Clinical Research Oriented Workshop (CROW) Meeting: December 22, 2011

Present: Ben Littenberg, Charlie MacLean, Connie van Eeghen

Guest: Tim Burdick, MD

1. Start Up: The effect of provider attitude on patient care encounters, especially motivational interviewing.

2. Rodger: Web-Based Self-Management Intervention for Multi-Morbidity R01, with co-PIs of Rodger and a colleague with much R01 experience. This grant has been under discussion for two years as the result of a conference not about collaborative care but health behavior interventions in medical disease.

a. NIH interest, through the Heart, Lung, Blood Institute. T his announcement came out in November regarding primary care patient with multi-morbid conditions, including mental health and substance abuse disorders. There was interest in alternative study methods to RCTs, including quasi-experimental design. The R01 announcement specifically calls for the development of an intervention. This application will be sent to the Dissemination and Implementation review session.

b. Progress on methods: The Oregon Research Institute has developed a track record and a web based tool, “MyPath,” a health risk appraisal with scoring/ranking and EBP patient support resulting in a plan with possible strategies and automated interventions (electronic reminders, journaling). Rodger has developed a positive working relationship with this Institute, proposing that bi-directional data sharing with provider based EHRs is an important addition. This study proposed to study MyPlan with depression, interaction with the EHR, and applying it in two models (dyadic primary care and collaborative care). (John Wasson at Dartmouth has done work with a health risk appraisal, barrier assessment, and visit planner print out for next appointment, accessible by patient and provider.) LOI needed followed by live presentation on January 4 (audio-visual web conferencing). Decision to be made about a week later.

c. In-depth discussion followed on us of the following design alternatives:

i. Usual care (no MyPath), all with EHR for a period of time

1. Patient portal exists and used

2. Behavioral health management application, with increasing use by patients over time (a threat to validity to be addressed by side analysis)

ii. MyPath in a traditional practice

iii. MyPath in a collaborative care BHC supported practice (pre-existing “patient centered behavioral health” aka PCBH)

iv. MyChart – the EPIC portal

1. with PCBH

2. without PCBH

v. Collaborative care with no MyPath (pre-existing PCBH)

1. studying ii and iii doesn’t prove anything about MyPath

2. studying i and ii looks at MyPath but doesn’t provide the “live coach” that Rodger is interested in

3. studying i and iii might show the highest impact but have the least explanatory ability

4. studying i and v, offering them both MyPath looks at all possible alternatives and needs the most number of practices (~300 per arm)

vi. Proposed design: study i and ii and iii, measuring by reaim

1. Reach: sign-ons created (may be contaminated by usual care patients with access to other patient portals)

2. Effective: PHQ-9, ER utilization

a. Measures: QUALI and composite measure

i. Euroqol 6D (how to obtain from usual care group, at least a sample; not obtainable from the experimental group who don’t access the portal)

ii. Better to use EHR based measures

1. ER utilization

3. Adapt: qualitative methods

4. Implement: qualitative methods – is this what NIH cares about most?

5. Maintenance: utilization of portal

vii. Recommendation: consider three arms and focus on what primary outcomes are

d. Process for exceeding the $500K cap (we didn’t get to this point, but it sounds interesting)

3. Next Workshop Meeting(s): Thursday, 12:30 p.m. – 2:00 p.m., at Given Courtyard Level 4

a. Dec 29: UVM closed

b. Jan 5: Journal Club; start new meeting time from 1:00 – 2:30 on Thursdays

c. Future agenda to consider:

i. Ben: budgeting exercise for grant applications

ii. Rodger: Mixed methods article; article on Behavior’s Influence on Medical Conditions (unpublished); drug company funding

iii. Amanda: presentation and interpretation of data in articles

iv. 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: C. van Eeghen

Abstracts Due Jan. 12 for AcademyHealth Annual Research Meeting

Abstracts       |       Agenda       |       Hotel & Travel       |       Adjunct Meetings       |       ARM Home

