Estimating improvement in prediction with matched case–control designs

When an existing risk prediction model is not sufficiently predictive, additional variables are sought for inclusion in the model. This paper addresses study designs to evaluate the improvement in prediction performance that is gained by adding a new predictor to a risk prediction model. We consider studies that measure the new predictor in a case–control subset of the study cohort, a practice that is common in biomarker research. We ask if matching controls to cases in regards to baseline predictors improves efficiency. A variety of measures of prediction performance are studied. We find through simulation studies that matching improves the efficiency with which most measures are estimated, but can reduce efficiency for some. Efficiency gains are less when more controls per case are included in the study. A method that models the distribution of the new predictor in controls appears to improve estimation efficiency considerably.     

Connecting and engaging with health and social care: Exploring the core components of a telephone and web-mediated family navigation prevention service

Early engagement with health care, mental health care, and social services can promote the well-being of children and families. How practitioners can best support family engagement with these services however remains largely unknown. To address this gap in knowledge, data from a voluntary 12-week telephone and web-mediated family navigation preventive intervention called Navigate Your Way were subject to mixed-methods analysis. Twenty-nine caregivers and five family navigators contributed data to the study. Thematic analysis of weekly navigator check-ins, participant closing interviews, navigator discharge notes, and lab meeting notes was conducted and followed by quantitative analysis of navigator effort across project activities. Results were then mixed to illuminate the essential conditions for supporting family connection to health care, mental health care, and social services. Qualitative analysis identified themes related to empathic engagement and person-centred navigation as central to connecting families to needed services. Quantitative analysis of navigator effort identified participant outreach, weekly check-ins, service identification, and ongoing supervision as essential navigation activities. Together, providing an environment that is supportive, consistent, flexible, person-centred and tailored to families' specific needs are important for connecting to health and social care.