This case study describes a cluster-randomized control trial comparing the effectiveness of two technology-based approaches to collaborative decision-making during mental health medication treatment visits. The case study reviews the impetus for the research trial, components of each approach, study design, and recruitment processes and discusses how dive... Read More

This case study describes a cluster-randomized control trial comparing the effectiveness of two technology-based approaches to collaborative decision-making during mental health medication treatment visits. The case study reviews the impetus for the research trial, components of each approach, study design, and recruitment processes and discusses how diverse stakeholders were engaged in all aspects of the research. Throughout the case study, details regarding methodological processes and challenges specific to randomization, data collection, and primary outcome measures are explained. Through the presentation of these challenges and subsequent impacts on data interpretation, this case study offers insights into workable solutions and the importance of methodological transparency in the conduct of patient-centered comparative effective research in real-world settings.

Older adults, including those with cognitive impairment, have been largely underrepresented in research. The National Institutes of Health released a research policy which aims to increase representation across the lifespan and targets traditionally underrepresented age groups, including older adults and children. Challenges in enrolling older adults, whi... Read More

Older adults, including those with cognitive impairment, have been largely underrepresented in research. The National Institutes of Health released a research policy which aims to increase representation across the lifespan and targets traditionally underrepresented age groups, including older adults and children. Challenges in enrolling older adults, which may contribute to the lower recruitment rates, include concerns about safety and frailty or obtaining informed consent for subjects with cognitive impairment or dementia. In addition, many studies explicitly exclude subjects with cognitive impairment. This case will explore the problem of underrepresentation of older adults in research, review ethical considerations, and describe components of decision making capacity necessary to consent for research. Strategies to address challenges in obtaining informed consent if the subject lacks decision making capacity will be discussed.

Research has shown that many emergency department visits could be avoided with better access to primary and ambulatory care. Thus, emergency department use has long been a barometer for researchers and policymakers looking to monitor health systems. In this study, a large administrative database containing insurance and health services information for mil... Read More

Research has shown that many emergency department visits could be avoided with better access to primary and ambulatory care. Thus, emergency department use has long been a barometer for researchers and policymakers looking to monitor health systems. In this study, a large administrative database containing insurance and health services information for millions of people allowed us to look for new insights into population-level changes in care patterns after health reforms in Massachusetts in 2006. We applied multivariable generalized linear regression models to predict a new measure of emergency department use that offers several advantages over other measures, giving us insights into the characteristics of individuals with potentially preventable visits. In this case study, we describe the measure, our approach to modeling, a number of unexpected issues we encountered along the way, and the solutions we used to resolve them.

Rapid reviews enable researchers to obtain a snapshot of what is known about a topic in a quick and systematic way, and are increasingly becoming an important aspect of the research literature. Despite this, there are currently no formal guidelines as to how best to conduct a rapid review. One method is to begin with a narrow search, and to expand the sea... Read More

Rapid reviews enable researchers to obtain a snapshot of what is known about a topic in a quick and systematic way, and are increasingly becoming an important aspect of the research literature. Despite this, there are currently no formal guidelines as to how best to conduct a rapid review. One method is to begin with a narrow search, and to expand the search successively, until the number of new/additional publications considered potentially eligible, based on title and abstract alone, is less than 1% of the total number of publications found overall (at this point, one can be reasonably confident that expanding the search is unlikely to yield any considerable new information). One of the main advantages of this method is that it provides a rationale for terminating the search at a given point, thereby making it less time-consuming than many other methods, which require the reviewer(s) to screen all articles found in response to a comprehensive list of search terms. In this case study, we describe our experience using the aforementioned method to review the literature investigating factors associated with flexible sigmoidoscopy (“bowel scope”) screening use, and the lessons learned from it. We also describe the problems encountered in performing our review, and the steps implemented to overcome them. Finally, we provide suggestions for methodological improvements for the benefit of those considering conducting a rapid review in the future.