Aspire Scholars

Dr. Ryan Boente is an Assistant Professor of Clinical Medicine for the Division of Pulmonary, Critical Care, Sleep and Occupational Medicine.  He completed his undergraduate education at Butler University followed by Medical School at the University of Illinois Chicago.  Residency and Chief Residency were completed at Case Western Reserve MetroHealth Medical Center prior to coming to Indiana University for his Pulmonary and Critical Care Fellowship.  He stayed on as faculty in 2018 where he started the Interstitial Lung Disease Program that he now directs.  He currently serves as principal investigator for numerous clinical trials for interstitial lung disease and performs clinical research with specific interests in improving delivery of care amongst the Pulmonary Fibrosis Foundation Care Center Network Sites and Rural populations in Indiana. I also serve as director of the medical intensive care unit at the RLR VA Medical Center and am an associate fellowship program director for the pulmonary and critical care fellowship. 

ASPIRE Project: Improving rural health through increased access to sub-specialty interstitial lung disease care

First, I would retrospectively assess clinical outcomes for rural vs. urban subjects with interstitial lung disease (ILD) and pulmonary fibrosis (PF) from a multi-center database that I will be able to gain access to. The outcomes of interest would be death, rate of decline in lung function (%predicted FVC and %predicted DLCO), hospitalization, antifibrotic medication use, and the likelihood of lung transplantation to name a few. I have an internal RedCAP database with 500+ phenotyped interstitial lung disease patients with a variety of data including longitudinal pulmonary function tests. I would collaborate with a friend/colleague of mine from the University of Chicago who I have worked with on other studies who has the complete dataset from multiple centers from across the United States that would have much of the data we would need. We can geocode these subjects using their 5-digit zip code to assess for rurality. These centers would include other parts of the country, both urban and rural to diversify our dataset and increase the number of subjects included.

Secondly, I would like to formally develop a rural-telehealth program at IU to improve access to care for patients in rural communities with ILD. A future or current study would be to assess barriers to telehealth while prospectively following rural subjects and assessing similar outcomes that we studied retrospectively in the larger multicenter cohort. 

 Dr. Katie Eckerle is an Assistant Professor of Clinical Medicine in the Division of General Internal Medicine and Geriatrics at Indiana University School of Medicine working as a hospitalist at Methodist Hospital.  In addition, she serves as the Quality and Safety co-lead for AAHC hospitalists for which she presents morbidity and mortality case conferences and addresses QI issues at the AAHC.  Her interests include quality improvement, population health, and improved access to care.

ASPIRE Project: Tobacco use is the leading preventable cause of premature death and disease in the US1. In 2019, Indiana ranked 10th out the United States in prevalence of current smokers1. It is estimated that tobacco costs 11,100 Hoosiers their lives every year and costs the state almost $3 billion dollars annually3. Despite this, Indiana receives less funding per capita for tobacco prevention and control than over half of the United States4. Of the 30 largest cities in the US, Indianapolis, along with 2 other cities, has the highest smoking rates. Not surprisingly, Marion County exceeds the state’s overall rates of lung cancer incidence and mortality, heart disease hospital admissions, stroke hospitalization, chronic lower respiratory disease mortality, and asthma hospitalizations.

Hospitalization provides an opportunity for smokers to try out tobacco abstinence; however, about half smokers resume tobacco use within 3 days of discharge from the hospital6. A number of trials have demonstrated that intensive counseling during the hospital stay and for one month after significantly increases smoking cessation rates. This benefit was augmented when nicotine replacement therapy (NRT) was added7. Hospitalizations at the AAHC provide a unique opportunity to encourage smoking cessation as patients are able to experience tobacco abstinence without usual environmental cues to smoke. In addition, critical illness and increased perceived vulnerability may boost receptivity to smoking cessation messages. To date, the AAHC has no specific policy on NRT or smoking cessation counseling during hospitalization or at discharge. I would like to assess current practice of our hospitalist staff regarding tobacco use screening and counseling as well as NRT use during hospitalization and at discharge. In addition, I would like to assess barriers to prescription and filling of NRTs at hospital discharge from the AAHC. To date, no study has assessed the effect of providing NRT alone at discharge without intensive counseling. Ultimately, I would like to investigate the effect of NRT in hand at discharge in our patients motivated to continue abstinence from tobacco use. I would like to start with a project assessing current practices within our hospitalist group and feasibility of such a project in the future.    

