Research Projects - Completed | Current

Completed Projects

"ASPN Referral Study"
Each year primary care physicians (PCPs) refer 16 million new patients to specialists. Appropriate referral can improve the quality of healthcare through prompt recognition of a health problem, and treatment of a patient's health problem that may have been out of the expertise of the PCP. This completed multi-site descriptive study examined the frequency and reasons for referral, as well as the satisfaction rate of referred patients.

"Family Practice Use of 'Back-Up' Antibiotic Prescriptions in URI"
Current literature indicates a general tendency among physicians to over-prescribe antibiotics to patients who present with complaints of upper respiratory infection. While many studies have been done in this area, our particular interest is the impact of what is called the "back-up" prescription. This is a practice which entails a written prescription given to a patient along with instructions to fill the prescription only if symptoms progress or do not resolve within a predefined period of time. The purpose of this completed cross-sectional study was to determine the frequency with which family physicians use the strategy and the satisfaction rate among patients.

"Healthy Lifestyles Headache Initiative: Migraine Disease Management Program"
One in every nine individuals is affected by migraine disease, which is a chronic condition that is characterized by acute episodes of intense, disabling pain and associated symptoms. The Healthy Lifestyles Migraine Disease Management Program utilizes patient and healthcare provider-based resources with the intent to educate migraineurs about their migraines, provide physicians with information regarding patient migraine perceptions and co-morbidities, and thereby improve migraine treatment. This project was designed to evaluate the effectiveness of migraine patient education in improving patient quality of life, productivity and satisfaction and to determine the program's impact on healthcare resource utilization.

"E-mail Communication"
Access to primary care is essential for any good medical system. Patients must have ready access to medical personnel for urgent medical problems but more and more patients expect very prompt responses to medication refill requests, lab results and appointment scheduling issues. With the growing acceptance and use of e-mail, many physicians and patients are exploring the use of this technology to address medical issues. In theory, this mode of asynchronous communication is well suited to meet many of the needs of patients, for example, prescription refills, some diagnostic test results and appointment scheduling. E-mail communication may have the potential to reduce office overhead costs while improving patient services and satisfaction.

To assess the proportion of our patients with access to e-mail, and their willingness to utilize this technology to expedite communication, a pilot survey was conducted at one of our clinics. In the survey, we determined the percentage of patients who would use e-mail and what their expectations were for timeliness of responses to a variety of medical applications. We then expanded the survey beyond one clinic before major efforts would be expended to establish a network-wide medical e-mail system for our patients.

"Open Access"
Inadequate access to their primary care physician remains one of the major reasons of patients' dissatisfaction in ambulatory primary care. In the United States, the waiting period for a routine appointment is at least three weeks on the average. The concept of open access for appointments has been identified as one of the ways to accommodate patients' urgent healthcare needs while at the same time provide continuity of care and routine care to patients.

Open access is the practice in the scheduling of patient appointments whereby some appointment slots are left vacant for later access on demand. The aim of the concept is to provide patients, if they wish, an appointment on the same day that they call to make one. The basis of the open access concept is the assumption that demand for same-day appointment is predictable in any practice. In general, an open access appointment system should result in an improvement. The goal of this project was to evaluate the degree of prediction in using the open access concept for appointments, determine the level of patient, staff and physician satisfaction, as well as determine the overall cost-effectiveness of the concept in one of 17 clinics in the Scott & White healthcare system.

"Physician Dictation"
To improve the completeness and legibility of medical records, dictation systems have been advocated in medical practice for quite some time. Since family practice involves a wide variety of patients with diverse health problems spanning all ages and both sexes, the volume or cost of medical dictation transcription should also vary widely. In this project, we study the determinants of the average length of physicians' dictated notes, determine whether there is a direct correlation with physicians' average charging behavior and estimate the cost of transcription as part of the overhead.

"Evidence Based Medicine And Complementary Alternative Medicine"
Evidence-Based Medicine (EBM) and Complementary & Alternative Medicine  (CAM) have been integrated into the six-week Family Practice clerkship during the third year at the Texas A&M University System Health Science Center College of Medicine in the 2000-2001 academic year. Three sessions of nine hours duration of interactive instruction are being provided to the students introducing the principles of epidemiology, methods of epidemiology, basic biostatistics, EBM and CAM.

Students are being introduced to skills in:

1. Assessing relevance and validity of journal articles
2. Detecting research design flaws
3. MEDLINE and internet search for relevant information
4. Critical appraisal of various types of journal articles, including clinical trials on CAM and other therapeutic measures and procedures

The specific aims of this project are to:

• Assess the students’ before and after knowledge and attitudes toward the new curriculum
• Evaluate the effectiveness of the new curriculum in equipping the students with the requisite skills to review, analyze and critique the medical literature through self reports.

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Current Projects

"Waco Traffic Safety District Helmet Promotion Project"
Bicycle-related traumatic brain injuries are a serious public health problem in the US. Two-thirds of the 600 young bicyclists killed each year die due to complications resulting from traumatic brain injury. Each year, about 3,000 Texans die or sustain injuries from bicycle-related crashes. In 1997, 20 children ages 18 years and younger died from bicycle-related crashes in Texas and another 1,599 bicyclists were injured in non-fatal crashes; 45 percent were 11 to 15 years of age and 75 percent of the injuries occurred on city streets.

