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Lachman P, Ruggajo P, Weakliam D. Understanding what it will take to sustain improvement in healthcare. Int J Qual Health Care 2024; 36:mzae073. [PMID: 39073559 DOI: 10.1093/intqhc/mzae073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2024] [Revised: 07/18/2024] [Accepted: 07/25/2024] [Indexed: 07/30/2024] Open
Affiliation(s)
- Peter Lachman
- Quality Improvement, Royal College of Physicians of Ireland, Frederick House, 19 South Frederick Street, Dublin D02 X266, Ireland
| | - Paschal Ruggajo
- Aga Khan University, P.O. Box 38129 Dar es Salaam, Tanzania, Dar es Salaam, Tanzania
| | - David Weakliam
- Global Health Programme, Health Service Executive, Dr Steevens Hospital, Steevens Lane, Dublin D08W2A8, Ireland
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Coury J, Coronado GD, Myers E, Patzel M, Thompson J, Whidden-Rivera C, Davis MM. Engaging with Rural Communities for Colorectal Cancer Screening Outreach Using Modified Boot Camp Translation. Prog Community Health Partnersh 2024; 18:47-59. [PMID: 38661826 PMCID: PMC11047025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/26/2024]
Abstract
BACKGROUND Colorectal cancer (CRC) incidence and mortality are disproportionately high among rural residents and Medicaid enrollees. OBJECTIVES To address disparities, we used a modified community engagement approach, Boot Camp Translation (BCT). Research partners, an advisory board, and the rural community informed messaging about CRC outreach and a mailed fecal immunochemical test program. METHODS Eligible rural patients (English-speaking and ages 50-74) and clinic staff involved in patient outreach participated in a BCT conducted virtually over two months. We applied qualitative analysis to BCT transcripts and field notes. RESULTS Key themes included: the importance of directly communicating about the seriousness of cancer, leveraging close clinic-patient relationships, and communicating the test safety, ease, and low cost. CONCLUSIONS Using a modified version of BCT delivered in a virtual format, we were able to successfully capture community input to adapt a CRC outreach program for use in rural settings. Program materials will be tested during a pragmatic trial to address rural CRC screening disparities.
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Badicke B, Coury J, Myers E, Petrik AF, Hiebert Larson J, Bhadra S, Coronado GD, Davis MM. Effort Required and Lessons Learned From Recruiting Health Plans and Rural Primary Care Practices for a Cancer Screening Outreach Study. J Prim Care Community Health 2024; 15:21501319241259915. [PMID: 38864248 PMCID: PMC11177742 DOI: 10.1177/21501319241259915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2024] [Revised: 05/20/2024] [Accepted: 05/21/2024] [Indexed: 06/13/2024] Open
Abstract
INTRODUCTION Recruiting organizations (i.e., health plans, health systems, or clinical practices) is important for implementation science, yet limited research explores effective strategies for engaging organizations in pragmatic studies. We explore the effort required to meet recruitment targets for a pragmatic implementation trial, characteristics of engaged and non-engaged clinical practices, and reasons health plans and rural clinical practices chose to participate. METHODS We explored recruitment activities and factors associated with organizational enrollment in SMARTER CRC, a randomized pragmatic trial to increase rates of CRC screening in rural populations. We sought to recruit 30 rural primary care practices within participating Medicaid health plans. We tracked recruitment outreach contacts, meeting content, and outcomes using tracking logs. Informed by the Consolidated Framework for Implementation Research, we analyzed interviews, surveys, and publicly available clinical practice data to identify facilitators of participation. RESULTS Overall recruitment activities spanned January 2020 to April 2021. Five of the 9 health plans approached agreed to participate (55%). Three of the health plans chose to operate centrally as 1 site based on network structure, resulting in 3 recruited health plan sites. Of the 101 identified practices, 76 met study eligibility criteria; 51% (n = 39) enrolled. Between recruitment and randomization, 1 practice was excluded, 5 withdrew, and 7 practices were collapsed into 3 sites for randomization purposes based on clinical practice structure, leaving 29 randomized sites. Successful recruitment required iterative outreach across time, with a range of 2 to 17 encounters per clinical practice. Facilitators to recruitment included multi-modal outreach, prior relationships, effective messaging, flexibility, and good timing. CONCLUSION Recruiting health plans and rural clinical practices was complex and iterative. Leveraging existing relationships and allocating time and resources to engage clinical practices in pragmatic implementation research may facilitate more diverse representation in future trials and generalizability of research findings.