Showcase Your Work at the 2012 Annual Research Meeting  Call for Abstracts Submission Deadline: January 12, 2012 The AcademyHealth 2012 Annual Research Meeting (ARM) call for abstracts is now open. With more than 50 percent of the conference agenda selected through the call for abstracts process, the ARM is an opportunity for researchers to share important findings with policymakers and providers who can move the research into action. Abstracts are invited for four categories: call for papers, call for posters, call for research panels, and call for policy roundtables. AcademyHealth seeks abstracts on 18 themes reflecting a variety of critical areas of study in health services research, as well as proposals for panels that present research or discuss key health policy topics. Abstracts submitted to the call for papers will also be considered for publication in JAMA.  Submit to the call for abstracts by January 12 to be considered for presentation at the 2012 ARM, June 24-26 in Orlando. Details on the specific theme topics, submission criteria, and instructions can be found online at www.academyhealth.org/arm/abstracts.

Clinical Research Oriented Workshop (CROW) Meeting: December 15, 2011

Present: Kairn Kelley, Amanda Kennedy, Charlie MacLean, Connie van Eeghen

1. Start Up: Kairn’s update on her dissertation study – In a recent meeting with Ben, it was suggested that perhaps Kairn should look at a different test with better reliability. Kairn explained the reasons for looking at dichotic words tests and acknowledged reliability is a major concern. The “goodness” of auditory processing tests as a category has not been established based on current literature. Comments made:

a. Consider the current state of auditory tests as the topic for the review article that is required of the PhD.

b. This study will not answer all the questions of what is true, what clinical practice should be, and how one helps an individual patient. That effort describes a career, specifically, a post-PhD career.

2. Kairn: Lit review progress. Kairn brought a chapter for discussion and support on normative values of a SCAN-3 auditory processing test, including how they were determined and what they mean. The group discussed the purpose of review. Instead of reviewing this article, the group sketched the outline of the review article that Kairn should write.

a. Audience: clinical audience

b. What is available (auditory tests) – cast the widest net possible, but must be available

i. Keep a separate listing of all tests, whether or not available

c. What studies have been done (not many)

d. How to select appropriate tests (based on what is available) – like a Consumer’s Report digest

i. Develop criteria for rating those tests

ii. Rate them

iii. Check a standard reference (Cochrane’s?) for examples

iv. Goal: one stop shopping for clinicians

e. Anticipate the dissertation study by outlining a method for further study

3. Next Workshop Meeting(s): Thursday, 12:30 p.m. – 2:00 p.m., at Given Courtyard Level 4

a. Dec 22: Rodger – Discussion of Web-Based Self-Management Intervention for Multi-Morbidity (no Amanda, maybe no Kairn)

b. Dec 29: UVM closed

c. Jan 5: Kairn – review of “Development and Evidence of Reliability and Validity” chapter from SCAN-3; start new meeting time from 1:00 – 2:30 on Thursdays

d. Future agenda to consider:

i. Ben: budgeting exercise for grant applications

ii. Rodger: Mixed methods article; article on Behavior’s Influence on Medical Conditions (unpublished); drug company funding

iii. Amanda: presentation and interpretation of data in articles

iv. 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: C. van Eeghen

Alan Rubin is Teacher of the Year

Last night the Fletcher Allen - University of Vermont Medical Group honored Alan Rubin, MD as the Teacher of the Year. In fact, a case could easily be made that he is the Teacher of the Decade, of the Century, of the Epoch! His excellence in teaching is matched only by his remarkable energy, his willingness to explore new ideas, engage new topics, address new audiences, and care for his friends, colleagues, neighbors and patients in new and thoughtful ways.

Alan is a major ingredient in the secret sauce that makes General Internal Medicine Research and the CTS grad program work, that makes it fun to be here, and that keeps me coming in to do all the great stuff we all do together.  Thank you, Alan!

Clinical Research Oriented Workshop (CROW) Meeting: December 8, 2011

Present: Kairn Kelley, Amanda Kennedy, Connie van Eeghen

1. Start Up: Plan for spring semester: Ben, Amanda, Charlie, Rodger and Kairn are good with the current schedule on Thursday afternoons. Abby gets out of class on Thursdays at 12:45. We agreed to reschedule CROW meetings for spring semester starting January 5, 2012 from 1:00 – 2:30.

