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2011 Annual Meeting

2011 NAPCRG Annual Meeting

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Viewing sessions 1 through 20 of 627 sessions

PR1 Evaluating Practice Transformation

Frank deGruy, MD, MSFM; Valerie Gilchrist, MD; William Hogg, MD; Jim Mold, MD, MPH; Kurt Stange, MD, PhD; Deborah Cohen, PhD

11/12/11 8:00 AM - 9:00 AM Sir Edward Beatty

The purpose of the precon workshop is to begin exploring this emerging science and to learn how others are measuring the effects of changes in practices. The specific objectives are to: 1. Learn about past experiences in evaluating practice transformation in the US and Canada 2. Determine gaps in knowledge about practice transformation that inform not only policy-makers but also local practitioners 3. Identify innovative processes to measure practice change 4. Identify what we should be measuring 5. Identify the benchmarks we should use to measure our successes in becoming new models of care (i.e. PCMHs) 6. Realize how we’ll know if we’ve been successful 7. Facilitate sharing of best practices (methodology, data sets, benchmarks) by those who are innovators in practice transformation.

PR2 Mixed Methods Research: Introduction, Research Questions, Study Design and Implementation Planning

Pierre Pluye, MD; Michael D. Fetters, MD, MPH, MA

11/12/11 8:30 AM - 9:30 AM Oak Room

Objectives: After attending this workshop, participants will: 1) understand basics of conducting mixed methods research, 2) develop rigorous mixed methods research questions appropriate to their topics, 3) identify appropriate qualitative and quantitative data sources, 4) understand mixed methods designs, 5) choose one mixed methods design appropriate to their research questions and 6) develop an implementation plan using a mixed methods implementation matrix. Content: Morning Session-Workshop leaders will provide an overview of mixed methods research followed by an open discussion. Second, in small groups, participants will reflect on their research questions, and present them to peer participants for refinement. Third, workshop leaders will lead a discussion on qualitative and quantitative data sources to stimulate participants to identify data sources to address their questions. Participants will develop their research questions, and identify appropriate data sources in consultation with their group members and workshop presenters. Afternoon Session-First, workshop leaders will provide major types of mixed methods designs and examples of each. Second, in small-groups, participants will consider each design, choose one that best fits their research question and qualitative and quantitative data sources, and present it to their peer participants for refinement. Third, workshop leaders will present an implementation matrix that illustrates the major steps, participant’s data collection procedures and outcomes for conducting a mixed methods research project. Participants will create an implementation matrix tailored to their research projects. The workshop will end with a mini “poster session” when participants will present their work to their peers and provide feedback to other participants. Expected Outcomes: Participants will develop a mixed methods proposal about a topic of interest, present their mixed methods proposals during the mini-poster, receive feedback from peers, and take home an outline of their projects.

P001 Family Physician Attitudes Toward Pharmacist-delivered Comprehensive Medication Management

Derek Jorgenson, PharmD; Julia E Bareham, BSP

11/12/11 6:00 PM - 7:00 PM Alberta/New Brunswick

Context: High rates of preventable medication related adverse events are well documented in primary care. Pharmacists can improve medication use by providing comprehensive medication management (CMM). Several North American studies have shown that CMM leads to a significant number of drug therapy problems being resolved. Unfortunately, very few pharmacists currently offer CMM in North America. One hypothesis for this low uptake is that physicians are not supportive of pharmacist-delivered CMM. Objective: To determine the extent to which physicians are supportive of pharmacist-delivered CMM. Design: Self-administered postal survey sent to practising family physicians. Results were entered into SPSS and analyzed using descriptive statistics. Setting: Family physician practices in a Western Canadian city (Saskatoon, Saskatchewan, population: ~232,000). Participants: 225 family physicians in Saskatoon were mailed a questionnaire. Physicians with tenure track appointments in the College of Medicine at the University of Saskatchewan were excluded. Instrument: 12-item questionnaire (10 closed-ended and 2 open-ended questions). Results: Response rate was 49.3%. 90.0% of respondents reported that pharmacist-delivered CMM would be valuable and 74.5% would refer their patients. Over 2/3 of respondents could think of one or more patients they would refer immediately; however, almost 1/3 required some guidance regarding which patients to refer. Respondents were most likely to refer patients from the following groups: >65 years of age, ?5 medications, ?1 chronic medical conditions. Data analysis of the two open-ended questions is in progress. Conclusions: Family physicians value pharmacist-delivered CMM and are willing to refer patients to the service. Despite the fact that many physicians have already identified patients they might refer, it appears that many will require education regarding which patients will benefit from CMM.

