Research Overview
The VCU Department of Family Medicine and Population Health has a tradition of leadership in research since its inception. The seminal "Virginia Study"-(PDF Download), which was published in 1975 and was among the first efforts to characterize the content of primary care practice, served as the guide for both medical student and resident education in the discipline. The North American Primary Care Research Group (NAPCRG) originated at VCU. We have an active practice based research network - the Ambulatory Care Outcomes Research Network (ACORN) that has tackled practical questions about how to improve care and care experiences since 1999. We lead and staff the enormously successful Grant Generating Project that, as of 2015, had helped 175 fellows acquire grantsmanship skills, with a resulting $781,000,000 in funding. Our department also supports the VCU Center on Society and Health, established in 2007 by one of our research faculty leads and now seen as a national leader in social determinants of health research that informs public policy.
Our core research faculty has expertise in both quantitative and qualitative methods and a well- funded history investigating chronic disease, prevention, practice redesign, medical errors, and health information technology. We have a terrific team of professional research associates who understand the needs of primary care practices and ensure the success and impact of our research. Two of our faculty are on tactic teams for the multi-million dollar Family Medicine for America's Health initiative, two of our faculty memebers has been elected to the prestigious National Academy of Medicine (formerly Institute of Medicine), and two of our faculty are current or former members of the U.S. Preventive Services Task Force. We are on an upward trajectory and are energized by the goal of helping achieve better health, better care, and lower costs for all Americans. Learn more about our team and more about our recent and current work.
Department of Family Medicine
Our Research
Our mission is to improve health and transform care delivery through primary care research and implementation.
We engage primary care clinicians who inform our investigative direction and focus, and encourage them to develop research questions and perspectives relevant to their everyday experiences. Collaboration is the key to ACORN’s success, relying on strong partnerships with practices, health systems, other universities and PBRNs, community organizations, businesses, insurers, and public health entities. Our relationships help to inform study ideas, carry out interventions, interpret and disseminate findings, and ensure that positive transformative methods found are implemented into practice.
ACORN consists of more than 100 primary care practices in the commonwealth of Virginia who currently collaborate, or have previously collaborated, with us on research activities. An additional 200 practices have been partners in academic and service activities. These practices serve suburban, urban, and rural communities throughout Virginia, range in size from 1 to 18 providers, and operate under diverse ownership models —essentially representing the entire spectrum of primary care in Virginia. ACORN has affiliations with multiple health systems across the state, with many receiving designations as Medicare Accountable Care Organizations (ACOs) and Patient-Centered Medical Homes (PCMH).
Supporting Practices to Adopt Registry-based Care (SPARC)
Principal Investigator: Rebecca S. Etz, PhD & Jesse Crosson, PhD (Mathematica, Inc.)
Sponsor: National Institute of Diabetes and Digestive & Kidney Diseases
Start Date: October 2013
The purpose of this study is to test the effectiveness, and cost-effectiveness, of a low resource, low impact process for initiating improvement in the primary care management of patients with type 2 diabetes through implementation of a diabetes registry. Using a self assessment tool, a milestones document, area-based peer mentors, and a physician informaticist, we help practices to adopt registries responsive to their community context and the people they serve.
Implementing Personal Health Records to Promote Evidence-Based Cancer Screening
Principal Investigator: Alex H. Krist, MD, MPH
Sponsor: National Cancer Institute
Start Date: September 2013
This study is based on the concept that patient-centered personal health records with higher levels of functionality, combined with practice redesign to make use of these functions, can help patients obtain recommended cancer screening tests by linking them to their doctor’s records, explaining information in lay language, displaying tailored recommendations and educational resources, providing logistical support and tools to stimulate action, and generating reminders. This project will measure whether making these resources available to primary care practices and patients promotes shared decision-making and increases the delivery of cancer screening compared to existing information systems.
Understanding Patient Preferences for Informed Decision-Making
Principal Investigator: Steven H. Woolf, MD, MPH
Sponsor: Patient Centered Outcomes Research Institute (PCORI)
Start Date: October 2012
The study seeks input from patients about how they approach difficult decisions about screening for breast, colorectal, and prostate cancer and their preferences for using scientific information in making those decisions. Users of MyPreventiveCare are invited to complete MyQuestions, a tool created for this project that assembles a profile of the patient's informed decision making preferences. If patients wish, their IDM preferences are forwarded to their physician ahead of upcoming appointments. Both patients and clinicians complete a Post-Encounter Survey after the appointments, and 30 of the visits are audio recorded, to study the extent to which the patient's preferences were addressed during the encounter.
Principal Investigator: Daniel R. Longo, ScD
Sponsor: Agency for Healthcare Research and Quality (AHRQ)
Start Date: September 2012
The objective is to build the scientific base for effective public reporting of healthcare quality by examining the nature, type and dissemination of public reports by engaging consumers in focus groups to identify their needs in healthcare decision-making. The project is intended to fill two of the major gaps in the public reporting evidence base identified through the engagement of subgroups of AHRQ’s priority populations and Medicare beneficiaries as they relate to study consumer views of the design, content, and dissemination of public reports.
