Morehouse School of Medicine (MSM) in collaboration with the Univ. Rochester Medical Center has recently received funding from NIH/NCRR to enhance the community physician's capacity for collaborating in comparativeness effectiveness research (CER). The Research in Comparative Effectiveness (RICE) Network funding will provide the opportunity for MSM faculty and community physicians to transform the Community Providers Network (CPN) into a state-wide Practice-Based Research Network (PBRN) for innovative CER work to determine which health care interventions work best, for whom, and under what circumstances.

The gold standard Randomized Control Trials (RCT) do not sufficiently capture the health-related experience and needs of underserved populations. In contrast, CER provides researchers the opportunity to systematically evaluate both the risks and benefits of two or more medical services, drugs, devices, therapies or procedures in routine clinical practice, and subsequently, transfer the knowledge gain faster and more efficiently into real-world settings for greater benefits to the consumer of healthcare. Defined as “the generation and synthesis of evidence that compares the benefits and harms of alternative methods to prevent, diagnose, treat, and monitor a clinical condition or to improve the delivery of care”, CER has tremendous potential to the mission of MSM of providing healthcare solutions to the medically underserved urban and rural communities we serve.

The RICE Network at MSM will:

1. Enhance the infrastructure of the MSM –CPN partnership to conduct CER
2. Provide the technical support and assistance community physicians need to enhance their practice infrastructure for CER
3. Offer an online training in CER leading to a research associate certificate and CME credit. Available topics include:
   • Introduction to PBRNs
     • Describe the importance of Practice-Based Research (PBR)
     • Describe the types of research that may take place in primary care practices and the levels of engagement of practice clinicians.
     • Describe the role of Practice-Based Research Networks in PBR
   • Overview of CER
     • To understand how comparative effectiveness research(CER) can improve quality care
     • To describe CER in the context of evidence based practice
     • To integrate value based assessment of health outcomes in diagnosis and treatment
     • To participate in CER as a core practice improvement process
   • Health Literacy & Communication
     • To understand the importance of health literacy in doctor-patient communication
     • To recognize the consequences of low health literacy on patient care outcomes
     • To recognize the role of health literacy in meeting public health service goals
     • To identify practical strategies for improving health literacy
   • Principles of Cost Effectiveness/Cost Benefit Analysis
     • To address gaps in knowledge and attitude among practicing physicians and trainees regarding the basic principles of cost effectiveness in health care delivery in a variety of clinical settings including office based practice and clinical teaching at the bedside.
     • To link curricula on cost effectiveness analysis with existing curricula on cultural competency and curricula on teaching about ethnic and racial disparities in health care to better address clinical decision making that impacts ethnic and racially diverse patient populations.
   • Assessment of Quality of Life/Patient Satisfaction
     • To construct/create a working definition of patient satisfaction.
     • To justify why patient satisfaction is important.
     • Identify the determinants of patient satisfaction.
     • To measure patient satisfaction in clinical practice.
     • To identify constructs of the concept of Quality of Life (QOL).
     • To select QOL measures are potentially useful in both the clinical encounter and in quality improvement.
     • To assess when measurement of QOL can guide clinical decision-making.
     • To evaluate Quality of Life (QOL) in clinical practice.
   • Overview of Clinical Decision Analysis
     • To provide an overview and open discussion among the participants on current clinical decision analysis tools and processes, challenges and opportunities.
     • To present systems modeling, simulation and process optimization tools, and illustrate to participants how they can be used for effective clinical decision analysis.
   • Collection and Analysis of Data for Clinical Design Analysis
     • To train internal medicine and family practice residents on how to collect data for quality care using the respective registries at Grady hospital and Family Medicine.
     • To learn how to formulate relevant clinical questions for analysis.
     • To integrate comparative effectiveness skills building in clinical design and analysis.
   • Overview of Guideline Implementation Research
     • To understand the process and evidence basis of guideline development.
     • To describe the relevance of practice guidelines to clinical practice.
     • To develop practice specific and patient demographic specific tools for guideline implementation.
     • To design practice specific feedback processes that will inform and improve practice guidelines.
   • Use of HIT and Decision Support
     • To provide open discussion among the participants on the definitions and scope of Health Information technology (HIT) and Decision Support.
     • To identify and discuss the uses of HIT and Decision support in health care.
     • To work on a practical healthcare problem to illustrate how health information technology can enhance its outcome.
   • Ethical & Regulatory Aspects of Clinical Research in PBRNs
     • To ensure the naïve learner understands the importance of HSPP training and certification.
     • To describe 14 principles of responsible conduct of research.
     • To describe the statutory, regulatory and policy requirements of proper conduct of research.
     • To prepare the learner to recruit within a PBRN.
   • Designing RICE Studies for PBRNs
     • To understand how to conduct Research in Comparativeness (RICE) studies in PBRN.
     • To describe potential relevant questions for research design.
     • To develop data collection techniques using practices’ electronic and personal health records.
     • To understand how to manage data and protect patient confidentiality in RICE studies.
   • Managing Your PBRN Research Projects
     • To evaluate PBRN projects for feasibility.
     • To identify practice resources important for conducting research.
     • To evaluate study contracts for feasibility.
     • To list 7 essential steps in project management.
   • Community Engagement
     • Formulate a definition of community for local research interests.
     • Define community engagement.
     • Compare & contrast techniques for community engagement.
     • Apply principles of community empowerment to case analysis.
   • QI Module for Practice Managers
     • To improve both productivity and effectiveness of the practice.
     • To facilitate the practice for PBRN.
     • To identify technology skills required of the Physician Practice manager in the present day medical practice.
     • To implement Patient-centered Medical Home in the practice
4. Plan and conduct research with the local physician network to demonstrate readiness for CER in diabetes

Widespread enthusiasm for CER has been steadily building partially in response to the federal government’s unprecedented investment in CER and as a result of patients, providers and payers realizations that the newest and most expensive innovations are not necessarily the best solutions. In some areas, closing the health information gap particularly for underrepresented and underserved populations will require primary CER which generates new best-practice evidence. In other cases there may currently be sufficient existing evidence which can be synthesized to generate credible secondary CER for healthcare decisions.

The RICE Network creates a model “laboratory to improve the quality of care and reduce disparities’’. Harnessing the resources and opportunity provided through the RICE Network for CER will undoubtedly provide a unique opportunity to shape the next wave of informed health care decision-making.

Program Contacts:
Robina Josiah Willock, MPH, PhD
Robert Mayberry, PhD
Priscilla Pemu, MD, MS