Social Networking for Abstinence and HIV Prevention
This project is designed to develop and test the efficacy of placing HIV prevention interventions on social networking sites on the Internet. We will develop interactive, Internet-based user-driven content to reduce HIV related risk behavior among young adults aged 16-20 years. Intervention materials will be developed with input from youth, and regularly updated over the two year trial. We will identify discrete social networks from among MySpace users and invite network members to participate in a randomized controlled trial to test the effects of the content on HIV prevention behaviors.
COHO role: Design, implementation, and dissemination
Principal Investigator: Sheana Bull, PhD
Funding Agency: National Institute of Nursing Research (NINR)
Community collaborators involved: Internet Sexuality Information Services (ISIS), Columbia University, Rutgers University
Text Messaging for Abstinence and HIV Prevention
This is a pilot study to test the use of text messages for the prevention of HIV-related risk behavior. We will work with African American men aged 16-20 years living in the Philadelphia area to develop a library of text messages for HIV prevention. We will then test the effects of the intervention on sustaining abstinence, monogamy, and/or condom use among a sample of 60 men recruited from community organizations in Philadelphia.
COHO role: Design, implementation, and dissemination
Principal Investigator: Sheana Bull, PhD
Funding Agency: National Institute of Mental Health (NIMH)
Community collaborators involved: Media Education Entertainment (MEE) Productions, Philadelphia, PA
Harnessing the power of the Internet for HIV Prevention: CyberSenga
This project is designed to develop and test a multi-session Internet-based intervention to prevent HIV among young adults in Uganda. We will target secondary school youth and invite them to participate in a randomized controlled trial testing the efficacy of an interactive, culturally appropriate information and skills building program for HIV prevention. Called CyberSenga, the project will invoke the traditional practice of relying on the Senga, or Aunt, in the Ugandan culture, who is responsible for education related to sexuality and coming of age for youth.
COHO role: Co-investigator and collaborator: Sheana Bull, PhD
Principal Investigator and lead agency for the project: Michele Ybarra, PhD, Internet Solutions for Kids, Inc.
Funding Agency: National Institute of Mental Health (NIMH)
Return to Work in Cancer Survivors: A Pilot Study
For working-age cancer survivors, the ability to return to paid work during or after cancer treatment may have substantial impact on quality of life. Little is known about the clinical, personal, or social characteristics that mediate return to work (RTW) after cancer. This exploratory project has two specific aims: 1) to conduct a qualitative study of adult cancer survivors to characterize the domains that are salient to their decisions about RTW; and 2) to develop and pilot test an interviewer-administered survey of work outcomes and the domains that affect work decisions. The results of this exploratory project will be used to develop a more extensive survey of cancer survivors, and to identify in a preliminary way the critical components of interventions to enhance RTW that can be tested in subsequent research.
COHO role: Design, implementation, and dissemination
Principal Investigator: John F. Steiner, MD MPH
Funding Agency: National Cancer Institute
Community collaborators involved:
Colorado Central Cancer Registry, AMC Cancer Research Center, Denver Health
Cognitive Remediation of Pediatric Cancer Survivors
As a result of central nervous system involvement or treatment, many survivors of childhood cancer frequently suffer from significant attention deficits. This project was developed to investigate the efficacy of a Cognitive Remediation Program (CRP) for children and adolescent cancer survivors who have completed treatment and demonstrate an attention deficit upon screening. This project involves a randomized trial to evaluate the effectiveness of a four to five month intervention consisting of 20, two-hour sessions of attention training. Evaluation will include measures of focused attention, working memory, memory recall, learning, vigilance, academic achievement, school behavior, and self-esteem.
