What's New with HCFO - April 17, 2009 (Print All Articles)
Health Information Technology
The $787 billion American Recovery and Reinvestment Act (ARRA) of 2009 (P.L. 111-5) is intended to stimulate the economy, create jobs, and provide other investments, including the infrastructure to transform the health care system and control future spending.1 The legislation includes $19 billion for health information technology (HIT), the first part of a commitment by President Obama to invest $50 billion over five years to encourage the widespread adoption of HIT in the United States. Policymakers and researchers promote HIT as a means to improve the safety, quality, and efficiency of health care.2 Some health services researchers, however, question the returns this investment is likely to yield.3
What Is HIT?
HIT is a general concept comprising a number of different types of specific applications:
- Electronic medical records (EMRs) are an electronic version of a provider’s paper medical records for the patients they treat. Electronic health records (EHRs) also contain information about a given patient, but are sometimes distinguished from EMRs in that they may include patient information from more than one provider as well as administrative information.
- Computerized physician order entry (CPOE) is a process by which a provider electronically transmits orders to other medical personnel for pharmacy, laboratory or other diagnostic tests, and treatment.
- Personal health records (PHRs) are an electronic tool controlled by patients themselves to track information and test results from providers, pharmacies, and insurance companies. PHRs can take the form of stand-alone internet or software applications in which the patient and/or one other entity enters information about the patient’s health, or an integrated tool that can receive information directly from multiple providers.
- Document image management systems (DIMS) or picture archive communication systems (PACS) allow electronic retrieval, routing, display and archiving of documents and/or images.
- Clinical decision support (CDS) systems help physicians make decisions about the preferred course of diagnosis or treatment for a patient. In hospitals, doctors often use CDS in conjunction with CPOE.
- Chronic disease management systems and disease registries collect, manage, and give information to help providers manage all of their patients with a particular disease or condition.
- Health information exchanges (HIEs) provide the capability to move clinical and administrative information among multiple providers (and sometimes payers) to help coordinate a patient’s care. HIEs are usually local or regional organizations governed by multiple stakeholders in the area’s health care system.
- Telemedicine, sometimes considered a form of HIT, uses telephonic and electronic technologies to provide consultation and patient monitoring between remote locations.4
Provisions of ARRA
ARRA adopts a multi-part approach to expanding the use of HIT. In particular, the legislation:
- Codifies and expands the responsibilities of the Office of the National Coordinator of Health Information Technology (ONCHIT), a function created by presidential executive order in 2004;
- Provides $17 billion in Medicare and Medicaid incentives between 2011 and 2016 to physicians and hospitals that demonstrate “meaningful use” of “certified EHRs;”
- Provides financial penalties in reduced Medicare and Medicaid reimbursements to physicians that do not adopt EHRs starting in 2017;
- Provides $2 billion to ONCHIT to support technical assistance for providers and to develop the HIT infrastructure, including standards for interoperable systems and regional HIEs; and
- Enhances privacy and security requirements for HIT by expanding the applicability of HIPAA rules requiring that patients be notified if the security of their medical records is compromised, and restricting the commercial use of patient information contained in HIT systems.5
Current Use of EHRs
ARRA focuses on EHRs, which are electronic versions of patients’ medical records from one or more providers.6 To date, EHR use has been limited to a small minority of physicians and hospitals. A recent study partially funded by the Robert Wood Johnson Foundation (RWJF) found that in 2008, 13 percent of physicians reported having a basic EHR system, but only 4 percent reported having extensive, fully functional electronic records. Primary care physicians as well as those practicing in the western United States, in large groups, in hospitals, or in medical centers, are more likely to be users of EHR systems.7 These findings are consistent with another recent RWJF-funded study of physician organizations in the United States.8 Prevalence of EHRs is even less in hospitals. A RWJF-funded survey of hospitals found that 7.6 percent used basic EHR systems in at least one clinical unit and that only 1.5 percent had comprehensive EHRs in all clinical units.9 These institutions were more likely to be teaching hospitals and located in urban areas.10 These studies and other research have found that the time and cost associated with the initial investment (especially for small physician practices), the lack of interoperability among different EHR systems,11 and the need for technical assistance and training for medical personnel are all barriers to EHR adoption.12
Implementation Challenges and Beyond
