Key research areas in the Division of General Internal Medicine and Clinical Innovation, part of NYU Langone’s Department of Medicine, include developing interventions for obesity and nutrition in primary care, increasing diabetes care equity, 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.

Obesity and Nutrition in Primary Care

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.

WOOP VA: Promoting Weight Management in Primary Care

Dr. Jay and Dr. Beasley have created a primary care-based intervention using a brief, novel intervention called Mental Contrasting with Implementation Intentions (MCII). This imagery technique uses a procedure called WOOP (Wish, Outcome, Obstacle, Plan) to promote weight loss and behavior change and increase engagement in MOVE!, an intensive weight management program. The study is funded by a Merit Review grant from the Veterans Affairs Office of Research and Development, Biomedical Laboratory Research and Development Service.

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.

Participants include patients from the Family Health Centers at NYU Langone, NYC Health + Hospitals/ Bellevue, and Olive View–UCLA Medical Center. This study is funded by an NIH R01 grant.

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.

Weight-Loss Maintenance for Low Income Patients

Stephanie L. Orstad, PhD, is the principal investigator on a study to develop, implement and evaluate an ecologically informed physical activity pilot intervention to prevent weight regain and promote quality of life for low-income primary care patients at the Family Health Centers at NYU Langone. This research is funded by an NIH K award.

Food Response Training to Improve Dietary Intake and Weight Loss

Sandra Wittleder, PhD, is the principal investigator of a study to determine the acceptability and feasibility of a food response training that targets implicit food biases to reduce cravings, food intake, and weight among racially and ethnically diverse patients with obesity and elevated cardiovascular disease. This study is funded by the American Heart Association and a NYU Global Health Pilot Grant Funding Award.

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.

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.

Lifestyle Medicine Program

Michelle McMacken, MD, has created the Lifestyle Medicine Program to support and guide patients in making healthy behavior changes and navigating structural barriers to weight loss. Originally a pilot project for NYC Health + Hospitals/Bellevue, lifestyle medicine clinics have been expanded to sites throughout the NYC Health + Hospitals system due to the program’s extraordinary outcomes, success, and demand. Each program is staffed by physicians, dietitians, and health coaches who help patients make evidence-based lifestyle changes related to their diet, exercise, and sleep habits. The program also provides opportunities for physicians and other health professionals to learn about evidence-based nutrition, lifestyle medicine, and culinary medicine.

Diabetes Care Equity

Our researchers investigate health equity in diabetes treatment and develop innovative ways to overcome barriers to care.

Diabetes Prevention Program for Geriatric Populations

Dr. Beasley is the principal investigator on the Bringing the Diabetes Prevention Program to Geriatric Populations study, also called BRIDGE, a five-year, randomized control trial comparing the effectiveness and implementation of two delivery modes of the CDC’s Diabetes Prevention Program adapted for older adults. Participants take part in a year-long lifestyle intervention either remotely or in-person. The researchers hope that findings from the study can help inform best practices in the delivery of an evidence-based intervention for older adults with prediabetes. The study is funded by the NIH.

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 conducted the Enhanced Quality in Primary Care for Elders with Diabetes and Alzheimer’s Disease or Related Dementias (EQUIPED-ADRD) study.

The EQUIPED-ADRD study linked 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 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 and Hypertension Health Equity in Asian Americans

In collaboration with the NYU Center for the Study of Asian American Health and the Department of Population Health, Dr. Beasley 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 is funded by the NIH.

Expanding Virtual Healthcare

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 VA NY Harbor Healthcare System is leading the telemedicine initiative with grants from the Office of Connected Care at the U.S. Department of Veterans Affairs.

Using Standardized Patients to Assess and Train Clinicians in Digital Communication

Principal investigators Dr. Dembitzer, Dr. Jay, and co-investigator Dr. Zabar, are creating a national model for competency-based experiential training in digital health communication. The researchers are training general internal medicine faculty and resident clinicians at the VA New York Harbor Health Care System in digital health communication skills using announced standardized patients. The researchers are creating exportable training materials to share with other VA sites and clinics.

