Research

The Institute for Family Health (IFH) engages in clinical and health services research in support of its core mission to provide access to superior primary care, especially for the medically underserved. Our research enables us to continually improve the care we offer and to contribute to the advancement of primary care knowledge and practices. We conduct and participate in national research on innovative strategies to enhance the utilization of integrative practice in health disparity populations. From the development of new technology to the creation of interprofessional curricula and competencies, the IFH is a leader in professional development and patient education to improve the care received by all primary care patients. While the Institute engages in a wide variety of research projects, we have focused efforts in several key research areas:

  • Racial and ethnic health disparities
  • Patient-centered care
  • Health information technology
  • Integration of mental health care and primary care
  • Women’s health

The IFH’s practice sites, providers, and organizational leaders comprise a primary care-based research network registered with the Agency for Health Care Quality and Research. We foster and support research that is initiated by individual clinicians, including family practice residents, as well as broader, organizational-level projects implemented across all practice sites. Each of our three family medicine residency programs has a required research curriculum through which residents complete a wide range of research projects under the supervision of a faculty member.

Institute research projects, as well as service and project grants with rigorous evaluation requirements, have received support from the National Institutes of Health, Agency for Health Care Quality and Research, Centers for Disease Control and Prevention, Health Resources and Services Administration, New York State Department of Health, and a variety of private foundations. The research conducted by Institute staff and residency faculty has resulted in numerous publications in a range of medical journals, including JAMA, Journal of the American Board of Family Medicine, and Journal of Healthcare for the Poor and Underserved. Institute staff have also published health policy articles, book chapters, commentaries, and letters to the editor on issues related to primary care and care for the underserved.

Research Team

Ongoing studies examine the effectiveness of integrative healthcare approaches for a variety of health conditions as well as strategies to make then more accessible to a wider population.

  • Group Acupuncture Therapy with Modified Yoga for chronic neck, low back and OA pain in safety net setting for an underserved population (GAPYOGA)
    Acupuncture has been proven to help with chronic pain, and appears to be feasible when delivered as group acupuncture in an underserved setting.  In addition, yoga has proven benefits for chronic pain. The kinds of movement incorporated in yoga are important both for strengthening and improving range of motion, maintaining gains, and promoting patient activation. No previous study has evaluated the combination of these therapies in patients with chronic pain. This study aims to see if acupuncture combined with modified yoga can be done feasibly in the underserved setting.  Raymond Teets, MD is Co-PI with Benjamin Kligler, MD on this project, along with Mirta Milanes, MPH, as research coordinator; and in collaboration with the AADDOPT team (previous PCORI acupuncture trial). This study has IRB approval and has begun recruitment November 2018. Participants with chronic pain (back pain, neck pain, and/or osteoarthritis) will receive 10 weeks of group acupuncture and 7 weeks of modified yoga, tailored for each participant based on his/her functional status and readiness to engage. Multiple pre- and post-intervention measures will be collected for each participant in order to compare primary outcomes (pain intensity) and the secondary outcomes of pain free days, depression, functional status, patient activation, and pain medication. The research intervention will take place at the Institute for Family Health’s Family Health Center of Harlem as well as two Montefiore sites in the Bronx.

  • Acupuncture Approaches to Decrease Disparities in Outcomes of Pain Treatment- A Two Arm Comparative Effectiveness Trial (AADDOPT-2)
    Benjamin Kligler, MD is Co-PI with Diane McKee, MD of Albert Einstein College of Medicine and Arya Nielsen, PhD is co-investigator along with Belinda Anderson, PhD on this 3-year Patient-Centered Outcomes Research Institute (PCORI). Acupuncture is slowly being integrated into pain management in many conventional healthcare settings, but cost and limited reimbursement for this service remain obstacles, especially in primary care and safety net settings. Because group acupuncture can be offered at a lower cost, demonstrating that individual and group delivery are both effective could reduce barriers to use of this effective pain management approach.

    The research team conducted a randomized comparative effectiveness study to assess outcomes of individual and group acupuncture for treatment of chronic pain. The project took place in the health centers of the New York City Research and Improvement Networking Group, a practice-based research network dedicated to decreasing health disparities. Patients were randomly assigned to receive either individual or group acupuncture for 12 weeks. Outcomes that are important to patients were compared, including pain and quality of life. A subgroup of 20 participants from each arm were interviewed in order to understand and describe the patient experience of both acupuncture approaches, to better incorporate the patient perspective into intervention delivery and dissemination. This study is in the data analysis and publication phase.

  • Qualitative Research in Patient Response to Lifestyle Intervention for Asthma and Chronic Pain Patients Receiving Integrative Medicine Interventions Effectiveness Registry (P.R.I.M.I.E.R.)
    Under an academic career development award from the NIH to Benjamin Kligler, MD, we conducted qualitative research in patient response to lifestyle interventions for asthma and chronic pain. This study is now in the data analysis stage.

    Mount Sinai Beth Israel was one of fourteen leading integrative medicine clinical centers from around the country funded by the Bravewell Collaborative to develop a Practice-Based Research Network for Integrative Medicine (Bravenet). This project, known as P.R.I.M.I.E.R., brings together a large network of practices to collaborate in collecting data regarding the effectiveness of a variety of integrative healthcare interventions.

A wide variety of feasibility, effectiveness and qualitative studies have been conducted to gain more knowledge on the need for, barriers to and experiences of integrative approaches in the hospital setting as well as different forms of use, such as group visits and mHealth apps.

