic Blood Pressure Intervention Trial (SPRINT) 

SPRINT is a clinical trial designed to test whether a treatment program aimed at reducing systolic blood pressure to a lower goal than currently recommended will reduce cardiovascular disease. Over 9,000 patients will participate in this study; participants must be age 50 or older, have a systolic blood pressure of equal or greater than 130mm Hg, and at least one other risk factor for heart disease. Patients will be randomly assigned to one of two blood pressure target groups. Their doctor will prescribe medications to help them reach and maintain their target pressure. This study will help determine if maintaining a lower target blood pressure level decreases cardiovascular events, slows the worsening of chronic kidney disease, and slows age-related declines in cognition.

The Intensive Medicine Clinical Program (IMCP) at Intermountain Healthcare leads quality improvement studies, translational research (new knowledge implementation), and traditional clinical trials. Currently, the IMCP is focusing its research efforts on better understanding sepsis, pneumonia, venous thrombosis and embolization, sedation and mobility in the ICU, and safety and harm prevention. These research projects are conducted by local hospital units or collaboratively between multiple clinical departments across Intermountain. The scientific findings resulting from the IMCP’s research are frequently presented at scientific meetings or published in a variety of journals.

Funding for IMCP research comes primarily from federally funded, multi-institutional grants; industry-funded grants; and local grants from the Intermountain Research and Medical Foundation. The IMCP is composed of clinical and research teams from the following hospital areas: Critical Care Medicine (ICU care), Emergency Department, Hospitalist Medicine (inpatient acute care), Transport Team (Life Flight), Trauma Services, and TeleCritical Care. Several of its clinicians have academic appointments at the University of Utah.

The IMCP is currently forming a research coordination team to help accelerate the productivity of its research efforts and to better implement its findings into regular patient workflows systemwide.

Clinicians and scientists with diverse areas of expertise in the Musculoskeletal Clinical Program are conducting innovative studies regarding skeleton, muscle, cartilage, ligament, and tendon research. Through a multidisciplinary approach, this research is helping people live the healthiest lives possible.

Key Projects

In long-term follow-up studies, clinicians and scientists are investigating if different knee arthroplasty procedures and components improve clinically based, patient-reported outcomes after surgery. Researchers are also investigating if different perioperative procedures (e.g. allogeneic transfusions) and standard of care blood matrixes improve outcomes and prognostic potential of adverse events (e.g. blood clot or infection) without increasing healthcare costs following knee arthroplasty.

Additionally, researchers with the Musculoskeletal Clinical Program are participating in a phase III, multisite, randomized clinical trial that is investigating a new approach to treat cartilage damage in the knee. A biopsy of the cartilage is grown in culture and subsequently implanted at the site of cartilage damage at a later date. A variety of studies have also been conducted investigating the role of micronutrients on a patient’s recovery from muscular and ligamentous injury and knee arthroplasty.

Additional research studies include:

• Cost Effectiveness of Cell Saver during Primary Total Knee Arthroplasty (Principal Investigator: Nathan G. Momberger, MD)
• Balanced Knee® System TriMax Outcome Study (Principal Investigator: Nathan G. Momberger, MD)
• Are Short- and Long-Term Outcomes Different Between Unicompartmental and Total Knee Arthroplasty Patients? (Principal Investigator: Roy H. Trawick, MD)
• A Randomized Comparison of NeoCart® to Microfracture for the Repair of Articular Cartilage Injuries in the Knee (Principal Investigator: Tyler Barker, PhD)
• The Neutrophil to Lymphocyte Ratio Predicts Venous Thromboembolic Events and Recovery Following Total Knee Arthroplasty (Principal Investigator: Tyler Barker, PhD)

Researchers at the Neurosciences Institute at Intermountain Medical Center are seeking to improve stroke care, both hemorrhagic and ischemic, for patients in the acute care setting. The Neurosciences Institute works closely with the Cardiovascular and Intensive Medicine Clinical Programs, as well as the Emergency Department and Imaging Services, to help manage and run its clinical research studies.

