IU Indianapolis ScholarWorks :: Browsing by Subject "Configurational comparative methods"

Browsing by Subject "Configurational comparative methods"

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Clinic Factors Associated With Mailed Fecal Immunochemical Test (FIT) Completion: The Difference-Making Role of Support Staff
(Annals of Family Medicine, 2022) Davis, Melinda M.; Schneider, Jennifer L.; Petrik, Amanda F.; Miech, Edward J.; Younger, Brittany; Escaron, Anne L.; Rivelli, Jennifer S.; Thompson, Jamie H.; Nyongesa, Denis; Coronado, Gloria D.; Emergency Medicine, School of Medicine
Purpose: Mailed fecal immunochemical test (FIT) programs can facilitate colorectal cancer (CRC) screening. We sought to identify modifiable, clinic-level factors that distinguish primary care clinics with higher vs lower FIT completion rates in response to a centralized mailed FIT program. Methods: We used baseline observational data from 15 clinics within a single urban federally qualified health center participating in a pragmatic trial to optimize a mailed FIT program. Clinic-level data included interviews with leadership using a guide informed by the Consolidated Framework for Implementation Research (CFIR) and FIT completion rates. We used template analysis to identify explanatory factors and configurational comparative methods to identify specific combinations of clinic-level conditions that uniquely distinguished clinics with higher and lower FIT completion rates. Results: We interviewed 39 clinic leaders and identified 58 potential explanatory factors representing clinic workflows and the CFIR inner setting domain. Clinic-level FIT completion rates ranged from 30% to 56%. The configurational model for clinics with higher rates (≥37%) featured any 1 of the following 3 factors related to support staff: (1) adding back- or front-office staff in past 12 months, (2) having staff help patients resolve barriers to CRC screening, and (3) having staff hand out FITs/educate patients. The model for clinics with lower rates involved the combined absence of these same 3 factors. Conclusions: Three factors related to support staff differentiated clinics with higher and lower FIT completion rates. Adding nonphysician support staff and having those staff provide enabling services might help clinics optimize mailed FIT screening programs.
Coincidence analysis: a new method for causal inference in implementation science
(BMC, 2020-12-11) Garr Whitaker, Rebecca; Sperber, Nina; Baumgartner, Michael; Thiem, Alrik; Cragun, Deborah; Damschroder, Laura; Miech, Edward J.; Slade, Alecia; Birken, Sarah; Emergency Medicine, School of Medicine
Background: Implementation of multifaceted interventions typically involves many diverse elements working together in interrelated ways, including intervention components, implementation strategies, and features of local context. Given this real-world complexity, implementation researchers may be interested in a new mathematical, cross-case method called Coincidence Analysis (CNA) that has been designed explicitly to support causal inference, answer research questions about combinations of conditions that are minimally necessary or sufficient for an outcome, and identify the possible presence of multiple causal paths to an outcome. CNA can be applied as a standalone method or in conjunction with other approaches and can reveal new empirical findings related to implementation that might otherwise have gone undetected. Methods: We applied CNA to a publicly available dataset from Sweden with county-level data on human papillomavirus (HPV) vaccination campaigns and vaccination uptake in 2012 and 2014 and then compared CNA results to the published regression findings. Results: The original regression analysis found vaccination uptake was positively associated only with the availability of vaccines in schools. CNA produced different findings and uncovered an additional solution path: high vaccination rates were achieved by either (1) offering the vaccine in all schools or (2) a combination of offering the vaccine in some schools and media coverage. Conclusions: CNA offers a new comparative approach for researchers seeking to understand how implementation conditions work together and link to outcomes.
