Person: Miller, Christopher
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Miller, Christopher
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Publication Practical application of opt-out recruitment methods in two health services research studies(BioMed Central, 2017) Miller, Christopher; Burgess, James F.; Fischer, Ellen P.; Hodges, Deborah J.; Belanger, Lindsay K.; Lipschitz, Jessica M.; Easley, Siena R.; Koenig, Christopher J.; Stanley, Regina L.; Pyne, Jeffrey M.Background: Participant recruitment is an ongoing challenge in health research. Recruitment may be especially difficult for studies of access to health care because, even among those who are in care, people using services least often also may be hardest to contact and recruit. Opt-out recruitment methods (in which potential participants are given the opportunity to decline further contact about the study (opt out) following an initial mailing, and are then contacted directly if they have not opted out within a specified period) can be used for such studies. However, there is a dearth of literature on the effort needed for effective opt-out recruitment. Methods: In this paper we describe opt-out recruitment procedures for two studies on access to health care within the U.S. Department of Veterans Affairs. We report resource requirements for recruitment efforts (number of opt-out packets mailed and number of phone calls made). We also compare the characteristics of study participants to potential participants via t-tests, Fisher’s exact tests, and chi-squared tests. Results: Recruitment rates for our two studies were 12 and 21%, respectively. Across multiple study sites, we had to send between 4.3 and 9.2 opt-out packets to recruit one participant. The number of phone calls required to arrive at a final status for each potentially eligible Veteran (i.e. study participation or the termination of recruitment efforts) were 2.9 and 6.1 in the two studies, respectively. Study participants differed as expected from the population of potentially eligible Veterans based on planned oversampling of certain subpopulations. The final samples of participants did not differ statistically from those who were mailed opt-out packets, with one exception: in one of our two studies, participants had higher rates of mental health service use in the past year than did those mailed opt-out packets (64 vs. 47%). Conclusions: Our results emphasize the practicality of using opt-out methods for studies of access to health care. Despite the benefits of these methods, opt-out alone may be insufficient to eliminate non-response bias on key variables. Researchers will need to balance considerations of sample representativeness and feasibility when designing studies investigating access to care. Electronic supplementary material The online version of this article (doi:10.1186/s12874-017-0333-5) contains supplementary material, which is available to authorized users.Publication Posttraumatic stress disorder, depression, and health-related quality of life in patients with bipolar disorder: Review and new data from a multi-site community clinic sample(Elsevier BV, 2013) Bajor, Laura; Lai, Zongshan; Goodrich, David E.; Miller, Christopher; Penfold, Robert B.; Myra Kim, Hyungjin; Bauer, Mark; Kilbourne, Amy M.Background Evidence suggests that patients with bipolar disorder have an elevated risk for comorbid posttraumatic stress disorder (PTSD) compared to those without a bipolar diagnosis. Although bipolar disorder is associated with decreased health-related quality of life (HRQOL), it is unclear whether comorbid PTSD interacts to affect HRQOL. Method Baseline data from a multi-site study of patients with bipolar disorder were analyzed. Patient surveys ascertained clinical and demographic information, including physical and mental HRQOL based on the SF-12, mood symptoms (PHQ-9, Internal State Scale), and self-reported co-occurring conditions including PTSD. Results Overall (N=384), 43.5% of patients self-reported co-occurring PTSD. Patients with PTSD had lower physical and mental HRQOL scores compared to those without PTSD (mean (SD) for those with and without PTSD, respectively): Mental Component Scale score 30.51 (8.22) and 32.86 (8.35); Physical Component Scale score 35.56 (7.77) and 37.21 (7.20). After adjusting for demographic and clinical factors including mood symptoms, multivariable linear regression analyses revealed that PTSD was no longer significantly associated with physical or mental HRQOL; however, depressive symptoms were independently associated with mental HRQOL (Beta −0.63, p<0.01). Conclusion Depressive symptoms may explain the association between PTSD and mental HRQOL. Clinicians working with these patients will want to emphasize treatment of depression as important towards improving HRQOL for this group.Publication Quality of life among patients with bipolar disorder in primary care versus community mental health settings(Elsevier BV, 2013) Miller, Christopher; Abraham, Kristen M.; Bajor, Laura; Lai, Zongshan; Kim, Hyungjin Myra; Nord, Kristina M.; Goodrich, David E.; Bauer, Mark; Kilbourne, Amy M.Introduction Bipolar disorder is associated with functional impairment across a number of domains, including health-related quality of life (HRQOL). Many patients are treated exclusively in primary care (PC) settings, yet little is known how HRQOL outcomes compare between PC and community mental health (CMH) settings. This study aimed to explore the correlates of HRQOL across treatment settings using baseline data from a multisite, randomized controlled trial for adults with bipolar disorder. Methods HRQOL was measured using the SF-12 physical (PCS) and mental (MCS) health scales. Independent sample t-tests were calculated to compare differences in HRQOL between settings. Multivariate regression models then examined the effect of treatment setting on HRQOL, adjusting for covariate demographic factors, mood symptoms (Internal State Scale), hazardous drinking (AUDIT-C), and substance abuse. Results A total of 384 enrolled participants completed baseline surveys. MCS and PCS scores reflected similar impairment in HRQOL across PC and CMH settings (p = .98 and p = .49, respectively). Depressive symptoms were associated with lower MCS scores (B = −.68, p < .001) while arthritis/chronic pain was strongly related to lower PCS scores (B = −5.23, p < .001). Limitations This study lacked a formal diagnostic interview, relied on cross-sectional self-report, and sampled from a small number of sites in two states. Discussion Participants reported similar impairments in both mental and physical HRQOL in PC and CMH treatment settings, emphasizing the need for integrated care for patients with bipolar disorder regardless of where they present for treatment.Publication Enhanced Fidelity to Treatment for Bipolar Disorder: Results From a Randomized Controlled Implementation Trial(American Psychiatric