Kyle Frick, M.D. is an interventional cardiologist and assistant professor of clinical medicine at Indiana University School of Medicine with research interests in clinical informatics, quality improvement, and the effects of cirrhosis on the cardiovascular system. He is currently collaborating with the Regenstrief Institute on a project aiming to improve cardiovascular care and outcomes by directly integrating cardiovascular disease specific health information exchange data into the electronic health record. In addition, he has a grant from the American College of Cardiology studying cardiac rehabilitation participation rates after removing frequently cited barriers to participation, cost and transportation, and an internal grant from the Division of Cardiology focused on cirrhotic cardiomyopathy and periprocedural cardiovascular care in patients undergoing liver transplantation.

ASPIRE Project: The project I would like to pursue for the ASPIRE program adds to the work on the NIH R01 grant application I am working on with Dr. Schleyer at the Regenstrief Institute entitled, “Improving Care and Outcomes in Cardiovascular Disease by Directly Integrating Community Health Information Exchange Data into the Clinical Workflow”. The major goal of this application is to directly integrate cardiology-specific data from Indiana’s health information exchange (HIE) into the electronic health record (EHR) so that it is easier to use. The reason this is important is because HIE use has been shown to reduce costs, minimize duplicate procedures and diagnostic tests, improve clinical decision-making, and enhance patient safety. However, despite these benefits, most providers do not use the HIE because it is cumbersome, frequently requiring users to exit the EHR to a different web portal that houses the HIE.

One criticism of our initial grant submission described above was a lack of preliminary data. This is largely because preliminary data on this topic does not exist in the domain of cardiology. My proposed project will obtain preliminary data on HIE and EHR usage by cardiology providers (faculty, advanced providers, and fellows). I would like to see how providers navigate the EHR and HIE during routine inpatient, outpatient and emergency department encounters; what information they retrieve; what obstacles they encounter in the process; and how we could improve efficiency and effectiveness of information retrieval and, ultimately, clinical decision-making. This will require direct observation of the provider as they navigate the EHR and HIE during a patient encounter, documenting their experience and receiving real-time feedback. The goal will be to write a manuscript which is expected to not only be helpful for the grant application, but also for the future study of HIE use in cardiology in general. Things I hope to specifically learn and improve on through mentorship on this project: study design, contextual design, study implementation, data analysis and synthesis, manuscript preparation, and grant development. 

Dr. Swapnil Khare is Assistant Professor of Clinical Medicine in Department of Endocrinology. Her clinical and research interest is in diabetes mellitus especially in patients with Cystic Fibrosis. She has established a dedicated clinic to streamline care of patients with CF at IU. She is currently studying the effect of modulator therapy in patients with CF. She is Medical Director of Inpatient Diabetes and has worked to improve and standardize diabetes care of patients during hospital stay. She started a pilot project to use continuous glucose monitor (CGM) for remote monitoring of blood glucose for patients during COVID19 pandemic. This not only helped in diabetes management but also decreased COVID exposure of nursing staff and helped in conserving PPE. 

ASPIRE Project: My passion is to advance knowledge regarding cystic fibrosis-related diabetes (CFRD). I firmly believe advances in technology will change the shape of how we provide care to patients with CFRD.