Defining optimal implementation packages for delivering community-wide mass drug administration for soil-transmitted helminths with high coverage
(Springer, 2022-06-18) Gwayi-Chore, Marie-Claire; Aruldas, Kumudha; Avokpaho , Euripide; Chirambo , Chawanangwa Maherebe; Kaliappan , Saravanakumar Puthupalayam; Houngbégnon , Parfait; Togbevi , Comlanvi Innocent; Chabi , Félicien; Nindi, Providence; Simwanza , James; Johnson , Jabaselvi; Miech , Edward J.; Kalua , Khumbo; Ibikounlé , Moudachirou; Ajjampur, Sitara S. R.; Weiner , Bryan J.; Walson, Judd L.; Rubin Means, Arianna; Emergency Medicine, School of Medicine
Background Recent evidence suggests that community-wide mass drug administration (MDA) may interrupt the transmission of soil-transmitted helminths (STH), a group of intestinal worms that infect 1.5 billion individuals globally. Although current operational guidelines provide best practices for effective MDA delivery, they do not describe which activities are most essential for achieving high coverage or how they work together to produce effective intervention delivery. We aimed to identify the various packages of influential intervention delivery activities that result in high coverage of community-wide MDA for STH in Benin, India, and Malawi. Methods We applied coincidence analysis (CNA), a novel cross-case analytical method, to process mapping data as part of the implementation science research of the DeWorm3 Project, a Hybrid Type 1 cluster randomized controlled trial assessing the feasibility of interrupting the transmission of STH using bi-annual community-wide MDA in Benin, India, and Malawi. Our analysis aimed to identify any necessary and/or sufficient combinations of intervention delivery activities (i.e., implementation pathways) that resulted in high MDA coverage. Activities were related to drug supply chain, implementer training, community sensitization strategy, intervention duration, and implementation context. We used pooled implementation data from three sites and six intervention rounds, with study clusters serving as analytical cases (N = 360). Secondary analyses assessed differences in pathways across sites and over intervention rounds. Results Across all three sites and six intervention rounds, efficient duration of MDA delivery (within ten days) singularly emerged as a common and fundamental component for achieving high MDA coverage when combined with other particular activities, including a conducive implementation context, early arrival of albendazole before the planned start of MDA, or a flexible community sensitization strategy. No individual activity proved sufficient by itself for producing high MDA coverage. We observed four possible overall models that could explain effective MDA delivery strategies, all which included efficient duration of MDA delivery as an integral component. Conclusion Efficient duration of MDA delivery uniquely stood out as a highly influential implementation activity for producing high coverage of community-wide MDA for STH. Effective MDA delivery can be achieved with flexible implementation strategies that include various combinations of influential intervention components.
Factors that distinguish opioid withdrawal during induction with buprenorphine microdosing: a configurational analysis
(Springer, 2022-10-04) Adams , K. K.; Miech, E. J.; Sobieraj, D. M.; Emergency Medicine, School of Medicine
Background: Novel buprenorphine dosing strategies have emerged with an aim to transition patients from opioid agonists to buprenorphine without prerequisite opioid withdrawal. We applied a configurational approach to a subset of data from our earlier systematic review to answer the following question: when patients received a buprenorphine initiation strategy aimed to eliminate prerequisite withdrawal, what factors consistently distinguished patients that experienced withdrawal during the initiation process from patients that did not? Methods: From the 24 cases identified by our systematic review, we included cases that were treated using buprenorphine microdosing strategies (oral or transdermal), cases with opioid use disorder, and cases that fully transitioned to buprenorphine without continuing the full opioid agonist. Configurational analysis was used to identify combinations of patient and regimen level factors that uniquely distinguished cases experiencing withdrawal during induction. Result: Fourteen cases were included in our analysis, of which 9 experienced opioid withdrawal symptoms. Three factors were involved in explaining both the presence and absence of withdrawal symptoms: history of heroin use, history of methadone use, and duration of overlap between buprenorphine and the full opioid agonist during induction. For the presence of withdrawal symptoms, the addition of a fourth factor "buprenorphine starting dose" resulted in a model with perfect consistency and coverage; for the absence of withdrawal symptoms, the addition of a fourth factor "induction duration" similarly resulted in a model with perfect consistency and 80% coverage. Conclusion: Application of configurational methods allowed synthesis of case reports identified through a systematic review.
How combinations of state firearm laws link to low firearm suicide and homicide rates: A configurational analysis
(Elsevier, 2022-12) Rich, John A.; Miech, Edward J.; Semenza, Daniel C.; Corbin, Theodore J.; Medicine, School of Medicine
Firearm violence, including both homicide and suicide, is a major public health problem in the United States (US). To decrease firearm mortality, US states have implemented laws to restrict firearm availability. We evaluated ten state firearm laws using configurational comparative methods (CCMs) designed to uncover how multiple factors are linked to a given outcome. We applied coincidence analysis, a novel CCM, to ten firearm laws in US states in 2016, to assess how different combinations of firearm laws distinguished states with low firearm homicide or suicide rates from those states with higher rates. The suicide analysis included all 50 US states; the homicide analysis involved the 47 US states with homicide rates reported by the Centers for Disease Control and Prevention (CDC) in 2016. For low firearm suicide rates, we identified three solution pathways - the presence of universal background checks OR the presence of under 21 firearm possession restrictions OR the presence of junk gun bans - which were sufficient for low firearm suicide rates with high consistency (0.87) and coverage (0.76). For low firearm homicide rates, we identified three solution pathways - presence of under 21 firearm possession restrictions OR the presence of universal background checks together with the absence of trafficking prohibited laws OR membership in the Northern Great Plains -which were sufficient for low firearm homicide rates with high consistency (0.87) and coverage (0.81). We conclude that CCM analysis can add new insights to how multiple firearm laws work together to reduce firearm violence.
