Gaps in quality of care delivery are widespread throughout our healthcare. Department of Family Medicine Research at Carolinas HealthCare System in Charlotte, NC pursues projects that seek to close these gaps through the study of methods that promote the integration of research findings and evidence into healthcare policy and practice (www.nih.gov).

Projects

Asthma Comparative Effectiveness Research

The Asthma Comparative Effectiveness Research (ACER) study funded by the Agency for Health Care Research and Quality aimed to improve asthma outcomes for patient through the use of integrated care, health information technology tools, and shared decision making (SDM).

Since June 2011, six primary care “safety net” practices within Carolinas HealthCare System across Charlotte, NC participated in our SDM intervention. Providers, staff and health coaches were trained in SDM using an evidence-based decision support toolkit. Resulting asthma SDM half-day clinics were tailored to capture each practice’s unique culture, focusing on sustainability and productivity. Currently, 258 English and Spanish- speaking pediatric, adolescent and adult patients with persistent and/or poorly controlled asthma have participated in 358 SDM half-day clinic visits. Asthma patients who underwent health coaching utilizing the SDM decision support toolkit experienced a greater reduction in ER visits, hospitalizations and oral steroid use than those exposed to trained providers and the control patients.

This project created an electronic asthma plan tool that is available both as an embedded tool within the electronic health record and through the internet (asthma.carolinashealthcare.org). The electronic asthma plan generator guides providers through the complexity of currently guideline-based therapy.

Choices/Opciones

7/1/13 - 7/1/2018 | This multisite study, sponsored by the American Cancer Society and directed by UNC Chapel Hill, is a randomized controlled trial that examines best practices for using health information technology and patient navigators in a primary care setting to improve health prevention behaviors.

Comparing Traditional and Participatory Dissemination of a Shared Decision Making Intervention

8/1/13 - 8/1/16 | Using a community-based participatory approach, researchers at DFM-Research created a facilitator-led participatory approach to dissemination that provided an ideal framework for rapid dissemination of a complex asthma shared decision making (SDM) toolkit across six practices. This study will test this novel method for dissemination on a larger scale by randomizing 30 practices to one of three arms:

  1.  Control with no dissemination;
  2.  Traditional dissemination with one didactic session and distribution of educational material; and
  3.  Facilitator-led participatory approach to dissemination

The primary outcome measures will be: reduction in asthma exacerbations and patients’ perceptions of involvement in their asthma care decisions. Secondary outcome measures will include: beta agonist overuse, controller medication use, and reported practice level use of the SDM toolkit. This study will provide crucial data to support a novel method for dissemination of an evidence-based toolkit into primary care practices.

The Effect of Cumulative Subconcussive Impacts on Neurocognitive Function in Adolescent Football Players: Pilot Project

7/1/13 - 1/1/14 | This is a pilot study that will demonstrate the feasibility of examining the effects of cumulative subconcussive impacts on neurocognitive outcomes for high school athletes. Ultimately, this pilot data will support a larger study that aims to:

  1. Define cumulative subconcussive impact thresholds at which short-term and long-term neurocognitive sequelae occur;
  2. Compare the effectiveness of various prevention strategies to avoid meeting subconcussive impact thresholds; and
  3. Test screening modalities that identify high school athletes who may benefit from early neurocognitive interventions.
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