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Childhood obesity affects 19.3% of children ages 2 to 19 years in the US, and 25.6% of Hispanic children. Study objectives were to (1) assess the feasibility of monitoring physical activity and daily caloric intake in children ages 3 to 6 years, (2) assess whether known obesity risk factors apply to this age-group, and (3) explore the factors that may contribute to the higher prevalence of obesity in Hispanic preschooler.Children ages 3 to 6 years were recruited at well child visits (n = 37, 65% male, 30% Hispanic). Parents completed a questionnaire (child's physical activity and screen time) along with a detailed dietary assessment. Children were provided with a fitness tracker worn for 5 days. Fisher's exact test,Thirty-four (92%) participants produced usable activity data. Baseline dietary recall was completed by 35 (97%) of the parents and 25 (68%) completed the second unassisted dietary recall. Mean body mass index of the study sample was 60th percentile, 12 (32%) classified as overweight/obese. Children with overweight/obesity showed no significant difference in mean daily calories compared with those without (1403.9 vs 1406.1 Kcal/day,Findings indicate that pedometer activity tracking can be used in children 3 to 6 years old and that decreased physical activity correlates more closely to preschool overweight/obesity than caloric intake.

PURPOSE: The purposes of this study were to determine if (1) certain demographic characteristics (potential predictors) of participants, and (2) clock-drawing test results (as a screening test for cognitive impairment) were associated with fecal immunochemical test (FIT) sample collection errors. METHODS: Patients scheduled for an upcoming colonoscopy were asked to collect stool samples using 5 different FITs. Patients completed a questionnaire that included the clock-drawing test. Errors included mistakes or omissions in recording the stool collection date and errors in stool collection. Each clock drawing was scored by 2 reviewers using 2 established methods. RESULTS: Of the 1,448 participants with a clock drawing, 63% were female with a mean age of 63 years. In this population there were 83% White, 6% Black, and 24% Hispanic persons. Cognitive impairment was found in 292 patients by the Mendes-Santos method. Kappa coefficient for the 2 clock-drawing scores was 0.79 (P

INTRODUCTION: Many US pre-health professional students prepare for applying to medical training by transcribing clinician-patient encounters. Scant literature of the effects of scribing experiences before starting medical training exists. We conducted a study to investigate student perspectives about medical scribing’s educational impact on clinical skill development. METHODS: Using a mixed-methods approach, medical and physician assistant students were surveyed and interviewed about clinical experiences and confidence before entering medical training, and the impact of scribing on clinical skills learning. Thematic analysis revealed salient themes in participants’ perspectives on the scribing experience. RESULTS: A total of 214 (33%) of the 658 students completed the survey; 66 (31%) had scribing experience. Scribes were more confident (p ≤ 0.001) in clinical note writing and history taking than non-scribes. Thematic analysis revealed perceptions that scribing impacted clinical note writing, medical knowledge, communication, and healthcare environment functioning. DISCUSSION: Findings suggest that the scribing experience affects confidence and perceived skills, particularly clinical note writing. Future research could explore the impact on clinical skill development through comparative performance-based assessment. CONCLUSION: Measuring the impact of scribing before entry to medical/physician assistant school on clinical skill development could provide directives for best approaches to clinical skills education in health professionals training.

INTRODUCTION: Electronic health records (EHRs) are often leveraged in medical research to recruit study participants efficiently. The purpose of this study was to validate and refine the logic of an EHR algorithm for identifying potentially eligible participants for a comparative effectiveness study of fecal immunochemical tests (FITs), using colonoscopy as the standard. METHODS: An Epic report was built to identify patients who met the eligibility criteria to recruit patients having a screening or surveillance colonoscopy. With the goal of maximizing the number of potentially eligible patients that could be recruited, researchers, with the assistance of information technology and scheduling staff, developed the algorithm for identifying potential subjects in the EHR. Two validation methods, descriptive statistics and manual verification, were used. RESULTS: The algorithm was refined over 3 iterations leading to the following criteria being used for generating the report: Age, Appointment Made On/Cancel Date, Appointment Procedure, Contact Type, Date Range, Encounter Departments, ICD-10 codes, and Patient Type. Appointment Serial Number/Contact Serial Number were output fields that allowed the tracking of cancellations and reschedules. CONCLUSION: Development of an EHR algorithm saved time in that most individuals ineligible for the study were excluded before patient medical record review. Running daily reports that included cancellations and rescheduled appointments allowed for maximum recruitment in a time frame appropriate for the use of the FITs. This algorithm demonstrates that refining the algorithm iteratively and adding cancellations and reschedules of colonoscopies increased the accuracy of reaching all potential patients for recruitment. (J Am Board Fam Med 2021;34:49–60.)