Key Projects

Studies aimed at improving hemorrhagic stroke care:

MISTIE III – Minimally Invasive Surgery plus rt-PA for Intracerebral Hemorrhage Evacuation
MISTIE III is an international, phase III, 500-patient clinical trial with the primary goal of defining a successful treatment for intracerebral hemorrhage (ICH), a sudden bleeding into the brain tissue. The MISTIE III intervention seeks to remove blood from the brain through minimally invasive surgery and intermittent dosing of a clot-busting drug called alteplase (rt-PA). The study premise is that by removing the blood clot faster, injury to the brain will be reduced and the patient’s long-term prognosis will improve.

ATACH II – Antihypertensive Treatment of Acute Cerebral Hemorrhage
ATACH-II is a five-year, multicenter, randomized, controlled, phase III clinical trial with blinded outcome ascertainment to determine the efficacy of early, intensive antihypertensive treatment using intravenous nicardipine for acute hypertension in subjects with spontaneous supratentorial ICH. The primary hypothesis of this large, streamlined, focused trial is that intensive systolic blood pressure (SBP) reduction using intravenous (IV) nicardipine with treatment initiated within three hours of onset of ICH and continued for the next 24 hours reduces the likelihood of death or disability at three months after ICH by 10 percent or greater compared with standard SBP reduction.

Studies aimed at improving ischemic stroke care:

MR WITNESS – A Study of Intravenous Thrombolysis with Alteplase in MRI-selected Patients
The purpose of the MR WITNESS study is to: 1) see if it is safe to give intravenous rt-PA (also called alteplase) to people with unwitnessed stroke but with MRI evidence of early ischemic stroke; 2) see if rt-PA is effective if given to people who are selected for treatment based on MRI evidence of an early stroke; and 3) get information about this new MRI diagnostic method for guiding stroke treatment. Learn more about this clinical trial.

Oncology Clinical Trials (OCT) is a unique department within Intermountain Healthcare that is dedicated solely to conducting cancer research. This department works closely with the Oncology Clinical Program, the Cancer Immunology Program, and medical and radiation oncologists throughout Intermountain to optimize research that will improve care for cancer patients. OCT manages research studies across seven different locations in Utah, spanning from Logan to St. George.

Key Projects

Oncology Clinical Trials is a main member of NRG Oncology, a national cooperative group dedicated to oncology research; the National Surgical Adjuvant Breast and Bowel Project (NSABP); the Radiation Therapy Oncology Group (RTOG); and the Gynecologic Oncology Group (GOG). Most recently, OCT was accepted as a member of the South Western Oncology Group (SWOG), a national cancer research cooperative group. OCT also works with many different pharmaceutical companies, providing clinical trial opportunities to patients.

The Pediatric Clinical Program at Intermountain Healthcare is overseeing development, implementation, and evaluation of clinical best practice for pediatric patients throughout Utah. This includes defining best practice across clinical settings (with special attention to transition points) and working with other Intermountain Healthcare clinical programs in caring for pediatric patients.

Key Projects

Chronic Disease Transition: Intermountain Healthcare and Stanford University’s CERC (Clinical Excellence Research Center) staff are teaming together to pilot a program for adolescents living with a chronic disease to help them transition from pediatric care to adult care providers. The pilot will focus first on adolescents with type 1 diabetes. The transition team is comprised of a care manager/RN, a health coach, and a transition guide who will help support the young adult and his or her parent/s through the months leading to his or her high school graduation and onto adult care. Some young adults will be moving away to college (out-of-state or in-state), living at home and attending college, attending a trade school, or working full time. The program’s goals are to ensure a smooth transition to adult care, increase patient satisfaction, and improve the patient’s overall health.

e-AsthmaTracker: Intermountain Healthcare and the University of Utah Department of Pediatrics has been awarded a grant to study a newly developed tool, the e-AsthmaTracker (e-AT), to facilitate medical decision making through communication between parents whose kids have asthma and their child’s primary care providers (pediatrician or family practice doctor). The e-AT helps engage parents in weekly monitoring of their child’s chronic asthma symptoms and guides parents to recognize warning signs of asthma attacks in order to prompt appropriate interventions and, if necessary, visits to primary care providers. The device also provides primary care providers with real-time, objective patient information that will help them monitor the effectiveness of asthma therapy. This research enables and empowers families and their providers to take charge of a difficult to control condition and create a model for sustainable, cost-effective patient care and smart utilization of information technology in a healthcare setting. This model is replicable across the country and has the potential to shape the future of asthma care delivery in the nation. The e-AT changes current ambulatory asthma care delivery to a new model that is continuous and proactive, focusing on prevention and control rather than reactive care.

