health outcomes

February 7, 2020: Using Nudges to Improve the Delivery of Health Care (Mitesh S. Patel, MD, MBA)

Posted on by Gina Uhlenbrauck

Speaker

Mitesh S. Patel, MD, MBA
Ralph Muller Presidential Assistant Professor
Perelman School of Medicine & Wharton School
University of Pennsylvania
Director, Penn Medicine Nudge Unit

Topic

Using Nudges to Improve the Delivery of Health Care

Keywords

Motivational nudges; Medical decision-making; Behavioral economics; Nudge units; Health behaviors

Key Points

  • Nudges remind, guide, or motivate a decision. In a healthcare setting, medical nudges use principles of behavioral economics and psychology to “steer medical decision-making toward higher value and improved patient outcomes.”
  • A “nudge unit” is a behavioral design team that systematically tests ways to improve decisions and change behavior.
  • It is important that medical nudges be testable and rigorously evaluated. Well-designed nudges have the right fit for the context, are aligned with health system and patient care goals, are scalable, and make a significant impact.
  • Nudges can be used to help clinicians promote evidence-based care, and help patients increase engagement and change health behaviors.

Discussion Themes

Nudges are prevalent in other industries; for example, when asked to add trip insurance to the purchase of an airfare.

In a healthcare setting, effective nudges can help achieve care delivery priorities (for example, improved screening, follow up, adherence) as well as reduce clinician burden.

Understanding the health system’s culture and workflow is essential for the sustainability and effectiveness of nudges.

Read more about nudges in Using Nudges to Improve Value by Increasing Imaging-Based Cancer Screening (Patel et al, Journal of the American College of Radiology, 2019).

Tags
#pctGR, @Collaboratory1, @miteshspatel, @PennNudgeUnit

January 10, 2020: Pragmatic Trials of Behavioral Economic Interventions to Increase Colorectal Cancer Screening (Shivan Mehta, MD, MBA)

Posted on by Gina Uhlenbrauck

Speaker

Shivan Mehta, MD, MBA
Assistant Professor of Medicine and Health Policy
University of Pennsylvania

Topic

Pragmatic Trials of Behavioral Economic Interventions to Increase Colorectal Cancer Screening

Keywords

Behavioral economics; Colorectal cancer; Pragmatic clinical trials; Health technology; Communication modality; Informed consent

Key Points

  • Colorectal cancer is the second leading cause of cancer deaths in the United States. Increased rates of screening can reduce mortality from colorectal cancer by 30% to 70%.
  • Use of behavioral economics can help us understand human motivation and behavior related to participating in clinical studies. How the message to patients is framed—and how choices are offered—can alter the response.
  • In the example pragmatic trial, the “choice architecture” for the colorectal cancer screening was designed by the study team in collaboration with health system stakeholders and clinical operations. Changing the framing from opt in to opt out had the effect of increasing participation in screening.

Discussion Themes

In some settings, choice overload can have a negative effect on participation.

When designing embedded pragmatic trials, researchers must be mindful not to increase burden on clinicians’ workflow.

While behavioral economics offers suggestions for how to increase colorectal cancer screening rates, its effectiveness in different contexts needs to be evaluated.

Read more about Dr. Mehta and colleagues’ study in Effect of Sequential or Active Choice for Colorectal Cancer Screening Outreach: A Randomized Clinical Trial (JAMA Network Open, 2019).

Tags
#pctGR, @Collaboratory1, @Shivan_Mehta

December 13, 2019: Reissuance of Funding Opportunity Announcement for HEAL Initiative/PRISM Coming January 2020

Posted on by Gina Uhlenbrauck

The National Center for Complementary and Integrative Health (NCCIH), with other NIH Institutes, Centers, and Offices, intends to reissue Funding Opportunity Announcement (FOA) HEAL Initiative: Pragmatic and Implementation Studies for the Management of Pain To Reduce Opioid Prescribing (PRISM) (UG3/UH3 Clinical Trial Optional).

This RFA solicits applications for phased cooperative research applications to conduct efficient, large-scale pragmatic or implementation trials to improve pain management and reduce the unnecessary use of opioid medications in the health care delivery setting. The re-issuance of the FOA will prioritize the following areas for pragmatic trials to integrate multimodal or multiple interventions that have demonstrated efficacy into health care systems or implement health care system changes to improve adherence to evidence-based guidelines:

  • Pain management in emergency departments, dental clinics, primary care, and hospitals
  • Chronic overlapping pain conditions
  • Pain management in individuals at risk of or with opioid use disorder
  • Pain management in those with co-occurring mental health disorders
  • Noncancer pain management in persons with medical comorbid conditions

The FOA is expected to be published in January 2020 with an expected application due date in March 2020.

The announcement is part of the NIH Heal (Helping to End Addiction Long-term) Initiative, which was created in April 2018 in an effort to speed scientific solutions for addressing the national opioid public health crisis.