BACKGROUND: Patient identification is an important step for advance care planning (ACP) discussions. OBJECTIVES: We conducted a scoping review to identify prognostic indices potentially useful for initiating ACP. ELIGIBILITY CRITERIA: We included studies that developed and/or validated a multivariable prognostic index for all-cause mortality between 6 months and 5 years in community-dwelling adults. SOURCES OF EVIDENCE: PubMed was searched in October 2018 for articles meeting our search criteria. If a systematic review was identified from the search, we checked for additional eligible articles in its references. DATA ABSTRACTION: We abstracted data on population studied, discrimination, calibration, where to find the index, and variables included. Each index was further assessed for clinical usability. RESULTS: We identified 18 articles with a total of 17 unique prognostic indices after screening 9,154 titles. The majority of indices (88%) had c-statistics greater than or equal to 0.70. Only 1 index was externally validated. Ten indices, 8 developed in the U.S. and 2 in the U.K., were considered clinically usable. CONCLUSION: Of the 17 unique prognostic indices, 10 may be useful for implementation in the primary care setting to identify patients who may benefit from ACP discussions. An index classified as ‘clinically usable’ may not be easy-to-use because of a large number of variables that are not routinely collected and the need to program the index into the electronic medical record.

Purpose The purpose of this qualitative study was to examine patient opinions about anxiety in cancer survivorship, particularly the role of the primary care provider in management of anxiety related to the trajectory of long-term cancer survivorship. Methods Respondents to a mass email (N=22,000) were invited to participate in 1 of 3 institutional review board-approved focus group meetings. Inclusion criteria were being an adult patient older than 25 years of age, having any type of cancer diagnosis, and being at least 18 months from treatment. The following specific issues were discussed: role of the primary care provider during and after therapy; the transition to primary care after therapy was finished; and advice the survivors would give to providers and cancer survivors. Focus group meetings were audio-recorded and later transcribed and reviewed by members of the research team using constant comparison methods. Results Three 2-hour focus groups were conducted to interview 22 cancer survivors. We found 5 main themes related to anxiety in cancer survivorship: memory of anxiety; anxiety related to possible cancer recurrence; role of close relationship with the health care provider in anxiety management; frequency of communication in reduction of anxiety symptoms; and effect of anxiety on future health decisions posttreatment. Conclusions Survivors described anxiety persisting throughout cancer diagnosis and treatment and well into survivorship. They reported receiving care from primary care providers as well as oncologists. Anxiety was discussed by most participants as a significant part of their experience with cancer.

Background: Advance care planning (ACP) involves patients and family members in discussions with clinicians about their values, goals, and preferences regarding future medical care. Objectives: To (1) assess whether an ACP conversation using the Serious Illness Conversation (SIC) was initiated and documented; (2) assess which components of SIC were documented; (3) determine how frequently clinicians trained to use the SIC guide used ACP billing codes during the study time period, (4) determine whether there was a significant difference in mortality risk score according to documentation of each component of the SIC. Methods; Thirteen clinicians at three family medicine offices were trained in the Serious Illness Care Program and asked to document SICs in the electronic medical record (EMR). A retrospective chart review of SIC components was conducted in the EMRs of patients who presumably had ACP conversations initiated by the trained clinicians. Patients were identified using the billing codes for ACP conversations and through referrals from another study that requires clinicians to have ACP conversations with their patients. Pearson chi-square test for categorical variables and t-tests for continuous variables were conducted. Results: A total of 157 patients were included in this study; 131 patients referred from another ACP study and an additional 26 patients using the billing codes of ACP conversations. Through retrospective chart review, the mean age of patients was 72 years and 54 were male. Sixty-two (40%) charts had one or more SIC components documented. “Explore key topics” was documented most frequently for 58 (38%) patients by the 13 participating clinicians. Mean mortality risk score was 10.7 and higher scores were significantly correlated with more SIC components documented ( rp = 0.217, P = 0.007). Conclusion: Little use of the SIC guide among trained physicians was found in the EMR. It was expected that provision of an EMR template for documenting the SIC would have facilitated documentation of SICs.

