NorTex 2017 Spring Newsletter

March 23, 2017 • NorTex

The North Texas Primary Care Research Network Newsletter

TRANSITIONARY MEDICINE: Children with Special Health Care Needs

With advancements in medicine, children who are born with chronic diseases or disabilities are living much longer than in previous decades. However, with increasing age comes increasing health issues. Children with special health care needs see pediatricians and teams of pediatric trained specialists who develop a strong rapport with their patients. Unfortunately, once they have reached adulthood, many children and their families are unable to find healthcare providers who are willing to take them. Much of this may stem from a lack of understanding regarding special health care needs ora lack of training in the management of chronic pediatric conditions in an adult health care setting. Development of a structured program, be that a formal clinic setting or an educational track, would greatly improve the transition experienced by families moving from a pediatric care setting to an adult health care setting. In order to address this issue, the Transition Medicine Coalition (TMC) was formed under the guidance of the UNT Health Science Center Department of Pediatrics. Dr. Sophie Jan from the Children’s Hospital of Philadelphia North Texas Transitional Care Conference 2017 The TMC consists of members from a variety of agencies, disciplines and professional backgrounds, including NorTex. The TMC seeks to develop a comprehensive transition program for families with CSHCN in North Texas. In order to foster collaboration and understanding of transition medicine for CSHCN, the TMC recently held a one-day conference at the UNT Health Science Center. Conference speakers came from several locations with established transition programs, and included Drs. Cynthia Peacock, Albert Hergenroeder, Sophie Jan (CHOP, Philadelphia) and Rita Nathawad (JaxHATS, Jacksonville) among others.
The Transition Medicine Coalition is looking for collaborators in their mission to develop a comprehensive and smooth transition program for the North Texas area. Collaborators would include representatives from health systems, managed care, policy makers, healthcare providers, and patients interested in changing the care available to them. For more information about the Transition Medicine Coalition at UNT Health Science Center, please contact Dr. Shane Fernando at shane.fernando@unthsc.edu.

NORTEX RESEARCH PROJECTS

FEATURED CURRENT NORTEX PROJECT

Standardizing Primary Care Pain Management Across Two Health Systems

At the primary care level, the lack of a coordinated approach to managing low back pain creates a serious gap for patients, especially the large number of indigent or Medicaid/Medicare patients seen by both the UNT Health Science Center and JPS Health Network. Currently, there is no standardized way low back pain is managed in family medicine clinics between these two systems. NorTex is collaborating with the UNT Health Science Center Office of Professional and Continuing Education and JPS Health Network to evaluate a new pain management protocol in family medicine clinics. The overall goal of this project is to improve outcomes of patients with chronic low back pain by standardizing and improving how it is managed in primary care. A new pain management protocol has been developed and implemented at one family medicine clinic from each system. One other family medicine clinic serves as a control site at each system by continuing with their current treatment protocols. A subset of 15 patients with low back pain at each of the 4 clinics will be recruited to wear a Microsoft Band activity monitor for three months to assess sleep quality, heart rate, physical activity, and calories burned per day. Information collected from the activity monitor will be obtained through a phone app, allowing the patient to monitor their health activity and get a better understanding of their health patterns during the duration of the study. Study investigators are using the data to help assess the effectiveness of the new protocol. Information about patients’ low back pain and satisfaction with treatment, as well as impact on cost of care will also be collected. This study is projected to end in October 2017. For more questions, please call 817-735-0522. This study is sponsored by an educational grant from Pfizer Independent Grants for Learning & Change (IGLC).

FEATURED COMPLETED NORTEX PROJECT

Active and Sedentary Activities as Potential Determinants of Intrinsic Motivation for Child Physical Activity

Physical inactivity and increases in sedentary activity among children have increased over the past two decades. As a result, the childhood obesity epidemic has grown and become more widespread. The goal of this research was to evaluate active and sedentary activities as possible factors of intrinsic motivation to engage in physical activity (IMPA). The targeted populations were African American and Hispanic youth from underserved populations. This study was a secondary analysis of self-report data from an after school obesity prevention program, which focused on underserved youth in Fort Worth, Texas. Surveys were conducted to assess the following variables: number of sports played in the past year, frequency of physical education classes per week, number of days of at least 1-hour of physical activity in the past week, hours of TV watching per school day, and hours of video/computer play per school day. Each variable was put into high/low categories based on clinical guidelines or available data. There were 117 children who participated in the study. Of those, 48.7% were male and had an average age of 9.2 years (sd=1.08). IMPA was significantly higher for those who reported playing three or more sports a year versus none (p=.041) and for those who watched one or fewer hours of TV per school day versus 2 or more hours (p=.016). The results of this study support the need for year-round sports participation and reduced TV
watching in children. This project was funded by the Coca-Cola Foundation and the UNT Health Science Center Foundation.

