Research and Projects: AHRQ Other Health IT Related Initiatives
Practice-based Research Networks (PBRN) Grants with an IT Focus
AHRQ awarded a number of Practice Based Research Networks (PBRN) grants. A selected number of the grants which have an IT focus are described below.
Building the Alabama Practice-based Research Network
Institution University of Alabama
Location Birmingham, AL 35205
Project No. HS013529-01
Principal Investigator T. Michael Harrington, M.D.
First Year of Funding $149,999
Total Estimated Funding $299,638
Project Period 9/30/02-9/29/04
Summary This new network, composed mostly of family practices in medically underserved rural areas in Alabama, will use infrastructure funds to enhance the capacity of its clinicians to translate research findings into practice using personal digital assistants (PDAs). It will also conduct translational studies on the use of PDA-managed protocols to promote smoking cessation and the reduction of morbidity/mortality related to obesity in primary care settings.
Abstract DESCRIPTION (provided by applicant)
The Alabama Practice Based Research Network (APBRN), in cooperation with the Department of Family and Community Medicine at the University of Alabama at Birmingham (UAB), seeks Category I (infrastructure) and Category II (research) support to enhance its capacity to conduct research and to translate research findings into practice using personal digital assistants (PDAs). The Category I phase will
recruit new physician members into APBRN, particularly minorities; assess members' technical capacity and needs, and practice populations demographics; provide assistance and training in PDA use in clinical practice to all members; and assist all members and their clinical staff in achieving IRB training. Category II funding will develop two TRIP studies which will test the feasibility of using PDAs for data collection and generate preliminary data for future study. These studies will employ best practice guidelines for assessment and counseling, and will address similar questions
What level of time and resources are required to conduct clinical data collection using PDAs? What are the barriers and how can they be overcome? Does this type of technical assistance create a teachable moment for the patient that could enhance patient compliance with physician recommendations? Specific aims are to
1) assess the technological and training needs of APBRN physicians, and provide them with training in the use of PDAs in clinical data collection; 2) ensure that all members are trained and prepared in the basic precepts of research methods and evaluation; 3) conduct a TRIP study on how a PDA-managed protocol for tobacco use will affect the assessment and counseling behaviors of family physicians with patients who smoke; and 4) conduct a pilot feasibility study on obesity, using PDAs to gather data that will serve as the basis for a larger study aimed at improving patient care and reducing morbidity and mortality related to obesity. The overarching question of this research is
Will use of PDAs aid physicians' in delivering health messages, and result in improved patient health?
Thesaurus Terms data collection methodology /evaluation, health science research, health service demonstration project, information dissemination, patient care, primary care physician, cooperative study, data management, health behavior, medically underserved population, obesity, tobacco abuse, clinical research, health services research tag, human data, questionnaire, training
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Expansion and Pilot Projects for SPUR-Net
Institution Baylor College of Medicine
Location Houston, TX 77030
Project No. HS013524-01
Principal Investigator Jeffrey Steinbauer, M.D.
First Year of Funding $100,000
Total Estimated Funding $199,998
Project Period 9/30/02-9/29/04
Summary Southern Primary Care Urban Research Network (SPUR-Net), a network of family practices located in Houston, will conduct a pilot study to determine if the use of a programmed lipid management reminder system within practices having an electronic medical record increases clinician compliance with national lipid management guidelines.
