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Current PIPER Projects

Unintentional Injury: Motor Vehicle
2013-2018 Physician Screening of Older Drivers: Decision Rules for Geriatric Injury Prevention
With the aging of the U.S. population, there is an urgent need for efficient, effective and acceptable methods of identifying, retraining or restricting unsafe older drivers without unfairly restricting the mobility of those who are safe. This project applies the model of a clinical decision rule to a public health program through the development of tiered older driver assessment, with widespread brief screening followed by referral for additional evaluation of those with a positive screen. The research plan aims to examine the viewpoints of older drivers, their families, and providers concerning driver assessment, to validate and refine a brief question-based screening tool, and to examine the feasibility of pilot program implementation in order to prepare for future implementation of a model tiered older driver assessment program (planned R01). This project is part of a Paul B. Beeson Patient-Oriented Research Career Development Award in Aging (K23) awarded to Dr. Betz.
PIPER Contact: Marian Betz, MD, MPH (PI)
Funder: National Institute on Aging
Unintentional Injury: Sports
2005-2014 High School Sports Injury Surveillance Study [Expansion]
The National High School Sports-Related Injury Surveillance Study uses an internet-based data collection tool called the High School RIO™ to capture US high school athletes’ exposure, injury, and injury event data weekly throughout the academic year across 20 sports. These data are used to describe the rates, patterns, and trends of high school sports-related injuries as the necessary first step toward the development, implementation, and evaluation of evidence-based, targeted prevention programs to reduce the number and/or severity of injuries among high school athletes. The goal is that High School RIO™ data will continue to be used to encourage students to safely play sports, which will in turn increase physical activity, improve physical fitness levels, and lead to life-long healthy behaviors. Annual funding continuations of the expansion of the study have allowed data collection to continue since its inception in 2005.
PIPER Contact: Dawn Comstock, MS, PhD (PI)
Funder: National Federation of State High School Associations 
2012 – 2015 Evaluating the Effectiveness/Outcomes of State Level Concussion Policies
The goal of this study is to evaluate the effectiveness of state level concussion legislation and specific components of state level concussion legislation using High School RIO concussion outcomes data. As High School RIO has collected data since the 2005/06 academic year and the first state level legislation was passed in 2009, the data from this surveillance system is uniquely situated to conduct pre-post comparison evaluation of concussion outcomes including concussion rates, severity, and compliance with return to play guidelines.
PIPER Contact: Dawn Comstock, MS, PhD (PI)
Funder: National Center for Injury Prevention and Control (Centers for Disease Control and Prevention), through a subcontract from the Nationwide Children’s Hospital Center for Injury Research and Policy ICRC grant
2012-2017 Functional Evaluation to Predict Lower Extremity Musculoskeletal Injury
The National Federation of State High School Associations considers pre-participation physical evaluations (PPE) a prerequisite to athletics participation, yet there are no large-scale controlled trials confirming the effectiveness of the PPE as it relates to musculoskeletal injuries. Recently updated PPE guidelines promote a "functional" aspect of testing by incorporating performance-based tests, but limitations exist concerning the best recommended functional test components, their ability to predict injury, and effectiveness as compared to a traditional PPE. To address this knowledge gap, this study will determine if a functional pre-participation physical evaluation (F-PPE) will better predict lower extremity injury than traditional PPE. This project includes developing a cost-effective and time-efficient F-PPE for use in clinical settings, recording injury occurrence using the High School RIO™ to identify which F-PPE measurement(s) are best associated with injury risk, and developing operational procedures for the F-PPE. The findings will help to understand the parameters of functional performance testing and evaluate methods for improving risk prediction of musculoskeletal lower extremity injury.
