ACORN-Research in the here and now

By Anne Buckley

In a select group of primary care medical practices across Virginia, a different kind of research takes place that has an impact in months or years rather than decades or generations.

Fifty medical practices throughout the state participate in Virginia Commonwealth University’s Ambulatory Care Outcomes Research Network, or ACORN. Led by Stephen Rothemich, M.D., and Daniel Longo, Sc.D., ACORN is part of a nationwide group of “PBRNs,” or practice-based research networks that serve as real-time research laboratories for studying how to better provide primary care.

ACORN tracks important trends and patterns in the health status of primary care patients and performs studies to test whether interventions by patients, providers or health systems are effective in improving the quality or outcomes of care. These interventions can include referrals into the community for weight loss assistance, smoking cessation advice and support and screening tests for diseases like cancer and diabetes, all proven efforts that directly reduce morbidity.

“ACORN practices are actively involved in cutting-edge research that is setting the standard nationally,” Rothemich said. This 10-year-old network is one of the forerunners in PBRNs, and the research conducted within is being noticed.
 
"ACORN has seen close to $4 million in grant funding over the past five years from sources as varied as the American Academy of Family Physicians, the Robert Wood Johnson Foundation, the Virginia Department of Health and the Agency for Healthcare Research and Quality," Longo said.

Recently, Alex Krist, M.D., received a $1.2 million federal grant to study whether an interactive system linking patients to their health information in the electronic record of their primary care physician will increase the delivery of screening tests, immunizations and behavioral counseling.

Krist is studying whether this interactive preventive health record, or IPHR, called "My Preventive Care," will result in more patients receiving preventive health care interventions and referrals.
And a 2005 National Cancer Institute grant to Steven Woolf, M.D., professor of Family Medicine, Epidemiology and Community Health, was awarded for study on why some people don’t seek colorectal cancer screening. 

Under the leadership of Resa M. Jones, Ph.D., this study — among more than 6,000 patients, ages 50 through 75, at a dozen ACORN-member primary care practices — seeks to uncover the factors that patients identify as their reasons for not having colorectal cancer screening and the relative importance they assign to each factor. The study may help prioritize strategies for improving colorectal cancer screening rates, leading to earlier detection and more effective treatments.

And Rothemich has recently shown in an ACORN study that routinely asking patients whether they smoke cigarettes as part of measuring blood pressure and other vital signs during a doctor's visit increases the chances that they will be advised to quit. Further, to increase the chances that smokers will get assistance too, Rothemich and Krist have both led studies to link practices with telephone quit lines and are conducting demonstration projects with the Quit Now Virginia, the Virginia state quit line.

ACORN researchers place a hefty premium on using information technology tools to promote public health efforts. This can mean flagging patients’ health behaviors in electronic medical records so the information can be addressed each visit. Or, it can result in actively linking a patient with resources in the community, or the use of performance monitoring systems within a practice to improve the way health care is delivered. It also has resulted in the creation of a Web site that practices can use to provide their patients with customized, current and authoritative educational information on improving health behaviors.

“We are at the nexus of information technology and ambulatory care,” Krist said. “We’re bridging the gap between primary care physicians and community counselors.”

ACORN is coordinated by the VCU School of Medicine’s Department of Family Medicine, chaired by Anton Kuzel, M.D.