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This dataset contains measures of the number and density of health care services per United States Census Tract or ZIP Code Tabulation Area (ZCTA) from 1990 through 2022. The dataset includes four separate files for four different geographic areas (GIS shapefiles from the United States Census Bureau).

Based on the state of the scientific evidence, the Sequenced Treatment Effectiveness for Posttraumatic Stress (STEPS) Trial was designed to address three specific aims. The first aim was to quantitatively compare engagement, self-reported PTSD symptom severity (primary outcome), quality of life, and recovery outcomes of primary care patients randomized to initially receive brief psychotherapy (Written Exposure Therapy - WET) or their choice of the three selective serotonin reuptake inhibitors (SSRIs). The second aim was, among patients not responding to initial treatment, to quantitatively compare outcomes of primary care patients randomized to: 1) augment the SSRI with WET, 2) switch from the SSRI to another class of antidepressants (serotonin-norepinephrine reuptake inhibitors - SNRI), or 3) switch from WET to the choice of the three SSRIs. The third specific aim was to quantitatively examine treatment heterogeneity among subgroups of primary care patients receiving pharmacotherapy and psychotherapy, including veterans, women, and those using cannabis.

Sometimes patients don't tell their doctors about all of their symptoms. For example, they may not tell their doctors about having low energy or not sleeping well. These symptoms can be signs of a health problem. Knowing about symptoms can help doctors find ways to help patients feel better. Using patient-reported outcomes (PRO) surveys is one way for doctors to collect this information. These surveys ask how health problems and their treatments affect patients from the patients' point of view. Filling out PRO surveys helps patients tell their doctors how they are feeling.

The research team wanted to know if giving doctors information from their patients about symptoms at the start of an office visit would lead to the patients feeling better. The team collected information from patients about their symptoms using PRO surveys. The surveys tracked five common symptoms: sleep problems, pain, anxiety, depression, and low energy.

Socioeconomically disadvantaged populations have a high prevalence of chronic pain, exacerbated by social isolation, intersectional stigma, and disparities in pain assessment and treatment options. Effective interventions using a multilevel, biopsychosocial approach are needed to decrease the unequal burden of pain. This pilot study tests group-based integrative models of pain management in primary care safety net clinics to improve pain care for racially and ethnically diverse low-income patients.

The primary objective of this study is to evaluate the feasibility of key study design features for a randomized clinical trial of group-based integrative pain management in primary care safety clinics. Parameters of interest are feasibility of randomization and retention of participants, and intervention fidelity and adherence. A secondary objective of the study is to evaluate assessment procedures in preparation for a larger scale 2x2 factorial trial of group acupuncture and integrative group medical visits.

The Broadening the Reach, Impact, and Delivery of Genetic Services (BRIDGE) randomized controlled trial included 3,073 eligible patients between 2020-2023. The trial examined whether chatbot and standard of care approaches are equivalent in completion of pre-test cancer genetic services and genetic testing.

For people with serious chronic conditions, healthcare that defaults to all available treatments without considering patient preferences risks harms that may exceed benefits. Advance care planning (ACP) has the potential to align healthcare with what is important to patients and maximize quality of life. While primary care is where most people receive most of their care, engaging patients in ACP is not routine in primary care given competing demands and limited resources. Primary care clinicians, patients, and families agree that it is preferred to make plans before there is a medical crisis. The research team's goal was to make ACP routine in primary care and to "move it upstream" so that it included improving the quality of the last years of life as well as respecting wishes for end of life care.

This study included a comparative effectiveness trial of team-based versus individual clinician-focused ACP in primary care practices. The research team adapted Ariadne Labs' Serious Illness Care Program (SICP) and aimed to determine if a team approach produces better patient outcomes and explore factors influencing implementation of ACP across practices.

