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Jalal H.,Center for Innovation to Implementation | Jalal H.,Stanford University | Goldhaber-Fiebert J.D.,Stanford University | Kuntz K.M.,University of Minnesota
Medical Decision Making | Year: 2015

Decision makers often desire both guidance on the most cost-effective interventions given current knowledge and also the value of collecting additional information to improve the decisions made (i.e., from value of information [VOI] analysis). Unfortunately, VOI analysis remains underused due to the conceptual, mathematical, and computational challenges of implementing Bayesian decision-theoretic approaches in models of sufficient complexity for real-world decision making. In this study, we propose a novel practical approach for conducting VOI analysis using a combination of probabilistic sensitivity analysis, linear regression metamodeling, and unit normal loss integral function - a parametric approach to VOI analysis. We adopt a linear approximation and leverage a fundamental assumption of VOI analysis, which requires that all sources of prior uncertainties be accurately specified. We provide examples of the approach and show that the assumptions we make do not induce substantial bias but greatly reduce the computational time needed to perform VOI analysis. Our approach avoids the need to analytically solve or approximate joint Bayesian updating, requires only one set of probabilistic sensitivity analysis simulations, and can be applied in models with correlated input parameters. © The Author(s) 2015.


Gidwani R.,Health Economics Resource Center | Gidwani R.,Center for Innovation to Implementation | Gidwani R.,Stanford University | Bhattacharya J.,Stanford University
Journal of General Internal Medicine | Year: 2015

BACKGROUND: In October 2008, the Centers for Medicare & Medicaid Services (CMS) stopped reimbursing hospitals for the marginal cost of treating certain preventable hospital-acquired conditions.OBJECTIVE: This study evaluates whether CMS’s refusal to pay for hospital-acquired pulmonary embolism (PE) or deep vein thrombosis (DVT) resulted in a lower incidence of these conditions.DESIGN: We employ difference-in-differences modeling using 2007–2009 data from the Nationwide Inpatient Sample, an all-payer database of inpatient discharges in the U.S. Discharges between 1 January 2007 and 30 September 2008 were considered “before payment reform;” discharges between 1 October 2008 and 31 December 2009 were considered “after payment reform.” Hierarchical regression models were fit to account for clustering of observations within hospitals.PARTICIPANTS: The “before payment reform” and “after payment reform” incidences of PE or DVT among 65–69-year-old Medicare recipients were compared with three different control groups of: a) 60–64-year-old non-Medicare patients; b) 65–69-year-old non-Medicare patients; and c) 65–69-year-old privately insured patients. Hospital reimbursements for the control groups were not affected by payment reform.INTERVENTION: CMS payment reform for hospital-based reimbursement of patients with hip and knee replacement surgeries.MAIN MEASURES: The outcome was the incidence proportion of hip and knee replacement surgery admissions that developed pulmonary embolism or deep vein thrombosis.KEY RESULTS: At baseline, pulmonary embolism or deep vein thrombosis were present in 0.81 % of all hip or knee replacement surgeries for Medicare patients aged 65–69 years old. CMS payment reform resulted in a 35 % lower incidence of hospital-acquired pulmonary embolism or deep vein thrombosis in these patients (p = 0.015). Results were robust to sensitivity analyses.CONCLUSION: CMS’s refusal to pay for hospital-acquired conditions resulted in a lower incidence of hospital-acquired pulmonary embolism or deep vein thrombosis after hip or knee replacement surgery. Payment reform had the desired direction of effect. © 2014, Society of General Internal Medicine.


Del Re A.C.,Center for Innovation to Implementation | Maisel N.C.,Center for Innovation to Implementation | Blodgett J.C.,Center for Innovation to Implementation | Finney J.W.,Center for Innovation to Implementation
BMJ Open | Year: 2013

Objectives: Intention to treat (ITT) is an analytic strategy for reducing potential bias in treatment effects arising from missing data in randomised controlled trials (RCTs). Currently, no universally accepted definition of ITT exists, although many researchers consider it to require either no attrition or a strategy to handle missing data. Using the reports of a large pool of RCTs, we examined discrepancies between the types of analyses that alcohol pharmacotherapy researchers stated they used versus those they actually used. We also examined the linkage between analytic strategy (ie, ITT or not) and how missing data on outcomes were handled (if at all), and whether data analytic and missing data strategies have changed over time. Design: Descriptive statistics were generated for reported and actual data analytic strategy and for missing data strategy. In addition, generalised linear models determined changes over time in the use of ITT analyses and missing data strategies. Participants: 165 RCTs of pharmacotherapy for alcohol use disorders. Results: Of the 165 studies, 74 reported using an ITT strategy. However, less than 40% of the studies actually conducted ITT according to the rigorous definition above. Whereas no change in the use of ITT analyses over time was found, censored (last follow-up completed) and imputed missing data strategies have increased over time, while analyses of data only for the sample actually followed have decreased. Conclusions: Discrepancies in reporting versus actually conducting ITT analyses were found in this body of RCTs. Lack of clarity regarding the missing data strategy used was common. Consensus on a definition of ITT is important for an adequate understanding of research findings. Clearer reporting standards for analyses and the handling of missing data in pharmacotherapy trials and other intervention studies are needed.