How education and racial segregation intersect in neighborhoods with persistently low COVID-19 vaccination rates in Philadelphia
(BMC, 2022-05-25) Rich, John A.; Miech, Edward J.; Bilal, Usama; Corbin, Theodore J.; Emergency Medicine, School of Medicine
Background: COVID-19 infection has disproportionately affected socially disadvantaged neighborhoods. Despite this disproportionate burden of infection, these neighborhoods have also lagged in COVID-19 vaccinations. To date, we have little understanding of the ways that various types of social conditions intersect to explain the complex causes of lower COVID-19 vaccination rates in neighborhoods. Methods: We used configurational comparative methods (CCMs) to study COVID-19 vaccination rates in Philadelphia by neighborhood (proxied by zip code tabulation areas). Specifically, we identified neighborhoods where COVID-19 vaccination rates (per 10,000) were persistently low from March 2021 - May 2021. We then assessed how different combinations of social conditions (pathways) uniquely distinguished neighborhoods with persistently low vaccination rates from the other neighborhoods in the city. Social conditions included measures of economic inequities, racial segregation, education, overcrowding, service employment, public transit use, health insurance and limited English proficiency. Results: Two factors consistently distinguished neighborhoods with persistently low COVID-19 vaccination rates from the others: college education and concentrated racial privilege. Two factor values together - low college education AND low/medium concentrated racial privilege - identified persistently low COVID-19 vaccination rates in neighborhoods, with high consistency (0.92) and high coverage (0.86). Different values for education and concentrated racial privilege - medium/high college education OR high concentrated racial privilege - were each sufficient by themselves to explain neighborhoods where COVID-19 vaccination rates were not persistently low, likewise with high consistency (0.93) and high coverage (0.97). Conclusions: Pairing CCMs with geospatial mapping can help identify complex relationships between social conditions linked to low COVID-19 vaccination rates. Understanding how neighborhood conditions combine to create inequities in communities could inform the design of interventions tailored to address COVID-19 vaccination disparities.
Improving Smoking and Blood Pressure Outcomes: The Interplay Between Operational Changes and Local Context
(Annals of Family Medicine, 2021) Cohen, Deborah J.; Sweeney, Shannon M.; Miller, William L.; Hall, Jennifer D.; Miech, Edward J.; Springer, Rachel J.; Balasubramanian, Bijal A.; Damschroder, Laura; Marino, Miguel; Emergency Medicine, School of Medicine
Purpose: We undertook a study to identify conditions and operational changes linked to improvements in smoking and blood pressure (BP) outcomes in primary care. Methods: We purposively sampled and interviewed practice staff (eg, office managers, clinicians) from a subset of 104 practices participating in EvidenceNOW-a multisite cardiovascular disease prevention initiative. We calculated Clinical Quality Measure improvements, with targets of 10-point or greater absolute improvements in the proportion of patients with smoking screening and, if relevant, counseling and in the proportion of hypertensive patients with adequately controlled BP. We analyzed interview data to identify operational changes, transforming these into numeric data. We used Configurational Comparative Methods to assess the joint effects of multiple factors on outcomes. Results: In clinician-owned practices, implementing a workflow to routinely screen, counsel, and connect patients to smoking cessation resources, or implementing a documentation change or a referral to a resource alone led to an improvement of at least 10 points in the smoking outcome with a moderate level of facilitation support. These patterns did not manifest in health- or hospital system-owned practices or in Federally Qualified Health Centers, however. The BP outcome improved by at least 10 points among solo practices after medical assistants were trained to take an accurate BP. Among larger, clinician-owned practices, BP outcomes improved when practices implemented a second BP measurement when the first was elevated, and when staff learned where to document this information in the electronic health record. With 50 hours or more of facilitation, BP outcomes improved among larger and health- and hospital system-owned practices that implemented these operational changes. Conclusions: There was no magic bullet for improving smoking or BP outcomes. Multiple combinations of operational changes led to improvements, but only in specific contexts of practice size and ownership, or dose of external facilitation.
Modeling Contingency in Veteran Community Reintegration: A Mixed Methods Approach
(Sage, 2023) Rattray, Nicholas A.; Miech, Edward J.; True, Gala; Natividad, Diana; Laws, Brian; Frankel, Richard M.; Kukla, Marina; Medicine, School of Medicine
Researchers need approaches for analyzing complex phenomena when assessing contingency relationships where specific conditions explain an outcome only when combined with other conditions. Using a mixed methods design, we paired configurational methods and qualitative thematic analysis to model contingency in veteran community reintegration outcomes, identifying combinations of conditions that led to success or lack of success in community reintegration among US military veterans. This pairing allowed for modeling contingency at a detailed level beyond the capabilities of either approach alone. Our analysis revealed multiple contingent relationships at work in explaining reintegration, including social support, purpose, cultural adjustment, and military separation experiences. This study contributes to the field of mixed methods by pairing a mathematical cross-case method with a qualitative method to model contingency.

Browsing by Subject "Configurational comparative methods"

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