PBRNs Translating Research into Practice (TRIP) Awards--Round One
Primary care practice-based research networks (PBRNs) are groups of primary care clinicians and practices working together to answer community-based health care questions and translate research findings into practice. In 2004, the Agency for Healthcare Research and Quality (AHRQ) awarded translational research grants totaling more than $2 million to 5 PBRNs.
In late 2003, the Agency for Healthcare Research and Quality (AHRQ), in conjunction with the National Cancer Institute (NCI), solicited research proposals from primary care Practice-Based Research Networks (PBRNs) to evaluate science-based strategies for translating evidence into sustainable improvements in clinical practice and outcomes, and/or the development, improvement, or validation of research dissemination methods applicable to cancer control in primary care practice. In 2004, AHRQ awarded grants to 5 networks in the first of 2 funding rounds.
Network: Ambulatory Care Outcomes Research Network (ACORN)
Principal Investigator: Stephen F. Rothemich
Project Number: HS014854
Summary: The offer of counseling and pharmacotherapy to patients who use tobacco products is among the most important primary care evidence-based interventions. Studies suggest, however, that only a fraction of tobacco users receive this assistance. The network proposed a novel solution that combined a simple office system—which is widely adoptable—with a form of third-party counseling (telephone quit lines) accessible by most U.S. practices.
The three-part intervention includes:
- An in-office expanded "vital signs" intervention that prompts nurses (or medical assistants) to determine tobacco use status, offer brief advice, and assess readiness to quit as vital signs are obtained.
- Invitations to preparation-stage tobacco users for proactive telephone counseling (provided by the American Cancer Society) comprised of three 30-minute sessions scheduled at the patient's convenience.
- Feedback from the Society to the practice—including fax requisitions for quit-attempt prescription aids, counseling results progress reports, and quarterly aggregate analyses of practice and clinician team referral outcomes.
The Virginia Ambulatory Care Outcomes Research Network will partner with the American Cancer Society to test this strategy in a randomized controlled trial conducted at 16 primary care practices in Virginia. Given the widening availability of state and national quit line programs, this model for referrals and bidirectional communication with primary care could markedly augment the effectiveness of both primary care and quit lines in promoting tobacco cessation, while providing an attractive alternative for clinicians who themselves lack the time and resources to provide effective counseling.
Network: Colorado Research Network (CaReNet)
Principal Investigator: Deborah S. Main
Project Number: HS014871
Summary: Primary care clinicians are responsible for delivering a large percentage of chronic illness care, yet the adoption of new chronic care models 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 the practice. Information technology offers the ability to automate many of the functions of a disease registry, while increasing 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, the project will test a bidirectional registry in which patients and practices can enter data and receive tailored information about guideline-concordant diabetes care and self-management. A multistep translational research framework is proposed to guide testing, implementation, and ongoing evaluation of the intervention.
Using the RE-AIM framework, our evaluation is designed to study reach, effectiveness, adoption, and implementation during all phases of the registry development and testing. Results from this project will inform a full-scale randomized controlled trial to study the effectiveness of a patient-centered diabetes registry across diverse practices, clinicians, and patients with diabetes.
Network: Collaborative Research Network (CRN)
Principal Investigator: Dean Schillinger
Project Number: HS014864
Summary: The IDEALL Project (Improving Diabetes Efforts Across Language and Literacy) is a 3-arm randomized controlled trial comparing a communication technology-based intervention (automated telephone diabetes management) to an interpersonally-oriented intervention (group medical visits) in a CRN-affiliated safety-net health system, the Community Health Network of San Francisco (CHNSF). The proposal aims to:
- Extend these self-management support strategies to more patients and providers in a total of 4-5 primary care practices within the CHNSF.
- Compare the relative effects of these two interventions with respect to each other as well as to usual primary care.
- Explore contextual factors that moderate both the effects of the interventions on patient outcomes as well as the success of implementation and maintenance.
The outcomes of interest for the IDEALL Project will include the extent of patient participation, engagement with the interventions, changes in diabetes indices (such as diabetes self-efficacy, and glycemic control), and relative resource use. Candidate-moderating variables of interest will include those at the patient/family level, clinician level, practice level, and organization level; additional contextual factors will reside in the interfaces between levels, such as the patient-clinician interface, the clinician-practice interface, the patient-practice interface, and organization-practice interface. Measures of main outcomes will consist of quantitative data; contextual factors will be collected through a combination of quantitative and qualitative methods, and analyses will proceed via a mixed methods approach.
We plan to apply what we learn with regard to effectiveness and contextual factors to better assess the transferability of interventions to other CRN practices, so as to target and facilitate future implementation and maintenance efforts. This proposal presents an opportunity both to assess the degree to which results of efficacy studies can be translated into improvements in health status for priority populations within a safety-net delivery system, and to identify those characteristics of the complex patient-clinician-practice-organization ecology that influence effectiveness for the target population.
Network: Oklahoma Physicians Resource/Research Network (OKPRN)
Principal Investigator: James W. Mold
Project Number: HS014850
Summary: 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., 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 compare the rates of delivery for selected immunizations and preventive services to determine the size of the intervention effect 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.
Network: Washington University Pediatric/Adolescent Ambulatory Research Consortium (WU PAARC)
Principal Investigator: Jane M. Garbutt
Project Number: HS015378
Summary: The daily use of inhaled steroids-shown to control symptoms and reduce morbidity and emergent health care utilization in children with persistent asthma-have been deemed safe for long-term use. Inhaled steroids are, however, underutilized in community asthma care. Delivering effective preventive care for children with asthma requires a change in mindset, for parents and physicians alike, from one of a reaction orientation to one of a proactive orientation. Provider-initiated calls have been shown to be an effective way to deliver routine care and behavioral interventions to patients with chronic diseases, and have reduced morbidity and utilization of health services.
Redesigning primary care to share the work of asthma care-and the use of the telephone in a self-management program for parents-can better provide optimal asthma care for children in the community. Collaboration among experienced Washington University asthma researchers and the WU PAARC network of community pediatricians affords an opportunity to build on previous work and to evaluate this approach in the primary care setting. The Telephone Asthma Program (TAP) comprises a series of brief, proactive telephone consultations with a trained nurse to augment the care provided by the child's pediatrician and facilitate self-management by the parent. The nurse monitors symptoms, teaches self-management skills, and collaborates with the parents to increase the effective use of inhaled steroids, while also providing support and reminding the parent to seek appropriate follow-up care with their pediatrician.
We hypothesize that the Telephone Asthma Program will reduce the incidence of acute exacerbations of asthma that require emergent care, improve the quality of life of children with asthma and their parents, and increase the daily use of inhaled steroids in children with persistent asthma. We will evaluate the Telephone Asthma Program in a randomized controlled trial involving 360 St. Louis-area children ages 5 to 12 years old and served by pediatrician members of WU PAARC.
TRIP Awards—Round Two
In 2006, AHRQ and the National Cancer Institute will award additional grants in the second and final round of this program.
Current as of May 2006
PBRNs Translating Research into Practice (TRIP) Awards—Round One. May 2006. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/research/pbrn/pbrntrip1.htm