P002 A Public Health Experiment in Bassano: Primary Prevention of Heart Disease and Stroke in the Hutterites

James Richards, MD FRCP(C); Aravind Ganesh

11/12/11 6:00 PM - 7:00 PM Alberta/New Brunswick

Context: Heart disease and stroke are leading causes of death in North America, presenting a major challenge in primary care. Hutterites are much more predisposed to cardiovascular disease (CVD), and their communal lifestyle offers the unique opportunity to uniformly apply primary prevention strategies of lifestyle modification. Objective: To determine whether reduced salt intake, increased activity, and moderated alcohol can decrease the incidence and/or disease burden of heart disease and stroke in a Hutterite colony over 2 years, and similarly impact CVD risk-factors, particularly hypertension, dyslipidemia, and diabetes. Human Subjects Review: Awaiting ethics approval. Design: Cohort study comparing one Hutterite colony adopting the interventions, with another maintaining status quo. Setting: Two colonies of roughly 200 settlers each, surrounding the town of Bassano, Alberta. Participants: All consenting adults (>20 years). Daily life is uniformly regulated in Hutterite culture, with voluntary settlers eating communal meals. Intervention: Selected by literature review (discussed): (1) Rationing alcohol to <30 drinks/adult/month, (2) Using podometers, aiming for 2000 step/day increments biweekly, targeting ?10,000/day, (3) Cutting out 1 tsp salt/meal and pig lard from 1 dish monthly, targeting 12-15tsp/meal with no pig lard. The Bassano Primary Care Network will follow-up monthly (or more) to monitor compliance, risk-factors, and provide support. Outcome Measures: Primary measures are incidence and disease burden (mortality, disability, target-organ damage) of heart disease and stroke. Secondary measures are incidence (and severity) of hypertension (SBP), dyslipidemia (LDL, TC:HDL), and diabetes (Fasting Glucose, Hemoglobin A1C).Anticipated Results: Over 2 years, the study expects to demonstrate significantly lower incidence and/or disease burden of CVD and/or hypertension, dyslipidemia, and diabetes, in the intervention colony compared to control colony. Conclusions: By assessing the longitudinal impact of uniform interventions on CVD, this study can provide further insight into effective primary prevention strategies, and facilitate public healthcare legislation like limiting salt content in foods.

P003 Toward Improved Risk Assessment and Reduction of HBV Transmission

Dave Hyman, MD, MPH; Susan Nash, PhD; Nathalie H Roff, MD

11/12/11 6:00 PM - 7:00 PM Alberta/New Brunswick

Context: Commercial nail salons are a potential source of HBV transmission in the US because nail technicians are overrepresented by foreign-born individuals with a rate of HBV infection estimated at 8% to 14%. Cosmetic manicures and pedicures are routine for many adult women and men not considered members of a high risk population and not HBV vaccinated. Risk of transmission is greater for HBV than for other blood borne pathogens because it can remain infectious on dry contaminated objects up to 7 days. However, HBV transmission can be reduced or prevented with proper barriers and hand hygiene similar to universal precaution guidelines in healthcare settings, and by patient education, screening and vaccination as appropriate. Objectives: To assess self reported blood exposure, current practice of standard precautions, HBV immunization status, and relevant health practices among nail salon technicians. Human Subjects Review: Protocol approved by Baylor College of Medicine IRB. Design: Cross-sectional survey conducted by telephone interview. Participants: Vietnamese licensees listed as manicurists in Texas Department of Licensing and Regulations database. Procedure: Prospective participants will be contacted by phone by a Vietnamese investigator to respond to a structured questionnaire survey. Interviews are done in English or Vietnamese and recorded in electroninc forms. Main and secondary outcome measures: To assess universal precautions among nail technicians. To promote awareness, HBV screening, and vaccination among susceptible adults; to promote universal precautions in nail salons. Anticipated results: Knowledge of HBV and adherence to universal precautions in commercial nail salons is expected to be low. Conclusions: Findings and recommendations will be disseminated to primary care providers to inform HBV screening and vaccination practices. Recommendations will be incorporated into patient education materials in primary care settings.