 

November 15, 2019: PCORnet: Health Plan Research Network Data Linkage and Patient Engagement with Patient-Powered Research Networks (Kevin Haynes, PharmD, MSCE)

Posted on by Gina Uhlenbrauck

Speaker

Kevin Haynes, PharmD, MSCE
Principal Scientist
HealthCore

Topic

PCORnet: Health Plan Research Network Data Linkage and Patient Engagement with Patient-Powered Research Networks

Keywords

Data linkages; PCORnet; Patient-powered research networks; Health plan research networks; Computable phenotypes

Key Points

  • One of the biggest challenges facing healthcare today is reducing gaps in evidence necessary to improve health outcomes. Research collaborations between health plans and patient-powered research networks (PPRNs) can help close this gap.
  • PCORnet enables linkages with patient groups through PPRNs, which include participating organizations and leadership teams of patients, advocacy groups, clinicians, academic centers, and practice-based research networks.
  • From the health plan perspective, postal mail outreach to members was more effective than email outreach around engaging patients in research opportunities.

Discussion Themes

When engaging with different patient-powered research networks, are there differences around common conditions compared with rare or stigmatized conditions?

What are participants told about the commercialization of findings, whether in terms of new treatments that might be identified, or the ways in which findings might affect health plans’ willingness to continue to cover certain treatments?

An essential aspect of collaboration is building and maintaining the trust of members in the research networks.

Read more about collaborations between PPRNs and health plans in a recent JAMIA publication and the PCORnet website.

Tags
#pctGR, @Collaboratory1, @KHaynes001

November 8, 2019: Lumbar Imaging with Reporting of Epidemiology: Initial Results and Some Lessons Learned (Jeffrey Jarvik, MD, MPH, Patrick Heagerty, PhD)

Posted on by Gina Uhlenbrauck

Speakers

Jeffrey (Jerry) G. Jarvik MD MPH
Professor, Radiology, Neurological Surgery and Health Services
Adjunct Professor, Pharmacy and Orthopedics & Sports Medicine
University of Washington

Patrick Heagerty, PhD
Professor and Chair
Department of Biostatistics
University of Washington

Topic

Lumbar Imaging with Reporting of Epidemiology: Initial Results and Some Lessons Learned

Keywords

Embedded pragmatic clinical trials; Radiology imaging; LIRE; Stepped-wedge; Cluster randomization; Epidemiology; Back pain

Key Points

  • The LIRE NIH Collaboratory Trial evaluated whether prevalence benchmark data inserted into lumbar spine imaging reports would reduce overall spine-related healthcare utilization for patients referred from primary care.
  • The inserted intervention text urges caution when interpreting the presence of certain findings that are common in normal, pain-free volunteers.
  • While the study team found no decrease in spine-related healthcare utilization for the overall cohort, there was a small but potentially important effect on reducing opioid prescriptions.

Discussion Themes

A characteristic of stepped-wedge study design is that it yields two comparisons: between-group comparisons (clinic A vs clinic B) and within-group comparisons. But temporal trends can have an impact and must be adjusted for in the analysis.

For what type of intervention would a stepped-wedge design be suitable?

The hope is for a wider dissemination about interventions where radiologic testing is done and incidental findings are common.

Read more about the LIRE NIH Collaboratory Trial.

Tags
#pctGR, #PragmaticTrials, @Collaboratory1

November 1, 2019: NIH Collaboratory: Looking Back, Looking Forward (Adrian Hernandez, MD, MHS, Lesley Curtis, PhD, Kevin Weinfurt, PhD)

Posted on by Gina Uhlenbrauck

Speakers

Adrian F. Hernandez, MD, MHS
Professor of Medicine
Vice Dean for Clinical Research
Duke University School of Medicine

Lesley H. Curtis, PhD
Chair and Professor
Department of Population Health Sciences
Duke University School of Medicine
Interim Executive Director, Duke Clinical Research Institute

Kevin Weinfurt, PhD
Professor and Vice Chair of Research
Department of Population Health Sciences
Duke University School of Medicine

Topic

NIH Collaboratory: Looking Back, Looking Forward

Keywords

Embedded pragmatic clinical trials; ePCTs; NIH Collaboratory; Health care systems research; NIH Collaboratory Trials; Living Textbook; HEAL Initiative; Coordinating Center; Research dissemination; Learning health systems; Real-world evidence

Key Points

Discussion Themes

How can we harmonize the different ideas about what it is to be “pragmatic” for NIH study sections, IRBs, and DSMB reviews? For example, if your DSMB isn’t knowledgeable about PCTs, you could end up with a very explanatory trial.

A willingness to share imperfections is an important part of learning and helps the clinical trial ecosystem evolve.

An important future topic would be how the NIH Collaboratory and PCORnet fit together.