Continuous glucose monitors (CGM) were FDA approved as adjunctive treatment to home glucose monitors for several years. In 2016, Dexcom G5 was approved by FDA to make treatment decisions without need for capillary blood glucose confirmation in outpatient setting. In March 2020, CGM received emergency authorization to be used for hospitalized patients. I started a Pilot project to use CGM in patients hospitalized with COVID. It significantly decreased number of fingerstick needed and helped conserved PPE and decrease nursing COVID exposure. The program was very successful and well received.

Patients with CF are usually require prolonged hospitalization during CF exacerbation. Blood glucose problems are common in hospitalized CF patients and there is need for multiple finger sticks. I recognized this need and expanded the CGM pilot program to CF patients hospitalized at University hospital CF floor.

There is strong evidence in patients with type 1 and type 2 diabetes that good control of blood glucose is associated with better outcomes. Use of CGM in hospitalized patients is of increasing interest. Studies in type 1 and type 2 diabetes show that identifying CGM trends allowing early intervention can help to control blood glucose more effectively within target range while avoiding hyperglycemia and hypoglycemia. Data is however very limited in patients with patients admitted with CF.

My objective is to evaluate the impact of using CGM on clinical variables. I want to demonstrate if CGM use is related to better blood glucose control, less hypoglycemia and better patient and staff experience. This will add tremendously to our current knowledge and set stage for future studies.

I am very passionate and dedicated to advance medical knowledge in the field of CFRD. I have worked tirelessly to establish CGM pilot project which is currently ongoing. I want to look into the data objectively which will immensely help medical community. I seek ASPIRE mentorship and resources to help design study which will be impactful and form basis for further research and grants.

Chandra Thippanna, MD is an associate professor of Clinical Medicine in the Division of Internal Medicine and Geriatrics at the Indiana University School of Medicine. After completion of my training in India and U.K, I worked briefly as a consultant in Pulmonary and Internal Medicine in U.K before moving to U.S.A. What I am passionate about is, how to bring changes the way to need practice medicine. In last two decades, there has been a radical change in the demographics of the population, with globalization, communities have grown to be more diverse, Patient’s needs have become more complex, exciting models of health care delivery is not sufficient to meet those needs. Hence, we need to explore different models of care delivery, provide institutional and structural support and skills we need. I am hoping with my Master’s degree in Medical Education from Cleveland Clinic and Cleveland State University I am able to explore and learn during the process and teach the future physicians in developing newer models of care delivery. I am excited and honored, that I was accepted to ASPIRE Program that will provide me academic research skill sets which I can use to develop health care delivery especially at point of care and able to share with my colleagues and students. 

ASPIRE project:  Early detection and Intervention of Sarcopenia and Myopathy at bedside by 2D ultrasound point of care testing.

Introduction: Sarcopenia and Myopathy are independent predictors of mortality and morbidity and most often it is underdiagnosed. Sarcopenia is a progressive musculoskeletal disorder. Sarcopenia and myopathy can be diagnosed at bedside using 2D ultrasound point of care testing and by early detection and intervention with targeted nutrition and physical therapy can reduce the mortality, morbidity, and length of stay.

Methods: Prospective study with longitudinal follow up of patients from hospital to rehabilitation facility. Initial study involves 20 patients post ICU, chronic illness of any cause, excluded are cancer patients. Age group included between 20- 60 yrs of age. By using 2D ultrasound (U/S) at bedside Quadriceps muscle thickness (QMT) and or Gastrocnemius muscles can be measured by trained radiologist, physician, nutritionist, or physical therapist. Once a patient is identified, his or her nutritional needs are assessed as per standardized protocol, nutrition plan is formulated, and intense targeted physiotherapy is initiated. Data is collected over a period of 6 months.

Outcomes:  Outcome of the study is to demonstrate whether early detection and intervention of sarcopenia and myopathy by 2D ultrasound and by early targeted therapies like nutrition and physiotherapy would reduce the mortality, morbidity, and length of stay.

