PROJECTS
Current Projects
STARNet's emphasis is to conduct research studies based upon the questions of member physicians. While these questions are being formulated into projects, member practices have the opportunity to participate in any the proposed studies:
The ABC Practice Improvement Initiative (NIDDK Translational Research Study)
Principal Investigator: Michael Parchman, MD
The purpose of this study is to use a Practice Facilitation intervention to improve the A1c, blood pressure and lipid levels among patients with type 2 diabetes in small, autonomous primary care practices. This intervention is based on complex adaptive system theory to support the selection, tailoring and implementation of one or more strategies to improve the above 3 risk factors in each intervention practice. Five strategies will be discussed during the facilitation to stimulate change in each practice: a diabetes registry, point-of-care testing of HbA1c and lipids, group clinic visits, improved decision support during the visit, and patient activation prior to each visit.
Pandemic Influenza Preparedness (a STARNet Pilot Study)
Principal Investigator: Walter Calmbach, MD
MRSA Card Study
Principal Investigator: Dr. Munoz
The purpose of the study is to gather information related to patients who present to primary care offices with skin and soft tissue infections. Information regarding associated risks, appearance and location of wound, organism isolated and treatment given will be obtained to better understand the more common bacterial etiologies (Methicillin Resistant Staph Aureus, MRSA; or Methicillin Sensitive Staph Aureus, MSSA) and recommend targeted preventive measures.
Behavioral Intervention for Exercise and Nutrition (BIEN): a STARNet Pilot Study
Purpose: evaluate use of PDA's for individualized counseling re healthy diets, physical activity
Subjects: Adult patients 18 years of age and older, recruited as they sign in for routine visits
Practices: 4 targeted practices
Electronic Data Collection:
Diet status: 1) 24-hour Dietary Recall; 2) “Stage of Dietary Change” questionnaire.
Readiness to adopt physical activity: Marcus 5-item questionnaire.
Physical activity: International Physical Activity Questionnaire (IPAQ) or
Physical Activity Scale for the Elderly (PASE)
Self Efficacy for exercise (SEE) questionnaire
Health status: Short Form 12 (SF-12)
PDA-facilitated Patient Counseling
PDA's will be used by physicians and nurses to provide individualized counseling about healthy diets and physical activity
Diet. 1) reduce calories from fat, 2) reduce total calories, 3) increase servings of fruits and vegetables to 5 per day
Physical Activity: Stage of Change -specific intervention to increase physical activity
Ease and Acceptability. Patients, MD's, and nurses will complete questionnaires on ease and acceptability of using slates for data collection and PDA’s for patient counseling.
Oral Health and Glucose Control in Type 2 Diabetes (Project currently on HOLD)
Investigators: Michael Parchman, Thomas Oates
Studies have indicated that treating periodontitis in diabetic patients has a beneficial effect on their glucose control. (1) Periodontal disease has also been shown to be a risk factor for developing diabetes. (2) The association between periodontal disease and diabetes has been demonstrated in several studies and periodontal disease is now recognized as the “sixth complication” of diabetes. (3) The majority of patients with type 2 diabetes receive their diabetes care from primary care physicians. (4) Although there is a growing body of literature about screening for and diagnosing microvascular complications such as nephropathy and retinopathy in primary care settings, little is know about the frequency with which patients with type 2 diabetes who are seen in primary care settings experience symptoms and/or problems with their teeth and gums that might be related to periodontal disease. Nor is there much known in these settings about how recent glycemic control is related to these symptoms.
The purpose of this study is to examine the relationship between glucose control among adult patients with type 2 diabetes and the oral health experience of these patients who present to their family physician. Specifically our hypothesis is: oral health scores will be significantly associated with glycosolated hemoglobin.
NAMCS: the National Ambulatory Medical Care Survey
We are in the process of implementing the CDC National Ambulatory Medical Care Survey (NAMCS). View more details on the CDC site.
STARNet NAMC Survey information
The data collected will allow us to describe STARNet’s patient population for any future studies that members might want to conduct. A description of our patient population will be enormously helpful in designing future studies. The NAMCS survey will provide each participating physician valuable information about their own patient population. See an example of report.
COMPLETED STUDIES
Exercise for Older Patients
Sedentary lifestyle more likely
· female · education < 8 years
· Mexican-American · income < $10,000/year
Recognition & Prevalence of Panic States in Patients Presenting with Chest Pain
Patients with panic disorder
· more follow-up or referral
· higher follow-up costs
Patients with infrequent panic
· more testing at higher costs
· higher overall costs
Family Conflict Study
Women
· 9% incidence as victim of violence
· 29% lifetime prevalence as victim of violence
Men
· 8% incidence as victim of violence
· 15% lifetime prevalence as victim of violence
Patients’ Advice to Physicians
· ask about domestic violence, listen to patients’ experiences
· be objective, collaborative, and nonjudgmental
Advance Directives Study
Older patients and their caregivers have very limited
knowledge of
· patient self determination act
· patient self determination act
· advance directives, living will
· resuscitation orders
· durable power of attorney
Determinants of Exercise in the Elderly
Greater physical activity is correlated with
· greater grip strength
· faster chair rise and timed walk
European-American seniors
· greater physical activity
· wider repertoire of activities
Mexican-American seniors
· more likely to be sedentary
· narrow repertoire of activities