Seven practice-based research networks (PBRNs) in the United States and Canada randomized their primary care practices to team-based or individual clinician-focused versions of SICP. Team members and clinicians completed training, and implementation was supported through practice facilitation. Consented patient participants completed a baseline survey after initial conversations and follow-up surveys at 6 and 12 months later. Forty practices (21 team, 19 clinician) completed training and referred patients to the study. Half of the practices were rural, 80 percent were family medicine, and 33 percent were medical residency training sites. 535 healthcare staff completed training. Both arms trained primary care providers; the team arm also trained nurses, medical assistants, and other roles. 1,321 patients and care partners were referred; and 917 consented and were enrolled (455 from team practices, 462 from clinician). Data from 802 patients were included in the primary analyses. Qualitative implementation data was collected during practice facilitation and from practice interviews.

This collection includes quantitative data collected from primary care practices (DS1) and team members and clinicians (DS2) from study sites located in the United States.

The National Study of Physician Organizations and the Management of Chronic Illness (NSPO) was designed to improve understanding of evidence-based care management processes (CMPs) as they relate to physician organizations (POs), that is, independent practice associations (IPAs) and medical groups. Since the first NSPO survey of physician organizations in 2000-2001 (NSPO1, archived as ICPSR 4455), considerable investments have been made by a number of different sources, including the Robert Wood Johnson Foundation, the California Healthcare Foundation, and The Commonwealth Fund, to bring about improved care for the chronically ill. This survey, the second NSPO survey of IPAs and medical groups (NSPO2), examined the extent to which the investments in quality improvement were translated into action. NSPO2 assessed the status of CMPs and preventive services use as well as their key drivers in 2006-2007 and the extent to which these factors have changed over time. As in the first NSPO survey, NSPO2 focused on the treatment of four chronic diseases: asthma, congestive heart failure (CHF), depression, and diabetes. Topics covered by the survey include practice type, size, age, ownership, and number of locations; clinical information systems; care management and clinical practice; activities of health insurance plans in chronic illness care; performance incentives; preventative care and health promotion; and organizational culture.

This collection has two data files. The first file contains the NSPO2 survey data, while the second contains a crosswalk between the NSPO1 and NSPO2 case identification numbers which can be used to link the data of the POs that responded to both surveys. Altogether, 369 of the 1,104 POs that responded to NSPO1 also responded to NSPO2.

This qualitative study was conducted in two United States health care systems. The research team conducted semi-structured interviews with medical assistants, physicians, and interpreters with experience collecting family history for Spanish-speaking patients and examined barriers and facilitators to family history collection.

This study addressed whether it is better to expand the scope of collaborative care programs to treat patients with more complex psychiatric disorders or to facilitate successful referrals to specialty mental health care. The primary objective of this study is to compare Telepsychiatry Collaborative Care (TCC) and Telepsychiatry Enhanced Referral (TER) from the patient and provider perspective. The secondary objective is to determine whether patients not engaging and responding to TER, improve with Phone-Psychiatry Enhanced Referral (PER). There are four specific aims.

Aim #1: To quantitatively compare the treatment experience, engagement, self-reported clinical outcomes, and recovery-oriented outcomes of patients initially randomized to TCC and TER.

Aim #2: For the subset of patients randomized to TER who do not engage in treatment and are still symptomatic at 6 months, quantitatively compare treatment experience, treatment engagement, self-reported clinical outcomes and recovery-oriented outcomes of patients randomized to continued-TER or PER.

Aim #3: To gain an in-depth understanding of patients' and providers' treatment experience, qualitatively compare those randomized to TCC, TER and PER.

Aim #4: To examine treatment heterogeneity among subgroups of patients randomized to TCC and TER based on race/ethnicity, age and clinical severity.

The TARGET (Targeted Interventions to Prevent Chronic Low Back Pain in High-Risk Patients) Trial was a primary care-based, multisite, cluster randomized, pragmatic trial comparing guideline-based care (GBC) to GBC + referral to Psychologically Informed Physical Therapy (PIPT) for patients presenting with acute lower back pain (LBP) and identified as high risk for persistent disabling symptoms. Chronic lower back pain (LBP) is defined as a response of "more than three months" to question 1, and a response of "half the days or more than half the days" in the past 6 months to question 2. See Appendix 1 for the LBP Questionnaire in the Protocol report.

