Friday, April 29, 2016                                                                                                    Volume 2. Issue 4.

The CHFM Pulse  

“Without continual growth and progress, such words as improvement, achievement, and success have no meaning.” -Benjamin Franklin



• Chair's Message 

• Achievements 

•Three Missions: Patient Care, Education, & Scholarship

• Upcoming Events and Past Event Highlights

• Faculty & Staff Spotlight

• Link to 2014-2015 Annual Report

• Past Grand Rounds Presentations

• PCP Live Presentations



Fellow CHFM Member,

Welcome to another addition of The Pulse. As you will note, the Department of Community Health and Family Medicine is an active participant in the academic activities at the University of Florida and in the discipline of Family Medicine. We continue to expand our activities as we meet goals in each of our three missions: Education, Patient Care, and Scholarship.

Best regards,

Peter J. Carek, MD, MS

Professor and Chair




We’re proud of all the awards  that our talented CHFM faculty and staff have received since our last newsletter in February. It shows we’re on the right track. Congratulations to the following award winners for all of their hard work and dedication: 

• Denny AganaOutstanding Research Award,  2016 UF Public Health and Health Professions         Research Day

• Peter Carek, MD, MS:  UF Health Quality and Patient Safety Award - 3rd place

• R. Whit Curry, Jr.,  MD:  Lifetime Achievement Award

• Rob Hatch, MD, MPH:  Ken Kellner, MD, PhD, Outstanding Clerkship Director Award

• David Quillen, MD:  UF Health Quality Leader

• Larry Rooks, MD:  2015 Society of Teaching Scholars Lifetime Achievement Award

• Dan Rubin, MD:  Inducted into the Chapman Chapter of the Gold Humanism Honor Society

• Kieran Shute, MD:  2015 Society of Teaching Scholars Outstanding Resident Teachers Award



Congratulations to the faculty, residents, and staff who were invited to present at the 49th Annual Spring Conference for the Society of Teachers of Family Medicine, April 30 - May 4, 2016, in Minneapolis, Minnesota. See the STFM Presentation section for an inclusive list. 





We continue to monitor our patient care activities and seek ways to expand services to meet the needs of our patients and communities. As such, we will be adding physicians to several practice sites in the next several months. These sites include Haile Plantation, Eastside, Main Street, Jonesville, and Old Town. Additionally, we have begun the process to relocate our Hampton Oaks practice to the northwest area of Gainesville.



We set our residency numbers to a 9-9-9 residency complement, with 27 students in total, and matched with 9 new residents. Three were from UF, one from Miami, one from Loma Linda, one from Albert Einstein, one from Des Moines Osteopathic School of Medicine, one from Royal College of Surgeons in Ireland, and one from Queensland, Australia.


Our fellows were very busy in February, attending several UF educational events – the Running Medicine Conference; Sports Medicine Conference; and Safety in Adolescent and High School Sports Medicine: Myth vs. Reality – and managing the medical station of the Five Points of Life Marathon under the direction of Drs. Katie Edenfield and Seth Smith.

In March and April, our fellows covered several multi-day UF Track and Field events. Additionally, Drs. Bonnet, Wilt, and Zapf attended the American Medical Society of Sports Medicine (AMSSM) Conference in Dallas, Texas, alongside Sports Medicine Faculty.  Fellows and faculty presented posters regarding cases and research, and Dr. Clugston conducted a SMART Workshop at this conference.

Our fellows will be graduating from our program on June 30.  We are excited for them to become the next physicians to receive their Certificate of Added Qualification in Sports Medicine.  All previous fellows – a total of 15 since 2007 – have had a 100 percent first-attempt pass rate on the CAQSM exam.  On July 1, we will welcome Drs. Thomas Starnes and Katherine Langley to our one year fellowship program.


The Advance Directives Training Project is currently underway. Drs. Bill Allen, Ray Moseley and Lauren Solberg will be visiting each CHFM clinic in order to train staff on how to assist patients with completing advance directives. The Project aims to raise awareness about this kind of early informed consent and increase their documented numbers in the electronic medical record.




