Bringing Clinicians
together to
IMPROVE

Primary Care!

FUNDED April 26, 2010

Responded to: AAFP PBRN Stimulation Grant Application

A Comparison of Cesarean Section Outcomes for Rural Obstetricians and Family Physicians

ABSTRACT

The proposed study is a retrospective descriptive study to compare the specific and overall complications of Cesarean sections performed in rural hospitals by family physicians and obstetricians.  Data will be obtained by chart abstraction and billing data.  The first phase of the study will be a pilot study in two New England community hospitals. At one hospital, all Cesareans are performed by family physicians. At a nearby hospital with similar patient demographics, obstetricians perform all C-sections. The 125 most recent C-sections will be studied in each hospital.  This will represent 2-5 years experience at the selected hospitals.

Outcomes data to be studied will be: maternal death, fetal death, Apgar score, newborn transfer to NICU, hemorrhage requiring transfusion, hemorrhage requiring Cesarean-hysterectomy, post-op infection, bowel injury, bladder injury, wound dehiscence, length of stay, length of procedure, and decision to incision time.  Basic demographic data will be obtained to confirm appropriate controls, including age, parity, insurance status, race and maternal medical conditions. Data will be collected by the principal investigator or her designee, following appropriate training in chart review and billing data collection techniques.  Data will be analyzed using standard statistical methods.

The Teen Mental Health Project

ABSTRACT

Adolescence is a time when mental health issues are common. Half of all lifetime mental health disorders emerge by age 14. Despite the majority of adolescents being seen every year in primary care, only a third of depressed teens are identified in the usual health visit without use of a screening tool. One in every twelve teens in rural New England at health visits screen at risk for depression or suicide. Evidence exists that a collaborative care system where teens are screened for depression, providers receive training and supports to
assess teens, and office staff are trained to provide follow up and referral will lead to better outcomes. The US Preventive Services Task Force recommends this approach. However, most clinicians, especially in small rural practices, find it overwhelming to change usual care and lack resources to establish enhanced office care linked to mental health services. Linking clinicians through the practice research network has provided regional practices with the support to implement innovative changes to enhance patient care.

Through AHRQ support the Dartmouth COOP Project and CECH Practice-Based Research Networks (PBRNs) will partner with Dartmouth Hitchcock and regional mental health key stakeholders to establish the structure to train clinicians and their office staff, enhance mental health counseling options, provide clinicians with adolescent psychiatric input, and support office changes to respond to teen depression. The Dartmouth COOP Project will provide the tools and staff to assist practices in quality improvement with the office and form an ongoing group of practices and stakeholders to sustain improvements in the delivery of primary care adolescent mental health services.

Child Well-Being Project

ABSTRACT

Key coping strategies for regulating emotions and handling stress develop during childhood. Inability to handle stress can limit children reaching their full potential and can result in anxiety, somatic complaints, and poor school performance. This pattern can continue into adulthood with emotional and cardiovascular consequences. Currently the healthcare system addresses acute problems and does not provide interventions to foster mental wellness or prevent the side effects of stress.

This pilot proposal seeks to develop and study, in a controlled trial, an innovative community approach to enhance mental wellness in preadolescent children. It will provide school and primary care activities that teach children to use relaxation techniques in their daily lives. This intervention of daily, brief relaxation exercises enhance focus and school performance, will be delivered to 4th/5th children in Walpole, NH by teachers trained by the Benson Mind Body Institute, with a goal of enhancing attention and school performance. Half the children will receive additional reinforcement from one primary care practice to encourage its regular use at home with parents. Evaluation will compare anxiety symptoms, physical health, social and school performance between 83 students in Walpole and 80 students in a control rural community in VT. The additive effect of a primary care component in Walpole will also be determined.

Mindfulness interventions are a priority of the Institute of Medicine’s comparative effectiveness research agenda. This “universal” preventive intervention has the potential for a larger study and wide spread use in rural communities.