Boden M.T.,Center for Innovation to Implementation | Thompson R.J.,Washington University in St. Louis
Emotion | Year: 2015

Emotion theories posit that effective emotion regulation depends upon the nuanced information provided by emotional awareness; attending to and understanding one's own emotions. Additionally, the strong associations between facets of emotional awareness and various forms of psychopathology may be partially attributable to associations with emotion regulation. These logically compelling hypotheses are largely uninvestigated, including which facets compose emotional awareness and how they relate to emotion regulation strategies and psychopathology. We used exploratory structural equation modeling of individual difference measures among a large adult sample (n = 919) recruited online. Results distinguished 4 facets of emotional awareness (type clarity, source clarity, involuntary attention to emotion, and voluntary attention to emotion) that were differentially associated with expressive suppression, acceptance of emotions, and cognitive reappraisal. Facets were associated with depression both directly and indirectly via associations with emotion regulation strategies. We discuss implications for theory and research on emotional awareness, emotion regulation, and psychopathology. © 2014 American Psychological Association.


Lewis E.T.,Center for Innovation to Implementation | Cucciare M.A.,Center for Mental Healthcare and Outcomes Research | Cucciare M.A.,University of Arkansas for Medical Sciences | Trafton J.A.,Center for Innovation to Implementation | Trafton J.A.,Stanford University
Clinical Journal of Pain | Year: 2014

OBJECTIVES:: The volume of opioid medications being prescribed in the United States is increasing rapidly. Problems associated with the misuse of opioid medications are also increasing, in part because of medication diversion from legitimate prescriptions. However, little is known about what patients do with any unused opioid medications. This paper uses a qualitative analysis of patients' self-report of medication storage and retention habits to begin to address this gap. METHODS:: We analyzed responses to the Prescription Drug Use Questionnaire in conjunction with other data on prescription opioid use in a sample of 191 Veteran patients (83% of whom had a preexisting factor associated with higher rates of opioid misuse) who received one or more opioid prescriptions in the previous 12 months. RESULTS:: Only 6.3% of participants disposed of extra medications and 24.1% reported having no extra opioids. A total of 65.4% of participants reported retaining some or all opioids even if they ceased taking the medication, and some participants accumulated large amounts of medication. A total of 34.0% of participants described engaging in sharing or diversion of opioids at least once, most often receiving them from a family member or a friend. DISCUSSION:: A majority of patients retain unused opioids, and medication sharing is common. Interventions to improve monitoring of patient experience with opioid medication, educate patients about the dangers of opioid use by nonprescribed others, and increase information about medication disposal options could decrease the supply of opioid medications available for misuse.Copyright © 2013 by Lippincott Williams & Wilkins.


Blodgett J.C.,Center for Innovation to Implementation | Del Re A.C.,Center for Innovation to Implementation | Maisel N.C.,Center for Innovation to Implementation | Finney J.W.,Center for Innovation to Implementation | Finney J.W.,Stanford University
Alcoholism: Clinical and Experimental Research | Year: 2014

Background: Influenced by several trials and reviews highlighting positive outcomes, topiramate is increasingly prescribed as a treatment for alcohol use disorders (AUDs). The only previously published meta-analysis of topiramate for AUDs was limited by a sample of only 3 randomized, placebo-controlled trials (RCTs). Methods: A systematic search identified 7 RCTs (including a total of 1,125 participants) that compared topiramate to placebo for the treatment for AUDs. This meta-analysis estimated the overall effects of topiramate on abstinence, heavy drinking, craving, and γ-glutamyltranspeptidase (GGT) outcomes and included several sensitivity analyses to account for the small sample of studies. Results: Overall, the small to moderate effects favored topiramate, although the effect on craving was not quite significantly different from 0. The largest effect was found on abstinence (g = 0.468, p < 0.01), followed by heavy drinking (g = 0.406, p < 0.01), GGT (g = 0.324, p = 0.02), and craving (g = 0.312, p = 0.07) outcomes. Sensitivity analyses did not change the magnitude or direction of the results, and tests did not indicate significant publication bias. The small sample size did not allow for examination of specific moderators of the effects of topiramate. Conclusions: Topiramate can be a useful tool in the treatment of AUDs. Its efficacy, based on the current sample of studies, seems to be of somewhat greater magnitude than that of the most commonly prescribed medications for AUDs (naltrexone and acamprosate). Further research will help to identify the contexts in which topiramate is most beneficial (e.g., dose, concurrent psychotherapy, patient characteristics). Published 2014. This article is a U.S. Government work and is in the public domain in the USA.