Matthew Turissini, MD is an Assistant Professor of Clinical Medicine in the Division of General Internal Medicine and Geriatrics at Indiana University School of Medicine and a Visiting Lecturer in the Department of Medicine at Moi University School of Medicine in Kenya. He works clinically as a hospitalist at Sidney & Lois Eskenazi Hospital. He lived in Kenya for four years working with the IU Center for Global Health providing medical education, growing the AMPATH Population Health program, and delivering clinical care at Moi Teaching and Referral Hospital (MTRH). With Dr. Edith Kwobah of MTRH, he co-leads several AMPATH mental health care programs including opening Kenya’s first transitional home for patients with severe mental illness, providing mentorship to establish mental health care at lower-level facilities, and implementing community-based group care for people with substance use disorders. He hopes to benefit from the ASPIRE program by developing academic research skills to develop implementation research projects within the AMPATH mental health care program and to develop reciprocal innovation projects to improve implementation of mental health care in Indiana. 

ASPIRE Project: While working in Kenya from 2017 through July 2021 with the Indiana University Center for Global Health and AMPATH, I worked to develop care programs for the Ampath Mental Health Program. This work has created opportunities for scholarly projects including implementation science evaluations of our community-based substance abuse groups, implementation and effectiveness evaluations in starting the MTRH Nawiri Recovery and Skills Center, and implementation and effectiveness evaluations of our programs to mentor primary care providers on treating patients with mental illnesses. Long term, I would like to develop implementation science projects to create evidence for the growth of similar mental health projects throughout Kenya. I suspect, given the timeline for a project during Aspire, my project will need to involve preliminary work to support a larger, formal research proposal in one of those areas. Currently, I would like to explore doing a feasibility and acceptability assessment for scaling the community substance abuse groups to new counties, including exploring county department of health oversight of the groups. We currently have 57 groups with about 926 active members. Multiple county governments have expressed interest in starting more groups in their counties. However, we have encountered significant obstacles in transitioning non-clinic based care to county supervision in the past, so a feasibility and acceptability implementation science assessment of county governments creating new community-based substance abuse groups would offer significant benefit in scaling access to care for alcohol and drug abuse care in Kenya.

Neeta B. Agarwal, MD
Assistant Professor of Clinical Medicine, IU School of Medicine

Neeta Agarwal, MD is an Assistant Professor of Clinical Medicine at Indiana University School of Medicine. She completed her residency in internal medicine/pediatrics at Los Angeles County/University of Southern California in 2007, worked at Kaiser Permanente in Southern California then joined Indiana University Medical Group (now Eskenazi Medical Group) in 2010. She has practiced primary care at both Westside and Pecar Community Health Centers, serving as Chief Physician Executive at Westside CHC 2015-2017. Neeta is now involved in expansion of lifestyle medicine practice in primary care. She also enjoys teaching the IU School of Medicine first year course, Foundations of Clinical Practice. Neeta serves as a faculty co-chair of IU’s chapter of American Medical Women’s Association. Outside of work, she enjoys connecting with her husband and two children, volunteering with her daughter at Coburn Place, playing tennis, tending a vegetable garden, and experimenting with new recipes.

ASPIRE Project: Predictors of Weight Loss in Primary Care: Provider Behaviors and Service Utilization
In her exploration of lifestyle medicine, Neeta became interested in the transformation of her own primary care practice to focus on preventative measures including exercise, nutrition, and mental well-being as the first-line treatment of many chronic illnesses and maintenance of good health alike. Her ASPIRE project is aimed at exploring current best practices within and outside Eskenazi Health, determining how to assess success of such practice transformation, and eventual piloting of a primary care model for lifestyle medicine based practice.

Diane Donegan, MB BCh
Assistant Professor of Clinical Medicine, IU School of Medicine

Diane Donegan, MB BCh, is an Assistant Professor of Clinical Medicine at Indiana University School of Medicine. Prior to moving to Indiana, she completed her Internal Medicine Residency followed by a Fellowship in Endocrinology, Diabetes and Metabolism at the Mayo Clinic, Rochester.  During this time she obtained her Masters in Clinical and Translational Science. She joined the Endocrinology faculty in 2017 and holds a joint position with Neurosurgery. She has a special interest in neuroendocrinology, in particular pituitary related pathologies.