The Primary Care Team: Learning from Effective Practices (LEAP), Phase 2
Principal Investigator: Rebecca S. Etz, PhD
Sponsor: Robert Wood Johnson Foundation
Start Date: September 2014
The purpose of Phase 1 of LEAP was to study high-functioning primary care sites with interesting team models and use of staffing in order to construct a Technical Assistance Package. Following intensive site visits to 30 exemplar practices conducted during Phase 1, Phase 2 involves pilot testing the tools created through Phase 1, as well as dissemination of findings.
Define and Support a Qualititative Research Agenda
Principal Investigator: Rebecca S. Etz, PhD
Sponsor: American Board of Family Medicine
Start Date: July 2013
The purpose of this project is to assist the American Board of Family Medicine in creating, prioritizing, and implementing a qualitative research program for the Board, as well as identifying, hiring, training, and mentoring a qualitative investigator to work full time for the Board. Our first collaboration involved a mixed methods analysis of over 1million open text comments to feedback surveys about the Self Assessment Modules.
Communities and Practices – Solutions through Open Neighborhood Engagement (CAPSTONE)
Principal Investigator: Rebecca S. Etz, PhD
Sponsor: Faculty Excellence Award
This project is focused on a process of collaboration with community members living in the East End of Richmond on a research priority defined by them. Following a three-day research retreat with ten community members, we defined our objective as building resources and skills in the community for parents of children diagnosed with ADHD. The team co-created the research questions, protocols, and tools. Following the analysis of focus group data, we will create brochures to be distributed widely with the help of our community partners: VCU’s Center of Excellence for Health Disparities and Healthy Start Richmond.
Care Coordination in Complex Care Clinics (C5)
Principal Investigator: Rebecca S. Etz, PhD
Sponsor: Faculty Excellence Award and Office of Health Innovation
This study will evaluate the inter-professional team model used by Virginia Coordinated Care’s Complex Care Clinic and the effectiveness of that model from the perspective of the clinical team and patients served by the clinic.
Community Vital Signs: Integrating community data with primary care
Principal Investigators: Winston Liaw, MD, MPH; Alex Krist, MD, MPH
Start Date: June 2015
Clinicians lack a road map for integrating public health and primary care. In this project, we will combine clinical data from primary care clinics with publicly available data about patients' communities (community vital signs). Following this integration, we aim to identify patients living in cold spots (resource poor communities), determine whether living in cold spots is associated with worse outcomes, and explore how practices could use community vital signs for population care.
It is the policy of the Department of Family Medicine and Population Health not to accept funding for its research program from the tobacco industry.
Best Research Paper | |
Awarded to: | A.H. Krist, S.H. Woolf, S.F. Rothemich, R.E. Johnson, J.E. Peele, T.D. Cunningham, D.R. Longo, G.A. Bellow, G.R. Matzke |
By: | Society of Teachers of Family Medicine (STFM), 2014 |
For: | “Interactive Preventive Health Record to Enhance Delivery of Recommended care: A Randomized Trial.” |
National Leadership Award | |
Awarded to: | S.H. Woolf |
By: | Society of Behavioral Medicine, 2012 |
National Committee Chair: Understanding International Health Differences in High-Income Countries | |
Honor to: | S.H. Woolf |
From: | National Research Council, 2011 |
Glasgow Faculty Excellence Award | |
Awarded to: | R.S. Etz |
By: | Glasgow Family Trust, 2011 |
2009 Year in Research Award | |
Awarded to: | S.H. Woolf |
By: | Robert Wood Johnson Foundation, 2010 |
Katherine Boucot Sturgis Award | |
Awarded to: | S.H. Woolf |
By: | American College of Preventive Medicine, 2010 |
For: | A New Decade of Opportunities and Expectations for Preventive Medicine |
Standing Study Section Member | |
Honor to: | D.R. Longo |
From: | Agency for Healthcare Research and Quality (AHRQ), 2010-2011 |
Family Physician of the Year | |
Awarded to: | J.W. Kerns |
By: | Virginia Academy of Family Physicians, 2010 |
Academy of Mentors Founding Member | |
Honor to: | D.R. Longo |
From: | VCU Center for Clinical and Translational Research (CCTR), 2010-2012 |
Distinguished Abstract Award | |
Awarded to: | A.H. Krist, S.H. Woolf, D.R. Longo, S.F. Rothemich, R.E. Johnson, J.E. Peele, J.F. Loomis, A.J. Kuzel, J.W. Kerns, G.R. Matzke |
By: | Academy Health, 2009 |
For: | "An Interactive Preventive Healthcare Record to Promote Delivery of Patient-Centered Preventive Care" |
Mid Career Achievement Award | |
Awarded to: | J.W. Kerns |
By: | Society of Teachers of Family Medicine, 2009 |
Best Research Paper | |
Awarded to: | A.H. Krist, R.M. Jones, S.H. Woolf, S. Woessner, D. Merenstein, J.W. Kerns, W. Foliaco, P. Jackson |
By: | Society of Teachers of Family Medicine (STFM), 2009 |
For: | "Timing of Repeat Colonoscopy: Disparity Between Guidelines and Endoscopists' Recommendation" |
The following projects and initiatives have been completed by the Department of Family Medicine and Population Health:
- Promoting Use of a Personal Health Record for Prevention
- Quality Performance Measurement
- An Interactive Preventive Health Record (IPHR) to Improve Patient-Centered Care
- Colorectal Cancer Screening Barriers Study
- QuitLink: A Leveraging Solution to Tobacco Counseling
- Comprehensive Practice-Friendly Model for Promoting Healthy Behaviors
- Colonoscopy Screening Frequency
- Promoting Health Behaviors in Primary Care Research Networks
- Does Checking Smoking Status as a Vital Sign Increase Physician Counseling? A Practice-Level Randomized Controlled Trial
- Tobacco Use in Primary Care Practice Populations: A Pilot Cohort Study
- A Preventive Care Website to Promote Primary and Secondary Prevention of Cancers
- Primary Care Practice-Based Research Networks: Network Defining Data
Promoting Use of a Personal Health Record for Prevention
Start Date: June 15, 2010
Principal Investigator: Alexander H. Krist, MD, MPH
Sponsor: Agency for Healthcare Research and Quality (AHRQ)
Description
Exploratory and developmental grant to improve health care quality through health information technology.
