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DESCRIPTION:Hello everyone\,\n\nAll students\, faculty\, research staff and
  post-doctoral fellows are invited to participate in the new EBOH Applied 
 Methods Discussion Group.\n\nThe objective of this group is to give us an 
 opportunity to address and discuss real methodological challenges in our a
 rea of practice. The goal of each session will be to tackle one methodolog
 ical challenge (or a small number of related challenges) that we encounter
 ed in our research\, all the while putting a strong emphasis on the applic
 ation and the implementation of related methods to overcome this problem. 
 The group is intended to be student-run and student-led for the most part.
 \n\nOur next meeting is to take place onJune 16th from 12-1pm in Purvis Ro
 om 24where Bruno Riverin will share a current challenge in developing a st
 udy design to assess outpatient follow-up with a physician after discharge
  from hospital (see below and attached for more details).\n\nRefreshments 
 will be served! \n\nIf you have any questions or have an interest in shari
 ng a methods related issue at a later date\, please feel free to contact D
 aniala Weir (daniala.weir [at] mail.mcgill.ca)\, Helen Cerigo (helen.cerig
 o [at] mail.mcgill.ca)\, Bruno Riverin (Bruno.riverin [at] mail.mcgill.ca)
  or Sahir Bhatnagar (sahir.bhatnagar [at] mail.mcgill.ca).\n\nThanks\,\n\n
 Daniala\, Helen\, Bruno and Sahir\n\n\nContext\n\nTimely outpatient follow
 -up with a physician after hospital discharge has been promoted as a strat
 egy to reduce readmissions. The quality of evidence supporting this strate
 gy is weak and inconsistent\, mainly due to methodological challenges.\n\n
 Study Question\n\nWe would like to know if the timing of physician follow-
 up plays a role in reducing the risk of hospital readmissions within 30 da
 ys. For instance\, is the reduction in risk of readmission greater if foll
 ow-up is provided earlier\; or is there a critical time after discharge at
  which the follow-up no longer has an effect?\n\nStudy Setting\n\nThis stu
 dy uses health care utilization data on nearly all elderly or chronically 
 ill patients hospitalized during a 5-year period. The unit of analysis is 
 the index admission\, and outpatient as well as inpatient billing data is 
 collected over the 30 days following hospital discharge.\n\nTarget Trial P
 rotocol\n\nEligibility criteria:                            Elderly or chr
 onically ill patient hospitalized for any cause\n\nTreatment strategies:  
                     Receive outpatient physician follow-up on any one day 
 following hospital discharge\, up to 30 days\, or no follow-up at all\n\nA
 ssignment procedures:                 Participants will be randomly assign
 ed at hospital discharge (t = 0) to one of the 30 days\, or to no follow-u
 p\n\nFollow-up period:                             Starts at randomization
  (at discharge)\; ends at readmission\, death\, or 30 days after hospital 
 discharge (no loss to follow-up)\n\nOutcome:                              
               Hospital readmission within 30 days of discharge\n\nCausal c
 ontrast:                                Per-protocol?\n\nAnalysis plan:   
                                  Per-protocol effect adjusted for pre-base
 line confounders\; IPTW derived from time-specific PS\; time-dependent cov
 ariates\; time-dependent effect of exposure in flexible parametric surviva
 l model with competing risk.\n\nDesign issues\n\nFollow-up begins after di
 scharge for everyone. However\, patients readmitted before their pseudo-as
 signed day have in fact incomplete follow-up\; and\, by design\, are count
 ed as unexposed\, which may increase the risk of readmission among the une
 xposed. So\, either those patients should have been assigned to earlier tr
 eatment\, or they are doomed* (readmission cannot be prevented))\; those w
 ho die before\, however\, are handled in a competing risk framework.  \n
DTSTART:20160616T160000Z
DTEND:20160616T170000Z
LOCATION:Room 24\, Purvis Hall\, CA\, QC\, Montreal\, H3A 1A2\, 1020 avenue
  des Pins Ouest
SUMMARY:June 16th: Applied Methods Discussion Group
URL:/epi-biostat-occh/channels/event/june-16th-applied
 -methods-discussion-group-261206
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