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Scientific & Data Resources

The CRN supports cancer research in integrated health care settings. These health care organizations provide a number of unique advantages for conducting population-based epidemiologic and health services research. Each participating institution has a defined population with insurance coverage and provision of most medical care with electronic medical records. The data that are available in the CRN provide greater breadth and depth of information than that available solely from medical claims data. Thus, most organizations provide the ability to identify study populations for epidemiologic studies, to examine aspects of care for health services research, and to generally conduct cutting-edge population sciences research.

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Community Linkages

With nine research centers based in integrated health care delivery organizations nationwide, the research capabilities of the CRN take substantial advantage of its proximity to and familiarity with the day-to-day provision of medical services across the spectrum of cancer care, from primary prevention such as smoking cessation, through detection, diagnosis, treatment, and palliative care. All CRN sites are longstanding health care organizations with a stable presence in their communities. They have research centers and investigators – the backbone of the CRN and through which the CRN is administered – who understand their enrollee populations, the organization and delivery of care, and the associated data systems.

The CRN is also a subset of institutions that form the HMO Research Network, a consortium of research centers affiliated with integrated health care delivery organizations. Several other HMO Research Network organizations are CRN affiliate organizations, thus expanding the reach of CRN-based research activities.

Because the CRN research centers are part of their parent health care organizations, the research that is conducted in the CRN setting can also take advantage of linkages with the clinical enterprise. The CRN provides the unique advantage of being able to work closely with clinical leaders who represent the best of community-based care in the communities in which they have a presence.

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Population Coverage

CRN member organizations have a combined population of nearly 9.5 million enrollees, or almost three percent of the US population. The age and sex distributions of enrollees collectively reflect those of the general US population, although individual plans vary substantially. The CRN includes population centers with a high percentage of African American enrollees (Henry Ford Health System); Asian Americans (Kaiser Permanente Hawai’i, Kaiser Permanente Northern California, and Kaiser Permanente Southern California); and Hispanics (Kaiser Permanente Southern California, Kaiser Permanente Northern California, and Kaiser Permanente Colorado). Participating organizations also provide care in urban, suburban, and rural settings. Racial, ethnic, geographic, and income diversity is an important strength of the CRN, which permits studies emphasizing effectiveness research focused within or comparing these subpopulations.

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Characteristics of the Research Centers

CRN Research Centers are leading population sciences research organizations in their communities, and provide a gateway to conducting grant-funded research in their associated health care settings. Some may have strengths in particular disciplines, but all conduct population sciences research.

Table 1. Selected Characteristics of CRN Research Organizations

A list of site names and abbreviations are located at the bottom of the page.

  GHRI HFHS KPCO KPHI KPNC KPNW KPSC MCRF MPCI
Year founded 1983 1983 1987 1991 1961 1964 1975 1959 1996
Research clinic      
Survey department          
Research lab facility  
Research pharmacy    
Research biorepository          
2010 funding, all sources
($ millions)
43.3 52.4 16.6 4.4 94.4 35.3 28.8 31.9 2.5
2010 federal funding, % 82 53 54 62 69 76 36 32 85
N Investigators 32 83 10 3 50 31 20 31 26

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Characteristics of the Health Plans

The integrated health care organizations with which the CRN research centers are affiliated consist of some of the longest-standing and largest non-profit HMOs in the United States. Many have a major presence in their communities, providing care to twenty percent or more of the populations in the communities in which they have a physical presence.

Table 2. Select Characteristics of Cancer Research Network Organizations and Membership

A list of site names and abbreviations are located at the bottom of the page.

  GHRI HFHS KPCO KPHI KPNC KPNW KPSC MCRF MPCI
Year Founded 1947 1960 1969 1958 1945 1942 1947 1916 1977
Enrollment, x1,000
Covered lives* 741 425 535 225 3,143 475 3,489 296 198
Covered lives in
Integrated delivery system
413 148 479 225 3,143 432 3,489 235 70
Age, y, %
<=17 19 15 21 22 23 22 25 20.6 19
18-44 34 26 34 35 35 34 36 31.8 33
45-64 34 35 31 30 28 30 28 25.9 29
65+ 13 23 14 13 14 14 11 20 19
Race, %

