HPRN - Practice-Based Research Networks

Practice-Based Research Networks

HPRN

TABLE OF CONTENTS

WHAT IS HPRN?. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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WHY DO RESEARCH IN EASTERN COLORADO? . . . . . . . . . . . . . . . . . . . .

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ENGAGING THE COMMUNITY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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HPRN MEMBERS

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HPRN PROJECTS AND PROGRAMS MEET THE TEAM

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WHAT IS HPRN?

The High Plains Research Network (HPRN) is a practice based research network that consists of rural primary care practices, hospitals, health care facilities, and communities located in eastern rural Colorado.

HPRN is committed to providing excellent rural health care by translating the best scientific evidence into everyday clinical practice.

We conduct research and quality improvement programs that reflect the social setting of primary care practice, including practice organization, patient population, and the community.

HPRN was formed in 1997 through funding from the Robert Wood Johnson Foundation. We originally consisted of rural hospitals and clinics in the nine counties of northeast rural Colorado. In 2008, we expanded to include all sixteen counties of eastern rural Colorado. The network includes 16 hospitals ranging from six to 40 acute care beds all between 50 and 180 miles from the closets tertiary care center.

Over 55 primary care practices are also part of the network.

The HPRN region (in green) covers 30,000 square miles and is home to approximately 150,000 people.

We receive independent funding for health care research and also collaborates with other healthcare-based agencies and networks.

The High Plains Research Network provides approved Continuing Medical Education; system-wide interventions aimed at quality improvement; and, feedback reports on outcomes of interest to physicians, other providers, hospital administrators, and patients.

WHY DO RESEARCH IN EASTERN COLORADO? Years ago, prestigious medical journals reported that small rural hospitals and primary care doctors did not provide as good of care as specialists in large hospitals. The founder of HPRN, Jack Westfall, MD, didn’t believe this. Since its inception in 1997, HPRN has worked with practices and communities to provide evidence of the excellent care provided in the rural high plains using research methods and evaluation tools. In doing so, we find out the best way to improve medical care for multiple diseases eastern rural Colorado and ensure that the rural experience is included in the primary care and public health research world.

ENGAGING THE COMMUNITY HPRN conducts its program in the primary care, hospital, and community settings.

The HPRN Community Advisory Council and Medical Advisory Council guides and informs the work done by HPRN. These local residents, of varying educational and socioeconomic backgrounds, help the research team conduct work that is relevant to the community of practices and people living in eastern Colorado.

HPRN MEMBERS: PRIMARY CARE PRACTICES IN THE HPRN • Akron Clinic • Archuleta MD PC (La Junta) • Arkansas Valley Family Practice (La Junta) • Brush Family Medicine • Centennial Family Health Center (Ordway) • Craig Van Schooneveld, MD (Sterling) • Dilley and Samples Family Practice (Brush) • Durand Kahler, MD (Sterling) • Eads Medical Clinic • Family Care Clinic (Sterling) • Family Practice Clinic, PC (Fort Morgan) • Family Practice of Holyoke • Fort Morgan Internal Medicine Center • Fort Morgan Medical Group • Fort Morgan Pediatrcs • Harmony Health Center (Rocky Ford) • Haxtun Family Medicine Center • High Country Internal Medicine (Sterling) • High Plains Community Health Clinic (Lamar) • Hilton Ray, MD (La Junta) • Holly Medical Center • Jason Sims, DO (La Junta) • Lincoln Community Hospital Family Practice (Hugo) • Loma Vista General and Family Practice, PD (La Junta) • Madhuri Bobba, MD (La Junta) • Medical Clinic (Burlington) • Mt. San Rafael Hospital Clinic (Trinidad) • Northeast Colorado Family Medicine (Sterling) • Parke Health Center (Burlington) • Plains Medical Center (Limon, Flagler, Strasburg) • Prairie View Clinic (Cheyenne Wells) • Prowers Medical Group (Lamar)

