IRENE Research

List of Grants Awarded for Research in IRENE

 “A Cluster-randomized Trial Comparing Team-based Versus Primary Care Clinician-focused Advance Care Planning in Practice-based Research Networks”
Funded by: Patient-Centered Outcomes Research Institute (PCORI)
Project dates: 11/17/2017 – 11/16/2021
Award: $560,000
Principal Investigator: Barcey Levy, MD, PhD 
Co-Investigators: Maresi Berry-Stoelzle MD, PhD and Jeanette Daly, PhD 

People want to spend their last months with family, not in the hospital. Most people have preferences about how they live in their last months of life and prefer to die at home. Unfortunately, too often they do not have the care experience they desire. Our project proposes to test ways to align patient preferences in the last months of life with the health care provided. We hope to identify the best model for primary care practices to develop patient-centered plans for care in patients’ last months and at the end of life.

 “Cancer Survivorship: Translating Good Research into Good Practice”
Funded by: Holden Comprehensive Cancer Center’s Diana Benz Memorial Fund Seed Grant
Project dates: 12/15/2016 – 12142017
Award: $20,000
Principal Investigator: Maresi Berry-Stoelzle MD, PhD

The goal of this project is to identify interventions which enable oncologists to support primary care physicians in providing high quality care to cancer survivors.

Many of our patients face a cancer diagnosis and begin the arduous process of cancer therapy. And, as therapies improve, active cancer treatments ends. What happens after chemotherapy, radiation and/or surgery? The number of cancer survivors will be increasing significantly over the next several years. Our aging population will have a higher incidence of cancer, and the combination of earlier detection and improved therapy have dramatically increased the number of cancer survivors in the population. Initially, they will follow up regularly with the oncologist, but, as time passes, there may be less need for regular, active oncology involvement Patients may start worrying more about their diabetes, obesity, hypertension, and mental health issues again. They may develop thyroid disease or osteoarthritis. However, they will always be a cancer survivor. As new symptoms arise, they will worry about whether these symptoms are a sign that the cancer has returned. This is a growing challenge for the primary care providers, those who knew the patient prior to their diagnosis and who will assume care later in the survivor’s life. Identifying the needs of a patient with a distant history of malignancy and highly toxic interventions requires efficient and timely communication among all stakeholders.

 “Planning a Community-Based Trial of Emolients for Atopic Dermatitis Prevention—CASCADE Trial Study”
Funded by: US DHHS, NIH NIAMS and Oregon Health Sciences University
Project dates: 02/01/2015–06/30/2015 Award: $6,000
Consortium Principal Investigator: Lyle Fagnan, MD from Oregan Health & Sciences University (OHSU) 
Grant Principal Investigator: Eric Simpson, MD from Oregan Health & Sciences University 
Principal Investigator: Barcey T. Levy, PhD, MD

As part of the CASCADE trial planning grant, two data‐gathering studies will be undertaken with the collaboration of four practice‐based research networks around the country: distribution of an eczema burden survey and distribution of an educational skincare brochure with request for later contact by OHSU researchers. Both surveys will be collected by OHSU personnel.

“INSTEPP—Implementing Networks “Self-management Tools Through Engaging Patients and Practices”
Funded by: the Agency for Healthcare Quality and Research and Oregon Health Sciences University
Project dates: 09/30/2013–03/31/2015 Award: $58,851
Consortium Principal Investigator: Lyle Fagnan, MD from Oregan Health & Sciences University 
Grant Principal Investigator: Don Nease, MD from University of Colorado
Principal Investigator: Barcey T. Levy, PhD, MD

The INSTTEPP’s proposal provides an enhanced practice-patient partnership model achieved through boot camp translation to increase patient skills and engagement in improving their health. We will develop optimal strategies to make the case for self-management skills and to implement and evaluate the Agency for Healthcare Research and Quality self-management support and tools. 

 "Meta-network Learning and Research Center (Meta-LARC)" 
Funded by:
 the Agency for Healthcare Quality and Research. 
Project dates: 07/01/12 – 06/30/17 
Award: $45,500 
Consortium Principal Investigator: Lyle Fagnan, MD from Oregan Health & Sciences University (ORPRN) 
Principal Investigator: Barcey T. Levy, PhD, MD 

The new Research Center in Practice-Based Research is a collaboration of six well established practice-based research networks (PBRNs) that joined together to create the Meta-network Learning and Research Center (Meta-LARC). Meta-LARC’s mission is to sustain a consortium of PBRNs dedicated to increasing the quality, effectiveness and safety of primary care through accelerated research and collaborative learning. Meta-LARC members include the Oregon Rural Practice-based Research Network (ORPRN, Center home), the Iowa Research Network (IRENE), State Networks of Colorado Ambulatory Practices and Partners (SNOCAP), Oregon’s Safety Net West Practice-based Research Network (SNW), the Quebec Practice Based Research Network (QPBRN), and the Wisconsin Research and Education Network (WREN). These PBRNs are comprised of 533 primary care practices and over 6,000 clinicians who provide care for an estimated three million patients in rural, urban, and underserved communities. Combined, the networks have conducted over 200 studies and published nearly 200 scientific publications.

