1)    Colorectal Cancer Screening in Primary Care Practice (C-TRIP)
        (06/01/2006 - 04/30/2010)

The National Cancer Institute (NCI) has recently funded a four-year randomized trial project to the Practice Partner Research Network (PPRNet) entitled "Colorectal Cancer Screening in Primary Care Practice (C-TRIP)."   The purpose of the activities in the project is to assess whether PPRNet-TRIP can improve colorectal cancer screening in primary care.  Recruitment of practices for this project is complete. 

PPRNet’s quality improvement model for successfully translating research into practice termed PPRNet-TRIP, has demonstrated effectiveness in improving cardiovascular disease prevention and treatment in primary care practice.  PPRNet-TRIP incorporates prioritization of evidence-based quality philosophies, involving all staff (teamwork),  delivery system redesign, patient activation, and EMR tools for individualized and population-based medicine. See (TRIP) II Model for details.  

The three main goals of the C-TRIP project are:

• Ascertain the extent of colorectal cancer screening in thirty PPRNet primary care practices across the United States and systematically incorporate this information in each practice’s electronic medical record and the PPRNet longitudinal database.

• Assess the impact of the PPRNet-TRIP model on improving clinician recommendation of colorectal cancer screening.

• Assess the impact of the PPRNet-TRIP model on improving patient receipt of colorectal cancer screening.

The improvement model is disseminated through a three-component intervention:

Practice Reports - Posted quarterly will show, for each measure, historical performance, performance at the present time, the median performance of all PPRNet practices, the 90th percentile among PPRNet practices, and national benchmarks.  Intervention group practices will receive a supplemental report on CRC screening.

Site Visits  - Four practice site visits (approximately every 6 months) during the 2 year intervention conducted by Drs. Ornstein and Nemeth who have extensive experience with academic detailing, Practice Partner Patient Records, and Quality Improvement in practice.  

Network Meetings -   Practice members (one clinician and one staff member) will participate in two annual network meetings.  Topics to include:  

• Project updates
• l"Best Practice" presentations
• lSmall group workshops, among participants with similar roles in their practices (Clinicians, nurses, back office staff)

This project is being conducted by Steve Ornstein, M.D., Department of Family Medicine, MUSC

2)  Ambulatory Safety and Quality Program: Improving Quality Through Clinician Use of Health IT (MS-TRIP)  (09/30/2007 - 09/30/2010)

Funded by the AHRQ, the MS-TRIP project is designed to improve safe medication use in PPRNet practices.  More specifically, the aims are to define a set of medication safety quality indicators, incorporate these into PPRNet performance reports and assess the impact of PPRNet-TRIP quality improvement model on the indicators in a 3-year demonstration project.  Read more in the MUSC Catalyst press release.

The MS-TRIP project is intended to develop a set of medication safety measures relevant for primary care, incorporate these measures in practice performance reports sent quarterly to participating practices, and assess the impact of PPRNet-TRIP on the incidence of these errors. The project will be 3 years in duration.

The purpose of the activities proposed in this project is to assess whether PPRNet-TRIP can also improve medication safety in primary care.

The three main goals of the MS-TRIP project are:

• Develop set of PPRNet medication safety indicators based on literature, refined to reflect cumulative expertise of members.
• Incorporate PPRNet medication safety indicators in quarterly practice reports distributed to twenty participating practices.
• Assess impact of PPRNet-TRIP QI model on medication safety indicators in participating practices.

The MS-TRIP project will be implemented in practice settings through a combination of 

Practice Performance Reports - Posted quarterly will show, for each measure, historical performance, performance at the present time, the median performance of all PPRNet practices, the 90th percentile among PPRNet practices, and national benchmarks.

Practice Site Visits - Two practice site visits, one each during year 2 and year 3 of the project.  Site visits will be conducted by Andrea Wessell, PharmD who has extensive experience with academic detailing, Practice Partner Patient Records, and Quality Improvement in practice.  

Network Meetings - Practice members (one clinician and one lead nursing staff member) will participate in three annual network meetings (2008, 2009, and 2010).

Web-Based Tools - Practice clinicians and clinical staff will complete anonymous surveys throughout the project.