Read more about the NIH Collaboratory Program and the Living Textbook of Pragmatic Clinical Trials.

Tags
#pctGR, #PragmaticTrials, @Collaboratory1, @texhern, @lmhcurtis, @KevinWeinfurt

October 11, 2019: Guiding Good Choices for Health (GGC4H) Pragmatic Trial Enrolls First Participant

Posted on by Gina Uhlenbrauck

The GGC4H NIH Collaboratory Trial, now in its implementation phase, has begun enrollment of study participants. Congratulations to Drs. Kuklinski, Sterling, and Catalano and the entire GGC4H study team!

GGC4H is a cluster-randomized trial that is testing the feasibility and effectiveness of implementing Guiding Good Choices—a universal evidence-based anticipatory guidance curriculum for parents of early adolescents—in three large, integrated healthcare systems serving socioeconomically diverse families. In prior community trials, the Guiding Good Choices curriculum has been shown to prevent adolescent substance use, depressive symptoms, and delinquent behavior. This study offers an opportunity to test the intervention’s effectiveness with respect to improving adolescent behavioral health outcomes when implemented at scale in pediatric primary care within a pragmatic trial.

Read more about GGC4H:

GGC4H NIH Collaboratory Trial

PI Interview

PCT Grand Rounds webinar

September 11, 2019: Deadline Extended for Special Supplement Seeking Papers on Embedded Research

Posted on by Gina Uhlenbrauck

AcademyHealth

The submission deadline has been extended to October 28, 2019, for a special supplement on embedded health services research in Healthcare: The Journal of Delivery Science and Innovation, the partner journal of AcademyHealth. Embedded research is a critical part of the learning health system in mining and analyzing health system data to improve patient care while also providing generalizable findings to transform the health care system at large.

This special supplement is being supported by the Department of Veterans Affairs Health Services Research & Development and will be published in March 2020. It is expected to feature 10-12 peer-reviewed articles. Ultimately, the supplement will be a resource for those aiming to improve the relevance and use of health research to improve patient care.

For details on relevant topics and how to submit your paper online, visit the journal’s special issue page.

August 2, 2019: AI and the Future of Psychiatry (Murali Doraiswamy, MBBS)

Posted on by Gina Uhlenbrauck

Speaker

Murali Doraiswamy, MBBS
Professor of Psychiatry and Behavioral Sciences
Duke School of Medicine

Topic

AI and the Future of Psychiatry

Keywords

Artificial intelligence; Machine learning; Psychiatry; Ethical adoption of technologies; Mental health; Wearables; Mobile health

Key Points

  • There is growing evidence from randomized controlled trials of the efficacy of using digital tools in mental health diagnosis and treatment.
  • Could artificial intelligence (AI) and machine learning technologies be used to:
    • Reduce the stigma associated with mental health treatment?
    • Predict the risk for future suicide?
    • Detect Alzheimer’s years before diagnosis?
  • Categories of AI applications include low-risk apps that measure but do not diagnose, and apps used in diagnosis or treatment that must meet the same high standards of evidence as medications.
  • Clinicians still struggle with how to integrate patient data from wearable devices. AI technology might help if it could be used to synthesize the data into a risk profile for an individual.

Discussion Themes

What are the roles of stress, exercise, and sleep in mental health, and can autonomic data from wearables help explain the variance in mental health symptoms?

To develop evidence thresholds for AI, we need larger scale public-private partnerships as well as pragmatic trials addressing key clinical questions.

Read more from Dr. Doraiswamy in How to Use Technology Ethically to Increase Access to Mental Healthcare.
Tags

#AI, #pctGR, @Collaboratory1

June 28, 2019: Moving Beyond Return of Research Results to Return of Value (Consuelo Wilkins, MD, MSCI)

Posted on by Gina Uhlenbrauck

Speaker

Consuelo H. Wilkins, MD, MSCI
Vice President for Health Equity, Vanderbilt University Medical Center
Executive Director, Meharry-Vanderbilt Alliance

Topic

Moving Beyond Return of Research Results to Return of Value

Keywords

Health outcomes; Research results; Patient preferences; Value of information

Key Points

  • In returning value to research participants, results are shared with added context, are prioritized by each participant, include specific suggestions for relevant actions, and incorporate participant recommendations and preferences.
  • Data captured for research purposes, including EHR data, vital signs, and genetic data, can be repurposed and reoriented for study participants.
  • Participants are more likely to trust research if results are returned—and they are more likely to participate again.

Discussion Themes

We need to return study results that are informed by participants, and we need to design approaches for accessing and understanding results that participants will want to use.

We should think carefully about risk mitigation when returning research results for which there is a clear next step or action for the participant.

Read more about understanding what information is valued by research participants in a recent article by Dr. Wilkins and colleagues in Health Affairs.

Tags

#pctGR, @Collaboratory1, @drchwilkins, @vumchealth