Dr. Edenfield recently obtained funding from the American Medical Society for Sports Medicine for a collaborative grant with the University of Georgia titled “Cardiovascular Screening with History, Physical, ECG and Echo in College Athletes.  5-Year Results from Two Division I Institutions”. The purpose of this study is to investigate the results of comprehensive cardiac screening done at the University of Florida and the University of Georgia from 2011 to 2016.  The primary objective of the study is to determine the sensitivity, specificity, positive and negative predictive value of history, physical, ECG and echo for cardiovascular screening for detection of cardiovascular conditions.  Secondary objectives are:  1) To determine high risk groups stratified by sport, gender, and race/ethnicity. 2) To report echocardiographic norms in college athletes. 3) To report any complications or morbidity caused by secondary investigations or treatments.


To further our readmission reduction initiatives, we are starting a new study called COMPARE2 (Comparison of Factors Identified by Patients and Providers Associated with Hospital Readmission) led by Eric Dietrich, PharmD. This study seeks to find common underlying causes for hospital readmissions by obtaining the patient’s perspective, in addition to the healthcare provider’s perspective, on the possible causes for the patient’s return to the hospital within 30 days or less of their previous discharge. The study will collect data via two separate interviews conducted by research staff that ask the patient and the provider (separately) to identify potential reasons for readmission. The results will then be analyzed to determine the main reasons that cause patients to have hospital readmissions and if there is a discrepancy in what patients perceive and what providers perceive to be the cause.


Dr. Clugston and his research team in the UF Sports Concussion Center are collaborating with the University of Georgia on a new study to explore the influence of sleep and physical activity on concussion recovery. The results of this study will help guide clinicians in determining the utility of sleep management programs and physical activity recommendations to aid recovery following concussion. Concussed students will be matched with non-concussed students; both will wear a wrist actigraph device to objectively capture sleep quality and physical activity bouts and will complete various assessments to track their concussion recovery and sleep quality.



We have numerous quality improvement projects occurring that are addressing issues such as readmission rates to the hospital, emergency department utilization by our patients, and referral rates of our physicians to specialists. These projects are meant to improve the care we provide as well as meet any additional needs of our patients and community.

As an example, the current status of our readmission rate project is noted in the graph below. While our rate has improved, we continually seek interventions that will lower this rate even further.

• Readmission= A patient discharged from Family Medicine service and admitted as urgent or emergent to any other service in Shands UF Health system within 30 days of the discharge (excludes observation patients on both discharges and readmits)

• Readmission rate= Readmissions/ Discharges

• Current Weekly Average = Average readmission rate for 10-week period (9/21/2015-11/29/2015), 1 year from pre-intervention period. Average weekly rate for pre-intervention period (9/22/2014- 11/30/2014) was 23%

• 1st Lower Limit= Current Weekly Average – 1 standard deviations; 1st Upper Limit= Current Weekly Average + 1 standard deviations

• 2nd Lower Limit= Current Weekly Average – 2 standard deviations; 2nd Upper Limit= Current Weekly Average + 2 standard deviations

• 3rd Upper Limit= Current Weekly Average + 3 standard deviations

Hospital Readmission Quality Improvement Projects

The inpatient team has taken several initiatives to address hospital readmissions and improve patient care.

• Weekly Quality Rounds Discussion

• COMPARE2 (see details of study in research section)

• Home Visits for High Risk Patients

• Risk Stratification: LACE Tool

• Follow Up Appointments

Clinic Quality Improvement Initiatives

As part of the department goal to improve patient care and continually improve our processes, all clinic sites are working within their own practice to implement process and or workflow changes to meet goals of various quality measures. Medical directors are taking the lead and engaging staff in quality improvements efforts tailored to their unique patient populations. Clinic sites also review monthly reports to monitor changes. Below are the items that clinics are focusing on:

• Chronic Conditions Management

      > Diabetes
      > Asthma/ COPD
      > Heart Failure
      > Hypertension

• Emergency Department Utilization

• Pneumococcal Vaccines

• Advanced Directives

Resident-Led Quality Improvement Project

The residents at the Main St. clinic form teams that develop and initiate quality improvement efforts in the clinic.

