Department of Family Medicine
Professor of Family Medicine
Since I became Director of the Upstate New York Practice-based Research Network (UNYNET) 2001, I have been working on translating evidence into practice. Our PBRN has been using practice facilitation as a key component of this continuously since 2005. The other modalities that we have found to work to help implement the chronic care model to translate evidence into practice in addition to practice facilitation are academic detailing, audit and feedback, and collaborative learning groups. The PBRN has had many successful grants for translating evidence into practice including asthma, diabetes, chronic kidney disease, breast cancer screening, and colorectal cancer screening. We have done this work with vulnerable and disadvantaged populations, including those from inner-city practices, and in patients with mental health and substance use issues. We also have a long track record of collaboration with community partners, specifically the Pursuing Perfection Collaborative of Western New York (P2; http://p2wny.org). I have done two national presentations discussing how PBRNs work with community collaboratives. Previous work I have done with P2 has included improving diabetes care in rural populations, funded by the New York State Health Foundation. We completed the New York State Department of Health Heal 10 grant, where we helped 42 practices achieve level III NCQA patient centered medical home (PCMH) recognition. P2 was a Robert Wood Johnson Aligning Forces for Quality (AF4Q) community, and we partnered with them on these efforts. We then teamed up with the regional RHIO, HealtheLink, and P2 as one of 17 Beacon communities funded by the Office of the National Coordinator. I was either PI or project director on all of these grants. In addition, we partnered with Dr. Mold from Oklahoma on his NHLBI R01 to translate asthma evidence into practice using practice facilitation, collaborative learning groups, or both. I was regional PI for this project that included practices from Oklahoma, the Western New York area, and Rochester. I was also subject matter expert for Dr. Mold’s AHRQ R18 for disseminating chronic kidney disease (CKD) evidence-based guidelines in primary care practices.
In addition to my work in community collaboration and practice facilitation, I have also been heavily involved in clinical informatics to make health information technology functional at the point of care for population health management. I was part of the original NIH Roadmap initiative in 2005 to produce an electronic primary care research network which later evolved into the Distributed Area Research and Therapeutics Network (DARTNet). DARTNet is an AHRQ-funded project that is now an independent 501c(3) to help researchers get usable data from multiple EMR practices across the nation. There are currently nine CTSAs, 13 PBRNs, 400 practice organizations, and 4,000 clinicians that are part of DARTNet. Through working with DARTNet, I am PI on an NIDDK-funded R01 for translating CKD evidence into practice. This involves 40 practices nationally and is a comparative effectiveness pragmatic clinical trial testing health information technology alone versus facilitated health information technology using an evidence-based implementation framework called TRANSLATE (an acronym for the nine evidence-based functions that are required to transform practice and drive quality improvement). This approach is used in this R18 proposal.
I am also research director of an AHRQ P30 network of networks center of excellence grant, and I collaborate with a second AHRQ P30 grant of which Dr. Mold is the PI. As part of this, we developed the only University certificate program for practice facilitation, which is offered at the University at Buffalo. This standardized training program for practice facilitation has been operational for over a year and is based on the open-source curriculum that was developed by AHRQ. I am course director for this project. My collaborators are Dr. Jim Mold and Lyndee Knox, PhD, who was instrumental in writing this curriculum. This Practice Facilitator Certificate training program is used in this R18.
In summary, the translation of evidence into practice through use of health information technology, practice facilitation and community collaboration has been the focus of my career.