Assessment Tools for Contextual Factors in Interactions in CAM

CAM 交互中情境因素的评估工具

• 批准号: 8690772
• 负责人: Ian Douglass Coulter
• 金额: $ 16.63万
• 依托单位: RAND CORPORATION
• 依托单位国家: 美国
• 财政年份: 2011
• 资助国家: 美国
• 起止时间: 2011-09-01 至 2018-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8690772
• 关键词: AT-10; Accounting; Address; American; Area; Chiropractor; Clinical Research; Complementary and alternative medicine; Confounding Factors (Epidemiology); Data; Development; Effectiveness; Effectiveness of Interventions; Ethnography; Evidence based practice; Funding; Gold; Health; Individual; Intervention; Left; Manuals; Measures; Mediating; Mediator of activation protein; Medicine; Methodology; Methods; Modality; Modeling; Outcome; Outcome Study; Patient Care; Patients; Placebo Effect; Placebos; Play; Provider; Randomized Controlled Trials; Recovery; Relative (related person); Research; Research Personnel; Role; Site; Stimulus; Therapeutic Intervention; Validation; Work; body-mind; chiropracty; clinically relevant; comparative effectiveness; contextual factors; effective intervention; effectiveness research; effectiveness trial; experience; health practice; interest; intervention effect; osteopath; patient-practitioner interaction; payment; pragmatic trial; response; systems research; tool

DESCRIPTION (provided by applicant): This proposal addresses a fundamental topic relative to Complementary and Alternative Medicine (CAM) treatments: How do we measure the context of an encounter? Encounters are defined as what patients experience between when they arrive at a CAM practice site and when they leave. The encounter can be divided into two parts: (a) the experience of the main treatment intervention (the intervention) and (b) all other experiences before, during, and after the intervention itself (the context). Contextual effects play two critical roles in assessing the efficacy and effectiveness of CAM interventions. First, contextual effects may mediate how well a treatment works (context as mediator). Second, context effects may actually contribute to outcomes directly (context-as-intervention). In a classic RCT, investigators typically want to control for context-as-mediator effects and measure context-as-intervention effects to disentangle what portion of the results are due to the intervention and what are due to the context. In CER, investigators are less concerned about controlling for context-as-mediator effects, but they would like to understand what part of the encounter accounts for any positive results. In either case, investigators MUST know how to measure the context. Without such measures, it is impossible to assess either type of context effect. This proposal has 3 specific aims: 1. to understand what kinds of contextual factors patients are exposed to during CAM encounters? 2. To determine how to measure such contextual factors reliably via observation and/or patient and provider recall; and 3. To assess the degree to which contextual factors might vary within and across (a) CAM modalities (i.e., chiropractic versus osteopath); (b) practice sites, (c) providers, and (d) individual patient encounters This study will use the chiropractic encounter as an exemplar for CAM and develop a rapid ethnographic observation method to study the context of the encounter. The objective of this project is to develop a reliable, valid, and rigorous methodology for collecting data about the context. The proposed study addresses a fundamental issue of all outcome studies in health: how to measure the effect of the context on the health outcomes.

描述（由申请人提供）：该提案解决了与补充和替代医学（CAM）治疗相关的基本主题：我们如何衡量遭遇的背景？遭遇的定义是患者到达 CAM 实践地点和离开之间所经历的事情。遭遇可以分为两部分：（a）主要治疗干预的体验（干预）和（b）干预本身之前、期间和之后的所有其他体验（背景）。情境效应在评估 CAM 干预措施的功效和效果方面发挥着两个关键作用。首先，情境效应可能会调节治疗的效果（情境作为中介）。其次，情境效应实际上可能直接影响结果（情境即干预）。在经典的随机对照试验中，研究人员通常希望控制情境作为中介效应并测量情境作为干预效应，以区分结果的哪些部分是由于干预而哪些部分是由于情境而产生的。在 CER 中，研究人员不太关心控制情境作为中介效应，但他们想了解遭遇的哪一部分导致了任何积极的结果。无论哪种情况，调查人员都必须知道如何衡量背景。如果没有这些措施，就不可能评估任何类型的背景效应。该提案有 3 个具体目标： 1. 了解患者在 CAM 接触过程中接触到哪些类型的背景因素？ 2. 确定如何通过观察和/或患者和提供者回忆来可靠地衡量此类背景因素； 3. 评估环境因素在 (a) CAM 模式内部和之间可能变化的程度（即脊椎按摩疗法与整骨疗法）； (b) 实践地点，(c) 提供者，以及 (d) 个体患者遭遇 本研究将使用脊椎按摩治疗遭遇作为 CAM 的范例，并开发一种快速人种学观察方法来研究遭遇的背景。该项目的目标是开发一种可靠、有效且严格的方法来收集有关上下文的数据。拟议的研究解决了所有健康结果研究的一个基本问题：如何衡量环境对健康结果的影响。