• Preventative Screenings



Millar J, Psychas P, Valle D. Identifying Malaria risk factors in a hyper-endemic setting using Baynesian model selection. University of Florida Emerging Pathogens Research Day. Gainesville, FL. February 18, 2016.



Agana D. UF Primary Care physicians’ satisfaction. University of Florida College of Medicine Celebration of Research Day. Gainesville, FL. February 13, 2016.

Agana D. Characteristics of Emergency Department utilizers of UF Family Medicine in 2015. 2016 University of Florida Public Health and Health Professions Research Day, Gainesville, FL. April 13, 2016.

Carek P. Lessons learned in the first two years of the I3 POP Collaborative Cohort.”  North American Primary Care Research Group Annual Meeting. Cancun, Mexico. October 2015.

Carek P, Dietrich E, Feller D, Malaty J, Lombardi J, Blanc P, Samraj G.  Addressing hospital readmissions: Impact of weekly review.  University of Florida Health Quality and Patient Safety Week.  Gainesville, FL.  March 17, 2016.

Clugston J. Concussion prevention in football. Concussion Across the Spectrum of Injury Conference: New York University, School of Medicine, Department of Neurology. New York, NY. February 26, 2016.

Clugston J. Update on concussion prevention in football. Safety in Adolescent and High School Sports Conference, University of Florida Orthopedics and Sports Medicine Institute. Gainesville, FL. February 20, 2016.

Porter M. The ‘July effect’: A look at medical admissions. North American Primary Care Research Group. Cancun, Mexico. October 24-28, 2015.

Porter M. A qualitative study to explore tobacco use and cessation in a homeless population. North American Primary Care Research Group. Cancun, Mexico. October 24-28, 2015.



Dickmann S, Blanc P, Dieuvil M, Kramer D, Malaty J. Mildly elevated transaminases and evaluation for Hepatitis B and C in a Family Medicine center.  The 49th Annual Spring Conference for the Society of Teachers of Family Medicine. Minneapolis, MN. April 30 - May 4, 2016.

George J, Malaty J. Type 2 Diabetes quality improvement project: utilizing EMR to improve quality of care. The 49th Annual Spring Conference for the Society of Teachers of Family Medicine. Minneapolis, MN. April 30 - May 4, 2016.

Malaty J, Taylor D, George J, Kramer D. Team-based chronic kidney disease quality improvement project. The 49th Annual Spring Conference for the Society of Teachers of Family Medicine. Minneapolis, MN. April 30 - May 4, 2016.

Carek P, Lombardi J, Malaty J, Porter M, Samraj G. Impact of weekly multidisciplinary readmissions rounds on readmission rate. The 49th Annual Spring Conference for the Society of Teachers of Family Medicine. Minneapolis, MN. April 30 - May 4, 2016.

Porter M, Agana D, Carek P, Hatch R, Rubin D. Family Medicine clerkship directors’ views and actions on medical students’ impressions of Family Medicine: A CERA study. The 49th Annual Spring Conference for the Society of Teachers of Family Medicine. Minneapolis, MN. April 30 - May 4, 2016.

Hatch R, Agana D, Carek P, Porter M, Rubin D. Job satisfaction among academic family physicians. The 49th Annual Spring Conference for the Society of Teachers of Family Medicine. Minneapolis, MN. April 30 - May 4, 2016.

Porter M, Carek P, Blanc P, Listhaus A. B120 referral rate in a Family Medicine Residency clinic: How does it compare? The 49th Annual Spring Conference for the Society of Teachers of Family Medicine. Minneapolis, MN. April 30 - May 4, 2016.

Dieuvil M, Carek P, Judge E, Listhaus A, Samraj G. Does insurance status influence HPV vaccination rates at university based primary care clinics? The 49th Annual Spring Conference for the Society of Teachers of Family Medicine. Minneapolis, MN. April 30 - May 4, 2016.

Judge E, Carek P, Dieuvil M, Listhaus A, Samraj, G. Racial differences in HPV vaccination rates at an Academic Family Medicine clinic. The 49th Annual Spring Conference for the Society of Teachers of Family Medicine. Minneapolis, MN. April 30 - May 4, 2016.

