About CERTs
Annual Report Year 1
Year 2 and Beyond
Developing Knowledge | Managing Risk | Improving Practice | Informing Policies
Improving Practice
We will collaborate to produce reports on effective methods of changing practice. We will share knowledge gained from demonstration projects aimed at both increasing the use of beneficial therapies and reducing the use of harmful ones.
Children and Adolescents
The ADHD project, once the data are complete, will be providing a standard "toolkit" to caregivers. The hope is that use of the materials will improve the diagnosis and treatment of the disorder.
We should have substantial data compiled on the incidence of Type 2 diabetes in adolescents during Year 2. If, as we suspect, this disease is more common in this group than has been realized, we can begin to develop better ways to screen for it.
Another project, on ear infections, will involve collaboration with a Medicaid organization. We will assess outcomes by choice of drugs prescribed, send personalized information to the physicians, and assess whether this intervention can improve prescribing and reduce costs for this condition.
The NC Immunization Registry, set to begin in May 2001, aims to improve the ability of primary-care doctors to monitor children's immunization schedules. We will be working with the state Department of Public Health to achieve this goal.
Because drugs typically have not been tested in children, pediatricians may not be familiar with how to participate in clinical trials. We will conduct seminars in pediatric clinical trials, provide pediatric pharmacology fellowships, and perform public outreach.
The results of a collaboration with Research Triangle Institute, on evidence-based tools to assess the health status of children, also will be disseminated.
Adults
We will release a patient education brochure and video on the use of beta-blockers in CHF. Other interventions could include education through an Internet-based technology (Medical CyberSessions), a training session for nurses to start community-based support groups, and brochures for caregivers on the use of beta-blockers. We will give physicians feedback on their rates of beta-blocker use before and after intervention, and a toll-free Helpline will be available for questions.
The methods used in the aspirin and beta-blocker projects (using a database to obtain use rates of drugs) may be applied to study of other therapies, such as drugs to lower cholesterol in people with CAD. After we develop and apply the beta-blocker intervention, we could tailor similar interventions to improve the use of other life-saving drugs. We also may study which components of interventions work best for specific types of therapies, physicians, or medical practices. This would be critical for tailored, cost-effective future interventions.
Based on the data gathered from the glucocorticoid project, we will begin to design programs to improve the identification and treatment of osteoporosis caused by these drugs. A collaboration of two CERTs centers will look at preventing fractures due to postmenopausal osteoporosis in people at risk.
For our studies of drug interactions, the goal for Year 2 is to develop targeted educational programs to reduce interactions in specific groups. We will select groups according to the potential for a drug interaction and by screening a large insurance database. We will expand upon our prototype approach, a Web-based international registry for cases of drug-induced torsades de pointes.
We will address the training needs of future caregivers by developing a curriculum for preventing drug errors, which will be made available to training programs. We also will evaluate curricula for therapies in women, a group often neglected in clinical research and medical education.
We should have substantial data by Year 2 on the use of aspirin, beta-blockers, and drugs to reduce cholesterol in a large Medicaid population. With this information, we aim to identify targets for education, including caregivers, patients, insurers, and policymakers.
We also should have data available from the COX-2 inhibitors project. Once analyzed, we will begin to release the information to the public.