Published Papers

The following studies were published from data collected from patient members of the North Carolina Health Project (NCHP) Research Cohort.

Syndromic Surveillance for Emerging Infections in Office Practice Using Billing Data
PURPOSE
We wanted to evaluate the feasibility of conducting syndromic surveillance in a primary care offi ce using billing data.

METHODS
A 1-year study was conducted in a primary care practice; comparison data were obtained from emergency department records of visits by county residents. Within the practice, a computer program converted billing data into deidentified daily summaries of International Classifi cation of Diseases, Ninth Revision (ICD-9) codes by sex and age-group; and a staff member generated daily summaries and e-mailed them to the analysis team. For both the practice and the emergency departments, infection-related syndromes and practice-specific thresholds were calculated using the category 1 syndrome codes and an analyitical method based upon the Early Aberration Reporting System of the Centers for Disease Control and Prevention.

RESULTS
A mean of 253 ICD-9 codes per day was reported. The most frequently recorded syndromes were respiratory illness, gastrointestinal illness, and fever. Syndromes most commonly exceeding the threshold of 2 standard deviations for the practice were lymphadenitis, rash, and fever. Generating a daily summary took 1 to 2 minutes; the program was written by the software vendor for a fee of $1,500. During the 2003-2004 influenza season, trend line patterns of the emergency department visits reflected a pattern consistent with that of the state, whereas the trend line in primary case practice cases was less consistent, reflecting the variation expected in data from a single clinic. Still, spikes of activity that occurred in the practice before the emergency department suggest the practice may have seen patients with infl uenza earlier.

CONCLUSIONS
This preliminary study showed the feasibility of implementing syndromic surveillance in an office setting at a low cost and with minimal staff effort. Although many implementation issues remain, further development of syndromic surveillance systems should include primary care offices.

reprinted from Philip D. Sloane, Jennifer K. MacFarquhar, Emily Sickbert-Bennett, C. Madeline Mitchell, Roger Akers, David J. Weber, Kevin Howard, Syndromic Surveillance for Emerging Infections in Office Practice Using Billing Data ,(Ann Fam Med 2006;4:351-358. DOI: 10.1370/afm.547.) http://nc-e-care.com/Syndromic_Surveillance_Published_Paper_7-06.pdf


Poor Nutritional Habits: A Modifiable Predecessor of Chronic Illness? A North Carolina Family Medicine Research Network (NC-FM-RN) Study
Purpose:
To examine associations between personal nutritional patterns and various indicators of health, disease risk, and chronic illness in a diverse, representative sample of adult patients from primary care settings.

Methods:
As part of a survey of adult patients conducted in the waiting rooms of 4 primary care practices in North Carolina (recruitment rate 74.8%), a 7-item nutrition screen was administered to 1788 study participants. Other questionnaire items addressed disease and functional status, race/ethnicity, health habits, and demographic factors.

Results:
Respondents included 292 African Americans (17.3%), 1004 non-Hispanic whites (59.4%), 255 Hispanics (15.1%), and 126 American Indians (7.4%); mean age 47.5 years. Thirty percent reported eating 3 or more fast food meals weekly, 29% drank 3 or more high-sugar beverages weekly, 22% ate 3 or more high-fat snacks weekly, 36% ate 3 or more desserts weekly, 11% reported eating “a lot” of margarine, butter, or meat fat; 62% ate 2 or fewer fruits or vegetables daily; and 42% reported consuming protein less than 3 times a week. Scores on a summary measure were worse for prediabetics than for diabetics, for young adults compared with older persons, and for persons reporting good/excellent health versus fair/poor health.

Conclusions:
People at high risk for developing chronic illnesses later in life reported poorer diets in comparison with people who are already ill. This probably represents increased nutritional awareness and motivation among people with chronic diseases. Because primary care patients have a high prevalence of chronic disease risk factors, the primary care office setting may constitute a particularly appropriate location for nutrition education.

reprinted from Nicole D. Gaskins, Philip D. Sloane, C. Madeline Mitchell, MURP, Alice Ammerman, Scott B. Ickes, and Christianna S. Williams, Poor Nutritional Habits: A Modifiable Predecessor of Chronic Illness? A North Carolina Family Medicine Research Network (NC-FM-RN) Study ,((J Am Board Fam Med 2007;20:124 –134.)) http://nc-e-care.com/Gaskins_Nutrition_Paper.pdf


Sleep Problems in Primary Care: A North Carolina Family Practice Research Network (NC-FP-RN) Study
Background:
The prevalence and nature of sleep disorders in primary care has not been widely studied. As part of a survey conducted in 5 family practice offices in North Carolina, we screened adult patients for sleep syndromes and sought to ascertain which demographic status and health status were associated with these disorders.

Methods:
We approached 2963 consecutive adults who presented for office visits to the 5 study practices. The 4-page study questionnaire, which was available in English and Spanish, included items on insomnia, excessive daytime sleepiness, obstructive sleep apnea syndrome, and restless legs syndrome. Analyses evaluated the relationship between sleep syndromes and demographic factors, health status, and disability.

Results:
We enrolled 1935 patients (65.3% response rate). More than half reported excessive daytime sleepiness, one third had insomnia, more than 25% had symptoms of restless legs syndrome, and 13% to 33% reported obstructive sleep apnea syndrome symptoms. Participants who rated their health as poor reported significantly higher rates of all sleep disturbance items. Patients with hypertension, pain syndromes, and depression had a significantly increased risk for all sleep complaints. Patients who reported limited activity had a significant risk of restless legs syndrome.

Conclusion:
Sleep complaints are highly prevalent in primary care populations. Patients with the highest risk for sleep disturbance are those with pain, mental illness, limited activity, and overall “poor physical and mental health.” Because sleep disorders are associated with a significant health impact, positive responses to questions regarding sleep symptoms should prompt further diagnostic inquiry.

reprinted from Maha Alattar, John J. Harrington, C. Madeline Mitchell, MURP, and Philip Sloane, Sleep Problems in Primary Care: A North Carolina Family Practice Research Network (NC-FP-RN) Study ,((J Am Board Fam Med 2007;20:365–374.)) http://nc-e-care.com/Alattar_Sleep_in_Pri_Care_2007.pdf