How long does it take to integrate medical advances into routine clinical practice? The oft-cited figure—17 years—reflects the need to validate results, disseminate findings, approve regulations, refine protocols, and educate physicians. But still … 17 years?
A proven way to reduce this time lag is through practice-based research—part of the academic landscape at Einstein and Montefiore since 2003, when the New York City Research and Improvement Networking Group (NYC RING) was founded. Supported by the department of family and social medicine and the Institute for Clinical and Translational Research at Einstein and Montefiore, NYC RING is a practice-based research network for improving primary care by involving primary-care providers in the research process.
The most powerful and distinctive feature of practice-based research networks is that they combine the insights of primary-care physicians and the expertise of the researchers.
– Jessica Kahn, M.D., M.P.H.
“To me, the most powerful and distinctive feature of practice-based research networks is that they combine the insights of these two types of experts,” says Jessica Kahn, M.D., M.P.H., senior associate dean for clinical and translational research at Einstein. “You have the practical expertise of primary-care physicians who deeply understand the questions that must be answered to benefit their patients. And you have the expertise of the researchers who can apply the rigorous research methods that are best able to address those questions. This combination leads to research findings that are highly relevant to both patients and clinicians.”
Andrew Telzak, M.D., M.Sc., assistant professor of family and social medicine and director of NYC RING, agrees: “Involving local physicians in research helps ensure that questions most relevant to the community are being addressed. Those doctors also give academic researchers like me a better sense of how to refine and implement our research protocols. And their help is essential for recruiting and retaining study subjects, thanks to the level of trust that doctors have with their patients.”
The academic-community partnerships also pay off after studies are completed. “We can easily reach out to doctors who worked with us and say, ‘Remember that study you were involved with? Well, these are our findings, and this is how you could implement them in your practice,’” says Dr. Telzak.
We can easily reach out to doctors who worked with us and say, ‘Remember that study you were involved with? Well, these are our findings, and this is how you could implement them in your practice.’
– Andrew Telzak, M.D., M.Sc.
To date, NYC RING has participated in dozens of studies. Recent studies supported by NYC RING and reported in high-impact journals include a study showing that use of inhaled glucocorticoids enabled adults with moderate to severe asthma to have fewer severe asthma attacks, published in 2022 in the New England Journal of Medicine (NEJM); development of a rapid, easy-to-use test for enabling primary-care physicians to diagnose dementia, published in 2024 in Nature Medicine; and a study comparing the effectiveness of four approaches to reduce blood-sugar levels in patients with type 2 diabetes, published in 2022 in NEJM.
Following are descriptions of three other NYC RING-supported studies now underway.
It’s critically important that people with type 1 diabetes maintain healthy blood-glucose levels to prevent organ damage and promote long-term health. But Shivani Agarwal, M.D., M.P.H., associate professor of medicine at Einstein and an endocrinologist at Montefiore, noticed that many of her young-adult patients were struggling.
“It’s a challenging time for this age group,” says Dr. Agarwal. “They’re leaving home, going to college, entering the workforce, and switching from pediatric to adult-care providers. All these potentially stressful transitions can disrupt usual care routines and lead to a whole host of serious complications.”
Another problem is that the brain’s frontal lobe—involved in reasoning, problem-solving, and impulse control—doesn’t mature until the mid- to late 20s. “This means that teens and 20-somethings don’t always make the best decisions for themselves,” she notes. “The unfortunate result is that many young adults with type 1 diabetes fall out of care at a time when they need it the most.”
A few years ago, Dr. Agarwal uncovered yet another factor contributing to poor blood-glucose control among her Bronx patients: limited access to proven diabetes technologies, such as continuous glucose monitors and automated insulin pumps.
“It was puzzling,” she says. “Cost wasn’t an issue, since this group was fully covered by Medicaid.”
We’re trying to integrate social and medical services so we can address barriers to care that might arise, whether it’s an insurance issue, a housing issue, or a technology issue.
– Shivani Agarwal, M.D., M.P.H.
To get some answers, Dr. Agarwal held workshops with stakeholders—doctors, nurses, psychologists, diabetes educators, community health workers, and patients. She found that many clinicians didn’t prescribe these technologies or that their prescriptions got lost in the system. She also discovered that patients who did get the devices either weren’t using them, weren’t properly trained in their use, or didn’t receive adequate tech support when the devices malfunctioned. Ultimately, she found that only half of the eligible patients had received monitors and pumps and were using them correctly.
To solve this problem, Dr. Agarwal proposed training community health workers (CHWs) to work one-on-one with young type 1 diabetes patients, helping them navigate the healthcare system and ensuring that they acquire and use diabetes technologies.
“Basically, we’re trying to integrate social and medical services so we can address barriers to care that might arise, whether it’s an insurance issue, a housing issue, or a technology issue,” she says. The program also tries to shorten the time spent on the logistics of care so physicians can instead focus on delivering it.
Dr. Agarwal is now testing the program under a National Institutes of Health grant. The nine-month study includes 130 adults (ages 18–35) with type 1 diabetes in the Bronx who were randomized to receive CHW support or standard care. The researchers will assess whether the support makes patients more likely to use diabetes technologies and achieve healthier blood-glucose levels and quality of life (in the form of reduced stress). The program’s cost-effectiveness will also be analyzed.
“A key aspect of our program is the ample amount of time provided for shared decision-making between CHWs and patients,” says Dr. Agarwal. “Such in-depth interactions generally aren’t possible during routine clinician visits, and they help build trust. We’ve found that many patients who decline these technologies when offered them by their clinicians say yes when CHWs recommend their use.
