Mind the translational gap: Stories from Harvard University’s Clinical and Translational Science Center

VCIID (COBRE) Seminar - 9 AM on Friday, April 6, 2012 in HSRF 400. 
Presented by:   Isaac Bernstein-Hanley, PhD
                 Research Associate in Clinical and Translational Research
                 Harvard University

Topic:           "Mind the translational gap: Stories from Harvard University’s Clinical and Translational Science Center"

How can we effectively promote, in an academic setting, translation of basic scientific discovery into improvements in human health?

How do we bridge the different disciplines ­ and sometimes different cultures ­ of the biomedical research enterprise?

Dr. Bernstein-Hanley will talk about Harvard University’s Clinical and Translational Science Center and some of their efforts

to promote collaborative translational research across Harvard and its many academic and healthcare affiliates.

Here is a link to Pub Med for any of Dr. Bernstein-Hanley's publications:  http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?orig_db=PubMed&db=PubMed&cmd=Search&term=Bernstein-Hanley+I[auth]

In addition, here is a link to his webbio at the Harvard Clinical and Translational Science Center:  http://connects.catalyst.harvard.edu/profiles/profile/person/32019

Clinical Research Oriented Workshop (CROW) Meeting: March 22, 2012

Present: Kairn Kelley, Ben Littenberg, Charlie MacLean, Connie van Eeghen

1. Check In: Cleveland may rock, but it’s a long way from Boston and it’s NOT Boston.

2. Presentation: Kairn – Next step is an article analyzing inter-rater scoring reliability; need feedback on structure and process.
a. This article will support the future study planned around the goodness of the tests being compared.
b. Research question: What is the inter-rater reliability (IRR) for scoring the dichotic words test in a convenience sample of children aged 6 – 11 years of age. Two certified clinicians, who were present for the same test, scored whether the child stated both words and if incorrect, what the word the child spoke was. Each child was tested with 100 pairs of words from a test not publically available and still under development. The test scores were entered in Excel and run through Stata. Data about children:
i. Age (6-11)
ii. Some sibling pairs
iii. Left/right handed
iv. Hearing sensitivity (mostly normal)
v. No known ADD
c. Definition of IRR:
i. The number of target words that the raters agreed on (binary: yes/no): proportion. Hard to interpret, unless there is a pattern. (n=8000) It evaluates the raters, not the kids.
ii. Number of target words agreed on: proportion (n=200). Did the raters rate the words the same.
iii. Mean score agreement by word (comparing average scores for each word) (Kairn had a great graph that generated this) – shows variability within the word list and could answer the question “what are the best words” – which is NOT the research question: mean difference. (n=200) Evaluates the words more than the raters. Did the raters agree on average.
iv. Mean score by subject: mean difference (n=40). At what point is the difference is important? Coefficient of variation (CV): the difference/standard deviation. However, the population of scores does not have a normal distribution, but there is no non-parametric equivalent to the CV.
v. By pass/file – to identify the threshold for passing the test proportion (n=40). This is the test for diagnosis – it affects clinical behavior. However, an accepted threshold does not yet exist and the children were not necessarily homogenous in hearing ability.
d. Tables that will answer the question: definitions 2 and 3 and 4 (as a summary) above.
i. For each word, the two raters P/F combinations A:P/F and K:P/F
ii. % P of A
iii. %P of K
iv. %P of mean (where P represents Pass)
v. # agree
vi. # disagree
vii. Mean difference
viii. % Agree
ix. Kappa
x. CI%
xi. P value
e. The tables themselves can start with the total number of words (200) for each of the above (plus the table total “All”), and then focus on the best and worst IRR scores.
f. The next layer is the total number of subjects/children (40). Subgroups:
i. Gender (M/F)
ii. Age (Old/Young by median) – or grade in school
iii. Handedness (L/R)
iv. High/Low scores (by median)
v. Hearing loss/no hearing loss
g. Other tables
i. Description of subjects
ii. Subject flow (how many invited, how many accepted, how many eligible, how many completed, …)
iii. “What if” tables – impact of dropping the hard words (which would improve the standard deviation) – is this a separate paper?
iv. IRR of recorded utterances – also another paper.
h. Draft article to Seminar on Friday, May 3

