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State Networks of Colorado Ambulatory Practices & Partners ~ A collaborative association of practice-based research networks in Colorado ~ Studies The grid below shows studies underway in SNOCAP. Many studies occur in more than one PBRN. Studies in Progress Completed Studies Studies in Development Studies in Progress Participating PBRNs Study Name   Exposure of low income children with asthma to household environmental tobacco smoke (ETS) CaReNet is participating in an NHLBI-funded study to examine whether primary school-aged children with asthma from low-income households have lower household environmental tobacco smoke (ETS) exposure than matched control children. Fred Wamboldt, MD, from National Jewish Medical and Research Center, is the PI. The study aims to impact future tobacco interventions and control efforts in families with children with asthma. This study is done by research assistants making patient home visits, and does not involve clinician/practice time.  Lipid and blood pressure management for patients with type 2 diabetes, funded by Bennett Parnes's Robert Wood Johnson Foundation Generalist Physician Faculty Scholar Award, will examine how primary care providers manage lipids and blood pressure for patients with type 2 diabetes.   Patient-Guided Tools to Promote Colon Cancer Screening is an NCI-funded study that will attempt to increase the rate of cancer screening by educating patients with an interactive multimedia presentation and implementing a reminder/tracking system in primary care offices. Back to top Completed Studies Participating PBRNs Study Name Applied Strategies for Improving Patient Safety (ASIPS) is a collaborative effort between the University of Colorado Department of Family Medicine and numerous organizations to analyze the causes and effects of errors in primary care and reduce the incidence of errors. Leaders for Effective Activity Planning (LEAP) is demonstration project funded by the Robert Wood Johnson Foundation's grant program Prescription for Health. The project is designed especially for promoting healthy behaviors in primary care patients.    Measuring Readiness to Translate Research into Practice is a study by CaReNet and the Colorado Health Outcomes Program (COHO) designed to collect information about practices and their ability to take research findings and make changes in their clinical care. Mental Health Referrals from Primary Care examines how primary care providers manage patients' mental health care needs.  Type 2 diabetes and hypertension care The data collected from this study will be used to describe hypertension care for patients with type 2 diabetes. We will determine the frequency that high blood pressures are considered "acceptable" to primary care providers and examines the decisions made by clinicians as they review the BPs.   Prediction of non-adherence to depression medication Sample use and patient education in primary care offices is examining the instructions given to patients when they receive sample prescription medications from their primary care office.   Domestic Violence in Pregnant Primary Care Patients is a project that examines the incidence of interpersonal physical violence during pregnancy. Missing Information in Ambulatory Care (MIA Care) is a card study to determine how clinicians care for patients when they cannot access important clinical information about that patient.    National Ambulatory Medical Care Survey (NAMCS) is a nationwide survey of health providers which provides information about ambulatory medical care services delivered and demographic, diagnostic and reason for visit information about patients receiving those services.   Practice Based Research Networks (PBRN) - Development Grant is to focus efforts and resources toward creating a sound growth and development plan. CaReNet is a primary care practice-based research network specifically devoted to studying health issues among underinsured and Hispanic people.   Primary Care Network Survey (PRINS) is a survey of care provided by practices and clinicians in CaReNet.   Stressful life events and multisomatoform disorder in female primary care patients is a cross-sectional anonymous survey of stressful life events and multisomatoform symptoms of women presenting for care in primary care clinics.   Type 2 Diabetes Card Study 2001 The data collected from this pilot study will be used to better describe patients with type 2 diabetes in CaReNet. This effort includes understanding variations in patient glycemic control and the variability of control among practices for developing interventions around improving care. These data will also help better characterize the network, strengthening our position when seeking funds for further diabetes investigations.   Why Don't PCPs Intervene when A1cs are Elevated? (AKA A1c Decision Making) determines the frequency that hemoglobin A1c values >8 are considered "acceptable" to primary care providers and examines the decisions made by clinicians as they review the results of a hemoglobin A1c.   Care of Acute Myocardial Infarction, Unstable Angina, and Chest Pain in Rural Colorado The primary aim of this study is to ascertain how rural primary care physicians currently care for patients suffering acute myocardial infarction.  To date, we have completed chart abstraction for 2072 patients who presented with chest pain to emergency departments in rural Northeast Colorado hospitals between 1995 and 1999.  We are continuing to abstract information for those patients who were seen initially in a rural emergency department and subsequently transferred to another hospital.    Use of the ACI-TIPI to Improve Heart Attack Triage and Transport Ten rural Colorado hospitals have been slated for participation in a study to assess the use of the Acute Cardiac Ischemia - Time Insensitive Predictive Instrument (ACI-TIPI).  The ACI-TIPI software was installed on ECG machines in the emergency departments of the hospitals.  In addition to the standard ECG reading, the software generates a probability score from 0% to 100% of the likelihood that a person is having a heart attack.  Physicians use the score as a tool to aid in diagnoses and treatment decisions.  ACI-TIPI report scores will be collected on all patients presenting to the hospital with chest pains or other symptoms suggestive of acute cardiac ischemia.  Chart abstraction will also be performed on patients to determine admission rates, transfer rates, and treatment decisions in conjunction with the availability of the ACI-TIPI report.    Improving the Care of Patients with Heart Failure In conjunction with the Colorado Foundation for Medical Care (CFMC), we examined whether there were major differences in the care of heart failure patients by geographic location (rural vs. urban). The primary analysis on the baseline data, however, has shown relatively few significant differences between the care received in the rural and urban hospitals. Significant differences were found regarding the frequency of type of assessment given to heart failure patients and may suggest areas where targeted intervention may be beneficial.  We are continuing to analyze the data to detect differences among groups based on demographics.  We hope that by identifying differences by patient groups, we can identify additional areas for targeted interventions.    Assessing and Improving Quality of Care for Dying Patients in Rural Colorado This study will involve assessing the knowledge and attitudes towards palliative care of physicians, nurses, other care providers, as well as staff at hospitals, nursing homes and clinics in each of the rural communities. Members of each community will be sampled as well.   Impact of double Counting and Transfer Bias on Estimated Rates and Outcomes of Acute Myocardial Infarction Ischemic heart disease is the leading cause of death in the United States.  Recent studies, that have looked primarily at hospital discharge data, report inconsistent findings on the changes in the incidence of hospitalizations for people suffering with ischemic heart disease.  Preliminary data suggest that a large number of patients with acute myocardial infarction in rural communities are transferred to urban centers for care.  Patients transferred to a second hospital may be counted twice for one episode of ischemic heart disease. (The abstract to this paper can be found on-line at Medical Care. To request a copy of the full text, please email Jack Westfall.) Back to top Studies in Development Participating PBRNs Study Name   Prenatal care and gingivitis - outcomes for pregnancy   Practice redesign for chronic care management Back to top