Wednesday, September 26, 2012

Clinical Research Oriented Workshop (CROW) Meeting: Sept 20, 2012

Present: Whitney Calkins, MD, Abby Crocker, Kairn Kelley, Mark Kelly, Amanda Kennedy, Rodger Kessler, Ben Littenberg, Charlie MacLean, Connie van Eeghen

1.                  Start Up:  Introductions and welcome to Whitney Calkins from Family Medicine.

2.                  Presentation: Rodger: The Department of Family Medicine has invited research proposals as part of the Transformation project, to be presented to Academy of Family Practice (1 year), to be followed by a broader project (2 years).  Goal: engage FM faculty in research. 
a.       Can patient engagement and population adherence to EBM guidelines be affected by development and implementation of a patient-centered 'MyActionPlan' that builds upon technology through large-scale health assessment data collection?"
                                                  i.      My Action Plan is an EMR generated document for the patient to take home, in support of shared decision making, e.g. to take cardiovascular medications, etc.  Probably exists as a separate tab from the AVS (After Visit Summary) to highlight what was most important to the patient in support of good health.
                                                ii.      Long term: Wilson Pace is bringing together investigators across the NRN who are building similar assessment tools.
b.      Question:  Can we develop and implement a tool within PRISM  to improve both population care and patient engagement specifically improving reliability of cardiovascular disease management. (To be implemented in one FM practice for this study.)
                                                  i.      Specific focus: CV goals (medications, smoking) with some clinical goals, either object (blood pressure) or categorical (better, worse, the same). 
                                                ii.      Research goal is to develop and implement in one site. 
                                              iii.      The evaluators/funders (Tom and John) are in support of this product development focus.  Resource: .25 FTE protected faculty time, with the support of PRISM developers to the extent needed.  This depends significantly on organizational decision making.
                                              iv.      Consider the construct: does goal setting affect behavior?  This can be tested on paper and does not necessarily depend on an EMR intervention (e.g. SMART goal setting; Excel spreadsheet 10 year projections related to patient risk factors).  There are also current web based interventions:
1.      The current literature indicates that goal setting in the provider office has limited support in connection with health outcomes.
2.      Self-efficacy literature does support links to positive outcomes, which links this work to a larger model of prevention effectiveness. 
                                                v.      Possible focuses (#1 below grew to be highest in interest):
1.      Collect data for patient goal setting and report – is this Novel?  Maybe good for infrastructure, if not of national interest.  Should be publishable.
a.       30 minute visit
b.      Structure conversation, e.g. SMART
c.       Specific to the patient’s selected issue (EtOH,…) – select which THIS project will focus on
2.      Report/plan goes with patient
3.      Report in PRISM
4.      Self-efficacy: patient belief/feeling about their ability to change
5.      Develop a SmartForm to support EBP patient care and generate an action plan (clinical decision support).  Test as to whether it has an effect on patients.
a.       Physician use of SmartForm likely to be low
                                              vi.      Approach
1.      Develop on the conference table/role plan
2.      Pilot in one clinic with one/few providers
3.      Develop as a PRISM specification (in the future)
                                            vii.      Evaluate
1.      Validation by patients in response to whatever the focus is producing, e.g. a standard goal setting exercise
2.      Identify a measure for change in “patient engagement”
3.      Include measures that matter to your future audiences: cost, time, and utilization
c.       Aims
                                                  i.      Develop 'MyAction Plan'
1.      develop an health assessment for patient-generated data
2.      use that date to develop an individualized self-management plan
                                                ii.      Implement My Action Plan in one FM practice
1.      develop EBM Cardiovascular content
2.      develop the CV SmartForm
3.      integrate SmartForm elements with the Action Plan incorporating data from health assessment
                                              iii.      Measure and Assess
                                              iv.      If there is time, develop a comprehensive set of SmartForms that include other chronic diseases
d.      Further research.  Generalize the My Action Plan beyond CVD first to other FA sites and then in a larger trial
e.       Next steps: narrow the focus and declare boundaries by early next week.  Proposal is due by next Wednesday. 

3.                  Next Workshop Meeting(s): Thursday, 2:00 p.m. – 3:30 p.m., at Given Courtyard Level 4. 
a.       Sept 27: 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. (No Amanda)
b.      Oct 4:
c.       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.      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.  Also: Prezi demo. 
                                              iv.      Amanda: presentation and interpretation of data in articles

Recorder: Connie van Eeghen

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