IBH-PC methods paper available as preprent

 

The first major report from IBH-PC, a detailed presentation of the study methods to be referred to by following papers, is now available in preprint form. The study is under review at the journal Trials which posted it on ResearchSquare.com where the full text, figures and tables are available as HTML or PDF while they finish their review. Many thanks to Abby Crocker for leading this writing effort!

Crocker, AM., Kessler, R., van Eeghen, C. et al. Integrating Behavioral Health and Primary Care (IBH-PC) to improve patient-centered outcomes in adults with multiple chronic medical and behavioral health conditions: study protocol for a pragmatic cluster-randomized control trial. 05 November 2020, PREPRINT (Version 1) available at Research Square https://doi.org/10.21203/rs.3.rs-54202/v1

ABSTRACT

Background

Chronic diseases that drive morbidity, mortality, and health care costs are largely influenced by human behavior. Behavioral health conditions such as anxiety, depression, and substance use disorders can often be effectively managed. The majority of patients in need of behavioral health care are seen in primary care, which often has difficulty responding. Some primary care practices are providing integrated behavioral health care (IBH), where primary care and behavioral health providers work together, in one location, using a team-based approach. Research suggests there may be an association between IBH and improved patient outcomes. However, it is often difficult for practices to achieve high levels of integration. The Integrating Behavioral Health and Primary Care study responds to this need by testing the effectiveness of a comprehensive practice-level intervention designed to improve outcomes in patients with multiple chronic medical and behavioral health conditions by increasing the practice’s degree of behavioral health integration.

Methods

43 primary care practices, with existing onsite behavioral health care, will be randomized to the intervention or usual care arm. The intervention is a 24-month supported practice change process including an online curriculum, a practice redesign and implementation workbook, remote quality improvement coaching services, and an online learning community. Each practice’s degree of behavioral health integration will be measured using the Practice Integration Profile. Approximately 75 patients with both chronic medical and behavioral health conditions from each practice will be asked to complete a series of surveys to measure patient-centered outcomes. Change in practice degree of behavioral health integration and patient-centered outcomes will be compared between the two groups. Practice-level case studies will be conducted to better understand the contextual factors influencing integration.

Discussion

As primary care practices are encouraged to provide IBH services, evidence-based interventions to increase practice integration will be needed. This study will demonstrate the effectiveness of one such intervention in a pragmatic, real-world setting.

 

- Ben Littenberg

Book club proposal: The Knowledge Machine, by Michael Strevens

On the basis of on one book review I read in a recent New Yorker (Review of Srevens' Knowledge Machine), I'd like to propose that CROW (and others as interested) read the book over Dec/Jan to give a broad perspective of how science really works.  An excerpt will explain better than I can:

"In “The Knowledge Machine: How Irrationality Created Modern Science” (Liveright), Michael Strevens, a philosopher at New York University, aims to identify that special something. Strevens is a philosopher of science—a scholar charged with analyzing how scientific knowledge is generated. Philosophers of science tend to irritate practicing scientists, to whom science already makes complete sense. It doesn’t make sense to Strevens. “Science is an alien thought form,” he writes; that’s why so many civilizations rose and fell before it was invented. In his view, we downplay its weirdness, perhaps because its success is so fundamental to our continued existence. He promises to serve as “the P. T. Barnum of the laboratory, unveiling the monstrosity that lies at the heart of modern science.”

Since science began, there has been disagreement about how those routes are charted. Two twentieth-century philosophers of science, Karl Popper and Thomas Kuhn, are widely held to have offered the best accounts of this process. Popper maintained that scientists proceed by “falsifying” scientific claims—by trying to prove theories wrong. Kuhn, on the other hand, believed that scientists work to prove theories right, exploring and extending them until further progress becomes impossible. These two accounts rest on divergent visions of the scientific temperament. For Popper, Strevens writes, “scientific inquiry is essentially a process of disproof, and scientists are the disprovers, the debunkers, the destroyers.” Kuhn’s scientists, by contrast, are faddish true believers who promulgate received wisdom until they are forced to attempt a “paradigm shift”—a painful rethinking of their basic assumptions.

