2023
Principal Investigator: Corrine Voils, PhD – UW SMPH, Dept of General Surgery
Project Summary: This study will provide critical insight into the efficacy of systematically involving domestic partners to optimize long-term weight loss. Results from the mediation analyses will provide unique knowledge about the mechanisms underlying a couples’-based approach for patient weight management. As such, the results will inform future intervention refinements to optimize patient outcomes and scalability. Completion of this study will contribute to our long-term goal of identifying and implementing efficacious, cost-effective approaches to reduce obesity and associated outcomes.
Funding Agency: National Institutes of Health (R01)
2022
Principal Investigator(s): Cassandra Sundaram, MS – UW Madison Department of Family Medicine & Community Health
Project Summary: 3-Minute Mental Makeover: This project aims to facilitate the use of an expressive writing tool, the 3MMM, in conversations between clinicians and their patients with chronic pain. The tool and associated surveys have been developed, but support is needed to train clinicians on use of the tool. Funding is additionally needed to produce study materials and support study staff to collect data, and conduct and review data analyses.
Funding Agency: UW Madison Department of Family Medicine & Community Health
Principal Investigator(s): Edmond Ramly, PhD – UW Madison Department of Family Medicine & Community Health
Project Summary: Our long-term goal is to improve evidence based care for chronic conditions in primary care while reducing health disparities. The overall objective is to engage a patient advisory board and a stakeholder advisory board in co-designing the AGILE tool, supported by an expert advisory panel. The resulting tool will enable primary care clinics to map strategies to address local barriers for adapting implementation of evidence based guidelines to the needs of racially/ethnically diverse populations in the midst of telehealth adaptations.
Funding Agency: UW Institute for Clinical and Translational Research-Stakeholder & Patient Engaged Research (ICTR-SPER)
Principal Investigator(s): Sarina Schrager, MD UW Madison School of Medicine & Public Health / Department of Family Medicine & Community Health
Project Summary: The purpose of this grant is to utilize the materials developed by our team to support the use of SDM for breast cancer screening and package them into CME and MOC part IV modules for use by primary care clinicians.
Funding Agency: DFMCH Small Grant
Principal Investigator(s): Rachel Grob, MA, PhD – UW Madison Department of Family Medicine & Community Health
Project Summary: To understand patients’ experiences with COVID-19 in the state of Wisconsin. Our understanding of the natural history, diagnosis, and treatment of COVID-19 is still in nascent stages of development, particularly related to long-term effects, and more work is needed to develop best practices to care for patients with long COVID. The work will help address knowledge gaps of the patient experience with long COVID.
Funding Agency: UW Madison Department of Family Medicine & Community Health
Principal Investigator(s): Sarina Schrager, UW Madison Department of Family Medicine & Community Health; Amye Tevaarwerk, UW Madison School of Medicine & Public Health
Project Summary: In order to improve breast cancer screening rates and survivorship in Prairie Ridge Health’s (PRH’s) rural service area, the reasons why residents are not obtaining mammography must be identified, understood and addressed. A more in depth evaluation is needed to develop a comprehensive plan to address the array of limitations specific to PRH’s rural location (biology, individual characteristics, social and physical contexts, and political/economic environment).
Funding Agency: UW Madison Carbone Cancer Center
Principal Investigator(s): Paul Hunter, MD; Mary Henningfield, PhD – UW Madison School of Medicine & Public Health / Department of Family Medicine & Community Health
Project Summary: In 2019, the Advisory Committee on Immunization Practices (ACIP) changed its age-based recommendations for pneumococcal conjugate vaccine 13 valent (PCV13) to a shared decision-making (SDM) process. The overall goal of this QI project is to evaluate the use of telehealth for SDM conversations regarding PCV13 vaccinations for adults being seen in the primary care setting. A secondary goal is the development of a template for clinicians to seek maintenance of certification (MOC) part IV for QI projects related to implementation of SDM via telehealth for vaccinations in adults.
Funding Agency: Pfizer, Inc.
Principal Investigator(s): Robin Gal, Jaeb Center for Health Research
Project Summary: This study will assess feasibility and efficacy of establishing a virtual diabetes clinic with a focus on introduction of CGM technology and ongoing CGM use to minimize such rate-limiting factors as geography, cost and access to specialty care.
The objective of this study is to evaluate a virtual diabetes clinic model, for adults with either T1D or T2D, that supports integration of CGM into diabetes self-management and evaluates use of decision support technology within the virtual clinic model.
Funding Agency: Helmsley Charitable Trust
2021
Principal Investigator(s): Shelbey Hagen, BS and Mary Henningfield, PhD UW Madison School of Medicine & Public Health / Department of Family Medicine & Community Health
Project Summary: The purpose of the study is address three aims, which are as follows: how participants believe weight stigma impacts their willingness to receive healthcare, how participants believe weight stigma impacts their satisfaction with their healthcare, and how participants believe weight stigma impacts their readiness to make healthy behavior changes.
