Part 1:
1. Choose a paper describing the development or validation of a measure of relevance in health disparities research (please give the full citation and/or upload the paper if that's possible).
Iverson, N; Najafi, N; Abe-Jones, Y; Kangelaris, KN; Prasad, PA; Fang, MC; Lau, CY. IMPLICATIONS OF USING AN ALTERNATIVE MEASURE TO ASSESS OPIATE DAYS SUPPLIED AT DISCHARGE. Abstract published at Hospital Medicine 2019, March 24-27, National Harbor, Md. Abstract 408. https://www.shmabstracts.com/abstract/implications-of-using-an-alternative-measure-to-assess-opiate-days-supplied-at-discharge/. Accessed February 25, 2020.
2. What was the definition of the construct?
Adjusted opioid days were defined as the morphine milligram equivalents (MMEs) provided on discharge divided by the MMEs used by the patient during the last 24 hrs of hospitalization.
3. How did the authors provide evidence on the validity of the measure? Could you think of additional approaches to validating the measure?
The authors compared this metric to the standard metric (MMEs or opioid days on discharge based on the prescription instructions). Because the study metric is derived from the standard metric, they are similar, but there was no external validity provided. It would be interesting to validate this measure by looking at the amount of opioids left over at the end of a prescription course.
4. How did the authors provide evidence on the reliability of the measure? Could you think of additional approaches to evaluating the reliability of the measure?
The authors did not provide a measure of reliability.
5. Describe the implications of a lack of measurement validity or reliability for future research applications.
The aim of this metric was to better assess whether the number of opioid days supplied reflected the actual opiate needs of the patient. If a clinician does not understand how tapering works using this metric, then it would be reliable but not a valid measure of actual opiate needs. For example, I understand how many tablets a patient may need based on standard oxycodone doses but thinking of MMEs adjusted to the last 24 hrs is more conceptually difficult to understand.
Part 2:
1. Find a paper describing a health disparity (please give the full citation or, even better, upload the paper so everyone else can look at it too)
Zachary G Jacobs, MD, Priya A Prasad, PhD, MPH, Margaret C Fang, MD, MPH, Yumiko Abe-Jones, MS, Kirsten N Kangelaris, MD, MAS, The Association between Limited English Proficiency and Sepsis Mortality. Published Online First November 20, 2019. DOI: 10.12788/jhm.3334
2. Summarize the construct and measurement of the dimension of disparity (e.g., racial inequalities?, SES inequalities?) and the outcome measured (e.g., self-rated health).
The construct is sepsis outcomes and the measure of disparity is English proficiency status (patients with Limited English Proficiency vs English Speaking patients). The main outcome was sepsis mortality.
3. What is the evidence for the validity and reliability of the measures?
They defined the primary outcome as inpatient mortality from sepsis. The measure for what defined LEP was most interesting. They defined LEP as patients who has a self reported language other than English in the EMR and marked yes to needing an interpreter. They based this on a chart review of 60 patients looking for notes indicating that the patient was non English speaking and/or that an interpreter was needed. By this metric, the interpreter needed variable in Epic was found to have a PPV of 100%.
4. What is the reference category used for the disparity measure (ie, who is the comparison group)? Why does this reference category make sense (or not) for this research question?
The reference group was English speaking patients. Yes, it made sense.
5. How is the disparity quantified or measured? Is this an absolute or relative measure or are both provided? Describe which type of measure you would prefer for this research area, or, if both, why.
The disparity was measured by comparing sepsis mortality rates. Both absolute and relative measures were used. I would be interested in both because the relative difference indicates the magnitude of the disparity, but for a rare event, like mortality, absolute numbers provide greater clinical context and relevance.