The Obama administration has appointed former HCFO grantee David Blumenthal, M.D., M.P.P., to lead ONCHIT, where he will oversee the implementation of the HIT provisions of ARRA.13 Among the challenges ONCHIT faces are meeting the tight timetable to develop the infrastructure and interoperability standards necessary for providers to benefit from the financial incentives, developing operational definitions for the terms “certified EHR” and “meaningful use,” 14 and assuring that EHR systems provide sufficient flexibility to support a variety of functions, including CDS and data useful for comparative effectiveness research. One model that experts have suggested that HIT policymakers adopt is that of the Apple iPhone, which has an openly-shared software platform and user interface for which outside developers can create compatible applications.15
Another challenge is to develop EHRs in a way that maximizes their effectiveness in improving the quality and efficiency of care. To date, the research on the benefits of HIT has produced mixed results. A recently published study produced as part of an on-going HCFO grant to Stephen Parente, Ph.D., and Jeffrey McCullough, Ph.D., both of the University of Minnesota, confirmed the need for health services researchers to continue work in this area. Using national data to estimate the relationship between HIT and clinical quality, Drs. Parente and McCullough found that EMRs16 are associated with a small, but statistically significant aversion of post-operative infections. However, they found no statistically significant relationships for two other types of HIT — nurse charting and PACS — or for two other measures of patient safety — post-operative hemorrhages/hematomas and pulmonary embolisms/deep vein thrombosis, which could reflect the true value of the HITs examined or limitations of the study.17 On-going work that Drs. Parente and McCullough have undertaken as a part their HCFO grant is examining the costs and benefits of CPOE.18
Health services research will play an important role in guiding the evolution of HIT. This will include efforts to provide a more definitive understanding of the benefits and costs of HIT and which types of technology are best suited to particular functions. Organizational health services research will play an important role in identifying “best practices” to guide training and other technical assistance to providers. Hence, a final, but important initial challenge for policymakers is to provide the resources and environment for researchers to study and learn from these early HIT efforts.
The following are select grants from the HCFO portfolio that address issues related to HIT. For other HCFO grants, see www.hcfo.net.
HCFO Grants:
Title: The Costs and Benefits of Health Information Technology: Computerized Physician Order Entry
Grantee Institution: University of Minnesota
Principal Investigator: Jeffrey McCullough, Ph.D.
Grant Period: September 01, 2008 - February 28, 2010
The researchers will measure the quality and cost effects of clinical information technology (IT), specifically computerized physician order entry (CPOE) systems. They will use data from 1997 to 2006 to measure the direct value of CPOE, as well as the value it creates in conjunction with complementary technological and organizational investments. The value of CPOE will be based on its causal effect on medical errors, financial costs of medical errors, financial value of CPOE-driven error reductions, and “charge capture,” which the researchers describe as more effective billing and the ability to extract higher payments from Medicare and other payers. The objective of this study is to provide new insight into how clinical IT creates both financial and clinical value, while enhancing the empirical rigor with which that value is measured.
Title: The Economics of Health Information Technology in Physician Organizations
Grantee Institution: University of California at San Francisco
Principal Investigator: Robert H. Miller, Ph.D.
Grant Period: February 01, 1999 - October 31, 2001
How do managed care organizations and large physician groups implement and use health information technologies (HIT)? Investigators at the University of California, San Francisco will: 1) develop a conceptual and theoretical framework for understanding HIT use; 2) obtain and analyze information on HIT, especially clinical information; and 3) analyze effects of existing HIT developments on purchaser, regulator, and legislator policies for quality reporting requirements and payment models. They will also explore the effects of HIT on contractual and ownership relationships among managed care organizations. Methods will include interviews of managers in 30 physician groups and 6 HMOs, and managers in the groups’ parent firms, if applicable. Both capitated groups and groups which accept few capitated contracts will be included. They will also conduct interviews of HCFA, industry association staff/ public managers in selected states, and NCQA staff about the relative importance of existing HIT as obstacles to strengthening performance reporting requirements and introducing risk-adjustment capitation rates. The objective of the project is to help policy makers, regulators, managers and researchers understand the economic logic of HIT use in managed care organizations and physician groups, and policies that could hasten the pace of HIT change. This study will complement another HCFO grant being investigated by researchers at the University of Minnesota on health information technologies.
Title: Information Technologies and the Use of Information in Managed Care
Grantee Institution: University of Minnesota
Principal Investigator: Jon B. Christianson, Ph.D.