The Pediatric Health Information System (PHIS): Primary Children’s Hospital is one of 45 children’s hospitals involved in a PHIS database, which compares the care of children and includes clinical and admissions data for inpatient, ambulatory surgery, and emergency department patient visits. As a member of this group of hospitals Intermountain Healthcare and Primary Children’s Hospital can compare (or benchmark) their care of children to the best children’s hospitals in the nation.

The Primary Care Clinical Program works with providers and staff in Intermountain clinics to deliver high-quality care to patients with chronic illness. This clinical program’s focus is to research and implement practices that help patients prevent chronic disease, better manage their chronic conditions, and live overall healthier lives.  

Key Projects

Diabetes

The Primary Care Clinical Program is researching ways to prevent at-risk patients from developing diabetes. Currently, it is evaluating the impact of Intermountain’s Diabetes Prevention Program by asking the following key questions:

• How helpful is the program in preventing progression to full blown diabetes?
• How effective is the program in helping patients lose the critical 5 percent of weight that will help change their course?
• How well is this program being communicated throughout the Intermountain system, specifically to at-risk patients?
• Does the program focus on the right population group?

Since starting this ongoing evaluation in 2014, the Primary Care Clinical Program has already steered a small but significant group of patients clear of the disease so far.

Mental Health Integration

Often patients who are managing chronic conditions are also at greater risk for suffering from mental health concerns. The Primary Care Clinical Program researched this connection and developed ways to provide better care. After analyzing 17 years of collected data on the subject, it invested in additional mental health professionals in Intermountain clinics systemwide. Patients now have fewer emergency visits and report better overall satisfaction with their care and quality of life.

Antibiotic Stewardship

To help cultivate a healthier future for all, the Primary Care Clinical Program is also partnering with infectious disease specialists at Intermountain to research how to decrease antibiotic utilization to levels that keep the community healthy now and in the future.

The Surgical Services Clinical Program is committed to research with the ultimate goal of helping patients live the healthiest lives possible. Its multidisciplinary teams analyze the best preoperative, intraoperative, and postoperative care.

Completed Studies

• Tonsillectomy Value Project – The Surgical Services Clinical Program shared outcome and cost data with Intermountain Healthcare ear, nose, and throat surgeons, allowing them to compare themselves to others on various techniques they use to directly drive outcomes and cost. Surgeons are changing to the techniques that have the best clinical and cost-effective outcomes.
• Alvimopan Study to Accelerate ERAS – Alvimopan (trade name Entereg) is a drug that behaves as an opioid antagonist. Alvimopan decreased length of stay by an additional day in already accelerated recovery patients (ERAS – Enhanced Recovery After Surgery). This led to an excellent outcome while also decreasing cost.
• Enhanced Recovery After Surgery (ERAS) – Through a patient-specific plan of eating and drinking, time out of bed, and pain management, the Surgical Services Clinical Program improved outcomes and decreased length of stay after surgery in order to get patients home healthier and happier.

Active Studies

• Blood Utilization Project – To decrease the use of blood transfusion to the lowest possible level with the best outcomes.
• Blood Salvaging Project – Analyze different techniques for salvaging the patient’s own blood and identify the value of these techniques to prevent transfusions relative to their cost. The Surgical Services Clinical Program uses this information to educate its surgeons and staff and thereby change how they do the procedures in the future.
• Activity Tracking Program/Study (Rx Navigait) – Key Questions: Will offering patients an accelerometer device to wear and tracking their activity before and after surgery encourage them to be more active? Does an increase in activity after surgery through early ambulation improve post-op outcomes and reduce complication rates?
• MESH Study – A trial to explore which FDA-approved biologic mesh is best in terms of long-term recurrence rates and avoidance of complications in a ventral hernia repair procedure.
• Single-stage Management of Common Bile Duct Stones with Laparoscopic Common Duct Exploration and Cholecystectomy is Safe and Cost Effective in a Large Multi-Hospital Healthcare System (a retrospective review of patients with gallstones undergoing removal of their gallbladder) – The Surgical Services Clinical Program looked at patients that needed ERCP (endoscopic retrograde cholangiopancreatography) and those that had common bile duct exploration during surgery. The cost and outcomes data will be shared with the surgeons and presented at a national conference.
• Spinal Surgery Outcomes – Looking at patient-reported outcomes via surveys and data abstraction to determine long-term spinal surgery outcomes in lower back and neck surgery patients.