“A Pilot Study to Investigate the Operational Feasibility and Screening Effectiveness of Telephonic Administration of Scales for the Assessment of Possible Cognitive Impairment in Primary Care Settings” 
Funded by: Astra Zeneca 
Project dates: 7/16/2013 – 10/31/2013 
Award: $128,500 
Principal Investigator: Barcey T. Levy, PhD, MD 

The purpose of this study is to identify a testing method/process that can effectively be used to identify subjects with early Alzheimer’s Disease in primary care settings. This testing method/process may be deployed to identify subjects for participation in future clinical trials of investigational drugs in Alzheimer’s Disease.

R18 HS019601 
"Building Research Culture and Capacity with Quality Improvement Strategies" 
Funded by:
 the National Institutes of Health. 
Project dates: 10/01/2010-9/30/2013. 
Award: $890,468. 
Principal Investigator: Victoria Neale, Wayne State University, Department of Family Medicine & Public Health Services. IRENE participants: Jeanette Daly & Barcey Levy

Building on recently-completed work in which PBRN leaders identified a core set of research best practices, the proposed demonstration project will engage PBRN interdisciplinary teams to develop and test Standard Operating Procedures that will define and streamline research processes.

"ARRA: IA-ADAPT: Improving Antipsychotic Appropriateness in Dementia Patients" 
Funded by:
 Agency for Healthcare Quality and Research. 
Project dates: 09/30/2010 – 09/29/2013. 
Award: $1,416,381. 
Principal Investigator: Ryan Carnahan, Co-investigator: Jeanette Daly and Barcey Levy. 

The risk-benefit balance of antipsychotic use in dementia is precarious. While evidence supports the efficacy of certain atypical antipsychotics in treating behavioral disturbances, these drugs have been found to increase the risk of death and cerebrovascular events in people with dementia. Despite these warnings, antipsychotic use in people with dementia remains common. Training providers to understand other aspects of care that impact behavioral disturbances, as well as appropriate antipsychotic selection and use, may improve antipsychotic utilization patterns and, as a result, the safety and quality of life of people with dementia. This collaboration of the University of Iowa Older Adults Center for Education and Research on Therapeutics, the Iowa Geriatric Education Center, the Iowa Foundation for Medical Care, and Iowa Health Systems proposes to adapt and disseminate the AHRQ comparative effectiveness research review and summary guide (CERSG) within a comprehensive program to guide providers in the care of patients with dementia and behavioral disturbances.

RC4 CA153493-01. 
"ARRA: Enhancing Community-Based Cancer Control in Iowa" 
Funded by:
 National Institutes of Health. 
Project dates: 8/30/2010-7/31/2013. 
Award amount: $1,000,000. 
Principal Investigator: Levy, BT and Co-Investigators: Ryan Carnahan, Elizabeth Chrischilles, Jeanette Daly, Brad McDowell, Charles Lynch, and Gerard Rushton. 

The University of Iowa Holden Comprehensive Cancer Center (HCCC), in collaboration with the Iowa Cancer Consortium (ICC), the Iowa Center for Education and Research on Therapeutics (CERT) and the Iowa Research Network (IRENE), propose development of a comprehensive program that will provide the infrastructure to support community-based, cancer control research across Iowa. This program will take advantage of strengths provided by an NCI-designated Comprehensive Cancer Center (HCCC), a statewide cancer control consortium (ICC), the University of Iowa CERT, and a statewide network of family physicians which has participated in practice-based research (IRENE). The initial research focus of this program will be geared toward understanding and addressing the disparities in the burden of colorectal cancer (CRC) across Iowa based on momentum in this area across the state of Iowa. The infrastructure built as part of this program can then be applied to community-based research that addresses other cancers and life-style issues relating to cancer burden (tobacco cessation, obesity, lack of physical activity, and poor dietary practices).

"Interventions to Improve Colon Cancer Screening in Poor, Rural Counties" awarded by the American Cancer Society. 
Project dates:
Award amount: $415,150. 
Principal Investigator: Levy, BT and Co-Investigators: Daly, J., Ely, J., James, P., Merchant, M., Xu, Y. 

The objective of this proposal is to conduct a randomized clinical trial to test several practical, educational interventions to improve CRC screening. An innovative aspect is that these interventions will be targeted at both the patient and the physician. This study, using our practice-based research network, the Iowa Research Network, will involve 1,500 patients aged 55 to 79 years of age, who are not up to date with CRC screening, attending one of 15 primarily rural family practices in poor Iowa counties.