Patient Use Characteristics of VA Telehealth Services and Impact on Quality of Care

Principal investigators Dr. Jay and Paul Krebs, PhD, are evaluating the impact of patient and provider characteristics on telehealth utilization, satisfaction, and individual clinical outcomes in chronic care delivery during the COVID-19 pandemic. They plan to assess patient, provider, and system-level factors associated with the uptake and impact of implementing synchronous, telehealth services in primary care.

Using Patient Generated Health Data to Improve Patient-Centered Communication in Weight Management

Patient-generated health data has particular promise to improve patient-centered communication in the setting of weight management. Principal investigators Dr. Jay, Dr. Dembitzer, and Omar El Shahawy, MD, are assessing both patient and provider factors associated with patient-generated health data utilization. Dr. Jay hopes to generate formal recommendations to support sustained engagement through improving shared-decision making practices and to optimize patient-generated health data utilization, including the potential expansion of a FitBit program to the wider VA audience.

Transitions of Care

Telemedicine has enabled us to create programs for transition of care management. At NYU Langone Hospital—Brooklyn, patients receive a video visit with the ambulatory resident who is managing their post-discharge care. At NYU Langone Tisch Hospital and the Kimmel Pavillion, hospitalist teams are collaborating with internists. Each program has demonstrated significant improvements to patient follow up, satisfaction, and care outcomes.

Pre-Exposure Prophylaxis for HIV

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 was funded by NYU Langone’s Clinical and Translational Science Institute.

Medical Education Curriculum Innovation and Program Evaluation

Our faculty conduct influential research in the field of medical education and participate in curriculum development and program evaluation across the medical education continuum. These projects are housed in the Program for Medical Education Innovations and Research.

Clinical Reasoning

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. This research initially received pilot funding with a Program for Medical Education Innovations and Research (PrMEIR) Innovation Grant.

Expanding upon the PrMEIR Innovations grant pilot funding, Dr. Schaye and her research team are developing a machine learning algorithm, NoteSense, to provide feedback on clinical reasoning documentation. Dr. Schaye plans to further develop and collect validity evidence for a machine learning model for automated workplace-based assessment of clinical reasoning documentation among residents. She hopes to address key gaps in the field by creating a machine learning model in a real-world clinical context that functions across a wide-range of chief concerns and documentation behaviors.

Patient Care Activities During Residency Drive Curricular Innovations

Daniel Sartori, MD and David Rhee, MD, have developed and implemented a tool that maps principal ICD-10 discharge diagnosis codes to American Board of Internal Medicine (ABIM) content at the four training hospitals where our residents work during the course of one academic year to characterize and compare clinical educational experiences.

They analyzed data from more than 18,000 discharges handled by inpatient resident teams. The tool captured more than 95 percent of discharges at each site. Infectious disease and cardiovascular disease were the most common clinical content areas representing almost 40 percent of resident experience, whereas areas such as allergy and immunology, dermatology, obstetrics and gynecology, ophthalmology, otolaryngology, and dental medicine were notably underrepresented (less than 1 percent at each site). There were significant differences in the frequencies of conditions within most content categories, suggesting that residents experience distinct site-specific clinical content during inpatient training experiences. These finding have prompted important programmatic and curricular changes to enrich hospital-based educational experiences for our residents. We’ve also given residents more agency in choosing among various inpatient and outpatient subspecialty rotation offerings across campuses to best fit their needs based on their training experiences. This research is funded by a Program for Medical Education Innovations and Research (PrMEIR) Innovation Grant.

Virtual Reality Simulation Training for the Management of Tracheostomy Emergencies

Lisa Altshuler, PhD, is collaborating with Mark H. Adelman, MD, and Brian S. Kaufman, MD, and Jordan W. Talan, MD, to develop and refine an evaluation strategy for a new, innovative pulmonary critical-care simulation curriculum for fellows. The project will serve as a model of how to effectively implement virtuial reality programs in other health education settings.

LGBTQ+ Health Equity

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 former Macy Faculty Scholar, Dr. Greene continues to develop curricula at the intersection of health equity, 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.

Point-of-Care Ultrasonography

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. This project is funded by a generous gift from the Goodman Family Foundation.