Showing papers by "Lee A. Green published in 2005"

Infrastructure requirements for practice-based research networks.

Abstract: BACKGROUND The practice-based research network (PBRN) is the basic laboratory for primary care research. Although most PBRNs include some common elements, their infrastructures vary widely. We offer suggestions for developing and supporting infrastructures to enhance PBRN research success. METHODS Information was compiled based on published articles, the PBRN Resource Center survey of 2003, our PBRN experiences, and discussions with directors and coordinators from other PBRNs. RESULTS PBRN research ranges from observational studies, through intervention studies, clinical trials, and quality of care research, to large-scale practice change interventions. Basic infrastructure elements such as a membership roster, a board, a director, a coordinator, a news-sharing function, a means of addressing requirements of institutional review boards and the Health Insurance Portability and Accountability Act, and a network meeting must exist to support these initiatives. Desirable elements such as support staff, electronic medical records, multiuser databases, mentoring and development programs, mock study sections, and research training are costly and difficult to sustain through project grant funds. These infrastructure elements must be selected, configured, and sized according to the PBRN’s self-defined research mission. Annual infrastructure costs are estimated to range from $69,700 for a basic network to $287,600 for a moderately complex network. CONCLUSIONS Well-designed and properly supported PBRN infrastructures can support a wide range of research of great direct value to patients and society. Increased and more consistent infrastructure support could generate an explosion of pragmatic, generalizable knowledge about currently understudied populations, settings, and health care problems.

Opening the black box: cognitive strategies in family practice

Abstract: PURPOSE We wanted to describe the cognitive strategies used by family physicians when structuring the decision-making tasks of an outpatient visit. METHODS This qualitative study used cognitive task analysis, a structured interview method in which a trained interviewer works individually with expert decision makers to capture their stages and elements of information processing. RESULTS Eighteen family physicians of varying levels of experience participated. Three dominant themes emerged: time pressure, a high degree of variation in task structuring, and varying degrees of task automatization. Based on these data and previous research from the cognitive sciences, we developed a model of novice and expert approaches to decision making in primary care. The model illustrates differences in responses to unexpected opportunity in practice, particularly the expert’s use of attentional surplus (reserve capacity to handle problems) vs the novice’s choice between taking more time or displacing another task. CONCLUSIONS Family physicians have specific, highly individualized cognitive task-structuring approaches and show the decision behavior features typical of expert decision makers in other fields. This finding places constraints on and suggests useful approaches for improving practice.

Prehypertension, patient outcomes, and the knowledge base of family medicine.

Abstract: In this issue of the Annals of Family Medicine, Liszka et al present their analysis of long-term follow-up of the majority of the members of the original NHANES I cohort, examining clinical outcomes against initial blood pressures and cardiovascular risk factor profiles.1 They find observational support in terms of patient-oriented outcomes for the 2003 report of the Joint National Commission on Prevention, Detection, and Treatment of High Blood Pressure (JNC 7).2 The JNC 7 recommended that we be concerned about patients with prehypertension: systolic pressures between 120 and 139 mm Hg, or diastolic pressures between 80 and 89 mm Hg. Even in the lower half of that range, patients with 1 or more risk factors (ie, almost all our patients) suffered increased rates of heart failure, strokes, and coronary disease.

Peptic Ulcer Guideline Team

Abstract: ■ Clinical approach. Ulcers are caused by an infection of a bacterium known as Helicobacter pylori or H. pylori. Eradication of HP infection alters the natural history of peptic ulcer disease. Successful eradication reduces PUD recurrence rate from 90% to < 5% per year [A*]. PUD generally does not recur in the successfully treated patient unless nonsteroidal anti-inflammatory drug (NSAID) use is present.