Intermountain Healthcare is at the forefront of researching new techniques and technologies that provide the best care possible for women and newborns. This research, which is led by the Women and Newborns Clinical Program, results in refined clinical expertise, advanced treatment plans, and better care options for patients.

Intermountain’s Women and Newborns Research Department actively participates in NIH-funded, multicenter clinical trials and is consistently one of the leading recruiters for networks including the Maternal Fetal Medicine Units Network, the nuMoM2b Network, the EAGeR study, and the Genomic and Proteomic Network for Preterm Birth Research. Results from these trials are answering the most important questions in obstetrics and neonatology and help improve patient care.

Key Projects

Maternal Fetal Medicine

• The ARRIVE Study will answer the following questions: When is the optimal time to deliver a baby? Is it better to wait until they are beyond their due date, to deliver just before, or at the 40 week milestone?
• The CHAP Study will investigate whether or not pregnant women with chronic hypertension should be treated more aggressively to keep their blood pressure even lower than is current practice.
• The PRESERVE-1 Study will determine if a new drug called Atryn is an effective treatment for pre-eclampsia. This study will see if the use of this drug will delay delivery, allowing babies more time to develop in the womb before birth. 

Neonatology

• Platelet Reference Ranges for Newborns : This study established a precise reference range for determining abnormal blood platelet counts in newborns. Identifying a platelet count as abnormal can help in the recognition of various diseases. Information for this study was extracted from electronic records of 47,000 newborns born in Intermountain facilities over six years. This study demonstrates that the advancing age of a newborn (from birth to nine weeks) has a significant effect on the platelet count.
• Adherence to NICU Transfusion Guidelines: Blood transfusions are an essential part of neonatal intensive care medicine, but they carry risks. With this in mind, every blood transfusion given at an Intermountain NICU in a one-year period was reviewed to determine the portion of transfusions given out of compliance with the Intermountain transfusion guidelines. The information was used to identify patterns of noncompliance that could be addressed and rectified. The data was collected from archived electronic and paper medical records.
• Using Umbilical Cord Tissue to Detect Fetal Exposure to Illicit Drugs: This study determined that umbilical cord tissue could be used to detect fetal exposure to illicit drugs. Specifically, the performance of a testing method called enzyme-linked immunosorbent assay (ELISA) was assessed to determine accuracy when testing five different classifications of illicit drugs. If certain criteria were met, suggesting the possibility of drug abuse in the mother, umbilical cord segments were sent to the United States drug testing laboratories to complete testing.
• The ELISA testing method provided faster results and is inexpensive in comparison to the other established testing methods. The Women and Newborns Clinical Program found that the ELISA method performed very well, reporting more than 98 percent accuracy in test results for all five drug categories. Information derived from this test can help guide proper treatment for newborns with drug withdrawal. This new diagnostic test is now available for detecting fetal exposure to illicit drugs because of the work done at Intermountain.

Blood and Marrow Transplant (BMT) and Acute Leukemia physicians at LDS Hospital participate in clinical trials for patients with advanced hematological malignancies. The service offers state-of-the-art treatment approaches based on national, international, and institutional IRB-approved investigative treatment protocols, and it evaluates the newest treatment concepts and modalities based on the most advanced understanding of these diseases.