Working scientists tend to prefer Popper to Kuhn. But Strevens thinks that both theorists failed to capture what makes science historically distinctive and singularly effective. To illustrate, he tells the story of Roger Guillemin and Andrew Schally, two “rival endocrinologists” who shared a Nobel Prize in 1977 for discovering the molecular structure of TRH—a hormone, produced in the hypothalamus, that helps regulate the release of other hormones and so shapes many aspects of our lives. Mapping the hormone’s structure, Strevens explains, was an “epic slog” that lasted more than a decade, during which “literally tons of brain tissue, obtained from sheep or pigs, had to be mashed up and processed.” Guillemin and Schally, who were racing each other to analyze TRH—they crossed the finish line simultaneously—weren’t weirdos who loved animal brains. They gritted their teeth through the work. “Nobody before had to process millions of hypothalami,” Schally said. “The key factor is not the money, it’s the will . . . the brutal force of putting in sixty hours a week for a year to get one million fragments.”"

Maybe it's a little simplistic as a description of the foundation of scientific thought...  but it provides room for discussion.  Or so I predict.  Check out the review and see what you think.  If the ink above doesn't work for you, email me and I'm send you a soft copy.

FW: NHATS Round 9 Final Data Released and Data Website Updated

FYI

From: NHATS Data <nhatsdata@westat.com>
Sent: Thursday, October 29, 2020 1:00 PM
To: NHATS Data <nhatsdata@westat.com>
Subject: NHATS Round 9 Final Data Released and Data Website Updated

 

The National Health and Aging Trends Study (NHATS) is pleased to announce that Round 9 final data files are now available at https://nhats.org/researcher/data-access. Data files are available in both SAS and Stata formats. Updated documentation, including a revised User Guide, technical papers on Round 9 weights and income imputation, a revised crosswalk between the instruments and the codebook, and a crosswalk of changes from the beta to final version, can be found at https://www.nhats.org/researcher/nhats.    

Additionally, a redesign of the NHATS data website is now live at https://nhats.org/researcher/data-access. Updates include a new process for requesting and accessing restricted data and the availability of a new online resource for researchers from Colectica. This searchable, cross-year database contains NHATS metadata (item numbers, variable names, labels, values and value labels, and question text) to facilitate multi-round analysis.

Prior to accessing the NHATS data download area, users will need to update their password https://nhats.org/user/password.

 

Standardized measures for social determinants of health from NIH

This announcement from NIH addresses an issue that was quite a big problem for IBH-PC over the last 6 years - the lack of standardized measures for SDOH. Progress! (I also like their brief definition of SDOH as "the conditions in which people are born, grow, live, work and age").

Notice Announcing Availability of Data Harmonization Tools for Social Determinants of Health (SDOH) via the PhenX Toolkit 

Notice Number: NOT-MD-21-003

The purpose of this Notice is to announce a major data-harmonization effort at the National Institute on Minority Health and Health Disparities (NIMHD) and to encourage the minority health and health disparities research community to use new data collection tools emerging from this effort.

The NIMHD is dedicated to advancing science by improving the yield and impact of its research portfolio. One way to accomplish this is to provide investigators with a common set of tools and resources that allow their work to span the diverse areas of the minority health and health disparities. Social determinants of health—the conditions in which people are born, grow, live, work and age—are known to drive health disparities. Recognizing this, the NIMHD, in collaboration with the National Human Genome Research Institute and the broader scientific community, has identified a series of Core and Specialty measures that will promote the collection of comparable data on social determinants of health (SDOH) across studies. The SDOH are categorized into categories of individual and structural factors that have impact on human health.  The list of constructs and measures is not exhaustive and NIMHD will continue to work towards greater harmonization of measures through vetted common data elements in the science of minority health and health disparities.

The NIMHD and its partners in the scientific community strongly encourages investigators to incorporate the measures from the Core and Specialty collections available in the Social Determinants of Health Collections of the PhenX Toolkit (www.phenxtoolkit.org) whenever possible.

Core collection: The measures in this collection are deemed relevant and essential to all areas of minority health and health disparities. Funded investigators are strongly encouraged to incorporate, at a minimum, the Core-Tier 1 measures in all primary data collection.