JOIN THE NORTH TEXAS PRIMARY CARE REGISTRY PROJECT (NRP)!

The North Texas Primary Care Registry Project (NRP) was established to develop and maintain a database of individuals who may be contacted for future NorTex studies. NorTex conducts research important to primary care, public health, and the community. We have worked in the areas of heart disease, asthma, diabetes, children’s health, HIV, and cancer prevention, among others. A large diverse database of potential study participants allows us to:• Expand research opportunities of NorTex,
• Assess the feasibility in planning for future projects,
• Demonstrate an accessible participant population for research grants,
• Assess the demographic distribution of patients served by NorTex member clinics, and
• Most importantly, quickly identify and recruit participants into studies.
The program is simple to implement. 4×6-inch cards are available next to a ballot box which is located in the clinics’ waiting area. Patients can pick up the cards, if they are interested, when they check in for their appointment. This card explains the project on one side and collects demographic and medical histories on the other side. The cards are returned to NorTex where they are entered in a confidential database. This information provides NorTex researchers with the ability to contact potentially eligible participants for future projects. Currently, 11 NorTex clinics are involved, and 1,395 patients have returned cards. We hope to grow this database to 10,000 potential research participants. If you are interested in signing up your clinic for the NRP, please email us at NorTex@unthsc.edu.

MEMBER HIGHLIGHT:

NAVNEET GILL, MD, MS

Navneet Gill, MD, MS, is an Assistant Professor at UNTHSC and the Regional Medical Director for the JPS Southeast patient centered medical home in Arlington, Texas. Under her leadership in 2014, the four JPS Arlington clinics, JPS dental clinic, JPS women’s center, JPS radiology, JPS lab and JPS pharmacy were consolidated under one roof. The Southeast clinic led the way amongst all the community medicine clinics in having high patient satisfaction and consistently meeting the quality targets. Dr. Gill has dual responsibilities as a clinician and administrator. She sees patients in the clinic and also oversees medical education, clinical quality, patient safety, performance improvement, clinical operations, and practice growth in the Southeast clinic. She is working on streamlining the processes in the patient centered medical home so that quality care can be provided to all patients in the clinic in a timely fashion. Before joining the Southeast Medical home, Dr. Gill was the medical director for the JPS Viola Pitts clinic. While there, she provided leadership and clinical direction to the clinic. She also played a pivotal role in the growth of the multi-specialty clinic from 5 to 15 physicians, with annual patient visit increases by 42,000. They improved clinic access by creating new work space in the center, resulting in 7,000 additional visits/year. In addition, they extended the walk-in clinic hours and started a Saturday clinic for patients, by transitioning the work space of 1-provider with a 5-day work-week to 2-providers with 3-day workweeks. Dr. Gill collaborated with Family Medicine to start a Geriatrics and memory clinic in Viola Pitts. She also led diabetes group visits in Viola Pitts as part of an $80,000 grant program. Additionally, she worked with the Fort Worth Transportation department and JPS to build a covered bus stop for patients in Viola Pitts to improve patient safety and satisfaction. She has supported clinical research with NorTex by getting clinic patients to sign up for clinical research projects. Her special interest is in chronic disease management by lifestyle changes. Dr. Gill earned her medical degree from India and then moved to Minneapolis where she did volunteer work for two years in Hennepin county and University of Minnesota before joining her residency in St Paul University Hospital in Dallas. She is board certified in Internal Medicine, and prior to joining UNTHSC, she practiced Internal Medicine and Geriatrics for four years in Parkland hospital. While working as the medical director in JPS, she did her Master’s in Medical Management from UT Dallas to strengthen her administrative skills. Dr. Gill enjoys golfing and gardening in her free time. She loves to work in her gardens and transplant perennials every year which will survive the Texas heat and cold. She lives with her husband and their two daughters and her parents in-law. Her elder daughter is at UT Austin and wants to be a physician, and the younger one is aspiring to be a dentist. Both have been inspired by their mother and want to serve in the medical field.