OBJECTIVES: This study assessed the relationship between the number of teeth present at 12 months and dmfs at 30 and 48 months. METHODS: Data are from a longitudinal, multi-site study with clinical dental examinations conducted at 12, 30 and 48 months of age. Spearman correlation, and chi-square tests assessed relationships between teeth present at 12 months and decayed, missing or filled surfaces (dmfs) at 30 (n=1,062) and 48 months (n=985). RESULTS: Spearman correlations were weak but significant for both 30- and 48-month time points (R= 0.066; p=0.032, R= 0.093; p=0.004, respectively). Mantel-Haenszel chi-square analyses of categories of teeth present at 12 months (0, 1–4, 5–8, and 9+) and categories of dmfs at 30 and 48 months (0, 1–2, 3–5, 6–15 and 16+), revealed non-significant (p=0.326) relationship with 30-month dmfs, but a significant (p=0.013) relationship with 48-month dmfs. CONCLUSION: Results suggest that early tooth eruption is weakly associated with occurrence of early childhood caries.

Background: Little is known about the burden of atopic dermatitis (AD) encountered in US primary care practices and the frequency and type of skin care practices routinely used in children. Objective: To estimate the prevalence of AD in children 0 to 5 years attending primary care practices in the United States and to describe routine skin care practices used in this population. Design: A cross-sectional survey study of a convenience sample of children under the age of 5 attending primary care practices for any reason. Setting: Ten primary care practices in 5 US states. Results: Among 652 children attending primary care practices, the estimated prevalence of ever having AD was 24% (95% CI, 21–28) ranging from 15% among those under the age of 1 to 38% among those aged 4 to 5 years. The prevalence of comorbid asthma was higher among AD participants compared to those with no AD, namely, 12% and 4%, respectively (P Conclusions: Our study found a large burden of AD in the primary care practice setting in the US. The majority of households reported skin care practices that may be detrimental to the skin barrier, such as frequent bathing and the routine use of moisturizers with high water: oil ratios. Clinical trials are needed to identify which skin care practices are optimal for reducing the significant burden of AD in the community.

Introduction/Objectives In February 2019, recruitment began in Iowa Research Network offices for a Patient-Centered Outcomes Research Institute (PCORI) funded Advance Care Planning (ACP) study to be conducted in 7 primary care practice-based research networks across the United States and Canada. The main study trained clinicians and nursing staff in serious illness care conversations and requested they refer eligible patients. Eligible patients were those with serious illness or frailty expected to live 1 to 2 years. Clinicians indicated it was difficult to identify eligible patients. This study aimed to find better methods for increasing patient recruitment for the ACP study. Methods Research staff brainstormed and implemented strategies to increase patient referrals from clinicians. Participating offices used Epic for their medical record and the Gagne Index was used to generate a list of eligible patients in Epic SlicerDicer. When patients from the Epic SlicerDicer report appeared on the schedule, clinicians and nursing staff were notified that they might be eligible for ACP. Clinicians and nursing staff were asked to complete a survey identifying their perception of implemented strategies. A Wilcoxon signed-rank test was conducted to compare referral numbers before and after the Gagne Index/Epic SlicerDicer intervention. Results Seven clinicians referred patients prior to and 11 after the Gagne Index/Epic SlicerDicer intervention. Clinicians referred a total of 120 patients; 31 patients prior to and 89 patients after the Gagne Index/Epic SlicerDicer implementation ( P = .002). Survey results indicated that several strategies facilitated clinician referrals, including patients identified as potentially appropriate on the schedule, quarterly meetings with researchers, and e-mails with a list of potentially eligible patients. Conclusions Notifying clinical staff about potential study participants increased patient referrals in this ACP study. Research staff must have time, funding, and patience to support clinical staff who are expected to refer patients to studies.