This project is being conducted by Steve Ornstein, M.D. and Andrea Wessell, PhamD, Department of Family Medicine, MUSC.

3)  Effect of FDA Boxed Warnings and Public Information on Pharmaceutical Use
        (09/01/2007 - 08/31/2011)

Public concern has grown about the safety of the U.S. pharmaceutical supply due to well-publicized drug withdrawals or adverse reactions.  The Institute of Medicine recently conducted a study of the oversight options available to the Food and Drug Administration (FDA) and concluded that substantial improvements are required in the way that post-marketing drug safety issues are identified and handled.  The most restrictive labeling tool used by the FDA is mandating a boxed warning.  However, boxed warnings are issued in the midst of a complex information environment that includes direct to consumer advertising (DTCA), general news media coverage, scientific journal publications, and direct to physician marketing. 

No research has been conducted to determine how the alternative sources of information on safety work simultaneously to prompt changes in prescribing behavior and whether the boxed warning mechanism has any marginal effect on pharmaceutical use.

This research will identify conditions under which the boxed warning program can be effective, and suggest alternative approaches for assuring the safe use of pharmaceutical products where necessary.

The three goals of this project are to examine:

      ·The effects of public information and black box warnings on the flow of patients into physician offices
·        The effects of public information on the likelihood of appropriate drug prescribing, and
·        The impact of FDA issued boxed warning on the likelihood of appropriate prescribing for specific medications

This project is being conducted by David Bradford, PhD, College of Health Professions, MUSC.

4)  Implementation and Evaluation of Standing Orders Using Health Information Technology (SOTRIP) (07/01/2008 - 06/31/2010)

• To facilitate the initiation of an electronic standing order system and its incorporation into daily workflow in nine primary care practices, identifying best methods and strategies utilized.
• To determine barriers and facilitators to the uptake and sustained use of electronic standing orders in these nine practices.
• To document changes in quality of care indicators and practice time management resulting from the use of electronic standing orders.
• To disseminate findings to the rest of the research network and to publish results in a peer-reviewed medical journal.

Practice Site Visits - Two practice site visits, one each during the two year project.  Site visits will be conducted by Steve Ornstein, M.D. and Lynne Nemeth, PhD. who have extensive experience with academic detailing, Practice Partner Patient Records, and Quality Improvement in practice.  

Network Meetings - Practice members (one clinician and one lead nursing staff member) will participate in two annual network meetings (2008 and 2009).

Tools - Practice clinicians and clinical staff will complete anonymous surveys throughout the project.

This project is being conducted by Heather Liszka, M.D. and Steve Ornstein, M.D. Department of Family Medicine, MUSC.

5)  Implementation of Alcohol Screening, Intervention and Treatment in Primary Care (AMTRIP) (09/20/2008 - 09/19/2012)

Recruitment is currently being conducted.

A prime reason that alcohol screening of patients in primary care has been recommended is that heavy alcohol use can worsen medical conditions such as hypertension and diabetes mellitus.  This project examines the effectiveness of the Practice Partner Research Network's (PPRNet) Accelerating Alcohol Screening-Translating Research into Practice (AATRIP) model to improve the detection, brief intervention, treatment (including pharmacotherapy and medical management) of alcohol problems by primary care physicians. 

Specific Aims of the Project:

• To compare the AATRIP model (with 10 primary care practices throughout the United States) to a control condition (10 primary care practices)

• Increase the use of NIAAA guidelines for alcohol screening, diagnosis, brief intervention, and pharmacotherapy treatment by primary care medical practices for adult patients.

• To further examine the influence of alcohol screening and intervention on the course of alcohol-sensitive medical diseases prevalent in primary care (i.e. hypertension and diabetes) 

Practice Site Visits - Practice site visits will be conducted by PPRNet Faculty who have extensive experience with academic detailing, Practice Partner Patient Records, and Quality Improvement in practice.

Network Meetings -  Intervention practice members (one clinician and one lead nursing staff member) will participate in three once-yearly network meetings (travel, accommodations, and some meals paid by the grant funds).

This project is being conducted by Peter Miller, PhD (Professor, Dept of Psychiatry and Behavioral Sciences ) and Steve Ornstein, M.D. (Professor, Dept of Family Medicine)