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:

Cancer incidence and treatment utilization patterns at a regional cancer center in Tanzania from 2008-2016: Initial report of 2,772 cases.

PURPOSE: To describe cancer incidence and treatment utilization patterns at the regional cancer referral center for the Lake Zone of northwestern Tanzania from 2008 to 2016. METHODS: This descriptive, retrospective study reviewed all cancer cases recorded in the Bugando Cancer Registry (BCR), a clinical and pathology based registry at the only cancer referral hospital in the region. Primary tumor site, method of diagnosis, HIV status, and cancer treatment were reported. Using census data, the 2012 GLOBOCAN estimates for Tanzania were scaled to the Lake Zone and adjusted for 2016 population growth. These estimates were then compared to BCR cases using one-sample tests of proportion. RESULTS: A total of 2772 cases were reported from 2008-2016. Among these, the majority of cases (82.5 %, n = 2286) were diagnosed among adults. Most cases (85 %, n = 1923) were diagnosed by histology or cytology. Among adults, the most common cancers diagnosed were cervix (22.7 %, n=520), breast (12.6 %, n=288), and prostate (8.5 %, n=195). Among children, the most common cancers were non-Burkitt non-Hodgkin lymphoma (17.3 %, n=84), Burkitt lymphoma (16.5 %, n=80), and Wilms tumor (14.6 %, n=71). The 1116 BCR cases represent 12.2 % of the 9165 expected number of cancer cases for the Lake Zone (p < 0.001). 1494 cases (53.9 %) received some form of treatment - surgery, chemotherapy, radiation, or hormone therapy - while 1278 cases (46.1 %) had no treatment recorded. CONCLUSIONS: This comprehensive report of the BCR reveals cancer epidemiology and treatment utilization patterns typical of hospitals in low-resource settings. Despite being the only cancer center in the Lake Zone, BMC evaluates a small percentage of the expected number of cancer patients for the region. The BCR remains an important resource to guide clinical care and academic activities for the Lake Zone.
Authors
Olson, AC; Afyusisye, F; Egger, J; Noyd, D; Likonda, B; Masalu, N; Suneja, G; Chao, N; Zullig, LL; Schroeder, K
MLA Citation
Olson, Adam C., et al. “Cancer incidence and treatment utilization patterns at a regional cancer center in Tanzania from 2008-2016: Initial report of 2,772 cases.Cancer Epidemiol, vol. 67, Aug. 2020, p. 101772. Pubmed, doi:10.1016/j.canep.2020.101772.
URI
https://scholars.duke.edu/individual/pub1450677
PMID
32653779
Source
pubmed
Published In
Cancer Epidemiol
Volume
67
Published Date
Start Page
101772
DOI
10.1016/j.canep.2020.101772

Disparities in Shared Decision Making and Service Receipt Among Children With Special Health Care Needs and Developmental Delay: A National Survey Analysis.

Shared decision making (SDM) is associated with increased service satisfaction among pediatric patients. Our objective was to examine the association between SDM and service use experiences across racial/ethnic child groups. This secondary data analysis used the 2009-2010 National Survey of Children with Special Health Care Needs (CSHCN) and 2011 Pathways to Diagnosis and Services Survey. We used a rank-and-replace matching approach consistent with Institute of Medicine recommendations for health disparities research. We included CSHCN aged 6 to 17 years. The exposure of interest was parents of CSHCN reporting engagement in SDM with clinicians. There were 4032 CSHCN included in analysis. CSHCNs experiencing SDM had a 16% higher probability of reporting service use compared to those not experiencing it (95% CI, 14.24-19.42). Black children experiencing SDM reported seeing all needed care providers at a lower rate than whites (79% and 87.6% respectively; 95% CI, -14.05-3.27). The benefit of SDM over not experiencing it for blacks was 12.2% less than for whites for the outcome of seeing all needed care providers. For the outcome of receiving all needed treatments and services, the SDM benefit was 9.1% lower for Hispanics compared with whites. SDM can improve service experiences but implementation flexibility may be needed.
Authors
Perez Jolles, M; Zullig, LL; Lee, P-J; Kolhatkar, G
MLA Citation
Perez Jolles, Monica, et al. “Disparities in Shared Decision Making and Service Receipt Among Children With Special Health Care Needs and Developmental Delay: A National Survey Analysis.J Prim Care Community Health, vol. 11, Jan. 2020, p. 2150132720924588. Pubmed, doi:10.1177/2150132720924588.
URI
https://scholars.duke.edu/individual/pub1448081
PMID
32560592
Source
pubmed
Published In
J Prim Care Community Health
Volume
11
Published Date
Start Page
2150132720924588
DOI
10.1177/2150132720924588

Lessons learned from two randomized controlled trials: CITIES and STOP-DKD.

