Sunday, May 30, 2010

Clinical Research Oriented Workshop (CROW) Meeting: May 26, 2010

Present: Abby Crocker, Amanda Kennedy, Rodger Kessler, Ben Littenberg, Carole McBride, Connie van Eeghen

1. Round Table: Fire drill rules: just leave. Don’t ask, don’t ponder, just leave. Safety first.

2. Abby’s Research:

a. Reviewing a research article Abby drafted last year as part of a student assignment: article needs to get out the door. It is titled “Outpatient Methadone Treatment of Neonatal Abstinence Syndrome: A Case Series Report” and needs to be reduced to a 1600 word limit. Abby would like to include a single figure that presents how population was identified (one figure will count towards the word limit as 200 words.)
b. Abby reviewed the study, along with the clinical protocol and underlying rationale for treating neonates born to drug addicted mothers. She noted that scores reflecting the acuity of the neonate have improved over time, apparently indicating reduced withdrawal symptoms over time, although other interpretations are possible.
c. Points:
i. Need to include raw score data in order to demonstrate the change in acuity over time
ii. Variation in treatment (methadone vs. morphine) is probably based on many factors, one of which may be the treatment protocol and how it is used by the provider. There is a future research opportunity to investigate this that requires the full participation of the providers. Such a study could include the long term effects of using morphine vs. methadone as the treatment of choice for neonates.
iii. Results indicate that the intervention (methadone) is safe, effective, less expensive from a payer perspective, and probably better for creating a maternal/infant bond.
iv. The group identified multiple research and funding paths, as well as strategies for moving forward from a career perspective.
v. Figure development: reference CONSORT as the standard for randomized control trials, which can be found on the CTS blog home page. Also, EQUATOR (not JUPITER) is a webpage with a variety of tools for different kinds of studies and the diagrams that help create a picture (e.g. of the results).
vi. Abby identified the main results: quantifiable outcomes of 127 selected babies treated for this syndrome, with related statistics that are easily available to describe the subjects. It was recommended that she explain why the other 228 babies were not included and summarize the results just for the focus of the study.

3. Next Fellows Meeting(s): Wednesday, 2:00 – 3:30 p.m., at Given Courtyard Level 4
a. June 2: Kairn’s article on factor analysis to explore with the group (no Connie)
b. June 9: Rodger: figure for article and metrics for dashboard for next start up
c. June 16: (no Connie or Matt)
d. June 23:
e. June 30:
f. Future agenda to consider:
i. Rodger’s mixed methods article
ii. How to predict medical events effectively (Ben)
iii. 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)
iv. Future: Informed consent QI: Connie to follow up with Nancy Stalnaker, Alan Rubin will follow up with Alan Wortheimer or Rob McCauly
v. Kairn will ask a librarian to join us for selected issues
vi. Matt away from July 21 to August 1

4. Fellows document – nothing this time – to be reviewed after trialing Wednesday meeting times, which started May 5, 2010.

Recorder: Connie van Eeghen

Saturday, May 29, 2010

Equator, not Jupiter

At the Workshop, we talked about CONSORT and related guidelines for producing research reports. They are all collected on a web site called EQUATOR, which is linked off the home page of this blog. (I knew it was something planetary, "Jupiter" was a bad guess - sorry!)

Ben

Monday, May 24, 2010

Clinical Research Oriented Workshop (CROW) Meeting: May 19, 2010

Clinical Research Oriented Workshop (CROW) Meeting: May 19, 2010

Present: Matt Bovee, Kairn Kelley, Rodger Kessler, Ben Littenberg, Carole McBride, Connie van Eeghen (in the flesh)

1. Round Table: Reported – this is a great week to go restauranting – check with Rodger for details. Skype is beta testing a group video function, in which the videos are fixed pictures of participants.

2. Matt’s Research:

a. Update on the diabetes follow up qualitative study that interviewed patients who participated in the VDIS project.
b. Captions to the previously conducted qualitative analysis were reviewed and reprocessed in relationship to each other. We discussed what direction a future publication(s) would take, with key ideas including:
c. Future studies could explore the use of these concepts in understanding why the original study found a significant economic impact from the VDIS project or how these concepts could help prepare other IT solutions that promote chronic care self-management.

3. Future Plans:
a. Kairn will be reassessing her next steps through the month of June
b. Matt will be here until late July, then off to Ohio for family time
c. Carol will be here until August, most likely
d. Connie will be around all summer, with sporadic days off to do research and consulting

4. Next Fellows Meeting(s): Wednesday, 2:00 – 3:30 p.m., at Given Courtyard Level 4
a. May 26: Abby’s questions on statistical tests
b. June 2: Kairn’s article on factor analysis to explore with the group (no Connie)
c. June 9:
d. June 16: (no Connie or Matt)
e. June 23:
f. June 30:
g. Future agenda to consider:
i. Rodger’s mixed methods article
ii. How to predict medical events effectively (Ben)
iii. 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)
iv. Future: Informed consent QI: Connie to follow up with Nancy Stalnaker, Alan Rubin will follow up with Alan Wortheimer or Rob McCauly
v. Kairn will ask a librarian to join us for selected issues
vi. Matt away from July 21 to August 1