Abstract The Southern Primary Care Urban Research Network (SPUR-Net) is a large, diverse practice based research network in Houston, Texas. This proposal responds to both categories of the RFA. Responding to Category I, SPUR-Net will increase its membership by adding another group of clinics in Houston. The new clinics will modestly increase the number of providers and patient visits within the network. However, each of the new clinics utilizes an electronic medical record already used by a current network member. The addition of more clinics using the EMR will facilitate research through
a) improving ease of data gathering, and b) allowing study of the EMR as a tool to facilitate translation of research into practice. As a component of the project, we will solicit research questions from new members and conduct pilot studies within the EMR network based on these suggestions. Our proposal responds to the priorities of
a) improving/developing information technology systems, b) recruitment of new members, and c) soliciting research questions from members. Responding to Category II, SPUR-Net will conduct a pilot study of the following question
Does the use of a programmed lipid management reminder system in clinics with an EMR and/or provider profiling increase compliance with the NCEPIATPIII Guidelines? This pilot project will be conducted within the SPUR-Net practices utilizing the EMR. The SPUR-Net executive committee developed this proposal which studies efficacy of an EMR based strategy to translate a clinical guideline into clinical practice. The project can provide important information to the members of SPUR-Net, and will provide data and experience to strengthen future translational research projects in the network.
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Bioterrorism and Influenza Surveillance Network
Institution UNIVERSITY OF WISCONSIN MADISON
Location MADISON, WI 53706
Project No. 1R03HS014417-01
Principal Investigator TEMTE, JONATHAN L.
First Year of Funding $99,630
Total Estimated Funding $99,630
Project Period 9/30/03-9/29/05
Abstract DESCRIPTION (provided by applicant)
The Wisconsin Bioterrorism and Influenza Sentinel Surveillance Network [BISSEN] Background
The ability to conduct sentinel surveillance for infections resulting from bioterrorism and other emerging infections is becoming an essential function of the health care system in the United States. There is little evidence in existence, however, to inform public health officials on how to engage in primary care--or on how to engage primary care clinicians--for purposes of surveillance. Building short-term or "drop-in" surveillance for bioterrorism as an add-on to existing practice-based research network (PBRN) function or to an existing nationwide influenza surveillance program may be an efficient and effective means to detect unusual events. Research Questions
Does participation in a PBRN enhance physician response to "drop-in" surveillance protocols for emerging infectious diseases and bioterrorism? Does participation by primary care physicians in an existing influenza sentinel surveillance program enhance response to "drop-in" surveillance protocols for emerging infectious diseases and bioterrorism? Experimental Design
Subjects are 120 physicians. Thirty family physician members of the Wisconsin Research Network (WReN), 30 Wisconsin Influenza Sentinel Clinician Program (WISCP) physicians, and 60 family physician members of the Wisconsin Academy of Family Physicians (WAFP) will be recruited to participate in two future episodes of "drop-in" surveillance with web-based reporting. One surveillance protocol will entail reporting the numbers and age categories of patients with acute diarrhea during a four-week period. The second protocol will involve reporting specific, HIPAA-compliant data on individual cases of acute rash illness during a two-week surveillance period. Outcome Measures
Primary outcome measures include the median rates of protocol compliance by each group of physicians for each type of protocol. The rate of participation will allow comparison of WReN physicians to WISCP physicians and family physicians engaged in organized collection of data (WReN+WISCP) to nonaffiliated physicians. Secondary outcomes will emerge as physician attitudes from a post-hoc meeting at which selected high- and low-responders from each group will be invited to interact with public health surveillance personnel. Significance
The results of this exploratory study will provide key information to public health officials, PBRN directors, and influenza surveillance coordinators as to the appropriate clinicians to recruit for bioterrorism and emerging infection surveillance. Since numerous PBRNs exist across the nation and most states have some level of influenza surveillance, the results should be generalizable to a wide geographic area. Moreover, the results will inform those interested in creating surveillance protocols on features that will enhance participation of clinicians, thus improving efforts to conduct surveillance for emerging public health threats.
Thesaurus Terms bioterrorism /chemical warfare, emerging infectious disease, epidemiology, influenza, primary care physician, public health, diarrhea, influenzavirus A, skin disorder, clinical research, human subject
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Infrastructure for Translational Research in a PBRN
Institution UNIVERSITY OF MICHIGAN AT ANN ARBOR
Location ANN ARBOR, MI 481091274
Project No. 5R03HS014413-02
Principal Investigator NEASE, DONALD E.