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Affiliation(s)
| | | | - Emily Myers
- Oregon Health & Science University, Portland, OR, USA
| | | | | | | | - Gloria D. Coronado
- University of Arizona Cancer Center and College of Public Health, Tucson, AZ, USA
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Golden SE, Young A, Sun CJ, Mayeda MS, Katz DA, Vander Weg MW, Gundle KR, Bailey SR. "It Is A Carrot-Stick Model": A Qualitative Study of Rural-Serving Clinician and Rural-Residing Veteran Perceptions of Requirements to Quit Smoking prior to Elective Surgery. J Smok Cessat 2023; 2023:3399001. [PMID: 38077280 PMCID: PMC10703528 DOI: 10.1155/2023/3399001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 11/02/2023] [Accepted: 11/14/2023] [Indexed: 05/30/2024] Open
Abstract
Introduction Some medical centers and surgeons require patients to stop smoking cigarettes prior to elective orthopaedic surgeries in an effort to decrease surgical complications. Given higher rates of smoking among rural individuals, rural patients may be disproportionately impacted by these requirements. We assessed the perceptions and experiences of rural-residing Veterans and clinicians related to this requirement. Methods We conducted qualitative semistructured one-on-one interviews of 26 rural-residing veterans, 10 VA orthopaedic surgery staff (from two Veterans Integrated Services Networks), 24 PCPs who serve rural veterans (14 VA; 10 non-VA), and 4 VA pharmacists. Using the knowledge, attitudes, and behavior framework, we performed conventional content analysis. Results We found three primary themes across respondents: (1) knowledge of and the evidence base for the requirement varied widely; (2) strong personal attitudes toward the requirement; and (3) implementation and possible implications of this requirement. All surgery staff reported knowledge of requirements at their institution. VA PCPs reported knowledge of requirements but typically could not recall specifics. Most patients were unaware. The majority of respondents felt this requirement could increase motivation to quit smoking. Some PCPs felt a more thorough explanation of smoking-related complications would result in increased quit attempts. About half of all patients reported belief that the requirement was reasonable regardless of initial awareness. Respondents expressed little concern that the requirement might increase rural-urban disparities. Most PCPs and patients felt that there should be exceptions for allowing surgery, while surgical staff disagreed. Discussion. Most respondents thought elective surgery was a good motivator to quit smoking; but patients, PCPs, and surgical staff differed on whether there should be exceptions to the requirement that patients quit preoperatively. Future efforts to augment perioperative smoking cessation may benefit from improving coordination across services and educating patients more about the benefits of quitting.
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Affiliation(s)
- Sara E. Golden
- Center to Improve Veteran Involvement in Care, VA Portland Health Care System, Portland, OR, USA
- Department of Pulmonary, Allergy, and Critical Care Medicine, Oregon Health & Science University (OHSU), Portland, OR, USA
| | - Allison Young
- Center to Improve Veteran Involvement in Care, VA Portland Health Care System, Portland, OR, USA
- Department of Pulmonary, Allergy, and Critical Care Medicine, Oregon Health & Science University (OHSU), Portland, OR, USA
| | - Christina J. Sun
- College of Nursing, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | | | - David A. Katz
- Department of Internal Medicine, University of Iowa Health Care, Iowa City, IA, USA
- Center for Access & Delivery Research and Evaluation (CADRE), Iowa City VA Health Care System, Iowa City, IA, USA
| | - Mark W. Vander Weg
- Center for Access & Delivery Research and Evaluation (CADRE), Iowa City VA Health Care System, Iowa City, IA, USA
- Department of Community and Behavioral Health, University of Iowa, Iowa City, IA, USA
| | - Kenneth R. Gundle
- Department of Orthopaedics and Rehabilitation, OHSU, Portland, OR, USA
- Operative Care Division, VA Portland Health Care System, Portland, OR, USA
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Feldman CA, Fredericks-Younger J, Fine D, Markowitz K, Sabato E. Advancing oral health through practice-based research. J Am Dent Assoc 2023; 154:959-962.e2. [PMID: 37115141 PMCID: PMC10792412 DOI: 10.1016/j.adaj.2023.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Revised: 02/17/2023] [Accepted: 03/05/2023] [Indexed: 04/29/2023]
Affiliation(s)
- Cecile A. Feldman
- Rutgers University, School of Dental Medicine
- Rutgers University, School of Public Health
| | | | - Daniel Fine
- Rutgers University, School of Dental Medicine
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Hatch BA, Kenzie E, Ramalingam N, Sullivan E, Barnes C, Elder N, Davis MM. Impact of the COVID-19 vaccination mandate on the primary care workforce and differences between rural and urban settings to inform future policy decision-making. PLoS One 2023; 18:e0287553. [PMID: 37368922 DOI: 10.1371/journal.pone.0287553] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Accepted: 06/07/2023] [Indexed: 06/29/2023] Open
Abstract