COHO role: Biostatistical support
Principal Investigator: Robert Butler, PhD
COHO project members involved: Diane Fairclough, DrPH
Funding Agency: National Cancer Institute
Latinos Using Cardio Health Actions to Reduce Risk (LUCHAR)
In the United States, Latinos suffer a disproportionate burden of risk factors for cardiovascular disease (CVD). Despite higher rates of obesity and similar or higher rates of hypertension and other traditional CVD risk factors, Latinos are less likely than non-Latino white Americans to receive blood pressure measurement or adequate treatment for hypertension, cholesterol screening or smoking cessation advice. Because of the dramatic growth of the US Latino population, the high prevalence of CVD risk factors in this population, the under treatment of these risk factors, and the relatively limited understanding of CVD risk in Latinos, our initiatives are dedicated to the primary prevention of CVD through enhanced detection and control of these risk factors. This project consists of four research aims and two educational aims. Aim 1 will test a novel, interactive, culturally appropriate computer-based tool to improve the identification and self-management of CVD risk behaviors in Denver’s Hispanic community. Aim 2 elucidates the concurrent burden of other traditional biomedical risk factors (hyperlipidemia, diabetes, and smoking) and behavioral risk factors (lack of primary care, non-adherence to appointments and medications), using a registry of all hypertensive patients in DH. Aim 3 assesses the ability of traditional CVD risk factors to identify a sub-population of hypertensive Hispanic patients at high risk of progressive CVD based upon pre-clinical markers of CVD disease burden and the mechanisms of endothelial dysfunction in Hispanics. Aim 4 augments measurement of traditional risk factors with the assessment of novel, inflammatory markers of CVD, and proposes a randomized trial of the impact of HMGCoA-reductase inhibitor (statin) therapy on these inflammatory markers in Hispanic and non-Hispanic white patients without concurrent hyperlipidemia. In Aim 5, we will develop, conduct, and evaluate a curriculum focused on the conduct of culturally proficient research, and in Aim 6 we will adapt existing research career development programs at University of Colorado Denver to the specific needs of Denver Health faculty and the topic of CVD disparities, and will conduct and evaluate that curriculum.
COHO role: Partner with Denver Health
Principal Investigator:John F. Steiner, MD MPH
Co-Investigator:Sheana Bull, PhD
COHO project members involved: Chandramouli, Gutierez-Raghunath, Henderson, Barrientos Ortiz
Project Period: October 2004 to October 2009
Funding Agency: National Heart, Lung, and Blood Institute, NIH
Community collaborators involved: Denver Health and Hospital Authority
Community Cardiovascular Disease Prevention Program-Community Voices
The purpose of this community-based, culturally competent, evidence-based program is to reduce the risk of cardiovascular disease (CVD) among adult residents in 30 Colorado communities in three years. This program links community outreach workers promoting awareness of modifiable CVD risk factors and screening to appropriate evaluation and treatment. Specifically, the program will provide screening, CVD risk assessment, health information and education as well as referrals to primary care and other resources for 1,200 residents of Denver county, 600 residents of Lamar in Prowers County, 600 residents of Glenwood Springs in Garfield County, 600 residents of Pueblo County, and 600 residents of Limon in Kit Carson County by June 2007. All sites have selected underserved populations and will refer individuals to their local community health centers for health care services. Additionally, we will link with and leverage local efforts aimed at improving nutrition and increasing physical activity. Tobacco users in all sites will be referred to the Colorado Quitline smoking cessation program. The expected outcomes are that individuals will be aware of their numbers (blood pressure, cholesterol, BMI) and their risk of developing CVD and will use the offered health information and education and other resources to assist them in changing modifiable behaviors related to nutrition, physical activity, and smoking. Additionally individuals at moderate and high risk for CVD will be identified and linked to primary care for evaluation and treatment.
COHO role: Design, implementation, and dissemination
Principal Investigator: Debbi Main, PhD
Funding Agency: Colorado Department of Public Health and the Environment
Project Period: 2006-2009
COHO members: Iwasaki, McGloin
Evaluation of vaccination reminder/recall systems for adolescent patients
Although patient reminder/recall systems have been shown to be effective at improving vaccination coverage levels for infants and younger children, little is known about the effectiveness of such systems for increasing immunization rates in adolescent populations. In the current project, this study team, with extensive experience in immunization delivery research, will explore the effectiveness of a reminder/recall system for adolescents in a number of different practice settings including: pediatric and family medicine practices, urban and rural practices, community health clinics, and public school-based health centers. Studies of reminder/recall for adolescents will be conducted at each type of site, with patients randomly selected to receive either reminders or their usual care. Our study will also estimate the cost of establishing and operating a reminder/recall system for adolescents in each type of clinical setting. Additionally, we will conduct key informant interviews with relevant staff about the feasibility of reminder/recall in the adolescent population. Parent surveys will also be distributed to determine interest in innovative recall systems such as email or text messaging.