Quality Performance Measurement
Start Date: Oct. 1, 2007
Principal Investigator: Daniel L. Longo, ScD
Sponsor: Agency for Healthcare Research and Quality (AHRQ)
Aims
This contract’s main objective is to produce a comprehensive report on issues involved in supporting primary care practices in collecting and reporting quality performance data, current effective strategies that practices have implemented to collect and report quality data, and potential innovations in the field as described in the tasks and sub-tasks in AHRQ’s Task Order Number Four. We are identifying barriers and facilitators to data reporting and collecting, as well as potential solutions and strategies for primary care offices. AHRQ Conference on Health Care Data Collection and Reporting: Collecting and Reporting Data for Performance Measurement serves as the task order’s foundation and guides the final report format.
Description
The Virginia Ambulatory Care Research Outcomes Network intervention is using a combination of comprehensive literature review, on-site focus group visits and consultative and peer mentoring approaches. To guide our work and analyses, our task order project utilizes a conceptual framework derived from three lines of inquiry including quality of care with an emphasis on performance reporting and provider behavior change, diffusion of innovation theory and competing demands in primary care practice. Nine ACORN practices are undergoing detailed assessment regarding data measurement and utilization, and staff and consultants work with six small practices selected from the nine. Using qualitative research methods, we are developing six case studies including “member checks,” conducting an in-depth literature review and synthesis, performing environmental scanning and synthesizing all project findings. Finally, we are focusing on the results of the task order’s identification, examination and recommendations on current challenges, strategies for overcoming barriers and facilitating solutions in collecting and reporting data for performance measurement. Innovative dissemination strategies using case studies are employed in a variety of venues to reach practicing primary care clinicians, administrative and office staff and policy-makers.
An Interactive Preventive Health Record (IPHR) to Promote Patient-Centered Care
Start Date: September 2007
Principal Investigator: Alexander H. Krist, MD, MPH
Sponsor: Department of Health and Human Services, Agency for Healthcare Research and Quliaty (AHRQ)
Hypothesis
We posit that an interactive preventive health record, designed to provide patients with preventive health information from their clinician’s electronic medical records and link patients to educational resources, decision aids and a tailored list of prevention recommendations, will increase the delivery of recommended screening tests, immunizations and counseling. We propose to test four specific aims in a randomized controlled trial.
Aims
Our study evaluates whether an invitation from a patient’s primary care clinician to use the IPHR, versus the usual delivery of preventive care, results in the following outcomes for adult patients:
- Increased delivery of age- and gender-appropriate clinical preventive services.
- Use of the IPHR.
- Increased shared decision-making for preventive services.
- Improved clinician-patient communication about preventive needs.
Description
We are conducting a randomized controlled trial involving 5,500 patients (2,750 intervention and 2,750 control patients) randomly selected from the practice population. Intervention patients receive a tailored postal request from their personal clinician to visit the IPHR for assistance with managing their preventive care, while control patients receive usual preventive care. Outcomes being investigated include both the delivery of preventive care (whether patients are up-to-date on age- and gender-appropriate preventive services) and specific domains of patient-centered care (the patient’s perspective on the care experience). Outcomes are assessed from two separate patient postal surveys (a Preventive Services Survey to assess delivery of preventive care and the CAHPS Clinician and Group Survey to evaluate patient-centered care measures), EMR data queries and automated reports from the IPHR about patient and clinician use of the HIT tool. To limit survey length and ensure adequate response rates, we are selecting two separate cohorts of study participants for outcomes measurement. We are mailing each cohort a different postal survey — the Preventive Services Survey for 4,500 patients and the CAHPS Survey for 1,000 patients — in January 2008 (baseline), January 2009 (six months after the intervention) and January 2010 (18 months after the intervention). We plan a pre-post cohort analysis of outcomes, comparing the change from baseline to six and 18 months for the intervention and control groups. Patient and practice perspectives about implementation of the IPHR are further assessed by qualitative analysis of focus groups.