First Year of Funding $49,999
Total Estimated Funding $99,998
Project Period 9/30/03-9/29/05
Abstract This project will conduct two detailed on-site structural and functional assessments of practices belonging to the Great lakes Research Into practice Network in Michigan (GRIN). Assessments will be made of practice infrastructure and clinician and staff attitudes relevant for implementation of translational network trials. Specifically, we will assess these factors in relationship to partial or full implementation of a computerized reminder system (CRS). At the completion of the project each practice will receive a specific action plan, tailored to their practice, describing the steps necessary to participate in translational network trials using a CRS.
Thesaurus Terms clinical research, health care professional practice, health science research, health science research support, computer assisted patient care, health care service evaluation, information seeking behavior, patient care personnel attitude, human subject
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The Effect of EMR on Medication Safety: A SPUR-Net Study
Institution BAYLOR COLLEGE OF MEDICINE
Location HOUSTON, TX 77030
Project No. 5R03HS014406-02
Principal Investigator KUO, GRACE M.
First Year of Funding $49,905
Total Estimated Funding $99,849
Project Period 9/30/03-9/29/05
Abstract DESCRIPTION (provided by applicant)
Every year, from 44,000 to 98,000 people in the United States die as a result of medical errors. One common medical error involves medication error (e.g., prescribing or administering the wrong medication, incorrect dosing, drug interactions, failure to order therapeutic monitoring tests). Data on medication errors are collected predominantly in hospitals, where it is easier to monitor such errors and to identify patients experiencing adverse drug events. However, in the United States, most medications are prescribed by primary care physicians in the outpatient setting. While computerized physician order entry systems (CPOE) have been shown to decrease medication errors in the inpatient setting, their effect at the point of care in the outpatient setting has not been well studied. The specific aim of this two-year study is to determine the frequency, type, severity, and preventability of medication errors in primary care settings that use an electronic medical record (EMR), with advanced decision support at the point of care, compared with primary care settings where a paper medical record (PMR), without advanced decision support, is used. The study will be conducted in four clinical settings, each representing one constituent organization of the Southern Primary Care Urban Research Network (SPUR-Net(SM)), which is located in Houston, Texas, and administered by Baylor College of Medicine. Two sites use an EMR, Logician(R), and two use PMR. The study will proceed in three phases. In phase I, a random sample of 500 adult patients (125 from each site) who receive a new prescription at the index study visit will be recruited. Consent will be obtained for a medical record review (phase II), where diagnostic codes (ICD-9), medications, and toxic/therapeutic monitoring test results will be abstracted. Phase III will involve a telephone interview occurring within two weeks of the index visit to assess prescription fill and significant symptoms experienced. Medication errors will be identified and classified using a modified version of the Brigham and Women's Medication Safety Protocol and the National Coordinating Council for Medication Error Reporting and Prevention Classification of Medication Errors. Inter-rater reliability will be assessed in a random 10-percent sample of patients. Several of the SPUR-Net partnering organizations have adopted an EMR, while other partners have plans for implementing an EMR in the future. We therefore have the opportunity to use this natural experiment to test the impact of an EMR, compared with a PMR, in reducing medication errors in primary care settings. The proposed research is innovative, as it will provide an understanding of medication errors in a diverse primary care population and assess the effect of computerized physician order entry system with computerized decision support in decreasing medication errors. Moreover, these outcomes will fundamentally advance our knowledge and the promotion of medication safety.
Thesaurus Terms automated medical record system, computer assisted medical decision making, computer assisted patient care, data collection methodology /evaluation, outpatient care, patient safety /medical error, primary care physician, drug adverse effect, medical record, outcomes research, user protection, behavioral /social science research tag, clinical research, health services research tag, human subject, interview, patient oriented research
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Trial to Reduce Antibiotic Use in A Primary Care PBRN
Institution BRIGHAM AND WOMEN'S HOSPITAL
Location BOSTON, MA 02115
Project No. 5R03HS014420-02
Principal Investigator BATES, DAVID W.