PURPOSE: With one-half of Americans projected to be living with at least one chronic condition before 2020, enhancing patient self-management support (SMS) may improve health-related behaviors and clinical outcomes. Routine SMS implementation in primary care settings is difficult. Little is known about the practice conditions required for successful implementation of SMS tools. METHODS: Four primary care practice-based research networks (PBRNs) recruited 16 practices to participate in a boot camp translation process to adapt patient-centered SMS tools. Boot camp translation sessions were held over a 2-month period with 2 patients, a clinician, and a care manager from each practice. Qualitative case comparison and qualitative comparative analysis were used to examine practice conditions needed to implement SMS tools. The Consolidated Framework for Implementation Research guided data collection and analysis. RESULTS: Four different practice conditions affected the implementation of new SMS tools: functional practice organization; system that enables innovation and change; presence of a visible, activated champion; and synergy and alignment of SMS changes with other work. Qualitative comparative analysis suggested that it was necessary to have an enabling system, a visible champion, and synergy for a practice to at least minimally implement the SMS tools. Sufficiency testing, however, failed to show robust consistency to satisfactorily explain conditions required to implement new SMS tools. CONCLUSIONS: To implement tailored self-management support tools relatively rapidly, the minimum necessary conditions include a system that enables innovation and change, presence of a visible champion, and alignment of SMS changes with other work; yet, these alone are insufficient to ensure successful implementation.

Purpose: Self-management support (SMS) is a pillar of the well-established chronic care model and a key component of improving outcomes for patients with chronic illnesses. The Implementing Networks’ Self-management Tools Through Engaging Patients and Practices (INSTTEPP) trial sought to determine whether a boot camp translation process could assist small to medium-sized primary care practices with care managers implement SMS tools. Methods: INSTTEPP used a stepped-wedge design across 16 practices from 4 practice-based research networks over 12 months. Each network completed a 2-month boot camp translation for creating SMS tools with 16 participants (2 patients, a clinician, and a care manager from each of 4 practices) and subsequent implementation. Outcome measures for patients were the Patient Activation Measure (PAM), self-rated health, and Patient Assessment of Chronic Illness Care (PACIC) process-of-care items at baseline, 1 and 2 months. Clinician Support for Patient Activation Measure (CS-PAM) and theory of planned behavior outcomes were assessed at 5 points over 10 months for clinicians and staff. Results: A total of 297 patients and 89 practice staff and clinicians completed surveys during the study. Over successive 2-month sampling periods, intervention patients experienced greater improvement in PACIC process of care and self-rated health compared to control patients (P < 0.0001 and P = 0.0273, respectively). PAM (P = 0.3515), CS-PAM (P = 0.7464), and theory of planned behavior outcomes (P > 0.10 for all) were not significantly different. Conclusions: Significant effects on process of care and self-rated health are evidence that the boot camp translation intervention impacted SMS. A larger trial with a typical 6-month boot camp intervention may show significant effects on other outcomes.

Purpose Patient self-management is an inevitable part of the work of being a patient, and self-management support (SMS) has become increasingly important in chronic disease management. However, the majority of SMS resources available in the Agency for Healthcare Research and Quality SMS Resource Library were developed without explicit collaboration between clinicians and patients. Methods Translation of SMS tools derived from the library into primary care practices occurred utilizing boot camp translation in four different practice-based research networks (PBRNs). The typical model of boot camp translation was adapted for the purpose of the Implementing Networks' Self-management Tools Through Engaging Patients and Practices (INSTTEPP) study to develop SMS tools for implementation in the participating practices. Clinicians, clinic staff members, and patients were involved throughout the translation process. Existing resources from the SMS library were reviewed and adapted by each boot camp translation group to create tools unique to the patients in each network. Results There was no preexisting resource within the library that was deemed suitable for implementation without modification. Each network adapted tools from the SMS library to create different products. Common themes emerged from each network's translation process that highlighted the importance of patient engagement in the translation process. Boot camp translation, in conjunction with PBRNs, can be implemented to adapt SMS tools for implementation in member practices. Conclusions Boot camp translation with a combination of practices and patients can be implemented to facilitate a process of local adaptation that improves the local applicability of SMS tools in primary care clinics.

Purpose: Boot camp translation is a proven process to engage community members and health professionals in translating and disseminating evidence-based “best practices” models for health prevention and chronic illness care. Primary care practice improvement studies, particularly involving patient-driven change, as seen with self-management support (SMS), require engaged practice teams that include patients. Models of engagement such as boot camp translation may be effective. Methods: Four geographically dispersed practice-based research networks (PBRNs) from the Meta-LARC consortium engaged 16 practices to form SMS implementation teams involving a clinician, care manager, and 2 patients in each team. Our study adapted the boot camp translation model to engage the implementation teams in describing patient SMS, studying the Agency for Healthcare Research and Quality’s SMS Resource Library, and adapting and implementing self-management tools at each practice site. Testimonials and quotes were collected across the 4 PBRNs through a facilitated brainstorming discussion and consensus model at each PBRN kickoff meeting to address the focused question, “What do patients want and need in order to self-manage their chronic illnesses?” Results: Testimonials collected across the 4 PBRNs and participation levels indicated there was a high degree of engagement in the boot camp translation process across the PBRNs and the practices. Each PBRN developed themes expressed by patients and the practices regarding what patients want and need to self-manage their illnesses. Each practice selected, adapted, and implemented an SMS tool. Conclusions: Results suggest that adapted boot camp translation was effective in guiding multiple practices to implement self-management support tools for the INSTTEPP trial. Additional study of the adapted boot camp translation process in practice quality improvement and practice redesign studies is needed.

