Littenberg Interview: Integrating Behavioral Health and Primary Care

Thanks to UVM College of Medicine Office of Medical Communications for posting this video on their YouTube channel.

Special thanks to UVM coinvestigators and staff:  Peter Callas, Abby Crocker, Sylvie Frisbie, Juvea Hitt, Rodger Kessler, Jen Lavoie, Doug Pomeroy, Paula Reynolds, Connie van Eeghen, Jon van Luling.

National Health and Aging Trends Study (NHATS) data released

The National Health and Aging Trends Study (NHATS) is a new resource for the scientific study of functioning in later life. NHATS is being conducted by the Johns Hopkins University Bloomberg School of Public Health, with data collection by Westat, and support from the National Institute on Aging. In design and content, NHATS is intended to foster research that will guide efforts to reduce disability, maximize health and independent functioning, and enhance quality of life at older ages.

Starting in 2011, NHATS has been gathering information on a nationally representative sample of Medicare beneficiaries ages 65 and older. In-person interviews collect detailed information on activities of daily life, living arrangements, economic status and well-being, aspects of early life, and quality of life. Among the specific content areas included are: the general and technological environment of the home, health conditions, work status and participation in valued activities, mobility and use of assistive devices, cognitive functioning, and help provided with daily activities (self-care, household, and medical). Study participants are re-interviewed every year in order to compile a record of change over time. The content and questions included in NHATS were developed by a multidisciplinary team of researchers from the fields of demography, geriatric medicine, epidemiology, health services research, economics, and gerontology.

As the population ages, NHATS will provide the basis for understanding trends in late-life functioning, how these differ for various population subgroups, and the economic and social consequences of aging and disability for individuals, families, and society.

National Health and Aging Trends Study (NHATS) Round 4 Public Use Data files are now available for download at http://www.nhatsdata.org. Data are available in both SAS and STATA formats. Round 4 annotated data collection instrument sections, including those from the Last Month of Life interview, and a crosswalk between the instruments and the codebook can be found at http://www.nhats.org/scripts/dataDocum.htm.

Additionally, Round 4 Sensitive Data Files, including the Sample Person (SP) Sensitive Demographic and Other Person (OP) Sensitive Demographic file, have been released. Information on how to apply for access to these sensitive data can be found at http://www.nhatsdata.org/ResDataFiles.aspx.

Blowing Smoke: The Lost Legacy of the Surgeon General's Report

Good morning!

The Vermont Center for Behavior and Health is very excited to welcome Alan Blum, M.D., who will speak about "Blowing Smoke: The Lost Legacy of the Surgeon General's Report," as part of our monthly lecture series on Wednesday August 26, 2015. One of the foremost authorities on tobacco problems, Dr. Blum is the director of the University of Alabama Center for the Study of Tobacco and Society, which he established in 1999.

Please forward the attached event announcement and dial-in instructions to your email lists (listservs). Also, if possible, please print and post in your department.

Dr. Blum's lecture is scheduled for August 26, 2015, from Noon to 1 p.m., in the Davis Auditorium. If you are unable to attend in person, please follow the easy directions to watch from your computer or dial-in conference room.

Thank you!

--

Marissa Wells

Research Staff Assistant

Vermont Center on Behavior and Health

University of Vermont

802.656.0079

http://www.uvm.edu/medicine/behaviorandhealth

UVM-Led Research Team Approved for $18.5 Million Award to Study Integrated Primary Care and Behavioral Health

August 21, 2015 For immediate release Contact: Jennifer Nachbur, (802) 656-7875 UVM-Led Research Team Approved for $18.5 Million Award to Study Integrated Primary Care and Behavioral Health BURLINGTON, VT – A University of Vermont-led research team has received approval for $18.5 million in funding to study whether patients with both medical and behavioral problems do better when their primary care physicians work in combination with behavioral health professionals including psychologists and social workers. Benjamin Littenberg, M.D., professor of medicine and Henry and Carleen Tufo chair in general internal medicine, gathered colleagues at UVM and across the country for a five-year research project, titled "Integrating Behavioral Health and Primary Care." The Patient-Centered Outcomes Research Institute (PCORI) selected Littenberg's project as one of four out of 124 original applications to receive funding. Based in Washington D.C., the organization seeks to answer questions that patients and their clinicians face daily and find approaches to health care that work best for the end user. Littenberg's UVM colleagues Rodger Kessler, Ph.D., associate professor of family medicine, and Constance van Eeghen, Dr.P.H., assistant professor of medicine, will help lead the project as co-principal investigator and project director respectively.   Patients with chronic illnesses, such as diabetes, heart disease or asthma that are exacerbated by behavioral difficulties -- anxiety, depression, alcohol or drug abuse, poor diet, smoking, sleep disruptions or lack of exercise -- particularly need to address those personal problems, but often struggle to do so. Their doctors might refer them for cognitive behavioral therapy or motivational interviewing to help them change their habits. Those personal challenges "heavily influence how their medical problems turn out," Littenberg says. "Also, their medical problems influence the severity of their behavioral problems." But the inconvenience and cost of going to another doctor, making another appointment and dealing with another billing office -- on top of managing their physical problems -- often prevents them from starting or continuing that behavioral treatment, says Littenberg, an expert in examining the patient experience to improve the health care system. In some cases, behavioral therapists are located within a primary care practice -- called "co-location" -- but, according to Littenberg, that arrangement doesn't eliminate all of "When it works, it works great, but it doesn't work well often enough," he says. The PCORI grant will allow Littenberg's team to look more closely at the benefits of fully integrating behavioral health care with medical care. The clinicians would collaborate -- possibly sharing notes, using the same nurses and support staff -- and even coordinate their appointment and billing offices. "The question here is really about how to design the systems for better care," says Littenberg. The researchers propose to include 30 practices nationwide and as many as 60 patients at each, for a total of 1,800 cases. The group will compare the integrated practices to those using the co-located model. The project team also includes three patients who will serve as funded co-investigators -- not just as consultants or advisors -- and who have dealt with their own or a family member’s chronic illness and behavioral health problems. The patients, who all live in Vermont, will sit alongside medical and academic professionals in guiding the study's progress. "At every turn, we want to be able to get their input," Littenberg explains. "We need them to keep us focused on what's important to the patients all along. To do that, they need to be at the table as we're making decisions." The inclusion of patients on the investigation team isn't unusual for studies funded by PCORI, because of its patient-oriented mission, says Christine Stencel, the institute's associate director of media relations. "But this is essentially a new thing for health research" in general, she says. "This study is among those that are really leading the way and demonstrating how the patients can be partners and not just subjects." To measure the integrated systems, Littenberg's team will rely on the patients themselves: how they're doing; how successfully they get treatment for their problems; how much those problems, their daily lives and their health improve. If the study can help remove some hurdles for these hard-to-treat patients, it could provide insights into ways to increase efficiency, cut costs and improve patient outcomes across the entire health care system, Littenberg suggests. "If it was easy," he says with a smile, "we would have done it years ago."                            ###

