The Northern States Ambulatory Research Network

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• The Northern States Ambulatory Research Network
• Charles E. Christianson, MD, ScM Network
  Director
• Kimberly Krohn, MD, MPH Board Chairman
• Jessica Behm - Network Coordinator

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What is NORTHSTAR?

• New clinical research activity sponsored by
  UNDSMHS.
• Housed at the Department of Family and Community
  Medicine.
• First practice-based research network in North
  Dakota.

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Practice-Based Research Networks (PBRNs)

• Putting research into practice and practice into
  research.
• Rapidly becoming a popular tool in the area of
  healthcare research, especially primary care.
• Group of practitioners who come together to
  conduct clinical research.
• Members direct research topics towards issues
  they feel are important, so research tailored to
  the needs of the practitioners.
• Learning network

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PBRNs

• Access to larger and more representative
  population bases
• Traditional areas of focus
• Disease surveillance (epidemics)
• Clinical problems seen in primary care,
  i.e. headache

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PBRNs and Quality Improvement

• Intersection of traditional research practices
  and quality improvement (QI) activities.
• Look at practice organization rather than
  individual patients
• Improving care often more appealing to clinicians
  that research
• Translational research
• Ally with state QIO?

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Why a PBRN in North Dakota?

• Rural health care encounters unique challenges.
• There is a shortage of research on quality and
  quality improvement efforts in rural health care.
• North Dakota is an excellent environment to
  initiate this type of research.
• North Dakota has a significant number of rural
  primary care practitioners 220 physicians, 39
  physician assistants and 200 nurse practitioners.
• Overcome isolation of rural practice

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Health Care Quality and Cost
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NORTHSTAR The Northern States Ambulatory
Research Network

• Composed of primary care practitioners from North
  Dakota and adjacent areas.
• Family physicians, general internists, physician
  assistants, and nurse practitioners.
• NORTHSTAR -- bridge connecting North Dakota
  practitioners to research resources at UND.

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NORTHSTAR Focus

• Improving quality of care, especially rural
  primary care.
• Conducting best-practices research.
• Identifying and testing new methods of health
  care delivery in the rural setting.
• Urban ?rural
• Rural ? urban
• Creating a professional community where North
  Dakota practitioners can connect, communicate,
  and learn from their fellow colleagues.

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NORTHSTAR Board of Directors

• The network is governed by a Board of Directors
  composed mainly of network participants.
• The Boards responsibilities include
• Setting the overall direction and policy of the
  network.
• Reviewing and selecting proposed research and
  quality improvement projects for the network.

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NORTHSTAR Board of Directors

• Members of the Board currently include
• Kimberly Krohn, MD, MPH Board Chairman
• Charles E. Christianson, MD, ScM
• David Remillard Director, North Dakota Health
  Care Review, Inc.
• Abe E. Shamoun, PhD Epidemiologist
• Lyle Best, MD Family medicine/ epidemiology
• Wesley Canfield, MD Peds/nutrition
• Madeline Luke IM Valley City

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Process

• Ideas come from network participants (or outside
  investigators)
• Board screens, approves
• At UND we
• Refine ideas, develop research protocol
• Collect and analyze data
• IRB approval, other administration
• Results presented to network for discussion ? new
  ideas for study,
• practice improvement

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Dilated Retinal Exams in Clinical Care (DREC)

• One standard of care for patients with diabetes
  annual retinal exam
• Lowest compliance of diabetes care standards
  nationally and in ND 50 -65.
• Re-examine the rates in participating practices
  through chart review

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DREC Project

• Have collected data and basic analysis rates
  lower than reported 16
• Performing more sophisticated correlations, e.g.
  continuity and compliance
• Follow-up methodological study
• Next steps?
• Post cards for reporting
• Diabetes Care Flow Sheets
• Possible Diabetes Registry System

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Upcoming Projects

• West Nile Virus
• Pediatric aspects
• Long term follow up
• Begin this summer
• Mammogram Examinations
• ND rates have slipped
• From 2 in nation to 7

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Why partner with NORTHSTAR?

• Diverse, more representative populations
• Translational research
• Two-way street

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References

• Lanier, D, Primary Care Practice-Based Research
  Comes of Age in the United States. Annuals of
  Family Medicine 2005 3 S2-S4.
• Mold, JW and Peterson, KA, Primary Care
  Practice-Based Research Networks Working at the
  Interface Between Research and Quality
  Improvement. Annuals of Family Medicine 2005 3
  (Supple 1) S12-S20

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NORTHSTAR Contacts

• Charles E. Christianson, MD, ScM
• Network Director
• cchristi_at_medicine.nodak.edu
• (701) 777 3240

• Jessica Behm
• Network Coordinator
• jbehm_at_medicine.nodak.edu
• (701) 777 - 3266

For More Information, Go To Our Web Site
At www.med.und.nodak.edu/northstar
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Questions?