“We’re fortunate to have a community health worker program here at Montefiore Einstein, along with supportive leadership,” Dr. Agarwal adds. “And since other healthcare systems around the country also have CHWs, with guidance those systems could readily put our new CHW model in place.”
Lung cancer is the leading cause of cancer death in the United States, accounting for about 20% of all cancer deaths. It’s well established that lung cancer screening (LCS) saves lives—and money—by detecting malignancies when they’re less advanced and more treatable. Both locally and nationally, however, barely 5% of those eligible for LCS—mainly older adults with a long history of heavy smoking—are screened for lung cancer. The procedure takes less than a minute and involves low-dose computed tomography (CT) scanning.
“This underutilization is particularly striking considering that 80% of those at risk for breast or colon cancer do get early screening,” says H. Dean Hosgood, Ph.D., professor of epidemiology & population health and the Atran Foundation Chair in Epidemiology & Population Health at Einstein and the associate director for population sciences at the National Cancer Institute–designated Montefiore Einstein Comprehensive Cancer Center. “Clearly, there’s room for improvement.”
Dr. Hosgood is evaluating a strategy for increasing LCS rates in the Bronx: integrating a single “centralized screening unit”—dedicated solely to lung cancer—into clinical practice throughout the Montefiore Einstein. Ideally, with the NYC RING network helping coordinate screening at primary-care practices, the centralized screening unit will become an integral part of a patient’s care team.
“The basic idea is to take over screening-related tasks—such as collecting the patients’ smoking history, determining eligibility, and arranging for follow-up visits—from primary-care physicians, who are generally busy attending to patients’ more-immediate health needs,” says Dr. Hosgood.
We can’t reach every patient who qualifies. But by catching more of these cancers at an early, treatable stage, I think we could finally start to bend the lung-cancer survival rate upward for the people of the Bronx.
– H. Dean Hosgood, Ph.D.
The unit will also conduct patient outreach and education. “Some patients simply aren’t aware of the benefits of LCS,” says the researcher. “Others have little trust in the healthcare system. And many have other stressors in their lives, such as food or housing insecurity. For them, lung cancer screening isn’t their top priority.”
The project is being funded by the American Cancer Society and is the first large-scale study of its kind in an economically disadvantaged and urban population.
Using Montefiore’s electronic medical record system, the unit will send postcards and electronic outreach messages to eligible patients. Trained lay “navigators” will call patients who do not respond to these electronic messages and will provide education and support in response to patients’ needs and concerns. They will also schedule appointments, send reminders, and track and support all steps of follow-up care.
The key, says Dr. Hosgood, is using an implementation-science design that allows a project to evolve as it goes along. “Things that look good on paper may not work well or efficiently in real-world clinical settings,” he says. “We plan to test different ways of communication and outreach with patients and see what’s working and what’s not. That way, knowledge gained from the first wave of our clinics can be used to modify later ones, so we improve the centralized screening unit over time. It’s a different design than, say, a randomized controlled trial, where the intervention remains the same throughout the course of the study.”
Thus far, 18 clinics have agreed to participate in the study, which started in February 2025. Dr. Hosgood estimates that as many as 40,000 of Montefiore’s patients in the Bronx would be eligible for LCS.
“We can’t reach every patient who qualifies,” Dr. Hosgood said. “But by catching more of these cancers at an early, treatable stage, I think we could finally start to bend the lung-cancer survival rate upward for the people of the Bronx. And the more people we screen, the more likely their friends and family members will be encouraged to undergo LCS, once they learn that it’s painless and potentially lifesaving.”
Numerous studies have shown that atorvastatin (Lipitor) and other statins are good at lowering blood-lipid levels and reducing the risk of heart disease, usually with no or mild side effects. Since these drugs may also delay the onset of dementia, why aren’t they used more often by people over age 75—a group prone to both heart disease and dementia?
“The answer is quite simple,” says Dr. Telzak. “Drug trials consistently exclude the elderly, since they’re at high risk for adverse drug effects. This was also true for statin studies. As a result, we don’t know if statins help against either of those conditions in the elderly—and if they do, whether the benefits outweigh the risks.”
Five years ago, Duke University scientists set out to fill this knowledge gap with a study called PREVENTABLE (PRagmatic EValuation of evENTs And Benefits of Lipid-lowering in oldEr adults). The Duke team invited NYC RING and a number of other research groups around the country to join the study, with the goal of enrolling as many as 20,000 participants.
“This trial is a perfect fit for our community,” says Dr. Telzak, a co-leader of the study at Montefiore Einstein. “The Bronx has a higher-than-average rate of heart disease—the result of poor access to care as well as a host of economic and lifestyle factors. And while the incidence of dementia in the Bronx is probably on par with that in the rest of the nation, the condition is significantly underdiagnosed here. Anything we can do to improve the care of patients with these problems would have a huge impact.”
Enrollees in PREVENTABLE will be randomized to receive 40 mg of atorvastatin or a placebo daily. After four years, patients will be assessed for side effects and to see whether atorvastatin has enabled them to continue living without persistent disability or dementia. The researchers will also assess the drug’s effect on rates of mild cognitive impairment, dementia, and death from cardiovascular disease.
All told, the results should indicate whether giving statins to older adults is worthwhile. “It’s likely that these drugs have benefits for older people,” says Dr. Telzak. “But many seniors are understandably reluctant to take yet another medicine.” He notes that polypharmacy—patients’ use of multiple medications—is a major problem for some seniors and that statins can also cause problems, including muscle pain, digestive issues, and headaches. “We need to better understand what works for this population and what doesn’t,” he adds.