P004 Overuse and Underuse of Cervical Cancer Screening Among Low-risk Women in a University-based Managed Care Practice

Janet Pregler, MD; Michael Rodriguez, MD, MPH; Samuel Skootsky, MD; Neil Steers, PhD; Neil Wenger, MD; Cristina M Almeida, MD, MPH

11/12/11 6:00 PM - 7:00 PM Alberta/New Brunswick

Context: Despite recommendations that triennial cervical cancer screening is acceptable for low-risk women over 30 years, annual screening remains common. Objective: We studied how often women enrolled in a university-based managed care group were screened, and patient and provider factors associated with over- and underuse of screening. Human subjects review: Expedited Design: Cross-sectional study using merged administrative, clinical and laboratory data. Patients: Women over 30 years continuously enrolled over a three year period. Exclusions are recent clinical history of abnormal cervical cancer testing and conditions high risk for cervical cancer. Outcome measures: 8018 women were eligible for inclusion; mean age 49 years (SD 10.5, range 31-91), 65% HMO and 35% Point of Service enrollment. Ninety-five percent saw a physician during the study period (mean 16 visits, SD 15, range 0-186); most frequently a primary care physician. A mammogram was performed at least once on 72% of women, and 9% received family planning care. Thirty-two percent received one-time screening during the study period, while 46% received two or more and 22% had no screening. Factors significantly associated with overuse (compared to recommended use) included age < 50 years (54% of overuse vs. 30% recommended use), HMO compared to POS enrollment (50% vs. 32%), greater than 50 medical visits (55% vs. 26%), and use of mammograms (49% vs. 34%) or family planning services (6% vs. 2%); ?2 p-value<0.0001. Among women with 2 or more tests, 67% were from one provider, and 33% from two or more. Among women who received tests from two or more providers, a higher percentage were from gynecologists (57%) vs. internal (21%) or family medicine (22%) physicians. Anticipated results: Hierarchical multivariate logistic regression model Conclusion: Overuse of screening remains prevalent, while underuse also occurs frequently. Age and utilization of health care is associated with overuse, while multiple testing among multiple providers is more prevalent in care provided by gynecologists. More appropriate use of pap smears can be targeted for intervention in the studied practice.

P005 Capturing the Complexity of Health Promotion Program Evaluations

Ania Kania; Duyen Nguyen; Alka Patel, PhD (c); Amrita Roy, PhD (c); Marja Verhoef, PhD; Gregory Scott Yelland, MA

11/12/11 6:00 PM - 7:00 PM Alberta/New Brunswick

Context: Health promotion (HP) initiatives are of great importance to primary care. Increasingly, there is recognition of the complexity of the relationships and interactions involved in HP interventions and the individuals that participate in them. To understand the impact such interventions have on people, and to ensure that the most effective interventions are being provided, we need to use evaluation designs that reflect this complexity. Objective: To determine if a complexity perspective (specifically, Complex Adaptive Systems or CAS) is reflected in the design of evaluations of alcohol and tobacco health promotion interventions. Methods: We used a scoping review, which seeks to map out what has been done in a defined area of research, but has a broader and more comprehensive scope than more traditional types of systematic literature review. We searched multiple databases for eligible peer reviewed (PR) and grey literature (GL) evaluations of HP interventions related to alcohol and tobacco, published between 1986 and 2009, to assess whether a CAS approach was used. We developed a set of indicator questions to identify whether key components of CAS were addressed in these studies. Results: A rigorous review process resulted in 45 eligible evaluations from PR articles and 9 from the GL. None of the evaluations we reviewed explicitly used a CAS framework. However, most evaluations at least implicitly incorporated some aspect of this perspective. Conclusion: The application of a CAS framework is theoretically meaningful; however, the question of how to apply it, in an appropriate and practical manner, is challenging. The indicator questions made CAS more accessible, and raised awareness of its potential utility in health promotion research. We anticipate that they will facilitate the application of CAS in the evaluation of health promotion interventions, thereby supporting the implementation of more effective primary care interventions.

P006 Farmers' Markets in the Bronx: Benefiting Community Nutrition? (Unexpected Findings)

