Objective The National Institutes of Health (NIH) spend billions of dollars annually on biomedical research. A crucial, yet currently insufficient step is the translation of scientific evidence-based guidelines and recommendations into constructs and language accessible to every-day patients and community members. By building a community of solution that integrates primary care with public health and community-based organizations, evidence-based medical care can be translated into language and constructs accessible to community members and readily implemented to improve health. Methods Using a community-based participatory research approach, the High Plains Research Network (HPRN) and its Community Advisory Council developed a multi-component process to translate evidence into messages and dissemination methods to improve health in rural Colorado. This process, called Boot Camp Translation has brought together various community members, organizations, and primary care to build a community of solution to address local health problems. Results The HPRN has conducted 4 Boot Camp Translations on topics including colon cancer prevention, asthma diagnosis and management, hypertension treatment and management, and the patient-centered medical home. Each Boot Camp follows a standard agenda that requires flexibility and creativity. Thus far, the HPRN has used Boot Camp Translation to engage over a thousand rural community members and providers. Dissemination of Boot Camp messaging through the community of solution has led to increased colon cancer screening, improved care for asthma, and increased rates of controlled blood pressure. Conclusions Boot Camp translation successfully engages community members in a process to translate evidence-based medical care into locally relevant, culturally appropriate language and constructs. Boot Camp Translation is an appropriate method for engaging community members in patient-centered outcomes research. Boot Camp Translation may be an appropriate first step in building a local or regional community of solution aimed at improving health of the community.

No abstract

Introduction: Asthma is often under-diagnosed and under-treated in primary care. The Colorado Asthma Toolkit Program was initiated to establish a method for improving asthma care by providing to primary care practices coaching, training, and support for (1) evidence-based asthma diagnosis and treatment, and (2) education and activation of patients toward effective self-management of their illness.Methods: A collaborative program was initiated involving 2 academic medical institutions and the High Plains Research Network, a primary care practice-based research network in eastern Colorado. Focus groups were conducted with rural Colorado patients and health care clinicians to assess need and determine the most effective intervention strategies. Two intertwined training programs, or "toolkits," were subsequently developed, one each for health care clinicians and patients. Clinicians received 3 coaching sessions conducted by 2 nurses in the practice that included training in guideline-based methods for evaluation and treatment of asthma, coaching to assist practices in implementing these methods, and training in communication techniques to promote asthma self-management. Practices were also given a spirometer and trained in its use and interpretation. Patient self-management toolkits were provided to clinicians, who were trained to use the materials to educate patients and increase treatment adherence. Evaluations were based on practice interviews 1 to 3 months after coaching.Results

This study suggests that health care providers should be vigilant in counseling their patients 50 and older to have a colorectal cancer test. Community programs designed to promote colon cancer screening should encourage residents to have regular contact with their primary care physician and ask their doctor for a screening test. Additionally, programs should provide financial assistance for testing for low-income and uninsured patients.

PURPOSE Observational studies that collect patient-level survey data at the pointof-care are often called card studies. Card studies have been used to describe clinical problems, management, and outcomes in primary care for more than 30 years. In this article we describe 2 types of card studies and the methods for conducting them. METHODSWe undertook a descriptive review of card studies conducted in 3 Colorado practice-based research networks and several other networks throughout the United States. We summarized experiences of the State Networks of Colorado Ambulatory Practices and Partners (SNOCAP). RESULTSCard studies can be designed to study specifi c conditions or care (clinicians complete a card when they encounter patients who meet inclusion criteria) and to determine trends and prevalence of conditions (clinicians complete a card on all patients seen during a period). Data can be collected from clinicians and patients and can be linked.CONCLUSIONS Card studies provide cross-sectional descriptive data about clinical care, knowledge and behavior, perception of care, and prevalence of conditions. Card studies remain a robust method for describing primary care. INTRODUCTIONO bservational and survey research continues to be an important source of information about primary care. Among the numerous methods available for gathering data about clinicians, patients, and their care, one method has persisted for more than 30 years and is considered by some to be the hallmark of practice-based research: the card study. A card study is a fi eld-tested method for gathering data in the location where patients receive care by those who provide the care.The card study method is designed to gather data at the point of care about such observable phenomena as disease incidence/prevalence, practice patterns, or clinical behaviors. Pioneered in the United States by the Ambulatory Sentinel Practice Network (ASPN) 30 years ago, card studies use short questionnaires that participating clinicians complete for patients with a specifi c condition. 1 The name card study derives from a weekly return card introduced by the Sentinel Stations in the Netherlands and later modifi ed by ASPN. The pocketsized card, which was designed to take fewer than 60 seconds to complete, allowed clinicians to carry it from room to room as they saw eligible patients. Although a card study is essentially a survey, it is designed to be completed as patients are seen by those who provide the care. Card studies have undergone signifi cant development by numerous researchers during the past 30 years and represent a wide array of data collection tools and methods. C A R D S T UDIES F OR OBSERVAT IONA L R ESE A RCHand otitis media. [7][8][9][10][11][12] For example, the publication of ASPN's card study on spontaneous abortion contributed to the evidence that uncomplicated spontaneous abortion could be managed safely without surgery. Using data from this study, Green et al found that card studies are as accurate as medical record review for identifying p...

Medical guidelines use language and concepts that are not understood by many patients, which makes it difficult for patients to choose the best treatment. The High Plains Research Network's Community Advisory Council, made up of farmers, teachers, and other community members in eastern Colorado, identified a lack of community knowledge about colon cancer and developed a process the council named Boot Camp Translation to turn complex screening guidelines into locally relevant messages. This article provides a brief history of the process and describes how it has been used to translate and disseminate evidence-based medical guidelines. The Colorado Clinical and Translational Sciences Institute tested the Boot Camp Translation process on multiple topics in communities throughout the United States from 2012 to 2015. During that period the institute used the process more than twenty-five times, addressing the topics of cancer prevention, hypertension, asthma, diabetes, and mental health. Multiple studies show that use of the process has led to improvement in cancer testing, asthma management, and hypertension control. Policies that support the translation of medical evidence into local programs will improve the health of patients.

No abstract

Background: There has been considerable focus on the uninsured from national and state levels. There are also many Americans who have health insurance but are unable to afford their recommended care and are considered underinsured. This purpose of this study was to determine the prevalence of underinsurance among patients seen in primary care clinics.Methods: Patients in 37 primary care practices in 3 practice-based research networks completed a survey to elicit the prevalence of underinsurance among those who had insurance for a full 12 months, including private insurance, Medicare, and Medicaid. Being underinsured was based on patients reporting the delay or omission of recommended care because of their inability to afford it.Results: Of those with insurance for a full year, 36.3% were underinsured. Of those who were underinsured, 50.2% felt that their health suffered because they could not afford recommended care, a rate similar among those who were uninsured.Conclusions: When evaluating underinsurance in primary care offices, using an experiential definition based on self-reports of patients about their inability to pay for recommended health care despite having insurance, the prevalence is quite high. It is important for the primary care physician to understand that a substantial percentage of their patients may not follow through with their recommendations because of cost, despite having insurance. This also has significant implications when considering health care reform, particularly considering that these patients reported that their health suffered at a rate equal to that of the uninsured.