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, 1:00 p.m. – 2:30 p.m., at Given Courtyard Level 4.
a. Mar 29: Charlie: Writers’ workshop Errors in Screening for Diabetic Kidney Disease
b. Apr 5: Rodger (topic TBD, perhaps Wilson Pace as guest?) or Steven Schroeder, MD: Improving Health in America – Why Change Comes So Hard from 12:00 – 1:30 in Davis Auditorium; reception to follow in HSRF 100, Hoehl Gallery ???
c. Apr 12: ask Amanda for a Journal Article (no Connie)
d. Apr 19: Kairn: draft article on Inter-Rater Reliability
e. Apr 26:
f. 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
vii. 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)

Recorder: C. van Eeghen

Friday Seminar Replacement Activity – Friday March 23, 2012

HRSA Health Information Technology & Quality Webinar

Friday March 23^rd 2pm

“Using Health IT for Patient Safety”

James Battles (AHRQ)

Steven W. Chen (USC)

Dr. Eric Gayle (Institute for Family Health)

The speakers presented a review of quality improvement theory, including Donabedian’s structure-process-outcome framework and then spoke about the use of HIT to improve patient safety and some the limitations of current HIT. One of the limitations that I found interesting was the presence of fragmented HIT systems – for example, different electronic systems that are not compatible and/or can’t communicate with one another. As a specific example, they explained that providers can electronically prescribe medications but they can’t tell if a patient is picking the medications up from the pharmacy. The patient’s EHR may have a list of medications but there is no information about the frequency with which the prescriptions are being refilled. There are also issues of system compatibility and communications between healthcare systems (for example, between a hospital and a non-affiliated nursing home).

This was a “live” webinar, so I don’t have a link to share with the CTS community. However, HRSA generally archives webinars within two weeks of occurrence, so if anyone is interested I can pass the permanent link along once it is available.

Clinical Research Oriented Workshop (CROW) Meeting: March 15, 2012

Present: Abby Crocker, Kairn Kelley, Ben Littenberg, Charlie MacLean

1. Presentation: Abby shared about her recent conversation with Dr. Robert Wheeler from BC/BS about the proposed hub-and-spoke methadone treatment legislation. BC/BS website was recommended for policy events.

a. There was general discussion about the challenges of maintaining a mission driven organization, pay-for-performance plans, and related ethical dilemmas.

b. Abby’s next conversation is planned with Barbara Cimaglio, Deputy Commissioner of the Vermont Alcohol and Drug Abuse programs.

2. Update: Charlie gave an update on the status of the VHCURES database.

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, 1:00 p.m. – 2:30 p.m., at Given Courtyard Level 4.

a. Mar 22: Kairn - analysis of inter-rater scoring reliability data (no Abby)

b. Mar 29: Ben: Writer’s workshop on the effect of the built environment on BMI (Littenberg & Austin Troy)

c. Apr 5: Rodger (topic TBD, perhaps Wilson Pace as guest?) or Steven Schroeder, MD: Improving Health in America – Why Change Comes So Hard from 12:00 – 1:30 in Davis Auditorium; reception to follow in HSRF 100, Hoehl Gallery

d. Apr 12: Journal Club: “Methods and metrics challenges of delivery-system research,” Alexander and Hearld, March 2012

e. Future agenda to consider:

i. Ben: budgeting exercise for grant applications

ii. 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.

iii. Amanda: presentation and interpretation of data in articles

iv. Sharon Henry: article by Cleland, Thoracic Spine Manipulation, Physical Therapy 2007

v. 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)

Recorder: K. Kelley

Friday Sem Replacement Activity – Week of March 16th

Presenter: Dr. John C.M. Brust, MD (Columbia University Medical Center)

Topic: Neurology of Music

NIH Clinical Center Grand Rounds

Wednesday March 14th at 12:00 pm

Link to Presentation Webcast: http://videocast.nih.gov/launch.asp?17164

Dr. Brust discussed the similarities and differences between how our brains read and write language and read and write music. He presented several case studies of individuals with preserved musicality in the presence of aphasia.

