Leah Zullig

Overview:

Leah L. Zullig, PhD, MPH is a health services researcher and an implementation scientist. She is an Associate Professor in the Duke Department of Population Health Sciences and an investigator with the Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT) at the Durham Veterans Affairs Health Care System. Dr. Zullig’s overarching research interests address three domains: improving cancer care delivery and quality; promoting cancer survivorship and chronic disease management; and improving medication adherence. Throughout these three area of foci Dr. Zullig uses an implementation science lens with the goal of providing equitable care for all by implementing evidence-based practices in a variety of health care environments. She has authored over 150 peer-reviewed publications. 

Dr. Zullig completed her BS in Health Promotion, her MPH in Public Health Administration, and her PhD in Health Policy.

Areas of expertise: Implementation Science, Health Measurement, Health Policy, Health Behavior, Telehealth, and Health Services Research

Positions:

Associate Professor in Population Health Sciences

Population Health Sciences
School of Medicine

Associate Professor in Medicine

Medicine, General Internal Medicine
School of Medicine

Member of the Duke Cancer Institute

Duke Cancer Institute
School of Medicine

Education:

Ph.D. 2013

University of North Carolina - Chapel Hill

Fellow

Washington University in St. Louis

Grants:

Dissemination and Implementation Science in Cardiovascular Outcomes (DISCO)

Administered By
Basic Science Departments
Awarded By
National Institutes of Health
Role
Mentor
Start Date
End Date

Dissemination and Implementation Science in Cardiovascular Outcomes (DISCO)

Administered By
Basic Science Departments
Awarded By
National Institutes of Health
Role
Mentor
Start Date
End Date

A Clinic-Based Behavioral Intervention to Reduce Cardiovascular Disease Risk in Persons Living with HIV

Administered By
Medicine, Infectious Diseases
Awarded By
National Institutes of Health
Role
Advisor
Start Date
End Date

PhRMA Editorial

Administered By
Population Health Sciences
Awarded By
PhRMA Foundation
Role
Investigator
Start Date
End Date

PRoteus OnCology fEaSibility Study (PROCESS)

Administered By
Population Health Sciences
Awarded By
Proteus Digital Health, Inc.
Role
Principal Investigator
Start Date
End Date

Publications:

Effectiveness of Quality Improvement Coaching on Process Outcomes in Health Care Settings: A Systematic Review.

BACKGROUND: A culture of improvement is an important feature of high-quality health care systems. However, health care teams often need support to translate quality improvement (QI) activities into practice. One method of support is consultation from a QI coach. The literature suggests that coaching interventions have a positive impact on clinical outcomes. However, the impact of coaching on specific process outcomes, like adoption of clinical care activities, is unknown. Identifying the process outcomes for which QI coaching is most effective could provide specific guidance on when to employ this strategy. METHODS: We searched multiple databases from inception through July 2021. Studies that addressed the effects of QI coaching on process of care outcomes were included. Two reviewers independently extracted study characteristics and assessed risk of bias. Certainty of evidence was assessed using GRADE. RESULTS: We identified 1983 articles, of which 23 cluster-randomized trials met eligibility criteria. All but two took place in a primary care setting. Overall, interventions typically targeted multiple simultaneous processes of care activities. We found that coaching probably has a beneficial effect on composite process of care outcomes (n = 9) and ordering of labs and vital signs (n = 6), and possibly has a beneficial effect on changes in organizational process of care (n = 5), appropriate documentation (n = 5), and delivery of appropriate counseling (n = 3). We did not perform meta-analyses because of conceptual heterogeneity around intervention design and outcomes; rather, we synthesized the data narratively. Due to imprecision, inconsistency, and high risk of bias of the included studies, we judged the certainty of these results as low or very low. CONCLUSION: QI coaching interventions may affect certain processes of care activities such as ordering of labs and vital signs. Future research that advances the identification of when QI coaching is most beneficial for health care teams seeking to implement improvement processes in pursuit of high-quality care will support efficient use of QI resources. PROTOCOL REGISTRATION: This study was registered and followed a published protocol (PROSPERO: CRD42020165069).
Authors
Ballengee, LA; Rushton, S; Lewinski, AA; Hwang, S; Zullig, LL; Ricks, KAB; Ramos, K; Brahmajothi, MV; Moore, TS; Blalock, DV; Cantrell, S; Kosinski, AS; Gordon, A; Ear, B; Williams, JW; Gierisch, JM; Goldstein, KM
MLA Citation
Ballengee, Lindsay A., et al. “Effectiveness of Quality Improvement Coaching on Process Outcomes in Health Care Settings: A Systematic Review.J Gen Intern Med, vol. 37, no. 4, Mar. 2022, pp. 885–99. Pubmed, doi:10.1007/s11606-021-07217-2.
URI
https://scholars.duke.edu/individual/pub1505319
PMID
34981354
Source
pubmed
Published In
J Gen Intern Med
Volume
37
Published Date
Start Page
885
End Page
899
DOI
10.1007/s11606-021-07217-2

