Clinical Research Oriented Workshop (CROW) Meeting: May 30, 2013

Present:  Marianne Burke, Kairn Kelley, Rodger Kessler, Ben Littenberg, Charlie MacLean, Connie van Eeghen

1.                  Start Up: New aptonym: a speech/hearing researcher name Dr. Speaks! 

2.                  Journal Article Review: Journal article by Feldman, 2013, “Impact of Providing Fee Data on Laboratory Test Ordering,” JAMA Internal Medicine (not the same as JAMA)

a.       Classic study to test method of reducing unnecessary lab orders, repeated here by attaching Medicare charges; no evaluation of effect on patient care

b.      Result: reduce by 1/3 of a test/day: significant difference

c.       Problems:

                                                  i.      Test panels were not symmetrical; numbers of tests (70) too low for comparable groups.  This may have been due to poor stratification.

                                                ii.      Financial benefit found was probably limited

                                              iii.      No measure of impact on patient: did the providers reduce orders for unnecessary tests?  Did they reduce orders for necessary tests?

                                              iv.      Not novel: a change in signal usually does result in a long term change in behavior. 

d.      Useful?  Do ACO’s want to reduce lab tests, when a missed test result could end up with a patient in the hospital instead?  Will they want to focus on the protocols for populations that generate lab orders?

e.       How to change this study re: changing behavior by displaying charges?  Leaving the research question alone, randomize 100 AMCs, half of which get displayed charges.  Time series analysis, or phased “turn on” individual lab tests.  Also, re-examine the relationship between the tests from a clinical perspective. 

3.                  Next Workshop Meeting(s): Wednesday, 11:30 p.m. – 1:00 p.m., at Given Courtyard South Level 4. 

a.       Wednesday, June 5: NOTE: New summer schedule starts: Wednesdays, 11:30 – 1:00.  Abby: Journal article (no Connie, Ben; Kairn to phone in)

b.      Wednesday, June 12: Marianne: Feedback on ideas for web site that will help CTS students (faculty, and fellows too)  find/know /access, evaluate/apply content and literature they need for courses and research (Kairn to phone in)

c.       Thursday, June 13: 2:00 – 3:30 Wilson Pace, Director & Dave West from the largest practice based research networks from American Academy of Family Physicians; access to Medicaid data base.  Kairn, Abby, Charlie can all make it. 

d.      Wednesday, June 19: (Kairn to phone in)

e.       June 26: (Kairn to phone in)

f.       July 3:

g.      July 10: Marianne: Review of literature review (no Connie)

h.      July 17:

i.        July 24:

j.        July 31:

k.      August 7

l.        August 14

m.    August 21

n.      August 28

o.      Future agenda to consider:

                                                  i.      Abby and Charlie: data analysis of Exploration of analytical plan for Natural History of Acute Opioid Use

                                                ii.      Peter Callas or other faculty on multi-level modeling

                                              iii.      Charlie MacLean: demonstration of Tableau; or Rodger’s examples of Prezi

                                              iv.      Journal article: Gomes, 2013, Opioid Dose and MVA in Canada (Charlie)

                                                v.      Ben: Tukey chapter reading assignments, or other book of general interest

                                              vi.      Summer plan: each week, one person will send out an article or prezi ahead for review or discussion by all.  Alternatively, if a participant is working on a key document for their professional development, this is also welcome (e.g. K awards, F awards, etc.)

Recorder: Connie van Eeghen