Specialty collections: The measures in these collections are organized at the individual and structural levels for more nuanced investigations of how SDOH influence health. The Individual SDOH Specialty collection includes measurement protocols for use in research where information is being collected from and about people answering for themselves or their family. The Structural SDOH Specialty collection includes measurement protocols at the structural or community level. Funded investigators conducting research in the specified areas of science are strongly encouraged to incorporate the Specialty measures related to the specific concepts covered and are discouraged from using alternative measures in lieu of the Specialty measures to collect similar data.

Through the use of these SDOH measures and common data elements, minority health and health disparity researchers will be able to share, compare, and integrate data across studies. By advocating the use of these common measures, the NIMHD and its partners in the scientific community aim to further enhance the science of minority health and health disparities while advancing a culture of scientific collaboration.

Quality Scholarship Award to Connie van Eeghen

At today's Grand Rounds, the Department of Medicine presented the annual Quality Scholarship Award to Connie van Eeghen, DrPH, Assistant Professor of Medicine.  Many congratulations!

Catalogue of Bias

Bias enters health studies at all stages and often influences the magnitude and direction of results. To obtain the least biased information, researchers must acknowledge the potential presence of biases and take steps to avoid and minimise their effects. Equally, in assessing the results of studies, we must be aware of the different types of biases, their potential impact and how this affects interpretation and use of evidence in healthcare decision making.

To better understand the persistent presence, diversity, and impact of biases, we are compiling a Catalogue of Bias, stemming from original work by David Sackett. The entries are a work in progress and describe a wide range of biases –  outlining their potential impact in research studies.

 See the catalogue here:  https://catalogofbias.org/

FYI

-Ben Littenberg

FW: Talkboctopus Virtual Seminar Series - Elisa Omodei Wed Oct 28 - Who, where, why: non-traditional data and predictive analytics to map socio-economic vulnerabilities

Elisa Omodei  Talkboctopus Virtual Seminar Series  October 28, 2020 12:00 PM ET (UTC -4)  Talk Title: Who, where, why: non-traditional data and predictive analytics to map socio-economic vulnerabilities Talk Abstract: In a rapidly changing world, severely affected by extreme weather events, epidemic outbreaks, economic shocks and conflicts, it is of fundamental importance to understand where the most vulnerable people are, how many they are, and to identify what it is that makes them more vulnerable than others to these threats. During the last decade, research has shown that data such as digital traces, phone metadata and satellite imagery carry relevant information beyond their original purpose and can be used as a proxy to measure socio-economic characteristics and detect vulnerabilities when traditional data is not available. Following an overview of these studies, the talk will deep dive into the UN World Food Programme’s original work on predicting food security. We will then conclude by discussing challenges and limitations, but also opportunities, that come with these approaches. Speaker Bio: Elisa Omodei, Predictive Analytics Lead, mobile Vulnerability Analysis, and Monitoring at the UN World Food Programme, Vice-President Secretary, The Complex Systems Society Elisa Omodei is the Predictive Analytics Lead of the Hunger Monitoring Unit at the World Food Programme’s Research, Assessment and Monitoring division. She also serves as Vice-President Secretary of the Complex Systems Society. She holds a BSc and a MSc in Physics and a PhD in Applied Mathematics for the Social Sciences. After her PhD, she spent a few years in academia before joining the United Nations in 2017, first at UNICEF's Office of Innovation and now at the World Food Programme. Follow Omodei on Twitter.    UPCOMING SPEAKERS:   Fall 2020: Elisa Omodei, Casey Fiesler, Stefani Crabtree, Karissa Sanbonmatsu, Guillermo García-Pérez   Spring 2021: Timnit Gebru, M. Ángeles Serrano, Fernanda S. Valdovinos, Marie-Josée Fortin, Carlos Gershenson   Learn More

 

Looking forward to seeing you all at this seminar. Just a reminder we will be sending out the zoom call-in details for this seminar one day before the event. 

 

Best Regards,

 

Juniper L. Lovato

Director of Partnerships and External Programs 

The Vermont Complex Systems Center

The University of Vermont