Sunday, January 29, 2017

CCTS faculty and staff publish two new papers on the PIP

Here are a pair of papers from Rodger Kessler, Juvena Hitt, Connie van Eeghen and Ben Littenberg on the development and validation of the Practice Integration Profile, an instrument used to assess the degree to which primary care practices have integrated Behavioral Health Services.

The Practice Integration Profile: Rationale, development, method, and research.
Macchi, C. R.; Kessler, Rodger; Auxier, Andrea; Hitt, Juvena R.; Mullin, Daniel; van Eeghen, Constance; Littenberg, Benjamin
Families, Systems, & Health, Vol 34(4), Dec 2016, 334-341. 
Insufficient knowledge exists regarding how to measure the presence and degree of integrated care. Prior estimates of integration levels are neither grounded in theory nor psychometrically validated. They provide scant guidance to inform improvement activities, compare integration efforts, discriminate among practices by degree of integration, measure the effect of integration on quadruple aim outcomes, or address the needs of clinicians, regulators, and policymakers seeking new models of health care delivery and funding. We describe the development of the Practice Integration Profile (PIP), a novel instrument designed to measure levels of integrated behavioral health care within a primary care clinic. The PIP draws upon the Agency for Health care Research & Quality’s (AHRQ) Lexicon of Collaborative Care which provides theoretic justification for a paradigm case of collaborative care. We used the key clauses of the Lexicon to derive domains of integration and generate measures corresponding to those key clauses. After reviewing currently used methods for identifying collaborative care, or integration, and identifying the need to improve on them, we describe a national collaboration to describe and evaluate the PIP. We also describe its potential use in practice improvement, research, responsiveness to multiple stakeholder needs, and other future directions.

Development and validation of a measure of primary care behavioral health integration.
Kessler, Rodger S.; Auxier, Andrea; Hitt, Juvena R.; Macchi, C. R.; Mullin, Daniel; van Eeghen, Constance; Littenberg, Benjamin
Families, Systems, & Health, Vol 34(4), Dec 2016, 342-356.
Introduction: We developed the Practice Integration Profile (PIP) to measure the degree of behavioral health integration in clinical practices with a focus on primary care (PC). Its 30 items, completed by providers, managers, and staff, provide an overall score and 6 domain scores derived from the Lexicon of Collaborative Care. We describe its history and psychometric properties. Method: The PIP was tested in a convenience sample of practices. Linear regression compared scores across integration exemplars, PC with behavioral services, PC without behavioral services, and community mental health centers without PC. An additional sample rated 4 scenarios describing practices with varying degrees of integration. Results: One hundred sixty-nine surveys were returned. Mean domain scores ran from 49 to 65. The mean total score was 55 (median 58; range 0–100) with high internal consistency (Cronbach’s alpha = .95). The lowest total scores were for PC without behavioral health (27), followed by community mental health centers (44), PC with behavioral health (60), and the exemplars (86; p < .001). Eleven respondents rerated their practices 37 to 194 days later. The mean change was + 1.5 (standard deviation = 11.1). Scenario scores were highly correlated with the degree of integration each scenario was designed to represent (Spearman’s ρ = −0.71; P = 0.0005). Discussion: These data suggest that the PIP is useful, has face, content, and internal validity, and distinguishes among types of practices with known variations in integration. We discuss how the PIP may support practices and policymakers in their integration efforts and researchers assessing the degree to which integration affects patient health outcomes.

- Ben Littenberg

Thursday, January 26, 2017

Ross Colgate passes her PhD comprehensive examination

I'm delighted to report that, as expected, Ross Colgate, did an outstanding job on her PhD comps and has now progressed to the research phase of her studies.

Congratulations to Ross!

- Ben Littenberg

Wednesday, January 25, 2017

Katharine Cheung, MD (PhD candidate in CTS) gets published

Congratulations to Katharine Cheung on the publication of your first PhD manuscript in the American journal of kidney diseases.

Measures of Kidney Disease and the Risk of Venous Thromboembolism in the REGARDS (Reasons for Geographic and Racial Differences in Stroke) Study    Original Research Article
Available online 23 January 2017
Katharine L. Cheung, Neil A. Zakai, Aaron R. Folsom, Manjula Kurella Tamura, Carmen A. Peralta, Suzanne E. Judd, Peter W. Callas, Mary Cushman

Friday, January 20, 2017

Clinical Research Oriented Workshop (CROW) Meeting: Jan 20, 2017

Present:   Justine Dee, Nancy Gell, Juvena Hitt, Charlie McLean, Gail Rose, Liliane Savard (by phone), Adam Sprouse-Blum, Connie van Eeghen

Start Up: RMS accrediation is in response phase; more to come.