COHO role: Statistical and Data Management Center
Principal Investigator: Allison Kempe, MD MPH
COHO/COR project members involved: Daley, Saville, Barrow, Benton, Glazner, Dickinson, Main
Project Period: October 2007 to September 2009
Funding Agency: Centers for Disease Control and Prevention
Vaccine Policy Collaborative Initiative
The Vaccine Policy Collaborative Initiative is a project designed to survey providers and public health officials about important issues relevant to national immunization policy, using a rapid turnaround survey method with a pre-recruited Sentinel Site Network. It is directed by Dr. Allison Kempe in the Children’s Outcomes Research Program at the University of Colorado at Denver and Health Sciences Center, and is conducted by a multidisciplinary team with experience and expertise in rapidly designing, conducting and analyzing surveys. The study team is well-equipped to conduct quantitative or qualitative surveys using telephone, mail, e-mail, mixed modality, focus group, or other face-to-face interview methodologies.
COHO/COR Role: Design, implementation, and dissemination
Principal Investigator: Allison Kempe, MD MPH
COHO/COR project members involved: Daley, Steiner, Barrow, Babbel, Beaty, Crane, Black
Project Period: 10/01/04 – 09/30/10
Funding Agency: Centers for Disease Control and Prevention (CDC)
Community collaborators involved: American Academy of Pediatrics, American Academy of Family Physicians, American College of Physicians
Promoting New Adolescent Vaccines: The Role of Complementary Health Care Settings
The scope of adolescent immunization in the United States has been expanding in recent years, with new vaccines such as meningococcal conjugate and human papillomavirus (HPV) vaccines universally recommended for certain groups, and other vaccines for adolescents anticipated within the next 1 to 2 years. While new vaccines targeted at adolescents certainly hold great promise, they also may be faced with certain challenges. Among all persons in the U.S., adolescents may be the age group least likely to routinely access health care. In addition to the underutilization of preventive health services, other obstacles to immunization exist for adolescents, including lack of health insurance, missed opportunities for vaccination during visits, and the scattering of immunization records across multiple providers. Finally, when adolescents access the health care system, they may not seek care in a traditional medical home, but rather may be seen in a variety of health care settings, such as school-based health centers, public health centers, or emergency departments. The proposed research project will collect and integrate data from a variety of sources, including 1) secondary data regarding the characteristics and utilization patterns of adolescent users of complementary sites; 2) survey data obtained from providers, parents, and adolescents; 3) detailed observations and focus groups in select complementary settings; and 4) published data on disease epidemiology and vaccine efficacy. This work is being done to facilitate the process of bringing vaccines to the sites where adolescents receive care, rather than necessitating that adolescents change their patterns of care-seeking in order to be immunized. Such an approach may lead to improved adolescent immunization rates overall, a national health objective established in Healthy People 2010. Most importantly, higher immunization rates in adolescents should lead to healthier adolescents suffering from fewer vaccine-preventable diseases.
COHO/COR role: Design, implementation, and dissemination
Principal Investigator: Matthew F. Daley, MD
COHO project members involved: Pyrzanowski, Barrow, Nowels
Project Period: September 2006 to September 2008
Funding Agency: Centers for Disease Control and Prevention (CDC)
Caregivers’ and Relatives’ Expectations for Spinal (CARES) Surgery Study
The purpose of this study is to explore the impact upon quality of life for children and their caregivers from spinal fusion surgery. Spinal fusion surgery is recommended in children with sagittal plane imbalances and spinal curves of 70 degrees or greater and involves attaching rods along one or both sides of the spine. The risk of not performing spinal fusion in these children is potentially fatal pulmonary compromise. The children with spinal deformities are also often likely to have comorbidities that place them at an increased risk for surgical complication. These children are often unable to bathe, dress, or feed themselves and the ability to communicate in this population can be effected by the same brain injury that causes the scoliosis. Thus, their dependence upon a caregiver is often significant. In the face of the known risks associated with surgery in this patient population and the unknown quality of life outcomes for patients and caregivers following this surgery, this study is undertaken to measure the quality of life of this patient and caregiver population as it is impacted by spinal fusion surgery completed at the Children’s Hospital of Aurora. We will enroll the caregivers of children who completed spinal fusion surgery in 2006 at the Children’s Hospital (approximately 40 caregivers).