Study sites included primary care clinics within each of four geographical regions in the United States, with clinics randomized to either GBC or GBC+PIPT. Acute LBP patients at all clinics were risk stratified (high, medium, low) using the STarT Back Tool. The primary outcomes were the presence of chronic LBP and LBP-related functional disability determined by the Oswestry Disability Index at 6 months. Secondary outcomes were LBP-related processes of health care and utilization of services over 12 months, determined through electronic medical records.

Study enrollment began in May 2016 and concluded in June 2018. The trial was powered to include at least 1,860 high-risk patients in the cluster-randomized controlled trial cohort. A prospective observational cohort of approximately 6,900 low and medium-risk acute LBP patients was enrolled concurrently.

This data collection contains a single data file with 223 variables and 9,730 cases. The number of respondents at each of the study locations were:

• Boston Medical Center: 997 respondents
• Intermountain Health (Salt Lake City): 2,094 respondents
• Johns Hopkins University (Baltimore): 1,615 respondents
• University of Pittsburg Medical Center: 5,024 respondents

These data were collected as part of an assessment of in-person and webinar AFIX consultations on best practices for adolescent HPV immunization. AFIX (which stands for Assessment, Feedback, Incentives, and eXchange) is a program of the Center for Disease Control and Prevention aimed at increasing vaccination of children and adolescents by reducing missed opportunities to vaccinate and improving immunization delivery practices at the provider level.

High-volume primary care clinics serving over 370,000 patients ages 11-17 in three states were randomly assigned to receive no consultation or an in-person or webinar AFIX consultation focused on improving adolescent HPV immunization. Immunization specialists from participating state health departments delivered the consultations. Physicians, nurses and other clinic staff in the in-person and webinar arms who participated in the consultation sessions completed web-based surveys pre-consultation (pre-visit survey), post-consultation (post-visit survey) and at six-month follow up (follow-up survey). Topics covered by the surveys include participation in and satisfaction with the assigned consultation delivery mode; strategies for improving HPV vaccination coverage used by the respondents' clinics; opinions about the level of HPV vaccination coverage in the respondents' clinics; and the respondents' self-efficacy for improving HPV vaccination coverage.

CCPC's long term vision is to use pragmatic comparative effectiveness methods, linked to an extensive primary care practice data repository, to establish evidence about best practices for complex real world patients and deliver appropriate, real-time decision support at point of service for primary care practitioners (PCPs) in a way that will account for individualized management of conditions and choice of treatments in order to provide optimal care.

The primary aim of BICEP was to advance analytical methods of observational Comparative Effectiveness Research (CER) to support evidentiary needs of primary care practitioners in answering important questions related to care of patient populations with Multiple Complex Conditions (MCCs).

The secondary aim of BICEP was to conduct a pilot study to demonstrate the feasibility and value of using the analytic methods for conducting CER among complex patients.

BICEP sought to answer the following clinical research questions: In adults with Type 2 Diabetes Mellitus (T2DM) coupled with additional chronic diseases,

1. What is the comparative effectiveness of T2DM medications in achieving glycemic control?
2. What is the comparative effectiveness of T2DM medications on intermediate outcomes, adverse events, side effects, tolerability?
3. Does the effectiveness and safety of the diabetic treatment options differ across subgroups of patients based on patient demographic characteristics, complex co-morbidities, or the use of other concurrent therapies?

Purpose. The CoNNECT Project enables comparative effectiveness research on mental health, behavioral health, and substance use in primary care. CoNNECT tracked two main elements: (1) the number of patients identified with a comorbid mental health and physical health diagnosis; (2) the number of patients who initiate treatment secondary to a mental health diagnosis. CoNNECT created the capacity to build a base for mental health in primary care comparative effectiveness research using electronic connectivity to generate retrospective and in time prospective clinical data.

Data Access. CoNNECT data are not available from ICPSR. The data from this study are hosted at DARTNet.

Overview

Through electronic data collection and improving the efficiency of existing data processes to allow both more complete and specific identification of chronic illness, the study objectives included:

1. Greatly enhance the scope of existing algorithms to permit comprehensive identification of the 20 chronic conditions key to primary care.
2. Improve the specificity of the existing algorithms to permit more precise automated identification of chronic conditions, limiting the amount of human review required.
3. Revise the algorithms to permit identification of more than one condition in a text string.

