Clinical Research Oriented Workshop (CROW) Meeting: March 17, 2011

Present: Abby Crocker, Amanda Kennedy, Rodger Kessler, Ben Littenberg, Connie van Eeghen

Guest: John Senders

1. Check In:

a. On the likelihood of finding redheads in Cambridge

2. John Sender’s as guest

a. Defining “translational science” – not just a matter of the providers doing what they’re supposed to do, but a question about how to bridge the gap between what they know and what they do

i. Education (insufficient)

ii. Guided instruction (limited)

iii. Academic detailing (effects are modest, at best)

iv. Default settings for known situations, e.g. standard order sets upon admission, resulting, for example, in fewer insulin overdoses

v. Skinnerian theory: positive reinforcement, using rewards

vi. Regulatory requirements

b. What are the barriers, in general

i. Human behavior

ii. Clinical complexity of treatment (e.g. how to prescribe insulin) and side effects

iii. Scientific uncertainty – when is there enough information to know what is the right thing to do

iv. Organizational complexity, including social complexity (e.g. regulations)

v. Economic incentives, including nefarious alternatives created out of greed

vi. Barriers will differ in the level of “translation” undertaken (T1 – T4)

c. How to characterize barriers:

i. Structural: addressed by JCAHO standards, which could include something like the number of candlefeet in pharmacies and the amount of background noise in taking phone orders

ii. Process barriers?

d. Relevant examples we played with to derive translational schemes:

i. Provider and patient behavior affecting treatment of addicted pregnant women

ii. Health Behavior cancer studies and the VT cancer center

iii. Diabetic patient letters from provider practices to their patients

e. Closing question: what translational strategies would result in better lighting in FAHC pharmacies? See article: http://ajhp.highwire.org/content/48/10/2137.abstract by Buchanan, et al., 1991: Illumination and Errors in Dispensing

3. Next Workshop Meeting(s): Thursday, 2:30 p.m. – 4:00 p.m., at Given Courtyard Level 4

a. March 24: Rodger: NCQA survey data (no Connie)

b. March 31: Rodger: State wide mental health in Blueprint evaluation design (no Amanda)

c. April 7: (no Connie or Ben)

d. April 14: (no Connie)

e. Future agenda to consider:

i. Rodger: Mixed methods article; article on Behavior’s Influence on Medical Conditions (unpublished)

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)

Recorder: Connie van Eeghen