Engaging providers in research: LA Net

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Engaging providers in research LA Net the
Reflective Practitioner

• Lyndee Knox, Ph.D.
• LA Net
• University of Southern California
• ASC 2006 Los Angeles

LA Net Los Angeles first Practice-based Research
Network devoted to health disparities
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Translating medical research into practice

• Lag

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Reasons for the lag

• Not relevant to practice.
• Works in theory, but cant be implemented
  effectively.
• Not acceptable/appealing to providers/patients.
• Lack of funding for translation studies.

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PBRNs as a solution

• Primary care practice-based research networks
  (PBRNs) started 20 years ago
• Collaborative of community providers linked
  together by shared infrastructure (bylaws, email,
  listserv, EHRs, commitment) to conduct research
  directly relevant to their patients care

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PBRNs vs. Traditional Approach

• Made-up mainly of practicing providers
• Providers play central role in 1) setting
  research priorities 2) defining research
  questions 3) designing studies 4)
  interpreting/implementing findings
• Funding supports substantive involvement of
  providers/clinics
• Focus is on patient-oriented evidence that
  matters eg things that will change practice

• Mainly researchers working in Academic Health
  Centers w/ limited involvement in community
• Researchers set priorities, design study,
  interpret findings
• Providers and clinics serve as labs for the
  study. Providers assist in recruiting patients
• Providers may read about study in professional
  journal or future guideline
• Focus is on questions of interest to providers
  and his/her line of research researcher-driven

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PBRNs in the US

• Insert Kevin Petersons map

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Funding/support

• Federal level support
• Agency for Healthcare Research and Quality
• Health Services and Resources Administration
• National Institute for Research Resources
  (Centers for Translational Research)
• Departments of Family Medicine
• Subscribers

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LA Net

• Founded 2002 w/ funding from HRSA/AHRQ
• 180 providers, 20 clinic partners in Los Angeles
  County
• .5 FTE Director,
• 1 FTE coordinator,
  .2 FTE statistician, .5 RA

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Map of LA Net
4 Residency Clinics
Pomona

• Insert map

11 Community Clinics
3 Clinics with multiple sites
West Covina
LA Net
Hollywood Center
Alvarado
Hollywood Wilshire
Marengo
Beverly
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Infrastructure

• .3 FTE Director
• 1 FTE Coordinator
• .2 FTE Statistician
• .2 Research Assistant
• Website www.lanetpbrn.net
• Listserv
• Email list
• Annual forum, travel, supplies
• Emergent EHR infrastructure
• Annual Budget 153,500

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LA Net project generation

• TOP DOWN Network Liaison
• Broker relationships w/ funded researchers/or RFA
  response
• BOTTOM UP Reflective Practitioner
• 1 cycle a year
• Grounded in CBPR/empowerment approach

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RP CBPR

• Engages community(subjects) as partners in
  research process (in this case HCPs)
• Studies are oriented toward change, not theory
  testing

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5 steps in RF Process

• Step 1 Generate topics real time
• Step 2 Select top 3 using network vote
• Step 3 Evaluate and finalize questions
• Step 4 Select top 1 using network vote
• Step 5 Design and implement study w/ providers

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RP in LA Net

• Annual
• Have implemented two cycles
• Costs- 215K
• Funded by Department

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Step 1 Generate topics real time

• Page (60) providers 2xs over 2 weeks during
  work hours
• Asked What problems or concerns have you
  encountered today w/ a patient or delivering care
  that you would like to see the network study?
• Generated 50/- topics each cycle

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Example Topics

• Cultural differences in newborn feeding practices
• What are the txt options for urinary tract
  infections?
• How satisfied are our patients with their primary
  care providers?
• What complementary and alternative medicines are
  our patients using?
• Using email to communicate with patients
• Health literacy in Latino patients
• Patient access to medication
• Pediatric obesity prevention

• I spend too much time on complicated patients
  that is not billable
• What are characteristics of diabetics with
  HgA1Cgt7
• How many of our clinics high risk cardiac
  patients are on daily ASAs?
• What are the long-term effects of inhaled
  steroids?
• How do I manage problematic child behaviors in my
  office?
• Resources for patients w/ dementia in Los Angeles

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Step 2 Select top 3 issues

• Providers get together at an Annual Forum
• Vote on issues of most concern to them
• Facilitated discussion on top 3-5 vote getters
• (1) refine questions for further consideration
• (2) triage to report/review to membership on
  issue

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Disposition of topics
How does immigration affect feeding practices?
Patients compliance/ satisfaction w/ provider
counseling?
Pediatric obesity prevention (triaged to
potential research)
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Evaluation criteria
Will it change my practice? Will it change my
colleagues practice? Is it feasible? Is it
publishable? Is it fundable? Is there a
provider champion?
How does immigration affect feeding practices?
Patients compliance/ satisfaction w/ provider
counseling?
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Step 3 Assess viability of issue as research
study

• Has question already been answered in the
  literature?
• What is the next good question?
• Does it meet our six criteria?
• Recommendation to network members

Provider Training
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Step 4 On-line voting

• Recommendations emailed to network members
• Members vote for 1 topic
• 25 network members voted in 2003

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Step 5 Design Implement

• Select study design
• IRB (FWAs with participating sites)
• Implementation and management of study
• Publications, presentations and grant
  applications

Provider Training
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LANet RP-Outcomes

• Provider-generated studies completed/under way
• Pediatric obesity
• Complementary Alternative Medicine
• Plagiocephaly
• Colonoscopy
• Provider-authored papers manuscripts
• Collaborative grant proposals
• Changes in practice
• Accessible colonoscopy screening in 3 practices
• Pediatric obesity intervention for immigrant
  parents
• Pre-visit screening for CAM use/curriculum for
  providers in LA

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Outcomes

• Attracted new network members
• Interest from Dean, Provost, Childrens Hosp,
  Planning Councils
• Changing provider perceptions/fears about
  research from fodder to
• partner

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Lyndee Knox, Ph.D.University of Southern
Californiaknox_at_usc.edu626-457-4220www.lanetpbr
n.net
LA Net Los Angeles first Practice-based Research
Network devoted to health disparities
Researching and Transforming Health Disparities
in Southern California