Monday, July 2, 2012

Clinical Research Oriented Workshop (CROW) Meeting: June 28, 2012

Present: Kairn Kelley (by phone), Rodger Kessler, Connie van Eeghen

1.                  Start Up:  Affordable Care Act passed – we will have a better battle ahead of us.

2.                  Presentation: Rodger and Connie shared the critique received they on their R03 application, which did not get scored well enough for an in-depth review.  The agenda for this CROW session will be focused only on comments related to “Significance” due to a conflict in Rodger’s schedule. Other topics will be discussed in future meetings; comments are welcome from all. 
a.       Weakness: Link of workflow implications to patient outcomes, conceptually, not developed
                                                  i.      Discussion: Connie found no existing model in the literature. Her dissertation showed a relationship (association, not causal) between clinician perception of processes and clinician perception of clinical outcomes. The Helfrich model proposed determinants of implementation effectiveness which were ultimately linked to measures of success, but this model is not specific to workflow (i.e. Lean) or to patient outcomes.
                                                ii.      Strategy: Look to following sources for rationale and associations between process and clinical outcomes: Sarah Scholle (NCQA VP of Research and Analysis) regarding survey data on associating processes and clinical outcomes and Katon & Unutzer’s body of work from the MN Collaborative Care experiences (AHRQ 2008 evidence report on collaborative care and MH outcomes).
b.      Weakness: Outcome Variables of specific Aims are process based rather than clinical.  Possible Strategies:
                                                  i.      Add initial and follow-up patient screening scores to the outcome measures
1.      Screening measures exist at the clinic level and can be used in before/after comparisons
2.      Unclear if GAD or PHQ are accessible and used consistently in the process
3.      Outside the scope of the project to get patient contact data
4.      Should it be the primary measure?
a.       Not clear (some sites will be using the screening but will not use panel based management or there won’t be an onsite clinician)
b.      How could/should differences in 6 month change scores be linked back to the toolkit?
c.       Should we have a comparison base? We’ll have the data base, so it’s not a large task to include other practices.  However, based on a two site pilot study, we will not have the power necessary to establish relationships.
5.      Are we changing the MISSION of this project?
a.       Toolkit is a solution to help practices change
b.      Not trying to test if PCBH makes a difference in screening outcomes.
c.       We would have to add practices that have PCBH but don’t have the toolkit intervention.
d.      Outcome: reduced costs, happier staff, PRESUME patients will have better outcomes. Staff satisfaction is an example of an outcome of successful implementation, which is the goal of the toolkit. 
e.       How do you get to demonstrating clinical outcomes to be consistent with the mission and responsive to the critique?
                                                ii.      Make it clear that the primary outcome is process based: treatment initiation
                                              iii.      Also trying to put clinical outcomes in place for future evaluation and an important part of future research.  In doing so, the toolkit should include measurement of clinical outcomes. 
c.       Rodger and Connie will continue to work on these and other weaknesses.  Part of their work is to develop a strategy that makes it easy for reviewers to see how their comments were responded to. 

3.                  Workshop Goals for 2012:
a.       Journal club: identify UVM guests and articles; invite to CROW ahead of time
b.      Research updates: share work-in-process

4.                  Next Workshop Meeting(s): Thursday, 11:00 p.m. – 12:00 p.m., at Given Courtyard Level 4. 
a.       July 5: Abby – research update (no Kairn)
b.      July 12: (Connie by phone, no Abby or Kairn)
c.       July 19: (no Abby or Ben)
d.      July 26: (no Ben)
e.       Aug 2:
f.       Aug 9: (no Abby)
g.      Aug 16: (no Abby)
h.      Aug 23:
i.        Aug 30: (new schedule?)
j.        Future agenda to consider:
                                                  i.      Ben: budgeting exercise for grant applications
                                                ii.      Ben: Writer’s workshop on the effect of the built environment on BMI (Littenberg & Austin Troy)
                                              iii.      Journal Club: “Methods and metrics challenges of delivery-system research,” Alexander and Hearld, March 2012 (for later in the year?)
                                              iv.      Rodger: Mixed methods article; article on Behavior’s Influence on Medical Conditions (unpublished); drug company funding.  Also: discuss design for PCBH clinical and cost research.
                                                v.      Amanda: presentation and interpretation of data in articles
                                              vi.      Sharon Henry: article by Cleland, Thoracic Spine Manipulation, Physical Therapy 2007

Recorder: Kairn Kelley

No comments:

Post a Comment

Note: Only a member of this blog may post a comment.