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The Cancer Research Network (CRN) is a consortium of 12 research groups, each affiliated with a nonprofit integrated health care delivery system, that was first funded in 1998. The overall goal of the CRN is to support and facilitate collaborative cancer research within its component delivery systems. This paper describes the CRN's 20-year experience and evolution. The network combined its members' scientific capabilities and data resources to create an infrastructure that has ultimately supported over 275 projects. Insights about the strengths and limitations of electronic health data for research, approaches to optimizing multidisciplinary collaboration, and the role of a health services research infrastructure to complement traditional clinical trials and large observational datasets are described, along with recommendations for other research consortia.

BackgroundQuality care for patients with cancer often requires access to specialty providers, but little is known about barriers to referring cancer patients for specialized care. Referral barriers may also lessen physician career satisfaction. The study was aimed at determining what factors are associated with these barriers and whether greater barriers are associated with low career satisfaction.MethodsThis cross-sectional study examined 1562 primary care physicians (PCPs) and 2144 specialists responding to the multiregional Cancer Care Outcomes Research and Surveillance Consortium physician survey. The prevalence of physician-reported barriers to referring cancer patients for more specialized care (restricted provider networks, preauthorization requirements, patient inability to pay, lack of surgical subspecialists, and excessive patient travel time) was assessed. The 5 items were averaged to calculate a barrier score. A multivariate linear regression was used to determine physician and practice setting characteristics associated with the barrier score, and a multivariate logistic regression was used to analyze the association of the barrier score with physician career satisfaction.ResultsThree in 5 physicians reported always, usually, or sometimes encountering any barrier to cancer patient specialty referrals. In adjusted analyses of PCPs and specialists, international medical graduates, physicians practicing in solo or government-owned practices, and physicians with

Background: Cancer survivors with ostomies face complex challenges. This study compared the Ostomy Self‐Management Telehealth program (OSMT) versus attention control usual care (UC). Methods: Three academic centers randomized participants. OSMT group sessions were led by ostomy nurses and peer ostomates (three for ostomates‐only, one for support persons, and one review session for both). Surveys at baseline, OSMT completion, and 6 months were primary outcome patient activation (PAM), self‐efficacy (SE), City of Hope quality of life‐Ostomy (COH‐O), and Hospital Anxiety and Depression Scale (HADS). Surveys were scored per guidelines for those completing at least two surveys. Linear mixed effects models were used to select potential covariates for the final model and to test the impact of OSMT within each timeframe. Results: A total of 90 OSMT and 101 UC fulfilled analysis criteria. Arms were well‐matched but types of tumors were unevenly distributed (p =.023). The OSMT arm had a nonsignificant improvement in PAM (confidence interval [CI], –3.65 to 5.3]; 4.0 vs. 2.9) at 6 months. There were no significant differences in other surveys. There was a significant OSMT benefit for urinary tumors (four SE domains). Higher OSMT session attendance was associated with post‐session improvements in five SE domains (p <.05), two COH‐O domains (p <.05), and HADS anxiety (p =.01). At 6 months, there remained improvements in one SE domain (p <.05), one COH‐O domain (p <.05), and HADS anxiety (p <.01). Conclusions: No clear benefit was seen for the OSMT intervention, although there may be an advantage based on type of tumor. Benefit with greater session attendance was also encouraging. Plain Language Summary: Cancer patients with ostomies have many challenges.We tested a telehealth curriculum compared to usual care.There are indications of benefit for the program for those that attend more sessions and those with urostomies. The Ostomy Self‐Management Telehealth (OSMT) program was designed to help cancer survivors with this consequence of their care. No clear benefit of the OSMT could be shown versus usual care, although there are indications of value in the program. [ABSTRACT FROM AUTHOR]

