Finding the Difference Makers: Revealing Necessary and Sufficient Conditions for Palliative Care Outcomes Through Coincidence Analysis (ME302)

Outcomes 1. Understand the methodological foundations of this novel analytic approach.2. Understand the different applications of CNA in research, contrast CNA with other analytic approaches, and explain study design considerations.3. Interpret the CNA results of a study on palliative care reach among people with advanced heart failure across 83 VA medical centers.4. Evaluate how study findings may inform the field of cardiovascular palliative care and assess and debate how CNA might be applied to other studies of palliative and hospice care. Background Palliative care is a complex intervention comprised of multiple conditions including team structures, processes, and strategies of implementation. In real-world contexts, the joint presence of multiple conditions is often required to attain a particular outcome such as, for example, the receipt of palliative care. New methods based on Boolean algebra, logic, and set theory have recently become available to researchers in palliative care and hospice science that are explicitly designed to identify such “bundles” of these difference-making conditions. Methods Coincidence Analysis (CNA) is a novel, case-based, mathematical method that can be applied to analyze the complex relationships between structures, processes, implementation strategies, and outcomes among phenomena. CNA is particularly well- suited for observational and implementation science studies of palliative care delivery. Investigators can apply CNA to large or small datasets; identify equifinality, when different pathways lead to the same outcome; handle complexity, when several conditions must appear together for an outcome to appear; and detect causal chains (if applicable). Investigators can also pair CNA with other methods (e.g., qualitative analysis). Freely available as an “R” software package, CNA has rapidly gained traction in health services research and implementation science over the last three years, with over 50 published articles appearing in the peer-reviewed literature. Content This symposium will provide an introduction and overview of CNA, focusing on how this new method can be applied to palliative care and hospice science. We will begin the symposium with a summary of the core elements of CNA and how it compares to other analytic approaches. Next, we will demonstrate the practical use of this method with an example from our team's research. We utilized CNA to identify facility-level conditions associated with an increased reach of palliative care among people with advanced heart failure across 83 medical centers within the Department of Veterans Affairs. Conclusions CNA is an innovative, emerging mathematical method well-suited to the analysis of complex interventions like the delivery of palliative care. This symposium will introduce palliative care researchers to CNA as a novel addition to the larger methodological repertoire that can greatly advance the science of palliative and hospice care.