COR ROLE: Principal Investigator: Elaine Morrato, DrPH MPH
COR project members involved: Kempe, Barnard
Project Period: February 2008 to June 2009
Funding Agency: COR and the Research Institute at TCH
Psychosocial Outcomes of Pediatric Brain Tumor Survivors
Intracranial tumors are the second most common form of pediatric cancer. The location of these tumors, and the risk to cerebral integrity posed by standard treatments, may increase psychosocial morbidity for brain tumor (BT) survivors compared to children treated for other types of malignancies. Numerous investigations have documented cognitive deficits for children treated for BT, however, much less effort has focused on their social, emotional, behavioral and family functioning. Evidence suggests that survivors of pediatric BT may also be at risk for longstanding social and emotional difficulties. The proposed research will identify school aged (8-15 years) children who have completed treatment for BT at four pediatric oncology centers. For each of these children, a comparison peer of the same race, gender, and age (COMP) will be recruited from their class at school. Identical data will be obtained for all participants from multiple sources in classrooms (teacher, peer, self-report) and homes (mother, father, and child-report) to allow tests of group differences in social, emotional, behavioral, and parent/family functioning. In addition to testing group differences, analyses will test models about the mechanisms that mediate differences in outcomes. This work will make a significant contribution to efforts to design clinical trials to prevent or ameliorate long-term psychosocial morbidity in BT survivors.
COHO involvement in project: Statistical and Data Management Center
Principal Investigator: Cathy Vannatta, PhD
COHO project members involved: Diane Fairclough, DrPH
Project Period: September 2003 to August 2008
Funding Agency: Ohio State University through a grant funded by the American Cancer Society
Oral Health Care Early Intervention Project
There has been interest in the U.S. at exploring whether innovative dental hygiene practice models could expand access to preventive services and improve outcomes for high-risk populations. This pilot project consists of co-locating dental hygienist services in medical primary care offices. Dental hygienists will work in close collaboration with the primary care offices, providing preventive dental care to young children either before or after scheduled well-child visits. The target population for this intervention will be children 0 to 3 years of age because: 1) early childhood caries starts at a very young age (before age 1 year in some cases); 2) children this age are less likely to receive preventive dental care than older children;2 and 3) children this age are less likely to have already established a dental home than older children. Services will be provided bi-annually (twice per year for any individual child), typically when children are seen for well-child visits. Children will be eligible for hygienist services regardless of health insurance or dental insurance status. However, for this pilot project, primary care practice with a higher proportion (>20%) of patients with public health insurance will be targeted for participation.
The overall aims for this project are to determine by randomized controlled trial the effect of bi-annual preventive dental care provided by dental hygienists on the incidence of early childhood caries; among parents of young children seen in pediatric primary care practices, determine the knowledge, attitudes, and beliefs of parents regarding the importance of oral health, means of preventing caries, and perceived barriers to accessing regular preventive dental care; and determine how parental oral health-related knowledge, attitudes, beliefs, and perceived barriers change over time, comparing parents that receive bi-annual oral health counseling with parents that receive one-time counseling. The project will run for three years in total. All children will have a standardized oral examination by a pediatric dentist approximately 24 months after their first visit with the dental hygienist.
