Thursday, September 11, 2014

Clinical Research Oriented Workshop (CROW) Meeting: Sept 4, 2014

Present:  Marianne Burke, Kat Cheung, Kairn Kelley, Amanda Kennedy, Rodger Kessler, Ben Littenberg, Connie van Eeghen

Start Up: Ben did a demonstration of a spontaneously dictated letter of support for Rodger and Connie’s SIM grant to the State of Vermont.   We also reviewed Rodger and Connie’s data flow management diagram and began to define the operational issues.  There is an obstacle regarding linkage of claims and clinical data.  Plan B is limited to incoming data streams from the practice EHRs that provide only primary care service information.  Incoming data streams from the all payers claims data might be able to match to primary care services from the EHRs.  This doesn’t provide patient level analysis, but may provide practice level analysis.

1.                  Discussion: Rodger and Connie: SIM grant draft review
a.       What data will be available for analysis:
                                                  i.      Facilitation data
                                                ii.      Clinical data
                                              iii.      Focus group
b.      It was not clear from the start that this is an intervention: MORE than just a demonstration/ observation project. 
                                                  i.      Which are being facilitated?  All 15? 
                                                ii.      Before and after comparisons
                                              iii.      What is the non-study comparator – for all the other practices we can know about?  In other words, how to evaluate secular trends?
1.      Before and after for arm 3
2.      Before and after for arms 1 and 2
c.       Suggestion: Identify 15 or more practices
                                                  i.      Recruit twice as many practices as can be facilitated (12 facilitated; 10-20 control; 30 total)
                                                ii.      Randomly assigned to intervention
1.      Two arms
a.       Integrated or not
b.      Improve VIP scores or not
                                                                                                                          i.      Do VIP scores correlate with outcomes
2.      Three arms, with sub-stratification to prevent downgrading
                                              iii.      Intervention for 18 months: use hard driving facilitation
                                              iv.      Compare integration with non-integration, using step-wedge (Rodger added this later)
d.      Questions
                                                  i.      Do VIP scores correlate with outcomes
                                                ii.      Can VT do integration: did VIP scores go up
                                              iii.      Did it make a difference: did changed VIP scores correlate with changed outcomes
                                              iv.      (Per Rodger, these questions are consistent with NCQA questions)
e.       Conclusion: 15 practices, all receiving facilitation over time, all with before/after comparisons of VIP and patient assessment scores

2.                  Next Workshop Meeting(s): Thursdays, 11:30 a.m. – 12:45 p.m., at Given Courtyard South Level 4.   Remember: the first 15 minutes are for checking in with each other.
a.       Sept 11: Kairn: draft of lit review
b.      Sept 18: Marianne: draft of IRB application
c.       Sept 25: ???

Recorder: Connie van Eeghen

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