Potts S, Carek P, Danoff R, Lausen H, Munzing T. Requirements, milestones, NAS, and other accreditation issues: A workshop with the ACGME review committee for Family Medicine. The 49th Annual Spring Conference for the Society of Teachers of Family Medicine. Minneapolis, MN. April 30 - May 4, 2016.



Baker R, Honeyford K, Levene LS, Mainous AG 3rd, Jones DR, Bankart MJ, Stokes T. Population characteristics, mechanisms of primary care and premature mortality in England: a cross-sectional study. BMJ Open. 2016; 6(2): e009981.

Beers PJ, Adgerson CN, Millan SB. Porcine tri-layer wound matrix for the treatment of stage IV pressure ulcers. JAAD Case Reports. 2016; 2(2): 122-124. doi:10.1016/j.jdcr.2016.01.001.

Carney PA, Conry CM, Mitchell KB, Ericson A. Dickinson WP, Martin JC, Carek PJ, Douglass AB Eiff MP. The Importance of and the complexities associated with measuring continuity of care during resident training: possible solutions do exist.  Fam Med. 2016; 48(4): 286-93.

Carris NW, Ghuschyan V, Libby AM, Smith SM. Health-related quality of life in persons with apparent treatment-resistant hypertension on at least four antihypertensives. J Hum Hypertens. 2016; 30: 191-6.

Gong Y, Wang Z, Beitelshees AL, McDonough CW, Langaee TY, Hall K, Schmidt SO, Curry RW, Gums JG, Bailey KR, Boerwinkle E, Chapman AB, Turner ST, Cooper-DeHoff RM, Johnson JA. Pharmacogenomic genome-wide meta-analysis of blood pressure response to β-blockers in hypertensive African Americans. Hypertension. 2016; 67(3): 556-63. doi: 10.1161/HYPERTENSIONAHA.115.06345. Epub 2016 Jan 4.

Harle CA, Listhaus A, Covarrubias C, Schmidt SOF, Mackey S, Carek PJ, Fillingim RB, Hurley RW. Overcoming barriers to implementing patient-reported outcomes in an electronic health record: A Case Report. JAMIA.  2016; 23(1): 74-79.

Mainous AG 3rd, Tanner RJ, Baker R. Prediabetes diagnosis and treatment in primary care. J Am Board Fam Med. 2016; 29(2): 283-5. doi: 10.3122/jabfm.2016.02.150252.

Mainous AG 3rd, Tanner RJ, Anton SD, Jo A. Grip strength as a marker of hypertension and diabetes in healthy weight adults. Am J Prev Med. 2015; 49(6): 850-8.

Mainous AG 3rd, Tanner RJ, Anton SD, Jo A. Low grip strength and prediabetes in normal-weight adults. J Am Board Fam Med. 2016; 29(2): 280-2.

Mainous AG 3rd, Tanner RJ, Mainous RW, Talbert J. Health considerations in regulation and taxation of electronic cigarettes. J Am Board Fam Med. 2015; 28(6): 802-6.

Malaty J.  Take a breath and consider the other’s perspective.  Fam Med.  2016; 48(3): 226-7.

Mims LD, Everard K, Hall K, Hatch RL, Malaty J, Rubin D, Agana DF, Carek PJ. Family medicine clerkship directors’ influence on the residency program selection process. Fam Med. 2016; 48(2): 108-13.

Moseley R. Healthcare Ethics Committee. Miami, FL: CITI Program, University of Miami; 2016.

Nguyen K, Jacobs K. Urethral prolapse. Consultant for Pediatricians. 2016; 15(3): 138-140.

Porter M, Mims L, Garven C, Gavin J, Carek P, Diaz V. International health experiences in Family Medicine residency training. Fam Med. 2016; 48(2): 114-2-.

Sacino AN, Shuster JJ, Nowicki KW, Carek PJ, Wegman MP, Listhaus A, Gibney JM, Chang LK. Novel application of a reverse triage protocol providing increased access to care in an outpatient, primary care clinic setting. Fam Med. 2016; 48(2): 136-9.