Funding Agency: DFMCH Small Grant
Principal Investigator: Ronald Aronson, MD Bristol-Myers Squibb
Project Summary: Pragmatic study of approximately 52,000 with Asymptomatic Atrial Fibrillation. An abnormal heart rhythm called atrial fibrillation (AF) can increase the risk of having a stroke if a blood clot forms and travels through the blood stream to the brain. The purpose of this study is to determine if screening patients with a device to detect abnormal heart rhythms reduces the risk of stroke compared to usual standard of care. Since abnormal heart rhythms can come and go, monitoring can increase the chance of detecting AF that is otherwise undiagnosed.
Funding Agency: Bristol-Myers Squibb
Principal Investigator: Ellen Goldstein, PhD, UW SMPH – Department of Family Medicine and Community Health
Project Summary: The first few years of life are a period of exponential brain growth and development. The effects of early exposure to opioids on infant and child development are unknown. To address this knowledge gap, NIH is supporting research to better understand typical brain development, beginning in the prenatal period and extending through early childhood, including variability in development and how it contributes to cognitive, behavioral, social, and emotional function. Knowledge of normative brain trajectories is critical to understanding how brain development may be affected by exposure to opioids and other substances (e.g., alcohol, tobacco, cannabis), stressors, trauma, and other significant environmental influences, including those that promote resilience.
Funding Agency: National Institute of Health
2019
Principal Investigator: Olayinka Shiyanbola, PhD – UW Madison School of Pharmacy
Project Summary: Surveys will be distributed to African American patients with Type II Diabetes taking oral medications to understand their attitudes around medication adherence. The survey will be repeated after 6 months to gauge if any changes in attitudes have occurred. These data will form the basis for developing appropriate interventions for increasing medication adherence that can be tested in future studies.
Funding Agency: UW Madison – School of Pharmacy
Principal Investigator: Paul Smith, MD (PI)
Project Summary: Our primary goal is to pilot test the effectiveness of a promising behavioral change program to improve communication between caregivers of older adults and healthcare professionals with a randomized wait-list controlled trial. We will evaluate a program developed and tested in 2014 which significantly improved communication confidence for a small sample of caregivers of older adults in rural Wisconsin.
Funding Agency: American Academy of Family Physicians (AAFP)
Principal Investigator: Amye Tevaarwerk, MD – UW SMPH Carbone Cancer Center
Project Summary: Our interdisciplinary team of experts in oncology, cancer survivorship, primary care and engineering will identify the necessary elements to develop a PCP-centered care plan from an existing patient-centered and EHR-based care plan. Collaborating with a large primary care research network, we propose a 12-month study relying on systems engineering approaches to accomplish this re-design.
Funding Agency: University of Wisconsin Institute for Clinical and Translational Research (UW ICTR)
Principal Investigator: Meghan Brennan, MD, MS – UW SMPH, Dept of Infectious Diseases
Project Summary: Long-term objective is to reduce the risk of major amputation and death for rural patients with diabetic foot ulcers by developing and implementing interventions that promote integrated care in the rural, ambulatory setting. Primary objective in this proposal, which is the next step in pursuit of that goal, is to identify existing, ad hoc strategies developed by rural providers, and barriers they continue to face, when attempting to provide integrated care for rural patients with diabetic foot ulcers.
Funding Agency: Institute for Clinical and Translational Research (UW ICTR) Community Academic Partnerships (CAP)
Principal Investigator: Matthew Halanski, MD – UW SMPH Department of Orthopedics & Rehabilitation
Project Summary: This project is a combination of retrospective and prospective chart review to develop a comprehensive database of interventions and outcomes of children with SMA, and to develop a prospective, PROM-based data collection method for future project development.
Funding Agency: UW SMPH – Department of Orthopedics & Rehabilitation
Principal Investigator: Elizabeth Burnside, MD, MPH, MS, FACR – UW SMPH, Dept of Radiology
Project Summary: This project will seek to optimize the Shared Decision Making Process of mammography screening for women aged 65 and over. The project will utilize a risk-assessment tool and will engage both patients and primary care clinicians in development of an optimum screening dialogue.
Funding Agency: National Institutes of Health/National Cancer Institute
Principal Investigator: Robin L Gal, M.S.P.H., C.C.R.A.
Project Summary: This pilot study will assess whether initiating CGM remotely (outside of the clinic setting) using a Peer trainer can be performed safely and effectively and will test procedures that could be used in a larger subsequent study.
Funding Agency: Helmsley Trust
Principal Investigator: Sarina Schrager, MD, MS – UW SMPH Department of Family Medicine & Community Health
Project Summary: Propose to develop, pilot and implement an integrated clinic team training program to address knowledge, perceptions, Shared Decision Making (SDM) competence, and cost concerns to improve the use of SDM with average-risk patients eligible for breast and lung cancer screening. Ultimately, the hope is that this training will increase provision of SDM in cancer screening across the UW Health enterprise.
