CROW NOTES 5/24

Present:   Marianne Burke, Levi Bonnell, Justine Dee, Juvena Hitt, Kairn Kelley, Ben Littenberg, Connie van Eeghen

Guest: Rodger Kessler

1.                   Rodger Kessler & Connie van Eeghen: PRECIS evaluation of IBHPC study on a pragmatic vs. and explanatory continuum

a.       Background: Rodger Kessler, Stephanie Brennhofer, and Connie van Eeghen are working on a manuscript to describe the PCORI Integrated Behavioral Health in Primary Care study from a research study management perspective: the inherent complexity of large pragmatic trials using IBHPC as a starting point, supplemented with results from a literature review.  They have come to CROW to conduct an exercise in re-evaluating IBHPC on the PRECIS continuum of pragmatic/explanatory trials.

b.       One key issue: in using this continuum, discussion focused on who the participants are (recipients of the intervention) and who the practitioners are (those who deliver the intervention).  IBHPC has two kinds of recipients: patients and practice members.  It has two kinds of practitioners: practice members and “the practice.”  The group used both perspectives in evaluating the study. 

c.       Ratings

                                                   i.      Eligibility

1.       Patient as participant: 10; was 9, because the sites that agreed to do this may have patients that are selected different than the general population of sites

a.       Rodger: “In the study that you are engaging in…” not “the issues outside the study that may relate to the study” Audience is not the Secretary of Health but the kinds of practices engaged in this study

2.       Practice as participant:  8, these practices were not pulled from a national random sample, but were Friends of Rodger, or identified through professional networks.  Not a perfectly generalizable set of practices; a convenient sample. But we didn’t restrict; we did do cold calls – random selection is not a criterion. 

a.       Rodger: common study section complaint: “you are biased towards early responders.”  Yes, that is the basis of being involved in the study.  This trial had to select in that way. 

b.       Ben: 14 states with 43 clinics (but not 213, as in the CLASP trial in Table 2)

c.       Gail: there were a lot of hoops to jump through: providing data, convince IRB, completing surveys – some sites could not get organized to participate in the study

d.       Juvena: PIP eligibility was pragmatic;

                                                 ii.      Experimental intervention – flexibility:

1.       Patient as participant

2.       Practice as participant: 7 – monitoring, suggestion, not CONSIDERABLE flexibility

a.       Rodger: having to function within the study is not a pragmatic issue

d.       Current Radar Charts:

e.       Future CROW sessions: focus on 2-3 domains (4-6 evaluations) per 1-hour session.

New article from Connie van Eeghen

Here's a new article about one of the case studies that informed the IBHPC intervention. Congrats to Assistant Professor Connie van Eeghen, DrPH  for this!

van Eeghen CO, Littenberg B, Kessler R. Chronic care coordination by integrating care through a team-based, population-driven approach: a case study. Translational Behavioral Medicine. 2018;8: 468-80. http://dx.doi.org/10.1093/tbm/ibx073
Patients with chronic conditions frequently experience behavioral comorbidities to which primary care cannot easily respond. This study observed a Vermont family medicine practice with integrated medical and behavioral health services that use a structured approach to implement a chronic care management system with Lean. The practice chose to pilot a population-based approach to improve outcomes for patients with poorly controlled Type 2 diabetes using a stepped-care model with an interprofessional team including a community health nurse. This case study observed the team’s use of Lean, with which it designed and piloted a clinical algorithm composed of patient self-assessment, endorsement of behavioral goals, shared documentation of goals and plans, and follow-up. The team redesigned workflows and measured reach (patients who engaged to the end of the pilot), outcomes (HbA1c results), and process (days between HbA1c tests). The researchers evaluated practice member self-reports about the use of Lean and facilitators and barriers to move from pilot to larger scale applications. Of 20 eligible patients recruited over 3 months, 10 agreed to participate and 9 engaged fully (45%); 106 patients were controls. Relative to controls, outcomes and process measures improved but lacked significance. Practice members identified barriers that prevented implementation of all changes needed but were in agreement that the pilot produced useful outcomes. A systematized, population-based, chronic care management service is feasible in a busy primary care practice. To test at scale, practice leadership will need to allocate staffing, invest in shared documentation, and standardize workflows to streamline office practice responsibilities.

- Ben Littenberg

CROW NOTES 5/10/18

Clinical Research Oriented Workshop (CROW) Meeting: May 10, 2018

Present:   Marianne Burke, Levi Bonnell, Juvena Hitt, Kairn Kelley, Ben Littenberg, Gail Rose, Connie van Eeghen

Notes: Connie

Start Up: Two sentence exercise:

“In a review of the literature prior studies reported their findings that outcomes were higher in men than women.”

In prior studies, outcomes were higher in men.

Or, prior studies reported higher outcomes in men.

Or, outcomes are higher in men.

Or, men had higher outcomes.

“In all probability, the data is biased”

These data may be biased.

Or, the data are biased.