COHO involvement in project: Evaluation, Statistical, and Data Management Center
Principal Investigator: Matthew F. Daley, MD
COHO project members involved: Shobe, Braun, Kempe
Project Period: May 2007 to April 2010
Funding Agency: Delta Dental Foundation
Stapleton 2040
Stapleton 2040 is a Community-University participatory partnership involving five neighborhoods-Northeast Park Hill, Greater Park Hill, East Montclair, Original Aurora, and Stapleton, the Stapleton Foundation and the University of Colorado. The core ideas of Stapleton 2040 are: to work together, to be a learning community engaging people from various walks of life, to identify important health and health care problems, and to create opportunities to redress them. Together, the partners ask and answer important questions, design and assess programs and policies to improve health in these neighborhoods. The Stapleton development is the largest urban renewal project in the United States, with development that began in 2001. One of the visions for redevelopment of what used to be the site of the old Denver airport is to connect Stapleton's open and green spaces with the older, well-established adjacent neighborhoods. These adjacent neighborhoods experienced over 40 years of exposure to airport noise, traffic, and by-products of airport usage; all participants on the 5-community advisory are involved in their respective communities.
COHO role: Design, implementation, and dissemination
Principal Investigator: Debbi Main, PhD
COHO project members involved: Main, Haverhals, Iwasaki, Barrientos-Ortiz, Phibbs
Project Period:
Funding Agency:
Community collaborators involved: Stapleton Foundation, Taking Neighborhood Health to Heart Community Coalition, Alisha Brown, Ira Gorman, Jennie Hill, Diane King, PhD, Joe McGloin, Javan Quintela
Taking Neighborhood Health to Heart
The Taking Neighborhood Health to Heart study is Community-Based Participatory Research project that is a collaboration among the following metro Denver, Colorado neighborhoods: East Montclair, Northwest Aurora, Park Hill, Northeast Park Hill, and Stapleton, along with the University of Colorado Denver and the Stapleton Foundation. The goal of this project is to learn more about the health of people in these neighborhoods and identify ways to improve it. It began in June 2006 and will conclude in July 2009.
The project involves performing physical walking audits of the neighborhoods to note opportunities available to be physically active, such as availability of recreation centers, as well as places that have been built specifically to encourage being active, such as parks. It is also studying the availability of affordable, healthy foods in these neighborhoods.
The Taking Neighborhood Health to Heart project is also gathering information about health from the community through surveying 1,000 households in these neighborhoods by telephone between June and December 2007. The survey asks community members about their levels of physical activity, where they buy healthy foods, and other questions about health. The project is taking the unique approach of randomly recruiting households door-to-door to complete this survey, which is being conducted by AMC Cancer Research Center in Lakewood, CO.
COHO role: Design, implementation, and dissemination
Principal Investigator: Debbi Main, PhD
COHO project members involved: Dickinson, Haverhals, Iwasaki, Barrientos-Ortiz
Project Period: May 2006 – July 2009
Funding Agency: National Heart, Lung and Blood Institute
Community collaborators involved: Stapleton Foundation, Taking Neighborhood Health to Heart Community Coalition, Alisha Brown, Ira Gorman, Jennie Hill, Diane King, PhD, Joe McGloin, Javan Quintela
Improving the Quality of Patient Care
Through a grant from the Colorado Trust, COHO has been funded to work collaboratively with the Colorado Clinical Guidelines Collaborative (CCGC) to identify and evaluate strategies for enhancing the implementation of evidence-based clinical care guidelines to improve healthcare quality. This program has focused on guideline implementation and evaluation efforts in two clinical areas: adult and pediatric immunization. The results of this evaluation will include publications that help to identify the most effective methods for ensuring that guidelines get used in busy medical practices.
COHO role: Design, implementation, and dissemination
Principal Investigator: Debbi Main, PhD
Funding Agency: The Colorado Trust
Community collaborators involved in project: The Colorado Clinical Guidelines Collaborative
Amendment 35 Program Evaluation Group
The University of Colorado Denver (UCD) will provide research and evaluation services for four program areas administered by the Colorado Department of Public Health and Environment (CDPHE) that award grants from Amendment 35 (A35) tobacco tax revenues. The four program areas are:
- Tobacco Prevention, Education and Cessation, managed by the State Tobacco Education and Prevention Partnership (STEPP);
- Cancer, Cardiovascular, and Pulmonary Disease (CCPD);
- Office of Health Disparities (OHD) grant program;
The A35 Program Evaluation Group (A35PEG) will serve the following general purposes:
- Inform CDPHE decisions to continue, improve, expand or curtail program strategies
- Assess new program strategies
- Document program successes
- Provide feedback that programs can use to refine and improve strategies
- Support accountability requirements
The CDPHE has identified several overarching evaluation questions to be addressed:
- Are the grant programs reducing the impact of chronic disease and health disparities?
