Present: Kairn Kelley, Amanda Kennedy, Rodger Kessler (by
phone), Ben Littenberg
1.
Presentation: Rodger
on discussion of patient generated health assessment, as the next evolution
past behavioral health risk appraisal in primary care
a. Presentation:
i.
Précis: ISO behavioral health screening data for about
15 years; FAHC now ready to act via PRISM and related resources. Rodger has been developing new concepts
regarding this topic with Wilson Pace, along the lines of Larry Weed’s work,
automating diagnostic support systems through structured patient
questions.
ii.
Prior to PHQ/GAD questionnaires, practitioners
asked/recorded questions taking 11-15 minutes to arrive at a reasonably
accurate diagnosis. This is beyond what
PCPs can devote to this work, resulting as PHQ9/GAD7/ETOH “The Audit” (brief
measures developed by Kronke). Issue:
the search for valid outcomes with fewer questions: PHQ2 and GAD2 (ultra brief
screens) – high level of false positives but decent sensitivity.
iii.
PRISM initially offered 4 fields for these data. Rodger worked with NIH (Cancer Institute,
Russ Glasgow re: on-the-ground research) for ~3 years: behavioral risk
assessment (previously shared with this group: 8 dimensions, 14 questions,
beyond mental health and substance abuse).
1. Criteria
for a measure: valid, brief (3 items), actionable, integratable into EHR
2. Interest
to Rodger: beyond depression and anxiety, including activity, health behavior,
and something else.
3. Phase
1: Milton; Phase 2: other FAHC practices
4. FAHC
primary care leaders: identify the features of patient function and what to
engage to improve healthcare, what to monitor
a. No
mechanism for patients to provide data on multiple dimensions of health,
readiness to change, preference to kind of interventions…
b. How
to overlay these core measures with the measures implied above
iv.
Efforts to do behavioral risk assessment is trapped in
a mental model about MH, separate from primary care.
1. Key
topics related: collaboration and integration
2. New
services are supposed to be adjunctive to primary care, within the same office
(but not part of the practice of primary care)
3. Aesculapius:
produces referrals for anxiety and depression, but doesn’t help practice deal
with behavioral health/medical comorbidities that affect the effectiveness of
medicine (reasons: referrals are reactive, clinician is inherently limited in
terms of service domain, …)
4. Integration:
processes and procedures that affect patient care are seamless within the
practice. Panel based integration
describes protocol driven care rather than provider driven referral.
5. Integration
has grown to mean (for Rodger) the integration of BH and PC questions that
assess the patient across these traditional boundaries.
b. Dialogue:
i.
For the most part the kind of data Rodger is looking
for is a function of informal provider initiated questions. There is no current model for collecting
“patient preferences” in general.
ii.
Rodger has looked at generalized health assessments
(NCQA standards, patient-based goal setting), for which there is some interest
but more resistance due to the dynamics of change currently in place at FAHC.
iii.
Rodger has just received permission to create a formal
work group at FAHC to develop this idea.
1. Robert
Gibbons, biostatistician, looking at MH issues and the development of questions
leading to differential diagnosis of various MH diagnoses.
2. Focus:
comprehensive health assessment: highest risk areas and highest
interest/readiness areas
iv.
Goal is to work both on how to research what happens in
practice and how to measure what happens clinically. Research choice
1. Least
number of questions to identify MH issues
2. Least
number of questions to identify patient issues (health status, health function,
and patient activation) (this is what Rodger wants to study)
v.
Ben: “The perfect assessment is the enemy of a good
assessment” – start small.
1. Starting
with BH assessments in PRISM in 3 weeks
2. Consider
alternate models of the end goal of comprehensive assessment: CATI –
computer-intelligent testing based on respondent choices.
vi.
Kairn’s research: many words in the dichotic word test;
need a shorter, simpler, quicker test.
Similar assessment issue.
vii.
Rodger’s choices:
1. Referral
model to BH clinician is limiting in scope, types of referrals, types of
patients, and exists outside of the relationship involved in the medical care
provider (Aesculapius)
2. Primary
care/BH consultant model: a model like the integrated pharmacist (a better team
approach to primary care), with the pharmacist as a consultant, not as a front
line provider.
a. The
clinician has a specified role
b. The
practice (and beyond) that determines where care happens and the outcomes that
result (Rodger’s focus: health services
research in primary medical and behavioral care)
2.
Summer
Session
a.
Not Mondays, Tues 1-4, Thurs 1-4 (Amanda’s summer
schedule)
b.
Not Tues or Wed (Kairn’s and Ben’s summer schedule)
c.
Doodle poll on its way – Connie to send out
3.
Kairn
update:
a.
Tomorrow: update on inter-rater reliability and The
Avengers
b.
Next: proposal on dissertation topic for committee
meeting next Thursday for their approval/rejection (the formal proposal was
originally due Aug 1). Agenda:
i.
Introductions
ii.
Research Domain Overview
1.
Define key terms
iii.
Research Question: What is the prevalence (or
role?) of Dichotic Listening Deficit in kids with ADHD?
1.
Specific Study Questions (the questions that result
in a paper)
a.
#1 What is the prevalence of abnormal tests in ADHD
– Brief Design
b.
#2 What is the prevalence of abnormal scores in
three groups (subtypes) of children – Brief Design
c.
#3 How to evaluate different tests, e.g. what is
the reliability of SSW, what is its accuracy, and what is the prevalence of
abnormal SSW in ADHD – Brief Design (in which the goal is cheap, fast,
reliable, accurate, and safe)
c.
Finish/submit article (which contributes to the
dissertation question but is not the same thing) and finish comps by end of
August
4.
Workshop
Goals for 2012:
a. Journal
club: identify UVM guests and articles; invite to CROW ahead of time
b. Research
updates: share work-in-process
a.
May 10: Connie – From Dissertation to Publication - draft
article with two questions: Does it read sufficiently like a journal article
(if not, what to change) and are the results presented clearly?
b.
May 17: Abby – TBA (last scheduled session of the
semester)
c. Future
agenda to consider:
i.
Ben: budgeting exercise for grant applications
ii.
Ben: Writer’s workshop on the effect of the built
environment on BMI (Littenberg & Austin Troy)
iii.
Journal Club: “Methods and metrics challenges of
delivery-system research,” Alexander and Hearld, March 2012 (for later in the
year?)
iv.
Rodger: Mixed methods article; article on Behavior’s
Influence on Medical Conditions (unpublished); drug company funding. Also: discuss design for PCBH clinical and
cost research.
v.
Amanda: presentation and interpretation of data in
articles
vi.
Sharon Henry: article by Cleland, Thoracic Spine
Manipulation, Physical Therapy 2007
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