American Indian/
Alaska Native

1 1 1 1 0 1 <1 <1 <1
Asian 4 3 2 28 10 4 7 <1 3
Native Hawaiian/
Pacific Islander
0 0 0 24 0 1 <1 <1 0
African American 2 37 4 1 6 3 8 <1 2
European American 31 50 52 20 45 64 58 68 87
Other / Unknown 61 9 41 26 39 28 27 30 0
Ethnicity, %
Ethnicity known 40 1 41 34 13 33 75 68  
Hispanic 2 1 9 5 13 2 32 2 8
Member Retention, %
At 1 y 82 99 91 85 87 85 85 88 95
At 3 y 63 86 66 72 75 68 71 83 92
At 5 y 52 63 54 63 66 58 61 70 92
Type of Insurance Coverage, %
Group 78 76 82 78 78 80 82 66 unk
Individual 24   12 11 12 4 11 2 unk
Medicaid 5   2 12 2 3 6 39 6
Medicare 18 24 18 14 14 14 13 21 16
Other public 3     12 6 0   17  
Health Plan Facilities and Providers, N
Hospitals owned/operated 1 5 0 1 21 1 14 2 0
Clinic sites owned/operated 26 36 22 17 464 27 97 63 20
Primary care providers 930 379 327 135 1500 880 5,300 295 120
Specialty providers 75 715 577 314 >7000 500 130
Electronic Medical Record Availability
EMR System Epic Care
Plus
Epic Epic Epic Epic Epic Cattails
MD
Epic
Roll-out began 2003 1990 2004 2005 2005 1996 2005 1958 2006

Patients with insurance coverage and/or some but not the vast majority of care data available in EMR or other medical records.
Covered lives in integrated delivery system: Comprehensive clinical data available in EMR
Total contracted providers (primary care and specialty)

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CRN Data Resources

CRN sites maintain longitudinal data resources that contain comprehensive health care delivery and patient information. The table below summarizes data resources supported and maintained by each participating CRN site. These data resources have been used for research for decades, for both single and multi-site studies. Early in the life of the CRN, CRN investigators and programmers realized that the multi-site distributed nature of collaborative research studies conducted in the CRN setting could benefit from the efficiency that would result from data standardization across CRN organizations. To achieve this goal, the Virtual Data Warehouse (VDW) was conceptualized, and now provides a backbone for many collaborative studies in the CRN and the HMO Research Network. The VDW consists of databases that are maintained locally at each Research Center, and these databases are built and maintained with a common set of standardized tables, variable names, and variable formats. Maintaining, updating, and validating the consistency and quality if the VDW, especially with respect to the cancer-related data elements, is an ongoing activity of the CRN Informatics Core. This is a critical ongoing process to maintain valid, quality data, as health care mandates and electronic medical record capabilities continually change.

Table 3. 2011 Status of VDW at CRN Sites

Domain GHRI KPCO KPHI KPNC KPNW KPSC MCRF HFHS MPCI
Demographics 1974- 2011 1969- 2011 1958- 2011 1995- 2011 1960- 2011 1988- 2011 1992- 2011 1915- 2010 1999- 2009
Enrollment 1988- 2011 1994- 2011 1958- 2011 1997- 2011 1960- 2011 1988- 2011 1992- 2011 1960- 2010 1999- 2009
Utilization 1993- 2011 1994- 2011 1995- 2011 1995- 2011 1994- 2011 1981- 2011 1979- 2011 1988- 2009 1999- 2009
Diagnoses 1993- 2011 1994- 2011 1995- 2011 1995- 2011 1994- 2011 1981- 2011 1979- 2011 1988- 2009 1999- 2009
Procedures 1993- 2011 1994- 2011 1995- 2011 1995- 2011 1994- 2011 1981- 2011 1979- 2011 1988- 2009 1999- 2009
Tumor 1974- 2011 1987- 2011 1960- 2011 1944- 2009 1960- 2011 1998- 2008 1960- 2011 1972- 2011 IP
Pharmacy 1977- 2011 1992- 2011 1995- 2011 1995- 2011 1986- 2011 1992- 2011 1999- 2011 1990- 2010 1999- 2009
EverNDC 2011 2011 1996- 2011 1996- 2011 1986- 2011 1998- 2011 2011 2006 2009
Census 1989- 2008 2007- 2011 2009 1996- 2009 2004- 2008 1988- 2008 2000 2009 2003
Provider specialty 1993- 2011 1998- 2011 1995- 2011 2000- 2011 1994- 2011 1990- 2011 1979- 2011 1988- 2011 Partial
Vital Signs 2005- 2011 2000- 2011 1995- 2011 2005- 2011 1996- 2011 2004- 2011 2001- 2011 1999- 2010 2007- 2009
Death 1977- 2009 1990- 2009 1995- 2011 1995- 2007 1995- 2011 1988- 2011 1997- 2006 1990- 2008 2005- 2009
Lab Results 1998- 2011 2000- 2011 1995- 2011 1996- 2011 1997- 2011 1991- 2011 1985- 2011 Partial 1997- 2011

IP = In process

GHRI = Group Health Cooperative (Group Health Research Institute)
HFHS = Henry Ford Health System (Center for Health Services Research)
KPCO = Kaiser Permanente Colorado (Institute for Health Research)
KPHI = Kaiser Permanente Hawai’i (Center for Health Research-Hawaii)
KPNC = Kaiser Permanente Northern California (Division of Research)
KPNW = Kaiser Permanente Northwest (Center for Health Research-Northwest)
KPSC = Kaiser Permanente Southern California (Department of Research & Evaluation)
MCRF = Marshfield Clinic (Marshfield Clinic Research Foundation)
MPCI = Fallon Community Health Plan (Meyers Primary Care Institute)

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