Rafael Frias; Sean Lucan, MD, MPH, MS; Omar Sanon

11/12/11 6:00 PM - 7:00 PM Alberta/New Brunswick

Abstract: CONTEXT - Obesity and diet-related diseases are enormous problems faced by family physicians. Helping patients change their eating behaviors may require changes to the food environment, including improved access to fresh fruits and vegetables. Past research on the food environment has focused mostly on food stores and restaurants. Farmers’ markets, which may be particularly important in urban communities, have been largely ignored. OBJECTIVE - To examine farmers’ markets in the Bronx, and compare fresh produce at farmers’ markets to fresh produce at adjacent stores HUMAN SUBJECTS REVIEW - Exempted by Einstein IRB DESIGN - Cross-sectional descriptive analyses SETTING - Bronx, NY PARTICIPANTS - Bronx farmers’ markets and adjacent produce-selling food stores METHOD - Researchers visited all 26 Bronx farmers’ markets June -July 2011, as well as stores selling produce within a half-mile walking distance of each market OUTCOME MEASURES - information on availability, quality, and price of all items sold at farmers markets and stores PRELIMINARY RESULTS - About 1/4 of all farmers’-markets’ inventory was “processed and prepared foods” (e.g. pies, jams, cakes, cookies, ciders) and honey. Workers at ~50% of farm stands encouraged the purchase of non-produce items (e.g. donuts, juices, quiche). All farmers’ markets were within a half mile of a store selling greater that twice as many fresh produce on average. Store produce was often cheaper (e.g. cilantro per bunch:$1.04 vs. $1.57, p<0.001 by paired t-test), but not as fresh. CONCLUSIONS - While farmers’ markets are widely believed to be valuable sources of fresh produce in urban communities, they actually sell lots of other items less optimal for good nutrition and health, and carry more expensive, less varied produce in neighborhoods that already have supermarkets. While produce seems to be fresher, farmers’ markets may not be improving the food environment in urban neighborhoods.

P007 Homeless Individuals' Thoughts on Exercise and Exercise Opportunities

Caroline Davis; Lillian Gelberg, MD; Kola Okuyemi, MD, MPH; John Song, MD, MPH, MAT; Carolyn T Bramante, BA

11/12/11 6:00 PM - 7:00 PM Alberta/New Brunswick

Context: It is easy to assume that individuals experiencing homelessness get enough exercise walking, but this might not be true and might not be a fulfilling way for individuals to control their bodies and exercise choices. A pub-med literature search found little research on how much exercise homeless individuals get, how homeless individuals feel about exercise, whether they would like access to more exercise opportunities, and if so what these opportunities should be. Objective: This research aims to assess homeless individuals’ thoughts on exercise and the exercise opportunities available to them, as well as the thoughts of shelter staff on whether or not having exercise opportunities at shelters is feasible. Human Subjects Review: University of Minnesota Institutional Review Board. Design: One-on-one interviews with qualitative analysis. Recruitment is done through an announcement by shelter staff during mealtimes. Setting: Five homeless shelters and transitional housing units in Minneapolis and St .Paul, MN. Participants: Twenty-five participants will be recruited, self-selection bias is present because of the voluntary nature. Participants are 18 years or older, are currently experiencing homelessness, and have no cognitive impairment. Outcome Measures: Main: whether or not homeless individuals want more exercise opportunities; Secondary: what specific exercise opportunities would be most desired, as well as how much exercise individuals currently get. Anticipated Results: Results of initial interviews show that individuals experiencing homelessness in Minneapolis and St. Paul, MN value exercise and want more exercise opportunities. The most commonly suggested opportunities include the addition of exercise equipment and classes at shelters. Conclusions: This study appears to be the first to ask homeless individuals how they feel about exercise, and what specific things could be done to give them more exercise opportunities. These results could be used to guide future interventions and research on exercise opportunities for homeless individuals.

P008 Association Between Electronic Health Record (EHR) Implementation and Productivity Amongst Family Medicine Residents

Jamal Islam, MD; David Santiago, MD; Mauricio Pinto, MD

11/12/11 6:00 PM - 7:00 PM Alberta/New Brunswick

Context: EHR is gradually being mandated for efficient patient care by several agencies. One of the questions that remain is; will EHR implementation affect productivity of practicing physicians? Several studies have been done on this subject amongst practicing physicians with mixed results. But there is a lack of studies that looked into resident’s productivity during the course of EHR implementation and 6 months after go live. Implementation of EHR can also be detrimental to residents achieving the patient count goal of 1650 mandated by the Family Medicine Review Committee. Objective: To determine: 1). Family Medicine Residents productivity during and after EHR implementation. 2. To determine the affect the number of patients accrued 2) To determine resident satisfaction with EHR use. Design: Prospective cohort. Setting: FM resident clinic in Odessa, Texas. Patients: All patients that are seen 6 months before and 6 months after EHR go live. Intervention/Instrument: Standardized data extraction forms to capture data on productivity report provided by administrator, resident training levels, number of patients seen, and the number of sessions residents are in clinic and information on patient’s health insurance. Outcome: 1. Difference in mean productivity before and after EHR go live. 2. Difference in number of patients seen after go live. 3. Resident satisfaction score of using EHR. Results: This is an ongoing project and do not have any data. Conclusion: We are expecting productivity will be low during the first three months after go live. We do expect the productivity level will increase but may remain lower than the period when EHR was not being used. We also expect that there will be increased satisfaction in use of certain function of the EHR.

