Wednesday, September 12, 2012

Clinical Research Oriented Workshop (CROW) Meeting: Sept 6, 2012

Present: Abby Crocker, Kairn Kelley, Amanda Kennedy, Rodger Kessler, Ben Littenberg, Connie van Eeghen

1.                  Start Up:  Charlie attended a good initial meeting of a Health Dept advisory group on pain management – a receptive group, with a new and very interested analyst.  New limitation of VPMS: the largest prescriber in the state (of opiates) is FAHC, unspecified.  (This probably refers to ED discharges and resident patients.)  This is because the vendor drops the identifying information in the provider field. 

2.                  Presentation: Kairn: what does probability mean in the context of inter-rater agreement
a.       Probability has 2 schools of thought (per Ben):
                                                  i.      Traditional: A probability is a fact, that is represented by the average and standard deviation of real world trials.  Usual example: coin toss.
                                                ii.      Bayesian: A probability is an opinion, or a prediction, about the world, that is more/less well informed.  Each is conditional, based on other probabilities.  Usual example: card game.
b.      Kairn presented an “ice cream cone” graphic to present the relationships that are possible of the two raters in her study in their agreement, resulting in “pass rate” outcomes

                                                  i.      Each of the 200 words can be evaluated based on the goodness of their inter-rater agreement (there were 34 subjects, each rated by two raters)
                                                ii.      We can hypothesize an ideal level of agreement (97% based on the mean in this data set) to evaluate the goodness of the word in auditory testing (within child agreement).  Note: none of the words rated worse that random agreement.
                                              iii.      Bland-Altman plots the difference of the pass-rate from each word for both raters over all the children rated. (Difference in average pass rates per word.)
                                              iv.      Outliers could be tested with Kairn’s data, in “decile” slices. 

3.                  Next Workshop Meeting(s): Thursday, 2:00 p.m. – 3:30 p.m., at Given Courtyard Level 4. 
a.       Sept 13: Abby: draft manuscript (minus analysis, at this point) (starting at 2:30) (No Ben, Kairn)
b.      Sept 20: Charlie on ways to analyze and understand narcotic prescribing in VT through various data sources and various ways to summarize and present data that are useful to clinicians. This generalizes to other medication categories as well and overlaps with Amanda's Medication Management Project.
c.       Sept 27:
d.      Oct 4:
e.       Future agenda to consider:
                                                  i.      Kairn – review of draft article on IRR  
                                                ii.      Ben: budgeting exercise for grant applications; NHANES – lower female mortality for women taking birth control medications
                                              iii.      Journal Club: “Methods and metrics challenges of delivery-system research,” Alexander and Hearld, March 2012 (for later in the year?).  UVM authors who have published interesting design articles (Kim, Osler)
                                              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: Connie van Eeghen

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