Key Projects

• Greater than 35 percent of patients in need of a donor transplant have no suitable related or unrelated donor available in a timely fashion. Until recently, the only alternative for patients with time constraints or who had no suitable donor was to use two cord blood units as the stem cell source. This is problematic in adults due to an adult’s weight compared to the cord blood unit’s cell count. Cord blood can also be cost prohibitive in addition to taking longer to engraft.
• Since 2012, the Intermountain Blood and Marrow Transplant/Acute Leukemia Program has offered a safe technology that uses family members who are matched for one chromosome (1/2 tissue type or haplo-identical) with the patient as stem cell donors. Intermountain’s program interacts with multiple national and international transplant programs to update and enhance transplant outcomes for this subset of patients. The feasibility, tolerance, and safety of a haplo-identical transplant is continuing to be convincingly documented.
• The Intermountain Blood and Marrow Transplant/Acute Leukemia Program is a member of the Dana Farber Acute Lymphoblastic Leukemia (ALL) Consortium that brings together physicians and scientists with expertise in treating patients with ALL. There are approximately 5,000 patients a year in the United States diagnosed with ALL, and only 25 percent of them are adults. The cure rates in children are now up to 90 percent, but historically adults have had 30 to 40 percent cures. Through current research and change in the treatment approach of adults, the current cure rates are 60 to 70 percent. New drugs have been developed and are being used at LDS Hospital to continue to improve outcomes and rescue patients who have relapsed.
• In collaboration with hematopathologists, a new protocol was created that allows pathologists to order specialized tests that can help determine the diagnosis of a patient. The pathologist orders the specialized tests based on early pathological results. The additional specialized test is beneficial for a timely diagnosis and is a more efficient use of resources. The College of American Pathologists has nationally recognized Intermountain’s work in this area as a model program.

Emergency Medicine and Trauma researchers at Intermountain are working on a wide range of projects to improve the care of patients. They have partnered with several departments of medicine at Intermountain, the Homer Warner Center for Informatics Research, and the Intensive Medicine Clinical Program on several high impact studies.

Key Projects

• Intermountain Medical Center is a national leader in rib plating and rib plating research. Through several studies, Intermountain researchers have shown that rib plating reduces pain and discomfort, decreases time to return to work or activities, and reduces the morbidity associated with multiple rib fractures.
• Emergency Medicine researchers have collaborated with Intermountain’s thrombosis clinic, the Homer Warner Center for Informatics Research, and the Pulmonary, Infectious Disease, and Intensive Medicine Departments to develop a computer-based decision support tool that provides ED physicians with guidance when preparing the diagnostic workup for pulmonary embolism. Current projects aim to reduce the number of unnecessary CT scans, which will reduce radiation exposure, decrease the costs associated with the diagnosis of pulmonary embolism, and improve patient outcomes.
• Trauma Services just completed a double-blinded, randomized controlled trial to determine the optimal dose of blood thinning medication to give trauma patients in order to prevent a very common side effect of trauma – venous thromboembolic disease.
• In collaboration with Intermountain’s thrombosis clinic, vascular lab service, and Emergency Medicine Department, Trauma Services is starting a randomized controlled trial that will compare surveillance ultrasound for deep vein thrombosis (DVT) in trauma patients with symptomatic screening only. The optimal method of screening for DVT is unclear and is currently being debated within the medical community. This project hopes to help definitively answer the question.

Hyperbaric medicine, or hyperbaric oxygen therapy, is a type of treatment used clinically for carbon monoxide poisoning, decompression illness, gas embolism, necrotizing fasciitis, gas gangrene, osteomyelitis, failing flaps and grafts, diabetic ulcers, crush injury, and other conditions. To undergo this therapy, a patient breathes in 100% oxygen while exposed to air pressure levels 1.5 to 3 times higher than atmospheric pressure at sea level. These exposures are provided in hyperbaric chambers, both of single and multiple person occupancy.