Grant Period: January 01, 1999 - June 30, 2001
How do health maintenance organizations (HMOs) implement and use health information technology (HIT)? Investigators at the University of Minnesota investigated: 1) What has been the role of HIT in shaping the development of the managed care industry over the past two decades? 2) How is HIT currently being used to organize and coordinate work within different model types of MCOs (group, staff, IPA, network, mixed model), and at different levels within individual MCOs? 3) What factors influence the structure of IT in HMOs? And 4) What public policy issues are emerging in relation to the organization and management of HIT in MCOs? The investigators used questions from the InterStudy survey database to examine these issues, as well as telephone surveys of 50 independent information technology vendors and 50 information technology managers within managed care organizations. The objective of the project was to inform policy makers about the role of HIT in managed care organizations, so they can better develop appropriate public policy towards HIT development in the managed care industry in the future.
1 "Building the Recovery," www.recovery.gov.
2 Blumenthal, D. “Stimulating the Adoption of Health Information Technology,” New England Journal of Medicine, Vol. 360, No. 15, April 9, 2009, pp. 1477-79; Bates, B.W. and A.A. Gawande. “Improving Safety with Information Technology,” New England Journal of Medicine, Vol. 248, No. 25, June 19, 2003, pp. 2526-34.
3 Soumerai, S.B. and S.R. Majumdar. “Bad Bet on Medical Records,” The Washington Post, March 17, 2009. Also see www.washingtonpost.com/wp-dyn/content/article/2009/03/16/AR2009031602618.html.
4 Definitions are drawn from: California Health Care Foundation, Health IT Glossary of Terms. www.chcf.org/documents/chronicdisease/HITGlossary.pdf; "Evidence on the Costs and Benefits of Health Information Technology," Congressional Budget Office, Washington, DC: May 2008; Parente, S.T. and J.S. McCullough. “Health Information Technology and Patient Safety: Evidence from Panel Data,” Health Affairs, Vol. 28, No. 2, March/April 2009, pp. 357-60; Tang, P.C. and T.H. Lee, “Your Doctor’s Office or the Internet? Two Paths to Personal Health Records,” New England Journal of Medicine, Vol. 360, No. 13, March 26, 2009, pp. 1276-1278.
5 Blumenthal, D. (2009) op. cit.; Mandl, K.D. and I.S. Kohane. "No Small Change for the Health Information Economy," New England Journal of Medicine, Vol. 360, No. 13, March 26, 2009, pp. 1278-81.
6 See footnote #1 for the distinction between EHRs and the similar term EMRs.
7 DesRoches, C.M., et al. “Electronic Health Records in Ambulatory Care – A National Survey of Physicians,” New England Journal of Medicine, Vol. 359, No. 1, July 3, 2008, pp. 50-60.
8 Robinson, J.C., “Financial Incentives, Quality Improvement Programs, and the Adoption of Clinical Information Technology,” Medical Care, Vol. 47, No. 4, April 2009, pp. 411-17.
9 The study also found that only 17 percent of hospitals used CPOE systems for medications.
10 Jha, A.K., et al. “Use of Electronic Health Records in U.S. Hospitals,” New England Journal of Medicine, Vol. 360, No. 1, March 26, 2009, pp.1-11.
11 Interoperability refers to the ability of two or more electronic systems to exchange and use information.
12 DesRoches, C.M. (2008) op cit.; Robinson, J.C. (2009) op cit.; Jha, A.K. (2009) op. cit.; "2008 HIMSS/HIMSS Analytics Ambulatory Healthcare IT Survey," Final Report, Healthcare Information and Management Systems Society (HIMSS), Chicago: October 2008.
13 "HHS Names David Blumenthal as National Coordinator for Health Information Technology," U.S. Department of Health & Human Services, March 20, 2009. See also www.hhs.gov/news/press/2009pres/03/20090320b.html.
14 Blumenthal, D. (April 9, 2009) op. cit.
15 Mandl, K.D. and I.S. Kohane (March 26, 2009) op.cit.
16 Drs. Parente and McCullough use the term EMR synonymously with EHR.
17 Parente, S. T. and J.S. McCullough. (March/April 2009). op. cit. The issue of Health Affairs in which Drs. Parente and McCullough’s study was published is devoted to HIT and contains other papers examining several aspects of the issue; "Is Health Information Technology Associated with Patient Safety in the United States?" Findings Brief, AcademyHealth, Vol. XII, No. 3, April 2009. See also www.hcfo.net/pdf/findings0409.pdf.
