Translating Evidence into Practice Translating Evidence into Practice Barbara Gerbert, PhD Professor Barbara Gerbert, PhD Professor October 9, 2008 Case Study

Barbara Gerbert, PhD Professor University of California San Francisco October 9, 2008

Running with Colleagues: How I Built a Rewarding Career and Thrived at UCSF Running with Colleagues: How I Built a Rewarding Career and Thrived at UCSF Barbara Gerbert, PhD Professor Barbara Gerbert, PhD Professor Research & Clinical Excellence Day October 16, 2008 Research & Clinical Excellence Day October 16, 2008

Barbara Gerbert, PhD Professor University of California San Francisco October 9, 2008

Barbara Gerbert, PhD Professor University of California San Francisco October 9, 2008

1994 – 1999 Funding: NCI 4 publications Improving Primary Care Physicians’ Diagnosing and Triaging of Skin Cancer 1990s Barbara Gerbert, PhD Professor University of California San Francisco October 9, 2008

Primary care physicians as gatekeepers in managed care. Primary care physicians’ and dermatologists’ skills at secondary prevention of skin cancer. Gerbert, B; Maurer, T; Berger, T; Pantilat, S; McPhee, S; Wolff, M; Bronstone, A; Caspers, N. Primary Care Physicians as Gatekeepers in Managed Care: Primary Care Physicians’ and Dermatologists’ Skills at Secondary Prevention of Skin Cancer. Archives of Dermatology, 1996, 132, Gerbert, B; Bronstone, A; Wolff, M; Maurer, T; Berger, T; Pantilat, S; McPhee, S; Improving Primary Care Residents’ Proficiency in the Diagnosis of Skin Cancer. Journal of General Internal Medicine, 1998, 13, Barbara Gerbert, PhD Professor University of California San Francisco October 9, 2008

Measurements and Main Results We compared the abilities of a control and an intervention group of primary care residents, and a group of dermatologists to diagnose and make evaluation plans for six categories of skin lesions including three types of skin cancer—malignant melanoma, squamous cell carcinoma, and basal cell carcinoma. The intervention group showed greater improvement than the control group across all six diagnostic categories (a gain of 13 percentage points vs 5, p <.05), and in evaluation planning for malignant melanoma (a gain of 46 percentage points vs 36, p <.05) and squamous cell carcinoma (a gain of 42 percentage points vs 21, p <.01). At posttest, both the intervention and control group demonstrated improved performance, with the intervention group revealing significantly larger gains. The intervention group performed as well as the dermatologists on five of the six skin cancer diagnosis and evaluation planning scores with the exception of the diagnosis of basal cell carcinoma. Barbara Gerbert, PhD Professor University of California San Francisco October 9, 2008

Discussions of Risks by Randomization Control Intervention Tobacco ** Control Intervention TotalNoYes Domestic Violence * Discussed with provider * p = ** p = Calderón, S; Gilbert, P; Jackson, R; Kohn, M; Gerbert, B. Provider Cueing Increases Discussions of Domestic Violence with Pregnant Women, submitted for review. Barbara Gerbert, PhD Professor University of California San Francisco October 9, 2008

Discussions of Risks by Randomization 60.0%1569 Control 100.0%190 Intervention Tobacco ** 23.5%17134 Control 85.0%20317 Intervention TotalNoYes Domestic Violence * Discussed with provider * p = ** p = Calderón, S; Gilbert, P; Jackson, R; Kohn, M; Gerbert, B. Provider Cueing Increases Discussions of Domestic Violence with Pregnant Women, submitted for review. Barbara Gerbert, PhD Professor University of California San Francisco October 9, 2008