First Year of Funding $50,000
Total Estimated Funding $100,000
Project Period 9/30/03-9/29/05
Abstract DESCRIPTION (provided by applicant)
Background
Upper respiratory tract infections (URIs) are the number one reason for prescribing antibiotics in the United States. Most antibiotic prescribing for URIs is done in primary care and much antibiotic prescribing for URIs is inappropriate. Inappropriate antibiotic prescribing exposes patients to unnecessary medication, increases the prevalence of antibiotic-resistant bacteria, and increases medical costs. Interventions are needed to reduce inappropriate antibiotic prescribing for URIs in primary care. The PBRN
The Brigham and Women's Primary Care Practice-Based Research Network (BWPC-PBRN) consists of 12 ambulatory clinics with 95 physicians who serve a socioeconomically and ethnically diverse patient population. The BWPC-PBRN had 237,530 total patient visits and had 17,443 visits for URIs in 2002. BWPC clinics are linked organizationally and electronically with e-mail and the use of a common electronic medical record that allows linkage of diagnostic, prescribing, and other clinical data. Research Plan
We propose to develop and evaluate a novel electronic medical record-based URI-care template in the BWPC-PBRN through two specific aims. Specific aim 1 is to design and implement an electronic medical record-based template for the care of patients with URIs in primary care practice, the URI Smart Set. The URI Smart Set will include easy documentation in the form of checkboxes for symptoms and physical findings; automatic importation of patients' problems, allergies, and medications; decision-support for the treatment of sinusitis, pharyngitis, and acute bronchitis; printable patient handouts about URIs, self-care, and antibiotics; and access to relevant medical literature. Specific aim 2 is to test the implementation of the URI Smart Set in a randomized, controlled trial. Following a baseline period, 18 practices within the BWPC-PBRN will be randomized to control status or to the use of the URI Smart Set. The primary outcome will be antibiotic prescribing for URIs during a six-month period. Secondary outcomes will be the appropriateness of antibiotic prescribing, 30-day repeat visits, antibiotic costs, and barriers to the use of the URI Smart Set. Future Directions
Longer term goals of this research include optimization of the usability and functionality of the URI Smart Set; serving as a prototype for standardizing documentation for other clinical problems in primary care; rapidly identifying patients who potentially meet criteria for inclusion in future trials of therapy in URI care; and providing real-time surveillance for bioterrorist attacks or the emergence of novel respiratory pathogens, such as severe acute respiratory syndrome (SARS).
Thesaurus Terms antibiotic, automated medical record system, computer assisted medical decision making, drug administration rate /duration, health care service evaluation, primary care physician, respiratory disease /disorder therapy, respiratory infection, bacterial disease, clinical trial, computer network, drug resistance, health care quality, health education, self care, behavioral /social science research tag, bioengineering /biomedical engineering, clinical research, health services research tag, human data, human subject, patient oriented research
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Computerized Interviews to Assist Secondary Prevention
Institution UNIVERSITY OF IOWA
Location IOWA CITY, IA 52242
Project No. 5R03HS014410-02
Principal Investigator HARTZ, ARTHUR J.
First Year of Funding $56,800
Total Estimated Funding $99,957
Project Period 9/30/03-9/29/05
Abstract DESCRIPTION (provided by applicant)
Good diabetic care depends on patient behaviors and clinical management. It is often more difficult to achieve in rural than in urban settings. Our practice-based research network (PBRN) proposes to develop and pilot test a new information technology for gathering and summarizing information about patient self-care behaviors. The technology will use computer tablets to administer a questionnaire that we have recently developed and validated for patients with diabetes. The questionnaire assesses behaviors that influence the course of diabetes (e.g., those relating to medications, nutrition, physical activity, and glucose monitoring), barriers to those behaviors, attitudes about diabetes, family support, general health, and mental health. We will program the questionnaire on computer tablets so that patients will be able to respond to the questions using touchscreen technology and handwrite or type answers to questions. Two versions of the questionnaire will be programmed on the computer tablet. One version will contain comprehensive closed-ended questions that the patient can respond to using touch screens. A second questionnaire will cover the same topics but use open-ended questions to substitute for a series of close-ended questions. The computer program will summarize the input from the questionnaire to identify behaviors or barriers that should be discussed further with the patient. The technology will be developed over a six-month period in one practice and tested for one year in two additional practices. All three practices are part of the Iowa Research Network (IRENE). This pilot study will evaluate and compare the questionnaires for whether they are well accepted by patients and physicians, require only a moderate effort to implement, and provide new information that helps the physician manage the patient. A cost-effective technology that helps physicians manage health behaviors of patients with diabetes could easily be extended for helping physicians assist patients with self-care of other chronic diseases.