ContextUse of diagnostic imaging has increased significantly within fee-for-service models of care. Little is known about patterns of imaging among members of integrated health care systems.ObjectiveTo estimate trends in imaging utilization and associated radiation exposure among members of integrated health care systems.Design, setting, and participantsRetrospective analysis of electronic records of members of 6 large integrated health systems from different regions of the United States. Review of medical records allowed direct estimation of radiation exposure from selected tests. Between 1 million and 2 million member-patients were included each year from 1996 to 2010.Main outcome measureAdvanced diagnostic imaging rates and cumulative annual radiation exposure from medical imaging.ResultsDuring the 15-year study period, enrollees underwent a total of 30.9 million imaging examinations (25.8 million person-years), reflecting 1.18 tests (95% CI, 1.17-1.19) per person per year, of which 35% were for advanced diagnostic imaging (computed tomography [CT], magnetic resonance imaging [MRI], nuclear medicine, and ultrasound). Use of advanced diagnostic imaging increased from 1996 to 2010; CT examinations increased from 52 per 1000 enrollees in 1996 to 149 per 1000 in 2010, 7.8% annual increase (95% CI, 5.8%-9.8%); MRI use increased from 17 to 65 per 1000 enrollees, 10% annual growth (95% CI, 3.3%-16.5%); and ultrasound rates increased from 134 to 230 per 1000 enrollees, 3.9% annual growth (95% CI, 3.0%-4.9%). Although nuclear medicine use decreased from 32 to 21 per 1000 enrollees, 3% annual decline (95% CI, 7.7% decline to 1.3% increase), PET imaging rates increased after 2004 from 0.24 to 3.6 per 1000 enrollees, 57% annual growth. Although imaging use increased within all health systems, the adoption of different modalities for anatomic area assessment varied. Increased use of CT between 1996 and 2010 resulted in increased radiation exposure for enrollees, with a doubling in the mean per capita effective dose (1.2 mSv vs 2.3 mSv) and the proportion of enrollees who received high (>20-50 mSv) exposure (1.2% vs 2.5%) and very high (>50 mSv) annual radiation exposure (0.6% vs 1.4%). By 2010, 6.8% of enrollees who underwent imaging received high annual radiation exposure (>20-50 mSv) and 3.9% received very high annual exposure (>50 mSv).ConclusionWithin integrated health care systems, there was a large increase in the rate of advanced diagnostic imaging and associated radiation exposure between 1996 and 2010.

Objectives Low gestational weight gain (GWG) in the second and third trimesters has been associated with increased risk of preterm delivery (PTD) among women with a body mass index (BMI) < 25 mg/m.sup.2. However, few studies have examined whether this association differs by the assumptions made for first trimester gain or by the reason for PTD. Methods We examined singleton pregnancies during 2000-2008 among women with a BMI < 25 kg/m.sup.2 who delivered a live-birth [greater than or equal to]28 weeks gestation (n = 12,526). Women received care within one integrated health care delivery system and began prenatal care [less than or equal to]13 weeks. Using antenatal weights measured during clinic visits, we interpolated GWG at 13 weeks gestation then estimated rate of GWG (GWG.sub.rate) during the second and third trimesters of pregnancy. We also estimated GWG.sub.rate using the common assumption of a 2-kg gain for all women by 13 weeks. We examined the covariate-adjusted association between quartiles of GWG.sub.rate and PTD (28-36 weeks gestation) using logistic regression. We also examined associations by reason for PTD [premature rupture of membranes (PROM), spontaneous labor, or medically indicated]. Results Mean GWG.sub.rate did not differ among term and preterm pregnancies regardless of interpolated or assumed GWG at 13 weeks. However, only with GWG.sub.rate estimated from interpolated GWG at 13 weeks, we observed a U-shaped relationship where odds of PTD increased with GWG.sub.rate in the lowest (OR 1.36, 95 % CI 1.10, 1.69) or highest quartile (OR 1.49, 95 % CI 1.20, 1.85) compared to GWG.sub.rate within the second quartile. Further stratifying by reason, GWG.sub.rate in the lowest quartile was positively associated with spontaneous PTD while GWG.sub.rate in the highest quartile was positively associated with PROM and medically indicated PTD. Conclusions Accurate estimates of first trimester GWG are needed. Common assumptions applied to all pregnancies may obscure the association between GWG.sub.rate and PTD. Further research is needed to fully understand whether these associations are causal or related to common antecedents., Author(s): Andrea J. Sharma[sup.1] [sup.3] , Kimberly K. Vesco[sup.2] , Joanna Bulkley[sup.2] , William M. Callaghan[sup.1] , F. Carol Bruce[sup.1] , Jenny Staab[sup.2] , Mark C. Hornbrook[sup.2] , Cynthia J. [...]

Studies report increased risk of preterm birth (PTB) among underweight and normal weight women with low gestational weight gain (GWG). However, most studies examined GWG over gestational periods that differ by term and preterm which may have biased associations because GWG rate changes over the course of pregnancy. Furthermore, few studies have specifically examined the amount and pattern of GWG early in pregnancy as a predictor of PTB. Within one integrated health care delivery system, we examined 12,526 singleton pregnancies between 2000 and 2008 among women with a body mass index 28 weeks gestation. Using self-reported pregravid weight and serial measured antenatal weights, we estimated GWG and the area under the GWG curve (AUC; an index of pattern of GWG) during the first and second trimesters of pregnancy (≤28 weeks). Using logistic regression adjusted for covariates, we examined associations between each GWG measure, categorized into quartiles, and PTB (, Author(s): Andrea J. Sharma[sup.1] [sup.3] , Kimberly K. Vesco[sup.2] , Joanna Bulkley[sup.2] , William M. Callaghan[sup.1] , F. Carol Bruce[sup.1] , Jenny Staab[sup.2] , Mark C. Hornbrook[sup.2] , Cynthia J. [...]