Network News Excerpts
(EXCERPTS TAKEN FROM THE SPRING 1999
EDITION OF THE NETWORK NEWS)
From the Director
By Mort Wasserman, MD, MPH
"I was so much older then, I'm younger than that now?."
A few years ago, based on experiences gleaned from numerous network
projects, I reached a sense of what PROS could and couldn't do -- all
the way from the nitty-gritty details of data collection and study protocols
to the choice of study topics and overall objectives for the network.
I felt very gratified. On the heels of the latest meeting of PROS Chapter
Coordinators and Steering Committee, I have completely lost that sense
of knowing exactly what PROS can do -- but somehow feel even more gratified!
PROS has begun to extend the limits for practice-based research networks.
The Life Around Newborn Discharge (LAND) project, which is being
launched this summer, provides a current example. In order to address
the study questions posed in the LAND project, PROS practitioners will
for the first time be collecting some data outside the practice
setting - enrolling subjects in the hospitals where they round on newborns.
During the planning for LAND, I had some concerns as to whether this
would work. Happily, the practitioners who participated in the LAND
pilot study have proved that my concerns were unfounded, enrolling patients
with little or no trouble.
As another example, at the recent PROS meeting, coordinators reviewed
plans for a new study on child development which calls for the use of
adaptive questionnaires -- questionnaires administered to parents
at serial visits in which the questionnaire items at subsequent visits
vary according to responses at previous visits. This strategy provides
a great way for PROS to begin to address a vital issue that lies at
the heart of primary care -- the complexity of caring for patients over
time. However, the logistics of providing different questionnaires for
different parents at different times struck me as completely overwhelming,
unless it could be done electronically. This is precisely the investigative
team's proposed approach to the problem - have parents complete questionnaires
using touch screen notebook computers and upload the day's data every
evening to an Internet-based server, which would in turn download and
store new questionnaires in the same notebook computer for the same
parents' next visit!! Does this sound like science fiction to you? The
technology to accomplish this already exists, and PROS is seeking funds
to try this technology out in the network.
Will this futuristic approach to data collection work? I'm no longer
certain as to exactly what will and won't work in the network. I am
certain, however, that PROS benefits from trying to broaden its capabilities.
Provided that we remember to pilot all of our new ideas in real practice
settings before committing to them wholesale, PROS should make every
effort to stretch out.
From The Steering Committee
Chair
By Gordon Glade, MD
I was on a clinical researcher's high in early February when the second
Helping Improve Pediatric Practice Outcomes (HIPPO) working conference
convened. Over the past few years, like all of you, I have attended
workshops and lectures and read guidelines on the most recent recommendations
for asthma management. With HIPPO I feel like I have finally found what
I needed--a room full of pediatricians and nurses determined to find
the best ways to implement the National Heart, Lung and Blood Institute
(NHLBI) guidelines in busy office practices. PROS colleagues were well-prepared
to share their successes. Charlie Homer, Pat Heinrich, et al. have shown
us how to make a significant change in office routine for the improved
treatment of a specific pediatric problem.
Shortly after the conference my office convened to deal with some communication
issues with families, schools, patients and psychologists about children
with ADHD. We used the skills and tools that HIPPO had given us. I was
glad we had them as a framework for our discussion. Part of the HIPPO
process is a biweekly conference call in which HIPPO practices converse
with each other about the strategies they are implementing. I missed
the last one because we were just too busy in my office to break away.
I learned that during the last round of conference calls less than a
third of the offices participated. I am sure everyone is just trying
to keep up with the huge demands of patient care in busy pediatric practices
in the winter.
On the other hand during the two maintenance visits I had with two
patients with asthma recently, I was glad to have HIPPO "Asthma Management
Plans" and "Asthma Management Forms" that had enhanced the care I was
giving and improved the home medical management these patients were
receiving.
What have I learned from this?
1. There is a reason that many primary care doctors do not actively
participate in clinical research; they cannot find the time.
2. Participation in office-based collaborative primary care research
positively affects how my office functions and helps me be a better
pediatrician.
3. It's imperative that I keep making time for research even with a
busy practice.
Thanks to all PROS practitioners for your hard work and commitment
to improving care for children even in the winter.
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