INTRODUCTION Little is known about the impact of mandated vaccination policies on the primary care clinic workforce in the United States or differences between rural and urban settings, especially for COVID-19. With the continued pandemic and an anticipated increase in novel disease outbreaks and emerging vaccines, healthcare systems need additional information on how vaccine mandates impact the healthcare workforce to aid in future decision-making. METHODS We conducted a cross-sectional survey of Oregon primary care clinic staff between October 28, 2021- November 18, 2021, following implementation of a COVID-19 vaccination mandate for healthcare personnel. The survey consisted of 19 questions that assessed the clinic-level impacts of the vaccination mandate. Outcomes included job loss among staff, receipt of an approved vaccination waiver, new vaccination among staff, and the perceived significance of the policy on clinic staffing. We used univariable descriptive statistics to compare outcomes between rural and urban clinics. The survey also included three open-ended questions that were analyzed using a template analysis approach. RESULTS Staff from 80 clinics across 28 counties completed surveys, representing 38 rural and 42 urban clinics. Clinics reported job loss (46%), use of vaccination waivers (51%), and newly vaccinated staff (60%). Significantly more rural clinics (compared to urban) utilized medical and/or religious vaccination waivers (71% vs 33%, p = 0.04) and reported significant impact on clinic staffing (45% vs 21%, p = 0.048). There was also a non-significant trend toward more job loss for rural compared to urban clinics (53% vs. 41%, p = 0.547). Qualitative analysis highlighted a decline in clinic morale, small but meaningful detriments to patient care, and mixed opinions of the vaccination mandate. CONCLUSIONS Oregon's COVID-19 vaccination mandate increased healthcare personnel vaccination rates, yet amplified staffing challenges with disproportionate impacts in rural areas. Staffing impacts in primary care clinics were greater than reported previously in hospital settings and with other vaccination mandates. Mitigating primary care staffing impacts, particularly in rural areas, will be critical in response to the continued pandemic and novel viruses in the future.
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Affiliation(s)
- Brigit A Hatch
- Department of Family Medicine, Oregon Health & Science University, Portland, Oregon, United States of America
- Oregon Rural Practice-based Research Network, Oregon Health & Science University, Portland, Oregon, United States of America
| | - Erin Kenzie
- Oregon Rural Practice-based Research Network, Oregon Health & Science University, Portland, Oregon, United States of America
- OHSU-PSU School of Public Health, Oregon Health & Science University, Portland, Oregon, United States of America
| | - NithyaPriya Ramalingam
- Oregon Rural Practice-based Research Network, Oregon Health & Science University, Portland, Oregon, United States of America
| | - Eliana Sullivan
- Oregon Rural Practice-based Research Network, Oregon Health & Science University, Portland, Oregon, United States of America
| | - Chrystal Barnes
- Oregon Rural Practice-based Research Network, Oregon Health & Science University, Portland, Oregon, United States of America
| | - Nancy Elder
- Department of Family Medicine, Oregon Health & Science University, Portland, Oregon, United States of America
- Oregon Rural Practice-based Research Network, Oregon Health & Science University, Portland, Oregon, United States of America
| | - Melinda M Davis
- Department of Family Medicine, Oregon Health & Science University, Portland, Oregon, United States of America
- Oregon Rural Practice-based Research Network, Oregon Health & Science University, Portland, Oregon, United States of America
- OHSU-PSU School of Public Health, Oregon Health & Science University, Portland, Oregon, United States of America
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Petrik AF, Coury J, Larson JH, Badicke B, Coronado GD, Davis MM. Data Challenges in Identifying Patients Due for Colorectal Cancer Screening in Rural Clinics. J Am Board Fam Med 2023; 36:118-129. [PMID: 36759133 PMCID: PMC10187985 DOI: 10.3122/jabfm.2022.220216r1] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Revised: 08/08/2022] [Accepted: 08/11/2022] [Indexed: 02/11/2023] Open
Abstract
INTRODUCTION Colorectal cancer (CRC) incidence and mortality are disproportionately high among rural residents despite the availability of effective screening methods. Outreach activities can improve CRC screening rates but rely on accurate identification of patients due for screening. We report on data challenges in rural clinics and Medicaid health plans in Oregon in identifying patients eligible for CRC screening, in a large project implementing mailed fecal immunochemical tests (FIT) and patient navigation. METHODS We analyzed data from clinic intake surveys and administrative claims. Clinics were asked to identify total population numbers relevant to CRC screening and follow-up. Health plans also identified enrollees eligible for CRC screening in Spring, 2021. Clinic staff validated patient lists for eligibility using their electronic health