Network Studies










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Network Studies


Studies in Development

Implementation of Decision Support for the Management of Obesity in a National Pediatric Primary Care Research Network
PI: Mona Sharifi, MD, MPH
Objectives: 1) To optimize an implementation strategy tailored to site-specific contexts among a national sample of pediatric primary care practices serving disparity populations. 2) To evaluate the effectiveness of the intervention package and tailored implementation strategy in improving obesity-related care delivery and children’s BMI within a national practice-based research network. 3) To identify organizational and provider-level factors that mediate and modify variability in the impact of the implementation strategy and in the effectiveness of the intervention to understand what works where and why in different settings.

IMAPP: Improving Mental Health Access with Parent Partners
PI: Iman Sharif, MD, MPH
Collaborators: Parent Partners
Objective: Understand the degree to which embedding a parent partner in a primary care practice can improve the outcomes of BMH referrals in pediatrics.

Perceptions of Adolescent Vaccines among Clinicians, Nurses, Parents, and Medical Front Office Staff
PIs: Paul Darden, MD & Jimmy Roberts, MD, MPH
Objectives: 1) To capture the attitudes of parents or guardians of adolescents toward different vaccines that are given to pre-teens and teens to determine the impact of a clinician recommendation for specific vaccines, and to capture the perceived importance of specific vaccines. 2) To capture the attitudes of Front Office medical clinic staff toward different vaccines that are given to pre-teens and teens to determine the perceived importance of specific vaccines in the clinic in which they work, and to capture any expressed concerns that exist with respect to these vaccines. 3) To capture the types of recommendations that clinicians (Physicians and Advance Practice Nurses) and nurses report that they with parents and patients about adolescent vaccines, and to identify any differences in recommendation strategies that are used when talking about HPV during a clinical encounter.

Ongoing Studies

National Immunization Partnership with the APA (NIPA).
PIs: Cynthia Rand, MD, MPH & Peter Szilagyi, MD, MPH
Collaborator: National Improvement Partnership Network (NIPN)
Objective: To implement a large-scale practice-based quality improvement (QI) program to prioritize HPV vaccination at every adolescent visit.

Wave 1: 14 CORNET sites, 38 NIPN practices
Wave 2: 15 CORNET sites, 60 NIPN practices
Wave 3: 12 CORNET sites, 109 NIPN practices
Wave 4: 5 CORNET sites, 51 NIPN practices
Wave 5: 13 CORNET sites, 58 NIPN practices

To learn more about this initiative, please visit the NIPA Virtual Toolkit.

WE CARE:
Collaborator: Pediatric Research in Office Settings (PROS)
Objective: Address poverty-related issues and unmet basic social needs of families through the following implementation strategies: 1) On-site training program, 2) off-site web-based program.

Wave 1: 2 CORNET sites
Wave 2: 1 CORNET site – looking to recruit 1 suburban site.

If your continuity clinic is interested in participating, please contact hollyce@academicpeds.org to learn more about eligibility.

Understanding Current Pediatric Faculty and Resident Physicians' Health Literacy Perceptions, Knowledge, and Continuity Clinic Practices
PIs: Townsend Cooper, MD & Marny Dunlap, MD
Objective: Examine Health Literacy training in pediatric residency.

If your pediatric residency program is interested in participating, please contact hollyce@academicpeds.org to enroll

 

Completed Studies

LitNet Reach Out and Read Survey. This study examined what pediatric residency programs are doing around resident training and Reach Out and Read. Pediatric residents, continuity faculty, and Reach Out and Read Champions completed a one-time survey. Participating programs that reached 80% completion of their surveys received 100 free books through Reach Out and Read. Programs that achieved 100% completion of surveys had their names put in a hat for two to be randomly selected to receive a pizza party for their residents. In total, 42 pediatric residency programs participated (over 1600 individual responses). This study was presented as a poster at the 2019 APA Region IV Meeting, as an oral presentation at the Southern Regional Meeting, and will be shown as a poster at the 2019 Pediatric Academic Societies’ Meeting. Manuscripts are in development.

Current Practices for Identifying and Addressing Social Determinants of Health in Continuity Clinic. The objective of this survey was to describe current practices in systematic screening for Social Determinants of Health (SDH) in pediatric resident clinics enrolled in the Continuity Research Network (CORNET) and examine correlations among screening and clinic characteristics. Findings reflect that screening for SDH in CORNET clinics is common but has not been universally implemented. Screening practices are variable and reflect the complex nature of screening, including the heterogeneity of the patient populations, the clinic staff composition, and the SDH encountered.

CORNET CARD STUDY #1: DO YOU SEE WHAT I SEE, AND CAN I DO WHAT YOU DO? [Caring for Children with Special Health Care Needs (CSHCN)]. Card Study #1 gathered data on the kinds of patients seen at resident continuity practices. The project team tested the hypotheses that 1) Patients seen by pediatric residents and faculty are of the same level of complexity; 2) Patients seen by senior residents are as likely as patients seen by faculty to see a provider with high self-efficacy (SE) in managing their care; 3) Patients seeing their own primary care provider (PCP) are more likely to see a provider with high SE for managing their care. CSHCN were seen mostly by attendings; more exposure may be needed for residents to develop SE in caring for CSHCN. This first CORNET CARD Study provides fertile data for further analyses. Residents were invited to participate as co-investigators with questions they would like to pose to the dataset, with resident education or QI projects that stem from the results, or with follow-up studies exploring parental confidence in care received.