Key Projects

• Hyperbaric medicine research at Intermountain Healthcare dates back to the late 1980s. Early studies included testing and improving medical equipment that interfaced with the hyperbaric chamber to allow treatment of critically ill patients, including patients who needed to be mechanically ventilated and required medications for blood pressure control and sedation. Additional research projects included the evaluation of brain imaging results, cardiac injury, and vestibular problems after carbon monoxide poisoning, as well as the long-term follow-up of carbon monoxide-poisoned patients.
• In 1992, Intermountain initiated a blinded, randomized trial of hyperbaric oxygen for acute carbon monoxide poisoning. This trial enrolled 152 patients, and the results were published as a lead article in the New England Journal of Medicine in 2002. Another ongoing randomized trial is investigating two different hyperbaric oxygen treatment regimens, complimented by an active biorepository.
• Intermountain’s hyperbaric medicine division is a collaborating training site for fellows in the field of undersea and hyperbaric medicine at the Department of Anesthesiology at Duke University. Almost all of the fellows passing through the program have been involved in research projects. Some of those projects studied the effect of carbon monoxide on the visual system, electroencephalography changes following carbon monoxide poisoning, a review of the literature regarding glycosylated hemoglobin and wound healing, cardiac magnetic resonance imaging results following carbon monoxide poisoning, and a number of case reports.
• Other hyperbaric medicine research endeavors include testing of intravenous infusion pumps, characterization of risk of hyperbaric oxygen, and hyperbaric oxygen as a potential treatment for patients with brain damage. For the last six years, some of the hyperbaric research staff have been involved in a Department of Defense-sponsored research program investigating hyperbaric oxygen for US service members with post concussive symptoms following mild traumatic brain injury. To compliment this research, Intermountain is planning to lead a similar randomized trial conducted locally in civilians with ongoing symptoms following mild traumatic brain injury.

Imaging researchers at Intermountain are working on innovations that will increase the accuracy and impact of imaging, reduce patient harm, and decrease imaging-related costs. Imaging works closely with Intermountain’s clinical programs and the Information Systems Department on these initiatives.

Key Projects

• In collaboration with the Cardiovascular Clinical Program, Imaging developed a longitudinal record of cumulative radiation exposure for exams with the highest level of radiation exposure. Building upon this infrastructure, current projects include reduction in radiation for adult and pediatric head CT scans and adjustment of radiation protocols for abdomen and pelvis CT scans based on patient size.
• Imaging is also leading the way in developing standardized methods to perform imaging exams through development and deployment of standardized service process models (SPMs). These models establish standards for appropriate utilization, patient preparation, imaging protocols, and structured reporting tied to specific clinical contexts. Active SPM development is underway in assessment of appendicitis in children and adults, assessment of neck infections in children, evaluation of low back pain with MRI in adults, follow-up of thyroid nodules detected by imaging, and imaging of knee trauma with MRI. An important component of this work is the transformation from prose to structured/synoptic reporting methodologies. Intermountain Imaging and Information Systems are developing models and IT solutions to facilitate synoptic reporting.
• In addition, Imaging is working on a project with TeleHealth that will facilitate tele-mentoring during pediatric ultrasound exams performed in adult facilities. This project is verifying that improved exam quality can be achieved when real-time, off-site support by pediatric radiologists and technologists is made available to ultrasonographers with limited pediatric experience at the point of care using telemedicine resources.

The Division of Infectious Diseases at Intermountain Medical Center and LDS Hospital is actively engaged in diverse research activities that focus on improving outcomes for patients admitted with complex infections, understanding the epidemiology of healthcare-associated infections, enhancing patient safety, and improving antibiotic use. Research activities are multidisciplinary in nature and are funded by Intermountain Medical and Research Foundation grants, along with extramural sources. Research projects involve use of information systems to collect and analyze “big data” in addition to employing cutting-edge laboratory methods.

Key projects

• Assessing the impact of pediatric vaccine use on invasive Streptococcus pneumoniae infections in adults
• Understanding and improving antibiotic use in small community hospitals that lack infectious diseases support
• Understanding the burden of invasive fungal infections in vulnerable patient populations
• Understanding the burden of healthcare-associated infections and infections due to Clostridium difficile and antibiotic resistant bacteria in the Intermountain Healthcare system
• Utilizing DNA sequencing technologies to examine the role of the microbiome in human disease, understand patient genetic factors in susceptibility to infection, and identify new virulence factors in key bacterial pathogens
• Evaluating the impact of new microbiology diagnostic tests on antibiotic use and clinical outcomes

Researchers at the Intermountain Transplant and Liver Clinic are conducting several clinical trials that will make cutting-edge therapeutics available to patients. These trials evaluate the safety of new treatment regimens as well as utilize new imaging techniques, such as Magnetic Resonance Elastography (MRE) and FibroScan, to diagnosis patients in a non-invasive and more accurate manner.