Kristi Johnson's Thesis to appear in the Journal of Lymphatic Research and Biology

Many congratulations to Kristi Johnson, MS. Her CTS thesis on "Ultrasound and clinical measures for lymphedema" has been accepted for publication in Lymphatic Research and Biology. Great work, Kristi!

Ross Colgate, CTS PhD Student, busy promoting Gates Foundation Grant received by the UVM Vaccine Testing Center

You might be interested in seeing Ross Colgate, PhD student in Clinical Translation Science and research analyst with the Infectious Disease Unit of the Department of Medicine in various media interviews regarding the new research grant awarded by the Gates Foundation (BMGF) to the UVM Vaccine Testing Center.

Media links:

ABC22/Fox44
http://www.mychamplainvalley.com/news/uvm-vaccine-testing-center-receives-grant-to-study-oral-vaccine-failure-in-less-developed-countries

WCAX

http://www.wcax.com/story/29719321/grant-to-fund-uvm-rotavirus-study

UVM Press Release

http://www.uvm.edu/medicine/?Page=news&storyID=21242&category=comstude

Clinical Research Oriented Workshop (CROW) Meeting: August 7, 2015

Present:  Marianne Burke, Nancy Gell, Kairn Kelley, Ayodelle LeBruin, Ben Littenberg, Connie van Eeghen

Start Up: Family drama is everywhere.

1.                  Discussion: Nancy Gell: Cancer Survivorship Exercise Adherence

a.       Nancy provided preliminary findings from analysis of “steps to wellness” data base

b.      The underlying issue: how would you intervene during Oncology Rehab to improve later adherence?

                                                  i.      What are the characteristics of the program that result in adherence 3 months after discharge?

1.      Age: not a predictor of interest; may be a confounder.  May indicate a need for a different intervention.

2.      Attendance: a variable that measures interaction of both patient and program

3.      Program: doesn’t vary

c.       Research question: what are the characteristics of patients that predict long term exercise

d.      Analytical plan:

                                                  i.      Use data at the start of STW as potential predictors

                                                ii.      Consider data at the end of STW as potential predictors as well

                                              iii.      Outcome data are limited to the 79 patients that completed the 3 months post data collection process

1.      Missing ~100 people’s data; that’s a lot to assign a “zero” score to

a.       The missing data are not missing randomly

b.      They did not finish the program (Baseline 288 – 162 = 126)

                                                                                                                          i.      Many are likely to be non-exercisers

                                                                                                                        ii.      Did not complete yet? These were taken out.

c.       They finished the program but could not be found (154 – 79 = 85)

                                                                                                                          i.      Did they die?

2.      54% of the 79 were exercisers: 43; 43/288 = 15% long term exercisers (Meets the PA recommendation); or 1 in 7 patients is a success

3.      If the program costs $100/person, then a success costs $700

                                              iv.      But we do know that whether the 288 met PA recommendations; for those that don’t have data afterwards, they are assigned their baseline status

                                                v.      With the 10:1 rule, there is room for about 5 predictors

1.      1 variable for every 10 positive patient outcomes

                                              vi.      Build a descriptive model and find the most strongly associated variables

1.      Age, sex, timing BMI, CA type (Table 1 characteristics), also including fatigue, PHQ9

a.       Eliminate those for which no action is possible from a programmatic perspective

b.      Outcomes: meets PA recommendations or GLTEK

2.      Identify most likely predictors

3.      Sub-analyses: sub groups

4.      Univariate analysis (loss of interactions)

e.       Come back with next step!

2.                  Next Workshop Meeting(s): Fridays, 12:00 p.m. – 1:00 p.m., at Given Courtyard South Level 4.   

a.       August 14: Kairn: Update on manuscript draft

b.      August 21: Marianne: Update

c.     August 28: Nancy: Preliminary findings from analysis of “steps to wellness” data base

d.      Future: Connie’s Pfizer application and reviewer comments

Recorder: Connie van Eeghen