Background There are nearly 50,000 colorectal cancer (CRC) deaths in the United States each year. CRC is curable if detected in its early stages. Fecal immunochemical tests (FITs) can detect precursor lesions and many can be analyzed at the point-of-care (POC) in physician offices. However, there are few data to guide test selection. Broader use of FITs could make CRC screening more accessible, especially in resource-poor settings. Methods A total of 3600 racially and ethnically diverse individuals aged 50 to 85 years having either a screening or surveillance colonoscopy will be recruited. Each participant will complete five FITs on a single stool sample. Test characteristics for each FIT for advanced colorectal neoplasia (ACN) will be calculated using colonoscopy as the gold standard. Results We have complete data from a total of 2990 individuals. Thirty percent are Latino and 5.3% are black/African American. We will present full results once the study is completed. Conclusions Our focus in this study is how well FITs detect ACN, using colonoscopy as the gold standard. Four of the five FITs being used are POC tests. Although FITs have been shown to have acceptable performance, there is little data to guide which ones have the best test characteristics and colonoscopy is the main CRC screening test used in the United States. Use of FITs will allow broader segments of the population to access CRC screening because these tests require no preparation, are inexpensive, and can be collected in the privacy of one's home. Increasing CRC screening uptake will reduce the burden of advanced adenomas and colorectal cancer.

Objectives: To summarize the fecal immunochemical tests (FITs) available in the United States, the 2014 pathology proficiency testing (PT) program FIT results, and the literature related to the test characteristics of FITs available in the United States to detect advanced adenomatous polyps (AAP) and/or colorectal cancer (CRC). Methods: Detailed review of the Food and Drug Administration’s Clinical Laboratory Improvement Amendments (CLIA) database of fecal occult blood tests, the 2014 FIT PT program results, and the literature related to FIT accuracy. Results: A search of the CLIA database identified 65 FITs, with 26 FITs available for purchase in the United States. Thirteen of these FITs were evaluated on a regular basis by PT programs, with an overall sensitivity of 99.1% and specificity of 99.2% for samples spiked with hemoglobin. Automated FITs had better sensitivity and specificity than CLIA-waived FITs for detection of AAP and CRC in human studies using colonoscopy as the gold standard. Conclusion: Although many FITs are available in the United States, few have been tested in proficiency testing programs. Even fewer have data in humans on sensitivity and specificity for AAP or CRC. Our review indicates that automated FITs have the best test characteristics for AAP and CRC.

PURPOSE: Boot camp translation is a proven process to engage community members and health professionals in translating and disseminating evidence-based “best practices” models for health prevention and chronic illness care. Primary care practice improvement studies, particularly involving patient-driven change, as seen with self-management support (SMS), require engaged practice teams that include patients. Models of engagement such as boot camp translation may be effective. METHODS: Four geographically dispersed practice-based research networks (PBRNs) from the Meta-LARC consortium engaged 16 practices to form SMS implementation teams involving a clinician, care manager, and 2 patients in each team. Our study adapted the boot camp translation model to engage the implementation teams in describing patient SMS, studying the Agency for Healthcare Research and Quality’s SMS Resource Library, and adapting and implementing self-management tools at each practice site. Testimonials and quotes were collected across the 4 PBRNs through a facilitated brainstorming discussion and consensus model at each PBRN kickoff meeting to address the focused question, “What do patients want and need in order to self-manage their chronic illnesses?” RESULTS: Testimonials collected across the 4 PBRNs and participation levels indicated there was a high degree of engagement in the boot camp translation process across the PBRNs and the practices. Each PBRN developed themes expressed by patients and the practices regarding what patients want and need to self-manage their illnesses. Each practice selected, adapted, and implemented an SMS tool. CONCLUSIONS: Results suggest that adapted boot camp translation was effective in guiding multiple practices to implement self-management support tools for the INSTTEPP trial. Additional study of the adapted boot camp translation process in practice quality improvement and practice redesign studies is needed.

