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Using Health Risk Appraisal to Prioritize Primary Care Interventions

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A current trend in evidence-based medical care is to develop clinical practice guidelines based upon the findings from clinical trials, epidemiologic studies and expert opinion, and then to apply them to the care of patients, taking into account patient preferences and contextual issues. This approach probably works best for the management of patients with one, or only a few, chronic health problems. However, it appears to break down in the face of multiple coexisting chronic conditions. The time required to identify, evaluate, and manage multiple health conditions can overwhelm a system designed for single problems. It has been estimated that implementation of United States Preventive Services Task Force Guidelines alone would take over seven hours a day per primary care clinician. It is therefore necessary to prioritize. This K08 application outlines a five-year plan to support a candidate who is already contributing to Reengineering the Clinical Research Enterprise in new ways by developing, implementing, and studying the use of health information technology resources in primary care settings. The candidate is an Assistant Professor of Research with over 10 years of combined biomedical, clinical, and practice-based research experience and strong support from his academic department. He is also a nationally recognized developer of health information technology resources. The career development plan provides a sequence of carefully selected training and mentored experiences, including doctoral-level research coursework, mentored research leading to collaborative studies and publications, and professional networking, which will substantially contribute to the candidate's professional development. His proposed research program, Using Health Risk Appraisal to Prioritize Primary Care Interventions, has three specific aims: 1) Conduct a systematic review of the existing literature in order to refine a novel implementation model of a clinically integrated Health Risk Appraisal (HRA) implementation that will help clinicians prioritize evidence-based interventions; 2) Refine and pilot test the integrated HRA technology within a primary care practice-based research network to determine the feasibility of implementation and the efficacy of the instrument; 3) Conduct a randomized clinical trial to examine the impact of this integrated HRA approach on important patient outcomes, including estimated life expectancy, patient centeredness of care, and provider and patient satisfaction in primary care practices.
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