If you are having trouble hearing today, please ask us for a listening device. (Reduced down from a much longer statement by Kairn with Patient & Family Services)

1.                   Android phone prevalence

a.       All Android users agreed to try out Gail’s alcohol use app

b.       I-phones: more common or less common than Androids

2.                   Updates

a.       Marianne: conducting a mixed methods study on why Visual Dx failed to change patient outcomes

                                                   i.      Created a model of possible reasons

                                                 ii.      11 providers interviewed in active group; 2 in control

                                               iii.      Is working with two independent coders (Alan and Lilliane)

1.       Not a grounded theory process; a thematic process

2.       Evidence-based evidence model

3.       Technology Acceptance Model

                                               iv.      Next: re-reviewing transcripts, de-identifying, and engaging in iterative reviews with coders (about 3 at a time)

1.       Transcripts range from very short to lengthy; on average 1 hour each

Next workshop meetings: Thursdays @ 11 AM. Given Courtyard South Level 4

·         May 17: Justine: Review of manuscript

·         May 24: Connie and Roger Kessler

·         May 31: Adam Atherly  & Eline Van Den Broek: MEPS Data

·         June 7:

Fwd: Announcing: Symposium on Complexity in Health & Wellness Behavior

 

We are excited to announce our inaugural symposium on complexity in human health and wellness behavior. During this intensive three-day professional education course, we will explore boundary-breaking science that is being used to tackle issues related to human behavioral wellness. Faculty for this course comes from data analytics, medicine and behavioral health, complexity science, computer science, psychology, neuroscience, economics, biology, and biomedical engineering. During this program, you will be introduced to methods, tools, and theory currently being used to understand human wellness from a multi-scaled perspective. No background in science or mathematics is required. The University of Vermont Complex Systems Center is a highly collaborative, open, and playful space that embraces intellectual curiosity, kindness, and rigor. Our educational programs are meant to be an idea collider. They bring together faculty and participants from many fields and spark new collaboration. They facilitate creativity. Our aim is not just to transfer complexity tools but to provide a life experience and create a community of complexity researchers and practitioners who are open, collaborative, and hungry for rigorous solutions to complex problems.  Faculty List: Allison Kurti, Chris Danforth, Dario Robleto, Diann E Gaalema, Laurent Hébert-Dufresne, Matt Bonds, Nicholas Allgaier, Peter Dodds, Ross A. Hammond, Ryan McGinnis. Additional speakers will be announced shortly.  Location: Burlington, Vermont  Date: Sept. 5-7, 2018 (primetime for Lake swimming, apple picking, Causeway Bike rides, & maybe even a bit of leaf peeping)    Find Out More & Register Here

Seminar 5/4/18

Friday Seminar Meeting: May (the) 4^th (be with you), 2018

Notes

·         Sponsored Project Administration

o   Uvm.edu/spa/

o   2017

§  715 awards

§  123 mm

§  COM -> > 50% of awards

o   Federal funders

§  NSF

§  NIH

o   Mission agencies

§  DOD

§  EPA

o   Solicited

§  Specific aims

o   Unsolicited (investigator initiated)

§  Braod

·         Hilda Alajajian

o   Help find funding opportunities (how to look for money)

·         PIVOT

o   UVM search platform for funding opportunities

o   Create username/ID

§  Save searches

§  Share searches

§  Alerts

§  Notifications

o   Method for narrowing down search opportunities

§  Keywords -> browse  -> (ex. Health & medicine -> outcomes research)

§  Uncheck ‘explode’ before hitting search

§  Search -> refine keywords

·         Add location, citizenship, new keywords

o   Tips

§  Look up dream grant -> use keywords associated with it.

·         They show you within pivot

§  Stay broad then narrow

CROW NOTES 5/3/18

Clinical Research Oriented Workshop (CROW) Meeting: May 3, 2018

Present:   Marianne Burke, Levi Bonnell, Justine Dee, Juvena Hitt, Ben Littenberg, Jennifer Oshita, Koela Ray, Gail Rose, Connie van Eeghen

Guest: Rycki Maltby, Professor of Nursing

Notes: Connie

Start Up: Introductions all around; Ricky works extensively internationally, including community based research (public health, cultural competency, service work)

1.                   Qualitative Research

a.       Rycki has a variety of examples and resources to learn from, as well as good experience in using NVivo 9

b.       Example: hermeneutical phenomenology, where assumptions are not bracketed (not set aside) but included in the process

                                                   i.      The research admits non-objectivity, up front

                                                 ii.      Public Health students doing this learning in Bangladesh place themselves in the research frame, and make observations about their own reactions (e.g. I’m very rich), leading to the question “Do students who go to high income countries learn something different from those who go to low income countries?”

                                               iii.      Coding: an exercise in sorting and describing findings

1.       Similarities between the two groups (“I’m a stranger in a strange land”)

2.       Differences between the two groups

                                               iv.      Next question: “Do students who go abroad learn differently from those that stay in VT?” (based on the objectives of the course) – the questions build on previous findings

c.       Presentation of data: based on exemplars

                                                   i.      How much data are enough?  It depends: 5 is plenty for a student

1.       Grounded theory: a new theory – 40-50 sources

                                                 ii.      Summarizing into categories – not what Rycki prefers but does appear in the literature

1.       Don’t count the subjects to report them

2.       Notice: what is showing up consistently?  Identify the major themes

d.       Conclusion: so what? Develop the take-away for the audience; policy and philosophic points

e.       Types of qualitative data

                                                   i.      Phenomenology: the lived experience, described by the source

                                                 ii.      Grounded theory: looking at developing theory by wide ranging data and constant dwelling with data, from many different researchers’ perspectives

f.        Data analysis

                                                   i.      First round: each researcher de novo, blinded to others

                                                 ii.      Later: negotiations and agreement

                                               iii.      It identifies what, but not degree or how much

g.       No funding – unless there is a quantitative aspect

2.                   The article she mentioned at the end of the session that talks about the difference between descriptive and interpretive phenomenological research is here.

Understanding the Differences between Husserl’s (Descriptive) and Heidegger’s (Interpretive) Phenomenological Research

Next workshop meetings: Thursdays @ 11 AM. Given Courtyard South Level 4

·         May 10: Email Levi

·         May 17: Email Levi

·         May 24: Connie and Roger Kessler

·         May 31:

·         June 7: Adam Atherly: MEPS Data