Historically, a single research project involving numerous practice-based research networks (PBRNs) required multiple institutional review boards (IRBs) to be involved in approval of the project. However, to avoid redundancies, federal IRB regulations now allow cooperative research projects that involve more than one institution to use reasonable methods of cooperative IRB review and to cede authority for review and oversight of the project to a single lead IRB. Through ceding, a lead IRB has the authority for review and oversight of the project delegated by all participating sites’ IRBs and becomes the IRB of record for the ceded sites. In the conduct of cooperative research projects, each institution or primary care office site is still responsible for safeguarding the rights and welfare of human subjects and for complying with applicable regulations. The purpose of this report is to delineate the process, including cooperation and effort of personnel, for accomplishing IRB approval for the Implementing Networks’ Self-management Tools Through Engaging Patients and Practices (INSTTEPP) clinical trial. This process involved 4 PBRNs, 16 family physician offices, 4 academic institution’s IRBs, and 4 family practice office external IRBs ceding to the lead IRB. Once ceding was accomplished, subsequent IRB modifications and continuing reviews were the responsibility of the lead IRB, ultimately saving time for all participants and keeping the project on schedule.

PURPOSE: Self-management support (SMS) is a pillar of the well-established chronic care model and a key component of improving outcomes for patients with chronic illnesses. The Implementing Networks’ Self-management Tools Through Engaging Patients and Practices (INSTTEPP) trial sought to determine whether a boot camp translation process could assist small to medium-sized primary care practices with care managers implement SMS tools. METHODS: INSTTEPP used a stepped-wedge design across 16 practices from 4 practice-based research networks over 12 months. Each network completed a 2-month boot camp translation for creating SMS tools with 16 participants (2 patients, a clinician, and a care manager from each of 4 practices) and subsequent implementation. Outcome measures for patients were the Patient Activation Measure (PAM), self-rated health, and Patient Assessment of Chronic Illness Care (PACIC) process-of-care items at baseline, 1 and 2 months. Clinician Support for Patient Activation Measure (CS-PAM) and theory of planned behavior outcomes were assessed at 5 points over 10 months for clinicians and staff. RESULTS: A total of 297 patients and 89 practice staff and clinicians completed surveys during the study. Over successive 2-month sampling periods, intervention patients experienced greater improvement in PACIC process of care and self-rated health compared to control patients (P0.10 for all) were not significantly different. CONCLUSIONS: Significant effects on process of care and self-rated health are evidence that the boot camp translation intervention impacted SMS. A larger trial with a typical 6-month boot camp intervention may show significant effects on other outcomes.

PURPOSE: Patient self-management is an inevitable part of the work of being a patient, and self-management support (SMS) has become increasingly important in chronic disease management. However, the majority of SMS resources available in the Agency for Healthcare Research and Quality SMS Resource Library were developed without explicit collaboration between clinicians and patients. METHODS: Translation of SMS tools derived from the library into primary care practices occurred utilizing boot camp translation in four different practice-based research networks (PBRNs). The typical model of boot camp translation was adapted for the purpose of the Implementing Networks’ Self-management Tools Through Engaging Patients and Practices (INSTTEPP) study to develop SMS tools for implementation in the participating practices. Clinicians, clinic staff members, and patients were involved throughout the translation process. Existing resources from the SMS library were reviewed and adapted by each boot camp translation group to create tools unique to the patients in each network. RESULTS: There was no preexisting resource within the library that was deemed suitable for implementation without modification. Each network adapted tools from the SMS library to create different products. Common themes emerged from each network’s translation process that highlighted the importance of patient engagement in the translation process. Boot camp translation, in conjunction with PBRNs, can be implemented to adapt SMS tools for implementation in member practices. CONCLUSIONS: Boot camp translation with a combination of practices and patients can be implemented to facilitate a process of local adaptation that improves the local applicability of SMS tools in primary care clinics.