  • Group Acupuncture for Pain (GAP) Study
    Thanks to a generous grant from the Blavatnik Foundation, we conducted a study to test the feasibility and effectiveness of group acupuncture for the treatment of musculoskeletal pain (back, shoulder, neck pain or osteoarthritis). Participants took place in eight weekly acupuncture treatments delivered in a group setting. We collected information on their pain symptoms, mood, ability to move and medication use before, during and after the treatment period. The goal of this project was to develop a low-cost, effective integrative intervention for chronic pain. The physician in charge of this study was Benjamin Kligler, MD.

  • Integrative approaches to managing Irritable Bowel Syndrome (IBS)
    This study examined whether a low cost, group-oriented integrative medicine approach to irritable bowel syndrome improves participant outcomes, specifically decreased symptoms and improved function and quality of life. 

    The intervention combined nutrition counseling on the low FODMAP diet– which limits foods in the carbohydrate family such as some sugars (fructose, lactose and fructans) and non-digestible fibers (galactans and polyols), as well as mind-body training with follow-up health coaching.

    Over the course of 18 months, participants were recruited from the Center for Health and Healing and other primary care and gastroenterologist offices in NYC. Participants were randomized to either 1) a four-week group-oriented treatment intervention incorporating a low FODMAP diet and mind-body therapies followed by an eight-week health coaching follow-up period or 2) a waitlist control group. At the end of the 12-week study period, waitlist subjects were offered the four-week nutrition and mind-body intervention. Over the 12-week study period, we examined and reported on the impact of this treatment intervention on IBS symptoms and quality of life in this population. Data was collected on IBS outcomes as well as on depression and stress.

    McDonald E, Teets R, Ortiz C, Gilchrist G, Waltermaurer E, Perez E, Kligler B. A randomized trial of a group-based integrative medicine approach compared to waitlist control on irritable bowel syndrome symptoms in Adults.  Explore (NY). 2018 Jul 20. [Epub ahead of print].

  • MHealth study, diabetes app Diabetes: Your Way
    This patient-centered, English/Spanish smartphone App, “Diabetes Your Way”, was funded through a grant from the Stavros Niarchos Foundation to the Center for Health and Healing, Mount Sinai Beth Israel. The Project Director was Marsha J. Handel, MLS who worked with a team of health professionals including Benjamin Kligler, MD, Research Director; Raymond Teets, MD; Diabetes Educator and registered dietician, Christina McGeough, MPH, RD, CDE, and two public health and integrative Clinical Nurse Specialists, Christine Gilchrist, RN, MSN, MPH, NC-BC and Caroline Ortiz, RN, MSN, MPH. 

    The primary purpose of this app was to help support the self-management capabilities of lower literacy, underserved patients with diabetes through two main strategies:
    1. Facilitate motivation and engagement with change through a variety of features including points and badges, social support, daily motivational quotes, push notifications, and goal setting with attention to the “readiness to change” continuum and how to set goals that match.
    2. Educational guidance on the role of food, exercise and relaxation in diabetes self-management and active support via online videos and interactive dietary features such as  a)  calculation of individual daily caloric intake (recalculated as they make changes in activity level and weight); b) seeing the percentage of calories, fat, carbs and fiber they are eating in each meal and over the course of the day, with the opportunity to substitute different foods to see the changes they produce in these values.

In year two the App was tested in partnership with the Institute for Family Health and their community health centers in the NYC area focused on underserved patient populations. Phase I of the study was begun in February 2016. This study evaluated ease of use, adoption rate, patient satisfaction and ability to increase self-efficacy regarding behavior change in diabetes self-management. Study results were gathered from two sources: 1) Analysis of statistics on usage via Google Analytics, which were coded into the app and 2) qualitative interviews with study participants.

  • Acupuncture Integration in a Hospital Setting
    This qualitative study was interested in the experience of acupuncturists, medical staff and patients who are a part of acupuncture in-patient care on selected floors of Mount Sinai Beth Israel. We have completed the first part of the study that described the experience of acupuncturists and we continue our research to describe the experience of physicians and nurses who collaborated with acupuncturists as well as the patients who received acupuncture treatments while being hospitalized at Mount Sinai Beth Israel. Primary Investigator: B. Basia Kielczynska, DMH, L.Ac; Co-Investigator: Benjamin Kligler, MD, MPH

  • Evaluation of Charles Evans Integrative Stress Management Program
    This program was directed at nursing staff at Mount Sinai Beth Israel teaching self-care stress management techniques including breathwork, centering and grounding, aromatherapy via hand M’ technique, Reiki and gentle yoga poses. A survey was administered to nursing staff on each clinical unit pre-intervention for baseline measures and was repeated every six months through the length of the program. The study goal was to evaluate the perception and experience of stress by clinical nursing staff on Mount Sinai Beth Israel unit floors.

  • Integrative Approaches to Chronic Pain
    SIMTAP (Study on Integrative Medicine Treatment Approaches for Pain), the BraveNet study of an integrative medicine approach to chronic pain, enrolled and followed over 400 patients at the nine BraveNet sites. The results of this study were recently published in the journal BMC Complementary and Alternative Medicine.

    Abrams DI, Dolor R, Roberts R, et al. The BraveNet prospective observational study on integrative medicine treatment approaches for pain. BMC Complementary & Alternative Medicine. 2013;13:146.

Many departments throughout the Mount Sinai Health System are engaged in clinical research incorporating integrative approaches for the development of best practices, provision of health promotion programs, early intervention, increasing wellness and resilience, and improving quality of life and optimal function.