1.                   Justine – poster review  
a.       Annual combined sections of PT; this is a research group; mostly clinicians, all PT related
b.       Comments
                                                   i.      Distinguish the instruments from the variables 
                                                 ii.      Focus on the key message: the ability to predict treatment success
                                               iii.      Move all methods info to left bar; keep together
                                               iv.      Shorten analysis to: univariate comparisons and multi-variable modeling of initial disability and treatment success
                                                 v.      Trim the presentation of Perason’s Correlation to focus on initial ODI, as the analsyis of predictors of treatment success includes this information
                                               vi.      Make “Clinical Relevance” statement short and pithy
                                              vii.      Add narrative interpretation to the Conclusions section
                                            viii.      Limit colors and any extra busy-ness; use color to highlight a few key points/findings
c.       Next: February 14 in San Antonio TX!

2.                   Next Workshop Meeting(s): Fridays, 2:00 p.m. – 3:15 p.m., at Given Courtyard South Level 4 until end of Dec.   
a.       Jan 27: Kairn Kelley’s dissertation defense
b.       Feb 3: Marianne – update
c.       Feb 10: Nancy – grant proposal
d.       Future topics:
a.       Juvena: protocol development
b.       LaMantia: predictors of successful R01 applications:

Recorder: Connie van Eeghen

Sunday, January 15, 2017

Gil Welch to speak on campus this Wednesday

Gil Welch is an internist, health policy expert and a very fine speaker and writer who has made important contributions to our current thinking on wise use of diagnostic tests. Highly recommended.

“Over-diagnosis & Cancer Screening: Challenges Posed by Birds, Rabbits and Turtles”
H. Gilbert Welch, MD, MPH, Dartmouth Institute for Health Policy & Clinical Practice, Pathology and Laboratory Medicine Grand Rounds, 1-2 pm, Davis Auditorium

- Ben Littenberg

LaMantia on emergency care of elders

Congratulations to Michael LaMantia, MD, MPH, Associate Professor of Medicine. He and Timothy F. Platts-Mills, MD, MSc of the University of North Carolina at Chapel Hill just published an editorial in Annals of Emergency Medicine on "Bending the Curve of Health Trajectories for Older Adults Discharged From the Emergency Department."

See the article here:

- Ben Littenberg

Clinical Research Oriented Workshop (CROW) Meeting: Jan 13, 2017

Present:   Marianne Burke, Deborah Hirtz, Kairn Kelley, Ben Littenberg, Mike LaMantia, Liliane Savard, Adam Sprouse-Blum, Connie van Eeghen

Start Up:  Happy new year!

1.                   Liliane – feedback on scoping review
a.       Goal of review: summarize current state of knowledge on motor learning in autism.  The purpose is to find gaps in the literature (this was not a problem; there are many). Liliane’s workshop on scoping reviews also including collecting data on the patient perspective – which is an unusual approach for a literature review-based activity.
                                                   i.      Definition of motor learning: a permanent change in motor behavior induced by practice, including ability to retain and generalize learning, engaging any kind of movement, limited to children
                                                 ii.      Similar to systematic review, but not limited to high level publications and not focused on a narrow topic
                                               iii.      Include existing evidence of physiologic presentation of autism, as related to motor learning
                                               iv.      The purpose of this type of review: wide range inclusion of what the field of research in a particular area has included, and what it has not.
1.       Use of terms
2.       Groups of research subjects
b.       Question: What are the motor learning characteristics of children with autism?
                                                   i.      Ability to learn new motor skills – must be measurable: acquisition rate or success; change in performance.  Ability defined as measured change in performance (which is evidence of learning).
1.       Simple skills
2.       Complex skills
                                                 ii.      Facilitators of motor learning
1.       Barriers
2.       Speed
                                               iii.      Differentiating acute vs retained vs generalized retention
                                               iv.      Typical vs autistic
c.       Who is the audience?  The feedback from this group discussed breadth and depth – both of which need more specificity. 
                                                   i.      Pick a focus and develop.  Then delve
1.       Does learning happen?
2.       What are the facilitators/barriers?
3.       What is the physiology?

2.                   Next Workshop Meeting(s): Fridays, 2:00 p.m. – 3:15 p.m., at Given Courtyard South Level 4 until end of Dec.   
a.       Jan 20: TBD
b.       Jan 27: Kairn Kelley’s dissertation defense
c.       Feb 3: Marianne - update
d.       Future topics:
a.       Juvena: protocol development
b.       LaMantia: predictors of successful R01 applications:

Recorder: Connie van Eeghen