- Have programs resulted in a decrease in health risk behaviors?
- What was the reach of the programs?
- What was the effectiveness of the programs?
- How do local grantees sustain programs after funding?
The Scope of Work describes our approaches to the design and implementation of evaluation activities to address these overarching questions. Also responding to CDPHE requirements, the A35PEG will establish a technical assistance service to assist evaluation planning by grantees, and by the four grant programs. As part of this service, we will summarize and present findings on state-of the-science program implementation and evaluation strategies/methods.
COHO role: Design, implementation, and dissemination
Principal Investigator: Debbi Main, PhD
COHO project members involved: Phibbs, Weister
Project Period:
Funding Agency: Colorado Department of Public Health and the Environment
The CORHIO Initiative
CORHIO is a not-for-profit regional health information organization that has the mission to provide state-wide health information exchange for individuals, health care providers, agencies, organizations, and community leaders across Colorado. For more information, go to www.corhio.org.
Formerly known as the Colorado Health Information Exchange (COHIE) Project, CORHIO is primarily funded by a federal contract from AHRQ. CORHIO is working to build Colorado’s capacity for state-wide health information exchange based on a federated, web-based model. The goal is to create a low-cost and self-sustaining service which accommodates diverse platforms, systems, needs, resources, and affiliations. As Colorado's statewide exchange CORHIO will synergize with the Nationwide Health Information Network (NHIN). This federated model is neither a data repository nor a comprehensive electronic medical record. Data "lives" at its point of generation and will be shared through CORHIO's hub when needed via a secure and confidential process. CORHIO provides the mechanism to transfer and aggregate into meaningful information for clinical decision making.
CORHIO will launch the data exchange service with four initial partner organizations in June 2008. The partner organizations are Denver Health, Kaiser Permanente, The Children’s Hospital and University Hospital.
COHO role: Design, implementation, and dissemination
Principal Investigator: Art Davidson, MD
COHO project members involved: Madison
Project Period: 9/30/2004 - 6/29/2010
Funding Agency: AHRQ
Community collaborators involved: Denver Health, Kaiser Permanente, The Children’s Hospital, University Hospital
Project Health Design: Managing Chronic Diseases and Transitions of Care in Elderly
Project Health Design: Managing chronic diseases and transitions of care in the elderly is a project funded by the Robert Wood Johnson foundation with the objective of studying how older adults and their caregivers manage their health information, specifically their medications, in order to inform the design of an electronic tool to help them manage this information. This 18-month project began in December, 2006. There are two main phases to the project, the first of which was a 6-month Design Phase where older adults and their caregivers were interviewed individually and in focus groups on their processes for managing medications. The second phase is the Prototype Phase where the same population is interviewed again and asked about their opinions on the prototype of the electronic, tablet-like device. The objective is to design a tailored, interoperable personal health record prototype that further addresses the information management challenges faced by older patients and their caregivers as they grapple with multiple chronic conditions.
COHO role: Design, implementation, and dissemination
Principal Investigator: Steve Ross, MD
Co-Investigator: Katie Siek, PhD
COHO project members involved: Haverhals
Funding Agency: Robert Wood Johnson Foundation
Link to news release: http://www.rwjf.org/newsroom/newsreleasesdetail.jsp?id=10449
Data Coordinating Center for the ASC National Surgical Quality Improvement Program (ASC NSQIP)
The American College of Surgeons has adopted the methodology of the VA NSQIP. Under VA NSQIP, the performance of all VA hospitals providing surgical services is compared using a risk-adjusted method. The results of these comparisons are provided to each hospital and are used to identify areas of poor performance and an excess of adverse events. The overall contribution to better and safer surgical care in the United States has been good. COHO performs an annual analysis that calculates O/E ratios and positions each institution’s performance in the context of all other institutions participating in the program. Each institution receives a report that shows its O/E ratios in relationship to those of the other hospitals in the program and provides comparative workload and patient risk data.