records (EHR). RESULTS EHR features varied across the 29 participating and 28 responding clinics. Among the 28 responding clinics, 21 were able to report their Medicaid population (75%), 19 reported the number of patients aged 50 to 75 (68%) and the number screened for CRC in the last year (68%). Only 8 (29%) were able to report screening details such as number screened by FIT and 9 were able to report on patients with an abnormal FIT or colonoscopy completed after FIT (32%). Health plans had challenges properly identifying where enrollees received care and had missing data for race and ethnicity (range 22 to 34% unknown race, <1% to 24% unknown ethnicity). DISCUSSION Most participating rural primary care clinics and Medicaid health plans experienced challenges identifying the population due for a CRC screening outreach program. Better EHR functionality and data reporting capabilities could help rural clinics apply population-based strategies and ultimately attenuate disparities in cancer screening and follow-up.
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Affiliation(s)
- Amanda F Petrik
- From the Center for Health Research, Kaiser Permanente Northwest (AFP, GDC); Oregon Rural Practice-based Research Network, Oregon Health & Science University, (JC, JHL, BB, MMD); and Department of Family Medicine & School of Public Health, Oregon Health & Science University (MMD).
| | - Jennifer Coury
- From the Center for Health Research, Kaiser Permanente Northwest (AFP, GDC); Oregon Rural Practice-based Research Network, Oregon Health & Science University, (JC, JHL, BB, MMD); and Department of Family Medicine & School of Public Health, Oregon Health & Science University (MMD)
| | - Jean Hiebert Larson
- From the Center for Health Research, Kaiser Permanente Northwest (AFP, GDC); Oregon Rural Practice-based Research Network, Oregon Health & Science University, (JC, JHL, BB, MMD); and Department of Family Medicine & School of Public Health, Oregon Health & Science University (MMD)
| | - Brittany Badicke
- From the Center for Health Research, Kaiser Permanente Northwest (AFP, GDC); Oregon Rural Practice-based Research Network, Oregon Health & Science University, (JC, JHL, BB, MMD); and Department of Family Medicine & School of Public Health, Oregon Health & Science University (MMD)
| | - Gloria D Coronado
- From the Center for Health Research, Kaiser Permanente Northwest (AFP, GDC); Oregon Rural Practice-based Research Network, Oregon Health & Science University, (JC, JHL, BB, MMD); and Department of Family Medicine & School of Public Health, Oregon Health & Science University (MMD)
| | - Melinda M Davis
- From the Center for Health Research, Kaiser Permanente Northwest (AFP, GDC); Oregon Rural Practice-based Research Network, Oregon Health & Science University, (JC, JHL, BB, MMD); and Department of Family Medicine & School of Public Health, Oregon Health & Science University (MMD)
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Davis MM, Coury J, Larson JH, Gunn R, Towey EG, Ketelhut A, Patzel M, Ramsey K, Coronado GD. Improving colorectal cancer screening in rural primary care: Preliminary effectiveness and implementation of a collaborative mailed fecal immunochemical test pilot. J Rural Health 2023; 39:279-290. [PMID: 35703582 PMCID: PMC9969840 DOI: 10.1111/jrh.12685] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Mailed fecal immunochemical test (FIT) outreach can improve colorectal cancer (CRC) screening rates. We piloted a collaborative mailed FIT program with health plans and rural clinics to evaluate preliminary effectiveness and refine implementation strategies. METHODS We conducted a single-arm study using a convergent, parallel mixed-methods design to evaluate the implementation of a collaborative mailed FIT program. Enrollees were identified using health plan claims and confirmed via clinic scrub. The intervention included a vendor-delivered automated phone call (auto-call) prompt, FIT mailing, and reminder auto-call; clinics were encouraged to make live reminder calls. Practice facilitation was the primary implementation strategy. At 12 months post mailing, we assessed the rates of: (1) mailed FIT return and (2) completion of any CRC screening. We took fieldnotes and conducted postintervention key informant interviews to assess implementation outcomes (eg, feasibility, acceptability, and adaptations). RESULTS One hundred and sixty-nine Medicaid or Medicare enrollees were mailed a FIT. Over the 12-month intervention, 62 participants (37%) completed screening of which 21% completed the mailed FIT (most were returned within 3 months), and 15% screened by other methods (FITs distributed in-clinic, colonoscopy). Enrollee demographics and the reminder call may encourage mailed FIT completion. Program feasibility and acceptability was high and supported by perceived positive benefit, alignment with existing workflows, adequate staffing, and practice facilitation. CONCLUSION Collaborative health plan-clinic mailed FIT programs are feasible and acceptable for implementation in rural clinics and support CRC screening completion. Studies that pragmatically test collaborative approaches to mailed FIT and patient navigation follow-up after abnormal FIT and support broad scale-up in rural settings are needed.
