Science in the Triangle

Improving health is a scientific process. For physicians to improve the way they deliver health care – to truly understand what works and what doesn’t — they have to study it. This idea of medicine as a work-in-progress was a theme of the first North Carolina Conference on Practice-Based Research, held Friday, March 4, in Chapel Hill.

Co-sponsored by the North Carolina Network Consortium (NCNC) and the NC Translational and Clinical Sciences (NC TraCS) Institute, home of the Clinical and Translational Science Awards (CTSAs) at UNC, the conference brought together over 100 primary care providers, clinic staff and research coordinators from across the state to discuss the kind of studies practice-based research networks can conduct to improve health care.

“The new treatments that come out all the time from drug companies, device makers, or even things we do in clinic, require testing and evaluation prior to widespread adoption,” said Rowena Dolor, M.D., M.H.S., director of the Duke Primary Care Research Consortium, one of six practice-based research networks in the NCNC. “What we do know though is once a new drug or device is out on the market, there is widespread variation in how it is used in clinical care. And despite good intentions, not all treatments benefit patients. For example, we didn’t realize the COX2 inhibitors that were meant to relieve arthritis pain would also increase the risk of heart attack or stroke. That is why research is necessary.”

Dolor explained that practice-based research networks are a group of ambulatory practices, devoted principally to clinical care of patients, which also have an ongoing commitment to participate in research. NCNC is one of 10 networks nationally that have received special recognition from the U.S. Agency for Healthcare Research and Quality (AHRQ), the lead federal agency charged with improving the quality, safety, efficiency and effectiveness of health care for Americans.

The conference convened an expert panel to present an update on electronic health records. Sam Cykert, M.D., a leader in the NC TraCS Community Engagement Core, presented the N.C. Regional Extension Center’s approach to helping practices with project management, workflow redesign and IT services. According Cykert, proper use of electronic health records can lead to improvements of anywhere from 5 percent to 56 percent in quality indicators. Next were Kensaku Kawamoto, M.D., Ph.D., who designs decision support software at Duke University, and Laurie Williams, Ph.D., who tests the security of electronic health records at NC State University.

The attendees also received “rapid-fire” updates on practice-based research results on a variety of topics, including Methicillin-resistant Staphylococcus aureas (MRSA), rural diabetes care, health literacy toolkits, vaccination of infants’ caregivers and better office management of asthma. In addition to sharing their research findings, the presenters commented on some of the lessons they learned from doing research outside of the academic setting.

“This research is unpredictable,” said Duke’s Alex Kemper, M.D., M.P.H., who partnered with NC TraCS’ Philip Sloane, M.D., M.P.H., to evaluate different strategies to improve the management of skin and soft tissue infections caused by MRSA. “Clinics can be in the middle of adopting electronic medical records and at the same time can be inundated with unexpected community illnesses such as the H1N1 influenza. This can make it hard to do everything, such as following up on the patient’s health after they leave the clinic.”

In the afternoon, a number of break-out sessions gave participants an introduction to research design and methods. Topics covered included how to develop research questions, how to start clinical trials in office practice and how to engage minorities to identify and address health priorities.

The final plenary panel gave an update on the Patient-Centered Medical Home (PCMH), an approach to providing comprehensive primary care that brings together patients, providers and sometimes even a patient’s family. Warren Newton, M.D., M.P.H., of UNC presented some of the challenges and opportunities inherent to developing a PCMH. John Anderson, M.D., M.P.H, of Duke, and Skip Cummings, PharmD, of East Carolina University, each presented their own experiences with this new model of care.

The conference ended with poster sessions and a reception that gave attendees the opportunity to foster new collaborations and pose new research questions of their own. As Dolor said at the meeting, practice-based research is not just about putting research into practice, but putting practice into research. What works and doesn’t work in the real world of community practice is valuable feedback to the researchers and will ultimately benefit patients and physicians alike.