Clinical Research Oriented Workshop (CROW) Meeting: June 9, 2010

Clinical Research Oriented Workshop (CROW) Meeting: June 9, 2010

Present: Abby Crocker, Kairn Kelley (by phone), Rodger Kessler, Ben Littenberg, Carole McBride, Charlie McLean, Connie van Eeghen

1. Round Table: Following up on Rodger’s May 5 discussion about his upcoming study

2. Rodger’s Discussion:

a. The discussion focused on a figure to support questions of the perceptions regarding improvement in care and change in cost from the experiences of practice, patient, and system in making a change to the behavioral health access, identification, and treatment.
i. Inquiring into health status: can have a narrow interpretation, implying specific metrics
ii. Inquiring into outcomes: broad interpretation, includes clinical and cost changes. Past models agree on three basic groups from Peek (2008) and Berwick (2008):
1. Clinical/Care
2. Operational/Health
3. Financial/Cost
4. Other candidates: patient centeredness, social justice…

iii. Ben’s graphic:

b. What is the focus of our communication? It depends on the clarity of:
i. The Audience
ii. The Medium (e.g. graphic)
iii. The Message
c. Collaborative Care Metrics: how do the measures line up with the three perspectives listed above?
i. Access (needs specification)
ii. Screening
1. Score distribution
2. % completing screens
3. % positive screens
4. disposition of docs when high score
5. 6 month follow up scores [code whether BH only or also CHT]
iii. Finance
1. RVU’s month
2. distribution of time codes( type and length of visits)
3. payer mix
iv. Clinical/operational
1. % ref'd out
2. % ref'd out where we have evidence of outside tx initiation
3. % ref’d out with evidence of communication from clinician
4. % with chronic disease co morbidity & distribution
5. prior treatment episodes
6. operations
7. time from referral to 1st visit
8. average time between visits
9. no show rate
a. No show 1st appointment, no show by # of sessions
10. average # of sessions
v. From the three perspectives (per Charlie)
1. What was the patient experience
a. Number seen (characterize the population)
b. What was the intervention (staff, method, practice)
c. What was it like (perception)
2. Later: What are the trends over time
3. Much later: determine the details of costs and the population specific outcomes
vi. Analytic planning
1. What tool (EMR) and collection (data queries)
2. What assessment (run charts-with outcomes over time) based on numbers, scores, or numerators that can be turned into rates or ratios
3. What are the input values to DocSite
d. Next steps: Clean up the measures, present to Randy Messier, select best, find sources by 10/10

3. Next Fellows Meeting(s): Wednesday, 2:00 – 3:30 p.m., at Given Courtyard Level 4
a. June 16: Kairn – fellowship proposal for Aug submission (no Connie, Matt, Rodger, Amanda)
b. June 23: Abby: run charts (no Connie or Matt or Amanda or Kairn)
c. June 30: Rodger: mixed methods article (no Connie)
d. July 7: (no Abby)
e. July 14:
f. July 21: Carol – data collection/analysis (no Matt through Aug 21)
g. Future agenda to consider:
i. How to predict medical events effectively (Ben)
ii. Future: Review of different types of journal articles (lit review, case study, original article, letter to editor…), when each is appropriate, tips on planning/writing (Abby)
iii. Future: Informed consent QI: Connie to follow up with Nancy Stalnaker, Alan Rubin will follow up with Alan Wortheimer or Rob McCauly
iv. Kairn will ask a librarian to join us for selected issues

4. Fellows document – nothing this time – to be reviewed after trialing Wednesday meeting times, which started May 5, 2010.

Recorder: Connie van Eeghen