Dr. Fox named to AHRQ technical assistance center
  UNYNET director Dr. Chet Fox has been named to the newly formed AHRQ PBRN technical assistance center that is being headed by WESTAT. This is a national collaboration of network directors to help build research capacity and collaboration within PBRNs
National Kidney Foundation Research Award $450,000 3-Year Award

Implementing KDOQI Guidelines in Primary Care Practices

Chronic Kidney Disease (CKD) is a worldwide public health issue. Primary care providers are largely unaware of evidence-based CKD Guidelines. This pilot study will examine the process and benefits of implementing the National Kidney Foundation's Kidney Disease Outcomes Quality Initiative (KDOQI) guidelines into primary care practice. The study will measure the effectiveness of two approaches (one basic and one enhances) to implementing national CKD guidelines in primary care settings and will explore factors related to barriers and benefits of KDOQI guideline implementation. This is a randomized trial to evaluate two site-level interventions in a sample pf practices(12 sites with about 1,200 CKD patients).

The Primary Aim is to test and compare the effectiveness of a _Basic Intervention _( a Quick Reference Guide) and an _Enhanced Intervention _(a Guide along with a Practice Enhancement Assistant over a 2-year period). Secondary Aims will explore factors related to barriers and benefits of guideline.

PI: Chester Fox, MD
Co - Investigators: Greg Homish, PhD and Renee Cadzow, PhD

Chronic Illness Demonstration Project

UB Family Medicine Research Institute and Gold Choice in partnership with UNYNET has received a 3 year, 1.8 million dollar grant to implement a Chronic Illness Demonstration Project (CIDP) to take 600 of the most expensive Medicaid recipients and provide multiple services for improved quality of care at reduced cost. 300 will be randomized to the demonstration project and 300 will receive usual care. Services for the demonstration project patients will include a Practice Enhancement Associate (PEA) for the patient’s doctor to help with preventive service and chronic disease care reminders, a visiting nurse to the home to measure BP, weight, glucose etc. and a 24 hour nurse available by phone for any questions. The two groups will be compared in terms of quality and cost at the end of three years.


Chronic Kidney Disease Collaborative Work with the University of Chicago

Chronic kidney disease (CKD) is a highly prevalent condition among older persons with significant morbidity and mortality consequences.  Decisions about the appropriateness and timing of interventions for older persons with CKD are poorly understood. 
We have developed a physician survey designed to better understand the factors that influence the referral decisions of primary care physicians (PCPs) for older patients with severe CKD.  Results of this survey will identify target areas for potential intervention with the goals of improving patient care and quality of life.

Principal Investigator:
Kellie Hunter Campbell, M.D., M.A.
Section of Geriatrics
University of Chicago

Chet Fox, M.D.
Director, UNYNET

Sandy G. Smith, PhD.
Department of Family Medicine
University of Chicago

Joshua A. Hemmerich, PhD.
Section of Geriatrics
University of Chicago

Nicole Stankus, M.D., MSc.
Section of Nephrology
University of Chicago

William Dale, M.D., PhD.
Section of Geriatrics
University of Chicago

Two New Chronic Kidney Disease Documents Posted

Now available for download in PDF form:


A Systems Engineering Approach: Improving Medication Safety with Clinician Use of Health IT Estimated Total Funding $1,200,000

Modifies and implements an IT-Based Crew Resource Management (CRM) tool called ACORN to examine the impact of the intervention on reducing selected adverse drug events among geriatric patients in a primary care setting; examines the impact of the intervention on improving monitoring for geriatric patients on Persistent Medications; and evaluates office staff use and application of the tool for improving geriatric medication safety by examining utilization of the IT tool and changes in safety attitude constructs.

Focus Area(s): Impact of health IT on outcomes in ambulatory settings.
Type of Health IT: Quality of care decision support

Principal Investigator: Gurdev Singh
Grant No. 1R18HS017020-01
Applicant Institution: State University of New York at Buffalo, Buffalo, NY
Estimated Dates: 9/30/2007 - 9/29/2008


AAFP-Based Fitness Research Gains $1.9 Million Pledge

September 26, 2007
Dr. Chet Fox - Co-Investigator
Americans in Motion-Healthy Intervention, or AIM-HI.

The project description says the study "is intended to help shift the paradigm of family physicians' use of common advice-giving methods to more effective patient-centered lifestyle counseling."

To show change as patients progress, clinicians will use a homeostatic assessment for insulin resistance, or HOMA-IR, and a nuclear magnetic resonance lipoprotein profile, or NMR lipoprotein profile. "You can see a change in the HOMA-IR and NMR lipoprotein profile more easily than in standard lipid studies," says Pace, explaining that shifts in the physiologic measures at three-month intervals may encourage patients to keep on the health track.


UNYNET collaborator Dr. Gurdev Singh, Director of Patient Safety Research Center at UB, receives a $1.2 million grant from AHRQ. Dr. Chet Fox is one of the Co-Investigators.

September 6, 2007
Medication errors are among the most serious medication use concerns in older persons cared for in ambulatory care settings. The introduction of health IT into such complex settings can improve patient safety, but its adoption in outpatient offices is only just beginning, and increased use of IT alone will not be enough to deal with the many complex cognitive processes that are intricately interlinked with human factors. This project will implement an IT-based Crew Resource Management (CRM) tool. The selected IT system that will be adapted (with CRM elements embedded) is the ACORN system, developed by the Dendress Corporation.
 This study was formulated in consultation with Upstate New York Practice Based Research Network (UNYNET) clinicians who are already using EMRs and interested in identifying affordable approaches that are useful and generalizable to their offices. Outcome assessment will be focused on medication safety among geriatric patients and office staff use/application of the IT-based CRM tool.