18 www.hcfo.net/grantees/grant.cfm?GrantNo=64845
Grantee Spotlight: Jeffrey McCullough, Ph.D.
Jeffrey McCullough, Ph.D., is an assistant professor in the division of health policy and management at the University of Minnesota School of Public Health. Dr. McCullough’s research focuses on the role of technology and innovation in health care. His ongoing projects include studying the value of health information technology (HIT) and the welfare consequences of direct to consumer pharmaceutical advertising. He currently teaches health care finance and has also taught health system accounting and health economics.
Dr. McCullough received his Ph.D. in health economics from the Wharton School at the University of Pennsylvania. Prior to joining the University of Minnesota, he was an assistant professor at the Medical University of South Carolina. Between 1998 and 2001, Dr. McCullough was the recipient of the National Research Services Award, granted by the Wharton Health Care Systems Department and funded by the National Institutes of Health to further health policy research.
Dr. McCullough is currently the principal investigator for a HCFO-funded grant entitled “The Costs and Benefits of Health Information Technology: The Impact of Computerized Physician Order Entry.” This project aims to measure both the clinical and financial consequences of HIT, focusing on the role of computerized physician order entry (CPOE) systems. He and his team are using data from 1997 to 2007 to measure the direct value of CPOE, as well as the value it creates in conjunction with complementary technological and organizational investments. The researchers are using HIT data from the Healthcare Information and Management Systems Society (HIMSS) Analytics™ Database merged with the American Hospital Association’s annual survey of hospitals and the 100 percent MedPAR inpatient Medicare claims data.
Dr. McCullough and his team have found that there is substantial selection bias in the adoption of HIT—essentially, high quality hospitals are early adopters. Their work has focused on correcting for this selection bias while measuring HIT value. Preliminary analyses provide evidence of a positive relationship between HIT and clinical quality. “Through this project, we hope to provide new insight into how HIT creates both financial and clinical value, while enhancing the empirical rigor with which that value is measured,” says McCullough.
More information about this project and the research findings can be found in this month’s Findings Brief, “Is Health Information Technology Associated with Patient Safety in the United States?" Initial findings from this project have also been published in a Health Affairs article entitled “Health Information Technology and Patient Safety: Evidence from Panel Data.” For more information about this grant, please visit http://www.hcfo.net/grantees/grant.cfm?GrantNo=64845.
New HCFO Grants
Institution: Stanford University School of Medicine
Title: Price Responsiveness in Health Plan Choice: Evidence for Policymaking
Principal Investigator: M. Kate Bundorf, Ph.D.
Duration: 4/1/09–6/30/10
Paragraph Summary: The researchers will explore the issue of price responsiveness in selecting health plans. Specifically, they will 1) review and synthesize the literature on consumer price responsiveness in health plan choice; 2) summarize the key features of existing studies that produce an estimate of health plan price responsiveness; 3) express price responsiveness consistently across studies; 4) determine what factors explain differences across studies in estimates of price responsiveness; and 5) develop recommendations for policy analysts choosing parameter estimates for simulations. The purpose of this project is to provide researchers and policy analysts with information that will enable them to easily and effectively apply the results of literature on consumer price responsiveness in health plan choice to policy simulations.
Institution: University of Michigan
Title: The Effect of Public Insurance Coverage and Provider Reimbursement on Access to Dental Care: Evidence from the SCHIP Expansion
Principal Investigator: Thomas C. Buchmueller, Ph.D.
Duration: 4/1/09–3/31/11
Paragraph Summary: The researchers will examine the role that public health insurance plays in improving access to dental care for poor and near-poor children. Specifically, they will study low-income children to assess how Medicaid/SCHIP eligibility generosity affects dental care utilization. They will investigate how changes in program features and market conditions affected the supply of dental care to the publicly insured, addressing the following research questions: 1) What is the effect of public insurance on the probability a child has an annual dental visit? What is the effect on the total number of visits per year? 2) How does the effect of public insurance on dental utilization vary with key program parameters? 3) How do changes in public dental insurance programs affect provider participation? 4) What was the public dental health insurance environment in the states prior to SCHIP, and how did it change as a result of SCHIP implementation? and 5) How did states change dental provider reimbursement rates with the implementation of SCHIP? The purpose of this project is to better understand the effects of public dental coverage in order to inform related Medicaid and SCHIP policymaking.
