A Pediatric PBRN (Pediatric PitNet) and a Pilot Project

描述(由申请人提供)：以实践为基础的研究网络(PBRN)是初级保健提供者与大学院系合作的研究实验室，可以产生确定最佳临床实践和治疗效果的证据。这个应用程序的目的是创建一个儿科PBRN，它将招募和保留有兴趣的实践者，参与专注于日常实践中重要问题的临床研究。PBRN的中心是匹兹堡儿童医院和UPMC卫生系统(CHP UPMCHS)。参与的诊所包括儿童社区儿科(CHP UPMCHS的一个子公司，由68名儿科医生组成(为100,000人服务)；匹兹堡儿科协会，一个密切相关的诊所(为12,000人服务)；以及CHP的初级保健中心(为13,500名儿童服务)。这个PBRN的规模和多样性非常适合进行有效的研究，从而得出可推广的结果。社区医生和CHP UPMCHS的这种合作将产生研究，并促进网络内外的最佳儿科实践。 拟议的试点项目将把瓦格纳慢性病模式的核心组成部分应用于初级保健中的健康促进和疾病预防。初步研究的目的将是加强对预防意外伤害的建议的遵守，意外伤害是幼儿死亡和残疾的最常见原因。这项研究将是一项前瞻性、对照的临床试验。干预措施将围绕5个安全问题进行：使用汽车约束、使用有效的烟雾探测器、适当的自来水温度、危险材料的安全储存和枪支的安全储存。这项研究的重点将是为医生提供决策支持和临床信息系统，重新设计医疗保健提供系统，促进家庭自我管理，并提供与社区资源的有效联系。试点的目的是确定这一模式在改变家庭和医生行为方面的可行性和可接受性。我们将确定对几个少数群体(种族、农村、城市)的不同影响，如果有的话，并将估计下一步在PBRN范围内进行研究的样本量和成本。

DESCRIPTION (provided by applicant): Practice-based research networks (PBRN) are research laboratories where primary care providers in concert with the University departments can generate evidence that will determine best clinical practice and treatment effectiveness. The aim of this application is to create a pediatric PBRN that will recruit and retain practices with interested practitioners to participate in clinical research focused on important problems in daily practice. The hub of the PBRN is the Children's Hospital of Pittsburgh of UPMC Health System (CHP UPMCHS). Participating practices are Children's Community Pediatrics, a subsidiary of CHP UPMCHS comprised of 68 pediatricians (serving 100,000), Pittsburgh Pediatric Associates, a closely affiliated practice (serving 12,000) and the Primary Care Center of CHP(serving 13,500 children). The size and diversity of this PBRN are ideal for the conduct of efficient studies leading to results that will be generalizable. This collaboration of community physicians and CHP UPMCHS will generate research and foster best pediatric practice within and beyond the network. The proposed pilot project will apply the core components of the Wagner chronic disease model to health promotion and disease prevention in primary care. The initial study will be aimed at increasing adherence to recommendations for the prevention of unintentional injuries, which are the most common cause of death and disability in young children. The study will be a prospective, controlled, clinical trial. The intervention will revolve around 5 safety issues: use of car restraints, presence of functional smoke detectors, appropriate tap water temperature, safe storage of hazardous materials and safe storage of guns. The study will focus on providing decision support and clinical information systems to the physicians, redesigning the health care delivery system, facilitating self-management for families and providing effective links with community resources. The purpose of the pilot is to determine the feasibility and acceptability of this model for changing behaviors of families and physicians. We will determine the differential impact, if any, on several minority populations (racial, rural, urban) and will estimate sample size and costs for a PBRN-wide study as the next step.