"Primary Care-Practice Based Research Networks (IRENE)" awarded by US Department of Health & Human Services, Agency for Healthcare Research & Quality. 
Project dates:
Award amount: $902,686. 
Principal Investigator: Levy, BT and Co-Investigator: Daly, J.

Master contract for the Iowa Research Network (IRENE) to bid on task orders from AHRQ.

Task Order 2. "Management of Skin and Soft Tissue Infections by Primary Care Clinicians in the Era of Community-Acquired Methicillin Resistant Staphylococcus Aureus: an Iowa Research Network Study" 
Funded by:
 Agency for Health Care Research and Quality. 
Project dates: 9/1/08-9/1/10. 
Award amount: $400,000. 
Principal Investigators: Levy, BT, Daly, J. and Co-Investigators: Bergus, G., Ely, J., James, P., Jogerst, G., Merchant, M., Xu, Y. 

The purpose of this RFTO is to 1)identify and evaluate best methods and procedures for primary care practices to follow in managing patients suspected of having community acquired methicillin-resistant staphylococcus aureus (CA-MRSA) infections and 2) disseminate widely those strategies found to be effective, efficient and sustainable.


1 R01 HL070740-01A1. 
"Improving Adherence to Blood Pressure Guidelines" 
Funded by:
 the National Institutes of Health. 
Project dates: 7/1/03-6/30/08. 
Award amount: $3,215,674. 
Principal Investigator: Carter, B. and Co-Investigators: Bergus, G., Chrischilles, E., Dawson, J., Doucette, W., Hartz, A., James, P., Milchak, J. 

The long-range goal of the principal investigator is to develop and evaluate collaborative relationships between physicians and pharmacists that improve pharmacotherapy. This will be a five-year, multi-center study to evaluate the impact of physician/pharmacist collaborative teams on adherence to hypertension guidelines in six community-based family practice sites. There will be two study phases. Phase I comprises a needs assessment to identify barriers to guideline adherence and design intervention implementation refinement strategies. Phase II will be a prospective, randomized trial to assess the impact of physician/pharmacist collaborative teams on hypertension guideline adherence and BP control.

R21 HS014859-01A1. 
"An Evaluation of the WISE QI Program" 
Funded by:
 the Agency for Health Care Research and Quality. Project period: 4/1/06-3/31/08. 
Award amount: $442,500. 
Principal Investigator: James, P., and Co-Investigators: Clark, E., Daly, J., Dawson, J., Hartz, A. Levy, B. 

The primary objective of this study is to test the effectiveness of a multifaceted intervention program to improve the quality of care for high-risk diabetic patients in rural settings. The program to be tested is the Wellmark Incentive-Support to Encourage Quality Improvement (WISE QI) a program based on the chronic care model. It applies aspects from each of the 6 components of the model, including 1) delivery system redesign, 2) health care organization, 3) clinic information systems, 4) decision support, 5) self-management support, and 6) community resources. This study is a prospective study to evaluate the impact of the WISE QI program on health care quality. The study will enroll 200 patients at four rural primary care practices.

R01 HL069801. 
"Collaborative Management of Hypertension," 
Funded by
: the National Institutes of Health. 
Project dates: 7/1/03-6/30/07. 
Award amount: $1,974,407. 
Principal Investigator: Carter, B. and Co-Investigators: Bergus, G., Chrischilles, E., Dawson, J., Doucette, W., Eastin, S., Ernst, E., Farris, K., Goerdt, C., Hartz, A., James, P., Katz, D., Kluesner, K., Milchak, J., & Stewart, J. 

The primary hypothesis of this proposal is that blood pressures will be reduced to a greater extent in patients who receive care from physician/pharmacist teams when compared to those who receive care from physicians alone (control). The rationale for this proposal is generated from studies demonstrating that knowledge about guidelines, quality of prescribing and attainment of treatment goals can be improved when physicians collaborate with clinical pharmacists.

1 R03 HS014410-01. 
"Computerized Interviews to Assist Secondary Prevention" 
Funded by: 
the Agency for Health Care Research and Quality. 
Project dates: 9/30/03-9/29/06. 
Award amount: $99,957. 
Principal Investigator: Hartz, A. and Co-Investigator: James, P. 

Good diabetic care depends on patient behaviors and clinical management. It is often more difficult to achieve in rural than in urban settings. Our practice-based research network (PBRN) proposes to develop and pilot test a new information technology for gathering and summarizing information about patient self-care behaviors. The technology will use computer tablets to administer a questionnaire that we have recently developed and validated for patients with diabetes. The questionnaire assesses behaviors that influence the course of diabetes (e.g., those relating to medications, nutrition, physical activity, and glucose monitoring), barriers to those behaviors, attitudes about diabetes, family support, general health, and mental health.

