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SNOCAP Newsletter

The SNOCAP Newsletter is distributed on a bimonthly basis to SNOCAP participants and subscribers.

    June 2011

Highlights in this issue:


The Community Immersion Program.......................…………………………………….............1

2011 Engaging Communities in Education and Research Conference..........................2

Changing Asthma Care on the Eastern Plains................................................................3

Integrated Behavioral Health and Primary Care in Rural Colorado..............................4 

Utility of Radiology Over Reads......................................................................................5

Engaging Communities in Research: The Immersion in Community Engagement Program

Several junior health researchers recently descended upon SNOCAP practices around the state to get a glimpse of a day in the life at a primary care practice in Colorado. These special visits were part of a unique training program for academic health researchers on community engagement in research.

mushroom farmerThe Immersion in Community Engagement (ICE) program also included stops at a variety of other local health organizations, historic sites, industries, and (of course) favorite local restaurants. Community engagement is essential to conducting effective and relevant health research. It involves understanding and working for the people who can benefit from and inform research. 

The ICE program is part of the Colorado Clinical and Translational Sciences Institute (CCTSI) and gives trainees an opportunity to explore first-hand the history, geography, and people of Colorado and to talk with local residents about factors that contribute to or threaten their health. The ICE program works with African American, Latino, Asian/Refugee, and American Indian/Alaska Native communities in Denver and rural communities in the San Luis Valley and northeast Colorado. Participants are impacted emotionally, intellectually, personally, and professionally.

Classroom conversation

Reactions include: “We talked about some really hard stuff.” “I learned things I would never learn at a conference.” “I’m motivated to use my talents as a researcher to work with this community.” “This was life-changing. I had to do some soul searching.”

Many thanks to the SNOCAP practices and friends who took the time to meet with the program trainees. For more information about this program, contact Dr. Jack Westfall ( or Linda Zittleman (

2011 Engaging Communities in Education and Research Conference

The Engaging Communities in Education and Research conference is only three short months away. The conference will be held Sept. 23-25, 2011 in Vail, Colorado. Registration for the conference opens July 1, 2011. You can register by clicking here. Registration, rooms, and most meals are complimentary. Space is very limited, so be sure to register on time!

Changing Asthma Care on the Eastern Plains: Findings from the "Asthma Toolkits" Program

Ask around and you’ll find that everyone in eastern Colorado either has or knows a handful of people with asthma. Primary care practices in the High Plains Research Network (HPRN) reported significant changes to how they diagnose, treat, and manage asthma in their patients with the help of the Asthma Toolkits program. Results of this assessment were recently published in the Journal of the American Board of Family Medicine. Many thanks to the HPRN practices for their participation. The Journal of the American Board of Family Medicine published “The Colorado Asthma Toolkit Program: A Practice Coaching Intervention from the High Plains Research Network” in May of 2011. See the full article here.

Asthma Patient

Asthma is often under-diagnosed and under-treated in primary care. Asthma Toolkits combines “toolkits” for health care providers and for patients. Three trainings were held onsite at 57 of 58 HPRN practices, which included guideline-based evaluation and treatment of asthma and communication techniques to promote self-management. Over 370 providers and practice staff received training. Practices also received a free spirometer and training on its use and interpretation. Additionally, toolkits for patients continue to be distributed to practices to give to patients for free.

Table 1 highlights some of the changes to patient care for asthma as reported by practices approximately 3 months after receiving training. After the first year of the program, over 2400 spirometry tests had been conducted. Asthma table 1Of these, over 50% had moderate to severe pulmonary obstruction.

Integrating Behavioral Health and Primary Care in Rural Colorado: What Do Health Care Providers Have to Say?

We’re about to find out. Inspired by conversations during site visits with primary care providers in rural eastern Colorado, the High Plains Research Network (HPRN) will be conducting a study later this summer on behavioral health integration. The HPRN Community Advisory Council also continually voices behavioral health as one of the leading health issues in their communities.

Many studies show that the integration of behavioral and primary care can help provide more effective behavioral health care to patients. However, the process of integrating care, and the challenges that go along with it, may be different in rural than in urban areas. A written survey will explore PCPs’ and BHPs’ attitudes toward mental health integration, their perspectives on best models of behavioral health care integration in their communities, and barriers to integration. Results of this study will help identify the commonalities and differences between PCPs and BHPs and needs that need to be addressed to provide effective behavioral health care. We appreciate your participation in this study.

Yuma hospital logo

Curiosity in Yuma Leads to Study on the Utility of Radiology Over Reads

Dr. John Glick and other primary care providers at Yuma Clinic and Hospital in Yuma, Colorado were curious how often official radiology reads for extremity joints changed plan of care in their practice. Many rural health clinics and hospitals lack onsite radiologists. The primary care provider (PCP) often interprets plain radiographs and begins treatment before receiving an official read from a radiologist. Previous studies to determine if interpretations of radiographs by PCPs agree with interpretations from radiologists have mainly been done in urban or academic centers. This study assessed the concordance for plain radiograph interpretations between PCPs in Yuma, CO and radiologists. The study also determined if there were specific joints or injury patterns where the practice should automatically request stat over reads.

Chart audit data were reviewed for patients aged 18 years and older who had received care at the Yuma hospital or clinic that included plain radiographs for extremity injury. Convenience samples of 30 cases for each of the following joints were obtained: ankle, knee, hip, write, elbow, and shoulder. Of 180 cases, 166 (92%) were cases where the PCP and radiologist interpretations agreed. The remaining 14 cases (8%) had discordant reads. Of those, the PCP had made the correct interpretation in 4. Four cases (2.2%) required a change in care. See Table 1 for a description of care changes.

Radiology Over Reads table 1

PCPs’ interpretations of radiographs had a very high overall concordance with radiologists’ interpretations. Further, this rate falls in the range of concordance found in previous studies (90%-95%). No specific injury patterns or joint subsets were found that would trigger an automatic request for a stat over read. CU Medical student Nicholas Mouw, Dr. Jack Westfall, and the High Plains Research Network partnered with Dr. Glick to conduct this study. A similar study on over reads is under development with Dr. Gary Grasmick and others at the Prairie View Clinic in Cheyenne Wells.