Funding Agency: UW Health Innovations Grant
Principal Investigator: Tosha Wetterneck, UW Medicine
PI Department: Department of Family Medicine & Community Health
Summary of Study: An Industrial Engineering initiated project as follow up to SAFE-C concentrating on the cognitive workload of EMR use.
Objective: The purpose of this project is to develop and test electronic health record (EHR) interface design requirements that support the cognitive work of primary care clinicians and their clinical teams.
The specific aims are
- to identify the cognitive work requirements of primary care clinicians and teams, and
- to develop and test specific EHR interface design requirements by performing usability testing of EHR prototypes with primary care clinicians.
Study Design: We will be using a specific method of CTA, namely, goal directed task analysis (GDTA). GDTA is a type of cognitive task analysis specifically designed for determining cognitive work requirements in order to design information technologies (IT) that support these requirements. The goal of GDTA is to develop IT that provides high levels of situation awareness (SA) for users by giving them the information they need and having them input the right information. For EHRs used by primary care clinicians and clinician teams, this would mean having EHR interfaces that (1) request meaningful information for the clinicians to enter and (2) display the right information for clinicians to produce quick, accurate, and complete pictures of the patients (i.e., the EHR provides high Situational Awareness). What is specifically innovative about GDTA is that it (1) focuses on goals, not tasks, and (2) determines cognitive work requirements so that IT can be developed that supports and extends the cognitive work of the users. GDTA takes information learned from observations and interviews of workers to create cognitive maps of individual and teams of worker’s goals, decision-making and information needs to understand the work that occurs; essentially a non-linear representation of work that can be used to create information technology, in our case, electronic heath records, that better supports the work to be done by individual clinicians and teams of clinicians.
2018
Improving Eye Health in Rural Wisconsin
Principal Investigator: Dr. Yao Liu
PI Department: UW School of Medicine & Public Health – Department of Ophthalmology and Visual Sciences
Summary of Study: Diabetic Retinopathy is the leading cause of blindness for working-age Wisconsin adults, effecting more than 135,000 Wisconsin people diagnosed with diabetes. While early diagnosis can reduce vision loss by 90% in these patients, less than 70,000 Wisconsin residents with diabetes received annual eye screenings.
Dr. Liu, as a practicing ophthalmologist at the Mile Bluff Medical Center in Mauston, was interested in increasing physician referrals for eye screenings. Dr. Timothy Bjelland, Chief Medical Officer at the Mile Bluff Medical Center, provided support to Dr. Liu in conducting this primary care research with primary care clinicians and the communities they serve. Dr. Liu engaged the Quality Improvement Facilitation resources of WREN, provided by Research Coordinator Deanne Boss, M.S., to increase referrals at the main clinic by 5-fold and overall screening rates by 13%, thereby improving the health outcomes for the people of Wisconsin.
Video: A Vision for Better Eye Care In Rural Wisconsin Featuring WREN Member Dr. David Hoffmann and WREN Steering Committee Member, Dr. Tim Bjelland.
Principal Investigator: Barry Carter/David Hahn
PI Department: University of Iowa/Department of Family Medicine & Community Health
Summary of Study: This is a multi-center, cluster-randomized study utilizing a centralized cardiovascular risk service (CVRS) in medical offices with large geographic, racial and ethnic diversity to determine the extent to which the CVRS model will be implemented. We will randomize 16 primary care offices to the CVRS or usual care and enroll 400 subjects of which 240 subjects will be from racial minorities. Our central hypothesis is that a centralized CVRS managed by clinical pharmacists will be implemented and significantly improve CVD guideline adherence using the Guideline Advantage metrics. The rationale for this proposed study is that implementation of a novel strategy to improve secondary prevention of CVD will lead to innovative strategies for broader adoption by health systems throughout the US.
Objective: The objectives of this study are 1: To determine if a web-based CVRS managed by clinical pharmacists will be implemented within diverse primary care offices; 2: To evaluate barriers and facilitators to implementation and dissemination of the intervention; 3: To demonstrate a favorable cost for the CVRS using a robust cost-effectiveness analysis.
Principal Investigator: Elizabeth Burnside, MD, MPH, MS, FACR – UW SMPH Department of Radiology
Project Summary: The purpose of the research is to develop and test a decision tool that will support evidence-based conversations between primary care providers and patients to weigh the benefits of mammographic screening to improve breast cancer detection and the harms of false positives, and to improve population health.
Funding Agency: UW SMPH – Department of Radiology
Project Summary: A formal coalition of 5 geographically diverse, research-experienced PBRNs: the Oklahoma Physicians Resource/Research Network (OKPRN), the Upstate New York Network (UNYNET), the Los Angeles Research Network (LANet), the Wisconsin Research and Education Network (WREN), and the Oklahoma Child Health Research Network (OCHRN), and a Coordinating Center, Westat. By formally linking 4 academic health centers and a private research organization, we will dramatically expand the range of methodological and clinical content expertise available on projects. Through their work with CoCoNet, they will have the resources to continue to nurture, expand, and sustain both local and coalition-wide learning communities that will influence primary care practices in four states.