Available scant data demonstrate that bicycle-related crashes are a significant problem in Bell and McLennan counties with a rate surpassing the statewide average (17.3 vs 14.6 per 100,000). In spite of proven effectiveness of bicycle helmets in reducing head injuries, many children do not always wear helmets when riding. There is apparent lack of accurate data on helmet usage rates in Bell and McLennan counties; anecdotal evidence indicates that helmet usage rate in the two counties may not be higher than the statewide rate of about 7 to 15 percent.

In this project, we will form a community coalition that will implement and evaluate a multi-faceted, comprehensive, community-based program to promote traffic safety by increasing helmet ownership and usage among child bicyclists, in-line skaters and skate-boarders in Bell and McLennan counties of the Waco Traffic Safety District. Our specific aims include:

• Increasing knowledge among children ages 5-18 years and their parents about helmet use
• Distributing helmets to at least 25% of needy children ages 5-18 years
• Increasing helmet ownership among children ages 5-18 years by 50% of baseline
• Increasing observed helmet use by child (ages 5-18 years) bicyclists, in-line skaters and skate boarders by 50% of baseline

"Weight And Contents Of Backpacks Carried By School Children"
Backpacks carried by school children have several potential health consequences including back strain, altered gait, bad posture and eventual low back pain. Although, to our knowledge, there are no published studies on the prevalence of backpack-related problems, concern about children carrying heavy school bags has been expressed not only in this country but also internationally including countries such as India, Brazil, Poland and Egypt. Heavy packs, as well as those carried improperly on the backs of school children, can put pressure on joints and ligaments to cause back strain.

While children carry these heavy, one-size-fits-all backpacks, it is unlikely that all the items in the pack will be needed on the day the backpacks are carried to school. Yet, one wonders how many parents take the time to check the weights or contents of these bulky backpacks. The specific aims of this project are to:

• Determine the average weight of backpacks carried by school children
• Determine the percentage of body weight represented by the backpack loads
• Determine the types of backpack carried
• Classify the content of the those backpacks weighing more than 10 percent of their body weight>
• Assess parental knowledge of the weights of the backpacks via children’s self-reports

"Concussion Among High School Football Players"
Concussion is a common occurrence in many sporting activities, particularly those involving contact such as football, hockey, boxing and wrestling. Although it is estimated that about 100,000 to 250,000 concussions occur in football annually in this country, there are no available statistics on the precise incidence of concussion. In addition, studies examining correlates of concussion are lacking. In this research, we propose to study the epidemiology of concussion among high school (n=31) football players in Central Texas.

"Practice-Based Research Network"
CenTexNet is one of the primary care practice-based research networks (PBRNs) funded by the Agency for Healthcare Research and Quality (AHRQ). CenTexNet was founded on October 17, 2002 and is based in Temple, Texas in the Department of Family & Community Medicine at Scott & White Memorial Hospital, and the Texas A&M University System Health Science Center College of Medicine. CenTexNet seeks to enhance the capacity of its members by providing resources for research, assisting with the research process and through collaboration with relevant experts. A Planning Committee and an Internal Advisory Committee govern CenTexNet. In addition, CenTexNet actively seeks the expert opinion and input from External Consultants.

CenTexNet was formed because one cannot simply overlook the fact that the majority of people residing in Central Texas first enter the healthcare system through a primary care office. Therefore, the importance of primary care research to the functioning of the entire healthcare system in Central Texas can’t be overstated. Many such networks have been formed in other areas with significant results and impact. PBRNs serve as laboratories for primary care and have been in existence since the mid-1970s.

"Miscommunication as a Cause of Medication Errors in Elderly Ambulatory Patients"
The long-term goal of this project is to improve patient safety through identification of the types of miscommunication that may lead to medication errors in the ambulatory/outpatient healthcare setting. The specific objectives of the proposed research are to:

1. Assess discrepancies between patients’ medical records and their self-reported manner of taking their medications.
2. Determine the incidence and types of miscommunications causing medication errors.
3. Determine the incidence and types of adverse medication effects on patients resulting from miscommunications.
4. Evaluate the effectiveness of a phone-initiated intervention by a nurse and subsequent physician patient education in resolving miscommunications causing medication errors.

Participants will comprise patients 65 years and older who are seeing a Family Physician for an illness or routine check-up. We will enroll patients (approximately 1,000 over a two-week period) until we obtain about 200 subjects with a medication discrepancy. Patients who enroll will be contacted by a clinical research nurse in 7-10 days by phone regarding their medication profile. The research nurse will compare medication instructions as documented by the doctor in the patient’s medical records with what the patient is actually doing at home. If there is no discrepancy the research nurse will survey the patient and thank them. However, if there is a discrepancy, the research nurse will survey the patient and initiate an intervention by contacting the patient’s physician. Research investigators will analyze patterns or trends of miscommunication and propose methods of improvement to be used by physicians in the interventional education of patients. Patient’s physician will continue with intervention through patient education and empowerment to resolve any miscommunication. The research nurse will administer a follow-up survey to both groups of patients (with or without a medication discrepancy) after one month to assess any changes in medication profiles with what patients are actually doing at home along with any adverse medication effects. A before-and-after evaluation design will be used to measure the success of the project. The proportion of patients found to have a medication discrepancy at the initial phone survey will be compared to that at the follow-up phone survey.

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