Wednesday, November 3, 2010

Clinical Research Oriented Workshop (CROW) Meeting: Oct 29, 2010

Present: Rodger Kessler, Ben Littenberg, Charlie MacLean, Connie van Eeghen

1. Round Table: The complexities of grant administration between departments are amazing.

2. Rodger’s Data

a. Past article submission has been returned with suggestions; new data from an additional site has meantime become available. May turn the paper into a “Brief Report” for the journal where it is under review. Two ways to look at incorporating the data from the additional site:

i. Compare the two sites, at least at a relatively simple level, to show that this approach worked in both

ii. Explain the two sites as a progression of implementing the same approach in two different practices with successful outcomes.

1. The sites are three years apart in time; this was the outcome of the practical issues around setting up the sites with this model. The message should be “you can do this in your practice,” so currency of data and process is important.

iii. Be able to discuss some of the details of patient condition: primary and secondary diagnoses, co-morbidities, payer mix, zip code, income, referrer (through the insurance claim), etc.

iv. Regardless of which strategy above is used, the journal will probably push for side by side comparisons. Anticipate questions that can’t be answered because of limits to generalizations preemptively, by stating that these limits exist and identifying the need for future studies.

b. AHRQ funded R24, “Connect” has two steps

i. Enroll practices, linked to EHR data abstraction and National Research Network “DARTnet” which has hooked up practices and pulled data (not MH data), in a collaborative around MH. Goal: enroll 30-40 organizations, some with multiple sites, with a goal of 100 sites in total. Ben Miller is the PI. Goal: can the data be abstracted?

ii. Descriptive data study, supported by DARTnet subcontractor, looking for practices with MH services on site that can be compared to other DARTnet practices not in the CCRN collaborative. Goal: is there a difference in the treatment conditions?

1. Identifies MH services that have been initiated based on diagnoses from the problem list – although this is still being sorted out with DARTnet. Not sure if the clinician providing the MH services matters (BH clinician or PCP).

2. The eligible population (i.e. the denominator for the study) is under question: a set of behavioral health and medical diagnoses provided by a list which has been true for the patient for an undetermined period of time.

3. Outcomes research study is outside the scope of this study and an important future study.

4. That there was a referral is one item to track; another is identifying the outcome of that referral, a.k.a. “treatment initiation” (which is a question that may be answerable only by the patient) or “care process” (which could include a range of steps that might include medication, counseling, and have a range of sources for collecting data). However, the only source of data available are through DARTnet as part of this step of the study.

3. Next Workshop Meeting(s): Friday, 11:00 a.m. – 12:00 p.m., at Given Courtyard Level 4

a. Nov 5: Abby: update on research study.

b. Nov 12: (no Connie)

c. Nov 19: (no Connie)

d. Nov 26: (day after Thanksgiving – cancel?)

e. Dec 3: (no Connie)

f. Dec 10: (no Connie)

g. Dec 17: (no Connie)

h. Dec 24: ???

i. Dec 31: ???

j. Future agenda to consider:

i. Rodger: Mixed methods article; article on Behavior’s Influence on Medical Conditions (unpublished)

ii. Future: Review of different types of journal articles (lit review, case study, original article, letter to editor…), when each is appropriate, tips on planning/writing (Abby)

iii. Future: Informed consent QI: Connie to follow up with Nancy Stalnaker, Alan Rubin will follow up with Alan Wortheimer or Rob McCauly

iv. Kairn will ask a librarian to join us for selected issues

4. Fellows document – to be reviewed in the future. We trialed Wednesday meeting times, which started May 5, 2010 and continued until August 25, 2010. We returned to Friday meetings on Sept 3, 2010

Recorder: Connie van Eeghen

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