P009 The Effect of Primary Care Model on Colorectal Cancer Screening Participation in Ontario

Gladys Honein

11/12/11 6:00 PM - 7:00 PM Alberta/New Brunswick

Context: Colorectal cancer (CRC) is the second leading cause of cancer death in Ontario. Colon Cancer Check program (CCC) is the population based screening program in Ontario promoting screening for colorectal cancer. Primary care providers play a pivotal role in that program. Objective: We will test the hierarchical effect of individual, provider and organizational factors on CRC screening participation. Human subjects review: Approved by the Research Ethics Board at University of Toronto and Institute for Clinical Evaluative Sciences (ICES) at Sunnybrook health sciences center. Design: A secondary data analysis using ICES databases. The study period was from April 2008 to June 2010. To identify our cohort and variables, we linked: Registered Person Database (RPDB), Ontario Health Insurance Plan (OHIP), 2006 Census from Statistics Canada and ICES Physician Database. The analysis is based on Generalized Estimation Equation. Cohort size = 3,371,618 Setting: A population based study. Patients and Providers: Cohort included individuals aged 50-74 eligible for OHIP excluding previous history of CRC, Colitis or Crohn’s disease. Socio-demographic characteristics were: gender, income, recent registrants on OHIP and urban/ rural. Provider characteristics included: age, gender, years in practice, school of graduation, urban/rural. Organizational characteristics included: model of primary care (FHG FHN solo), family health team (FHT) status and nurse practitioner on board. Main outcome variable: Unadjusted and adjusted odds ratio for Fecal Occult Blood Test and Endoscopy Tests participation. Anticipated Results: Physicians affiliated with a FHT and who have a nurse practitioner on board are expected to be significantly at higher odds of providing large bowel tests regardless of physician’s profile and patient’s attributes. Conclusions: empirical evidence for the superior role multidisciplinary model of primary care plays in the delivery of preventive services.

P010 Usual Source of Care, Avoidable Hospitalization and Selected Health Outcomes

Bazemore Andrew, MD, MPH; Stephen Peterson, PhD; Robert Phillips, MD, MSPH; Benjamin Blagogee, MD, PhD

11/12/11 6:00 PM - 7:00 PM Alberta/New Brunswick

CONTEXT: Having a usual source of care is an indication of primary care access. The benefits to have a usual source of care include better problem recognition and prevention, earlier and accurate diagnosis, fewer hospitalizations, lower costs, fewer unmet needs, and less emergency department use. Also quality primary care access can potentially prevent unnecessary hospitalization for some medical conditions. High avoidable hospitalization rates have been shown to be associated with poor primary care access. But very few studies have looked into how having a usual source of care and areas with high avoidable hospitalizations impact health outcomes such as hypertension, diabetes, infant mortality, and low birth weight. OBJECTIVE: To determine whether there is association among usual source of care, avoidable hospitalizations, and selected health outcomes. HUMAN SUBJECTS REVIEW: N/A PARTICIPANTS: N/A DESIGN: Secondary data analysis of multiple pre-existing datasets. Factor analysis was done for some variables of interests from Behavioral Risk Factors Surveillance System (BFRSS), American Community Survey (ACS), Primary Care Service Areas (PCSA) and PCSA Medicare. These variables include social deprivation index (SDI), ethnicity factor, SES, no usual source of care, high cost of care, no checkup, avoidable hospitalization, and the selected health outcomes. SETTING: N/A INTERVENTION: N/A Main and Secondary Outcome Measures: Hypertension, diabetes, infant mortality, and low birth weight are the main study outcomes. ANTICIPATED RESULTS: We anticipate that those without usual source of care should have poor health outcomes. In addition, areas with high avoidable hospitalization rates should show poor health outcomes. CONCLUSION: If the hypothesized anticipated results do not hold, the underlying premise of usual source of care and avoidable hospitalizations as indicators of primary care access maybe undermined.

P011 Emergency Department Use By Patients Enrolled at a New Student-run Free Clinic

