PPRNet Completed Research

 

PPRNet MembersJoining PPRNetOngoing ResearchPPRNet Collaborators

Facilitating Alcohol Screening of Hypertensive Patients - AATRIP     
        (7/1/04 - 8/31/07)

The primary objective of this study was to utilize the Practice Partner Research Network's Translating Research into Practice (PPRNet-TRIP) model to improve detection and management of excessive drinking among primary care patients with hypertension.

This project was conducted in collaboration with Peter Miller, PhD in the Department of Psychiatry & Behavioral Sciences.  

This study has been published: Miller PM, Stockdell R, Nemeth L, Feifer C, Jenkins R, Nietert PJ, Wessell A, Liszka H, Ornstein S: Initial steps by nine primary care practices to implement alcohol screening guidelines with hypertensive patients: The AA TRIP project, 2006,  Substance Abuse, 27(1/2):61-70

 

Accelerating Translation of Research Into Practice -  ATRIP
      (9/30/2002 - 9/30/2006)

This Partnership for Quality demonstration project was funded by AHRQ. The goal of this study was to disseminate the PPRNet-TRIP model of quality improvement to a broader number of PPRNet practices. The project addressed practice guidelines for priority conditions and improvement approaches advocated in the Institute of Medicine (IOM) report and Healthy People 2010 activities. The project expanded PPRNet’s approach to quality improvement to 100 primary care practices in 36 States with more than 500 clinicians and nearly 850,000 patients.  Improvement activities focused in eight clinical areas: prevention and treatment of cardiovascular disease and diabetes, cancer screening, adult immunization, respiratory and infectious disease, mental health and substance abuse, obesity and nutrition, and safe medication prescribing in the elderly.  All practices received PPRNet performance reports, 64% participated in practice-site visits, and 59% in network meetings.  Across all practices, a summary measure of care across all the clinical indicators improved an absolute value of 2.43% annually (p < 0.0001 for trend over time), and clinically and statistically significant improvements occurred for 29 of the 36 individual quality measures. 

This study was conducted by Steve Ornstein, MD, Department of Family Medicine, MUSC

This study has been published: Feifer C, Nemeth L, Nietert PJ, Wessell AM, Jenkins RG, Roylance LF, Ornstein SM: Different Paths to High-Quality Care: Three Archetypes of Top Performing Practice Sites.  Annals of Family Medicine, 5(3): 233-241, 2007  

 

Primary and Secondary Prevention of CHD and Stroke (TRIP II Project)
      (10/1/2000 - 9/30/2003)

TRIP-II was a three-year grant funded by The Agency for Healthcare Research and Quality (AHRQ) entitled "Primary and Secondary Prevention of Cardiovascular Disease and Stroke."  The long-term objective of the research was to validate a method implementing evidence-based medicine in primary care, using an approach combining information tools and behavioral change theory. Twenty non-academic primary care practices in 14 U.S. states with 61 health care professionals and over 87,000 patients participated.  The control group practices only received PPRNet reports, while the intervention group practices also participated in practice-site visits and network meetings.  Improvements were found in both groups, with evidence of greater improvement in the intervention group. 

This study has been published:  Ornstein SM, Jenkins RG, Nietert PJ, Feifer C, Roylance LF, Nemeth L, Corley S, Dickerson L, Bradford WD, Litvin, C: Multi-Method Quality Improvement Intervention to Improve Cardiovascular Care: A Cluster Randomized Trial, Annals of Internal Medicine, 2004; 141(7):523-532  

This study was conducted by Steve Ornstein, MD, Department of Family Medicine, MUSC

 

Impact of Direct to Consumer Pharmaceutical Advertising
      6/30/2003 to 5/31/2006

This study examined how direct to consumer advertising has affected physicians' prescribing behavior for osteoarthritis patients. Monthly clinical information on fifty-seven primary care practices during 2000-2002, matched to monthly brand specific advertising data for local and network television, was analyzed. DTC advertising of Vioxx and Celebrex increased the number of osteoarthritis patients seen by physicians each month. DTC advertising of Vioxx increased the likelihood that patients received both Vioxx and Celebrex, but Celebrex ads only affected Vioxx use.

This project was conducted with David Bradford, PhD, College of Health Professions, MUSC.

This study has been published:  Bradford W, Kleit A, Nietert P, Steyer T, McIlwain T, Ornstein S: How direct to consumer television advertising for osteoarthritis drugs affects physicians' prescribing behavior, 2006, Health Affairs, 25(5):1371-1377

 

DTC Advertising Effect on Adherence to Statin Therapy     
        (7/1/2004 - 5/31/07)

This grant was funded by the National Heart, Lung, and Blood Institute. The goal of this research was to assess the effect of direct to consumer advertising for prescription of cox-2 inhibitors and statins on the cost and the cost effectiveness of pharmacological care for treatment of hyperlipidemia.

This project was conducted with David Bradford, PhD, College of Health Professions, MUSC.                  