Publishing, 2014) Waxmonsky, Jeanette; Kilbourne, Amy M.; Goodrich, David E.; Nord, Kristina M.; Lai, Zongshan; Laird, Christina; Clogston, Julia; Kim, Hyungjin Myra; Miller, Christopher; Bauer, MarkBackground We determined whether application of a novel implementation intervention (Enhanced Replicating Effective Programs-REP) versus its standard, dissemination-focused version (REP) improved fidelity to bipolar disorder treatment (Life Goals Collaborative Care- LGCC). Methods Five community practices from Michigan and Colorado were randomized to receive LGCC using Enhanced or standard REP. One provider at each practice implemented LGCC which included patient self-management support (4 group sessions focused on symptoms and behavior goals), guideline dissemination to providers, and ongoing phone care management focused on maintaining behavior goals and provider engagement. Standard REP included intervention packaging (i.e., translation of LGCC core components into user-friendly language), training, and as-needed technical assistance. Enhanced REP added customization of LGCC and ongoing, proactive technical assistance through an internal and external facilitator that focused on enhancing provider buy-in and uptake. Multiple and logistic regression analyses determined the impact on patient-level LGCC fidelity between Enhanced versus standard REP. Results Participants (N=384; mean age = 42 years, 67% women, 29% nonwhite) averaged 3.0 out of 4 LGCC group sessions and had 4.0 care management contacts. Enhanced REP implementation was associated with 2.6 (p<.001) greater total number of sessions/contacts than standard REP, which was driven by 2.5 (p<.01) more care management contacts, after adjusting for patient factors. Women and those with a history of homelessness received fewer sessions. Conclusions Enhanced REP implementation was associated with improved LGCC fidelity, primarily for care management contacts. Additional customization of interventions such as LGCC may be needed to ensure adequate treatment fidelity for key vulnerable populations. Go to:Publication Understanding collaborative care implementation in the Department of Veterans Affairs: core functions and implementation challenges(BioMed Central, 2017) Lipschitz, Jessica; Benzer, Justin K.; Miller, Christopher; Easley, Siena R.; Leyson, Jenniffer; Post, Edward P.; Burgess, James F.Background: The collaborative care model is an evidence-based practice for treatment of depression in which designated care managers provide clinical services, often by telephone. However, the collaborative care model is infrequently adopted in the Department of Veterans Affairs (VA). Almost all VA medical centers have adopted a co-located or embedded approach to integrating mental health care for primary care patients. Some VA medical centers have also adopted a telephone-based collaborative care model where depression care managers support patient education, patient activation, and monitoring of adherence and progress over time. This study evaluated two research questions: (1) What does a dedicated care manager offer in addition to an embedded-only model? (2) What are the barriers to implementing a dedicated depression care manager? Methods: This study involved 15 qualitative, multi-disciplinary, key informant interviews at two VA medical centers where reimbursement options were the same— both with embedded mental health staff, but one with a depression care manager. Participant interviews were recorded and transcribed. Thematic analysis was used to identify descriptive and analytical themes. Results: Findings suggested that some of the core functions of depression care management are provided as part of embedded-only mental health care. However, formal structural attention to care management may improve the reliability of care management functions, in particular monitoring of progress over time. Barriers to optimal implementation were identified at both sites. Themes from the care management site included finding assertive care managers to hire, cross-discipline integration and collaboration, and primary care provider burden. Themes from interviews at the embedded site included difficulty getting care management on leaders’ agendas amidst competing priorities and logistics (staffing and space). Conclusions: Providers and administrators see depression care management as a valuable healthcare service that improves patient care. Barriers to implementation may be addressed by team-building interventions to improve cross-discipline integration and communication. Findings from this study are limited in scope to the VA healthcare system. Future investigation of whether alternative barriers exist in implementation of depression care management programs in non-VA hospital systems, where reimbursement rates may be a more prominent concern, would be valuable.Publication A systematic review of team-building interventions in non-acute healthcare settings(BioMed Central, 2018) Miller, Christopher; Kim, Bo; Silverman, Allie; Bauer, MarkBackground: Healthcare is increasingly delivered in a team-based format emphasizing interdisciplinary coordination. While recent reviews have investigated team-building interventions primarily in acute healthcare settings (e.g. emergency or surgery departments), we aimed to systematically review the evidence base for team-building interventions in non-acute settings (e.g. primary care or rehabilitation clinics). Methods: We conducted a systematic review in PubMed and Embase to identify team-building interventions, and conducted follow-up literature searches to identify articles describing empirical studies of those interventions. This process identified 14 team-building interventions for non-acute healthcare settings, and 25 manuscripts describing empirical studies of these interventions. We evaluated outcomes in four domains: trainee evaluations, teamwork attitudes/knowledge, team functioning, and patient impact. Results: Trainee evaluations for team-building interventions were generally positive, but only one study associated team-building with statistically significant improvement in teamwork attitudes/knowledge. Similarly mixed results emerged for team functioning and patient impact. Conclusions: The evidence base for healthcare team-building interventions in non-acute healthcare settings is much less developed than the parallel literature for short-term team function in acute care settings. Only one intervention we identified has been tested in multiple non-acute settings by distinct research teams. Positive findings regarding the utility of team-building interventions are tempered by a lack of control conditions, inconsistency in outcome measures, and high probability of bias. Considering these results alongside the well-recognized costs of poor healthcare teamwork suggests that additional research is sorely needed to develop the evidence base for team-building in non-acute settings.