Colorectal Cancer Screening Barriers Study
Start Date: May 5, 2005
Principal Investigators: Steven H. Woolf, MD, MPH, Resa M. Jones, PhD, project director
Sponsor: National Cancer Institute and Agency for Healthcare Research and Quality (AHRQ)
Hypothesis
Colorectal cancer is the second leading cause of cancer-related deaths in the U.S. An estimated 148,610 new cases of CRC and 55,170 deaths will occur in 2006. Screening for all Americans aged 50 and older is uniformly recommended by at least one of four screening options: fecal occult blood testing, flexible sigmoidoscopy, colonoscopy or double-contrast barium enema. A major factor limiting screening effectiveness is the low proportion of the eligible population that undergoes screening. Understanding the relative importance of screening determinants is essential to prioritize potential public health, clinical and policy strategies to enhance CRC screening.
Description
The primary aim of this study is to describe the factors that patients identify as their reason(s) for not undergoing screening for CRC and the relative importance they assign to each factor. The primary outcome of this study is a profile of CRC screening barriers that patients identify in their responses to the postal survey.
QuitLink: A Leveraging Solution to Tobacco Counseling
Start Date: May 2005
Principal Investigator: Stephen F. Rothemich, MD, MS
Hypothesis
Providing a new configuration of existing tools to identify smokers and connect them with community resources will increase rates of smoking-cessation counseling provided in primary care settings and will increase the number of smokers who receive community-based counseling to stop smoking.
Aim 1
To test whether delivery of A3-5 (Assess, Assist, Arrange) will be enhanced by a practice support system that combines (1) an expanded smoking as a vital sign intervention, (2) fax referral of preparation-stage patients for telephone counseling and (3) feedback to the provider.
Aim 2
To assess contextual factors that might affect implementation of the intervention and account for its ultimate success or failure. In particular, to assess: 1) environmental and practice-level factors that affect practices’ ability to successfully implement and use the intervention and 2) patient characteristics beyond readiness to change (i.e., age, gender, race/ethnicity) that affect willingness to use the quit line and complete counseling.
Description
The primary purpose of this project is to test whether the delivery of A3-5 (Assess, Assist and Arrange) is enhanced by a system that combines (1) an expanded vital sign intervention with (2) fax referral of preparation-stage patients for telephone counseling provided by the American Cancer Society (ACS) and (3) feedback to the provider. The question is examined in a randomized trial, with practices as the unit of analysis and with a control intervention consisting of a conventional vital sign intervention. The experiment therefore compares what intervention and control practices accomplish beyond simply identifying patients who use tobacco. The secondary purpose of this study is to assess contextual factors that might affect implementation of the intervention and account for its ultimate success or failure. In particular, to assess: (1) environmental and practice-level factors that affect practices’ ability to successfully implement and use the intervention and (2) patient characteristics beyond readiness to change (i.e., age, gender, race/ethnicity) that affect willingness to use the quit line and complete counseling. The study is conducted at 16 diverse family practices in Virginia.
Comprehensive Practice-Friendly Model for Promoting Healthy Behaviors
Date: 2005-2009
Principal Investigators: Steven H. Woolf, MD, MPH, Alexander H. Krist, MD, MPH, project director
Sponsor: Robert Wood Johnson Foundation
Description
Six affiliated practices adopted a brief, three-minute routine to deliver A1-3 (Ask, Advise, Agree) in the office and offered patients four options for intensive assistance (Assist [A4], Arrange [A5]) outside the office. Patients could select nine months of online, telephone or group counseling, or usual care. An electronic health record expedited the in-office intervention and referrals. Outcome measures included health behaviors, derived from 7,200 surveys administered pre-intervention and three and nine months post-exposure, and implementation, derived from EHR data, “counselee” surveys and patient/staff interviews.
Colonoscopy Screening Frequency
Date: November 2006-December 2007
Principal Investigators: Alexander H. Krist, MD, MPH, Resa M. Jones, PhD
Sponsor: Not funded
Question
To what extent are endoscopists’ recommendations on repeat colonoscopy concordant with the most current (2006) guidelines on post-polypectomy surveillance and screening?
Background
Colonoscopy possesses the highest sensitivity of available screening tests for colorectal cancer and polyps, but it also carries risks. Appropriate intervals for repeating colonoscopy are important to ensure that the benefits of screening and surveillance are not offset by harms. The study objective was to examine whether endoscopists’ recommendations for repeat colonoscopy, as communicated to primary care clinicians after the procedure, adhered to published guidelines.
Method
Analysts abstracted medical records at ten primary care practices in Virginia and Maryland in 2006. The records of a random sample of men and women (300 per practice) aged 50 to 70 years were reviewed. The sample included patients who had a colonoscopy and a written report from an endoscopist, and who lacked designated risk factors. The main outcome was concordance between endoscopists’ recommendations and published guidelines regarding repeat colonoscopy.
Results
Of 3000 charts reviewed, 1,282 (42.7 percent) included records of a colonoscopy and 1,021 (34 percent) included an endoscopist’s report. In 64.9 percent of communications, the endoscopist specified when retesting should occur. Recommendations were consistent with contemporaneous guidelines in only 39.2 percent of cases and with current guidelines in 36.7 percent of cases. The adjusted mean number of years in which repeat colonoscopy was recommended was 7.8 years following normal colonoscopy and 5.8 years and 4.4 years, respectively, when hyperplastic polyps or one to two small adenomatous polyps were found.