Mission Statement We are committed to increasing understanding of the barriers to optimal health care and to improving the quality of health care in the rapidly changing health care system. Specifically, our goals are to: Identify behavioral risks and patient, provider, and systemic barriers to optimal health care delivery Design and test innovative interventions to support and simplify the providers’ role in prevention Develop new methods of providing health risk assessment and prevention counseling, such as multimedia computer programs Disseminate our research findings to influence health care policy and practice Barbara Gerbert, PhD Professor University of California San Francisco October 9, 2008

My Research Domain Educational Intervention Continuing Education Change Provider Knowledge Change Provider Attitudes Change Provider Behaviors Provider-Patient Visit Change Patient Knowledge Change Patient Attitudes Change Patient Behaviors Improved Patient Health Outcomes Barbara Gerbert, PhD Professor University of California San Francisco October 9, 2008

COPD Funding: NHLBI 8 publications Measuring Physician Performance: A Comparison of Four Methods 1980s Barbara Gerbert, PhD Professor University of California San Francisco October 9, 2008

Barbara Gerbert, PhD Professor University of California San Francisco October 9, 2008

Barbara Gerbert, PhD Professor University of California San Francisco October 9, 2008

Barbara Gerbert, PhD Professor University of California San Francisco October 9, 2008

Barbara Gerbert, PhD Professor University of California San Francisco October 9, 2008

Ring the Bell Model for Preventive Care in Clinical Settings Ring the Bell Model for Preventive Care in Clinical Settings Assess Patient’s Risks & Prevention Counseling Needs Cue or Alert the Health Care Provider about Patient’s Risk/Needs Health Care Provider Rings a Bell Something Else Happens to Supplement Provider Behavior Improved Patient Health Outcomes: Something Happens and It Will Be Good Health Care Provider Does Something with Patient Barbara Gerbert, PhD Professor University of California San Francisco October 9, 2008

Something Else Happens Domestic Violence Expert on Site Tobacco Cessation Counselor on Site Referral Resources Offered Warm Handoff to Appropriate Resources Barbara Gerbert, PhD Professor University of California San Francisco October 9, 2008

Support and Simplify Clinic based Video Doctor Provider Cueing Patient Worksheet Resource Referred Barbara Gerbert, PhD Professor University of California San Francisco October 9, 2008

2002 – now Funding: NIDA Positive Choice: Prevention for Positive Health Can the Video Doctor Model Decrease HIV- Infected Individual’s Risky Behaviors? 2000s Barbara Gerbert, PhD Professor University of California San Francisco October 9, 2008

Barbara Gerbert, PhD Professor University of California San Francisco October 9, 2008

Barbara Gerbert, PhD Professor University of California San Francisco October 9, 2008

Barbara Gerbert, PhD Professor University of California San Francisco October 9, 2008

Barbara Gerbert, PhD Professor University of California San Francisco October 9, 2008

Barbara Gerbert, PhD Professor University of California San Francisco October 9, 2008

Barbara Gerbert, PhD Professor University of California San Francisco October 9, 2008

Barbara Gerbert, PhD Professor University of California San Francisco October 9, 2008

2002 – now Funding: NIDA Positive Choice: Prevention for Positive Health Can the Video Doctor Model Decrease HIV- Infected Individual’s Risky Behaviors? 2000s Barbara Gerbert, PhD Professor University of California San Francisco October 9, 2008

The most striking finding was that many of the intervention arm participants eliminated risky behaviors altogether—38 percent who reported unprotected sex at baseline reported no vaginal or anal sex without a condom after the intervention. Even among those participants who continued risky behaviors, those in the intervention arm had three fewer casual sex partners and reported five fewer days of drug use in the prior month than those in the control arm. Forty-four percent who had been using drugs at the first visit had stopped using all drugs at the conclusion of the study six- months later. The program meets or exceeds the CDC’s “best evidence” criteria for HIV behavioral prevention interventions. To date, there are only 18 interventions that meet these rigid standards. This means that providers can use Positive Choice in prevention programs funded directly by the CDC. Barbara Gerbert, PhD Professor University of California San Francisco October 9, 2008