• Rocky Ford Family Health Center, LLC • Richard Shand, MD (La Junta) • Salud Family Health Centers (Fort Morgan, Sterling) • Southeast Colorado Medical Clinic (Springfield) • Stephen Godar, DR (Fort Morgan) • Stratton Medical Clinic • Trinidad Family Medical Center • Valley Medical Clinic (Julesburg) • Valley-Wide Health Systems (La Junta, Rocky Ford, Las Animas) • Walsh Medical Clinic • Washington County Clinic (Akron) • Wiley Medical Clinic • Wray Medical Clinic • Yuma Clinic

HOSPITALS IN THE HPRN • Arkansas Valley Regional Medical Center (La Junta) • Colorado Plains Medical Center (Fort Morgan) • East Morgan County Hospital (Brush) • Haxtun Community Hospital • Keefe Memorial Hospital (Cheyenne Wells) • Kit Carson County Hospital (Burlington) • Lincoln Community Hospital (Limon) • Melissa Memorial Hospital (Holyoke) • Mount San Rafael Hospital (Trinidad) • Prowers Medical Center (Lamar) • Sedgwick County Hospital (Julesburg) • Sterling Regional Medical Center • Weisbrod Memorial Hospital (Eads) • Wray Community District Hospital • Yuma District Hospital

HPRN PROJECTS AND PROGRAMS MEDICATION ASSISTED TREATMENT (MAT) AND TEAM TRAINING IN RURAL COLORADO (IT MATTTRS™ COLORADO) Eastern Colorado (the High Plains Research Network region) has seen a 300% increase in the rate of deaths due to drug overdose in the last decade, the majority of these are related to opioids. While OUD can be effectively treated with medication assisted treatment (MAT), only 1015% of people in need of treatment receive it. This is not acceptable.

To change the trajectory of this epidemic, the High Plains Research Network (HPRN) received funding from the Agency for Healthcare and Quality to implement a multicomponent program in a 24-county region of rural eastern Colorado and the San Luis Valley. Inspired by calls for help from local primary care practices and community members, Implementing Technology and Medication Assisted Treatment and Team Training in Rural Colorado (IT MATTTRs™ Colorado) (link to www.itmatttrscolorado. org here or above or both) aims to increase access to MAT for OUD in local, rural primary care practices. The project includes: 1. T he “HAVE YOU MET MAT?” and “MAT FOR OUD IN THE SLV” community awareness campaigns created in partnership with local community members to increase awareness and knowledge of OUD and MAT. Patients will better understand their options for treatment – and obtain it locally.

2. S upport for provider waiver training to prescribe buprenorphine. Courses and free and providers can receive monetary incentive for completing the training.

3. A comprehensive MAT team-based training program for full primary care and behavioral health teams.

Since the start of IT MATTTRS, the number of providers in the study region with their DEA waiver to prescribe buprenorphine has increased from two to almost 30. Over 40 practices have participated in the IT MATTTRs Primary Care Team Training.

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Provider and Practice Team Training is now available statewide. For more information, contact itmatttrscolorado@ucdenver.edu.

ASTHMA TOOLKITS …is a quality improvement program funded by the Colorado Department of Public Health and Environment designed to provide “Asthma Toolkits” for primary care clinicians and their patients to help improve asthma care in rural Eastern Colorado.This project is a result of a partnership between HPRN and National Jewish Health.

COMMUNITY ASTHMA INTEGRATION AND RESOURCES (AIR) …is a community-based project designed to improve community knowledge, attitudes, and self management of asthma in rural Eastern Colorado.The project uses a community-based participatory model and complements and strengthens the current “Asthma Toolkits” program occurring in eastern Colorado. This program is funded by the Caring for Colorado Foundation.

A CARE …is a home blood pressure monitoring project to improve their cardiovascular health bygenerating timely and useful information for providers and patients through home blood pressure monitoring (HBPM) and point-of-care (POC) lipid testing. We are in the evaluation phase of this project, which was funded by Colorado Department of Public Health and Environment.

IMPROVING ASTHMA OUTCOMES THROUGH ETS REDUCTION INTERVENTIONS IN PRIMARY CARE …combines a card study with practice-specific feedback.