5. Fellows document – nothing this time – to be reviewed after trialing Wednesday meeting times

Recorder: Connie van Eeghen

Tuesday, May 18, 2010

[Fwd: Centers for Disease Control and Prevention (CDC) Behavioral Risk Factor Surveillance System (BRFSS) Update]

Now Available Online:  2009 BRFSS Dataset and Documentation

and Prevalence and Trends Tables

The Centers for Disease Control and Prevention’s (CDC) Division of Behavioral Surveillance (DBS) is pleased to announce the release of the 2009 Behavioral Risk Factor Surveillance System (BRFSS) data and documentation and Prevalence and Trends tables.  This represents the 25th year of BRFSS data.

The BRFSS is a unique, state-based surveillance system active in all 50 states, the District of Columbia, Guam, Puerto Rico, and the U. S. Virgin Islands. Information on health risk behaviors, clinical preventive health practices, and health care access (primarily related to chronic disease and injury) is obtained from a representative sample of noninstitutionalized adults aged 18 years and older in each state. The BRFSS provides flexible, timely, and ongoing data collection that allows for state-to-state and state-to-nation comparisons. State-specific data including racial-and-ethnic-specific data from the BRFSS provide a sound basis for developing and evaluating public health programs, including programs targeted to reduce racial and ethnic disparities in health risks. The BRFSS is the largest telephone-based surveillance system in the world, with more than 430,000 interviews conducted in 2009.

The 2009 BRFSS data and documentation files are available at http://cdc.gov/brfss/technical_infodata/surveydata/2009.htm

The 2009 BRFSS prevalence and trends data are available  at http://apps.nccd.cdc.gov/brfss/  

For more information about the data, please contact the BRFSS office at (770) 488-2455. 

 


Monday, May 17, 2010

Clinical Research Oriented Workshop (CROW) Meeting: May 12, 20010

Present: Matt Bovee, Abby Crocker, Amanda Kennedy, Rodger Kessler, Ben Littenberg, Charlie MacLean, Carol McBride, Connie van Eeghen (by Skype)

1. Round Table: Rodger updated on the application asked what the reference re: “counsel” is related to. Per Ben, these are the super-reviewers, who make additional suggestions to create a balanced portfolio. They make a recommendation to staff; the director of the Institute decides.

2. Rodger’s Research:

a. This paper is the outcome of a work reviewed a year ago, which was split into two possible articles. The presentation expected this June has been delayed, but Rodger is pushing forward with the work anyway.
b. Abby: no much detail on costs, although this is one third of the evaluation model
c. Amanda: got lost on figure 1 (the model)
d. Charlie: why is a new paradigm needed for mental health, relative to the evaluation of other clinical care processes? Rodger: need a consistent set of terms to discuss the elements and evaluate the results of this somewhat unique challenge of integrating mental health into primary care practices.
i. Ben: PCMH (primary care medical home) is not focused on mental health.
ii. Rodger: mental health has a high impact on morbidity and morality; has larger obstacles with respect to access, identification, and use of evidence based treatment
iii. Ben/Charlie: The key topic of interest may be the hypothesis about collocation, but this article is about evaluation of the outcome of those services.
1. Argument 1: here’s what we need the health care system to do (mental health)
2. Argument 2: the current solution (collocation), is one of many solutions; we need a measurement system to evaluate any solution
iv. Big problems in MH; many attempts to change; how to identify how to measure success will transcend any solution put forward
1. Berwick’s framework works – three aims of patient experience, clinical care, and cost, which can be evaluated over a population and society’s choices (e.g. care of acute care elderly as a tradeoff to providing preventive care to a pregnant woman) – per Charlie
2. Peek’s framework works – clinical, operational, financial – or what you need to do
3. Rodger explains how to use them
e. The use of “model” is either a view of the world or an approach to solving a problem. Rodger’s “model” is an approach, which is different than how to evaluate. This is a model of how to think about quality in mental health as applied to a PCMH.
i. First, make the problem obvious to policy makers. Produce measurements that shame the world into taking MH seriously.
ii. The results of the measurement system will identify the solution, but don’t make that proposal in this paper. Invite other practices to measure this for you, and get good at collecting the data.
iii. In another paper, use the results of the measurement system to make this case.
f. Ben provided an 18 segment framework in the shape of a cube
i. Access, outcome, cost
ii. Population, person, practice
iii. Cost & quality

