Priority Research Areas

Evidence-Based Clinical Research

Evidence-based practice is defined as the integration of the following parameters in making decisions about patient care:

  1. Research-generated current best evidence
  2. Clinical expertise
  3. Patho-physiological knowledge
  4. Patient preferences.

Evidence-based practice results in cost-containment for efficacious therapies, improved patient care and enhanced access to care. Of the four key pieces of the puzzle in evidence-based practice, DORFAM realizes that the one concerning research is the most dynamic and in need of most attention. The systematic research in evidence-based medicine includes:

  • Clinico-epidemiological studies (e.g., case-control and cohort studies) to yield practice guidelines
  • Randomized controlled trials to measure performance
  • Meta-analysis to refine pathways of care
  • Cost-effectiveness analysis to yield process-based data
  • Decision analysis to yield outcomes-based data

DORFAM is committed to conducting well-designed research projects in the clinical setting to complete the puzzle. Examples of completed projects in this area are:

  • The ASPN Referral Study
  • Family Practice Use of "Back-up" Antibiotic Prescriptions in URI
  • The Healthy Lifestyles Headache Initiative: Migraine Disease Management Program

Medical Informatics and Disease Management

Medical informatics is concerned with the use of computing and information technology in:

  • Medical research
  • Teaching
  • Patient care
  • Hospital administration

Simplistically, it is the use of computer applications in medical care. As an emerging discipline, it can be seen as the study, invention and implementation of structures and algorithms to improve communication, understanding and management of medical information. Some of the components of medical informatics are the electronic medical record, order entry, decision support and information retrieval.

Disease management is the maintenance of the complete health of populations, including their preventive care, optimal self-management and optimal professional care. Disease management differs from the "infectious disease model" of medical care by covering the full continuum of the health care of a population and not just medical care. In addition, while the patient in the acute care delivery model is a passive recipient of services, the patient in the disease management model is an active partner in the care provided. With the population growth in this country and the increase in median age, there is a concomitant increase in the incidence and prevalence of chronic conditions. In fact, 80% of the country's present illness burden is the result of chronic illness in persons ages 55 years and older.

In this priority area of research, DORFAM seeks to use medical computer technology to provide continuous, integrated and comprehensive care to individuals with chronic diseases such as diabetes, congestive heart failure (CHF), depression and asthma. Examples of ongoing and prospective projects in this area are:

  • Management of Diabetes and CHF Using Medical Informatics
  • The Use of e-mail To Expedite Physician-Patient Communication in Family Practice
  • PDA Use in Diabetes Care

Family Violence Prevention and Mental Health Issues

Family violence is defined as any act carried out by an individual to a family member with the intention of, or a perceived intention of, causing death, injury, physical harm or emotional pain. Family violence comes in many forms including murder, sexual coercion or assault, incest, physical intimidation, threats to harm or kill, restriction of normal activities or freedom and denial of access to resources. Additional forms of violence directed specifically at women include acts of rape, stalking, forced prostitution and pornography and genital mutilation.

Family violence including many of its descriptors such as:

  • Domestic violence
  • Spousal abuse
  • Intimate partner violence
  • Wife battering
  • Violent victimization
  • Date rape
  • Child neglect
  • Child abuse
  • Child maltreatment
  • Elder abuse

is pervasive in any society.

In this country, about two million women are battered by an intimate partner each year and another 1,500 women are murdered by their husbands or boyfriends. About 2,000 deaths to children ages 0-17 years are also recorded annually as a result of maltreatment and an additional 160,000 result in injuries. Besides death and the acute physical harm or injury, the consequences of family violence may be long-lasting including post-traumatic stress disorders and other severe mental problems.

It is the aim of DORFAM to contribute to the search for knowledge in this relatively young and fragmented field. In particular, the proximity of Fort Hood provides a unique opportunity for research on cultural influences of family violence. In addition, opportunity exists for training our family physicians in the recognition and management of family violence. Examples of ongoing and prospective projects are:

  • Child Maltreatment Related Injuries Resulting in Hospitalization
  • Follow-up of Patients with Somatization Disorders
  • The Healthy Families Initiative in Fort Hood

Safety Promotion and Injury Control

Injury remains the number one cause of mortality of persons ages 1-44 years in this country as in most of the world. In Texas, injury is the fourth leading cause of death for all ages and the leading cause of death for persons ages 1-44 years. In 1996, there were 11,198 injury deaths among Texans, approximating 31 deaths from injury-related causes each single day. Motor vehicle crashes, suicide and homicide were the three leading causes of injury mortality. Most injuries and trauma are predictable, are not freak events or 'acts of God,' and may result from behavioral problems such as alcohol abuse, failure to buckle up when riding in a car, failure to wear a helmet when riding a bicycle or motor-cycle or skating and even from the lack of knowledge about what to do in case one's clothes catch on fire. Fortunately, there are counter-measures for most of the causes of injury. The only problem is the translation of research into practice.

DORFAM sees the opportunity for some research activities and targeted educational interventions through the network of family physicians in our 17 regional clinics and via our contact with various doctors' offices and other state and local agencies. Examples of completed projects are:

  • Concussion Among High School Football Players
  • Helmet Promotion among Child Bicyclists and Skaters in Central Texas
  • School Backpack Safety

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