Community Practice Core
The Community Practice Core (CPC) offers access to a clinical laboratory of over ten million patients within Harvard Vanguard Medical Associates, Harvard Pilgrim Health Care, and the HMO Cancer Research Network. These large, diverse populations are ideal for studies in basic, clinical and population sciences; addressing topics in cancer screening, prevention, treatment and quality of care; as well as dissemination. The CPC provides DF/HCC investigators access to comprehensive computerized patient and provider data including medical records, pathology and radiology reports, tumor registry data, and offers support to members developing research proposals within these community practice settings.
Listed below are a few examples illustrating how the core has contributed to various projects:
An example of a dissemination study using the community practice settings is an NCI-funded study led by Karen Emmons, PhD (DFCI), “Multiple Risk Behavior Intervention in Health Care Settings” (also known as Health Directions 2/HD2). This study takes place at Harvard Vanguard Medical Associates and is a follow-up to the very successful Healthy Directions 1, a cancer prevention intervention in working class, multi-ethnic adults which also took place at HVMA. HD2 is a randomized controlled trial that is currently being conducted at two Internal Medicine Departments of HVMA and is aimed at reducing cancer risk by smoking cessation, nutrition, and physical activity. To date, the study has completed enrollment with 2,442 participants. The CPC assisted Dr. Emmons with the submission process by providing preliminary data, identifying collaborators at HVMA, informing the clinicians about the project and soliciting their participation, completing the required administrative protocols, and assisting with budget preparation.
An example of a study that uses clinical and pathological materials and demonstrates the collaboration between population-based and clinical researchers is the “Predictors of Recurrence after Ductal Carcinoma in Situ (DCIS)” project. For this study, Stuart Schnitt, MD (BIDMC) used CPC to link with investigators at the CRN in order to conduct a study of 3,600 women with DCIS. This is the largest study of its type ever undertaken. By providing access to medical records and tumor specimens for pathological and molecular analysis, this study is the first to explore the link between basic and population research in our setting. The study has the potential to contribute important information about the natural history of DCIS, predictors of recurrence, and follow up after treatment. To date, three manuscripts have been published and several are underway. Members of the CRN DCIS study team have participated in DF/HCC Breast Cancer Program meetings aimed at enhancing collaborative research in DCIS.
An example of a study using the automated Virtual Data Warehouse (VDW) data for large-scale population studies is the “Ovarian Cancer Treatment Diffusion" study. For this project, 1,647 women with ovarian cancer diagnosed between January 1, 2004 and June 30, 2006 were identified from eight sites in the HMO Cancer Research Network. Using the VDW, the investigators collected automated data on patient characteristics including: demographics (age, race, ethnicity, vital status), health plan enrollment, tumor characteristics (stage and histology), and treatment received (surgery, radiation, chemotherapy, or hormone treatment based on information provided by tumor registries). The study, published in Medical Care, validated the utility of automated data and may be used for studies of chemotherapy across the CRN. An ongoing NCI-funded study, “Building a Pharmacovigilance Population-Based Laboratory,” is creating a population research laboratory to conduct pharmacoepidemiologic and pharmacogenomic studies and will answer important questions about the cardiotoxicity of systemic agents used to treat invasive breast cancer. The CPC is involved in all aspects of this study.
If you are interested in conducting a study using real world, racially diverse populations within the local and national community-based clinical practices, please contact Jane_Colagiovanni@harvardpilgrim.org (Community Practice Core Manager) or Larissa_Nekhlyudov@vmed.org (Community Practice Core Director).