This study uses a “5A’s based” change strategy to survey pediatric practices to assess their current use of proven ETS reduction strategies. Practices work through advise, agree and assist cycles to increase their use of proven ETS reduction strategies. Changes made in the practices are examined with feedback to the practices to Arrange for sustainability HPRN partnered with National Jewish Health for this study.

UNDERINSURANCE IN PRIMARY CARE PATIENTS …is an anonymous patient survey of patients at time of visit to describe underinsured patients in primary care in Colorado. This study was funded by the Colorado Health Foundation.

PROMOTING COLON CANCER TESTING IN RURAL COLORADO ...is a CDC-funded community participatory project designed to increase screening for colorectal cancer in the High Plains region. The HPRN Community Advisory Council worked with the research team to develop a set of main messages and a multi-component, culturally relevant dissemination strategy. Over 250 local residents helped to implement this intervention in the northeast counties of Colorado. Southeast Colorado counties served as the control region. Preliminary analysis indicates encouraging results. Final outcomes will be available soon.

LEADERS FOR EFFECTIVE ACTIVITY PLANNING (LEAP) ...is a demonstration project funded by the Robert Wood Johnson Foundation’s grant program PRESCRIPTION FOR HEALTH. The project is designed especially for promoting healthy behaviors in primary care patients. This study is also occurring in CaReNet practices. .

APPLIED STRATEGIES FOR IMPROVING PATIENT SAFETY (ASIPS) ... is a collaborative effort between the University of Colorado Department of Family Medicine and numerous organizations to analyze the causes and effects of errors in primary care and reduce the incidence of errors. This study also occurred in CaReNet practices.

LIPID AND BLOOD PRESSURE MANAGEMENT FOR PATIENTS WITH TYPE 2 DIABETES …is funded by Bennett Parnes’s Robert Wood Johnson Foundation Generalist Physician Faculty Scholar Awardto examine how primary care providers manage lipids and blood pressure for patients with type 2 diabetes. This study is also occurring in CaReNet practices.

MENTAL HEALTH REFERRALS FROM PRIMARY CARE

CARE OF ACUTE MYOCARDIAL INFARCTION, UNSTABLE ANGINA, AND CHEST PAIN IN RURAL COLORADO …ascertains how rural primary care physicians currently care for patients suffering acute myocardial infarction.

Chart abstraction were completed for patients who presented with chest pain to emergency departments in rural Northeast Colorado hospitals between 1995 and 1999.

IMPROVING ACCESS TO HEALTH CARE FOR HISPANIC COMMUNITY MEMBERS IN WESTERN YUMA COUNTY …was a community assessment to better understand the barriers that exist in Western Yuma County that prevent Hispanic Community Members from accessing health care. Focus groups with Hispanic community members, Yuma hospital and clinic staff, and community agency staff. assessed participants’ belief about health care, prenatal care, barriers to accessing health care, and ideas about overcoming these barriers. In addition, over 250 Hispanic community members were surveyed regarding their current physical and mental health, knowledge of community resources available, and what they perceive the barriers to be that limit their access to health care.

This project also included a chart audit of all patients who gave birth at Yuma hospital to detail trends in mothers’ demographics, prenatal care, and prenatal risk factors.

...examines how primary care providers manage patients’ mental health care needs. This study is also occurring in CaReNet practices.

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HPRN PROJECTS AND PROGRAMS USE OF THE ACI-TIPI TO IMPROVE HEART ATTACK TRIAGE AND TRANSPORT ….ten rural Colorado hospitals were slated for participation in a study to assess the use of the Acute Cardiac Ischemia Time Insensitive Predictive Instrument (ACI-TIPI). The ACI-TIPI software was installed on ECG machines in the emergency departments of the hospitals. In addition to the standard ECG reading, the software generates a probability score from 0% to 100% of the likelihood that a person is having a heart attack.

