Research

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Current Projects

Improving Care for Patients with Chronic Kidney Disease (CKD): Helping Practices Implement CKD Guidelines

Funding Agency: Agency for Healthcare Research and Quality
Project Summary: The purpose of the project is to implement and test ways to help primary care practices who are part of the Wisconsin Research and Education Network (WREN) improve implementation of the current chronic kidney disease (CKD) guidelines developed by the National Kidney Foundation (NKF). We will assess the impact of two interventions in two phases. Phase I will test use of practice facilitators (WREN Regional Research Coordinators) and Phase II will test the use of local learning collaboratives. We hope to determine how well these practice interventions together improve uptake of and adherence to CKD guidelines. We are one of four practice-based research networks that will take part nationwide. Eight Wisconsin practices will take part in Phase I, and an additional 16 practices will take part in Phase II.

Project Resources

SAFE-C (Situational Awareness Facilitating Excellent Care)

Funding Agency: Agency for Healthcare Research and Quality
Project Summary: Evidence demonstrates that ambulatory care is unsafe, and more unsafe with elderly patients. Little is known about what underlies the safety problems. In an earlier study, proactive hazard analysis of the data from 15 clinics identified that underlying nearly all of the hazards is one most serious hazard: physicians are experiencing information chaos. Information chaos is simultaneous (a) information overload, (b) information underload, (c) uncertainty about information, and (d) lack of awareness of some information. This contributes to two unwanted outcomes: poor situation awareness (SA), a person's awareness and understanding of their situation, and high mental workload (MWL), which occurs when a person's mental capacity is exceeded. Both factors ultimately impair memory, problem identification, decision making, and decision execution and therefore have clear, negative impacts on safety. An intervention that provides better SA will reduce MWL and improve problem identification and decision-making for the primary care physician (PCP). This project will test a SA intervention to improve PCP performance and thus safety of primary care of the elderly (aged >75). The intervention involves a nurse who will act as a "care coordinator" who (a) collects discrete patient data such as problem lists, medications, test results and procedure results from other providers 5 business days before a scheduled visit and (b) meets with the PCP at a scheduled time before the PCPs first visit to provide him/her with the right information at a time when the PCP can focus and talk. We use a randomized design involving 4 WREN clinics, 16 primary care physicians, and 1536 elderly patients randomly assigned to the intervention or care as usual. We will evaluate the impact on physician SA and MWL, patient perceived PCP SA, patient clinical outcomes, and return on investment. We will evaluate intervention barriers and facilitators and share the results widely with a theory-driven plan.

Understanding Patient Trust in Physician and Patient Outcomes

Funding: Dr. Montague is a KL2 scholar-one of a group of researchers interested in healthcare systems with an emphasis on translational research. Her work is supported by the UW Institute for Clinical and Translational Research (ICTR).

Project Summary: The purpose of this project is to identify how computer use by clinicians impacts clinician/patient trust during the clinical encounter. This study will identify practical changes that can be made in clinical practice to improve patient-clinician trust during a clinical encounter. In order to accomplish this we will explore nonverbal interpersonal interactions with individuals and technologies and ratings of trust. Multiple questionnaire measures of trust are needed to validate the interaction model. For this study, two forms of data will be collected: observational and questionnaire. Video and audio recordings will be collected to obtain data about interactions during the visit and questionnaires will collect measures of trust and demographics.

Recently Completed Projects

Proactive Risk Assessment in Primary Care of the Elderly

Funding Agency: Agency for Healthcare Research and Quality (AHRQ)
Principal Investigator(s): Ben-Tzion Karsh, PhD (PI); John Beasley, MD (Co-PI)
Project Summary: This study uses proactive risk assessment methods to identify hazards and model their risk in the primary care of elderly patients. Physicians and patients participate in observation and focus groups. Study results were used to develop a three year intervention study to improve care of the elderly that began in late 2008.

AZMATICS: AzithroMycin/Asthma: Trial in Community Settings

Funding Agencies: Pfizer, Inc., and the Joint Grants Awards Program of the American Academy of Family Physicians/AAFP Foundation
Principal Investigator(s): David L. Hahn, MD (PI); Michael E. Grasmick, PhD (co-PI)
Project Summary: This pilot project, conducted in collaboration with six other practice-based research networks, is a double-blind randomized controlled trial of the treatment of adult asthma with azithromycin.