Neveda A.,Center for Innovation to Implementation | Sankar A.,Wayne State University
Gerontologist | Year: 2016

Purpose of the Study: Aging and HIV/AIDS research focuses primarily on standardized clinical, social, and behavioral measures, leaving unanswered questions about how this chronic and stigmatizing condition affects life course expectations and the meaning of aging with the disease. Utilizing Gaylene Becker's (1997) life course disruption theory, we explored older African Americans' experiences of living with HIV/AIDS. Design and Methods: A purposive sample (N = 43) of seropositive African Americans aged 50 and older was selected from a parent study. Thirteen participants completed one semi-structured in-depth interview on life course expectations and experiences of living with HIV/AIDS. Interview transcripts were analyzed using standard qualitative coding and thematic analysis. Results: Responding to broad, open-ended questions about the impact of HIV on life course expectations, participants emphasized how HIV limited their ability to experience sexuality and intimacy. Two major themes emerged, damaged sexuality and constrained intimacy. Implications: Older African Americans' discussions of living with HIV focused on the importance of and the challenges to sexuality and intimacy. Researchers and clinicians should be attentive to significant and ongoing HIV-related challenges to sexuality and intimacy facing older African Americans living with HIV/AIDS. © The Author 2015. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved.


Humphreys K.,Center for Innovation to Implementation | Humphreys K.,Stanford University
Addiction | Year: 2015

Griffith Edwards made empirical contributions early in his career to the literature on Alcoholics Anonymous (AA), but the attitude he adopted towards AA and other peer-led mutual help initiatives constitutes an even more important legacy. Unlike many treatment professionals who dismissed the value of AA or were threatened by its non-professional approach, Edwards was consistently respectful of the organization. However, he never became an uncritical booster of AA or overgeneralized what could be learnt from it. Future scholarly and clinical endeavors concerning addiction-related mutual help initiatives will benefit by continuing Edwards' tradition of 'rigorous sympathy'. © 2015 Society for the Study of Addiction.


Goldberg S.B.,University of Wisconsin - Madison | Del Re A.C.,Center for Innovation to Implementation | Hoyt W.T.,University of Wisconsin - Madison | Davis J.M.,University of Wisconsin - Madison
Journal of Counseling Psychology | Year: 2014

As mindfulness-based interventions become increasingly widespread, interest has grown in better understanding which features of these treatments produce beneficial effects. The present study examined the relative contribution of mindfulness practice time and practice quality in predicting psychological functioning (negative affect, emotion regulation, quality of life, mindfulness). Data were drawn from a randomized clinical trial of mindfulness training for smokers and assessed outcomes at posttreatment (n = 43) and 5-month follow-up (n = 38). The intervention included instruction in mindfulness techniques targeted to smoking cessation and relapse prevention and was composed of 10 group meetings over 8 weeks. Data from 8 treatment groups were used. Mindfulness practice quality was measured weekly over the course of treatment, and multilevel modeling was used to estimate trajectories of change in practice quality. The measure of practice quality was shown to be valid and reliable, with change in practice quality predicting change in psychological functioning at both posttreatment (ß=.31, 95% CI = [0.04, 0.56], p = .022) and follow-up (ß=.45 [0.16, 0.73], p = .002), even when controlling for practice time. Practice time predicted outcomes at posttreatment (ß = .31 [0.05, 0.57], p = .019) but not at follow-up (ß = .16 [-0.14, 0.47], p = .293). Neither practice time nor change in practice quality predicted smoking abstinence at 1 month or 6 months postquit. Results support the importance of practice quality as a relevant aspect of mindfulness interventions. © 2014 American Psychological Association.


Baldwin S.A.,Brigham Young University | Del Re A.C.,Center for Innovation to Implementation
Journal of Counseling Psychology | Year: 2016

Meta-analysis has played a key role in psychotherapy research for nearly 40 years. There is now an opportunity for technology to assist with transparent and open meta-analyses. The authors describe an open-access database of effect sizes and a corresponding web application for performing meta-analyses, viewing the database, and downloading effect sizes. The initial databases provide effect sizes for family therapy for delinquency studies and for alliance-outcome correlations in individual psychotherapy. Disciplinary norms about data sharing and openness are shifting. Furthermore, meta-analyses of behavioral interventions have been criticized for lacking transparency and openness. The database and web application are aimed at facilitating data sharing and improving the transparency of meta-analyses. The authors conclude with a discussion of future directions for the database. © 2016 American Psychological Association.

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