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Affiliation(s)
- Melinda M. Davis
- Oregon Rural Practice-based Research Network, Portland, Oregon, USA,Department of Family Medicine and School of Public Health, Oregon Health & Science University, Portland, Oregon, USA
| | - Jen Coury
- Oregon Rural Practice-based Research Network, Portland, Oregon, USA
| | | | | | | | | | - Mary Patzel
- Oregon Rural Practice-based Research Network, Portland, Oregon, USA
| | - Katrina Ramsey
- Biostatistics, Epidemiology, and Research Design (BERD) Program, Oregon Health & Science University, Portland, Oregon, USA
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Singh AN, Sanchez V, Kenzie ES, Sullivan E, McCormack JL, Hiebert Larson J, Robbins A, Weekley T, Hatch BA, Dickinson C, Elder NC, Muench JP, Davis MM. Improving screening, treatment, and intervention for unhealthy alcohol use in primary care through clinic, practice-based research network, and health plan partnerships: Protocol of the ANTECEDENT study. PLoS One 2022; 17:e0269635. [PMID: 35763485 PMCID: PMC9239445 DOI: 10.1371/journal.pone.0269635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Accepted: 05/24/2022] [Indexed: 11/18/2022] Open
Abstract
Background Unhealthy alcohol use (UAU) is a leading cause of morbidity and mortality in the United States, contributing to 95,000 deaths annually. When offered in primary care, screening, brief intervention, referral to treatment (SBIRT), and medication-assisted treatment for alcohol use disorder (MAUD) can effectively address UAU. However, these interventions are not yet routine in primary care clinics. Therefore, our study evaluates tailored implementation support to increase SBIRT and MAUD in primary care. Methods ANTECEDENT is a pragmatic implementation study designed to support 150 primary care clinics in Oregon adopting and optimizing SBIRT and MAUD workflows to address UAU. The study is a partnership between the Oregon Health Authority Transformation Center—state leaders in Medicaid health system transformation—SBIRT Oregon and the Oregon Rural Practice-based Research Network. We recruited clinics providing primary care in Oregon and prioritized reaching clinics that were small to medium in size (<10 providers). All participating clinics receive foundational support (i.e., a baseline assessment, exit assessment, and access to the online SBIRT Oregon materials) and may opt to receive tailored implementation support delivered by a practice facilitator over 12 months. Tailored implementation support is designed to address identified needs and may include health information technology support, peer-to-peer learning, workflow mapping, or expert consultation via academic detailing. The study aims are to 1) engage, recruit, and conduct needs assessments with 150 primary care clinics and their regional Medicaid health plans called Coordinated Care Organizations within the state of Oregon, 2) implement and evaluate the impact of foundational and supplemental implementation support on clinic change in SBIRT and MAUD, and 3) describe how practice facilitators tailor implementation support based on context and personal expertise. Our convergent parallel mixed-methods analysis uses RE-AIM (reach, effectiveness, adoption, implementation, maintenance). It is informed by a hybrid of the i-PARIHS (integrated Promoting Action on Research Implementation in Health Services) and the Dynamic Sustainability Framework. Discussion This study will explore how primary care clinics implement SBIRT and MAUD in routine practice and how practice facilitators vary implementation support across diverse clinic settings. Findings will inform how to effectively align implementation support to context, advance our understanding of practice facilitator skill development over time, and ultimately improve detection and treatment of UAU across diverse primary care clinics.