The specific aims of the study are to:

  1. Examine the impact of an IT-based CRM intervention on reducing selected adverse drug events (ADEs) among geriatric patients.

  2. Examine the impact of an IT-based CRM intervention on improving monitoring for geriatric patients on Persistent Medications.

  3. Evaluate office staff use and application of the IT-based CRM Tool for improving geriatric medication safety.

Participatory research methods will be used to assess provider- and staff-identified barriers to implementation.

The overall purpose of this proposed study is to conduct and publish the results of an IT demonstration project using a human factors approach to geriatric medication safety so as to provide pilot data for larger confirmatory studies and perhaps to develop and market test the IT-CRM software via Small Business Innovation Research (SBIR) mechanisms for eventual national release.


UNYNET Leads Practice Facilitator Workshop Fast Video Conference for National Collaboration September 20, 2007

Buffalo, Minnesota, and Alabama

Click to enlarge


UNYNET leads Practice Facilitator Workshop at AAFP Convocation of Practices

June 27, 2005
At the annual AAFP Convocation of Practices, UNYNET led a discussion of Network Director Practice Facilitators from Alabama, Buffalo, Colorado, Oklahoma and Oregon on the scientific evidence of how to do practice enhancement in PBRN's.

The AHRQ annual PBRN meeting requested that this workshop be repeated at their meeting in July 2005.

UNYNET, part of NIH roadmap initiative to create Electronic Primary Care Research Network (EPCRN) under the leadership of Dr. Kevin Peterson, the University of Minnesota, received a 3 million dollar grant for a three year feasibility study to produce a functioning electronic research network. UNYNET is one of 10 collaborating networks on this project. The goals of the project are to:

  1. Create electronic connectivity through a secure web portal for all 10 networks
  2. To produce high-speed video conferencing capability
  3. To produce a million-patient registry using a Common Clinical Record (CCR) for translational research purposes.

New collaborative work

New collaborative work between the Departments of Family Medicine, Psychiatry and Infomatics are well underway. We have had several working group meetings to date. The research plans of this group include

  1. prevalence study of detection of unipolar/bipolar disorder in the primary care setting.
  2. Focus groups of providers in looking at primary care management of depressive disorders
  3. Focus groups of patients looking at the management of depressive disorders in the primary care setting vs. mental health setting
  4. Based on the above results, develop and implement a screening tool for bipolar disorder for use in the primary care setting

UNYNET paper presented in London
  Gurdev Singh, director of Patient Safety Research Center, presented a paper on December 13, 2004 at the London Conference of the Association of Specialists in Medical Education. The paper, entitled “Enhancing Capabilities of Teachers of Patient safety with Safety Journal” is based on the premise that creation of a culture of safety is the best strategy for sustainable systems enhancements and for abandonment of the culture of blame and shame. It proposes a safe, easy and worthwhile method of recording and learning from errors and sharing experiences with a structured and consistent analytical methodology.

This paper was very well received. Subsequent communication from the chief executive of the ASME, Professor Frank Smith indicates that they are planning to make safety the main theme of the 2006 Annual Conference. The Safety team is hoping to make significant contributions to this.

UNYNET recieves $60,000 from PhRMA foundation to study medication adherence in Asthma patients
  Angela Wisniewski PharmD was awarded a two year $60,000 grant to study patient factors in adherence to anti-inflammatory medications in asthma patients. This will have an oversampling of minority patients in order to help deal with health disparity issues. This is a joint project of UB School of Pharmacy and the Department of Family Medicine. Co-Investigators on the grant are Laurene Tumiel-Berhalter PhD (Epidemiology), Patrick Smith PhD (Pharmacology), and Luis Zayas PhD (Socio-Cultural Anthropology)

UNYNET to do four presentations at the 2004 American Academy of Family Physicians Convocation of Practices
  • Effective Collaboration in a PBRN
  • Building a toolkit for beginning networks
  • A study of the effect of the implementation of an EMR on patient safety issues
  • A study of asthma medication adherence

Network begins pilot project to test if Telephonic Case Management can reduce cardiovascular risk in primary care practices.
  In partnership with a PhD in Pharmacology and Clinical Support Services™, an African American urban practice, a Hispanic urban practice, and a suburban practice will test if have telephone case support for management of lipid lowering agents will reduce Framingham risk scores

Network receives two AAFP research stimulation grants this year.

Dr. Ranjit Singh was awarded a $5,000 research stimulation grant to study the effect of the implementation of an electronic medical record on error reduction in a multi-site Family Practice Group. The study uses a visual interactive model developed by Dr. Singh and his colleagues to bring a systems engineering approach to the study of medical errors.

Dr. Chet Fox was also awarded a $5,000 research stimulation grant to study physician’s knowledge and attitude about the detection and treatment of early kidney disease.

Network is working closely with the P2 collaborative

The P2 collaborative is a broad based community effort of all three major HMOs, the Department of Family Medicine, and large primary care and multi-specialty groups to work jointly and non-competitively for quality improvement across the whole region. The effort is being Chaired by Dennis Horrigan from Independent Health. Dr. Rosenthal, Chair of UB Department of Family Medicine is on the Board of the P2. The two major foci for improvement are:

  • Improvement in prevention of Cardiovascular disease through risk factor reduction and appropriate secondary prevention
  • Improvement in breast cancer care through rapid ascertainment of abnormal mammographic results and real time information for the Primary Care clinician and the patient as to what the latest national guidelines are

Network joins the Target the Heart group

Target the Heart is a community coalition of researchers, patients, clinicians, and faith-based networks to develop strategies to reduce cardiovascular disease.



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