Smith SM, Carris NW, Dietrich ED, Gums JG, Uribe L, Coffey C, Gums TH, Carter BL. Physician-pharmacist collaboration versus usual care in treatment-resistant hypertension. J Am Soc Hypertens. 2016; 10(4): 307-17.

Shniderman A, Solberg LB. Cosmetic psychopharmacology for prisoners: Reducing crime and recidivism through cognitive intervention. Neuroethics. 2015; 8(3): 315-326.



The grip strength and diabetes publications listed above in the Publication section have received a lot of press, notability with Fox News TV and the Wall Street Journal. Links to articles are listed below.

Fox News TV - Detroit

Fox News TV - Los Angeles

Wall Street Journal

The prediabetes studies have also generated more than 100 news articles including US News and World Report, MSN, AARP, Medline Plus, and many TV stations. Links to articles are listed below.



US News and World Report

Dr. Ray Moseley participated in a televised discussion on the show Viewpoint titled “Navigating Ethics: Computers and Patient Privacy.” The conversation, which featured a discussion about the ethical implications of electronic health records on patient care and privacy, aired March 6, 2016 on WPBT2, a local PBS-affiliate network in the Miami area. Link to the video is listed below.






The Florida Bioethics Network’s second annual conference on Issues in Clinical Ethics will take place on Friday, April 29, 2016 at the Sheraton Orlando North in Maitland, Florida. Panel and speaker topics will include “How Do You Ask for Consent? The Dos and the Don’ts,” “Informed Consent: A Modest Proposal for More Informed Research Participants” and “Giving Consent for Future Procedures: Advance Directives.” Some of our UF colleagues will be speaking at the conference, including Drs. Bill Allen, Bob Guenther, Lauren Solberg, and Ray Moseley. To register or learn more about the conference, you may visit:


The annual UF Health Community Health Fair is coming up on May 10 at the UF Hilton Conference Center on 34th Street and Hull Road and will run from 8:30 a.m. until noon.  This event has traditionally been called the Women’s Advantage Health Fair but since some men attend, the name has changed to Community Health Fair. Organizers are anticipating 300-400 people to attend. CHFM will have the following people attend to help with blood pressure screenings, cholesterol/glucose results, and marketing.

Run Gan, MD – Jonesville

Mitul Jones, MD – Haile

Helen Hagan, MD – Hampton Oaks

Danielle Chaplin, ARNP – Haile

Misty Gray and Sherri Swilley – Administration Office 


The CHFM family will gather to celebrate the distinguished careers of Drs. R. Whit Curry, Jr., Linda Hensley, and Larry Rooks on May 20. The event will begin at 5:30 p.m. at the Main Street clinic and will last until 7:30 p.m.


On June 4, Community Health and Family Medicine will host a summer picnic at Poe Springs Park for all staff, faculty, and their families. The event will be from 11 a.m. to 3 p.m. with BBQ lunch provided for all.

Please bring your bathing suits and take a swim or enjoy many outdoor games from volleyball to frisbee. Here is a link to Alachua County’s Parks and Recreation webpage for Poe Springs Park. WE HOPE TO SEE YOU ALL THERE!


Starting on June 7, Grand Rounds will be hosted at the Main Street clinic and will also continued to be video conferenced via Jabber at each of the clinics and admin conference room as well as streamed live via Mediasite.

 June 7th Presenter:

Thomas A. Pearson, MD, MPH, PhD

Executive Vice President for Research and Education

Professor of Epidemiology and Medicine


The 1st annual department research day will be held on June 23 from 6 - 8:30 p.m.  The event will be held at the Champions Club with dinner and poster presentations. Faculty members are expected to attend.


Congratulations to our 11 3rd-year residents on their graduation! They will celebrate their achievement on June 24 at 6 p.m. at the Kanapaha Botanical Gardens.




Gator Day is one of the oldest traditions in Tallahassee during session and has been celebrated for decades in the State Capitol. As part of Gator Day, Dr. Carek was selected to be Doctor of the Day, proving patient care in the State Capitol clinic.  Congratulations Dr. Carek…what an honor to be chosen.



