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Department of Family Medicine and Population Health, VCU Medical Center, Virginia Commonwealth University Department of Family Medicine and Population Health Virginia Commonwealth University VCU Medical Center

VCU Department of Family Medicine

Research

Active projects

Researchers reviewing a mapThe following projects represent the current and ongoing Department of Family Medicine and Population Health
research initiatives:

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.

Engaging vulnerable consumers in developing useful public healthcare reports

Start date: September 2012
Principal investigator: Daniel R. Longo, Sc.D.
Funding:Agency for Healthcare Research and Quality

Objective

Our 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.  Consistent with the Patient Protection and Affordable Care Act of 2010, that aims to improve dissemination of measure of healthcare quality and resource use and as identified in AHRQ’s request for applications, we intend 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. We intend to focus on the Medicare population with a diagnosis of type 2 diabetes, because previous cognitive interviews and focus groups indicate that consumers want relevant information, such as physician or hospital performance for patients with similar health conditions. Accordingly, the diabetic population is more likely, than an apparently healthy population, to have a greater need to learn about their disease, as self-management is vital to living well.  Further, because of the variation among ethnic and racial populations relative to health information needs, we specifically target African Americans, Latinos, and White populations, aged 65 to 85, who are non-institutionalized, Medicare beneficiaries.  Data indicate the increasing burden of diabetes with age, a higher incidence in African Americans, as well as great disparities in African Americans and Latinos in Virginia and nationally.

Aims

Our specific study aims are to determine:

  • How public reports can be designed to address the varying information needs of vulnerable populations as they make decisions for their personal healthcare including selection of healthcare providers – both physicians and hospitals.
  • How the content, design and dissemination of public reports can best reflect meaningful information that consumers would actually use in their personal decision-making.

Study Design

Our qualitative study design proposes two rounds of focus groups. The first round will focus on Aim 1 and the results will be used by project staff together with Virginia Health Information (VHI), developer of Virginia consumer reports, to develop public report templates and to identify themes, both of which will be relevant in the design of the round two focus groups, which will focus on Aim 2. Final study results will be used by VHI to develop a final public report to Virginia Medicare beneficiaries on type 2 diabetes; further we will disseminate project findings with the assistance of our national advisory committee to ensure wide scale dissemination beyond Virginia.

Using health information technology to improve healthcare quality in primary care practices and in transitions between care settings

Start date: September 15, 2010
Principal investigator: Alexander H. Krist, M.D., M.P.H.
Funding:Agency for Healthcare Research and Quality

 

Promoting use of a personal health record for prevention

Start date: June 15, 2010
Principal investigator: Alexander H. Krist, M.D., M.P.H.
Funding:Agency for Healthcare Research and Quality

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, Sc.D.
Funding: Agency for Healthcare Research and Quality

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, M.D., M.P.H.
Funding: Department of Health and Human Services, Agency for Healthcare Research and Quality

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:

  1. Increased delivery of age- and gender-appropriate clinical preventive services.
  2. Use of the IPHR.
  3. Increased shared decision-making for preventive services.
  4. 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, M.D., M.P.H., Resa M. Jones, Ph.D., project director
Funding: National Cancer Institute and Agency for Healthcare Research and Quality

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 age 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, M.D., M.S.

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.