Current Research Abstracts

Jodi Summers Holtrop has found four sources of funding for the CHERL project.

CHERL: Connecting Primary Care Patients with Community Resources to Facilitate Health Behavior Change

Abstract

#1 - Prime Funding Source: Robert Wood Johnson Foundations – 7/1/05-6/30/07 - $299,998

This project aims to increase the delivery of effective comprehensive behavior change services by creating a Community Health Educator Referral Liaison (CHERL) to accept health behavior referrals, connect patients with appropriate resources, and provide patient-specific feedback to referring clinicians. Study aims are outlined using the RE-AIM framework. “At risk” indicates needing improvement in tobacco or alcohol use, physical activity, or diet.

1. R each: Determine if providing a community CHERL increases the connection of at-risk patients with health behavior resources.
2. E ffectiveness: Determine if patients referred to the CHERL demonstrate significant health behavior improvement at three months.
3. A doption: Determine the degree to which consultant-enhanced versus referral-only study practices adopt a system to identify, advise/agree, and refer at-risk patients.
4. I mplementation: Determine facilitators and barriers to practice referral to the CHERL.
5. M aintenance: Determine if practices, together with their communities, maintain and utilize the CHERL throughout the study period, and beyond (if funded).

#2 - MPHI/MDCH – 9/1/05-9/30/05 - $7,172 – CHERL PROJECT: FP/Primary Care Initiative

The following objectives were identified for this project:

• Development of the template for the database to accomplish the following:

• System to track referrals incoming from primary care providers, contact with these patients, health educator counseling or referral to community or online health behavior services, follow-up of health behaviors, and physician feedback on patient plans/behavior changes.
• Data collection on patient demographic and background characteristics, health behaviors (tobacco use, alcohol use, level of physical activity, diet) as well as quality of life, risk for depression, internet availability, and programmatic interests.
• Health behavior change counseling for the noted health behaviors, including scripts to be used for prompting health behavior change counseling between the educator and the referred patient.

• Database management system using a Filemaker Pro system as a base will be created with the following capabilities:
• Collect patient data
• Control data collection through the referral process
• Provide follow-up reminders and Clinician letter composition
• Upload capability from collection sites to central storage system.
• Data exporting into analysis software for report generation
• Research assistant and student assistance in creating and coding the variables
• Use of the College of Osteopathic Medicine server space for secure maintenance of the data
• Purchase of site licenses (3) for the three community pilot test sites.

Final Deliverable:

The ultimate goal of this larger project is to connect primary care patient with health behavior risks to health behavior change services available in the community or online by use of a health educator referral liaison. In order for this person to work effectively, a database is needed to track, collect data and prompt counseling. The final deliverable will be the completed database that can perform the functions described under objective 1. A prototype for review will be available on September 30, 2005. Additional changes based on input provided for a final complete database to be complete by November 16, 2005.

#3 - MDCH – 10/1/05-10/30/06 - $44,520 – CHERL Supplement

Medicaid patients face great difficulty in changing their health behaviors to stop smoking, drink alcohol in moderation, eat a healthy diet, and be regularly physically active. One way to assist patients with improving these health habits is for primary care physicians to identify these health risks and refer at-risk patients to community resources for assistance with behavior change. Often these resources are not available for Medicaid patients.

This project aims to increase the delivery of effective comprehensive behavior change services by creating a Community Health Educator Referral Liaison (CHERL) to accept health behavior referrals, connect patients with appropriate resources, and provide patient-specific feedback to referring clinicians. Each CHERL will be housed in a community agency/organization and his/her role includes accepting patient health behavior referrals from participating study practices, providing brief telephone counseling for behavior change and/or referral to community or other resources, tracking patient progress with behavior change, and providing feedback to the study clinicians on patient progress. To determine if there is an additional effect of the CHERL acting as a practice facilitator, we will conduct a randomized trial in which half of the practices within each community will receive, in addition to the described services, consultation support from the CHERL to develop a practice change plan to improve the practice ability to systematically identify, advise, agree, and refer for health behaviors. Both arms will receive clinician feedback on patient progress.

The focus of this project is to recruit practices to participate that have a high percent Medicaid insurance in their patient populations. Patients on Medicaid are disproportionately at-risk for these identified health behaviors. Medicaid patients typically engage in higher rates of these unhealthy behaviors, yet have less access to services. However, interventions testing health behavior change services demonstrate ability to adopt healthier behaviors if available. Modification of health behaviors such as smoking, risky drinking and physical inactivity have the potential to provide substantial savings in preventable health outcomes such as diabetes, cardiovascular disease, and accidental injury.

#4 - University of Michigan / MCFPR – 7/1/05-6/30/07 - $9,300 – CHERL Supplement

Other expenses such as phone and fax costs related to the project estimated at $50/month ($600 annually), practice participation payments at $100/practice x 16 practices for one year ($1600), and training expenses at $750/year, and $2,500 per year for required collaboration costs with other funded grantees. The University of Michigan has committed to ($9,300) to cover the cost of the other expenses portion of our project.

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