 

Other Completed Research:

Coxibs and Blood Pressure

PPRNet participated in a study funded by Pharmacia, “The Effects of Vioxx® (Rofecoxib) and Celebrex® (Celecoxib) on Ambulatory Care Patients' Blood Pressure.” The goal of the study was to compare the effects of Rofecoxib and Celecoxib on blood pressure and other outcomes in a PPRNet practices


Prevention

Adherence with Recommended Preventive Services in the Primary Care Practices of the Practice Partner Research Network

This study described the preventive services that are monitored in PPRNet primary care practices and measures patient adherence with USPSTF recommendations.

This study has been published: Preventive Services in the Primary Care Practices of the Practice Partner Research Network.  Topics in Health Information Management 2000; 20(3):80-84

 

Electronic Medical Records

The Impact of Electronic Medical Records on Primary Care Practice

The purpose of this study was to examine the organizational and economical impact of electronic medical records on community-based, primary care practice. Six PPRNet practices that had converted from paper records to electronic medical records within the past five years participated. The final report was a narrative description and an analysis of themes that emerged. Included were similarities and differences in perspectives between different user groups and different sites regarding changes that occurred in practice that may be attributed to the electronic medical record. The report included changes in costs associated with maintaining paper versus electronic medical record systems, while controlling for patient volume, inflation, and changes in reimbursement rates over time. The study findings were important in furthering our understanding of how electronic medical records have changed physician practice through the perspectives of experienced users.

This study has been published:  Wager KA, Lee FW, White AW, Ward DM, Ornstein SA. Impact of an Electronic Medical Record System on Community-Based Primary Care Practices. J Am Board Fam Pract 2000;13:338-48

 

Quality Improvement

Quality of Care for Asthma, Coronary Disease, Diabetes Mellitus and Hypertension in the Practice Partner Research Network

The purpose of this study was to study adherence with practice guidelines for chronic disease PPRNet practices. The focus was on adherence to quality indicators for asthma, coronary disease (CHD), diabetes mellitus (DM), and hypertensive in the fourth quarter of 1997.

This study has been published: Ornstein SM, Jenkins RG: Quality of Care for Chronic Illness in Primary Care: Opportunity for Improvement in Process and Outcome Measures. The American Journal of Managed Care. 1999; 5(5):621-627

 

Congestive Heart Failure

Congestive Heart Failure in the Practice Partner Research Network

Collaborators: Douglas Smucker, MD, Steven Ornstein, MD, Ruth Jenkins, MS.

This study was conducted by Dr. Smucker, from the Department of Family Medicine at the University of Cincinnati. Dr. Smucker used PPRNet data to study the epidemiology of congestive heart failure in patients > 50 years of age.

 

Respiratory Illness

Antibiotics for Upper Respiratory Infections: Follow-up Utilization and Antibiotic Use

Collaborators: William J. Hueston, M.D., Arch G. Mainous III, Ph.D., Steven Ornstein, M.D., Ruth G. Jenkins, M.S., Qin Pan, M.S.

This study assessed the impact of antibiotic prescribing during an intial visit for viral respiratory infections on future care seeking and the cost of care. Patients who received antibiotics at the index visit were slightly less likely to return for a follow-up visit (15.4% vs. 17.4%). Those who received antibiotics on the first visit were prescribed more expensive antibiotics in follow-up. The cost of intial antibiotic use outweighed any benefit from reduced utilization.

This study has been published:  Arch Fam Med. 1999; 8:426-430


Treatment of Recurrent Ottitis After a Preceding Resistant Case: Which antibiotics work best?

Collaborators: William J. Hueston, M.D., Steven Ornstein, M.D., Ruth G. Jenkins, M.S., Qin Pan, M.S., and Jeffery Wulfman, M.D.

The purpose of this study was to examine if the use of a second-line drug resulted in fewer treatment failures in a recurrent otitis episode following an episode of otitis media resistant to first-line antibiotics. 343 patients with an otitis media episode more than 90 days after an episode of resistant otitis media were selected for study. Of this group, 236 (69%) received first line antibiotics (amoxicillin, ampicillin, penicillin or sulfa-trimethoprim) and 107 (31%) received a second line antibiotic. The primary outcome was the need for an additional antibiotic for otitis media within the next 45 days. Failure rates for first and second line antibiotics in recurrent episodes were not significantly different (13% vs. 18%, p=0.20). We concluded that for a new otitis media episode in a patient with a previous resistant otitis, amoxicillin or sulfa-trimethoprim are just as effective as broader spectrum, more expensive antibiotics.

This study has been published:  The Journal of Family Practice. 1999; 48(1):43-46

 

EMR Use

PPRNet Members Use of CPR Systems in Practice

This study describes the use of CPR systems among PPRNet physician practices and highlights the many advantages realized by system users. In general, the PPRNet member practices viewed their use of the PMSI computer-based patient record as very positive, particularly in improving the overall quality of the patient record and as a tool in providing patient care.

This study has been published: Wager KA, Ornstein SM, Jenkins RG: The Perceived Value of Computer Based Patient Records Among Clinician Users. MD Com