Conclusion
Endoscopists often recommended repeat colonoscopy at shorter intervals than are advised either by current guidelines or by guidelines in effect at the time of the procedure. Endoscopists’ communications to primary care clinicians often lacked contextual information that might explain these discrepancies. Unless appropriate caveats apply, adhering to endoscopists’ recommendations may incur unnecessary harms and costs.
Promoting Healthy Behaviors in Primary Care Research Networks
Date: July 1, 2003-Oct. 31, 2004
Principal Investigator: Steven H. Woolf, MD, MPH
Sponsor: Robert Wood Johnson Foundation
Hypothesis
Primary care patients who visit a specially designed, practice-sponsored Web site will exhibit a greater shift toward readiness to change behaviors in relation to diet, physical activity, smoking and problem drinking than occurs under usual care.
Aims
To test the effectiveness and feasibility of using a practice-sponsored Web site to help primary care clinicians promote healthy diet, physical activity, tobacco cessation and healthy alcohol use among their patients.
Description
This 16-month study employed a pre-post design to study effectiveness and feasibility in four intervention and two control practices in Northern Virginia. The aim of the Web site was to link patients with the information, resources and services that were most likely to facilitate behavior change but that were difficult to identify or arrange at the conventional office visit, or at other times when patients needed them. The Web site hosted a comprehensive array of resources regarding healthy behaviors.
Conclusion
The intervention increased the rate at which patients were referred for intensive behavioral counseling compared to current practice norms. Given the evidence that intensive counseling is more effective in promoting behavior change, implementing eLinkS could have substantial public health benefits.
Collaboration between clinicians and community resources presents a “win-win” scenario for patients, clinicians and community programs. Patients obtain more intensive assistance, while clinicians welcome an easy means to connect patients with the help they need. Community programs, which often struggle to attract clients through media and advertising, appreciate the influx of referrals from the medical community.
This formula has implications that extend beyond behavioral counseling. A system like eLinkS that facilitates systematic screening and referrals could, with some modification, help clinicians arrange screening tests and chronic disease management. Clinician-community collaboration has long been advocated for these purposes, but applying modern technology to make collaboration easy holds considerable promise.
Does Checking Smoking Status as a Vital Sign Increase Physician Counseling? A Practice-Level Randomized Controlled Trial
Dates: 1998-2005
Principal Investigator: Stephen F. Rothemich, MD
Sponsor: Robert Wood Johnson Foundation’s Generalist Physician Faculty Scholars Program
Purpose
Guidelines encourage primary care clinicians to document smoking status when obtaining vital signs, but whether this promotes cessation counseling is unclear. We examined whether the vital sign intervention influenced patient-reported frequency and intensity of tobacco-cessation counseling.
Methods
Cluster-randomized controlled trial in . Nursing staffs at intervention practices were instructed to assess the tobacco status of every adult patient and record it with the traditional vital signs. Control practices used no systematic tobacco screening or identification system. Outcomes were the proportion of smokers reporting clinician counseling of any kind and the frequency of two counseling subcomponents — simple quit advice and more intensive discussion.
Results
A total of 6,729 adult patients, including 1,149 smokers, at 18 primary care practices completed exit surveys during a six-month comparison period. Among 561 smokers at intervention practices, 61.9 percent reported receiving any counseling compared with 53.4 percent of the 588 smokers at control practices (difference 8.6 percent, p=0.04). The effect was largely restricted to simple advice, which was reported by 59.9 percent of intervention patients and 51.5 percent of control patients (p=0.04). There was no significant increase in more extensive discussion: 32.5 percent and 29.3 percent at intervention and control practices respectively (p=0.18).
Conclusions
The vital sign intervention promotes tobacco counseling at primary care practices through a modest increase in simple advice to quit. Implemented as a single intervention, it does not appear to increase intensive counseling.
Tobacco Use in Primary Care Practice Populations: A Pilot Cohort Study
Date: 2003-2004
Principal Investigators: Stephen F. Rothemich, MD, MS, Diane B. Wilson, EdD
Sponsor: Massey Cancer Center, Virginia Commonwealth University
Hypothesis
- The proposed postal methodology for longitudinal follow-up of prior in-office survey participants will result in at least a 50 percent participation rate.
- The resulting longitudinal data will be of sufficient volume and quality to estimate tobacco cessation, initiation and relapse rates in practice populations.
- The resulting longitudinal data will be of sufficient volume and quality to perform additional exploratory data analyses as described in the second aim.
Aims
- Demonstrate the feasibility of using a postal survey methodology to collect longitudinal patient-provided data in multiple primary care practices on health behaviors, functional health status, demographics and receipt of evidence-based screening tests for subsequent use in larger, longer cohort studies.
- Using longitudinal data collected from patient responses to a mailed survey, linked to participants’ administrative data and previous in-office survey responses, perform statistical analyses to examine tobacco cessation and relapse in this population, including associations with demographics, comorbidities, health status and other health behaviors, such as diet and exercise.