ASPIRE Project: Anxiety in Patients with Pituitary Tumors
Given the unique potential complications of pituitary surgery, Dr. Donegan’ s ASPIRE project has focused on the optimization peri-operative care of pituitary patients through the development of evidence-based standardization of practice and assess the impact such changes will have on patient care and team satisfaction. In recognition of the vital role patients play in their care, the project will also focus on enhancing and standardizing patient education through the development of novel educational tools.

Carrie Leathers, MD
Assistant Professor of Clinical Medicine, Indiana University School of Medicine

Carrie Leathers, MD is an Assistant Professor of Clinical Medicine and Pediatrics at Indiana University School of Medicine and practices in both the inpatient and outpatient settings. She is an active educator in the clinical setting, supervising residents from the Internal Medicine, Pediatric, and combined Med-Peds training programs, as well as IUSM medical students both in the hospital and in clinic. Her primary outpatient site is Pecar Health Center, where a large Spanish-speaking population is served. Prior to her career in medicine she worked in youth development in the non-profit sector with United Hispanic Americans and Boys and Girls Clubs of Fort Wayne, as well as Primeros Pasos clinic in Guatemala. She is currently part of team developing an advanced training program for pediatricians practicing in urban settings, “Our Kids Our Community.”

ASPIRE Project: Symptoms in Latino Young Adults Who Have Moved to the United States: Depression, anxiety, and somatization
Dr. Leathers’ ASPIRE project seeks to better understand the mental health of Spanish speaking young adults who reside in the United States without a federally recognized lawful status. This vulnerable population has limited access to healthcare and recent immigration policy changes and continued violence in Central America pose additional threats to emotional and physical health.

Kristi Lieb, MD

Kristi Lieb is a Geriatrician and Certified Medical Director specializing in post-acute and long-term care medicine.  Kristi trained in internal medicine at Indiana University where she then went on to complete her Geriatric fellowship.  Kristi has been involved with IMDA—Indiana Society for Post-Acute and Long-Term Care Medicine since 2011.  She served as the education chair for the organization for several years and helped to establish and organize quarterly educational meetings.  She also served as president of IMDA from 2014-2016.  Kristi participated in the Indiana SMART campaign which was a state-wide quality improvement project for Indiana nursing homes funded by the Indiana State Department of Health aimed at reducing polypharmacy in Indiana nursing homes.  Kristi also served as the Associate Medical Director then as the Medical Director of the OPTIMISTIC Program.  Kristi is a Geriatrician at the Richard L Roudebush VA Medical Center.  Outside of work, Kristi enjoys spending time with her husband, their 2 children, and extended family

ASPIRE Project:  Nursing Home Residents with Urinary Tract Infections: A Comparison of Treatment in Place Versus Hospitalization
Antibiotics are frequently overprescribed in nursing home with the most common indication being urinary tract infection.  This has led to a rise in antibiotic resistance in long term care facilities which affects not only the nursing home facility but also the hospital system which receives residents from the facility and the surrounding medical community.   Kristi’s ASPIRE project used the rich OPTIMISTIC database to evaluate antibiotic prescribing patterns in nursing homes for urinary tract infections with the long term goal of improving antibiotic prescribing in the nursing home setting.

