Overview In 2001, CORE received a 3-year, $500,000 grant from the Robert Wood Johnson Foundation to study the use of electronic medical records in tobacco cessation efforts. In 2002, CORE was awarded a $712,000 grant from the Center for Disease Control to implement a prototype stroke registry in Oregon. The skills represented within CORE are used by prominent organizations such as the Foundation for Accountability (FACCT) to develop measures of consumer satisfaction and health.
CORE participates in the AHRQ Integrated Delivery System Research Network, within a consortium headed by the Research Triangle Institute. CORE is also a partner in the Oregon Patient Safety Center, the Evidence-based Practice Center housed within Oregon Health Sciences University, and is an active member of the Oregon research collaborative focused on the needs of the Medicaid population and the uninsured.
In addition to the grants described below, CORE research staff are involved in a number of innovative projects such as measuring the impact of computerized prescriber order entry (CPOE), studies of patient provider communication, and exploring the impact of e-visits on health care utilization. CORE supports the active Providence Health & Services Nursing Research program in areas like efficient and thorough patient discharge processes, fall prevention and skin integrity in the elderly, and the deployment of mobile electronic charting and bar-coding systems.
Partnerships for Advancing Quality Together
Investigator:Bruce Bayley, Ph.D. Funding source: AHRQ Study period: September 2002 - September 2005 Research question: How can Integrated Delivery Systems (IDSs) collaborate to develop approaches for quality of care improvement? Brief study description: Development of a workbook to support health care planning for bioterrorist events; and analysis of data on the implementation of safe practices within integrated delivery systems.
Estimating Risk Reduction and Cost of Improving Medication Information Transfer
Investigators:Bruce Bayley, Ph.D. Funding source: AHRQ Study period: March 2003 - March 2005 Research question: Does the work of a clinical pharmacy specialist in the hospital reduce adverse events and readmission among the hospitalized elderly? Brief study description: This randomized trial tests an integrated intervention of medication reconciliation, pharmaceutical consultation, discharge planning, patient education, and inter-setting communication on the outcomes of reported adverse events and hospital or ED re-admissions in the elderly. The study population consists of Medicare managed care hospital patients who are members of a primary care medical group that utilizes an electronic medical record system. The pharmacist works within a hospitalist group at one medical center in Portland, Oregon.
Cost of Poor Quality or Waste in Integrated Delivery System Settings
Investigator:Bruce Bayley, Ph.D. Funding source: AHRQ Study period: September 2004 - September 2005 Research question: How can areas of poor quality and waste be identified, along with their financial implications? Brief study description: Through this project a taxonomy of waste in health care will be developed, as well as methods for quantifying this waste. Improvement projects at Intermountain Health Care and Providence Health & Services will be used as examples for how waste can be identifying and reduced. This project analysis will be supplemented by literature review as well as observational and qualitative measures of poor quality and waste.
Investigators:Valerie Stewart, Ph.D. and Ted Lowenkopf, M.D. Funding source: Center for Disease Control and Prevention Study period: 2002-2004 Research question: What is the best way to measure and improve stroke outcomes? Brief study description: This grant funded the development and implementation of a statewide prototype stroke registry to pilot test data collection and reporting for the purpose of improving the quality of acute stroke care. OScPREY was a unique grassroots collaborative among 16 hospitals throughout Oregon. The collaborative was led by an executive committee representing CORE, Providence St. Vincent’s Stroke Center, Oregon Health and Science University, the Oregon Department of Health and Human Services, and the Emergency Medical System.
Patient Provider Communication
Investigators:Valerie Stewart, Ph.D. and William Ventres, M.D. Funding source: American Association of Family Practitioners Foundation Study period: 2002-2004 Research question: How do physicians communicate with patients while using electronic medical records? Brief study description: The addition of computers in exam rooms have changed the manner in which communication occurs between doctor and patient. Most of the focus on electronic medical recording has been on the technology itself. This project looks at how physicians use the computer during exams and what techniques might affect the way they interact with patients. This is a qualitative study that uses participant observation and recording as a methodology.
5 A’s Tobacco Cessation Using a Primary Care EMR
Investigators:Charles J. Bentz, M.D. Funding source: Robert Wood Johnson Foundation Study period: December 2001 – December 2004 Research question: Does EMR generated provider performance feedback increase compliance with the Public Health Service guidelines for tobacco cessation? Brief study description: The purpose of this study was to determine whether EMR generated provider performance feedback increased compliance with the PHS guideline for tobacco cessation in 19 primary care clinics. The primary outcome was defined as successful referral to the Oregon Tobacco Quit Line. Secondary outcomes were defined as:
EMR generated rates of the 5 A’s
Qualitative assessment of post training clinic processes
Cost analysis of resources required to develop/implement the Quit Line connection
Designing a Provider Reimbursement System to Increase Adherence with Maternity Tobacco Cessation Guidelines
Investigators:Charles J. Bentz, M.D. Funding source: Robert Wood Johnson Foundation Study period: December 2001 – November 2003 Research question: Is it possible to develop a financial reimbursement system that would incentivize obstetrical providers to consistently deliver the 5A’s to all pregnant smokers during each prenatal visit? Brief study description: The goals of the initial planning grant were to:
Develop a comprehensive reimbursement system for obstetrical providers
Develop a strong implementation strategy for the reimbursement system
Develop the capacity to conduct future systems-level tobacco research by establishing relationships between key Oregon entities engaged in maternity tobacco cessation
The Use of Tracking Codes to Monitor Tobacco Cessation in an IPA-Model HMO
Investigators:Charles J. Bentz, M.D. Funding source: Robert Wood Johnson Foundation Study period: January 1999 - December 1999 Research question: Can using Tracking Codes improve tobacco status measurement? Brief study description: The overall goal of the planning grant was to improve the ability of managed care organizations (MCOs) to measure tobacco status assessment and cessation advice in primary care offices, by implementing a new measurement system of Tracking (TR) Codes. The TR Codes planning project had three specific objectives:
To develop and pilot test the Tracking Code system for tobacco use
To assess the performance of the system for measuring tobacco use
To create a protocol for applying the system in clinics in other MCOs.
Oregon Health Plan (OHP) Panel Study
Investigators:Bill Wright, Ph.D., Matt Carlson, Ph.D. (PSU) Funding source: RWJ, OMAP, and Commonwealth Fund have all contributed Study period: 2003-2006 Research question: What is the impact of Oregon's 2003 Medicaid policy changes on low-income adults? Brief study description: After Oregon implemented several significant policy changes in its Medicaid program in early 2003, a prospective cohort study was launched to assess the short and long term impacts of those policy changes. Particularly, the study examines the impacts of increasing cost sharing (through premiums and copays) on enrollment and insurance status, access to care, utilization of care, health, and personal finances for individuals who were enrolled in Oregon's Medicaid program at the time of the changes. The study surveys the same 2,800 panel members three times in three years. At present the study has completed the second wave of data collection; preliminary results for waves one and two have been and continue to be released. Wave three of data collection is planned for the end of 2005.
