Crozer-Keystone Health System (CKHS) requests funding for both Category I, and Category II. Infrastructure support will further develop the research capacity within the Crozer-Keystone Health Network (CKHN), a system-owned network of 36 primary care practices and eight specialty practices with 89 primary care physicians and 30 specialists serving over 125,000 individuals. It is the goal of CKHS to advance research activities within the Network to accomplish a PBRN. The CKHN PBRN will be a unique real-world opportunity to implement evidence-based guidelines for best practices and to further the mission of improved community health through researching barriers to implementation and diffusion issues. Infrastructure development will include the implementation of a Research Steering Committee; incorporation of core health data elements in the electronic database; promotion of clinical preventive guidelines with both physicians and patients; and expansion of research activities into affiliated community practices serving predominately minority and socioeconomic ally disadvantaged populations. Procedures for diffusion of best practices into the community setting is a key interest. The CKHS PBRN will also demonstrate the benefit of linking a well -organized community-based delivery system and the research capacity of the Johns Hopkins Bloomberg School of Public Health. Under Category II, a Pilot Research project will test the effectiveness of using multiple integrated interventions at physician and patient levels for achieving improvements in the use of Healthy People 2010 clinical preventive guidelines for cardio-vascular (including diabetes) risks in adult patients. Twenty adult primary care practices will be randomized. Interventions in ten will be tested for significant improvement in physician practice patterns and patient risk behaviors and whether they are significantly different from those in the 10 control practices. Results will be additionally adjusted for secular trends as measured by CKHS 6th (2002) and 7th (2004) stratified random community health household field survey. This Category II pilot research builds on a current CKHN dsylipidemia-ATP III guidelines IRB approved research project using chart reminders for 928 patients in 10 practices. This Category II pilot research in turn will be the basis for a countywide R01 application by early 2005. Category I infrastructure development and Category II research experience will achieve an operational, community-based, academic supported PBRN.