The investigators developed advanced SAS text string search algorithms and developed a modified parsing table that included inclusion and exclusion patterns and resultant diagnoses. The automation searches through each input text string for the inclusion pattern that is not equivalent to the exclusion pattern and maps the string to the corresponding resultant diagnosis. This technique allows the search functions to be easily modified to include additional search criteria and scaled to encompass additional conditions.

Data Dictionary

A data dictionary for 24 chronic conditions was developed. The dictionary assigns ICD-9 diagnosis codes to problem list text in electronic health record data. The dictionary contains 78,458 records and exists in two forms, a Microsoft Access database and a SAS 9.2 dataset. The Microsoft Access database contains 24 tables, one for each condition. The SAS 9.2 dataset contains four fields. The 24 chronic conditions for which problem list text data were examined and assigned to ICD-9 codes. Conditions include Alcohol Use Disorder, Asthma and Allergic Rhinitis, Atherosclerosis, Atrial Fibrillation, Cerebrovascular Disease, Chronic Liver Disease, COPD, Chronic Renal Disease, Coronary Disease, Dementia, Depression, Diabetes Mellitus, Epilepsy, GERD, Heart Failure, Hyperlipidemia, Hypertension, Migraine Headache, Obesity, Osteoarthritis, Osteopenia/Osteoporosis, Parkinson's Disease, Peptic Ulcer Disease and Rheumatoid Arthritis.

Data Access

The data dictionary is not available from ICPSR. For use arrangements, please contact Ruth G. Jenkins, PhD ([email protected]) or Steven M. Ornstein, MD ([email protected]) at the Practice Partner Research Network (PPRNet), Medical University of South Carolina.

Prescription for Health was an initiative funded by the Robert Wood Johnson Foundation in collaboration with the Agency for Healthcare Research and Quality. Under this initiative, primary care practice-based research networks (PBRNs) -- groups of ambulatory practices devoted principally to the primary care of patients -- developed, tested, and evaluated innovative strategies to improve the delivery and effectiveness of health behavior change services in primary care practice. The strategies targeted four health risk behaviors: tobacco use, unhealthy diet, lack of physical activity, and risky alcohol use. Prescription for Health was conducted in two rounds. Round one awarded grants to 17 PBRNs to test the feasibility of implementing the strategies, while round two awarded grants to ten PBRNs to measure the strategies' effectiveness and the expenses associated with them. More than a 100 primary care practices from the ten PBRNs participated in the evaluation.

This data collection comprises the data from one of the data collection efforts carried out by the second round: the responses to the Practice Information Form (PIF), a Web-based instrument which captured key organizational attributes of the participating practices. The PIF data were collected at two time points. Baseline data were collected from each practice before the intervention was implemented and follow-up data were collected approximately one year after the start of the intervention.

Information about the practices collected by the PIF include practice type and ownership; characteristics of each clinician and non-clinician staff person; number of vacancies for clinicians and non clinicians; number of exam rooms and volume of office visits; average number of new patients per month; percentages of patients in various age, race, Hispanic origin, and payer categories; and the predominant type of payment arrangement with health plans. In addition, the PIF asked whether a specific health plan controlled over half of the practice's total business; whether the practice had a pay-for-performance program; whether any payers or organizations publicly reported practice level performance information, such as patient satisfaction, chronic care/disease management, and/or preventive service delivery; and whether practices had a formal process for routinely measuring satisfaction among patients, clinicians, and other staff. The PIF also investigated how practices motivated their clinicians and staff; the level of competition among practices in local markets; the use of computers, electronic medical record systems, and patient registries; major changes that affected each practice's ability to make improvements in patient care; factors that prevented practices from translating the results of research into changes in medical practice; and the use of health risk assessment protocols or questionnaires to identify patients who may benefit from counseling or interventions. Questions about the four Prescription for Health behaviors -- physical activity, healthy eating, smoking cessation, and addressing risky drinking -- asked how practices linked patients to outside resources for each of the four behaviors; how practices used evidence-based guidelines and informed patients about recommendations for the behaviors; and which approaches practices used to support patients ready to engage in a behavior change for each of the behaviors.