2009 Call for Proposals
HCFO released the 2009 Call for Proposals (CFP), which provides an overview of the HCFO program, including the types of research projects that the HCFO program supports, eligibility and selection criteria, and directions for submitting proposals online. Proposals are accepted and reviewed on a rolling basis. Click below to learn more about the HCFO program’s grantmaking activities.
Spotlight on Grantee Publications
Yuting Zhang, Ph.D., assistant professor at the University of Pittsburgh and formerly a research fellow at Harvard Medical School, and colleagues published the article, “Effects of Prior Authorization on Medication Discontinuation among Medicaid Beneficiaries with Bipolar Disorder,” in the April 2009 issue of Psychiatric Services. This HCFO-sponsored study—led by Stephen B. Soumerai, Sc.D., professor at Harvard Medical School—is evaluating the effects of prior authorization of new medications among Medicaid beneficiaries with bipolar disorder in the state of Maine.
Grantees in the News
HCFO grantee, David Blumenthal, M.D., was selected by the Obama Administration to serve as the National Coordinator for Health Information Technology. In this role, Dr. Blumenthal will spearhead efforts to implement a national health information technology (HIT) infrastructure as stipulated in the American Recovery and Reinvestment Act (ARRA) of 2009.
On April 2, HCFO grantee Paul Ginsburg, Ph.D., president of the Center for Studying Health System Change, testified before the U.S. House of Representatives, Committee on Energy and Commerce, Subcommittee on Health in a hearing titled, “Making Health Care Work for American Families: Saving Money, Saving Lives.” In his testimony, Dr. Ginsburg discussed price and quality transparency. Dr. Ginsburg completed a HCFO-sponsored study that examined hospitals’ quality reporting activities, the strategies hospitals use to manage the demands associated with reporting activities, and the role of external stakeholders in streamlining quality reporting demands.
David Dranove, Ph.D., professor at Northwestern University, was quoted in the March 14 New York Times article, “Bad Economy Leads Patients to Put Off Surgery, or Rush It.” The article discusses how individuals are delaying elective procedures as a result of the economic downturn. Dr. Dranove states, “During good economic times, the trade-offs aren’t as severe. It’s that $2,000 for elective surgery versus that vacation in Cancun. Now it’s $2,000 for surgery versus making the mortgage payments, and suddenly the surgery can wait.” Dr. Dranove is completing HCFO-sponsored work examining how insurance status affects personal wealth and earnings in the population nearing age 65 that have a heightened probability of adverse health but have not yet qualified for Medicare.
HCFO Releases a New Findings Brief
Previous research trying to measure the effects of health information technology (HIT) on clinical outcomes have been limited to academic and integrated medical systems that may not be nationally representative. Stephen T. Parente, Ph.D., and Jeffrey McCullough, Ph.D., from the University of Minnesota addressed these limitations by merging Medicare claims data and a database documenting the use of electronic medical records (EMRs) at inpatient hospitals. They found a small but statistically significant, positive relationship between the use of EMRs and the avoidance of post-operative infections, but no significant relationships for two other types of HIT used at hospitals nor for two other measures of patient safety. These results and some potential limitations of the study underscore the need for further research including the development of additional measures of patient safety from claims data.
HCFO Releases a New Issue Brief
In an effort to explore the problems inherent in predicting the impact of proposed health insurance market reforms, AcademyHealth conducted a special meeting to identify key questions about the impact of health care reform on employers and their workforce, as well as the data necessary to answer those questions. The meeting was supported under the Robert Wood Johnson Foundation’s Changes in Health Care Financing and Organization (HCFO) initiative and is part of a larger health reform initiative conducted by HCFO to build the research base and expert capacity to assist policymakers in tackling key topics likely to emerge during the upcoming debates about health care reform. The issue brief, “Insurance Choices: Behaviors of Firms and Their Workforces,” identifies the key questions policymakers will need to answer when predicting firm and workforce behavior as well as the data available and needed to answer these questions.
New Data for Researchers
The
“Health, United States, 2008”
“Health, United States, 2008,” is an annual report documenting changes in the nation’s health through 151 detailed trend tables on health status and its determinants, health care utilization, health care resources, and medical expenditures.
