# The Flint Neuropathy Study: assessing diagnostic and management gaps in a Black, low-income population

> **NIH NIH K23** · UNIVERSITY OF MICHIGAN AT ANN ARBOR · 2024 · $218,267

## Abstract

ABSTRACT
Neuropathy is a highly prevalent, disabling condition that leads to pain and reduced quality of life, yet little is
known about neuropathy diagnosis and management in Black, low-income populations. Our preliminary data
indicates that 61% of primarily Black, low-income patients >40 years with neuropathy are undiagnosed.
Without appropriate diagnosis, optimal management of modifiable risk factors, such as hyperglycemia and
obesity, and neuropathic pain is unlikely. Computerized clinical decision support systems (CDSSs) improve
primary care physician (PCP) diagnoses and management by delivering evidence-based recommendations
based on patient characteristics. This proposal’s overall objective is to assess neuropathy diagnosis and
management at two Flint, Michigan clinics (54% Black, 40% <US poverty line), then adapt and pilot an
intervention to address determinants of gaps in neuropathy diagnosis and management. We expect that there
is substantial a neuropathy diagnostic and management gap among Black, low-income patients and that an
adapted CDSS will reduce these gaps. These hypotheses will be tested by pursuing three specific aims: 1)
quantify gaps in neuropathy diagnosis and management in a predominantly Black, low-income population, 2)
determine PCP-level predictors of gaps in diagnosis and management, and 3) adapt a CDSS intervention
emphasizing neuropathy screening, risk factor modification, and pain management and evaluate CDSS reach,
adoption, and implementation. The first aim will use a piloted study design to assess neuropathy prevalence
and determine gaps in diagnosis and management. The second aim will utilize the Theoretical Domains
Framework to assess PCP knowledge, attitudes, and clinic level determinants of neuropathy diagnosis,
management of risk factors and neuropathic pain using mixed methods. The final aim involves adapting an
existing CDSS intervention for neuropathic pain to include neuropathy diagnosis and risk factor management.
This intervention will then be piloted at two clinics in different health systems serving predominantly Black and
low-income patients. The proposed research is highly innovative because it examines gaps in neuropathy
diagnosis and management among a population most likely to be affected by neuropathy and their usual
PCPs, which few studies have done. Even fewer have assessed determinants of gaps in neuropathy diagnosis
and management in this patient population. Uncovering determinants of neuropathy diagnosis and
management represents a significant impact as this will form the foundation for an intervention aimed at
improving neuropathy diagnosis and management in this population and other similar, underserved
populations.

## Key facts

- **NIH application ID:** 10849777
- **Project number:** 5K23NS131444-02
- **Recipient organization:** UNIVERSITY OF MICHIGAN AT ANN ARBOR
- **Principal Investigator:** Melissa Elafros
- **Activity code:** K23 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2024
- **Award amount:** $218,267
- **Award type:** 5
- **Project period:** 2023-07-01 → 2028-06-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10849777

## Citation

> US National Institutes of Health, RePORTER application 10849777, The Flint Neuropathy Study: assessing diagnostic and management gaps in a Black, low-income population (5K23NS131444-02). Retrieved via AI Analytics 2026-05-29 from https://api.ai-analytics.org/grant/nih/10849777. Licensed CC0.

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