We propose to continue the Southern Primary-care Urban Research Network (SPUR-Net), including 26 practices, 239 primary care providers, and an annual patient visit volume of 885,000. This urban- based network provides a laboratory for evaluating the effectiveness of primary care services delivered to the large, socio-economically and ethnically diverse population of Houston (the 0 largest city in the US) and its surrounding communities. Unique aspects of this network include a significant representation of minority patients (African American, Hispanic, and Asian American); inclusion of clinical sites providing health care to the underserved and the homeless; a variety of providers including family physicians, general internists, and general pediatricians; and involvement of a research team with experience in the use of electronic medical records for research and in developing and evaluating health care informatics and decision support tools. The Department of Family and Community Medicine, Baylor College of Medicine, serves as the academic hub for this network, with collaboration from four health care organizations: 1) Harris County Health District Community Health Centers; 2) Healthcare for the Homeless - Houston, Inc.; 3) Kelsey-Seybold Clinic and 4) the Baylor Family Medicine Clinic. The Baylor Institutional Review Board has review authority over all the participating organizations. This oneyear continuation grant will conduct the network-defining study proposed by AHRQ providing information about patients, providers and encounters, utilizing the NAMCS survey instrument. The survey will be conducted in all 26 SPUR-Net clinical sites, sampling a subset of physicians in the network. In addition, this proposal requests funds to conduct a special data-related research project for administering network-defining surveys. In this second project, we propose to evaluate a portable, electronic data tablet for gathering survey data directly from patients. The knowledge gained from this project should generalize to other practice-based research networks in both urban and rural settings. The impact of this study will be: 1) to describe the practice demographics of SPUR-Net, 2) to enhance the ability of PBRN's to gather data directly from patients in a cost effective manner that minimizes the burden on physicians, and 3) in the long term to improve the quality of patient care in our network through building upon our research infrastructure and database.
