A Practice-Based Research Network of Community Health Centers (Infrastructure Development - Category I) The Community Health Center Network (CHCN) is a non-profit organization that provides management services for seven long-established, community health centers (CHC) in Alameda County, California. The CHCs are staffed by 85 physicians and 40 mid-level practitioners who are safety-net providers for over 60,000 uninsured and Medicaid managed care patients. The patients are largely low-income Latinos, Asians, and African-Americans. CHCN coordinates clinical quality improvement with a committee of medical directors from each CHC and CHCN's medical director. The committee promotes evidence-based guidelines and selects annual topics for the evaluation of clinical performance (""""""""audits""""""""). The audits follow the specifications of HEDIS (e.g., cervical cancer screening, glycemic control in diabetics, appropriate asthma care), and are carried out under the guidance of CHCN's epidemiologist. Technical reports are fed back to medical directors who initiate follow-up for patients and clinic staff to improve practices. To carry out the audits, CHCN has begun to create a centralized data warehouse based on automated reporting of encounters, commercial laboratory data, enrollment, and free-standing diabetes registries at each CHC. CHCs maintain their own automated practice management systems, but report to CHCN in standardized EDI formats. The warehouse is built on an enterprise database platform (MS SQL Sever), exporting data to standard statistical packages for analysis. Grants from two private foundations help support CHCN's quality improvement activities. CHCN participates in the National Health Disparities Collaborative of the US Bureau of Primary Health Care (BPHC), which provided training in quality improvement techniques. CHCN also participates in the Sentinel Centers Network, a national data standardization project sponsored by BPHC, Johns Hopkins University, and Morehouse School of Medicine. CHCN is an emerging PBRN that seeks to strengthen data collection and analysis infrastructure, and its historical links to Kaiser Permanente - North (KPN). Among priorities as a PBRN is the integration of computerized clinical data from different sources, the creation of disease registries, and, planning intervention research that will use a diabetes registry. CHCN and KPN will jointly develop a research protocol for a diabetes care management intervention adapted from a successful Kaiser educational model. To create and validate a disease registry, algorithms for file linkage will be tested and core data elements in the data warehouse will be compared to information in a sample of medical charts. On-going planning with KPN will lead to the development of a research proposal for future funding.