PIPER Contact: Dawn Comstock, MS, PhD (Co-I)
Funder: National Institute of Arthritis, Musculoskeletal and Skin Diseases 
2013-2015 Evaluation of Spot Light: A Concussion Injury Management App for Youth Sports
Sports-related traumatic brain injuries, including concussions, are a serious public health concern. Diagnostic criteria and consensus return to play (RTP) guidelines exist, but these guidelines are almost completely unsupported by an evidence base. However, it is well known that by increasing awareness of concussion signs and symptoms as well as the importance of addressing this injury, improving coaching on proper techniques and good sportsmanship, providing appropriate protective equipment, and quickly responding to injuries, the incidence, severity, and long-term negative health effects of sports-related concussion among children and adolescents can be reduced. Thus, there is a critical need for tools for prevention. Spot Light is a free and easy-to-
use application (app) that coordinates diagnosis, management, and RTP procedures from concussion injury to safe return to sport. This project will evaluate whether Spot Light increases reporting rates of sports-related concussion, increases referrals to physicians, and increases athlete compliance with RTP guidelines. This research has potential impacts in the areas of sports injury prevention and the related use of mobile app technology, and is the first step toward attaining the long-term goal of reducing the negative consequences of sports-related concussion, specifically in youth sports.
PIPER Contact: Dawn Comstock, MS, PhD (Co-PI)
Funder: National Institute of Child Health and Human Development
Other Unintentional Injury
2011-2015 Longitudinal Approach to Examining Deaths in Correctional Facilities
This is a Visiting Fellowship in the Criminal Justice Statistics Program to examine mortality among prisoners in the United States and develop a framework for future data collections on health in correctional populations. The overall purpose of this fellowship is to support the scholarly use of Bureau of Justice Statistics data collections, expand the body of policy-relevant research that uses these data, and enhance or inform bureau programs. The focus of the first project in this Visiting Fellowship is to assess the impact of tobacco control policies on tobacco-related deaths in prisons. The second project develops a framework for data collections on health and health care delivery across the spectrum of criminal justice involvement.
PIPER Contact: Ingrid Binswanger, MD, MPH, MS (PI)
Funder: U.S. Bureau of Justice Statistics
2011-2016 Centers for Autism and Developmental Disabilities Research and Epidemiology (CADDRE): Study to Explore Early Development (SEED) II
While diagnostic practices are improving, little is known about the causes or correlates of the neurodevelopmental disorders known collectively as Autism Spectrum Disorders (ASDs). The Centers for Autism and Developmental Disabilities Research and Epidemiology were established to address the magnitude, incidence, and causes of autism and related developmental disabilities and recently completed Phase I of the Study to Explore Early Development (SEED I) with more than 3500 children enrolled. The current project, SEED Phase II, involves recruiting another 1080 children in each study group across six national study sites to address hypotheses in five domains: phenotype, infection and immune function, reproductive and hormonal features, genetic features, and socio-demographic features. A sub-study examines injuries and injury hospitalizations in children with autism, including self-injurious behavior. The combined SEED phases will provide clinical, risk factor, and biological specimens and data on over 6000 families – the largest study of ASDs of this kind – and is poised to make significant contributions to our understanding of ASDs. This is a joint project with Pediatrics and Psychiatry (School of Medicine), Colorado School of Public Health, and Colorado Department of Public Health and Environment.
PIPER Contact: Carolyn DiGuiseppi, MD, MPH, PhD (Co-PI)
Funder: Centers for Disease Control and Prevention
Suicide & Interpersonal Violence