Preventive Services Improvement Project - State Spread (PreSIPS2). PreSIPS2 was one component of many ongoing efforts to enhance Bright Futures implementation at the state, community, practice, and family levels. With participation from AAP National, AAP chapters, CORNET academic programs, and national and state partners, PreSIPS2 was a 17-month quality improvement (QI) state-based learning collaborative designed to create sustainable state to local improvement infrastructure to achieve awareness and improvement in the preventive health outcomes of children based on Bright Futures. Four CORNET practices participated in the project.

National Partnership for Adolescent Immunization (NPAI). This project focused on enhancing adolescent immunization delivery through the implementation of quality improvement activities in primary care practices and pediatric resident training programs. During the learning collaborative stages of this project, participating practices were asked to choose one of two strategies to improve their HPV vaccine immunization rates. The two strategies included a point of care prompt (either nurse or EMR) or standing orders. The selected strategy was implemented in each participating practice for 12 months, during which faculty/resident/staff champions participated in monthly learning collaborative conference calls. Thirteen practices participated, with five choosing standing orders as their strategy and eight utilizing prompts. Findings were presented in two platforms and two posters at PAS 2016, in addition to a workshop on involving pediatric residents in QI in continuity clinics, using adolescent immunizations as a template. Three manuscripts are currently underway.

Initial results from the Bright Futures Oral Health study funded by the Maternal and Child Health Bureau (Hank Bernstein, PI) were presented at the 2011 Denver PAS meeting. Twenty-seven pediatric training programs (143 residents) participated. This RCT was very successful in showing that residents improved in confidence and knowledge about BF concepts, and were able to incorporate preventive health strategies into their practices. Two manuscripts are underway. This was a very intensive and important CORNET study. Thanks to everyone who participated!

Secondary Sexual Characteristics in Boys Study (SSCIB). Seven CORNET practices, including 10 CORNET faculties, collaborated with the PROS network in this study that examined the onset of secondary sexual characteristics in boys. Marcia Giddens, DrPh, PA served as the PI. CORNET contributed data on 300 minority and underserved boys, increasing the generalizability of study results. Results have been presented at the last two PAS meetings.

The Survey of Pediatric Asthma Care Education in Residency (SPACER) study was completed in 2009. This study, with Sande Okelo, MD as PI, and Terry Hetzler and Cindy Ferrell as CORNET co-investigators, was a cross-sectional survey to assess asthma management and incorporation of national practice guidelines by pediatric residents. Ten pediatric training programs participated and surveys were obtained from 369 residents. Two PAS abstracts were presented in 2009 and 2010 and a manuscript is under revision. Future analysis will compare resident responses to those of practitioners from a similar study Dr. Okelo conducted within the American Academy of Pediatrics and practicing pediatricians.

Health Care of Pediatric Residents and their Families. This cross-sectional study funded by East Carolina University was led by Kristina Simeonsson, MD and John Olsson, MD and examined pediatric residents' perceived access to health care for themselves and their families, self-prescribing practices, whether colleagues provide care and the care their families receive. Nineteen pediatric training programs participated, with 834 residents providing data. Results were presented in two posters at the PAS meeting. Manuscript preparation has begun. The results from this study will help to inform the Residency Review Committee (RRC) and the Accreditation Council for Graduate Medical Education (ACGME).

How is Continuity Defined in Continuity Clinics? Paul Darden, MD, MPH was the principal investigator for this CORNET-APA Continuity SIG collaboration which surveyed pediatric continuity directors to determine how they measure and define continuity, an important concept to the Residency Review Committee. Results from 170 programs (over 75% of all pediatric training programs nationally) were presented at the 2011 Denver PAS.

Bright Futures, Preventive Services Improvement Project (PreSIP). Paula Duncan, MD, the PI on this project, obtained funding from HRSA and MCHB for a collaborative project based in four CORNET sites and several practices participating in the QUINN program. The goal is to determine if Bright Futures can be easily implemented in a busy clinical setting, targeting children birth to 3 years. The methodology is a quality improvement project to develop and test specific changes, using rapid cycle change strategies. Results from the project are now in the analysis phase.

Adolescent Immunizations within Medical Homes Initiative (AIMHI). This 3-phase study, funded by the Centers for Disease Control, is a quality improvement study to increase adolescent immunization rates, and a collaboration between CORNET and the Rochester practice-based network (GR-PBRN). Peter Szilagyi, MD, MPH is PI. Phase 1 was a survey of 47 CORNET practitioners that determined potential interventions, barriers, strategies and critical components of interventions to enhance immunization of adolescents. Results were presented at the 2011 PAS meeting. The second phase has consisted of a series of focus group discussions using a modified Delphi technique. Participants have discussed the most feasible and sustainable strategy to enhance adolescent immunizations. Use of an EMR and nurse prompts were the most promising tools. In Phase 3, 12 CORNET sites participated in a trial of 3 different strategies in order to measure the effectiveness of the selected strategies in increasing adolescent vaccination rates and impact on utilization of services in the medical homes.

Pediatric Residency Integrated Survey: Mental Health in Primary Care (PRISM-PC). The PI for this 2-phase study is Maya Bunik, MD, MPSH. The first phase, funded by University of Colorado, was a cross-sectional survey of continuity directors focusing on mental health patient access, resident education of mental health issues, and whether practices have integrated mental health models at their sites. Surveys were completed by 54 programs and results were presented at the 2011 PAS meeting. Funding is being secured for the second phase, which will be a comparative study examining patient and resident educational outcomes among different mental health integration models.


 

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