Funding Agency: Agency for Healthcare Research and Quality
2017
Lead Investigator: David Hahn, MD, MS
Project Summary: This is a brief patient survey-based study initiated by WREN associate Dr. Bob Mead. Dr. Mead has made clinical observations suggesting that cough drops containing menthol may actually prolong and/or worsen some coughs. The side effect profile of mentholated cough drops is poorly described, and the “counter irritant” properties of menthol could hypothetically play a role in prolonging and/or worsening cough. Better understanding of potential harms of cough drops could improve patient care.
The goal is to understand how many people with an acute cough are using cough drops or throat lozenges to treat their cough symptoms, and whether menthol-containing products, compared to non-menthol products, are associated with longer duration of cough. The purpose of this pilot study is to gather preliminary data to plan for future WREN projects into possible harms of menthol-containing cough drops/throat lozenges.
Principal Investigator: David Hahn; Alek Zgierska, Co-PI
PI Department: Department of Family Medicine & Community Health
Summary of Study: This is a system-based improvement project incorporating evidence-based practices for chronic pain management and opioid prescribing that can ultimately lead to improved clinical outcomes of primary care patients with chronic pain who are treated with prescription opioids.
Objective: Our objectives are to:
- Increase patient-clinician education and discussion surrounding issues relevant to long-term opioid therapy
- Increase assessment of the risks associated with long-term opioid therapy
- Improve monitoring for prescription medication misuse or abuse
Study Design: We will recruit clinics to participate in this randomized controlled trial (stepped-wedge design) of an educational intervention for primary care clinicians. Nine clinics within the UW Health system (caring for adult patients) will be enrolled. The desired outcome is to change clinician behavior so that patient care and, ultimately, safety and outcomes, are improved.
- Performance of enrolled clinics will be assessed at baseline via review of EHR.
- Knowledge-based intervention (spaced education) will occur for all opioid-prescribing clinicians and their supporting medical staff in the nine intervention clinics.
- Academic detailing (dedicated lecture) will occur for clinicians and supporting medical staff completing spaced education.
- Patient education tools will be provided to enrolled clinics.
- Practice facilitation will occur on a monthly basis to reinforce the interventions.
- Post-intervention change will be assessed via review of EHR and clinician use of the Wisconsin Prescription Drug Monitoring Program (PDMP).
Lead Investigator: Betty Gyllstrom (Minnesota)
Local Investigators: Susan Zahner and David Hahn
Project Summary: Primary care and public health practice-based research networks across four states (Colorado, Minnesota, Washington, and Wisconsin) are working together to describe the extent of collaboration between primary care and public health systems. Each state will identify at least 5 pairs of key informants, to include a public health director and a primary care representative from the same jurisdiction. Over the span of three years, these dyads will be interviewed individually, complete an electronic survey, and participate in a focus group. The relationship between the extent of collaboration and services and health outcomes (in regards to immunizations, tobacco use, and physical activity) will be examined.
Funding Agency: Robert Wood Johnson Foundation
Principal Investigator: David Wolff, MD; Cynthia Wolff, MD
Project Summary: Since the 1990’s there has been an increasing epidemic of prescription pain pill addiction in rural communities, and those affected often do not know where to turn for help.
The Project is dedicated to improving the lives of those suffering from the disease of addiction, their families, and their communities, by building infrastructure and partnerships with the capacity to develop high-quality patient-centered research, with a focus on rural areas by finding ways to help encourage and develop more rural primary care practices that use Medication Assisted Therapy; ask difficult questions and explore possible innovative methods appropriate to rural, more remote populations, such as utilizing telemedicine techniques. As these ideas are developed, there may be additional discoveries that devise new options suitable for comparison as CER ideas.
Everyone is personally affected by addictive disease. This study will take steps to make a positive change in our communities.
Funding Agency: PCORI
Principal Investigator: Margaret (Meg) Wise, PhD, UW School of Pharmacy
Project Summary: The National Kidney Foundation recommends that nephrologists engage pre-dialysis patients in shared decision-making (SDM) to incorporate evidence and patient values into these treatment decisions. This pilot will incorporate a dialysis decision-aid tool into the nephrology clinic workflow (My Life, My Dialysis Choice) and analyze whether patients in this group had more dialogue with their clinician, and made different dialysis decisions than those who did not have the decision-aid tool. We will also assess the feasibility of integrating the SDM tool within clinic workflow.
Funding Agency: UW Institute for Clinical & Translational Research (ICTR)
Principal Investigator: David Hahn, MD, MS
Project Summary: Lyme disease is caused by the bacterium Borrelia burgdorferi and is commonly transmitted to humans through the bite of infected blacklegged ticks. Typical symptoms include fever, headache, fatigue, and a characteristic skin (“bulls-eye”) rash called erythema migrans (EM). If left untreated, infection can spread to joints, the heart, and the nervous system. Lyme disease is diagnosed based on symptoms, physical findings (e.g., rash), the possibility of exposure to infected ticks and validated laboratory testing methods.
