Dual-energy CT iodine overlay improves efficiency of oral contrast leak assessment.

Background: Evaluation for gastrointestinal leak is a frequent imaging indication, and dual-energy computed tomography (DECT) with oral or rectally administered contrast can be used to improve efficiency and diagnostic confidence.

Purpose: To assess the value of the DECT iodine overlay (IO) reconstruction as a stand-alone image set compared to routine CT in assessing oral or rectal contrast leak from the gastrointestinal system.

Material And Methods: A blinded, retrospective audit study was performed by three readers who each interpreted 50 studies performed for assessment of oral or rectal contrast leak that were acquired using DECT.

Development and Initial Use of an Evidence-Based Home Blood Pressure Monitoring mHealth Platform.

Home blood pressure monitoring (HBPM) has been shown to provide a more reliable assessment of blood pressure (BP) than in-office measurement and may lead to improved BP control. While many mHealth apps are available to help users track their blood pressure (BP), no apps incorporate the full set of evidence-based HBPM recommendations for ensuring accurate measurement at home. Through an agile development approach employing user stories, we translated an evidence-based standardized protocol for BP measurement and monitoring over a recommended 3-7 day monitoring period into a mHealth app and corresponding clinician portal.

Translating CKD Research into Primary Care Practice: a Group-Randomized Study.

Background: Chronic kidney disease (CKD) is common in the primary care setting. Early interventions may prevent progression of renal disease and reduce risk for cardiovascular complications, yet quality gaps have been documented. Successful approaches to improve identification and management of CKD in primary care are needed.

Use of Clinical Decision Support to Improve Primary Care Identification and Management of Chronic Kidney Disease (CKD).

Background: Early detection of chronic kidney disease (CKD) can lead to interventions to prevent renal failure and reduce risk for cardiovascular disease, yet adherence to treatment goals is suboptimal in the primary care setting. The purpose of this study was to assess whether clinical decision support (CDS) can be used to improve the identification and management of CKD.

Methods: This 2 year demonstration study was conducted in 11 primary care PPRNet practices.

"Meaningful" clinical quality measures for primary care physicians.

Objectives: To systematically solicit recommendations from Meaningful Use (MU) exemplars to inform Stage 3 MU clinical quality measure (CQM) requirements.

Study Design: The study combined an electronic health record (EHR)-based CQM performance assessment with focus groups among primary care practices with high performance (top tertile), or "exemplars."

Methods: This qualitative exploratory study was conducted in PPRNet, a national primary care practice-based research network.

Learning from primary care meaningful use exemplars.

Background: Submission of clinical quality measures (CQMs) data are 1 of 3 major requirements for providers to receive meaningful use (MU) incentive payments under the 2009 Health Information Technology for Economic and Clinical Health (HITECH) Act. Some argue that CQMs are the most important component of MU. Developing an evidence base for how practices can successfully use electronic health records (EHRs) to achieve improvement in CQMs is essential and may benefit from the study of exemplars who have successfully implemented EHRs and demonstrated high performance on CQMs.

Quality indicators for primary care: an example for chronic kidney disease.

Although clinical guidelines exist for the management of chronic kidney disease, there is some evidence that care provided by primary care physicians is not concordant with these guidelines. To translate guidelines into practice, a set of quality indicators that are valid and feasible is needed. In this study, which was conducted in PPRNet in 2011, a consensus process was used to develop a set of 12 face valid and reliable quality indicators that can be utilized by primary care physicians to measure and improve chronic kidney disease management.

The prevalence of chronic diseases and multimorbidity in primary care practice: a PPRNet report.

Introduction: Multimorbidity (multiple chronic illnesses) greatly affects the delivery of health care and assessment of health care quality. There is a lack of basic epidemiologic data on multimorbidity in the United States. This article addresses the prevalence of 24 chronic illnesses and multimorbidity from primary care practices across the United States.

Preventive services delivery in patients with chronic illnesses: parallel opportunities rather than competing obligations.

Purpose: Whether patients with 1 or more chronic illnesses are more or less likely to receive recommended preventive services is unclear and an important public health and health care system issue. We addressed this issue in a large national practice-based research network (PBRN) that maintains a longitudinal database derived from electronic health records.

Methods: We conducted a cross-sectional study as of October 1, 2011, of the association between being up to date with 10 preventive services and the prevalence of 24 chronic illnesses among 667,379 active patients aged 18 years or older in 148 member practices in a national PBRN.

Use of an electronic health record clinical decision support tool to improve antibiotic prescribing for acute respiratory infections: the ABX-TRIP study.

Background: Antibiotics are often inappropriately prescribed for acute respiratory infections (ARIs).

Objective: To assess the impact of a clinical decision support system (CDSS) on antibiotic prescribing for ARIs.

Design: A two-phase, 27-month demonstration project.

Medication Safety in Primary Care Practice: results from a PPRNet quality improvement intervention.

Reducing medication errors is a fundamental patient safety goal; however, few improvement interventions have been evaluated in primary care settings. The Medication Safety in Primary Care Practice project was designed to test the impact of a multimethod quality improvement intervention on 5 categories of preventable prescribing and monitoring errors in 20 Practice Partner Research Network (PPRNet) practices. PPRNet is a primary care practice-based research network among users of a common electronic health record (EHR).

The use of clinical decision-support tools to facilitate geriatric education.

Innovative methods are needed to incorporate effective geriatric education into internal medicine residency programs. The purpose of this report is to describe the development and use of clinical decision-support (CDS) tools to facilitate geriatric education and improve the care delivered to older adults in an academic internal medicine residency ambulatory care clinic. Starting in 2009, CDS tools were implemented as a major strategy of an initiative to improve resident physician clinical competencies in geriatrics and improve the quality of care and quality of life of older adults.

Adoption of a clinical decision support system to promote judicious use of antibiotics for acute respiratory infections in primary care.

Purpose: Overuse of antibiotics for acute respiratory infections (ARIs) in primary care is an established risk factor for worsening antimicrobial resistance. The "Reducing Inappropriate Prescribing of Antibiotics by Primary Care Clinicians" study is assessing the impact of a clinical decision support system (CDSS) on antibiotic prescribing for ARIs using a multimethod intervention to facilitate CDSS adoption. The purpose of this report is to describe use of the CDSS, as well as facilitators and barriers to its adoption, during the first year of the 15-month intervention.