Monday, August 26, 2013

Clinical Research Oriented Workshop (CROW) Meeting: Aug 28, 2013

Present:  Marianne Burke, Kat Cheung, Abby Crocker, Ben Littenberg, Charlie MacLean, Connie van Eeghen
Guest: Thomas Joseph visiting from India

Start Up: Next semester’s schedule will start August 29 on Thursday’s from 11:45 to 12:15.  Noted also were the finer points of grant writing, which includes planning and delivering letters of support – and which also includes the fine art of diplomacy.

1.                  Discussion: Abby provided an update on a group research project around the Natural History of Opioid Use, based on the all payor claims data base for VT.  The question is: what predictors can we find that result in long term opioid use.  The original time frame has been adjusted due to access barriers and usability of the source data.
a.       How to maintain momentum: keep this project going and define a more focused topic that could move forward more quickly using, for example, another national data base.
b.      Barriers related to the current project: hardware, software, and political issues
                                                  i.      Software: it takes time to use the tools
                                                ii.      Policies: a new IRB-like entity to sort out; similar process
                                              iii.      Steve is able to do extract (1% of total, but without medical claims – it just has pharmacy claims); resides on Charlie’s desktop.  Have not yet tackled linking the data sets.
                                              iv.      Hardware: keep running into size limits.  NATIZA hardware does have capacity but cannot run STATA (SPSS only, which no one uses any more).  Limited to IBM based software.  Picking the right DB server is really important; Ben will follow up on this.
                                                v.      Will take a while, but is moving forward.
c.       Alternate plans: YRBSS (Youth Risk Behavior Survey System) or BRFSS (Behavior Risk Factors Survey System - adults) to use for a group study.
                                                  i.      BRFSS includes a county field (FIPS code – 5 digit)
1.      Ben has 3 years downloaded; many more years available
2.      Rich data set; many variables, included SES, employment, income, demographics…
3.      No EtOH or drug taking behavior questions
                                                ii.      YRBSS: consider using to develop a predictive model for answering “yes” to opioid use. 
1.      Consider an explanatory model: what risk factors are related to opioid use
2.      Seek clusters: smoking and other behaviors of concern
3.      Key characteristics: age, sex, region…
4.      Changes over time (assuming stability in the survey question)
5.      Some health questions: asthma (for some states), height and weight
                                              iii.      Cross over study from YRBSS to BRFSS for opioid patterns?
                                              iv.      State/territory data are only available upon request; county data in North Carolina and Florida
d.      NAMCS: National Ambulatory Medical Care Survey – a sample of O/P providers, including private practices, EDs, walk-in centers… asking about the clinic, the characteristics of the visit, the drugs on the med list.  No county, but do have MSA and rural/urban designation. 
                                                  i.      The data support time series study
                                                ii.      Abby has already started learning about this source (kid data is in age categories; low numbers)
                                              iii.      Consider determining prevalence of “starts” vs. “continued use” by age group.  What are the patient characteristics (diagnosis)?  May look at a time series later.
e.       DAWN: Emergency room visits involving drugs – a sample from selected cities
f.       The group discussed the research question that will support the longer term study on the natural history of opioid use.
                                                  i.      What can we say about opioid users vs. non-opioid users?
                                                ii.      NAMCS: is available up to 2011; there has been a rising trend of opioid prescriptions, may now be declining – identify the temporal trend in opioid prescribing
                                              iii.      Where does opioid prescribing start?  What setting and how does it change?
g.      Next steps
                                                  i.      Look at NAMCS data – what variables do we have?
                                                ii.      Literature review – now novel?
                                              iii.      Develop a FINER research question
h.      Addendum: After the close of the meeting, Kat circulated a link to a recent NEJM “Perspectives” article entitled: “Abusive Prescribing of Controlled Substances — A Pharmacy View” by Betses and Brennan (Aug 21, 2013), describing a CVS-based program to identify prescribers with abusive prescribing habits, resulting in a policy of refusing to fill the controlled substance prescriptions of selected providers.  Very interesting - to view the article, go to:  Thank you Kat!

2.                  Next Workshop Meeting(s): Starting next week: Thursday, 11:45 a.m. – 1:15 p.m., at Given Courtyard South Level 4.   
a.       Thursday, August 29, from 11:45 – 1:15?: Rodger: Review of Lexicon Checklist
b.      September 5: Abby – Natural History of Opioids projects
c.       September 12:
d.      Future agenda to consider:
                                                  i.      Peter Callas or other faculty on multi-level modeling
                                                ii.      Charlie MacLean: demonstration of Tableau; or Rodger’s examples of Prezi
                                              iii.      Journal article: Gomes, 2013, Opioid Dose and MVA in Canada (Charlie)
                                              iv.      Ben: Tukey chapter reading assignments, or other book of general interest
                                                v.      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

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