PBRN Grant Summaries (R03) RFA-05-011, 2006 Small Research Grants

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 2006, the Agency for Healthcare Research and Quality (AHRQ) awarded small research grants totaling more than $1 million to 10 PBRNs.

Program Summary

In 2004, the Agency for Healthcare Research and Quality (AHRQ), solicited research proposals from primary care Practice-Based Research Networks (PBRNs) for pilot projects or feasibility studies. In addition to funding the exploratory projects, the RFA also sought to further the growth of new and emerging PBRNs. The awards provided up to $100,000 in direct and indirect funding over a 1- to 2-year period.

Budget reallocations in 2005 delayed the application review process until 2006, when AHRQ awarded more than $1 million to 10 new and emerging primary care PBRNs. The awards advance the continuum of PBRN development and complement PAR-04-041, which targeted more mature networks capable of larger and more involved studies.

Small Grant Recipients

Project Title: Management of Vaginal Complaints: A Pilot Study Within a Practice-Based Research Network
Principal Investigator: Matthew R. Anderson, M.D.
Organization: New York City Research and Improvement Network
Grant Number: R03 HS016050
Project Period: 7/1/06-8/31/08
AHRQ Funding Amount: $100,000
Status: Complete

Anderson, et al., conducted a randomized control trial on two different methods (full pelvic examinational with microscopic evaluation of discharge or no examination) to manage vaginal complaints in primary care. Although they found no difference between the two methods, the authors suggested that sexually transmitted disease screening be considered for patients with vaginal pain.

• Anderson M, Cohrssen A, Klink K, et al. Are a speculum examination and wet mount always necessary for patients with vaginal symptoms? A pilot randomized controlled trial. J Am Board Fam Med 2009 Nov-Dec;22(6):617-24. PubMed PMID: 19897689

Project Title: Enhancing Dementia Diagnosis and Care in Rural Primary Care: A Feasibility Study
Principal Investigator: Linda Boise, Ph.D.
Organization: Oregon Rural Practice-based Research Network
Grant Number: R03 HS016007
Project Period: 7/1/06-6/30/07
AHRQ Funding Amount: $100,000
Status: Complete

Boise and colleagues implemented and tested a clinical practice model for dementia screening called Rural Older Adult Memory (ROAM), which is a variation of ACOVE (Assessing Care of Vulnerable Elders) developed by UCLA and RAND. They found that the ROAM protocol was, overall, easy to use and beneficial for helping to diagnose dementia or mild cognitive impairment. They further noted that future research needs to look at community-based resources.

In process of writing publication.

Project Title: Creation of a PBRN To Study Healthcare Delivery to a Transitioning Community
Principal Investigator: Michael F. Dulin, M.D., Ph.D.
Organization: Mecklenburg Area Partnership for Primary Care Research
Grant Number: R03 HS016023
Project Period: 6/1/06-5/31/08
AHRQ Funding Amount: $100,000
Status: Complete

Dulin, et al., created a PBRN to study health care delivery in a rapidly expanding Hispanic population in the Charlotte, North Carolina, area. Using the concept of community-based participatory research (CBPR), they examined health care utilization and barriers. They found that CBPR can be useful in increasing the number of Hispanic patients in a primary care setting.

• Dulin MF, Ludden TM, Tapp H, et al. Geographic Information Systems (GIS) demonstrating primary care needs for a transitioning Hispanic community. J Am Board Fam Med 2010 Jan-Feb;23(1):109-20. PubMed PMID: 20051550
• Dulin MF, Ludden TM, Tapp H, et al.. Using Geographic Information Systems (GIS) to understand a community's primary care needs. J Am Board Fam Med 2010 Jan-Feb;23(1):13-21. PubMed PMID: 20051538

Project Title: Parents & Health Care Professionals Working Together To Improve Adolescent Health
Principal Investigator: Carol A. Ford, M.D.
Organization: North Carolina Multi-site Adolescent Research Consortium for Health
Grant Number: R03 HS016021
Project Period: 6/1/06-11/30/07
AHRQ Funding Amount: $100,000
Status: Complete

Ford, et al., conducted a study to explore parent and health care providers' perceptions of parent-provider alliances to improve adolescent health. They found that mothers perceived parents' roles in promoting adolescent health to include monitoring (e.g., what they watch, eat, do), communicating, being informed, and asking for help. Providers indicated that their role included being respectful, communicating, and encouraging healthy behaviors.

• Ford CA, Davenport AF, Meier A, et al. Parents and health care professionals working together to improve adolescent health: the perspectives of parents. J Adolesc Health 2009;44(2):191-4. PubMed PMID: 19167670

Project Title: Making CKD Guidelines Work in Underserved Practices
Principal Investigator: Chester H. Fox, M.D.
Organization: Upstate New York Practice-based Research Network
Grant Number: R03 HS016031
Project Period: 5/1/06-4/30/08
AHRQ Funding Amount: $100,000
Status: Complete

Fox and colleagues conducted a randomized control trial of evidenced-based national chronic kidney disease (CKD) guidelines. They found that practices in the intervention group (those who received the CKD guidelines) showed improvement in CKD and anemia diagnosis, percentage of people with hemoglobin A1c at goal, and stable glomerular filtration rate compared to the control practices.