Lyme disease is endemic in Wisconsin. Timely diagnosis and treatment is important to avoid rheumatologic and neurologic complications. A rapid, easy to perform serologic test available point-of-care would contribute to effective management.
The overall objective of this project is to validate a rapid result test for Lyme disease and seek approval from the FDA for use in clinical labs.
Funding Agency: Quidel Corporation
2016
PI Department: Oregon Health & Science University/Department of Family Medicine
Summary of Study: CASCADE’s primary objective is to plan a large, 5-year, multi-site, pragmatic clinical trial to test the hypothesis that a skin care regimen utilizing emollient therapy from birth can prevent or delay onset of atopic dermatitis. This UM1 grant application to the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS) will be submitted by November 2015 and will be informed by the current 2-year planning grant. During the planning grant, we will develop a study protocol and data coordination plan with all supporting materials. We will also perform a pilot study to assess rate of accrual and parental willingness to participate in the projected 5-year study activities.
Study Design: We plan to solicit anonymous questionnaire participation using standard opt-out methods by directly contacting eligible patients identified by the DFMCH data warehouse and also at point-of-service if feasible (i.e., staff hands out and retrieves questionnaires at clinic visits). The mail approach will not interfere with clinic flow or impact clinics cost-wise. The point of care approach has minimal impact.
PI Department: Wisconsin Research & Education Network (WREN)
Summary of Study: WREN recently participated in an AHRQ-funded P30 (Meta LARC) SMS toolkit evaluation called INSTTEPP that included patient advisors, clinicians and care managers at four WREN clinics (and at 12 other Meta-LARC sites). The purpose of INSTTEPP2 is for WREN to work with one of the four INSTTEPP clinics to create and sustain SMS work groups within clinics to pursue the following aims: (1) Explore the SMS needs of the clinic; (2) Define the membership and roles/responsibilities for a clinic SMS workgroup; (3) Find resources to sustain the group and (4) Create and pilot at least one SMS project within the initial 9-month period
Funding Agency: UW Department of Family Medicine and Community Health
Local Investigators: David Hahn, MD, MS
Project Summary: We seek to clarify and explore what physicians see as ways pharmacists can contribute to improved patient medication management and then based on this assessment refine tools and processes to support their referrals. Specific objectives include the following:
- Adapt and refine marketing information handouts for physicians and patients describing MTM related services in relation to patient needs;
2. Adapt and refine tools/forms for patient referrals, service documentation, and feedback.
3. Identify 2-way communication process strategies for pharmacists and physicians to exchange information about patients medication management needs, activities, and recommendations.
4. Identify desired patient outcomes such as knowledge, medication behaviors, or clinical endpoints.
5. Evaluate outcomes from the referral process – including patient uptake of the physician referrals (% keeping appointment); physician and pharmacist evaluation of sustainability and value; patient confidence, knowledge and perception of service value; and regimen improvement.
Funding Agency: Community Pharmacy Foundation
Web: VVA Resources for Patients and Clinicians
Principal Investigator: Paul Smith, MD
PI Department: Department of Family Medicine & Community Health
Summary of Study: The project will develop an internet-based Vulvovaginal Atrophy (VVA) shared decision making (SDM) aid and educational interventions to teach SDM methods to clinicians. This will lead to increased recognition and management of symptomatic VVA in family medicine and OB/GYN clinics by raising awareness of patients, clinicians and office staff about the impact symptomatic VVA has on patient quality of life.
Objective: Increased clinician knowledge of SDM and current evidence for benefits and harms of treatments for VVA will result in: 1) Increased clinician knowledge about appropriate management of symptomatic VVA; 2) Change in clinician behavior to increase appropriate management of symptomatic VVA; 3) Increase diagnosis rates of symptomatic VVA in women age 50-80. 3) Improved Quality of Life (QOL) for women with symptomatic VVA as measured by the Menopause-Specific Quality of Life Questionnaire (MenQOL).
Study Design: Participating clinicians will be asked to complete a self-directed, educational activity on VVA and SDM followed by 4-6 meetings over 3 months with WREN staff to facilitate integration of identification of patients with VVA and VVA SDM into the practice workflows. Physicians will be asked to identify patients with symptomatic VVA to participate in the SDM process and refer to WREN staff for enrollment. Anticipated enrollment is two patients per month for each clinician for 6-12 months. Clinic staff will work with WREN staff to extract EHR billing data to assess frequency of VVA diagnosis before and after the educational intervention and create a list of patients for WREN staff to conduct chart reviews.
2015
Principal Investigator(s): Robert Lemanske, MD
Project Summary: The purpose of this study is to compare asthma treatments for African American/Black people who have asthma that is not well controlled on a low dose of inhaled steroid. This study will also try to find out if adults and children differ in how they respond to these asthma medications.