Physicians use the score as a tool to aid in diagnoses and treatment decisions. ACI-TIPI report scores will be collected on all patients presenting to the hospital with chest pains or other symptoms suggestive of acute cardiac ischemia. Chart abstraction will also be performed on patients to determine admission rates, transfer rates, and treatment decisions in conjunction with the availability of the ACI-TIPI report

IMPROVING THE CARE OF PATIENTS WITH HEART FAILURE …examined whether there were major differences in the care of heart failure patients by geographic location (rural vs. urban). This study was done in conjunction with the Colorado Foundation for Medical Care (CFMC).

ASSESSING AND IMPROVING QUALITY OF CARE FOR DYING PATIENTS IN RURAL COLORADO …assessed the knowledge and attitudes towards palliative care of physicians, nurses, other care providers, staffs at hospitals, nursing homes and clinics, and community members in rural communities.

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IMPACT OF DOUBLE COUNTING AND TRANSFER BIAS ON ESTIMATED RATES AND OUTCOMES OF ACUTE MYOCARDIAL INFARCTION ...followed up on inconsistent findings on the changes in the incidence of hospitalizations for people suffering with ischemic heart disease. Preliminary data suggest that a large number of patients with acute myocardial infarction in rural communities are transferred to urban centers for care. Patients transferred to a second hospital may be counted twice for one episode of ischemic heart disease.

MEET THE TEAM

Tamara Oser, MD

Linda Zittleman, MSPH

HPRN Director

HPRN Co-Director

Email: tamara.oser@cuanschutz.edu

Bio: Linda is the Co-Director for the High Plains Research Network (HPRN). With HPRN, she oversees all aspects of research and program activities and fosters and coordinates the HPRN Community Advisory Council. She is experienced in community-based participatory research and practice-based research. Linda greatly enjoys working with people on Colorado’s eastern plains and informing urban folks of the knowledge gained and new ideas from rural settings.

Special interest(s):​ Working with people on the eastern plains and informing urban folks of the knowledge gained and new ideas from rural settings — travel, photography, gardening.

Interesting facts: Part owner of an NFL team – the Green Bay Packers.

Email: linda.zittleman@cuanschutz.edu

Christin Sutter

HPRN Senior Research Assistant and Practice Facilitator Bio: Christin Sutter is a Senior Research Assistant and Practice Facilitator for the High Plains Research Network (HPRN). She helps implement, maintain, and evaluate research studies — covering topics such as colon cancer, asthma, home blood pressure management, childhood obesity, behavioral health, opioid use disorder, COPD, and cancer survivorship. Her work helps practices link their research work and practice change efforts. Christin also serves as a liaison between practices, community-based organizations, and academic research teams.

Special interest(s):​ She lives in the small town of Merino with her husband and three teenage daughters.

Interesting facts: She has coached the local high school volleyball team for the past 6 years.

Email: christin.sutter@cuanschutz.edu

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MEET THE TEAM

Jennifer Ancona

HPRN Community Research Liaison Bio: In 2014, Jennifer retired from a background of 15 years of corporate experience in Human Resource Management & Health Care Insurance for Employee Benefits in Denver, Colorado, where she had been an advocate and facilitator of corporate wellness programs.

She has a Bachelor’s degree from Marylhurst University in Interdisciplinary Studies of Education, English, and Cultural and Historical Studies. As a Community Research Liaison for the University of Colorado Anschutz Medical Campus and the Department of Family Medicine, specifically the High Plains Research Network, Jennifer supports community-based participatory research through a variety of health research projects and quality improvement programs to the six counties in southeastern Colorado.

Special interest(s):​ Jennifer enjoys building relationships, increasing health equity, understanding relevant local issues, promoting genuine, respectful patient care, and engaging communities in health awareness.

Interesting facts: She is a Healing Touch Certified Practitioner, which is energy therapy support to facilitate connection, openness, and balance in clients’ energy field systems. Jennifer is also a certified Graphologist and does handwriting therapy to help clients improve their memory, motivation, self-esteem, and change unwanted behaviors.

Email: jennifer.ancona@cuanschutz.edu

University of Colorado Department of Family Medicine Anschutz Medical Campus 12631 East 17th Avenue, Box F496 Aurora, CO 80045 FMNews@cuanschutz.edu