Neetu Mahendraker, MD, CHCQM, FHM was born and raised in India. She finished her medical school from the prestigious Gandhi medical College, Hyderabad, India. She completed internal medicine residency from University of Illinois-Urbana Champaign in 2009. She started her hospitalist career in 2009 with Indiana University Health (IUH) Physician as an academic hospitalist. Her goal is to thrive as an academic hospitalist with nationally recognized expertise in clinical medicine, research and an educator. She has recently received the designation of a fellow in hospital medicine for her commitment to the field of hospital medicine. She was awarded Indiana University (IU)-COVID heroes’ award in 2020 for her exemplary services to IU during the COVID-19 pandemic. She is the quality improvement pillar lead at IU-AHC and has led several quality improvement projects at IUH-AHC. She strives to improve the inpatient care for seriously ill hospitalized patients by identifying and reporting rare cases with a high mortality and improving end of life patient-clinician communication by identifying them early in the hospital course. She is a peer reviewer for prestigious journals including Health informatics journal and Journal of General Internal Medicine. As an educator, she is focused on education of quality improvement methods to the medical students.

ASPIRE Project: Mortality Predictive Model for Inter-Facility Transfer Patients
Predicting the risk of in-hospital mortality on admission is challenging but essential for risk stratification of patient outcomes and designing an appropriate plan-of-care, especially among transferred patients. The aim of this project was to develop a model that uses administrative and clinical data within 24 h of transfer to predict 30-day in-hospital mortality at an Academic Health Center (AHC). This was a retrospective cohort study. We used 30 putative variables in a multiple logistic regression model in the full data set (n = 10,389) to identify 20 candidate variables obtained from the electronic medical record (EMR) within 24 h of admission that were associated with 30-day in-hospital mortality (p < 0.05). This model can use electronic health record and administrative data within 24 hours of transfer to predict the risk of 30-day in-hospital mortality with reasonable accuracy among seriously ill transferred patients.

Maria Robles, MD

Maria went to University of Wisconsin-Madison for her undergraduate education, where she earned a Bachelor of Science in Mathematics and Molecular Biology. She then joined the Peace Corps and taught Mathematics and Health Education in a small rural high school in Ghana, West Africa for two years. After returning she earned a Master of Science in Biology. She then completed medical school from IU School of Medicine and moved to Rhode Island to do her residency in General Internal Medicine with Alpert School of Medicine/Brown University. After completing residency, she returned to Indianapolis in 2011 and has been working with Eskenazi since that time. She became Chief Physician Executive of West 38^th Street in 2017. She has two Internal Medicine resident continuity clinics per week and also works with medical students and fellows. 

She started treating patients with medications for opioid use disorder (OUD) in 2017 and learned that people responded well to MOUD in the primary care setting.  She then listened to the experiences her learners were having with people with OUD and realized that the majority of their experiences were with people when they were in the hospital and in crisis. They were not getting exposed to people with OUD who were in long term recovery. She worked to create a week-long curriculum for the residents focused on exposure to patients with OUD who were receiving treatment in the outpatient setting and then completed a qualitative study to gain a deeper understanding of the impact of the curriculum on the residents.

ASPIRE Project: Teaching Learners about Medication Based Treatment for Opioid Addiction
Opioid misuse has reached epidemic proportions in the United States; more than 115 people die daily from opioid overdose. The medical community as a whole has been slow to respond, leaving patients without good options.   Less than 10% of patients with substance use disorder receive treatment. Although medications for opioid use disorder (MOUD) is safe, effective and the standard of care, the majority of internal medicine residents do not receive training in it.  The study’s purpose was to understand internal medical residents’ perceptions of a new week-long substance use curriculum with a focus on opioid addiction and MOUD (Addiction Week).

Neshahthari Wijeyakuhan, MD, FACP, FHM

Neshahthari Wijeyakuhan MD, FACP, FHM was born in London, England and raised in Toronto Canada. She completed her Internal Medicine residency from NYU Langone Hospital Brooklyn in New York; Followed by Fellowship in Geriatrics at Abington Hospital Jefferson Health in Pennsylvania. She is both Internal Medicine and Geriatric board certified. Neshah worked as a hospitalist at IU Methodist Hospital, prior to transitioning to her Geriatric position. During her practice, she combines her geriatric and internal medicine skills and knowledge to provide the best interdisciplinary care for her elderly patients and teach those skills to the students and residents.