Introduction: The Centers for Medicare and Medicaid Services released the final payment rules for reimbursement of advance care planning (ACP) effective January 2016. In its first year, 23,000 providers nationwide submitted 624,000 claims using the Current Procedural Terminology codes 99497 and 99498. The objectives of our study were to 1) assess the frequency of ACP codes used at a single academic tertiary care center in Iowa, 2) determine when and by whom the codes were used, and 3) summarize ACP clinical notes. Methods: Using the electronic medical record data warehouse from a single tertiary teaching hospital and affiliated clinics, date of service, department where service was provided, provider name and type, patient medical record number, date of birth, and gender linked to the ACP codes 99497 and 99498 were collected. The content of ACP clinical notes were reviewed and summarized. Study period was from January 1, 2016 through September 19, 2018. Results: During the 33 months, code 99497 was used 17 times and code 99498 was never used. Code 99497 was successfully reimbursed 4 times. Discussion: Charges were not reimbursed if the ACP visits did not meet the minimum time requirement or were conducted by an individual not considered a qualified health care professional per Medicare rules. Conclusion: ACP codes 99497 and 99498 were very rarely used at this tertiary care center during the initial 33-months after the Medicare rules went into effect. Interventions are needed to promote the use of ACP codes, so the time spent in important ACP discussions are properly compensated.

Background: A cancer diagnosis is a monumental event in a patient’s life and with the number of cancer survivors increasing; most of these patients will be taken care of by a primary care provider at some point after their cancer therapy. The purpose of this study is to identify primary care physician’s needs to care for a patient who has had cancer. Methods: A cross-sectional survey of the physician members of the Iowa Research Network was conducted. The survey was designed to measure physician confidence in cancer survivor’s care, office strategies regarding cancer survivorship care, and resources available for patients with cancer. Two hundred seventy-four Iowa Research Network members were invited to participate in this survey. Results: Eighty-two physicians (30%) completed the questionnaire with 96% reporting that they are aware of their patient’s cancer survivorship status. Seventy-one physicians reported they were aware of cancer survivorship status by an oncologist sending a note to the office, 68 being diagnosed in their office, 61 by the patient keeping the office apprised, and 15 receiving a survivorship care plan. Physicians reported the top changes in a cancer survivor’s physical health as fatigue (81%) and pain (59%). Sixty-two physicians reported not feeling confident for managing chemobrain, cardiotoxicity (71%), and skin changes (35%). Male physicians were significantly more confident managing patients’ skin changes ( P = .049) and musculoskeletal disturbances than female physicians ( P = .027), while female physicians were significantly more confident managing early-onset menopause than male physicians ( P = .027). Conclusion: Most respondents are aware of their patients who are cancer survivors and are mostly confident in the care they provide for them related to long-term effects and side effects of cancer therapies with limited receipt of cancer survivorship care plans.

Background/aims:Recruitment of parent/infant pairs can be more difficult and challenging than recruitment of adult subjects alone as the parent has to consider themselves along with the infant to be study participants. In order to determine which recruitment methods most effectively resulted in accrual of subjects, recruitment efforts at the University of Iowa were evaluated, one of three clinical sites involved in a longitudinal prospective study of dental caries.Methods:Enrollment goals were 300 parent/infant pairs within a year. Recruitment strategies included (1) a direct mailing to potential subjects who were University of Iowa Hospitals and Clinics patients and potentially met inclusion criteria; (2) face-to-face recruitment visits at medical offices; (3) provision of recruitment materials to staff at off-campus agencies and medical offices serving low-income individuals; (4) a campus-wide mass e-mail; (5) recruitment materials to daycare centers and neighborhood centers; and (6) recruitment at a children’s museum.Results:From these recruitment efforts, 515 potential participants expressed interest and were screened for this study and 348 (68%) were enrolled during an 11-month time period. The face-to-face strategy had the highest recruitment rate of 25%, followed by direct individual mailings at 9% and follow-up telephone calls at 7%. For the face-to-face strategy, the contact at the children’s museum was most successful compared to the other office settings. The lowest rate of recruitment of 0.09% was attained with the mass e-mail. However, in terms of actual numbers recruited, the mass e-mail remained an important modality since it yielded 21 recruits and was much less time-intensive.Conclusion:An intensive, multi-pronged recruitment strategy proved successful in meeting enrollment goals and resulted in finishing the enrollment prior to the projected study deadline. Effective recruitment approaches are imperative for a study’s success and each recruitment strategy needs to be budgeted and planned for in a study. Investigators may need to adapt their approach to attain the needed number of subjects. Planning needs to include the numbers needed to be approached to attain your recruitment goal, how you will recruit, who will be responsible, and the costs and time commitment for various strategies.