• Fox CH, Swanson A, Kahn LS, et al. Improving chronic kidney disease care in primary care practices: an upstate New York Practice-based Research Network (UNYNET) study. J Am Board Fam Med 2008;21:522-530. PubMed PMID: 18988719

Project Title: Investing the Correlates and Outcomes of Depression in Adult Diabetics
Principal Investigator: Jennifer E. Granger, M.P.H.
Organization: New England Clinicians Forum Practice-based Research Network
Grant Number:R03 HS015987
Project Period: 7/7/06-7/6/07
AHRQ Funding Amount: $100,000
Status: Complete

Granger, et al., conducted a study to examine the correlation and consequences of depression in adult diabetic patients. They found that diabetic patients with depression differed significantly on self-reported overall health, physical and social limitations, and bodily pain than diabetic patients without depression. No significant differences in A1c levels were observed.

No publication from this grant.

Project Title: An Intervention in Urban CHCs To Increase Tobacco Use Treatment
Principal Investigator: Donna R. Shelley, M.D., M.P.H.
Organization: Ambulatory Care Research Network
Grant Number: R03 HS016000
Project Period: 8/1/06-7/31/07
AHRQ Funding Amount: $99,980
Status: Complete

Shelley and colleagues conducted a nonrandomized control trial to see if a “vital sign” chart system (intervention sites) increased the delivery of smoking cessation assistance than the chart system alone (comparison sites). The "vital sign" chart system contains five questions about tobacco use and readiness to quit that are asked when patient vital signs are obtained and fax referral to a telephone Quitline. They found that referrals to the Quitline increased (p < 0.001) in intervention sites and decreased in comparison sites from baseline to followup. Providers and clinical staff reported being satisfied with the chart system and were able to integrate the chart system and referral into daily practice workflow.

• Cantrell J, Shelley D. Implementing a fax referral program for quitline smoking cessation services in urban health centers: a qualitative study. BMC Fam Pract 2009 Dec 17;10:81. PubMed PMID: 20017930

Project Title: The Feasibility of Assessing the Prevalence of Rickets
Principal Investigator: James A. Taylor, M.D.
Organization: Puget Sound Pediatric Research Network
Grant Number: R03 HS016029
Project Period: 5/1/06-10/31/08
AHRQ Funding Amount: $99,703
Status: Complete

Taylor and colleagues conducted a study to determine compliance with recommendations for vitamin D supplements for breastfed infants and to assess the utility of alkaline phosphatase (AP) as a screening measure for rickets in breastfed children. They found that only 15.9 percent of breastfed children received supplemental vitamin D; most mothers believed that breast milk contains all the needed nutrition. Pediatricians who did not recommend vitamin D had significantly higher agreement (p = 0.005) with the statement that supplemental vitamin D was not based on evidence. The authors also found that AP is a good screening tool for infants 6 to 15 months with a cutoff of 552 U/L.

• Taylor JA, Geyer LJ, Feldman KW. Use of supplemental vitamin D among infants breastfed for prolonged periods. Pediatrics 2010 Jan;125(1):105-11. Epub 2009 Nov 30. PubMed PMID: 19948571

Project Title: Problem Density, Workload, and Medical Error in Primary Care Practice: A WREN Study
Principal Investigator: Johnathan, L. Temte, M.D., Ph.D.
Organization: Wisconsin Research and Education Network (WREN)
Grant Number: R03 HS016026
Project Period: 6/1/06-5/31/08
AHRQ Funding Amount: $99,998
Status: Complete

Temte, et al., studied the relationship between number of problems per encounter (NPPE; problem here was the reason for the visit), clinician workload (CWL), and perceived medical error (PME). They found that clinicians averaged 3.3 NPPE and, for each additional problem, CWL increased by 7.2 percent. They also found that for each 10-point increase in CWL, PME increased by 3.5 percent. They conclude that reducing CWL may help to reduce PME.

In process of preparing publication.

Project Title: Assessing Barriers to ADA Guideline Adherence
Principal Investigator: Mitchell A. Kaminski, M.D.
Organization: Crozer-Keystone Health Network
Grant Number: R03 HS016065
Project Period: 5/15/06-8/14/08
AHRQ Funding Amount: $100,000
Status: Complete

Kaminski and colleagues sought to develop and validate the barrier assessment tool (BAT) to quantify provider-perceived barriers to implementing diabetes guidelines. They administered the BAT to primary care providers and staff during two time periods, 5 months apart. They found that the BAT had strong internal consistency (Cronbach's alpha 0.83 and 0.88). Reviewing patients charts for diabetes flowsheet completion and clinical lab outcomes, they found that BAT results were inversely correlated with the use of the flowsheet and do not inversely correlate with clinical lab outcomes.

No publication from this grant.