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 the reduction of healthcare disparities, improving cancer care delivery and quality, supporting medication adherence, and promoting cancer survivorship and chronic disease self-management. She has authored over 100 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:

The INSPIRE Population Survey: development, dissemination and respondent characteristics.

BACKGROUND: Most older adults prefer to continue living at home despite increasing care needs and demand for services. To aid in maintaining independence, integrated care models for community-dwelling older people are promoted as the most cost-effective approach. The implementation of such care models is challenging and often the end-users are not involved or their needs are not considered. We conducted a population survey in order to understand the needs and preferences of home-dwelling older adults living in Canton Basel-Landschaft, Switzerland. The aims of this paper are to chronicle the development of the INSPIRE Population Survey, outline its variables and measurements, describe the marketing strategy utilized for survey dissemination and report on the response rate and respondent characteristics. METHODS: The INSPIRE Population Survey, conducted between March and August 2019, is a cross-sectional survey of older adults aged 75 and older living at home in Canton Basel-Landschaft. The questionnaire was developed by expert input and stakeholder involvement. Its readability and acceptability were pilot-tested with older people. To ensure the likelihood of a high and representative response rate, a meticulous step-by-step marketing strategy was developed prior to the dissemination of the questionnaire. RESULTS: The overall response rate was 30.7% (n = 8,846), with variations between 20.6 and 34.5% across the different care regions in the canton. A generally higher response rate was found in the care regions with a higher density and which bordered the urban city of Basel. We received support from local stakeholders, policy makers and media through using a broad combination of marketing channels and targeting our community partners who have a strong relationship with our target audience. CONCLUSIONS: Although recruiting older adults in research is challenging, our study shows that a high response rate can be achieved by developing the survey through expert input and by involving all important stakeholders, including older adults, throughout the entire process.
Authors
Siqeca, F; Obas, K; Yip, O; Stenz, S; Vounatsou, P; Briel, M; Schwenkglenks, M; Quinto, C; Blozik, E; Zeller, A; Zullig, LL; De Geest, S; Deschodt, M
MLA Citation
Siqeca, Flaka, et al. “The INSPIRE Population Survey: development, dissemination and respondent characteristics.Bmc Med Res Methodol, vol. 21, no. 1, June 2021, p. 131. Pubmed, doi:10.1186/s12874-021-01329-3.
URI
https://scholars.duke.edu/individual/pub1485643
PMID
34162324
Source
pubmed
Published In
Bmc Medical Research Methodology
Volume
21
Published Date
Start Page
131
DOI
10.1186/s12874-021-01329-3

Applied Rapid Qualitative Analysis to Develop a Contextually Appropriate Intervention and Increase the Likelihood of Uptake.

BACKGROUND: Rapid approaches to collecting and analyzing qualitative interview data can accelerate discovery timelines and intervention development while maintaining scientific rigor. We describe the application of these methods to a program designed to improve care coordination between the Veterans Health Administration (VHA) and community providers. METHODS: Care coordination between VHA and community providers can be challenging in rural areas. The Telehealth-based Coordination of Non-VHA Care (TECNO Care) intervention was designed to improve care coordination among VHA and community providers. To ensure contextually appropriate implementation of TECNO Care, we conducted preimplementation interviews with veterans, VHA administrators, and VHA and community providers involved in community care. Using both a rapid approach and qualitative analysis, an interviewer and 1-2 note-taker(s) conducted interviews. RESULTS: Over 5 months, 18 stakeholders were interviewed and we analyzed these data to identify how best to deliver TECNO Care. Responses relevant to improving care coordination include health system characteristics; target population; metrics and outcomes; challenges with the current system; and core components. Veterans who frequently visit VHA or community providers and are referred for additional services are at risk for poor outcomes and may benefit from additional care coordination. Using these data, we designed TECNO Care to include information on VHA services and processes, assist in the timely completion of referrals, and facilitate record sharing. CONCLUSION: Rapid qualitative analysis can inform near real-time intervention development and ensure relevant content creation while setting the stage for stakeholder buy-in. Rigorous and timely analyses support the delivery of contextually appropriate, efficient, high-value patient care.
Authors
Lewinski, AA; Crowley, MJ; Miller, C; Bosworth, HB; Jackson, GL; Steinhauser, K; White-Clark, C; McCant, F; Zullig, LL
MLA Citation
Lewinski, Allison A., et al. “Applied Rapid Qualitative Analysis to Develop a Contextually Appropriate Intervention and Increase the Likelihood of Uptake.Med Care, vol. 59, no. Suppl 3, June 2021, pp. S242–51. Pubmed, doi:10.1097/MLR.0000000000001553.
URI
https://scholars.duke.edu/individual/pub1481706
PMID
33976073
Source
pubmed
Published In
Med Care
Volume
59
Published Date
Start Page
S242
End Page
S251
DOI
10.1097/MLR.0000000000001553

Replicating an effective VA program to train and support family caregivers: a hybrid type III effectiveness-implementation design.