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Affiliation(s)
- Amrita N. Singh
- Oregon Rural Practice-Based Research Network, Oregon Health & Science University, Portland, Oregon, United States of America
| | - Victoria Sanchez
- Oregon Rural Practice-Based Research Network, Oregon Health & Science University, Portland, Oregon, United States of America
| | - Erin S. Kenzie
- Oregon Rural Practice-Based Research Network, Oregon Health & Science University, Portland, Oregon, United States of America
| | - Eliana Sullivan
- Oregon Rural Practice-Based Research Network, Oregon Health & Science University, Portland, Oregon, United States of America
| | - James L. McCormack
- Oregon Rural Practice-Based Research Network, Oregon Health & Science University, Portland, Oregon, United States of America
| | - Jean Hiebert Larson
- Oregon Rural Practice-Based Research Network, Oregon Health & Science University, Portland, Oregon, United States of America
| | - Alissa Robbins
- Oregon Health Authority Transformation Center, Portland, Oregon, United States of America
| | - Tiffany Weekley
- Oregon Rural Practice-Based Research Network, Oregon Health & Science University, Portland, Oregon, United States of America
| | - Brigit A. Hatch
- Oregon Rural Practice-Based Research Network, Oregon Health & Science University, Portland, Oregon, United States of America
- Department of Family Medicine, Oregon Health & Science University, Portland, Oregon, United States of America
| | - Caitlin Dickinson
- Oregon Rural Practice-Based Research Network, Oregon Health & Science University, Portland, Oregon, United States of America
| | - Nancy C. Elder
- Oregon Rural Practice-Based Research Network, Oregon Health & Science University, Portland, Oregon, United States of America
- Department of Family Medicine, Oregon Health & Science University, Portland, Oregon, United States of America
| | - John P. Muench
- Oregon Rural Practice-Based Research Network, Oregon Health & Science University, Portland, Oregon, United States of America
- Department of Family Medicine, Oregon Health & Science University, Portland, Oregon, United States of America
| | - Melinda M. Davis
- Oregon Rural Practice-Based Research Network, Oregon Health & Science University, Portland, Oregon, United States of America
- Department of Family Medicine, Oregon Health & Science University, Portland, Oregon, United States of America
- Community Health, OHSU-PSU School of Public Health, Portland, Oregon, United States of America
- * E-mail:
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Slatore CG, Golden SE, Thomas T, Patzel M, Bumatay S, Shannon J, Davis M. Beliefs and Practices of Primary Care Providers Regarding Performing Low-Dose CT Studies for Lung Cancer Screening. Chest 2022; 161:853-859. [PMID: 34480957 PMCID: PMC8941621 DOI: 10.1016/j.chest.2021.08.062] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 07/29/2021] [Accepted: 08/16/2021] [Indexed: 11/19/2022] Open
Affiliation(s)
- Christopher G Slatore
- Center to Improve Veteran Involvement in Care, VA Portland Health Care System, Portland, OR; Departments of Medicine and of Radiation Medicine, Division of Pulmonary & Critical Care Medicine, Knight Cancer Institute, Oregon Health & Science University Portland, OR; Section of Pulmonary & Critical Care Medicine, VA Portland Health Care System, Portland, OR
| | - Sara E Golden
- Center to Improve Veteran Involvement in Care, VA Portland Health Care System, Portland, OR.