This year’s report includes a special feature on young adults, 18-29 years of age. The report may be found at: www.cdc.gov/nchs/hus.htm
“Collecting Medication Data in the 2004 National Nursing Home Survey”
“Collecting Medication Data in the 2004 National Nursing Home Survey” provides researchers with information needed to analyze and interpret data from the National Nursing Home Survey Prescribed Medications Public Use File (PM PUF). Medications are an important component of nursing home care. Data on their use, combined with information about resident health status and diagnoses can help researchers better assess quality of care in U.S. nursing homes. The PM PUF contains the most recent nationally representative data on medications—both prescription and over-the-countertaken—by U.S. nursing home residents. Data were obtained on 13,507 current nursing home residents, 98.5 percent of whom took one or more medications. The report summarizes the survey design, provides guidance for statistical analysis, and offers detailed information about the naming conventions for the PM PUF medication variables. It also provides information about searching for specific medications and linking medication data with resident characteristics. The report concludes with a discussion about data limitations and recommendations for future efforts.
The report may be accessed at: www.cdc.gov/nchs/data/series/sr_01/sr01_047.pdf
For more information or to download public-use data and summary tables from the National Nursing Home Survey, see www.cdc.gov/nchs/nnhs.htm.
Announcements
Full Agenda Now Available for Annual Research Meeting
The 2009 Annual Research Meeting (ARM) offers a rich and exciting slate of invited and peer-reviewed research sessions, policy roundtables, methods workshops, poster presentations, and networking opportunities. With more than 150 sessions, the ARM is the premier forum for health services research.
This year’s meeting focuses on the need for better research translation and the connection between the research community and health care reform in the new administration. Keynote speaker, Dr. Julio Frenk, will address those issues in his opening talk, “Moving from Research to Policy in Health System Reform.”
The full agenda is now available online, including presentations selected from the call for abstracts. Register by April 28 to qualify for early registration discounts.
Special Opportunities for Students at the 2009 Annual Research Meeting
AcademyHealth is offering special opportunities for students in health services research and policy at the 2009 Annual Research Meeting (ARM) in
Interest Group Annual Meetings
June 27 and June 30, Hilton Chicago
The following interest groups will host meetings in conjunction with the Annual Research Meeting (ARM) in
- Behavioral Health (June 30)
- Child Health Services Research (June 27)
- Disability Research (June 30)
- Disparities Research (June 30)
- Gender and Health Services Research (June 27)
- Health Economics (June 27)
- Health Information Technology (June 27)
- Interdisciplinary Research Group on Nursing Issues (June 27)
- Quality (June 27)
- State Health Research and Policy (June 27)
In addition, the Public Health Systems Research (PHSR) Interest Group will be holding a two-day meeting, June 30-July 1. Scientific sessions and poster presentations will take place on Tuesday, June 30. On Wednesday, July 1, the meeting will focus on methods, featuring a workshop and panels on PHSR data and use.
Registration for each of these meetings is done through the Annual Research Meeting registration page.
Building Bridges: Making a Difference in Long-Term Care 2009 Colloquium
June 27, Hilton Chicago
The sixth annual Long-Term Care (LTC) Colloquium, sponsored by The Commonwealth Fund and conducted by AcademyHealth, is June 27 at the Hilton Chicago in conjunction with the Annual Research Meeting. The Colloquium is the cornerstone of an initiative seeking to foster development of a network of LTC researchers, policy leaders, providers, consumer representatives, and funders through colloquia, policy seminars, and ongoing workgroup discussions. The topics of discussion include highlights from a commissioned paper on the intersection between LTC and end-of-life care, and a second topic that will be determined from the LTC call for commissioned papers. For more information visit the LTC Web site.
Seminars in Health Services Research Methods
June 26-27, Hilton Chicago
AcademyHealth is offering five health services research methods seminars in conjunction with the Annual Research Meeting in
Friday, June 26:
- Issues in the Analysis of Complex Survey Data
- Methods of Comparative Effectiveness Research
Saturday, June 27:
- Introduction to Medicare Part D Data Research
- Enhancing your Methodological Toolbox: An Introduction to Qualitative Research
- Methods for Addressing Endogeneity and Selection Bias in Observational Studies
For full descriptions of each of the sessions, visit the ARM Web site.