1

Using an AHRQ-supported Practice- Based Research Network (PBRN) To Design, Implement, And Evaluate Communication Strategies

Jeralyn Bernier, M.D., M.P.H.

Research DirectorCincinnati Pediatric Research GroupCincinnati Children’s Hospital

Medical CenterCincinnati, OH

Overview● Midwest regional Practice-Based Research

Network spanning 8 counties in three States● Established in 1996 with support from

General and Community Pediatrics, CCHMC● 45 providers in 22 practices● Ideas generated in “bottom-up” fashion at

monthly meetings of members tackling clinical problems

● Ongoing support from the Agency for Healthcare Research and Quality (AHRQ) and Cincinnati Children’s Hospital Medical Center

Symptom Surveillance Project

● Web-based password protected database

● Physicians enter data re: symptom complexes of high prevalence in outpatient office settings, as well as unusual cases

● Symptoms as manifest in children● Symptoms likely in transmissible

diseases or bioterrorism

Symptom Surveillance—Who?

● Practice-based research networks of primary care providers▬CPRG (Cincinnati Pediatric Research

Group)▬OPRC (Ohio Pediatric Research

Consortium)● Regionally distributed practices● Medical community leaders

Trends over time: CPRG at Large

0

50

100

150

200

250

300

350

400

450

500O

ct 6

-12,

200

3 (3

prov

ider

s/ 1

95vi

sits

)

Oct

13-

19, 2

003

(7pr

ovid

ers/

627

visi

ts)

Oct

20-

26, 2

003

(6pr

ovid

ers/

519

visi

ts)

Oct

27-

Nov

2, 2

003

(4 p

rovi

ders

/ 345

visi

ts)

Nov

3-9,

2003

(5pr

ovid

ers/

168

visi

ts)

Nov

10-1

6, 2

003

(8pr

ovid

ers/

620

visi

ts)

Nov

17-2

3, 2

003

7pro

vide

rs/6

80vi

sits

)

Nov

24-3

0, 2

003

(8pr

ovid

ers/

650

visi

ts)

Dec

1-7,

200

3 (7

prov

ider

s/ 8

00vi

sits

)

n/10

00

FeverRashBlisterMyalgiasEarPainSoreThroatRhinorrheaCoughHemoptysisRespiratoryDistressVomitingDiarrheaAbdominalPainParesthesiasSeizuresHeadacheDysuriaUrinary Frequency

Symptom Surveillance—Unique Features● Bidirectional communication between

providers and public health officials● Portal for educating providers to

facilitate timely translation of research into practice

● Symptoms vs. diagnoses● Community-based providers● Pediatric focus● Interactive graphical output

Symptom Surveillance—Provider Motivation● Involvement in ongoing research● Immediate data feedback● Access to public health officials● Office staff rewards● Modest financial remuneration

Symptom Surveillance—Health Department Participation● Regular review/analysis of data● Notices, bulletins to providers● Investigations as needed● Restrained use of alert function to

maintain effectiveness● Governing boards

Health Department Communications

Symptom Surveillance—Relevance to Everyday Practice● Answers the commonly posed

question, “What’s going around?”● More timely detection of naturally

occurring outbreaks● Rapid targeted information source

Symptom Complex Data

0

50

100

150

200

250

300

350

400

Oct

6-1

2, 2

003

(3pr

ovid

ers/

195

vis

its)

Oct

13-

19, 2

003

(7pr

ovid

ers/

627

vis

its)

Oct

20-

26, 2

003

(6pr

ovid

ers/

519

vis

its)

Oct

27-

Nov

2, 2

003

(4pr

ovid

ers/

345

vis

its)

Nov

3-9,

2003

(5pr

ovid

ers/

168

vis

its)

Nov

10-1

6, 2

003

(8pr

ovid

ers/

620

vis

its)

Nov

17-2

3, 2

003

(7p

rovi

ders

/680

vis

its)

Nov

24-3

0, 2

003

(8pr

ovid

ers/

650

vis

its)

Dec

1-7

, 200

3 (7

prov

ider

s/ 8

00 v

isits

)

n/10

00 p

atie

nt v

isits

0

20

40

60

80

100

120

140

160

180

200

raw

num

ber o

f con

firm

ed in

fluen

za c

ases

Fever with rhinnorhea,cough, headache, ormyalgias

Fever and Sore Throat

Sore throat, rhinorrhea,cough, headache

Fever and Rash

Ear Pain

Vomiting and Diarrhea

Confirmed Influenza

Symptom Surveillance—Future Expansion● Expansion

throughout Ohio via Health Departments and sister PBRNs

● Mapping feature with automated analysis

● Improved community provider penetration

Symptom Surveillance—Future Expansion

● Daily data entry ● Phone triage data collection● Automated analysis of

claims/billing data● Automated linkage to

corresponding lab data● Improved informational resources

Symptom Surveillance—Other Uses● Discussion of research and

preliminary findings● Network/Hospital/Health

Department news briefs● Shared practice management tools● Links to information resources● Meeting reminders● Event announcements