Background: Even well-designed, theoretically driven clinical trials can fall short of achieving the desired clinical outcomes. Our research team had an opportunity to conduct two randomized controlled trials that were enrolling patients in parallel. While both studies were targeting chronic disease management among patients with multiple comorbid conditions, the patient population and settings varied. The studies were the Cardiovascular Intervention Improvement Telemedicine Study (CITIES) and Simultaneous Risk Factor Control Using Telehealth to slow Progression of Diabetic Kidney Disease (STOP-DKD) studies. Both studies had null findings. Objectives: Our goal is to discuss common design considerations across CITIES and STOP-DKD and potential implications for the design of future randomized controlled trials. Methods: These were two 1:1 randomized controlled trials with attention control groups that recruited patients from various clinical practices in the Research Triangle area of North Carolina. Conclusions: We make three recommendations for future studies. First, we assert that it is important to allow for piloting the enrollment process to ensure that it is possible to identify and recruit a patient population that is well aligned with the clinical outcomes of the intervention. Second, analysis plans should be more targeted in their approach and should consider heterogeneity of treatment effects. Third, in order to support the transition of evidence generated from randomized controlled trials into clinical practice, it is important to consider even early stage randomized controlled trials through an implementation science lens. Trial registration: Simultaneous Risk Factor Control Using Telehealth to slow Progression of Diabetic Kidney Disease (STOP-DKD) NCT01829256; Cardiovascular Intervention Improvement Telemedicine Study NCT01142908.
Authors
Zullig, LL; Oakes, MM; McCant, F; Bosworth, HB
MLA Citation
Zullig, Leah L., et al. “Lessons learned from two randomized controlled trials: CITIES and STOP-DKD.Contemp Clin Trials Commun, vol. 19, Sept. 2020, p. 100612. Pubmed, doi:10.1016/j.conctc.2020.100612.
URI
https://scholars.duke.edu/individual/pub1452142
PMID
32685766
Source
pubmed
Published In
Contemporary Clinical Trials Communications
Volume
19
Published Date
Start Page
100612
DOI
10.1016/j.conctc.2020.100612

Mobilizing Hospitals to Mobilize Patients.

Authors
Hastings, SN; Zullig, LL
MLA Citation
Hastings, Susan N., and Leah L. Zullig. “Mobilizing Hospitals to Mobilize Patients.J Am Geriatr Soc, Aug. 2020. Pubmed, doi:10.1111/jgs.16698.
URI
https://scholars.duke.edu/individual/pub1454056
PMID
32757213
Source
pubmed
Published In
Journal of the American Geriatrics Society
Published Date
DOI
10.1111/jgs.16698

Using digital health to facilitate compliance with standardized pediatric cancer treatment guidelines in Tanzania: protocol for an early-stage effectiveness-implementation hybrid study.

BACKGROUND: In high-income countries (HICs), increased rates of survival among pediatric cancer patients are achieved through the use of protocol-driven treatment. Compared to HICs, differences in infrastructure, supportive care, and human resources, make compliance with protocol-driven treatment challenging in low- and middle-income countries (LMICs). For successful implementation of protocol-driven treatment, treatment protocols must be resource-adapted for the LMIC context, and additional supportive tools must be developed to promote protocol compliance. In Tanzania, an LMIC where resource-adapted treatment protocols are available, digital health applications could promote protocol compliance through incorporation of systematic decision support algorithms, reminders and alerts related to patient visits, and up-to-date data for care coordination. However, evidence on the use of digital health applications in improving compliance with protocol-driven treatment for pediatric cancer is limited. This study protocol describes the development and evaluation of a digital health application, called mNavigator, to facilitate compliance with protocol-driven treatment for pediatric cancer in Tanzania. METHODS: mNavigator is a digital case management system that incorporates nationally-approved and resource-adapted treatment protocols for two pediatric cancers in Tanzania, Burkitt lymphoma and retinoblastoma. mNavigator is developed from an open-source digital health platform, called CommCare, and guided by the Consolidated Framework for Implementation Research. From July 2019-July 2020 at Bugando Medical Centre in Mwanza, Tanzania, all new pediatric cancer patients will be registered and managed using mNavigator as the new standard of care for patient intake and outcome assessment. Pediatric cancer patients with a clinical diagnosis of Burkitt lymphoma or retinoblastoma will be approached for participation in the study evaluating mNavigator. mNavigator users will document pre-treatment and treatment details for study participants using digital forms and checklists that facilitate compliance with protocol-driven treatment. Compliance with treatment protocols using mNavigator will be compared to historical compliance rates as the primary outcome. Throughout the implementation period, we will document factors that facilitate or inhibit mNavigator implementation. DISCUSSION: Study findings will inform implementation and scale up of mNavigator in tertiary pediatric cancer facilities in Tanzania, with the goal of facilitating protocol-driven treatment. TRIAL REGISTRATION: The study protocol was registered in ClinicalTrials.gov (NCT03677128) on September 19, 2018.
Authors
Vasudevan, L; Schroeder, K; Raveendran, Y; Goel, K; Makarushka, C; Masalu, N; Zullig, LL
MLA Citation
URI
https://scholars.duke.edu/individual/pub1436633
PMID
32223740
Source
pubmed
Published In
Bmc Cancer
Volume
20
Published Date
Start Page
254
DOI
10.1186/s12885-020-6611-3

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