# Development of a multilevel implementation intervention to equitably prescribe evidence-based therapy for hospitalized heart failure patients

> **NIH NIH K23** · UNIVERSITY OF MICHIGAN AT ANN ARBOR · 2024 · $194,400

## Abstract

PROJECT SUMMARY/ABSTRACT
Candidate’s Long-Term Career Goal: To become an independently funded, leading physician-scientist
focused on advancing health equity through multilevel implementation interventions that increase evidence-
based care and improve the health outcomes of patients with heart failure.
Clinical Problem: Heart failure is common, costly, and deadly, with a disproportionate burden among
underserved groups. Evidence-based therapies that improve outcomes, including mortality, are not
implemented adequately, and disparities exist in the receipt of treatments for underserved groups.
Candidate Background: Dr. Cascino is a Clinical Instructor in the Division of Cardiovascular Medicine at the
University of Michigan (U-M). He received an MD from Loyola University Chicago, Stritch School of Medicine
and an MSc in Health and Healthcare Research from U-M. He has published 49 papers, including 38 original
peer-reviewed manuscripts, 14 of which he is the first or senior author. He has been awarded four internal
grants from U-M, a departmental T32, and an institutional K12.
Career Development Plan: Dr. Cascino will develop new skills in health equity-centered research, electronic
health record (EHR) observational data analyses, mixed-methods, and implementation intervention design
through a combination of intensive mentorship, didactic course work, participation in a community of scientists,
progressively independent research, and on-the-job-training.
Specific Aims: 1) Assess multilevel variation in equitable guideline-directed medical therapy (GDMT)
prescribing during an acute heart failure with reduced ejection fraction (HFrEF) admission, 2) Identify and
prioritize determinants to promote the equitable implementation of GDMT prescribing in the hospital setting,
and 3) Design the components of a multilevel implementation intervention using implementation science
methods to address prioritized determinants of equitable inpatient GDMT prescribing.
Research Plan: Dr. Cascino will employ an implementation mapping process framework to 1) use multi-health
system electronic health record data from PCORnet to understand multilevel factors that are associated with
variation in GDMT prescribing for admitted HFrEF patients considering race, sex, and socioeconomic status, 2)
use explanatory sequential mixed methods including qualitative interviews with key stakeholders to identify and
prioritize determinants of GDMT prescribing, and 3) design the components of a multilevel implementation
intervention targeting prioritized determinants to promote equitable inpatient GDMT prescribing.
Impact: The proposed research will advance the understanding of inpatient GDMT prescribing for patients with
HFrEF and prepare Dr. Cascino to write an R-level application for a multi-site trial evaluating the
implementation of a multilevel intervention to increase equitable access to lifesaving HFrEF therapies.

## Key facts

- **NIH application ID:** 10982594
- **Project number:** 1K23HL171910-01A1
- **Recipient organization:** UNIVERSITY OF MICHIGAN AT ANN ARBOR
- **Principal Investigator:** Thomas Matthew Cascino
- **Activity code:** K23 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2024
- **Award amount:** $194,400
- **Award type:** 1
- **Project period:** 2024-09-01 → 2029-08-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10982594

## Citation

> US National Institutes of Health, RePORTER application 10982594, Development of a multilevel implementation intervention to equitably prescribe evidence-based therapy for hospitalized heart failure patients (1K23HL171910-01A1). Retrieved via AI Analytics 2026-05-25 from https://api.ai-analytics.org/grant/nih/10982594. Licensed CC0.

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