Kayla Heller, MD; Joseph LeMaster, MD; Erik Lindbloom, MD; Emily D Doucette, MD

11/12/11 6:00 PM - 7:00 PM Alberta/New Brunswick

Context: MedZou is a student-run free community clinic associated with the University of Missouri (MU) School of Medicine, opened in 2008 with the goals to increase healthcare access for uninsured patients and to educate students about the care of this population. Student-run community clinics are becoming more prevalent across the country, but there is little evidence to support their potential benefit in reduction of local emergency department (ED) usage. Objective: To assess patient’s ED usage before and after enrollment at MedZou. Human Subjects Review: Approved as an Institutional Review Board Exempt project. Design: Retrospective chart review. Setting: Free community clinic for uninsured patients and a University ED. Patients: 132 adult uninsured patients (18 and older) seen both at MedZou and MU ED between 2006 and 2010. Main and Secondary Outcomes: Number of ED visits in the two years before and up to two years after MedZou enrollment. Secondary: Most frequent diagnoses at ED visits and at MedZou visits, as well as the number of ED visits related to a previously validated group of ambulatory care sensitive conditions (ACSCs). Anticipated Results: Hypothesis #1: MedZou patients have less ED visits after MedZou enrollment, compared to the two year period prior to MedZou enrollment. Hypothesis #2: The greatest impact MedZou has on ED usage is a reduction in ED visits related to ACSCs. Conclusions: Preliminary data suggests a reduction in ED usage after MedZou enrollment, but statistical analysis is ongoing. Further discussion of analytical approaches, statistical adjustments, and other potentially pertinent outcome measures are welcome.

P012 Recruitment of Medical Student Volunteers for Community Engagement and Health Service Activities

Dan Belz; Alicia Brooks; Allen Greiner, MD, MPH; Autumn Kirk-Phillips; Rebecca Mullen

11/12/11 6:00 PM - 7:00 PM Alberta/New Brunswick

Context: There is a growing demand for primary care physicians who will treat underserved populations. One approach to promote positive attitudes towards primary care among medical students is through volunteer opportunities with uninsured and poor populations. It may be important for medical schools to identify the factors that contribute to student volunteerism. These factors can then be targeted by medical schools during the admissions process or by community service organizations wishing to partner with medical schools, thereby enhancing both the service mission and the likelihood that students will stay interested in community engagement and primary care through training and into practice. Objective: To describe a community volunteerism program for medical students and explore factors that relate to volume of student interest in different volunteer activities with the medically underserved. Design: Mixed method qualitative/quantitative study. Setting: Volunteer opportunities organized by the Community Leadership Track (CLT) student organization at an urban academic health center. Participants: Medical students in years 1-4 at the University of Kansas School of Medicine. Main and Secondary Outcome Measures: Volume of medical student response to volunteer solicitations for community engagement and service, as well as type of event, mode of solicitation, timing in relation to coursework and tests, etc., were measured. Results: Final results pending. To date, the volume of student responses to volunteer events are: Project Boost (n=110), Back to School Fair (n=30), Latino Health Fair (n=14), 5K Dog Jog (n=11). Conclusion: Preliminary; this study suggests that medical students respond most vigorously to events in which strong and urgent wording is used in relation to a community health need or clinical service. This may provide practical strategies to encourage volunteerism among medical students and thereby promote primary care and service to the underserved.

P013 A Nutrition Assessment of Peruvian School-age Children

Ann Deneris, PhD, CNM; Jessica Greenwood, MD, MSPH; Lauren Jensen; Laura Simpson

11/12/11 6:00 PM - 7:00 PM Alberta/New Brunswick

Context: Malnutrition of children in developing countries increases the risk of stunted growth, cognitive impairments, and death. Most literature focuses on nutrition and stunting from infancy to 5 years of age. A gap in knowledge exists for research on nutrition for children between 5 and 18 years of age. Objective: Assess nutrition in Peruvian school-age children. Compare height/weight measurements with World Health Organization (WHO) statistics. Human Subjects Review: Non-human subjects research (IRB# 00051073). Design: Retrospective descriptive study. Setting: Primary and secondary schools in Sinsicap, La Libertad, Peru. Participants: 93 children who attended school the day of data collection: 53 boys, 40 girls, ages 3-18 years (mean 10 years). Instrument: Anthropometrics were obtained with a tape measure, calipers, stadiometer, and scale. Then, a dietary survey that assessed intake for 5 food categories using a 4-point Likert Scale ranging from “never” to “daily” was administered. Outcome Measures: Height, weight, hip and waist circumference, tricep and subscapular skinfold thickness, and responses to dietary survey. Results: 45.2% of participants were <5th percentile of children in a standard WHO population. 22.6% weighed <5th percentile. The average hip/waist ratio was 0.9 (min 0.7, max 1.0). Median triceps and subscapular skinfold measurements were: 10.0 mm (min 4 mm, max 28 mm) and 7.0 mm (min 1 mm, max 20 mm), respectively. Adequate consumption of dairy, fruits/vegetables, and carbohydrates (defined as daily intake) was 20%, 55%, and 76% respectively. Adequate meat and legume consumption (defined as 3 times/week) was 61%. 41% reported eating candy most days of the week. Conclusions: Malnutrition continues to be a problem for children in developing countries as they enter school years. This study showed persistent height/weight and nutrition deficits for this population, an area which is lacking in research. Further research on effective interventions to reverse these deficits is suggested.