| | - Tara Thomas
- Center to Improve Veteran Involvement in Care, VA Portland Health Care System, Portland, OR
| | - Mary Patzel
- Oregon Rural Practice-based Research Network, Oregon Health & Science University, Portland, OR
| | - Sarah Bumatay
- Oregon Rural Practice-based Research Network, Oregon Health & Science University, Portland, OR
| | - Jackilen Shannon
- Community Outreach and Engagement, Knight Cancer Institute, Oregon Health & Science University, Portland, OR; School of Public Health, Oregon Health & Science University-Portland State University, Portland, OR
| | - Melinda Davis
- Oregon Rural Practice-based Research Network, Oregon Health & Science University, Portland, OR; Department of Family Medicine, Oregon Health & Science University, Portland, OR; School of Public Health, Oregon Health & Science University-Portland State University, Portland, OR
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Morgan AR, Hendricks MA, El Ibrahimi S, Hallvik SE, Hatch B, Dickinson C, Wright D, Fischer MA. COVID-19-related adaptations to the implementation and evaluation of a clinic-based intervention designed to improve opioid safety. Drugs Context 2022; 10:dic-2021-7-5. [PMID: 34970321 PMCID: PMC8687093 DOI: 10.7573/dic.2021-7-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Accepted: 09/24/2021] [Indexed: 11/25/2022] Open
Abstract
The United States faces an opioid crisis with an unprecedented and increasing death rate from opioid overdose. Successfully reducing the rates of opioid use disorder (OUD) and overdose will require the engagement of frontline clinicians to prescribe opioids more safely and to build their capacity to treat patients with OUD using evidence-based approaches. The COVID-19 pandemic has created significant challenges for patients, clinicians and health systems and has been associated with increasing risks of overdoses and deaths. Herein, we review a multidisciplinary project designed to implement and evaluate clinic-based interventions in Oregon, USA, to improve pain management, opioid prescribing and treatment of OUD. The intervention, called Improving PaIn aNd OPiOId MaNagemenT in Primary Care (PINPOINT), combines practice facilitation, academic detailing and education through the Oregon ECHO Network. Implementation of PINPOINT has occurred across the Oregon Rural Practice-based Research Network and has involved 49 clinic sites to date. To evaluate the impact of the intervention, the research team created the Provider Results of Opioid Management and Prescribing Training (PROMPT), a dataset that links information from the state prescription drug monitoring program, all-payer claims database, emergency medical services, vital records and substance use disorder treatment system. The PROMPT dataset will allow evaluation of the impact of the intervention at both the clinician and clinic levels. Due to the constraints of the COVID-19 pandemic, elements of both implementation and evaluation required significant adaptations to continue to meet the original project goals.
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Affiliation(s)
- Anna R Morgan
- National Resource Center for Academic Detailing, Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women's Hospital, Boston, MA, USA
| | | | - Sanae El Ibrahimi
- Comagine Health, Portland, OR, USA.,School of Public Health, University of Nevada, Las Vegas, Las Vegas, NV, USA
| | | | - Brigit Hatch
- Oregon Rural Practice-based Research Network, Oregon Health & Science University, Portland, OR, USA
| | - Caitlin Dickinson
- Oregon Rural Practice-based Research Network, Oregon Health & Science University, Portland, OR, USA
| | - Dagan Wright
- Injury and Violence Prevention Program, Public Health Division, Oregon Health Authority, Portland, OR, USA
| | - Michael A Fischer
- National Resource Center for Academic Detailing, Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women's Hospital, Boston, MA, USA
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Structure, function, and productivity from the National Dental Practice-Based Research Network. J Clin Transl Sci 2022; 6:e87. [PMID: 35989860 PMCID: PMC9379935 DOI: 10.1017/cts.2022.421] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Revised: 06/14/2022] [Accepted: 06/16/2022] [Indexed: 11/06/2022] Open
Abstract
Abstract
Introduction:
Following inception in 2005 as a multiregional practice-based research network (PBRN), the “National Dental PBRN” expanded nationwide in 2012, and in 2019 implemented additional organizational changes. The objectives are to: (1) describe the new structure and function of the network; and (2) quantify its scientific productivity since 2005.
Methods:
A national Administrative and Resource Center is based in Alabama; regional and specialty nodes are based in Alabama, Florida, Illinois, Minnesota, Oregon, New York, and Texas. A Network Coordinating Center is based in Oregon. Studies are funded via investigator-initiated grants. Scientific productivity is assessed using specific metrics, including the Relative Citation Ratio.
Results:
To date, 58 studies have been completed or are in data collection or development. These studies have investigated a broad range of topics using a wide variety of study designs. Of the studies that have completed enrollment, 70,665 patients were enrolled, as were 19,827 practitioners (some participated in multiple studies), plus electronic records for 790,493 patients in two data-only studies. To date, these studies have led to 193 peer-reviewed scientific publications in 62 different journals. The mean (1.40) Relative Citation Ratio of Network publications connotes a greater-than-average influence in their fields.
Conclusions:
These metrics demonstrate that the PBRN research context can successfully engage practitioners and patients from diverse settings nationally with a high and sustained level of scientific productivity. This infrastructure has enabled clinical scientists in oral health and nonoral health topics and provided additional recruitment venues outside of the typical academic health center research context.
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