Daria Szkwarko, DO, MPH

Associate Professor of Family Medicine


Advance-CTR Mentored Research Awards (2019)

"Improving Rhode Island's Tuberculosis Preventive Services in Primary Care: A Mixed-Methods Evaluation of an Innovative Telementoring Model"

Reactivation of latent tuberculosis (TB) infection is responsible for 80% of infectious TB disease cases in the United States despite the availability of preventive therapy that significantly reduces this risk. The United States Preventive Services Task Force recommends that TB infection testing and treatment is an important preventive measure that primary care physicians should provide patients. However, many primary care physicians do not have the training to manage this critically under-addressed infection. The broad objective of this study is to establish and evaluate an innovative preventive strategy that will aid in reaching TB elimination. This study will incorporate an exploratory sequential translational research design. In Specific Aim 1, primary care physicians will be interviewed for the first time to explore their knowledge, attitudinal, and skill gaps related to TB infection testing and treatment. In Specific Aim 2, the qualitative results from Aim 1 will inform the design of a TB infection telementoring intervention - the Extension for Community Healthcare Outcomes (ECHO) Model. The results from Aim 1 will also inform quantitative surveys to be administered pre- and post- ECHO course and post-ECHO sessions. Participants will be recruited to join the six-month TB infection ECHO course and survey data will be collected and analyzed to assess feasibility and primary care provider learning and performance. In Aim 3, a retrospective data review from two ECHO participants' clinic sites will be performed to compare providers' testing and prescribing behavior before and after the ECHO model. To achieve these aims, the PI (Daria Szkwarko) will obtain additional training in qualitative research and survey research methods. She will work with her three mentors, Dr. Roberta Goldman (qualitative methods expert), Dr. Jane Carter (TB content and ECHO expert) and Dr. Charles Eaton (implementation science expert) as well as members from the RI Department of Health to ensure success and relevance of the project to Rhode Island. This study will lead to the creation of the first ECHO hub in Rhode Island, and an ECHO framework that could be used to design, implement, and evaluate ECHO courses for other high priority diseases in the state.