Description
Sequential mailing method of a survey to more than 2,500 patients in two practices who had completed a similar in-office survey at least 12 months previously. The initial survey mailing included a cover letter of invitation, consent information, a $2 participation incentive and a postage-paid pre-addressed return envelope. One week after the first mailing a reminder postcard was sent to each recipient of the initial mailing. A second survey mailing was sent to non-respondents at three weeks past the initial mailing.
Outcomes
The response rate was 56 percent, which was deemed successful in this setting. The methods used in this sequential mailing have served as the model for other studies that involved a postal survey. Analysis of respondents’ changes in responses compared to their previous in-office survey has not yet been completed.
A Preventive Care Website to Promote Primary and Secondary Prevention of Cancers
Date: April 2005-March 2006
Principal Investigator: Alexander H. Krist, MD, MPH
Sponsor: Massey Cancer Center, Virginia Commonwealth University
Hypothesis
This pilot study seeks to evaluate whether patients and physicians will use a cancer preventive care website prior to a health maintenance examination. Ultimately the Web site has the potential to improve the delivery of cancer preventive services.
Aims
- To develop a cancer preventive care website for patients that would effectively integrate multiple tools proven to improve primary and secondary cancer prevention, such as tailored health messages, reminder systems, decision aids and risk-assessment instruments.
- To evaluate perceived value and use of such a Web site by primary care clinicians and patients.
Description
A cancer preventive care website, was developed. More than 500 patients presenting for a health maintenance examination were asked to use the Web site prior to their next office visit. Participants were surveyed about their experience.
Outcomes
Of the patients instructed to use the Web site prior to their office visit, 78 percent did so. Among patients and physicians who used the website, there was satisfaction with the information provided. Helpful information about desired Web site format and content was learned and will be used in redesigning future versions of MyPreventiveCare.
Primary Care Practice-Based Research Networks: Network Defining Data
Dates: February-August 2002
Principal Investigator: Stephen F. Rothemich, MD, MS
Sponsor: Agency for Healthcare Research and Quality (AHRQ)
Objectives
This study was done in parallel with 18 other practice-based research networks across the country as part of the AHRQ Primary Care Practice-Based Research Network Initiative.
- Providing benchmark data to practices for visit data not otherwise available in ’s core data set, such as reason for encounter, health counseling/education services, medications and visit duration.
- Establishing an initial data set of provider and practice characteristics for the core data set.
- Making it possible to compare to other PBRNs and determine in what ways is similar or unique both for planning collaborative studies with other PBRNs and for speaking to the generalizability of research findings through comparison with national data.
- For data elements that do overlap with those collected through other means in , such as patient self-reported race/ethnicity and demographic, insurance status, diagnoses and procedural data from administrative data, providing an opportunity for making comparisons between these two data sources at the individual level as well as at the aggregate level as means of characterizing practices.
- Helping us focus on classification and translation of data we currently obtain, such as the practice’s designation of primary insurance type for visits, but had yet to organize in ways that allow us to make comparisons between practices or collapse the data into meaningful categories.
Description
Of 93 clinicians in 12 practices, 100 percent were invited to participate in the study, as well as 29 providers. They were asked to complete a survey form about themselves and, if willing, to record 30 encounters on a different survey form. The survey was developed in collaboration with the other 18 networks in the study, with many data elements based upon the content of the National Ambulatory Medical Care Survey from the Center for Health Statistics.
Outcomes
- contributed to AHRQ’s national inventory of practice-based research networks.
- Elements from the practice and provider surveys were incorporated into ’s yearly inventory.
Etz RS, Hahn KA, Gonzalez MM, Crabtree BF, Stange KC. |
Etz, R. 2014. Engaging the Public Through Communities of Solution and Collaborative Empowerment. Discussion Paper, Institute of Medicine, Washington, DC. http://www.iom.edu/Global/Perspectives/2014/EngagingThePublic |
Krist AH, Beasley JW, Crosson JC, Kibbe DC, Klinkman MS, Lehmann CU, Fox CH, Mitchell JM, Mold JW, Pace WD, Peterson KA, Phillips RL, Post R, Puro J, Raddock M, Simkus R, Waldren SE. Electronic health record functionality needed to better support primary care. J Am Med Inform Assoc. 2014 Sep;21(5):764-71. PMID: 24431335; PMCID: PMC4147605. |