Financial interventions to improve medication adherence: a narrative review

Authors
Blalock, DV; Hung, A; Miller, J; McDermott, J; Wessler, H; Zullig, LL
MLA Citation
Blalock, Dan V., et al. “Financial interventions to improve medication adherence: a narrative review.” International Journal of Clinical Pharmacy, vol. 44, no. 1, 2022, pp. 287–88.
URI
https://scholars.duke.edu/individual/pub1512658
Source
wos-lite
Published In
International Journal of Clinical Pharmacy
Volume
44
Published Date
Start Page
287
End Page
288

Secondary Prevention Risk Interventions via Telemedicine and Tailored Patient Education (SPRITE): A randomized trial to improve post myocardial infarction management.

OBJECTIVE: We evaluated the impact of a low intensity web-based and intensive nurse-administered intervention to reduce systolic blood pressure (SBP) among patients with prior MI. METHODS: Secondary Prevention Risk Interventions via Telemedicine and Tailored Patient Education (SPRITE) was a three-arm trial. Patients were randomized to 1) post-MI education-only; 2) nurse-administered telephone program; or 3) web-based interactive tool. The study was conducted 2009-2013. RESULTS: Participants (n = 415) had a mean age of 61 years (standard deviation [SD], 11). Relative to the education-only group, the 12-month differential improvement in SBP was - 3.97 and - 3.27 mmHg for nurse-administered telephone and web-based groups, respectively. Neither were statistically significant. Post hoc exploratory subgroup analyses found participants who received a higher dose (>12 encounters) in the nurse-administered telephone intervention (n = 60; 46%) had an 8.8 mmHg (95% CI, 0.69, 16.89; p = 0.03) differential SBP improvement versus low dose (<11 encounters; n = 71; 54%). For the web-based intervention, those who had higher dose (n = 73; 53%; >1 web encounter) experienced a 2.3 mmHg (95% CI, -10.74, 6.14; p = 0.59) differential SBP improvement versus low dose (n = 65; 47%). CONCLUSIONS: The main effects were not statistically significant. PRACTICAL IMPLICATIONS: Completing the full dose of the intervention may be essential to experience the intervention effect. CLINICAL TRIAL REGISTRATION: The unique identifier is NCT00901277 (http://www. CLINICALTRIALS: gov/ct2/show/NCT00901277?term=NCT00901277&rank=1).
Authors
Zullig, LL; Peterson, ED; Shah, BR; Grambow, SC; Oddone, EZ; McCant, F; Lindquist, JH; Bosworth, HB
MLA Citation
Zullig, Leah L., et al. “Secondary Prevention Risk Interventions via Telemedicine and Tailored Patient Education (SPRITE): A randomized trial to improve post myocardial infarction management.Patient Educ Couns, vol. 105, no. 9, Sept. 2022, pp. 2962–68. Pubmed, doi:10.1016/j.pec.2022.05.011.
URI
https://scholars.duke.edu/individual/pub1522025
PMID
35618550
Source
pubmed
Published In
Patient Educ Couns
Volume
105
Published Date
Start Page
2962
End Page
2968
DOI
10.1016/j.pec.2022.05.011

Medication adherence interventions in transplantation lack information on how to implement findings from randomized controlled trials in real-world settings: A systematic review.