Key Projects

Hepatitis C Virus  - Hepatitis C virus (HCV) is among the leading causes of liver cirrhosis, hepatocellular carcinoma, and liver transplantation. Over the past few years major breakthroughs have been made in treatment of HCV with the advent of all-oral direct acting antiviral (DAA) regimens. Intermountain is partnering with industry sponsors to conduct clinical trials that evaluate the efficacy and safety of these new therapeutic regimens. Intermountain is also following patients who have achieved a sustained viral response (SVR) to HCV in long-term registry studies in order to assess the durability of SVR.

Chronic Liver Disease - There are no FDA-approved treatments for nonalcoholic steatohepatitis (NASH) and primary sclerosing cholangitis (PSC), two chronic and progressive liver diseases. Intermountain is working with several industry partners to evaluate novel treatment regimens in patients with these underlying conditions and ultimately bring them to the market in the United States.

Cytomegalovirus - Cytomegalovirus (CMV) is a virus that commonly causes complication in immunosuppressed recipients of organ transplants. Intermountain is conducting an observational research trial that is evaluating the utility of a blood test that can more accurately predict which patients are at greater risk of CMV complications in the kidney transplant setting. This study may influence clinical standard of care, as patients who can more easily be identified as high risk can be given more prolonged antiviral therapy after transplant.

Physical therapists at Intermountain are committed to delivering evidence-based care that relieves low back pain (LBP). They are actively engaged in determining exactly what is the best and most cost-effective care for patients through innovative research.

Key Projects

• Physical therapists at Intermountain have researched the initial management strategies of primary care providers for patients consulting them with a new episode of LBP. In 40 percent of cases, opioids were prescribed, while only 13 percent of patients were referred to physical therapists for care. The total cost of physical therapy was not found to be a significant factor for patients’ total cost of care over the following year. The most significant factor related to driving higher costs was opioids. (Fritz JM 2013)
• In partnership with SelectHealth, physical therapists have collaborated to decrease the proportion of patients that fail to achieve significant progress clinically when referred for LBP. One important innovation in this effort is to predict the patient’s likelihood of success at the start of care using an algorithm based on factors that are known about the patient at the first visit. The hope is that physical therapists will engage patients more effectively who are at risk not to progress. To support this process, physical therapists have been trained in motivational interviewing techniques to facilitate communication with patients at risk for delayed recovery.
• In 2015, a physical therapy research team at Intermountain will begin studying interventions for chronic LBP as part of a national multi-site study that has been approved for $14 million in funding from the Patient-Centered Outcomes Research Institute. The funding will support a five-year study to examine the transition of patients from an acute low back pain condition to chronic low back pain and to compare two care approaches that can be delivered in a primary care office. One approach is “usual care” that allows the primary care provider (PCP) to do what they think is best. The second approach is where the PCP refers to physical therapists that incorporate cognitive behavioral principles into the patient’s physical therapy care process. The aim is to reduce the proportion of patients that progress to a chronic LBP condition from an acute episode.
• Physical therapists have also been active researching factors associated with successful outcomes in outpatient physical therapy clinics following total knee replacement. A decrease in the number of days that elapse from hospital discharge to the start of physical therapy outpatient care was associated with better function and less pain for patients at the end of outpatient care. Better function was also associated with older age, a higher initial disability score, not using a continuous passive motion machine, and a longer length of stay in physical therapy.
• As part of a multi-site, federally funded Agency for Health Research and Quality study, Intermountain Physical Therapy also completed a randomized trial to compare the effectiveness of exercise alone to exercise with manual therapy in patients with knee osteoarthritis. Within this same study, Intermountain Physical Therapy examined the effectiveness of receiving “booster” care over the course of treatment. Booster care is periodic face-to-face follow-up appointments that take place several weeks or months following discharge from the supervised therapy program. These appointments are designed to review the patient’s current rehabilitation program, troubleshoot any problems with the program, and make recommendations for program progression or modification. At this time, the study data is being analyzed and the results will be submitted for publication very soon.

