Think Tank Topics
| Year | Topic | Methodological Obstacle | Think Tank Outcome |
|---|---|---|---|
| 1994, 1995 | Nature of caring | How to measure and foster caring in physicians | After a pilot study using focus groups to establish the domain of caring, the study would use a continuous quality improvement approach to enhance caring behaviors in the clinical encounter and assess the impact on patient outcomes |
| 1996 | Assessing complexity in practice patterns | How to measure complexity in clinical practice | The use of 3 data sources to triangulate results and identify chaotic patterns via interstaff relations, congruence between activities and stated practice philosophy, and the impact of events on system stability |
| 1997 | Epidemiology of bioethics | Definition of what practice interaction needs informed consent and how to incorporate patients’ views | An initial grounded theory study would be the basis for a subsequent quantitative survey |
| 1998 | Effectiveness of integrated complementary and alternative medicine | How to compare an integrated approach to traditional care | Use a multilevel randomized case study design in which a matched cohort of patients with chronic back pain is assigned to either the traditional care of a spine clinic vs the care at the integrated care clinic after in- depth interviews about the meaning of pain |
| 1999 | Diabetes and continuity of care | Current concepts and methods for defining and easuring continuity were inadequate | Multiple factors identified that contribute to the process of continuity of care at the level of the family, the individual, and the community. Developed a research plan for a cohort study to determine the temporal relationships between continuity, readiness to change self-care behaviors, and events that occur in the life of the patient and the family |
| 2000 | Factors in smoking cessation in adolescents | Mixed methods study with wealth of data but uncertain analysis plan | Relying heavily on visual time series plots of the data, analyses were developed that consisted of reflexively alternating between the qualitative and quantitative data. Visual plots would identify clusters of subjects that would then be subjected to further analyses, looking for common themes. The plan would call for identifying clusters based on one type of data (eg, quantitative) and then describing each cluster based on the alternative data (eg, qualitative) |
| 2001 | Development of a typology for health habit advice | Uncertain approach for developing a typology of health habit advice | The approach derived in the think tank was to use the data from the Exemplar Study13 to develop an initial typology that would be reviewed and altered by the Exemplar physicians in the study itself. A panel of national experts in prevention would then review this typology; their input would be used with a review of the research and theoretical literature to produce a revised typology. This revision would be reviewed again by the expert panel. The resultant typological framework would then be tested using existing databases. If this typology appears robust, it would be used in clinical trials as a final validation |
| 2002 | Interprofessional collaboration of primary care providers in managing patients with hyperlipidemia | Current measures of collaboration—self-reported style of relationships, counts of structural characteristics that promote collaboration, and measures of provider satisfaction with joint decision making—are poor surrogates | Before developing an instrument to measure collaboration on a continuum that could be used to study the relationship between collaboration and outcomes, a pilot study was needed to identify typologies of collaboration. The research question for the pilot study would be, How do primary care clinicians and staff work together to provide patient care? This multimethod study would use a comparative case study design with 3 to 5 primary care practices. Data collection would include practice genograms, observation of practice behavior, in-depth interviews with clinicians and staff, and focus groups of staff across practices |
| 2003 | Integration of visual and audio data on the clinical encounter to assess impact in depression and smoking cessation | Identifying a method by which visual and auditory data from the clinical encounter could be integrated | Pilot work was necessary to identify specifics about the doctor-patient interaction that were associated with important outcomes. It was decided to focus on development of an R03 in the area of smoking cessation; it was deemed to be “cleaner” than addressing management of depression. Baseline assessment will establish current smoking behavior and stage of change. The clinical encounter will use digital recording technology and multiple cameras to captive interactions. Postencounter assessment will address patient characteristics, postencounter stage of change, and patient perceptions of the encounter. Follow-up assessment will assess stage of change. All current smokers will be recorded until 15 patients report a baseline-followup improvement in stage of change. From the remaining subjects, a matched control group of 15 subjects matched on patient characteristics will be selected. The interactions of these 30 subjects will then be analyzed using conversational analysis |