1 R21 HS014490-01. 
"Colorectal Cancer Screening Among Patients Attending Rural Family Physicians' Practices" 
Funded by:
 the National Institutes of Health. 
Project dates: 9/9/03-8/31/06. 
Award amount: $289,015. 
Principal Investigator: Levy, B. and Co-Investigators: Dawson, J., Hartz, A., James, P., Rosenbaum, M. 

The objective of this application is to assess current rates and modalities of CRC screening in busy, primarily rural, primary care settings and to identify physician and patient barriers/facilitators to screening. By accurately assessing patterns of preventive care for CRC in the primary care setting, this will set the stage for developing new strategies to improve CRC screening and early diagnosis, reducing untreatable CRC.

Grant #1 8996200. 
"Comparative Effects of Hydrochlorothiazide and Chlorthalidone on Ambulatory and Office Blood Pressures," 
Funded by:
 the American Association of Colleges of Pharmacy. 
Project dates: 12/1/03-12/01/05. 
Award amount: $10,000. 
Principal Investigator: Ernst, M. and Co-Investigators: Bergus, G., Carter, B., & Phillips, B. 

The purpose of this study was to perform an 8-week, open-label, crossover trial comparing the blood pressure lowering effects of hydrochlorothiazide (HCTZ) versus chlorthalidone on both office based and ambulatory blood pressures in hypertensive patients. We expect to show that (1) 24-hour ambulatory blood pressure monitoring will reveal that blood pressure is lowered to a greater extent with chlorthalidone than HCTZ (hypothesis 1); and (2) that the differences in antihypertensive effects between the two agents will not be apparent in office based measurements (hypothesis 2).

5 R21 HS013581-02. 
"Development of the Iowa Research Network" awarded through an Agency for Health Care Research and Quality. 
Project dates: 
Award amount: $297,456. 
Principal Investigator: Paul James, MD and Co-Principal Investigator Arthur Hartz, PhD, MD. 

The Iowa Research Network, IRENE, is a practice-based research network affiliated with the Iowa Academy of Family Physicians and the University of Iowa, Department of Family Medicine. Its purpose is to create new knowledge that is relevant to rural primary care clinicians and their patients with the outcome of improving patient care through the development of a primary care research laboratory. For Category I funding, we intend to build the 1) Organizational structure of IRENE to enable linkages between practicing clinicians and researchers, improving communication and establishing long-term commitments to common goals for research, 2) Capacity Building Infrastructure to grow the network, especially in medically underserved communities and among minority practices, certify physicians and offices for Federal Wide Assurance, and develop and test communication pathways to collect and disseminate research findings to practitioners, and 3) Research Development Process to generate grant applications, conduct research, assure integrity of projects and produce products of research for dissemination. The proposed pilot research project will address translation of research to care of diabetic patients.

1 R01 LM007179-03. 
"Obstacles to Answering Physicians' Patient-Care Questions" 
Funded by:
 the National Institutes of Health. 
Project dates: 5/15/01-5/31/05. 
Award amount: $650,475. 
Principal Investigator: Ely, J. and Co-investigators: D'alessandro, D., Rosenbaum, M. 

The purpose of this study is to characterize areas where knowledge sources, such as textbooks and the Internet, fail to meet the information needs of primary care physicians. The long-term goal is to provide high-quality answers to busy clinicians asking about how to care for their patients.

"Improving the Research Infrastructure of Family Medicine and General Internal Medicine" 
Funded by:
 the Health Resources and Services Administration. 
Project dates: 9/01/00-8/31/04. 
Award amount: $619,920. 
Principal Investigator: Johnson, C. and Co-investigators: Bentler, S., Dawson, J, Doebbeling, C., Ely, J, Hartz, A, Levy, B., Noyes, R., Vaughn, T., Ward, M., Doebbeling, B. 

A small portion of this grant funded the depression study in two IRENE offices to assess whether screening for depressive symptoms improves outcomes for depressed patients seen in rural fee-for-service primary care offices. This was the first study conducted within the IRENE network.

Grant #1 8175700. "Advanced Research Training Grant" 
Funded by: the American Academy of Family Physicians Foundation. 
Project dates: 
Award amount: $99,471. 
Principal Investigator: Barcey Levy, B., with mentor Hartz, A. 

The main long-term objective of the proposed two-year advanced research training program is to provide the applicant with a firm foundation in the skills needed to perform high quality, family practice-based clinical research and to learn to successfully compete for research funding to support these efforts. The specific aims of this training are for the applicant to: 1) Learn the basics of epidemiology and statistics in order to appropriately design studies and communicate with methodological experts; 2) Learn how to develop, utilize, and maintain a research network to help answer research questions that are important to practicing primary care physicians; 3) Develop special expertise on factors involved in adherence to practice guidelines; and 4) Learn how to write a grant application to obtain funding to further extend the pilot research project which will be developed as part of this work.