P014 Comprehensive Stool Analysis Findings in Integrative Medicine-Primary Care Clinic Patients

Jeanne Drisko; Allen Greiner; Garrett Sullivan; Kristin Young; Christina M Hester, PhD

11/12/11 6:00 PM - 7:00 PM Alberta/New Brunswick

Context: Comprehensive stool analysis (CSA) is a useful tool for evaluating the general health and integrity of the digestive tract, examining functional parameters which may play a role in the prevention of gastrointestinal symptoms and colorectal cancer (CRC). Beneficial bacteria in the gut, such as Bifidobacter and Lactobacillus, produce short chain fatty acids (SCFAs) which have been shown to have protective effects against CRC in vivo and in vitro. In this study, we used CSA to assess the levels of beneficial bacteria and total SCFAs in a group of Integrative Medicine ? Primary Care Clinic Patients. Objective: This study was performed to evaluate relationships between patient clinical characteristics, symptoms, and CSA findings in a group of patients evaluated in an Integrative Medicine – Primary Care Clinic at the University of Kansas Medical Center. Human Subjects Review: Full Committee Review Approval through the KUMC Human Subjects Committee. Design: Retrospective chart review. Setting: Primary care in the KUMC Integrative Medicine Clinic. Patients or Other Participants: Patient clinical characteristics, self-reported symptoms, and clinical lab values, including CSA results, were abstracted from charts of 295 adult patients seen at the KUMC Integrative Medicine – Primary Care Clinic between 2007 and 2010 who had undergone CSA testing. Main and Secondary Outcome Measures: Clinical symptoms and characteristics associated with low levels of Bifidobacter, Lactobacillus, and total SCFAs will be identified. Anticipated Results: Patients with low levels of beneficial bacteria and total SCFAs will have different demographic, clinical, and symptom profiles than those with normal levels. Conclusions: Identification of patient characteristics, symptoms, and lab values associated with beneficial bacterial and total SCFA levels detected by CSA will provide preliminary insight into factors related to CRC risk and will begin to provide evidence that CSA is a useful tool for primary care clinicians to evaluate overall gastrointestinal health.

P015 Validation of a New Health Education Program for Hispanic Seniors

Nora Gimpel, MD; Jay Morrow, DVM, MPH; Patti Pagels, MPAS, PA-C; Allison Peddle

11/12/11 6:00 PM - 7:00 PM Alberta/New Brunswick

Context: The U.S. Hispanic geriatric population (>65 years) is expected to increase 555% by 2030. Since 80% of the geriatric population has at least one chronic condition and 52% have two or more chronic conditions, Hispanics will bear a large disease burden. Personal management is essential for control of chronic diseases. In 2009, the Wesley-Rankin Community Center restructured their senior program to include health education. A health needs assessment of the Hispanic seniors was conducted in order to help guide the new programming. The three most prevalent conditions were hypertension, arthritis and teeth problems. Health education modules were created on these and other general health topics and delivered by UT Southwestern family medicine residents and medical students over a period of 18 months. Objective: The purpose of this study is to evaluate a general health educational program at a community center serving a Hispanic geriatric population. Human Subjects Review: Study approved by UT Southwestern IRB. Design: Pre/post knowledge tests and satisfaction surveys. Setting: Wesley-Rankin Community Center serving primarily Hispanics in an underserved area of West Dallas, Texas. Patients or Other Participants: Convenience sample of Spanish-speaking Hispanic seniors: over the age of 60, low-income, enrolled in the senior program. Intervention/Instrument: Seniors receive pre/post knowledge tests and satisfaction surveys following delivery of multiple, 60-minute educational modules over 18 months. Main and Secondary Outcome Measures: Comparison of group total scores on pre and post knowledge tests. Group satisfaction measured on a 5 point Likert scale, 1-strongly disagree to 5- strongly agree. Anticipated Results: Post knowledge scores increase by 20%. Average group satisfaction scores of 3.5 or greater. Conclusions: This study validates a disseminable health education curriculum for community centers and other groups serving Hispanic seniors. These programs enhance personal management of chronic disease and promote healthier lifestyles in a vulnerable population.