g. Amanda: pretty complex. Cut the Gordian knot: just pick three measures and state them as a starting point that strips away the complexity of all the past thinking.
i. Pick them to fit your conceptual framework, but don’t explain the framework
ii. Get away from cubes and trees and other complex constructs
iii. Stimulate people’s imaginations to understand how to use the measures, both to collect and to apply
1. Improve the precision with which the metrics are described
2. Don’t rely on only EMR; there are other methods… and EMRs are not always (maybe not usually?) simple data collection devices
iv. Remove everything else; there is too much stuff in this paper
h. Review of the metrics
i. Suggestion: start with a simple outline – what is the minimum necessary for the message
ii. Assertion: Behavioral care is in trouble; there is a lot of unmet need, quality of care is poor…
iii. The characteristics of ideal care are uncertain. Many proposals; a range of suggestions…
iv. Systematic improvement requires agreed upon measures and common goals/consensus
1. Berwick’s triple aims, as an example of selective focus on key components
2. Peek’s relates directly to the mental health world
3. Identify the deficits in current measures; don’t compare the two above but use them as examples of what good measures look like
4. Note that most/all of the measures proposed are process measures, not outcome measures
v. Measures need to be explicit, easily calculable, applicable across multiple settings, transparent (e.g. high face validity), and related to the goals of care
vi. Propose: attend to the following domains that are particularly notable trouble areas:
1. Access
2. Identification
3. Use of evidence based care
vii. Measures:
1. Access
a. 95% of patients seen in less than 1 day (constants – the percent and the number of days – may be placed under discussion)
b. # of 1 day patients/# total patients referred
c. Check the literature on measures of access; managed care has created great metrics to evaluate access
2. Identification (not covered)
3. Use of evidence based care (not covered)

3. Connie’s research request:
a. Connie has transcripts from interviews, surveys, and a field journal intended to identify characteristics related to a set of independent and dependent variables about conducting a quality improvement project in a provider practice.
b. She would like to set up a method of analyzing these data by asking a set of individuals (those who volunteer from this workshop) to sort these utterances into these categories (the two types of variables) and to ask what, if any, conclusions each of us would come to.
c. Proposal: Each volunteer receives a set of PowerPoint slides, with one utterance per slide, to be sorted (using the slide sorter) under a set of “variable” headings, with a conclusion from each person for each header.
d. The conclusions will be collected and discussed at a future workshop meeting
i. Ben, Charlie, Rodger, Abby, Carol McBride agreed to participate

4. Next Fellows Meeting(s): Wednesday, 2:00 – 3:30 p.m., at Given Courtyard Level 4
a. May 19: Matt’s Diabetic study for the next steps to achieve progress
b. May 26: Abby’s questions on statistical tests
c. June 4: (no Connie)
d. June 11: (no Connie or Matt)
e. June 18: (no Connie or Matt)
f. June 25:
g. Future agenda to consider:
i. Rodger’s mixed methods article
ii. How to predict medical events effectively (Ben)
iii. 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)
iv. Future: Informed consent QI: Connie to follow up with Nancy Stalnaker, Alan Rubin will follow up with Alan Wortheimer or Rob McCauly

5. Fellows document – nothing this time – to be reviewed after trialing Wednesday meeting times

Recorder: Connie van Eeghen

Monday, May 10, 2010

Clinical Research Oriented Workshop (CROW) Meeting: May 5, 2010

Present: Matt Bovee, Abby Crocker, Rodger Kessler, Ben Littenberg, Connie van Eeghen (by Skype)

1. Round Table: Abby is applying for a lecturer position to teach statistics; wish her luck!

2. Rodger’s Research:

a. Questions for new behavioral health primary care program: a six month follow up survey on whether location influences perception of attending treatment. Points that followed:
i. Parallel structure of questions and scales used in response
ii. Evaluate the questions by testing what possible response combinations demonstrate
iii. Research question: what motivates people to attend therapy; how to explicitly link this question to the survey? Much discussion on how to think about the three questions from different perspectives, and how to rephrase depending on goals.
b. Human subjects piece on subject flow – based on recent R18 submission
i. Patient consent not needed for QI activity for which there is no intention to publish
ii. If later data is used for publication, it can be used once having received patient consent
iii. Baseline data collection can be collected after patient consent, based on the study design
iv. Flow diagram – technical feedback from Ben
1. Top diamond: negative/positive (not no and yes)
2. Second diamond: less than moderate or greater than/equal to moderate
3. Rectangle: physician recommendations: from automatic clinical system to physician
4. Does patient consent to the study?

3. Ben: updates from NHANES data, including mortality data that may not be perfect (birthdates and death dates) for 13 years

4. Next Fellows Meeting(s): Wednesday, 2:00 – 3:00 p.m., at Given Courtyard Level 4
a. May 12: Rodger’s paper: “A framework to evaluate mental health as part of the patient-centered medical home,” previously distributed (no Kairn)
b. May 19: Matt’s progress on the Diabetic study
c. May 26: Abby’s questions on statistical tests
d. Future agenda to consider:
i. How to predict medical events effectively (Ben)
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

5. Fellows document – nothing this time – to be reviewed after trialing Wednesday meeting times

Recorder: Connie van Eeghen

Thursday, May 6, 2010

FW: 3rd Annual Transportation Research Expo - 5/12/10

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