NorTex 2015 Spring Newsletter

March 22, 2015 • NorTex

Spring 2015 1

The North Texas Primary Care Research Network Newsletter


Spring 2015 2Through collaboration with the Office of Professional and Continuing Education (PACE) at UNT Health Science Center, NorTex is exploring ways to increase rates of immunization in the uninsured adult population in Tarrant County, focusing on influenza, pneumococcal, pertussis and hepatitis B. Uninsured patients are vulnerable to vaccine-preventable diseases and generally do not have access to either medical or preventative care. Grace Community Clinic in Grapevine and Cornerstone Charitable Clinic in Fort Worth are two clinics that provide a medical home to these high-risk patients. Both clinics are staffed mostly by clinical and nonclinical volunteers and only have two paid employees. NorTex has conducted staff focus groups, interviews, and surveys to identify systemic, competence, and performance barriers that impede effective vaccination practices. Additionally, NorTex has conducted two focus groups with patients at each clinic to assess their thoughts on how to best implement an immunization clinic. These measures were part of the first phase of a larger study. The overall goal of this Delivery System Reform Initiative Payment (DSRIP) Medicaid Waiver project is to establish a baseline assessment in order to increase the number of vaccinations received by the uninsured population. The project aims to increase community collaboration in order to achieve a common goal: implementing effective and practical vaccination practices.


NorTex is excited to collaborate with three other primary care practice-based research networks (PBRNs) to form the Fab4Super PBRN. The PBRNs comprising the Fab4Super PBRN span across rural/frontier and urban regions in Kentucky, Texas, West Virginia, and Colorado, allowing for a strategic opportunity to have rural and urban comparisons. The PBRNs include the Kentucky Ambulatory Network (KAN) (Director Roberto Cardarelli, DO), the Frontier Rural Innovations Network (FRIN) (Director Joel Dickerman, DO), the West Virginia Practice-Based Research Network (WV-PBRN) (Director Dana King, MD), and NorTex (Director Kim Fulda, DrPH). The Fab4Super PBRN initiated its collaboration at the end of 2013 as its members share a common and passionate mission of conducting research that is pertinent to providers and their patients with a primarily vulnerable population. The Fab4Super PBRN was developed to share resources, perform cross-state studies, and develop relationships for large patient-centered trials. These 4 PBRNs have a common focus on rural and urban underserved populations and already have a history of collaborating on research and quality improvement projects, with on-going funded studies between several partners. The Fab4Super PBRN conducts bi-monthly teleconference calls to discuss updates within and between PBRN members. As a result of rapid changes in the U.S. healthcare system, PBRN leadership and its members voiced their opinions on the types of research that should be conducted. Research must be important to primary care providers, beneft their patients, and help sustain such efforts within their clinics. NorTex looks forward to collaborating on innovative projects that improve primary care practice.



Evaluating the Challenges and Impact of Expanded Hepatitis C Virus Screening

NorTex is participating in a multisite project with Duke School of Medicine, Med-IQ, and the UNTHSC Office of Professional and Continuing Education (PACE) and Department of Family Medicine to study Hepatitis C Virus (HCV) screening in family medicine clinics. There is an increasing prevalence of HCV infection, resulting in rising rates of liver cancer and decompensated cirrhosis, particularly among the baby boomer generation, born between 1945 and 1965. The project has two major goals. The first goal is to assess clinical and provider performance, knowledge, and attitudes related to HCV screening in the primary care clinic and adherence to recent guidelines (CDC and USPSTF) regarding screening for HCV infection in populations not traditionally believed to be at risk. The second goal is to improve HCV screening rates in the primary care clinic and linkage of HCV positive patients to appropriate specialty care by providing continuing medical education to the clinicians. Physicians and physician assistants will complete surveys before and after receiving a medical education intervention. The medical education intervention will include a robust audit/feedback model, a series of live interventions via teleconference, and a series of electronic “e-brief” publications. Data on screening for HCV among the proposed age group, referral to specialty care for positive patients, and screening specifically among HIV positive patients will be retrieved from electronic medical records before and after implementation of the educational intervention. The funding source is Gilead Sciences Inc., and the project will be completed by the end of August 2015. Dr. Kimberly Fulda is the Site Researcher.


BriSpring 2015 3dging the Gap in Obesity Prevention Through Community-Oriented Primary Care


UNTHSC Seminary Family Medicine Clinic, under the direction of Jon Sivoravong, DO, conducted a program from September 2013 through June 2014 titled “Bridging the Gap in Obesity Prevention Through Community-Oriented Primary Care.” The program was funded by a grant from the American Academy of Family Physicians’ Americans in Motion – Health Interventions (AIM-HI) initiative through the MetLife Foundation. The goal was to better engage the community and address childhood obesity in the clinic setting. After gathering and developing AIM-HI resources and improving clinic processes related to managing children at risk for obesity, 14 children and parents from the clinic participated in group medical visits. Two cohorts attended six weekly after-school group medical visits at the clinic. Participants’ knowledge about health, nutrition, physical activity and emotional wellness improved, and the frequency of targeted health behaviors significantly increased from an average of three per week to eight per week. Some of these target health behaviors included eating more vegetables, decreasing portion sizes and/or being more physically active. One patient, aged 9, said after the program, “We’ve learned so much that we didn’t know…I’ve tried spinach, cucumbers, celery and a bunch of other vegetables.”


