Funded Through The North Carolina Network Consortium, Chapel Hill,
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
We wanted to evaluate the feasibility of conducting syndromic surveillance
in a primary care offi ce using billing data.
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.
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.
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.
Poor Nutritional Habits: A Modifiable Predecessor
of Chronic Illness? A North Carolina Family
Medicine Research Network (NC-FM-RN) Study
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
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
health habits, and demographic factors.
Respondents included 292 African Americans (17.3%), 1004 non-Hispanic whites
255 Hispanics (15.1%), and 126 American Indians (7.4%); mean age 47.5 years. Thirty percent
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.
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.))
Sleep Problems in Primary Care: A North Carolina
Family Practice Research Network (NC-FP-RN) Study
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.
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.
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.
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.))