I found it interesting that naïve, untrained listeners appear to listen to music with almost entirely their right hemispheres while more sophisticated listeners tend to listen with their left cerebral hemisphere. Researchers in Columbia’s psychology department have concluded that this is because the right hemisphere is emotional and the left hemisphere is analytic – when you are more familiar with music you tend to analyze it more as you listen to it.

Improving Pediatric Medication Management

Week of March 9th

Friday Afternoon Seminar Replacement Activity

ACT Sheets: Clinical Decision Support Tools for Bridging Genetics, Primary Care and Public Health

Speakers: Barry Thompson, MD (Medical Director at American College of Medical Genetics) and

Alisha Keehn, MPA (NCC Project Manager)

Originally presented at HRSA on February 14^th 2012

Accessed March 9^th 2012

Link: https://services.choruscall.com/links/hrsa110310.html#

The ACT sheets (or Action Sheets) were developed as part of a collaborative agreement between the American College of Medical Genetics and HRSA’s Maternal and Child Health Bureau, and were intended to be a tool to guide the infant screening process. They are clinical decision support tools.

The QuIIN (Quality Improvement and Innovation Network) project was conducted by the American Academy of Pediatrics and the American College of Medical Genetics with the intent of conducting a quality and utility analysis of the ACT sheets in 15 diverse primary care practices.

An interesting outcome of the study was that 86.7% of the participating sites reported that they found the ACT sheets improved the newborn screening process in their practice and helped develop a plan of action between parents and providers with no additional provider time necessary. The study also found that the primary care practices participating in the study increased their use of clinical decision support tools after the study.

Congratulations to Assistant Professor Rodger Kessler, PhD who just published:

Mental Health Care Treatment Initiation When Mental Health Services Are Incorporated Into Primary Care Practice. 

J Am Board Fam Med 2012; 25:255-259.

Abstract

Purpose: Most primary care patients with mental health issues are identified or treated in primary care rather than the specialty mental health system. Primary care physicians report that their patients do not have access to needed mental health care. When referrals are made to the specialty behavioral or mental health care system, rates of patients who initiate treatment are low. Collaborative care models, with mental health clinicians as part of the primary care medical staff, have been suggested as an alternative. The aim of this study is to examine rates of treatment startup in 2 collaborative care settings: a rural family medicine office and a suburban internal medicine office. In both practices referrals for mental health services are made within the practice.

Methods: Referral data were drawn from 2 convenience samples of patients referred by primary care physicians for collaborative mental health treatment at Fletcher Allen Health Care in Vermont. The first sample consisted of 93 consecutively scheduled referrals in a family medicine office (sample A) between January 2006 and December 2007. The second sample consisted of 215 consecutive scheduled referrals at an internal medicine office (sample B) between January 2009 and December 2009. Referral data identified age, sex, and presenting mental health/medical problem.

Results: In sample A, 95.5% of those patients scheduling appointments began behavioral health treatment; in sample B this percentage was 82%. In sample B, 69% of all patients initially referred for mental health care both scheduled and initiated treatment.

Conclusions: When referred to a mental health clinician who provides on-site access as part of a primary care mental health collaborative care model, a high percentage of patients referred scheduled care. Furthermore, of those who scheduled care, a high percentage of patients attend the scheduled appointment. Findings persist despite differences in practice type, populations, locations, and time frames of data collection. That the findings persist across the different offices suggests that this model of care may contain elements that improve the longstanding problem of poor treatment initiation rates when primary care physicians refer patients for outpatient behavioral health services.

Click here for the full text.

Links to Dollars for Docs Data, Response Rates to Surveys, and How to Cite a Tweet

I came across some random things on the web today that might be of interest to others. I share some here in no particular order:

• Info about ProPublica's compilation of pharmaceutical companies' reports of payments to providers at About the Dollars for Docs Data
  

• "Response Rates in Organizational Science, 1995–2008: A Meta-analytic Review and Guidelines for Survey Researchers" looks at the interactions between different types of incentives and response methods and different types of respondents to 2,037 surveys in a recent 13 year period. It includes a table of expected response rates from different respondent types (i.e., consumer respondents, non-managerial respondents, top-management respondents, etc) by percentile for researchers' planning purposes.

• MLA instructions on how to cite a tweet in an academic paper here
• Or for a giggle see the PhD Comic Methodology Translator.

Kairn Kelley