Highlighted Research Themes
Patient Centered Outcome Research
Patient Centered Outcomes Research (PCOR) is research that incorporates the needs and quality of life of patients. Sometimes this type of research is called Comparative Effectiveness Research. This research is important to identify best practices and provide more information to patients, families and providers on key health care decisions. The Sheps Center has engaged in projects to identify priorities for patient centered outcome research for serious mental illness, to increase validity of comparative effectiveness research in the elderly, and to define approaches for capturing divergent stakeholder views on research needs.
Evidence Based Practice is using the evidence from quality research studies, combined with the expertise of the provider, and the needs of the patient to make better healthcare decisions. The goal is to have healthcare decisions made based on research results and data, rather than on opinion or tradition. Some recent systematic review topics at the Sheps Center included screening and behavioral counseling interventions for alcohol misuse, psychological and pharmacological treatments for adults with PTSD, interventions to improve adherence to self-administered medications, comparative effectiveness of medications for rheumatoid arthritis, and effective characteristics of nursing homes and other residential long-term care settings for people with dementia.
A practice based research network (PBRN) is a group of community-based practices that are primarily devoted to the primary care of patients. These practices affiliate with an academic center to work on ways to use science and evidence to improve service to their patients. These practices have an interest in ongoing network and research activities that go beyond the scope of one specific research project. Researchers at the Sheps Center are developing information about how to implement and sustain provider based research networks and what can be expected of this model for disseminating and implementing evidence based clinical services in community settings.
Materials are often provided to patients to guide them in making better decisions about their healthcare. These materials might include brochures, pamphlets, videos, DVDs or computer programs. Decision support materials can provide non-biased information on treatment options that are all medically sound. For example, decision support materials for prostate cancer might provide information on surgery, radiation and watchful waiting. Sheps Center researchers are currently doing decision support work on an educational video to improve nursing home care in end stage dementia, and also doing work related to breast cancer reconstruction decision making.
Community Based Participatory Research
Community Based Participatory Research (CBPR) is a partnership of community participants and academic researchers who together develop, plan and conduct research. This type of research encourages the partners to work together, share all resources and knowledge, and together determine how to put the research into action in the community. At the Sheps Center researchers have used this method to work with communities to conduct research on how to reduce HIV and sexually transmitted infections in African American Rural Youth, conduct research in assisted living facilities, mitigate disparities in breast and lung cancer care, and work on CBPR derived health equity training for cancer care providers and staff.
Expanded Use of Health Care Administrative Data
The Sheps Center houses and utilizes an expanding set of healthcare administrative databases. Researchers are taking advantage of the increasing capacity to store and analyze large datasets and learn new information about health care services. For example, researchers at the Sheps Center have linked a number of separate administrative healthcare databases to create an infrastructure for comparative effectiveness research with medically indigent and uninsured patients who present with complex medical and psychiatric comorbidities. The databases include Medicaid claims, state psychiatric hospital admissions, state-funded outpatient mental health services, and carved-out behavioral health services. This integrated database is being used to conduct a number of studies of medical homes in the NC Medicaid program for complex patients with mental illnesses as well as those with other chronic conditions. The Sheps Center’s portfolio of work on rural health focuses on Federal insurance programs (Medicare and Medicaid) to examine their effect on rural populations and providers. Recent projects used data from these program to examine utilization of Medicare’s Rural Health Clinic reimbursement program, rural hospitals’ experience with swing beds, and an analysis of patterns of care-seeking behavior in rural communities.