CHFM joined colleagues from UF Health in support of National Wear Red Day on February 5 to help raise awareness for heart disease. Attendees were offered lessons in hands-only CPR and automated external defibrillator use.


On March 28, the University of Florida 2015-2016 Superior Accomplishment Awards program luncheon was held at the Wyndham Garden Gainesville.  Congratulations again to Sheila Diuguid and Rachel Rivera for winning the Superior Accomplishment Award and to Sherri Swilley for the Diversity and Inclusion Award.  




Dr. Clugston is currently involved in several concussion research studies. The largest of which is the NCAA-DoD Concussion Awareness Research Education (CARE) Consortium which has enrolled 20,000 athletes from 30 institutions and collected post-injury data from nearly 1,000 sports related concussions.  Clugston is the UF site principal investigator (PI) and also serves on the study’s Operating Committee.  In addition to CARE, Clugston is PI of the AWARE study with Banyan Biomarkers Inc., looking at serum markers for brain injury in UF football, lacrosse, and soccer athletes.  This study also measures head impacts using helmet sensors in UF football players.  He is the PI for the UF Athletic Association Concussion Databank and for the UF Student Health Concussion Databank.  These banks allow concussion information to be collected and accessed for research.  He is also collaborating with the University of Georgia on a sleep and concussion study and also participates as a co-investigator on several concussion studies with other UF researchers in neuropsychology, neurology, orthopedics, physical therapy, and radiology. 


Amanda serves as the nursing lead for Family Medicine and is responsible for developing and implementing Department specific policies, protocols, and critical pathways. She works closely with clinical staff (RN, LPN, MA, and CCA) on core competencies and provides clinical nursing assessment, support, counseling, and direct patient care in an ambulatory setting. She also works in collaboration with other health care providers and ancillary services and maintains mandatory regulatory institutional policy and procedures under the direction of the Chair.

Amanda moved to Florida in August 2015 to be closer to family and started working for CHFM in December 2015. Before working for CHFM, she started her health care career working as a medical assistant in both family medicine and internal medicine. In 2008 she graduated from nursing school with a BSN from the University of Maryland. Her roles as an RN included emergency room nursing, school nursing, and various teaching positions. She graduated from Stevenson University with her MSN with a focus on health care leadership and management.



The 2014-2015 Annual Report has been published and added to the CHFM webpage.  Here is the link to the report: 2014-15 Annual Report



In case you missed any of the latest sessions, below are links to past Grand Rounds presentations:


January 5, 2016

Jennifer Keehbauch, MD

Going All in for the FAFP 

January 2016 Grand Rounds Presentation - Mediasite


February 2, 2016

Timothy C. Flynn, MD, FACS

Reflections of the Chief Medical Officer (CMO)

February 2016 Grand Rounds Presentation - Mediasite


March 1, 2016

Dean A. Seehusen, MD, MPH

Practical Scholarship for Residency Programs

March 2016 Grand Rounds Presentation - Mediasite



In case you missed any of the latest sessions, below are links to past PCP Live presentations:


January 20, 2016

Mustafa M. Ahmed, MD

Device Therapy: A Contemporary Approach to Advanced Heart Failure

January 2016 PCP Live Presentation - Mediasite


February 17, 2016

Mustafa M. Ahmed, MD

Advanced Heart Failure: A Stepwise Approach

February 2016 PCP Live Presentation - Mediasite


March 16, 2016

F. Kayser Enneking, MD

Thrombosis versus Hemorrhage: Managing Antiplatelets & Anticoagulants in the Perioperative Period

March 2016 PCP Live Presentation - Mediasite


April 20, 2016

Catherine M. Edwards, MD

Thyroid Function Disorders: Hyperthyroidism and Hypothyroidism

April 2016 PCP Live Presentation - Mediasite


If you missed the last issues of the CHFM Pulse, here's where you can find it on our website!

(Clicking on the picture will take you to the website)


Would you like to add something to this newsletter or have any suggestions? Any questions, comment, or concerns? Please email Sherri Swilley at with subject “CHFM Newsletter”.