Glasgow RE, Kessler RS, Ory MG, Roby D, Gorin SS, Krist A. Conducting rapid, relevant research: lessons learned from the My Own Health Report project. Am J Prev Med. 2014 Aug;47(2):212-9. PubMed PMID: 24953520. |
Hahn KA, Gonzalez MM, Etz RS, Crabtree BF. National Committee for Quality Assurance (NCQA) patient-centered medical home (PCMH) recognition is suboptimal even among innovative primary care practices. J Am Board Fam Med. 2014 May-Jun;27(3):312-3. PubMed PMID: 24808108. |
Rodriguez HP, Glenn BA, Olmos TT, Krist AH, Shimada SL, Kessler R, Heurtin-Roberts S, Bastani R. Real-world implementation and outcomes of health behavior and mental health assessment. J Am Board Fam Med. 2014 May-Jun;27(3):356-66.PubMed PMID: 24808114. |
Longo DR, Woolf SH. Rethinking the information priorities of patients. JAMA.2014 May 14;311(18):1857-8. PubMed PMID: 24825638. |
Stange KC, Etz RS, Gullett H, Sweeney SA, Miller WL, Jaén CR, Crabtree BF, Nutting PA, Glasgow RE. Metrics for assessing improvements in primary health care. Annu Rev Public Health. 2014;35:423-42. PubMed PMID: 24641561. |
Quillin JM, Krist AH, Gyure M, Corona R, Rodriguez V, Borzelleca J, Bodurtha JN. Patient-reported hereditary breast and ovarian cancer in a primary care practice. J Community Genet. 2014 Apr;5(2):179-83. PMCID: PMC3955454. |
Mazmanian PE, Coe AB, Evans JA, Longo DR, Wright BA. Are researcher development interventions, alone or in any combination, effective in improving researcher behavior? A systematic review. Eval Health Prof. 2014 Mar;37(1):114-39. PubMed PMID:24214416. |
Friedman A, Hahn KA, Etz R, Rehwinkel-Morfe AM, Miller WL, Nutting PA, Jaén CR, Shaw EK, Crabtree BF. A typology of primary care workforce innovations in the United States since 2000. Med Care. 2014 Feb;52(2):101-11. Review. PubMed PMID: 24374421. |
Krist AH, Shenson D, Woolf SH, Bradley C, Liaw WR, Rothemich SF, Slonim A, Benson W, Anderson LA. Clinical and community delivery systems for preventive care: an integration framework. Am J Prev Med.2013 Oct; 45(4):508-16. PubMed PMID: 24050428. |
Krist AH, Glenn BA, Glasgow RE, Balasubramanian BA, Chambers DA, Fernandez ME, Heurtin-Roberts S, Kessler R, Ory MG, Phillips SM, Ritzwoller DP, Roby DH, Rodriguez HP, Sabo RT, Sheinfeld Gorin SN, Stange KC; MOHR Study Group. Designing a valid randomized pragmatic primary care implementation trial: the My Own Health Report (MOHR) project. Implement Sci. 2013 Jun 25; 8:73. PMCID: PMC3694031. |
Goldberg DG, Beeson T, Kuzel AJ, Love LE, Carver MC. Team-based care: a critical element of primary care practice transformation. Popul Health Manag. 2013 Jun;16(3):150-6. PubMed PMID: 23405875. |
Goldberg DG, Mick SS, Kuzel AJ, Feng LB, Love LE. Why do some primary care practices engage in practice improvement efforts whereas others do not? Health Serv Res. 2013 Apr;48(2 Pt 1):398-416. PubMed PMID: 23034072. |
Kerns JW, Krist AH, Longo DR, Kuzel AJ, Woolf SH. How patients want to engage with their personal health record: a qualitative study. BMJ Open. 2013; 3(7): e002931. PMCID: PMC3731712. |
Thomson MD, Siminoff LA, Longo DR. Internet use for prediagnosis symptom appraisal by colorectal cancer patients. Health Educ Behav. 2012 Oct; 39(5):583-8. PMCID: PMC3521844. |
Krist AH, Woolf SH, Rothemich SF, Johnson RE, Peele JE, Cunningham TD, Longo DR, Bello GA, Matzke GR. Interactive preventive health record to enhance delivery of recommended care: a randomized trial. Ann Fam Med. 2012 Jul-Aug;10(4):312-9. PMCID: PMC3392290. |
Sweeney SA, Bazemore A, Phillips RL Jr, Etz RS, Stange KC. A reemerging political space for linking person and community through primary health care. Am J Public Health. 2012 Jun;102 Suppl 3:S336-41. PubMed PMID: 22690969. |
Goetz Goldberg D, Kuzel AJ, Feng LB, DeShazo JP, Love LE. EHRs in primary care practices: benefits, challenges, and successful strategies. Am J Manag Care. 2012 Feb 1;18(2):e48-54. PubMed PMID: 22435884. |
Woolf SH, Harris R. The harms of screening: new attention to an old concern. JAMA. 2012 Feb 8;307(6):565-6. PubMed PMID: 22318274. |
Krist AH, Peele E, Woolf SH, Rothemich SF, Loomis JF, Longo DR, Kuzel AJ. Designing a patient-centered personal health record to promote preventive care. BMC Med Inform Decis Mak. 2011 Nov 24;11:73. PMCID: PMC3250934. |
Kuzel AJ. Keys to high-functioning office teams. Fam Pract Manag. 2011 May-Jun;18(3):15-8. PubMed PMID: 21842804. |
Longo DR, Katerndahl DA, Turban DB, Griswold K, Ge B, Hewett JE, Dougherty TW, Schubert S. The research mentoring relationship in family medicine: findings from the grant generating project. Fam Med. 2011 Apr;43(4):240-7. PubMed PMID: 21499996. |
Katerndahl DA, Longo DR, Griswold K. Issues important to the research mentoring relationship. Fam Med. 2011 Mar;43(3):193-7. PubMed PMID: 21380952. |
Krist AH, Woolf SH. A vision for patient-centered health information systems. JAMA. 2011 Jan 19;305(3):300-1. PubMed PMID: 21245186. |
DeGruy FV, Etz RS. Attending to the whole person in the patient-centered medical home: the case for incorporating mental healthcare, substance abuse care, and health behavior change. Fam Syst Health. 2010 Dec;28(4):298-307. PubMed PMID: 21299277. |