2016-2019 The SAFETY Study

The SAFETY Study is a collaboration between Northeastern University, the Colorado School of Public Health, and the Harvard T.H. Chan School of Public Health. The project aims to understand parent responses to safety counseling in the emergency department (ED). Ultimately, our goal is to help prevent youth suicide by strengthening counseling for parents of adolescents who visit the ED for a mental health emergency. Learn more.

PIPER Contact: Carol Runyan, MPH, PhD (Co-PI)
Funder: American Foundation for Suicide Prevention

2014-2016 Means Restriction for Discharge of Suicidal Patients in Emergency Care
This project will examine, in the Mountain West, the potential adoption of emergency department discharge practices that include counseling on limiting access to guns during times of mental health crisis. Also, we will examine the practices and perspectives of law enforcement, gun retailers, and shooting range proprietors about offering temporary safe storage of firearms for families of suicidal patients. More information.
PIPER Contact: Carol Runyan, MPH, PhD (PI)
Funder: National Institute of Mental Health
2009-2014 Emergency Department Safety Assessment and Follow-up Evaluation (ED-SAFE)
The goals of this quasi-experimental clinical trial are to develop and test a standardized approach to screening ED patients for suicide risk, to refine and test an ED-initiated intervention to reduce suicidal behavior and associated morbidity and mortality, and to complete a comparative economic analysis of treatment as usual, screening, and the intervention. The ED-SAFE study tests the concept that not all patients with suicidal ideation need to be evaluated by a psychiatrist or to be hospitalized. We hypothesized that ED clinicians can provide a brief intervention during the visit and that in-person or telephone counseling sessions after the ED visit can be used to reinforce the treatment received during the ED visit and to facilitate linkage with specialized care, thereby improving patient outcomes. ED-SAFE consisted of three phases of data collection (now complete, with analysis ongoing) and also included three rounds of surveys to providers at the eight participating EDs.
PIPER Contact: Marian Betz, MD, MPH (Site-PI)
Funder: National Institute of Mental Health
2011-2014 Lethal Means Restriction for Suicide Prevention: Beliefs and Behaviors of Emergency Department Providers
As part of the Emergency Department Safety Assessment and Follow-up Evaluation (ED-SAFE) study, ED providers completed three rounds of surveys. These surveys included a module on “lethal means restriction,” or the restriction of access to medications and firearms. The purpose of this study is to learn the beliefs and behaviors of providers in EDs regarding lethal means restriction for suicide prevention.
PIPER Contact: Marian Betz, MD, MPH (PI)
Funder: American Foundation for Suicide Prevention
2011-2016 Academic Centers for Excellence in Youth Violence Prevention
The overall aim of this grant is to develop an Academic Center of Excellence (ACE) in Denver to initiate a multifaceted, evidence-based approach to addressing youth violence. The study will enhance the body of research associated with studies on community-wide prevention efforts and will advance our understanding of "what works" at this level of implementation by targeting the reduction of youth violence in a high risk Denver community. Immediate and long-term goals are to reduce levels of youth violence, implement and evaluate a multifaceted, evidence-based primary prevention/intervention approach, provide training for junior researchers in a variety of related fields, provide training to medical practitioners to recognize and treat youth violence, and embed activities coordinated through the ACE into the existing community infrastructure of youth services to ensure sustainability after completion of the grant. The sites participating in this study are two of Denver's most high-risk residential neighborhoods: Montbello and Northeast Park Hill.
PIPER Contact: Eric Sigel, MD (Co-I)
Funder: National Center for Injury Prevention and Control
2013-2017 Reducing Youth Access to Firearms through the Health Care Setting
This randomized control trial examines the implementation and effectiveness of an intervention, delivered in a health care setting, to decrease home firearm access by youth aged 12-17. Health care providers are initially trained to provide means restriction education to parents, focused on the risk of having access to firearms for youth who live in a home with firearms. Youth and their families will be screened for firearm access, complete a violence risk and depression screening survey, and be randomized to either a non-intervention control group, a group that receives means restriction counseling alone, or a group that receives means restriction education and free safe storage devices (lock boxes or trigger locks). Parental behaviors to follow firearm means restriction recommendations will be examined, as will whether the distribution of free lock boxes leads to greater reduction of firearm access compared to counseling alone. The implementation process will be assessed to guide future dissemination. We expect to demonstrate that the health care setting can be used effectively to reduce youth access to guns. By doing so, youth will have less opportunity to perpetrate crime using firearms and will be less likely to use a guns for self-harm or experience an unintentional shooting.
PIPER Contacts: Eric Sigel, MD (PI) and Carol Runyan, MPH, PhD (Co-I)
Funders: National Institute of Justice
2013-2018 Nurse Family Partnership – Keeping Kids Safe and Families Healthy 2.0.
The Nurse Family Partnership ® (NFP) is a home visitation program for low-income mothers having their first babies. The goals are to improve pregnancy outcomes via enhanced prenatal health, to improve children’s health and development by helping parents provide competent care, and to improve economic self-sufficiency by helping parents make choices consistent with their values regarding their educations, work, and planning subsequent pregnancies. The NFP is grounded in the highest standards of scientific evidence and is of high clinical and social value, but always will be a work in progress. In the original trial of the NFP, there was found a reduction in the rates of substantiated reports of child abuse and neglect, and nurse-visited cases were identified at lower thresholds of severity. The current project incorporates these findings: its aims are to increase statewide NFP referrals of Medicaid eligible pregnant women bearing first children, increase voluntary NFP enrollment rates, consolidate NFP nurses’ skills in the primary prevention of child abuse and neglect and in reducing maltreatment recidivism among those identified as having abused or neglected their children, and strengthen child welfare agencies’ understanding of the value of collaborating with NFP nurses to address the needs of families in which maltreatment appears imminent or has occurred.
PIPER Contact: Gregory Tung, MPH, PhD (Co-I)
Funder: Colorado Department of Human Services
2014   Health Impact Assessment on Youth and Gang Violence in Aurora
In collaboration with the Aurora Gang Reduction Impact Program (A-GRIP), PIPER led the process of conducting a Health Impact Assessment (HIA) on youth and gang violence in the city of Aurora. The HIA helped to define target communities and prevention strategies throu​gh data analysis, stakeholder input, and a review of the scientific evidence.
PIPER Contact: Gregory Tung, MPH, PhD (PI)
Funder: City of Aurora

