Wednesday, July 14, 2004

Underutilized is an Understatement

The monotony of too much time to occupy, too little to do was to be broken up by an hour-long meeting with a list of attendees comprising myself, my direct supervisor, and the three other people in the same position as I. In the meantime, I filled the vast spaces between activity that was directly work-related with research.

One of the main topics I've been researching of late is that of Best Practices guidelines in disease management. How does our program stack up? How could it be improved? Exactly how much and what kind of research has gone into establishing these guidelines? What research could later be attempted to get a better idea of the effectiveness of disease management interventions in general?

In the process of researching that topic, I came across a conference in Boston. Next week! With a talk devoted specifically to the successes of disease management in affecting health behavior! I plunged deeper into the conference's page, only to find that it was a talk being given by someone from my company. Someone who I have never heard of. Someone who probably doesn't even work in the same building with me, but spends her days plugging numbers away deep inside our Main Office. Someone who has zilch familiarity with the day-to-day workings of disease management.

The cost for the conference was $2095. I never even bothered to ask if I could go.

Scrolling away from that page, I decided to start thinking of my optional work-from-home day assignment. (My Department is being oh-so-generous and allowing us to choose one day during the clusterfuck of the DNC to "work from home".) The topic assigned to me is humiliatingly basic, something akin to What I Did on My Summer Vacation, or at least it seems that way to me. I had decided to branch out from the topic (actually, something like Describe in words (as opposed to what, interpretive dance?) the style you use to engage people into the program...) into the actual behavioral change theories utilized by designers of health messages (like myself) to best engage people into listening, and subsequently making, changes in their behavior.

My plan: to make a ridiculously in-depth, professional presentation where they expected just a silly fluff piece, (I mean really, can one describe one's own personal style?) thereby blowing minds and opening up future opportunities for me.

Following me so far? Good. To that end, I began flipping through some of the texts I still have from grad school and taking notes on active v/s passive cognitive functioning, and how best to design a message that causes the recipient to cognitively "switch gears" and take part in a more active learning process. For example, using novel approaches (putting something we've all heard in a different way, or in a completely different context) or words that suggest spatial immediacy ("this" instead of "that") have been shown to lead to more active, and thus more permanent, learning.

This is all great information, information that everyone on my disease management team should be privy to. I smiled, thinking of how successful the eventual fruit of my labors would be.

When I tired of that topic, I decided to do a bit of research on the Framingham Heart Study parameters we use in scoring the risk level of our own disease management enrollees. I found the original Framingham Risk Probability scoring information and began sizing up the algorithms we're running here, in my department. Hmm. I was just starting to make note of pertinent questions I should really ask about the design of our program when I was, at last, summoned for the meeting by an insistent Outlook message.

The meeting opened with a rehashing of how 2 of the 4 of us are aiding a group of lower-level employees by doing some of their lower-level brainless data entry work. They will soon be needed to do more. I uttered a silent prayer of thanks that I am not yet trained on the mainframe system they use to do the data entry. I'm safe for now...

The next item up for discussion was how the contractor currently doing the bulk of what will eventually be our job is going to be doing it for another few months. (This means another few months of unending boredom...) The contractor's report was passed around, my co-workers glancing at it with expressions of disinterest. I flipped through it, glancing at the results.

"Wait. Are these numbers accurate? Contractor has enrolled 4200 people, but has been turned down by 2300?" I interjected. "Those results are terrible, compared with ours! We've got more like a 90% enrollment rate! And they've been rejected by a third of the potential enrollees?"

"Yes, I know. You guys are much better..." my supervisor began, "and you know I've been pulling for you in countless meetings. But things just aren't ready to come to fruition yet..."

I sighed gently, began drawing a few more things in the report to her attention, discussed the cost-effectiveness of hiring a contractor with a high failure rate v/s hiring more People Like Me.

Things moved on. The next agenda item my supervisor brought up was the exact same topic I had introduced at the last meeting. I had brought it up gently, proposed a solution, and suggested a bit of education for the entire team, offering to personally go over the steps with anyone who requested I do so. My supervisor asked if we knew the steps and proceeded to go over them with us--listing out the steps I had hammered home at the last meeting.

I sighed inwardly. "Do you think this could be brought up at the next team meeting, so everyone is aware of the solution, like we talked about at the last meeting?" I asked, gently.

The meeting drug on. "I have trouble with the medical information, sometimes.", the crazy stupid awful girl I can't stand piped up with. She looked at me accusingly. "YOU don't have a medical background, either. How come you don't have trouble?" she asked with a scowl.

I faced her glance dead-on. "I have a graduate degree in health." I said without emotion. "I've gone through a good amount of medical school coursework, public health courses, and countless professional medical journals."

"Yeah, and I have a degree in Exercise Physiology." my friend and co-worker piped up. "I had to take anatomy and physiology, medications classes, you know. Stuff like that."

"Yes," my supervisor smiled, "he is kind of in a field that is more 'along-side' of nursing."

We discussed the scoring of members, whether we should use the Framingham data (which is nearly useless because it's mostly comprised of default values) or the scoring mechanism that was designed for this program in particular.

The meeting went on. "Does anyone have anything else?" my supervisor asked.

Everyone looked at each other, and I prepared to segue into my questions about the Framingham parameters. "I'm turning 40 this weekend!" my friend laughed, keeping the conversation going. We all smiled, wished him a happy birthday. Then we gathered up our things and left.

I am sitting here at my desk, my unanswered questions about why our version of the Framingham Risk Scoring doesn't consider smoking or systolic blood pressure for men, or whether or not we are in any way tracking the ethnic background of enrolled members (Framingham was based on an almost entirely caucasian population, therefore does not generalize well across the board. We have an opportunity now to compare results from different ethnic backgrounds with the original study parameters...) still staring at me from my little steno pad.

But I know the correct procedure for answering the phone.

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