Thesaurus Terms computer assisted patient care, computer program /software, computer system design /evaluation, data collection, data collection methodology /evaluation, disease /disorder prevention /control, health behavior, noninsulin dependent diabetes mellitus, patient care management, questionnaire, self care, attitude, functional ability, mental health, personal computer, physician, behavioral /social science research tag, bioengineering /biomedical engineering, clinical research, human subject, rural area
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Piloting Tools to Improve Nutritional Health in Primary*
Institution CHILDREN'S MEMORIAL HOSPITAL (CHICAGO)
Location CHICAGO, IL 606143394
Project No. 5R03HS014431-02
Principal Investigator ARIZA, ADOLFO J.
First Year of Funding $90,324
Total Estimated Funding $100,001
Project Period 9/30/03-12/31/05
Abstract DESCRIPTION (provided by applicant)
The Pediatric Practice Research Group (PPRG) is a well-established primary care research network in the Chicago area. It is a diverse network representing an array of patients across racial and ethnic groups and socioeconomic categories, with a research agenda that includes the study of preventive care delivery, particularly related to nutritional health. Its directors are supported within Children's Memorial Hospital and the Department of Pediatrics, Feinberg School of Medicine, Northwestern University. This pilot study will test the implementation of a program to aid health providers in the interpretation of child growth and the routine delivery of nutritional counseling in two PPRG practices. The program includes a practice educational intervention and the use of a computerized system using newly-developed software that has the ability to track growth and provide personalized handouts about child nutrition according to child age and nutritional status categories. The aims of the study are to
1) determine changes effected by the program in the rates of identification of overweight or at risk for overweight children, in the provision of counseling on healthy behaviors, and in patient flow; 2) assess practice use of and reactions to the new systems; 3) obtain feedback that will lead to improvements in the proposed changes to common practice processes and the software; and 4) examine the cost of implementing this system. The proposed program will be implemented at 2 diverse practices, one with a majority of white, privately-insured patients and the other a community health center serving low-income African American and Hispanic patients. This study will use visit observations and medical record reviews to evaluate practice system changes and care delivery. Acceptance of the system by the practice members will be done through practice member survey and interviews of key informants. Through this pilot study, we will test and refine the implementation of the computerized system. The program has been developed by the PPRG based on findings from other PPRG studies. The program could change the delivery of care to allow practices to more easily include routine growth interpretation and child-specific counseling on healthy behaviors, thus increasing the motivation of physicians to address this key area. This pilot will provide sufficient data to support wide-spread evaluation of the program across an array of diverse practice settings.
Thesaurus Terms child physical development, computer assisted patient care, developmental nutrition, health care personnel education, patient care management, pediatrics, primary care physician, African American, Hispanic American, caucasian American, community health service, counseling, health care cost /financing, health care professional practice, obesity, racial /ethnic difference, clinical research, human subject, nutrition related tag
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Evaluating a Patient-Centered Diabetes Registry
Institution UNIVERSITY OF COLORADO DENVER/HSC AURORA
Location AURORA, CO 800450508
Project No. 1R21HS014871-01
Principal Investigator MAIN, DEBORAH S.