References:

Fritz JM, B. G., Hunter SJ, Magel JS (2013). "Initial management decisions after a new consultation for low back pain. Implications of the usage of physicalt therapy for subsequent health care costs and utilization." Archives of Physical Medicine and Rehabilitation 94: 808-816.

The pulmonary and critical care research team is working to understand how to prevent and treat life-threatening illnesses, including sepsis and pneumonia. This work begins in the Emergency Department, moves to the Intensive Care Unit (ICU), and follows the patient through discharge with long-term follow-up of survivors.

Intermountain’s pulmonary and critical care research team plays an important role in furthering national research on the treatment and prevention of acute respiratory distress syndrome (ARDS). Intermountain has been a clinical site for the National Heart, Lung, and Blood Institute’s ARDS network since the network’s inception in 1994, as well as a clinical site for PETAL, the Prevention and Early Treatment of Acute Lung Injury network, since in 2014. The ARDS network is known for efficiently testing promising agents, devices, and management strategies to improve care of patients with ARDS. The 6ml/kg national standard for low tidal volume ventilation of ARDS patients came from the ARDS network study.

Key Projects

• Development of computerized decision support tools and electronic protocols that are based on national best practice standards to improve patient outcomes and enhance compliance with best practice. Examples are the ED-Pneumonia tool and e-protocol insulin.
• Utilization of bedside echocardiography: Intermountain critical care physicians are learning how the cardiovascular system responds to the stress of critical illness and how to effectively treat it.
• Creation of the Center for Humanizing Critical Care at Intermountain, which is leading the development of tools to help patients and families recover after life-threatening illnesses.
• Testing new treatments for pulmonary hypertension (both drugs and devices) and exploring the relationship of genetic defects.

For several years, the Sleep Medicine group at Intermountain Healthcare has studied and published original research on the sleep breathing patterns of patients who use opioid medications. This group of researchers has continued to investigate the phenomenon, focusing on the effects of specific opioid medications on sleep and breathing and the effectiveness of various treatment options.

The Sleep Medicine group is also very involved with perioperative screening for sleep apnea at Intermountain Healthcare and on the national level. They developed screening and treatment algorithms that have been adopted at Intermountain facilities systemwide and have been highlighted by the Society of Anesthesia and Sleep Medicine.

Additionally, the Sleep Medicine group is studying cardiac function and morphology in patients with sleep apnea. Through research, they have shown that cardiac geometry is adversely affected in patients with sleep apnea, and treatment with nasal CPAP improves these abnormalities and may improve cardiac function.

The Sleep Medicine group created and oversees the University of Utah's fellowship training program for sleep medicine. Through this program, physician fellows receive specialty training in sleep medicine and go on to share their expertise throughout the country.

Reducing injury risk and improving human performance are the objectives of the Sports Medicine and Sport Science researchers at Intermountain. This group of researchers works collaboratively with orthopedic and primary care physicians, as well as physical therapists, to develop testing protocols and interventions aimed at those goals.

Key Projects

• The TOSH Human Performance Laboratory team is engaged in an in-depth analysis of the risks and benefits of running barefoot or in minimalist shoes. The lay media has made these practices popular, but evidence suggests that not everyone will benefit, and it may even increase a runner’s risk of injury and/or decrease his or her performance as a result of adopting these practices. Sports Medicine and Sports Science researchers are utilizing 3D motion analysis, 3D ground reaction forces, and center of pressure measures combined with metabolic energy expenditure variables to comprehensively assess the biomechanical and physiological responses to running barefoot, in minimalist shoes, and in traditional cushioned running shoes in an effort to address this issue.
• The team is also collaborating with orthopedic surgeons to develop lower extremity functional testing protocols to assist in the tracking of patients’ progress as well as measure objective outcomes following ACL, total knee arthroplasty, and hip surgeries in an effort to optimize the surgical and rehabilitative processes for these conditions.
• Nutrition and the role of nutritional supplements in health and recovery processes are of particular societal interest. This team is engaged in investigating the role of various nutritional supplements, particularly those of the antioxidant variety, in recovery from surgical and physical training interventions. Various projects are looking at the effects of different supplements such as vitamins D and E on recovery of muscle strength and function following ACL surgery and total knee arthroplasty, as well as muscle damaging exercise in healthy individuals.