2014   Evaluating Aurora’s Gang Reduction Impact Program
PIPER serves as the evaluation partner on Aurora Police Department's violence-prevention initiative under Aurora’s Gang Reduction Impact Program (A-GRIP). The goals of the “Violence Prevention" (ViP) project are: 1) Decrease the attractiveness of gang membership. 2) Reduce risk factors for gang membership/violence & increase protective factors. 3) Provide opportunities for youth/families to build positive relationships with APD.  Prevention programming is provided by Friends for Youth, Hood Monsters & APD's Aurora for Youth. The project will serve 756 youth (4–17) + 65 parents.
PIPER Contact: Gregory Tung, MPH, PhD (PI)
Funder: Colorado Division of Criminal Justice 

Other: Infrastructure Development/Training
2003-2016 National Research Service Award
The National Research Service Award training programs are designed to train individuals to conduct research and to prepare for research careers. Institutional NRSA programs allow the Program Director to select the trainees and develop a program of coursework, research experiences, and technical and/or professional skills development appropriate for the selected trainees, providing high-quality research training and offering opportunities in addition to conducting mentored research. This program at UC-Denver trains physicians in outcomes and health services research methods.
PIPER Contact: Ingrid Binswanger, MD, MPH, MS (Program Director)
Funder: Health Resources and Services Administration 
2011-2015 Monitoring Services for Tribal Injury Prevention Cooperative Agreements – Training Workshop Component
The Tribal Injury Prevention Cooperative Agreement Program (TIPCAP) provides funds to American Indian and Alaska Native Tribal organizations to develop their infrastructure and capacity in injury prevention. Econometrica assists the Indian Health Service (IHS) by serving as an outside monitor, providing oversight and technical assistance to the 33 current TIPCAP grantees in support of IHS’s priority of increasing accountability. Econometrica is responsible for a variety of rolls related to training, resource development, and technical assistance, including annual site visits. Subcontracted by Econometrica, the PIPER program is responsible for planning and participating in an annual 2-day training workshop for grantees.
PIPER Contact: Carol Runyan, MPH, PhD (PI)
Funder: U.S. Indian Health Service, through a subcontract with Econometrica
2013-2018 Developing Infrastructure for Patient-Centered Outcomes Research at Denver Health
The proposed Center for Health Systems Research at Denver Health, an integrated safety net health system, directly addresses two national priorities for patient-centered outcomes research: addressing disparities and improving healthcare systems. The Center will partner with an academic research unit and an applied healthcare research organization to develop a research infrastructure and to create collaborations that will sustain meaningful patient-centered outcomes research well into the future. Such infrastructure includes teaching and mentorship and development of a cross-institution data integration structure that will connect the Center with much larger research networks. Specific projects target the "healthcare required to achieve best outcomes" among socioeconomically disadvantaged groups, including racial and ethnic minorities; designs effective in a safety net can inform high-value design in other systems.
PIPER Contact: Ingrid Binswanger, MD, MPH, MS (Co-I, Director of PCOR Scholars Program)
Funder: U.S. Department of Health & Human Services, Agency for Healthcare Research and Quality

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