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
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
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