Jones RM, Vernon SW, Woolf SH. Is discussion of colorectal cancer screening options associated with heightened patient confusion? Cancer Epidemiol Biomarkers Prev. 2010 Nov;19(11):2821-5. PMCID: PMC2976781. |
Longo DR, Schubert SL, Wright BA, LeMaster J, Williams CD, Clore JN. Health information seeking, receipt, and use in diabetes self-management. Ann Fam Med. 2010 Jul-Aug;8(4):334-40. PMCID: PMC2906528. |
Wilson DB, Johnson RE, Jones RM, Krist AH, Woolf SH, Flores SK. Patient weight counseling choices and outcomes following a primary care and community collaborative intervention. Patient Educ Couns. 2010 Jun;79(3):338-43. PubMed PMID: 20338714. |
Jones RM, Woolf SH, Cunningham TD, Johnson RE, Krist AH, Rothemich SF, Vernon SW. The relative importance of patient-reported barriers to colorectal cancer screening. Am J Prev Med. 2010 May;38(5):499-507. PMCID: PMC2946819. |
Jones RM, Devers KJ, Kuzel AJ, Woolf SH. Patient-reported barriers to colorectal cancer screening: a mixed-methods analysis. Am J Prev Med. 2010 May;38(5):508-16. PMCID: PMC2946825. |
Rothemich SF, Woolf SH, Johnson RE, Devers KJ, Flores SK, Villars P, Rabius V, McAfee T. Promoting primary care smoking-cessation support with quitlines: the QuitLink Randomized Controlled Trial. Am J Prev Med. 2010 Apr;38(4):367-74. PubMed PMID: 20307804. |
Krist AH, Woolf SH, Johnson RE, Rothemich SF, Cunningham TD, Jones RM, Wilson DB, Devers KJ. Patient costs as a barrier to intensive health behavior counseling. Am J Prev Med. 2010 Mar;38(3):344-8. PubMed PMID: 20171538. |
MyPreventiveCare: Methods to engage stakeholders in a multi-PBRN study to disseminate and implement a patient portal for prevention. |
Interactive Preventive Health Record (IPHR) to enhance delivery of recommended care. |
Innovation in data sharing and integration for community health impact. |
Electronic health record functionality needed to better support primary care: Joint statement from the AAFP, AAP, ABFM, and NAPCRG |
My Own Health Report (MOHR): Can primary care practices implement a behavioral and mental health assessment? |
Developing a Methodology to Engage Community Partners and Patients in Research. |
Obesity Prevention and Remission for Warren County VA middle school students: Improving interventions via qualitative analysis of free time. |
Public Reporting as a Communication Tool to aid Vulnerable Consumers in Healthcare Decisions: The state of the science. |
Research Challenges in the Integration of Primary Care and Public Health. APHA Panel on Advancing the Reintegration of Public Health and Healthcare. |
Clinical-Community Relationships Measures. |
Community Engaged Research and its Role in Translational Research: A Personal Discovery. Keynote address. |
Linking Primary Care and Resources in the Community to Improve Health (Workshop). |
Connecting the Dots. |
Improving Preventive Care: The Implementation Challenge and the Role of Practice-Based Research. |
BreathEasy: Development and Testing of a Smartphone Personal Health Record for Patients with Asthma. |
Dissemination and Implementation Studies across Practice-Based Research Networks. |
This Bridge Called My Practice: U.S. Healthcare and the “Business” of Primary Care Practice. |
Observations from the Academic Medicine Trenches. |
Social Determinants of Health and the Role of the Family Physician. |
Randomized Trial of an Interactive Preventive Health Record to Enhance the Delivery of Recommended Care. |
Identifying, Assessing, and Acting Upon Common Behavioral and Psychosocial Data Elements within Electronic Records. |
Patient-Centered HIT to Promote Prevention. |
Integrating a Preventive Personal Health Record into Primary Care Practice Workflow. |
Health Disparities and the Role of the Family Physician. |
Facilitators and Barriers to Integrating a Personal Health Record for Prevention into Primary Care Practices. |
Assessing the Value of Community-Based Preventive Interventions. |
The Role of Measurement in Action and Accountability. The IOM Report on Measuring Health: Methodological Implications. |
Innovations in Primary Care Staffing/Workforce Solutions and Barriers to Their Spread. |
Leveraging health information technology for patient empowerment. |
For more information and the application, please visit the GGP page on the North American Primary Care Research Group (NAPCRG) site.
Established during the 1995-96 academic year through the efforts of the NAPCRG Committee on Building Research Capacity, the GGP seeks to equip family medicine researchers with the skills they need to successfully develop and submit grants for research funding. Once learned, these skills continue to help generate new funds for family medicine research and training, year after year.
The original concept of the GGP was based on an attempt to replicate several elements of the grant generating process developed and used in the Department of Family and Community Medicine at the University of Missouri-Columbia, where faculty have successfully obtained several major research grants.
GGP is now owned and administered by NAPCRG.