First Year of Funding $230,994
Total Estimated Funding $461,972
Project Period 9/30/03-9/29/06
Abstract DESCRIPTION (Provided by Applicant)
Primary care clinicians are responsible for delivering a large percentage of chronic illness care, yet adoption of new models of chronic care has been slow in these settings. Some primary care practices use disease registries to identify and track patients with chronic disease, but few collect and track clinical data to monitor and/or improve practice. To realize the benefits of an improved system of chronic care, registries must become easier to use and sustain in busy primary care offices. Information technology offers the ability to automate many of the functions of a disease registry and improve its feasibility. Also, the effectiveness of registries might be enhanced by expanding their use beyond the primary care practice to include another important member of the chronic care team
the patient. The purpose of this proposed project is to study the feasibility of implementing a patient-centered registry for improving diabetes care in primary care. Unlike typical, passive diabetes registries designed to monitor only those services initiated by clinicians, we will test a bi-directional registry where both patients and practices can enter data and receive tailored information about guideline-concordant diabetes care and self-management. A multi-step translational research framework is proposed to guide testing, implementation, and ongoing evaluation of the intervention. First, we will involve "end-users" (patients, clinicians, and clinic support staff/administration) in usability testing of our patient-centered diabetes registry. Second, we will use evidence-informed processes for planning and implementing this patient-centered registry within primary care practices, with strategies designed to enhance acceptance, adoption and implementation. Finally, using a participatory research approach, we will work closely with primary care practices in ongoing learning and improvement. Using the RE-AIM framework, our evaluation is designed to study reach, effectiveness, adoption and implementation during all phases of developing and testing the patient-centered registry. Results from this project will set the stage for a full-scale randomized controlled trial to study the effectiveness of a patient-centered diabetes registry across diverse practices, clinicians and people with diabetes.
Thesaurus Terms diabetes mellitus, health care service evaluation, patient /disease registry, patient care management, primary care physician, self care, clinical research, health services research tag, human subject
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Delivery of Preventive Services in Primary Care
Institution UNIVERSITY OF OKLAHOMA HLTH SCIENCES CTR
Location OKLAHOMA CITY, OK 73117
Project No. 1R21HS014850-01
Principal Investigator Mold, James
First Year of Funding $219,750
Total Estimated Funding $439,500
Project Period 9/30/03-9/29/06
Abstract DESCRIPTION (Provided by Applicant)
The Center for Family Medicine Research at the University of Oklahoma and the Oklahoma Physicians Resource/Research Network, in collaboration with Medical Data Solutions, Inc., (a software development company) will study the effectiveness of a multi-component intervention to translate three office system strategies known to increase delivery of immunizations and other preventive services in a group of primary care practices. The translational intervention will include medical record audits with feedback and benchmarking, academic detailing by a local opinion leader including suggestions derived from peer exemplars (results of "best practices research"), a practice enhancement assistant (practice facilitator), and a computer application designed to help the practice incorporate and maintain the office system strategies. The strategies of interest include nurse standing orders, a recall and reminder system, and special immunization and preventive services clinics. Practices will be randomized to the multi-component intervention group or to the control group, which will receive feedback with benchmarking alone. The primary outcome measure will be the number of office system strategies (of the three) adopted by the practice. Contextual factors and barriers and their impact on adoption of the office system strategies will analyzed. Finally, we will also compare the rates of delivery of selected immunizations and preventive services to determine the size of the effect of the intervention on preventive services delivery. This two-year study, though relatively small, will contribute to our understanding of multi-component translational interventions within practice-based research networks.
Thesaurus Terms disease /disorder prevention /control, health care model, health care policy, health care service availability, health care service evaluation, health care service planning, patient care management, primary care physician, clinical trial, computer assisted patient care, health care referral /consultation, human middle age (35-64), human old age (65+), immunization, mammography, medical appointment, neoplasm /cancer diagnosis, preschool child (1-5), behavioral /social science research tag, clinical research, data collection methodology /evaluation, focus group, health services research tag, human data, medical record, questionnaire
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