Funding Agency: National Heart, Lung and Blood Institute (NHLBI)
Principal Investigator(s): Paul Smith, MD (PI); Betty Chewning, PhD (Co-I); Karen Kehl, PhD (Co-I); Beth Martin, PhD (Co-I)
Project Summary: This one-year pilot project, conducted in collaboration with the Aging and Disability Resource Center of Green County (ADRC) and Monroe Clinic, aims to develop and test a small group educational program for caregivers of elders to improve health communication with health care professionals. Our participants will be 8-10 caregivers of older adults for each of three workshops for a total of 24-30 participants. We hope that this will ultimately result in improved self-efficacy of the caregivers and reduced caregiver burden.
Funding Agency: UW Institute for Clinical and Translational Research (ICTR)
Video: BeST Communication
Project Summary: Four primary care clinics across the state will start the new year working with WREN on an innovative study that brings patients to the table as clinics consider implementing self-management support tools for chronic conditions.
INSTTEPP (Implementing Networks Self-Management Tools Through Engaging Patients and Practices) will use an intervention called Boot Camp Translation (BCT) to evaluate the patient Self-Management Support (SMS) toolkit published by the Agency for Healthcare Research and Quality (AHRQ).
Boot Camp Translation is a two month intervention which begins with a 1 day retreat where patients and clinicians come together to learn about patient self-management for chronic conditions and the AHRQ SMS Toolkit. The retreat participants will continue the conversation with their clinics over the two month intervention period and implement selected elements of the AHRQ SMS Toolkit.
WREN is collaborating with Practice Based Research Networks (PBRNS) in Colorado, Oregon and Iowa on this study to promote and study the use of the AHRQ SMS Toolkit across 16 primary care practices in 4 PBRNS. This study will assess the impact of the SMS Toolkit on practice staff and patients engaged in chronic care management, and identify factors related to successful implementation.
Funding Agency: Agency for Healthcare Research and Quality (AHRQ)
Poster: Hahn D, Judge K, Hoffmann A. Boot Camp Translation in Primary Care Settings: A WREN Qualitative Case Study. Presented at the 2015 North American Primary Care Research Group (NAPCRG) Practice-based Research Network Conference. June 29-30, 2015. Bethesda, MD.
Workshop: Hahn D, Hoffmann A, Judge K. How the INSTTEPP Study Used Consolidated Framework for Implementation Research (CFIR). Workshop presented at the Institute for Clinical and Translational Research-Community-Academic Partnership (ICTR-CAP) Dissemination and Implementation 101: Pre-Conference Workshop. April 15, 2015. Madison, WI.
Principal Investigator(s): Heather Johnson, MD, MS; David Hahn, MD
Project Summary: This study will use physician interviews and patient focus groups to (1) learn what factors help and hinder the diagnosis and treatment of high blood pressure among young adults, and (2) inform the development of sustainable primary care clinical interventions.
Funding Agency: National Heart, Lung and Blood Institute (NHLBI)
Principal Investigator(s): Jonathon, Temte, MD, PhD
Project Summary: Although multiple surveillance systems are currently used to monitor influenza, there are delays in reporting. As such, current estimates of influenza trends are 1-3 weeks old. Since influenza outbreaks tend to last about 9 weeks or less, this delay is significant. To address this lag, PI Dr. Jonathan Temte, has partnered with the Wisconsin State Laboratory of Hygiene, the Wisconsin Division of Public Health, UW School of Medicine of Public Health’s Department of Family Medicine and Community Health, and WREN.
This project aims to assess the feasibility and performance of using an innovative approach to influenza surveillance in typical primary care settings. Primary care clinics will use rapid influenza detection coupled with instantaneous transmission of results to a public health agency. 16 WREN clinics will conduct routine nasal swabs for influenza and process the swabs using a CLIA-waived, rapid-response analyzer to detect influenza A and B. Test results are available to the clinic in approximately 15-20 minutes and de-identified results are sent instantly, via wireless technology, to the Wisconsin Division of Public Health to enhance statewide flu surveillance.
Poster: Leege E, Irwin A, Judge K, Bockenfeld M, Hahn D, Temte JL, Barlow S, Schemmel A, Temte E, Haupt T, Residorf E, Wedig E, Shult P, Booker D, & Tamerius J. Back to the Future, With a Twist: Utilizing a PBRN for Real-Time Influenza Surveillance. Presented at the North American Primary Care Research Group (NAPCRG) Practice-Based Research Network Conference. June 30-July 1, 2014. Bethesda, MD.
Poster: Leege E, Irwin A, Judge K, Bockenfeld M, Hahn D, Temte JL, Barlow S, Schemmel A, Temte E, Haupt T, Residorf E, Wedig E, Shult P, Booker D, & Tamerius J. Back to the Future, With a Twist: Utilizing a PBRN for Real-Time Influenza Surveillance. Presented at the 31st Annual Clinical Virology Symposium, April 26-29, 2015. Daytona Beach, FL.