COHO role: Data Coordinating Center
Principal Investigator: William Henderson, PhD
Project Period: Ongoing since 1998
Funding Agency: American College of Surgeons
Development, Implementation, and Evaluation of the Surgical Bed Management System
Development, Implementation, and Evaluation of the Surgical Bed Management System. The purpose of the project is to develop, implement, and evaluate a software system, the Surgical Bed Management System (SBMS), that assists hospitals in enhancing the efficient use of their most valuable resource, their hospital beds and the personnel servicing these beds. The scope of work (hereinafter referred to as “Work”) includes: (1) selecting data elements for inclusion in the length of stay (LOS) prediction model; (2) refining the statistical models for estimating length of stay; (3) specifying the functional requirements of the SBMS; and (4) testing and evaluating the SBMS prototype. The work under this agreement will be performed in a 3-year period from November 1, 2007 to October 31, 2010.
Principal Investigator: Katherine Rowell, MS MHA
COHO PI: Karl Hammermeister, MD
Project Period: 11/01/07 – 10/ 31/10
Funding Agency: Small Business Innovative Research (SBIR), NIH
Benefits of “Repeat Back” Within a Computer-Based Informed Consent Program
Informed consent for surgical procedures is critical to patient care in the VA. This three-year, multi-center, randomized trial compares the benefit of using the “Repeat-back” technique, whereby patients are asked to recount what they have been told in the informed consent discussion, with the use of the standard iMedConsent program. The study will be linked to the National Surgical Quality Improvement Program (NSQUIP) data which will provide baseline data on patient characteristics, intraoperative variables and the data on 30 day surgical outcomes. We hope that iMedConsent program with repeat-back (enhanced iMedConsent) will improve the surgical patient’s comprehension regarding the surgical technique, treatment alternatives, and risks and benefits of the proposed surgery when compared to the standard iMedConsent approach. We also hope that the enhanced system will lead to better patient satisfaction with the consent process, less anxiety about the operation, increased acceptance by providers, and ultimately better clinical outcomes.
COHO role: Data analysis
Principal Investigators: Aaron S. Fink, MD and Allan Prochazka, MD M.Sc.
COHO project members involved: Henderson, Nyirenda
Funding Agency: Veterans Administration Medical Center (VAMC)
Intra-operative Predictors of Adverse Outcomes
There is limited, but tantalizing, evidence that aberrations in intra-operative physiology (e.g., rapid heart rate, low or high blood pressure, hypothermia, and greater depth of anesthesia) are related to an increased risk of longer-term adverse outcomes after surgery – particularly one-year mortality. The sparse evidence is largely the result of the commonly used hand-written anesthesia record, which makes it difficult to aggregate data on intra-operative physiology across large numbers of patients. These limited data have led to our hypothesis: Intra-operative variables amenable to intervention by the care provider, such as heart rate, blood pressure, temperature, arterial oxygen saturation, depth of anesthesia, etc. are important determinants of both short- and long-term outcomes from surgery. The introduction of computerized anesthesia information management systems (AIMS), which automatically record and store data on intra-operative physiology and provide for electronic entry of medications given and intra-operative events by the anesthesiologist/anesthetist, now makes our hypothesis testable.
Our long-term goal is to enhance the safety of patients undergoing surgery in the Veterans Health Administration (VA). This proposal has four immediate research goals: 1) analyze archived data from disparate AIMS to understand the variability in data recording, 2) develop preliminary data standards that will allow the merging of data from disparate AIMS, 3) merge archived AIMS data on intra-operative physiology from approximately 19,000 patients from seven VA medical centers with data from the National Surgical Quality Improvement Program (NSQIP) on patient-related risks, operative procedures, and outcomes, and 4) perform multivariable analyses to assess the associations between altered intra-operative physiology and adverse operative outcomes. We will translate the results of the present proposal into practice through 1) participation in the development of vocabulary standards for intra-operative care, and 2) collaboration in the development of a standardized VA electronic anesthesia report. The standards that we develop for the anesthesia record will be contributed to the VA National Anesthesia Service, Office of Patient Care Services for use in the Anesthesia Record Keeping Systems Standards (Appendix B).