BACKGROUND: Caring for a growing aging population using existing long-term care resources while simultaneously supporting and educating family caregivers, is a public health challenge. We describe the application of the Replicating Effective Programs (REP) framework, developed by the Centers for Disease Control Prevention and used in public health program implementation, to scale up an evidence-based family caregiver training intervention in the Veterans Affairs (VA) healthcare system. METHODS: From 2018 to 2020, clinicians at eight VA medical centers received REP-guided implementation including facilitation, technical assistance, and implementation tools to deliver the training program. The project team used the REP framework to develop activities across four distinct phases - (1) pre-conditions, (2) pre-implementation, (3) implementation, and (4) maintenance and evolution - and systematically tracked implementation facilitators, barriers, and adaptations. RESULTS: Within the REP framework, results describe how each medical center adapted implementation approaches to fit local needs. We highlight examples of how sites balanced adaptations and intervention fidelity. CONCLUSIONS: The REP framework shows promise for national expansion of the caregiver training intervention, including to non-VA systems of care, because it allows sites to adapt while maintaining intervention fidelity. TRIAL REGISTRATION: NCT03474380 . Date registered: March 22, 2018.
Authors
Boucher, NA; Zullig, LL; Shepherd-Banigan, M; Decosimo, KP; Dadolf, J; Choate, A; Mahanna, EP; Sperber, NR; Wang, V; Allen, KA; Hastings, SN; Van Houtven, CH
MLA Citation
Boucher, N. A., et al. “Replicating an effective VA program to train and support family caregivers: a hybrid type III effectiveness-implementation design.Bmc Health Serv Res, vol. 21, no. 1, May 2021, p. 430. Pubmed, doi:10.1186/s12913-021-06448-7.
URI
https://scholars.duke.edu/individual/pub1481648
PMID
33952263
Source
pubmed
Published In
Bmc Health Services Research
Volume
21
Published Date
Start Page
430
DOI
10.1186/s12913-021-06448-7

A Contextual Analysis and Logic Model for Integrated Care for Frail Older Adults Living at Home: The INSPIRE Project.

Introduction: Implementation science methods and a theory-driven approach can enhance the understanding of whether, how, and why integrated care for frail older adults is successful in practice. In this study, we aimed to perform a contextual analysis, develop a logic model, and select preliminary implementation strategies for an integrated care model in newly created information and advice centers for older adults in Canton Basel-Landschaft, Switzerland. Methods: We conducted a contextual analysis to determine factors which may influence the integrated care model and implementation strategies needed. A logic model depicting the overall program theory, including inputs, core components, outputs and outcomes, was designed using a deductive approach, and included stakeholders' feedback and preliminary implementation strategies. Results: Contextual factors were identified (e.g., lack of integrated care regulations, existing community services, and a care pathway needed). Core components of the care model include screening, referral, assessment, care plan creation and coordination, and follow-up. Outcomes included person-centred coordinated care experiences, hospitalization rate and symptom burden, among others. Implementation strategies (e.g., nurse training and co-developing educational materials) were proposed to facilitate care model adoption. Conclusion: Contextual understanding and a clear logic model should enhance the potential for successful implementation of the integrated care model.
Authors
Yip, O; Huber, E; Stenz, S; Zullig, LL; Zeller, A; De Geest, SM; Deschodt, M; INSPIRE consortium,
MLA Citation
Yip, Olivia, et al. “A Contextual Analysis and Logic Model for Integrated Care for Frail Older Adults Living at Home: The INSPIRE Project.Int J Integr Care, vol. 21, no. 2, Apr. 2021, p. 9. Pubmed, doi:10.5334/ijic.5607.
URI
https://scholars.duke.edu/individual/pub1481705
PMID
33976598
Source
pubmed
Published In
International Journal of Integrated Care
Volume
21
Published Date
Start Page
9
DOI
10.5334/ijic.5607

Relevant Journals for Identifying Implementation Science Articles: Results of an International Implementation Science Expert Survey.

In implementation science (IS), conducting well-targeted and reproducible literature searches is challenging due to non-specific and varying terminology that is fragmented over multiple disciplines. A list of journals that publish IS-relevant content for use in search strings can support this process. We conducted a cross-sectional online survey of 56 Australian, European, and North American IS experts to identify and prioritize relevant journals that publish IS articles. Journals' relevance was assessed by providing each with a list of 12 journals, to which they were encouraged to add additional journal names and comments as free text. We also assessed which journals had published special IS-focused issues-identified via PubMed and Google searches-over the last 20 years. Data were analyzed descriptively. Between February 28 and March 15, 2020, a purposive sample of 34/56 experts participated in the survey (response rate: 60.7%). Implementation Science and BMC Health Services Research were perceived as relevant by 97.1% of participants; other journals' relevance varied internationally. Experts proposed 50 additional journals from various clinical fields and health science disciplines. We identified 12 calls and 53 special issues on IS published within various journals and research fields. Experts' comments confirmed the described challenges in identifying IS literature. This report presents experts' ratings of IS journals, which can be included in strategies supporting searches of IS evidence. However, challenges in identifying IS evidence remain geographically and interdisciplinary. Further investment is needed to develop reproducible search strings to capture IS evidence as an important step in improving IS research quality.
Authors
Mielke, J; Brunkert, T; Zullig, LL; Bosworth, HB; Deschodt, M; Simon, M; De Geest, S
MLA Citation
Mielke, Juliane, et al. “Relevant Journals for Identifying Implementation Science Articles: Results of an International Implementation Science Expert Survey.Front Public Health, vol. 9, 2021, p. 639192. Pubmed, doi:10.3389/fpubh.2021.639192.
URI
https://scholars.duke.edu/individual/pub1482794
PMID
33996719
Source
pubmed
Published In
Frontiers in Public Health
Volume
9
Published Date
Start Page
639192
DOI
10.3389/fpubh.2021.639192

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