Abstract: Danz T, Reisdorf E, Temte J, Tamerius J, Wedig M, Barlow S, Haupt, T, Landsverk M, Schemmel A, Temte E, Bowles E, Whyte T, Leege E, and Shult P. Near Real-Time Surveillance For Influenza Using the Cellular-Linked SOFIA® Immunoassay Analyzer. Presented at the 31st Annual Clinical Virology Symposium, April 26-29, 2015. Daytona Beach, FL.
Funding Agency: Industry (Quidel)
Principal Investigator(s): Olayinka Shiyanbola
Project Summary: This study aims to improve the design of prescription warning labels by incorporating the patient and pharmacist perspective into the redesign of the labels.
Funding Agency: University of Wisconsin, Graduate School
2014
Principal Investigator(s): Paul Smith, MD
Project Summary: Using an evidence-based multi-component strategy, implement National Kidney Foundation Chronic Kidney Disease Guidelines at two UWMF practices with resultant improvement in their processes and outcomes for patients with this condition. The project will use Practice Facilitators to develop workflow changes, offer DLI tools to enhance patient education, develop a statewide local learning collaborative and implement changes to Health Link to increase efficiency and sustainability of workflows for CKD care and pilot test the changes.
Funding Agency: Wisconsin Division of Public Health
Principal Investigator(s): Anne Victoria Neale, PhD, MPH ~ Wayne State University
Project Summary: A collaboration of 6 PBRNs to develop best practices Standard Operating Procedures for practice-based research.
Funding Agency: Agency for Healthcare Research & Quality (AHRQ)
Publications: Anne Victoria Neale, PhD, MPH PBRN Research Good Practices North American Primary Care Research Group (NAPCRG) Copyright 2015
Principal Investigator(s): Louis Sanner
Project Summary: Wingra and Northeast Clinics are two of 48 primary care clinics in the Pharmacist Practice-based Research Network. Central investigators for the University of Iowa are developing a pharmacist invention focusing on the improvement of hypertension and asthma. Selected sites will receive information about a pharmacist-directed intervention and study coordinators will be trained to enroll patients and collect data. Each site will be asked to enroll 35-40 subjects with poorly controlled blood pressure and asthma.
Funding Agency: National Institute of Health (NIH)
Principal Investigator(s): Paul Smith, MD
Project Summary: Wisconsin Research and Education Network (WREN) will work with the National Kidney Foundation of Wisconsin (NKF-WI) and Wisconsin Diabetes Prevention and Control Program (WI DPCP) to improve the health of people with diabetes by building awareness of the need to detect, delay, and manage the serious complications associated with diabetes, including diabetic kidney disease, through specific health system changes. Health system changes are changes occurring through organizations, organizational policy, or environmental supports. These targeted system changes are interventions which aim to promote and create awareness at various levels with the ultimate goal of improving health outcomes for people with diabetes.
Funding Agency: National Kidney Foundation of Wisconsin
Principal Investigator(s): Lyle Fagnan, MD & David Hahn, MD, MS
Project Summary: This project aims to study and describe the utility of “The Toolkit” on clinic workflow processes while implementing health IT in eighteen small- and medium-sized primary care practices in Oregon and Wisconsin and two Regional Extension Centers. A highly effective Toolkit will provide practices with the effective means to evaluate workflow during many types of HIT implementation such as creating disease registries, collecting quality measures, using patient portals, and implementing a new EHR.
Funding Agency: Agency for Healthcare Research & Quality (AHRQ)
Presentation: Leege E, Irwin A, Smith P. The Value of Research Participation for Practices: A Case Study. Oral presentation at the 2013 Wisconsin Health Improvement & Research Partnerships Forum. September 12, 2013.
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.
Funding Agency: Agency for Healthcare Research and Quality (AHRQ)
Clinician Resources
- Blood Pressure Control and Treatment in the CKD Patient
- Chronic Kidney Disease Quick Reference Guide for the Primary Clinician
- The Primary Care Physician’s Guide to GFR
- A Quick Guide to Evidence-Based Chronic Kidney Disease Care for the Primary Care Physician
- CKD Reflexive Lab Testing Logic
- Managing Metformin and IV Iodinated Contrast
Patient Resources
- An important new educational DVD for the public is available titled “The Links to Chronic Kidney Disease: Diabetes, High Blood Pressure, and Family History.” Email (freekidneyDVD@wlf.info) for a free copy and include your name and address!
