Background: Previous work has established a surprisingly high prevalence of acanthosis nigricans (AN) and its association with increased risk of type 2 diabetes in a Southwestern practice-based research network (PBRN). Our objective was to establish whether this high prevalence of AN would be present in other areas.Methods: We examined the prevalence of type 2 diabetes and its risk factors and the prevalence of AN among patients aged 7 to 65 years who had been seen by one of 86 participating clinicians in a national PBRN consortium during a 1-week data collection period. In a subsample of nondiabetic matched pairs who had or did not have AN, we compared fasting glucose, insulin, and lipid levels.Results: AN was present in 19.4% of 1730 patients from among all age ranges studied. AN was most prevalent among persons with more risk factors for diabetes. Patients with AN were twice as likely as those without AN to have type 2 diabetes (35.4% vs 17.6%; P < .001). In multivariable analysis, the prevalence ratio for diabetes was 2.1 (95% CI, 1.3-3.5) among non-Hispanic whites with AN and 1.4 (95% CI, 1.1-1.7) among minority patients with AN. In a subsample of 11 matched pairs, those with AN had higher levels of insulin and insulin resistance.

PURPOSEThe advent of Web-based survey tools has provided the investigator with an alternative to paper-based survey methods that in many instances may be less expensive to implement than traditional paper-based surveys. Newer technology, however, does not diminish the importance of obtaining an adequate response rate. METHODSWe analyzed response rate data obtained from a survey implemented across 3 practice-based research networks (PBRNs) in which the survey was fi rst implemented electronically with 5 rounds of electronic solicitation for an Internet-based questionnaire and then by 2 rounds of a paper-based version mailed only to nonresponders.RESULTS Overall, 24% of the total survey responses received were in the paper mode despite intense promotion of the survey in the electronic phase.CONCLUSIONS Our results suggest there is still an important role for the use of paper-based methods in PBRN survey research. Both hard copy and electronic survey collection methods may be required to enhance clinician response rates in PBRNs. INTRODUCTIONR esearch using surveys for data collection is common in practicebased research networks (PBRNs). The continuing growth of electronic communications, potential for cost savings, and more rapid results has created interest in Internet-based survey designs. Regardless of the method or technology used in performing a survey, it is clear that an adequate response rate is still critical to the scientifi c validity of survey fi ndings.1 Several investigators have shown that the mode of the survey measurably affects response rates in various biomedical venues.2 Our objective was to ascertain the value of a paper follow-up to an electronically based survey conducted on clinicians across 3 PBRNs . METHODSWe performed a secondary, retrospective analysis on data obtained from a completed survey on clinician attitudes toward the screening and treatment of hepatitis C. The survey was conducted in the Primary Care Multi-Ethnic Research Network (PRIME Net).3 At the time of this study, PRIME Net was a collaboration of W EB -BA SED A ND M A IL SURV E Y SThe survey instrument 7 consisted of 28 questions exploring clinicians' approaches to hepatitis C in their practices and available resources for care of patients infected with the hepatitis C virus.Invitations to participate in the survey were sent to all 805 active clinician members of the 3 PRIME Net PBRNs for whom a valid e-mail and postal address was available. Before the survey began, clinicians received 1 or more advance e-mail messages from their home PBRN describing the purpose of the survey and requesting participation.At the start of the survey, each clinician received a personalized e-mail solicitation from his or her home PBRN with a link to the Web-based version of the survey. The customized link had the target's unique identifying code embedded to provide automatic log-in and response identifi cation. We repeated the e-mail solicitation to nonresponders at intervals of 1 to 2 weeks for a total of 5 e-mail solicitations. ...

BackgroundThe goal of these analyses was to determine whether there were systematic differences in Emergency Severity Index (ESI) scores, which are intended to determine priority of treatment and anticipate resource needs, across categories of race and ethnicity, after accounting for patient-presenting vital signs and examiner characteristics, and whether these differences varied among male and female Veterans Affairs (VA) ED patients.Methods and FindingsWe used a large national database of electronic medical records of ED patients from twenty-two U.S. Department of Veterans Affairs ED stations to determine whether ESI assignments differ systematically by race or ethnicity. Multi-level, random effects linear modeling was used to control for demographic characteristics and patient’s vital signs (heart rate, respiratory rate, and pain level), as well as age, gender, and experience of triage nurses. The dataset included 129,991 VA patients presenting for emergency care between 2008 and 2012 (91% males; 61% non-Hispanic White, 28% Black, 7% Hispanic, 2% Asian, <1% American Indian/Alaska Native, 1% mixed ethnicity) and 774 nurses for a total of 359,642 patient/examiner encounters. Approximately 13% of the variance in ESI scores was due to patient characteristics and 21% was due to the nurse characteristics. After controlling for characteristics of nurses and patients, Black patients were assigned less urgent ESI scores than White patients, and this effect was more prominent for Black males compared with Black females. A similar interaction was found for Hispanic males. It remains unclear how these results may generalize to EDs and patient populations outside of the U.S. VA Health Care system.ConclusionsThe findings suggest the possibility that subgroups of VA patients receive different ESI ratings in triage, which may have cascading, downstream consequences for patient treatment quality, satisfaction with care, and trust in the health equity of emergency care.

Background: Continuing growth of the research spectrum of practice-based research networks (PBRNs) creates a need (1) for new approaches to training clinicians in research protocols and (2) to standardize clinician data collection. Each existing training method has shortcomings when used in geographically dispersed PBRNs. We describe here the use and costs of Internet-based training in support of a research protocol across a PBRN consortium.Methods: Clinicians in 4 PBRNs in the PRIME Net consortium participated in training for a study of acanthosis nigricans (AN). We compared results of pre-and posttraining assessments of knowledge and ability to correctly diagnosis AN. We also calculated costs for placement of the training on the Internet.Results: Among 103 participating clinicians, statistically significant increases in knowledge acquisition were demonstrated for all but 2 of the individual topics and in total scores on the assessments. AN diagnostic sensitivity increased from 52% to 99% to 96% to 100%, whereas specificity increased from 70% to 96% to 74% to 97%. Total costs for the web aspects of the training were $3732.