2. Connie: Presented her data from “Office Systems Analysis Case Study 2,” which focused on a quality improvement (QI) project conducted by an academic medical center’s primary care office practice in Burlington, VT. The project’s focus: integrate a new position for a behavioral health clinician into the primary care process, team, and systems. This project was conducted by using a QI process called “A3” to complete the team’s work, which took place from August 2010 to November 2010, followed by three months of implementation. Data were collected from the EHR system, staff surveys, and interviews. Connie’s question: which of two directions should she go to produce an article on this work?

a. Option 1: “An Effective Change Process,” which provides a tutorial of the A3 method in the context of a hypothetical project to integrate behavioral health into a primary care practice. The advantage of this choice is that it leads to a further publication on the application of the method.

b. Option 2: “A Case Study on an Effective Change Process,” which provides the data presented above as the outcomes of an implementation using the A3 method. The advantage of this choice is that it is likely to be seen as more practical and compelling.

The intended audience for this article are primary care and behavioral health clinicians. The group provided helpful feedback:

a. One good article that gets published is more valuable than several that never quite get written or accepted.

b. Case studies are compelling; multiple case studies even more so

c. Whichever chosen, research the publication, write the abstract, and email the editor. Publications to consider:

a. Journal of General Internal Medicine

b. Archives of Internal Medicine

c. Other publications related to Family Medicine

Connie will develop an outline based on a case study of her work with Rodger and circulate it for comments. Thank you to all!

3. Next Workshop Meeting(s): Thursday, 12:30 p.m. – 2:00 p.m., at Given Courtyard Level 4

a. Dec 15: Kairn: Review of normative values of a SCAN-3 auditory processing test, including how they were determined and what they mean. (No Ben)

b. Dec 22: Rodger (no Amanda, Kairn)

c. Dec 29: UVM closed

d. Jan 5: Kairn – update; start new meeting time from 1:00 – 2:30 on Thursdays

e. Future agenda to consider:

i. Ben: budgeting exercise for grant applications

ii. Rodger: Mixed methods article; article on Behavior’s Influence on Medical Conditions (unpublished); drug company funding

iii. Amanda: presentation and interpretation of data in articles

iv. 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)

Clinical Research Oriented Workshop (CROW) Meeting: December 1, 2011

Present: Kairn Kelley, Ben Littenberg, Connie van Eeghen

1. Start Up: Connie has done some new learning about homelessness in Burlington. After a brief case history, we redirected ourselves to planned (rather than spontaneous) research.

2. Connie: Shared an overly long re-draft of an R03 grant application to develop and implement a “toolkit” for integration of behavioral health in primary care office practices. The group shared three kinds of feedback:

a. Language: rewrite in short, declarative sentences with little/no jargon using well structure paragraphs.

b. Logical relationships: re-evaluate the reason why each sentence is in the document. Some are just “extras” and don’t reflect the purpose of the heading.

c. Intent: it was not clear to everyone what the purpose of the study was. Develop a clearer message along with a more process-based table of study steps:

i. Previous site evaluates draft tool kit

ii. Review and revise tool kit

iii. First implementation

iv. First site evaluation:

1. By participants (Aim 1)

2. By EHR (Aim 2)

v. Review and revise again

vi. Second implementation

vii. Second site evaluation:

1. By participants (Aim 1)

2. By EHR (Aim 2)

viii. Final review and revision

d. Connie will have a new draft soon… stay tuned. And a big thank you to all!

3. Next Workshop Meeting(s): Thursday, 12:30 p.m. – 2:00 p.m., at Given Courtyard Level 4

a. Dec 8: Connie – case study data; outline for paper (no Ben)

b. Dec 15: Rodger (no Ben)

c. Dec 22: (no Amanda, Kairn)

d. Dec 29: UVM closed

e. Jan 5: Kairn – update; check for spring schedule for CROW meetings

f. Future agenda to consider:

i. Ben: budgeting exercise for grant applications

ii. Rodger: Mixed methods article; article on Behavior’s Influence on Medical Conditions (unpublished); drug company funding

iii. Amanda: presentation and interpretation of data in articles

iv. 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: C. van Eeghen

For those who are supposed to be working on their dissertations... or not

Tone Matrix

Enjoy! Connie