- What is Chronic Kidney Disease (CKD)? – English
- What is Chronic Kidney Disease (CKD)? – Arabic
- What is Chronic Kidney Disease (CKD)? – Spanish
- Chronic Kidney Disease: Patient Wallet Reference Cards – Version 1
- Chronic Kidney Disease: Patient Wallet Reference Cards – Version 2
Clinician, Patients, Families, & Community Resources
Publication: James W Mold, Cheryl B Aspy, Paul D Smith, Therese Zink, Lyndee Knox, Paula Darby Lipman, Margot Krauss, D Robert Harris, Chester Fox, Leif I Solberg and Rachel Cohen Leveraging Practice-based Research Networks to Accelerate Implementation and Diffusion of Chronic Kidney Disease Guidelines in Primary Care Practices: A Prospective Cohort Study Implementation Science 2014, 9:169
Poster: Lipman P, Mold J, Krauss M, Cohen R, Aspy C. Impact of Local Learning Collaborative (LLC) on the Diffusion of CKD Guidelines in a Multi-PRN Quality Improvement (QI)Project. Presented at the 41st North American Primary Care Research Group (NAPCRG) Annual Meeting. November 9-13, 2013. Ottawa, Ontario. Canada
Poster: Lipman P, Cohen R, Bockenfeld B, Knox L, Aspy C; Mold J. Implementation of Local Learning Collaborative (LLC) for the Diffusion of CKD Guidelines in a Multi-PBRN Quality Improvement Project: Description of Intervention Fidelity, Participant Attendance, and Guidelines Addressed. Presented at the 2013 North American Primary Care Research Group (NAPCRG) Practice-Based Research Network Conference. June 18-19, 2013. Bethesda, MD.
Workshop: Aspy C, Lipman P, Bockenfeld M. Lessons Learned in Multi-Network Quality Improvement Research Using Local Learning Collaborative to Disseminate Practice Guidelines: Case Studies from a CKD Quality Improvement Project in Primary Care Workshop presented at the 41st North American Primary Care Research Group (NAPCRG) Annual Meeting. November 9-13, 2013. Ottawa, Ontario. Canada
Workshop: Aspy C, Bockenfeld M, Lipman P, Lange C, Knox L. Practice Facilitation Evaluation: Case Studies From a CKD Guidelines Dissemination, Implementation and Diffusion Project in Primary Care. Workshop presented at the 2013 North American Primary Care Research Group (NAPCRG) Practice-Based Research Network Conference. June 18-19, 2013. Bethesda, MD.
Principal Investigator(s): Amy Tevaarwerk, MD
Project Summary: A survey of primary care providers to determine the usability and desirability of a Breast Cancer Survivorship care plan.
Funding Agency: UW Institute for Clinical and Translational Research (ICTR)
Publication: Amye J. Tevaarwerk Evaluating Primary Care Providers’ Views on Survivorship Care Plans Generated by an Electronic Health Record System Journal of Oncology Practice Published online March 24, 2015.
Principal Investigator(s): Tosha Wetterneck, MD, MS
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.
Funding Agency: Agency for Healthcare Research and Quality (AHRQ)
Principal Investigator(s): Roy Beck, MD, PhD
Project Summary: The objective of this project was to determine the number of individuals with type 1 diabetes (T1D) who are followed by a primary care medical practice, and to determine the proportion of patients using an insulin pump. This was an exploratory analysis required to develop hypotheses and future research approaches.
Funding Agency: Leona & Harry Helmsley Charitable Trust
Principal Investigator(s): Luke M Funk, MD, MPH
Co-Investigators: Corrine Voils, PhD, Matthew Maciejewski, PhD, and Caprice Greenberg, MD, MPH
Project Summary: Less than 1% of severely obese U.S. adults undergo bariatric surgery annually. It is critical to understand the factors that contribute to its utilization. This focus group research project will examine the management of severely obese patients in the primary care setting. The goal of this research is to improve our understanding of how primary care physicians make decisions regarding their morbidly obese patients who often have multiple medical problems.
Publication: Funk L, Jolles S, Greenberg C, Schwarze M, Safdar N, McVay M, Whittle J, Maciejewski M, Voils C Primary Care Physician Decision-Making Regarding Severe Obesity Treatment and Bariatric Surgery: A Qualitative Study Surgery for Obesity and Related Diseases Published online December 2nd, 2015.
2013
Project Summary: The Electronic Medical Record (EMR) is a rich source of patient information with the potential to provide population-based surveillance of chronic disease in real-time, identify environmental and community risk factors that affect disease onset and control, and help determine where to allocate public health resources. The goal of this research is to develop standardized electronically searchable definitions of both persistent asthma and type II diabetes mellitus and validate them by comparing electronic search results to a gold standard of manual EMR review. We hypothesize that our automated EMR search definitions of persistent asthma and type II diabetes mellitus will provide an accurate diagnosis similar to manual EMR review. Furthermore, we expect our detailed automated EMR search definitions will provide a more accurate diagnosis than each of its individual components.
Funding Agency: University of Wisconsin, Department of Family Medicine & Community Health
Project Summary: The primary goal of this project is to improve exercise prescription by physicians by developing a web-based Therapeutic Exercise Resource Center (TERC) that can be used by physicians to counsel patients and prescribe exercise as a part of their treatment for osteoarthritis (OA) of the knee.
Funding Agency: University of Wisconsin, Department of Family Medicine & Community Health