P016 Determination of Time in Therapeutic Range for Patients on Coumadin for Atrial Fibrillation Using Java-based Software

Allan Bailey, MD; Adam Kirk; Scott MacLean, MD

11/12/11 6:00 PM - 7:00 PM Alberta/New Brunswick

Background: The introduction of dabigatran for risk reduction in patients with atrial fibrillation presents physicians with a dilemma - should patients be switched from coumadin to a new, relatively untested agent. The concept of time in therapeutic range (TTR) allows for an estimate of the efficacy of coumadin treatment, and may serve as a tool that can guide therapeutic choices in patients with atrial fibrillation. Previous study suggests that patients on coumadin who have a therapeutic international normalized ratio (INR) prothrombin time less than 65% of the time may benefit from other therapies. Purpose: To develop a rapid method of determining TTR for patients taking coumadin for atrial fibrillation in a Family Medicine Clinic. Methods: A JAVA-based software module was developed using the Rosendaal model for estimating INR and time in therapeutic range. This model was used in a family medicine clinic, where 100 charts were reviewed for therapeutic efficacy of coumadin therapy. The model was used to estimate the time in therapeutic range in the last two years for these patients. Results: The average TTR for all patients using the model was 66 +/- 17%. Using measured INR values only, TTR was estimated at 60 +/- 16%. Of 100 patients, 42 were identified as having TTR less than 65%. Conclusions: The development of a JAVA-based tool to quickly determine TTR of patients taking coumadin for risk reduction in atrial fibrillation allowed for the rapid identification of patients who are not receiving optimal therapy for risk reduction. Currently, this work is being expanded in order to examine trends in INR values and their variability in order to identify sub-therapeutic patients earlier in therapy.

P018 Does Mission Matter? Searching for Social Accountability in US Medical School's Missions, Student Experiences, and Outcomes

Scott Shipman, MD, MPH; Joseph C Park

11/12/11 6:00 PM - 7:00 PM Alberta/New Brunswick

Context: Since Flexner’s report, medical education has been rooted in the scientific method, embracing the tripartite missions of education, research, and patient care. However, predicted healthcare disparities have brought into question whether medical education has been successfully addressing the needs of society. Because of this, schools have been urged to include “social missions” in mission statements. Objective: 1) Evaluate mission statements of U.S. allopathic medical schools, categorize/quantify stated priorities emphasizing social mission. 2) Test association between schools’ missions and their graduates’ educational experiences and practice outcomes. Design: Mixed methods study, with dual qualitative review of mission statements of LCME accredited medical schools, reported online or in 2012-13 Medical School Admissions Requirements, published by the Association of American Medical Colleges. Quantitative analyses - descriptive data on stated missions, correlation between mission and medical school experiences and outcomes. Setting: 137 U.S. Medical Schools accredited by the Liaison Committee on Medical Education. Main/Secondary Outcome Measures: Number/variety of schools whose missions address societal need (student-body diversity, service to underserved, entry into primary care). Associations between stated social mission and a) matriculating characteristics (% rural, underrepresented minority, SES background, primary care interest), b) medical school experiences (quality of family medicine clerkship, community medicine experience, service to underserved, etc), c) workforce outcomes (% entering primary care, practicing in underserved areas). Anticipated results: Initial review of missions suggests few schools demonstrate strong emphasis on social mission. It is anticipated that the outcome associations demonstrate the degree to which mission statement reflects commitment to social mission, and workforce diversity that is prepared to meet the needs of society. Conclusion: If mission matters, schools with socially-oriented missions will demonstrate greater likelihood of meeting these objectives. As mission statements serve as a beacon to the public, this study may offer insight into the nation’s medical schools’ commitment to social accountability.

P019 Community Health Fair Effectiveness: Are We Providing What Participants Want/Need?

Dan Belz; Allen Greiner, MD, MPH; Beka Mullen; Heraclio Perez; Neil Bryan

11/12/11 6:00 PM - 7:00 PM Alberta/New Brunswick

Many communities in the U.S. and both urban and rural areas in the state of Kansas are medically underserved. Community based health fairs provide valuable screening, immunization, and education services for these communities, but little evidence exists about how the services offered at these events meet the perceived needs of underserved community members. The impact of health fairs and other community health events could be improved with better understanding of what health concerns communities members would like addressed at these events. Objective: To assess characteristics of individuals attending health fairs, reasons for attendance, community member perceptions of the usefulness of community screening events and health fairs, and to determine additional services that might be highly valued during future events. Design: Mixed method qualitative/quantitative study. Setting: Health fairs held in a series of rural and urban community locations over a 6 month period. Participants: Health fairs attendees 18 years old and older (n=400). Intervention/Instrument: written survey as well as in-depth interviews with selected health fair attendees. Main and Secondary Outcomes: Reasons for attendance, perceived value of screenings, and desired or suggested services for future events. Anticipated Results: Health fairs are primarily attended by underserved populations and generally offer a wide variety of health education and screening topics that meet the wants and perceived needs of attendees. Conclusions: With improved understanding of participants’ perceived needs, health fairs can improve attendance and better serve their communities.