Prinicpal Investigator: Terri Monk, MD
COHO Principal Investigator: Karl Hammermeister, MD
COHO Co-Investigators: Henderson, Min
Project Period: 10/01/06– 9/30/08
Funding Agency: Department of Veterans Affairs Health Services Research and Development
Development of Medicare Quality Outcome Measures for Vascular Surgeries
The Colorado Foundation for Medical Care (CFMC) has received funding from Centers of Medicare & Medicaid Services (CMS) for a special project: “Medicare Quality Measurement Support Project: Mortality Implementation and Measures Development and Monitoring.” Obligations to this project include the development of two to three outcome measures for vascular surgeries by working with professional societies or organizations that have developed comprehensive registries to track patterns of care and improve health care system performance. The vascular surgeries of interest include:
• Carotid Endarterectomy (CEA)
• Lower Extremity Bypass (LEB)
• Abdominal Aortic Aneurysm (AAA) Repair (Open and Endovascular or EVAR)
COHO role: Data Coordinating Center
Principal Investigator: Karl Hammermeister, MD
Project Period: Ongoing since 1991
Funding Agency: Colorado Foundation for Medical Care (CFMC)
Additional Research Projects Using the VA NSQIP Database
The VA NSQIP database includes close to 1.5 million observations on patients undergoing major surgery in the Department of Veterans Affairs hospitals. Observations on each patient include demographics, preoperative risk factors and comorbidities, preoperative laboratory values, intraoperative data, and postoperative outcomes including mortality and morbidity up to 30 days after the operation. The VA NSQIP database is currently being used by investigators from around the country to answer various surgical research questions. COHO currently receives funding for these projects:, including the investigator name, institution, title of the project, and funding source.
| Investigator/Institution | Title of Research Project | Funding |
| Lori A. Alvord, MD - Dartmouth VA | Surgical Outcomes in American Indian Veterans | N/A |
| Ann Borzecki, MD - Bedford VA | Translating the AHRQ Quality Indicators to the VA | VA HSR&D |
| Katharine Bradley, MD - Seattle VA | Alcohol Misuse and the Risk of Post-surgical Complications and Mortality | VA HSR&D |
| Ellen Flanagan, MD - Durham VA | Surgical Outcomes of Elderly Patients with DNR Orders | Amer. Geriat. Society |
| Tom Houston, MD - Birmingham VA | Detailing Smoking-Attributable Risks for Postoperative Morbidity | VA HSR&D |
| Marty London, MD - San Francisco VA | Perioperative Beta Blockade: A Pharmaco-epidemiologic Analysis in the VA | Anesthesia Foundation |
| Steve Luther, PhD - Tampa VA | Quality of Locoregional Treatment for Breast Cancer in the VA | VA HSR&D |
| Matt Maciejewski, PhD - Durham VA | Long-term Outcomes of Bariatric Surgery in the VA | VA HSR&D |
| Tiffany Radcliff, PhD - Denver VA | Hip Fracture Repair and Outcomes: A National Cohort Study of Veterans | VA HSR&D |
| Amy Rosen, PhD - Bedford VA | Validating the Patient Safety Indicators in the VA: A Multi-faceted Approach | VA HSR&D |
| John Schneider, PhD - Iowa City VA | The Business Case for Reduction in Surgical Complication Rates in the VA | VA HSR&D |
| Ted Speroff, PhD - Nashville VA | Electronically Identifying Adverse Events in Clinical Narrative | VA HSR&D |
| Wen-Chih Wu, MD - Providence VA | Variability in Surgical Blood Transfusion Practices & Cardiovascular Outcome | VA HSR&D |