Wisconsin Initiative to Promote Healthy Lifestyles (WIPHL)

Funding Agency: US Substance Abuse and Mental Health Services Administration
Principal Investigator(s): Richard L. Brown, MD, MPH (PI)
Project Summary: The WIPHL project is enhancing delivery of substance abuse screening, intervention, and referral and treatment services (SBIRT) in 22 practices affiliated with UW Health, Aurora Health Care, Wisconsin Research and Education Network, Wisconsin Primary Healthcare Association, and the Polk County Health Department. Clinic leaders are guiding their teams in implementing and improving SBIRT services in monthly plan-do-study-act (PDSA) cycles.

Quality of Life and Depression as Determinants of Treatment Adherence in Hypertensive Patients

Funding Agency: American Heart Association
Principal Investigator(s): Leonelo Bautista, PhD (PI)
Project Summary: This study is evaluating 280 patients newly diagnosed with hypertension who are starting antihypertensive medications to determine the relationship between medication compliance, depression, and quality of life. Patients complete a series of self-administered questionnaires about quality of life and depression over a one-year period. Several WREN practices are participating in this project.

Assessing Risk in Ambulatory Medication Use after Hospital Transitions

Funding Agency: National Institutes of Health
Principal Investigator(s): Tosha Wetterneck, MD (PI)
Project summary: This study will evaluate three practices to assess and identify hazards during the transition from hospital care to ambulatory care. Study results will provide pilot data for a future federal grant.

Improving and Expanding Primary Care Treatment of Chronic Kidney Disease

Funding Agency: UW Institute of Clinical and Translational Research
Principal Investigator(s): David Feldstein, MD (PI)
Project Summary: This project will develop and test a web-based system to track the treatment of patients with chronic kidney disease.

Establishing Benchmarks for the Medical Office Survey on Patient Safety

Funding Agency: Agency for Healthcare Research and Quality
Principal Investigator(s): Lylle J. Fagnon, MD (PI), Paul D. Smith, MD (local PI)
Project Summary: This project is a collaboration of 12 practice-based research networks and 300 practices to establish a national database for an AHRQ developed survey about the patient safety environment of primary care practices.

Improving the Health Literacy Environment of Wisconsin Hospitals - A Collaborative Model

Funding Agency: American Academy of Family Physicians
Principal Investigator(s): Paul D. Smith, MD (PI)
Project Summary: This project is training nine adult students enrolled in the GED program at Omega School in Madison to be consultants to St. Mary's Hospital. Students will work with St. Mary's to improve the health literacy environment of the hospital.

Problem Density, Mental Workload and Medical Error in Primary Care Practice

Funding Agency: Agency for Healthcare Research and Quality (AHRQ)
Principal Investigator(s): Jonathan L. Temte, MD, PhD (PI); Beth E. Potter, MD, Paul D. Smith, MD, and Ben-Tzion Karsh, PhD (co-PIs)
Project Summary: Thirty clinicians enrolled over 600 patients to investigate the relationship between the number of medical problems per hour (problem density) and the likelihood of medical error. Data collection for this project ended in early 2008.

What are Important Health Issues For Low Literate Adults? A Focus Group Evaluation of Health Literacy Issues

Funding Agency: American Academy of Family Physicians Foundation
Principal Investigator(s): Paul D. Smith, MD (PI)
Project Summary: In collaboration with Wisconsin Literacy, Inc., and three community-based Wisconsin literacy councils, WREN conducted six focus groups of low literate adults to explore how low literacy impacts their health and health care.

Educating Physicians and Patients in the Value and Use of Body Mass Index to Reduce Overweight and Obesity-Phase 2

Funding Agency: WellPoint Foundation
Principal Investigator(s): Paul D. Smith, MD (PI); Leon J. Radant, MD (co-PI)
Project Summary: In 2007, WREN completed this one-year follow-up survey of Wisconsin family physicians about use of and attitudes towards Body Mass Index as a tool to diagnose and manage obesity.

Sidebar content

Wisconsin Research and Education Network (WREN)

WREN Team Members
WREN Team Members, L to R: Veronica Harper, MA, BS; Kate Judge, MSSW; and Mark Remiker, MA.

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Last updated: January 26, 2012
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