BACKGROUND: Growing numbers of randomized controlled trials (RCTs) are showing the effectiveness of interventions to improve medication adherence in transplantation recipients. However, real-world implementation is still a major challenge. This systematic review assesses the range of information available in RCTs supporting these interventions' clinical adoption in adult transplant populations. METHODS: We included RCTs of interventions that a) targeted any phase of medication adherence in solid organ or allogeneic stem cell transplantation recipients and b) were published between January 2015 and November 2020. We excluded study protocols, conference abstracts and studies focusing only on pediatric populations. We identified relevant database and trial registries as well as traced references backward and citations forward. Implementation-relevant information was evaluated using adapted versions of Peters' ten criteria: 1. healthcare/organizational context; 2. social/economic/policy context; 3. patient involvement; 4. other stakeholder involvement; 5. sample representativeness; 6. trial conducted in a real-world-setting; 7. presence of feasibility study; 8. implementation strategy; 9. process evaluation; 10. implementation outcomes, using a stoplight color-rating system. RESULTS: Screening 17'004 titles/abstracts resulted in 23 eligible RCTs, including 2'339 patients (n = 19-209/study). All included studies focused on the implementation phase of medication adherence. The best-reported criteria were feasibility study (43%), representative sample (17%) and conducted in a real-world-setting (17%). Least reported were context (9%), implementation strategies (4%), process evaluation (4%). CONCLUSIONS: RCTs testing medication adherence interventions tend to report limited implementation-relevant information. This hinders their translation to real-world transplant settings. Integrating implementation science principles early in the conceptualization of RCTs would fuel real-world-translation, reducing research waste.
Authors
Kostalova, B; Ribaut, J; Dobbels, F; Gerull, S; Mala-Ladova, K; Zullig, LL; De Geest, S
MLA Citation
Kostalova, Barbora, et al. “Medication adherence interventions in transplantation lack information on how to implement findings from randomized controlled trials in real-world settings: A systematic review.Transplant Rev (Orlando), vol. 36, no. 1, Jan. 2022, p. 100671. Pubmed, doi:10.1016/j.trre.2021.100671.
URI
https://scholars.duke.edu/individual/pub1501921
PMID
34773910
Source
pubmed
Published In
Transplant Rev (Orlando)
Volume
36
Published Date
Start Page
100671
DOI
10.1016/j.trre.2021.100671

Addressing Hypertension Outcomes Using Telehealth and Population Health Managers: Adaptations and Implementation Considerations.

PURPOSE OF REVIEW: There is a growing evidence base describing population health approaches to improve blood pressure control. We reviewed emerging trends in hypertension population health management and present implementation considerations from an intervention called Team-supported, Electronic health record-leveraged, Active Management (TEAM). By doing so, we highlight the role of population health managers, practitioners who use population level data and to proactively engage at-risk patients, in improving blood pressure control. RECENT FINDINGS: Within a population health paradigm, we discuss telehealth-delivered approaches to equitably improve hypertension care delivery. Additionally, we explore implementation considerations and complementary features of team-based, telehealth-delivered, population health management. By leveraging the unique role and expertise of a population health manager as core member of team-based telehealth, health systems can implement a cost-effective and scalable intervention that addresses multi-level barriers to hypertension care delivery. We describe the literature of telehealth-based population health management for patients with hypertension. Using the TEAM intervention as a case study, we then present implementation considerations and intervention adaptations to integrate a population health manager within the health care team and effectively manage hypertension for a defined patient population. We emphasize practical considerations to inform implementation, scaling, and sustainability. We highlight future research directions to advance the field and support translational efforts in diverse clinical and community contexts.
Authors
Drake, C; Lewinski, AA; Rader, A; Schexnayder, J; Bosworth, HB; Goldstein, KM; Gierisch, J; White-Clark, C; McCant, F; Zullig, LL
MLA Citation
Drake, Connor, et al. “Addressing Hypertension Outcomes Using Telehealth and Population Health Managers: Adaptations and Implementation Considerations.Curr Hypertens Rep, vol. 24, no. 8, Aug. 2022, pp. 267–84. Pubmed, doi:10.1007/s11906-022-01193-6.
URI
https://scholars.duke.edu/individual/pub1520404
PMID
35536464
Source
pubmed
Published In
Curr Hypertens Rep
Volume
24
Published Date
Start Page
267
End Page
284
DOI
10.1007/s11906-022-01193-6

Research Areas:

Attitude to Health
Behavior Therapy
Benchmarking
Cancer
Cardiovascular Diseases
Caregivers
Clergy
Communication
Delivery of Health Care
Delivery of Health Care, Integrated
Diabetes Complications
Diabetes Mellitus
Diabetes Mellitus, Type 2
Diffusion of Innovation
Disclosure
Disease Management
Drug Packaging
Evidence-Based Medicine
Feasibility Studies
Glycated Hemoglobin A
Guideline Adherence
Health Care Costs
Health Expenditures
Health Services Accessibility
Healthcare Disparities
Hemoglobin A, Glycosylated
Hypertension
Minority Health
Oncology
Osteoarthritis
Outcome and Process Assessment (Health Care)
Pastoral Care
Patient-Centered Care
Pilot Projects
Program Evaluation
Quality of Health Care
Quality of Life
Religion and Psychology
Reproducibility of Results
Self Care
Survivors
Telemedicine
Treatment Outcome
Veterans Health