Introduction: Parents have an important role ensuring their infants receive oral and medical health care. Their decisions affect the well-being of their children. Methods: This study used data collected from a longitudinal, prospective study with the aim of developing and validating a caries risk assessment tool. The objectives of this study are to ( a) compare parents’ perceptions of how well they do in taking care of the infants’ teeth and/or gums versus how well they do in taking care of the infants’ medical health and ( b) determine factors associated with parental perceptions of how well they do in taking care of the infants’ teeth and/or gums. Results: A total of 1323 parent/infant pairs were enrolled in the study at Duke University, Indiana University, and the University of Iowa. Through a survey, 283 (21%) of the parents perceived they did an excellent job of both taking care of both the infant’s oral and medical health, while 861 (65%) perceived the care of their infant’s medical health was better than their care of the teeth and/or gums. In the multivariable model, parents who perceived they provided excellent/very good/good care for the infants’ teeth and/or gums were more likely to brush the infant’s teeth daily, use toothpaste daily, clean inside the infant’s mouth and/or gums daily, and not let the infant have something other than water after brushing and prior to bedtime. Also, those with infants having Medicaid or State Insurance, parents not eating sugary snacks frequently, and parents getting dental checkups at least annually were likely to perceive that they provided excellent/very good/good care for their infant’s teeth and/or gums. Conclusions: Parents who provide good infant oral health care are more likely to perceive they provide good care and more likely to have better personal dental health behaviors. This agrees with previous studies concerning older children.

Expanded partnership with the medical community is a promising strategy for reducing disparities in dental caries among young children. However, no validated caries risk instrument exists for use in primary health care settings. To help resolve this gap, a 52-item caries risk questionnaire was developed and targeted to primary caregivers (PCGs) to test in a 3-y prospective study. To begin to understand the validity of the questionnaire items, the purpose of this study was to compare responses to the questionnaire based on key demographic characteristics known to be associated with disparities in caries experience (e.g., race/ethnicity and insurance status). A total of 1,323 one-year-old children were recruited primarily through 3 medical research networks. Baseline questionnaire responses were analyzed via logistic regression. The sample was 49% female. Its racial/ethnic makeup was as follows: 13% Hispanic, 37% White, 37% Black, and 13% other or multiracial. Sixty-one percent were enrolled in Medicaid, and 95% resided in urban communities. Mothers represented 94% of PCGs. There were significant differences ( P < 0.05) in baseline responses based on Medicaid status and race/ethnicity. As compared with those not enrolled in Medicaid, children in the Medicaid group were significantly more likely (after adjusting for race/ethnicity) to 1) go to sleep while nursing or drinking something other than water, 2) eat sugary snacks between meals, 3) consume sugary drinks between meals, 4) receive topical fluoride from a health professional, 5) visit the dentist, and 6) not have an employed adult in the household. PCGs of children enrolled in Medicaid were significantly more likely to be the mother, have bleeding gums, eat sugary snacks between meals, consume sugary drinks between meals, eat or drink something other than water before going to bed, and not get regular dental checkups. In conclusion, there are significant differences in caries risk questionnaire responses based on Medicaid status and race/ethnicity that provide construct and criterion validity to the developed caries risk tool (ClinicalTrials.gov NCT01707797).

Cancer prevention efforts at the community level are essential in the fight against cancer. Understanding community dynamics provides insights into building meaningful relationships between researchers and community organizations. In this study, community assistants were hired to organize and host forums to encourage interdisciplinary collaboration, with the goal of strengthening and transforming relationships between a university academic health center and communities. A 19-item questionnaire was developed to determine the strategies community assistants used to schedule and host community forums. Community assistants completed the questionnaire and were interviewed. Community assistants successfully scheduled and hosted 113 forums in 49 cities throughout the state of Iowa, with 2,209 persons attending. Strategies used included cold calls, using contact lists from the Iowa Cancer Consortium membership list, and contacts from business associates. Additionally, electronic and social media were used to arrange and advertise scheduled forums. The various strategies used and lessons learned by the community assistants proved successful in organizing and hosting forums throughout the state of Iowa, which reached 40 of Iowa's 99 counties. The efforts of the community assistants, the Iowa Cancer Consortium, and the Iowa Research Network, laid the foundation for continued cancer research and education collaboration between researchers and community organizations.