In the first week of June 2014, the Pediatric Mobile Clinic began operations, bringing high-quality health care to underserved children and their families in the Fort Worth community. Spring 2015 4These families often experience barriers to health care access, including financial hardship, lack of transportation, language barriers and lack of insurance coverage. These needs are often accompanied by concerns about food, clothing and shelter. The Pediatric Mobile Clinic addresses both the health and social services needs of these children at no cost to the families. While children with illnesses beyond the scope of the mobile clinic are referred to community clinics or hospitals, the clinic offers well-child exams, sick visits, immunizations, laboratory testing and an array of health screenings. The clinic also provides significant patient-centered health education in nutrition, physical activity and oral health. While at the unit, each family meets with a social worker to discuss its current social conditions and to work together to develop a personalized plan. The social worker identifies children who currently are uninsured and who are eligible for governmental insurance benefits, and assists the families with enrollment. In order to improve health care outcomes, address community health issues and determine efficacy, the clinic includes a research team that focuses on community-based participatory research. A new venture, named “Catch 1 for Health,” will provide school-based screenings for health issues such as obesity, Type 2 diabetes mellitus and dental needs and link those identified with the Pediatric Mobile Clinic for further medical management. It is expected to launch in Fall 2015. The mobile clinic is a state-of-the-art medical facility staffed by an expert team of pediatricians, physician assistants, licensed nurses, social workers, health care professionals, students and volunteers from UNT Health Science Center. This dynamic interprofessional team creates a welcoming and compassionate environment for delivering non-emergency medical care.


NorTex is working with the Office of Professional and Continuing Education (PACE) at the UNT Health Science Center (UNTHSC) to build a community coalition of stakeholders to explore the effective utilization and promotion of preventive health services on patient-centered outcomes. PACE has been invited to submit an application to the Patient-Centered Outcomes Research Center (PCORI) for its project titled “Assessing the Effectiveness of Strategies to Increase Uninsured Patient Utilization of Preventive Health Services.” Its objective is to develop a coalition which includes patients, clinicians, charitable clinics, a county-funded hospital system, and UNTHSC, aimed at increasing the use of preventive services by uninsured patients. If funded, the coalition will work together to develop a research question important to the community, discuss research activities, develop a communication plan, and identify other projects that could be leveraged to meet its goal. Building this coalition is just the first step in working toward improving the health of uninsured patients.



Jon C. Sivoravong, DO, is a practicing family physician and has been part of the UNT Health Science Center family for over 18 years. He received his DO degree from the Texas College of Osteopathic Medicine (TCOM), (UNTHSC), and his undergraduate degree in Biology from the University of Missouri – Columbia. Spring 2015 5He completed his Family Medicine residency at UTMB-Galveston and completed a Faculty Development Fellowship at UNTHSC. He currently serves as the Vice Chair for Clinical Affairs in the Department of Family Medicine and as Program Director for the dually accredited UNTHSC/TCOMPLAZA Family Medicine Residency Program. He is also actively involved in a wide array of research activities, especially with NorTex. Currently Dr. Sivoravong is Principal Investigator on a project titled, “Biomarkers of Pain and Range of Motion after a Brief OMT,” in which his team is attempting to document improved stress, pain and range of motion after a single session with OMT with correlating biomarker changes. He is also a site Principal Investigator for a National Institute of Allergy and Infectious Diseases (NIAID) funded observational study that characterizes adults with influenza. This study is carried out by the International Network for Strategic Initiatives in Global HIV Trails (INSIGHT) to track global influenza. Dr. Sivoravong is a co-investigator for a study titled “Psychosocial and Physiological Predictors of Type 2 Diabetes Mellitus Risk Among Children Aged 10 -14 Years,” which attempts to identify factors associated with risk for Type 2 Diabetes in adolescents. Dr. Sivoravong’s research team has won many accolades for its work, including frst place at the National Annual ACOFP resident research competition for the last three years. In 2013, Dr. Sivoravong and his team received a grant from the American Academy of Family Physician for a project called “Bridging the Gap in Obesity Prevention through Community Orientated Primary Care (COPC.)” The results of this work were recently presented at both Cook’s Children and UNTHSC Grand Rounds. Dr. Sivoravong is noted for his role in the Regional Healthcare Partnership that works toward expanding the primary care workforce by increasing and retaining family medicine residents in the North Texas area. Locally, he has served as a judge at the UNTHSC Research Appreciation Day. He also serves as adviser and has conducted health fairs for and participated in research with the UNTHSC Asian Pacific Islander American Student Associates (APAMSA). He is the medical director and a board member of TIOPA, which is an independent IPA with over 600 physician members in the North Texas area, and he has lectured at the Annual Dr. Stanley Weiss Primary Care Update at South Padre Island and at the Annual North Texas Family Medicine Update in Fort Worth. Dr. Sivoravong currently resides in North Texas with his wife Samantha and their three sons. The oldest is a second-year college student at the University of North Texas at Denton, majoring in biology, and the two younger twins are seniors at Keller Central High School. During his time off work, Dr. Sivoravong enjoys tennis, golf, fishing and playing music with his friends.

Spring 2013 8