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Funded by Health and Human Services, Department of-Agency for Health Care Research and Quality

Funding Years: 2013 - 2016.

Both patient-centered care approaches and health information technology advances (e.g. patient portals to electronic health records) are increasing how often patients are directly presented with medical test results that identify health concerns, monitor health status, or predict future health risk. In principle, such data enable patients to actively mange health conditions and participate in care decisions. In practice, availability of data may not result in understanding, as test results are often presented in confusing formats with little context. Many patients, especially those with lower numeracy skills (i.e., poor ability to draw meaning from numbers), may be unable to interpret test outcome data and use it in decision making. For these patients, knowing test results or risk estimates does not ensure that they understand what those numbers imply or what actions they need to consider. Such data can be, quite literally, meaning-less, and patients are likely ignore such information in decision making even when they are fully informed.
We propose to draw on research methodologies from design science, decision psychology, human-computer interaction, and health communication and integrate them into a single, highly innovative research process that will tackle the problem of how best to present Hemoglobin A1c values and similar test results to patients with diabetes as an exemplar of the larger problem of meaningless medical test data. We will (a) define the problem space from multiple perspectives, (b) clarify what we can hope to achieve when we present diabetic patients with their test results, and (c) and identify possible approaches for improving data meaningfulness. Our iterative research approach involves three phases. In Phase 1, we will use intensive deep dive design sessions (a methodology borrowed from design science) with a multidisciplinary team combining experts in health communication and human-computer interaction with both practicing clinicians and expert patients. These sessions will identify discrepancies between patient needs for test result data and the formats in which such data are provided to patients, identify when low numeracy skills will be a barrier to patient interpretation and use of such data, and brainstorm potential solution concepts. In Phase 2, we will conduct rigorous comparative evaluations of proposed designs using (a) user-experience design sessions, and (b) an iterative sequence of large-sample, multi-factorial, randomized-controlled experiments in order to identify what formats make test data most meaningful and useful for facilitating informed patient decisions about medical care. In Phase 3, we will take our identified test results communication best practices and develop, program, and disseminate a test results display generator application that will be able to be integrated with existing electronic health record systems and other applications and will be made available to patients via a freely available website.

PI(s): Brian Zikmund-Fisher

Co-I(s): Angela Fagerlin, Reshma Jagsi, Predrag Klasnja, Kenneth M. Langa, Beth A. Tarini,, Sandeep Vijan

Funded by NIH - Department of Health and Human Services
Funding Years: 2016-2021

Post stroke disability represents a significant public health problem as there are over 7 million stroke survivors in the US, most of whom have persistent disability. Despite the fact that acute stroke treatments dramatically reduce post-stroke disability and are cost saving, they are markedly underutilized. There is no region in the US where acute stroke treatments are more underutilized than in Flint, Michigan. Flint is an urban, underserved city of about 100,000 residents of whom about 60% are African American.

The Peoples Health partnership was formed in 2009, consisting of stroke neurologists, experts in health behavior and health education, nurses, and Bridges into the Future, a faith based organization dedicated to improving the health of the community. The goal of the partnership was to reduce the burden of cardiovascular disease in Flint. The Peoples Health partnership completed a community needs assessment, designed and tested a peer-led, health behavior theory-based stroke preparedness (recognizing stroke warning signs and the importance of calling 911) intervention in African American churches. This community intervention, Stroke Ready, successfully increased stroke preparedness. This application represents the larger scale adaption and testing of the Stroke Ready intervention to increase the Flint community?s acute stroke treatment rates.

Stroke Ready expands to a multi-level intervention aims to increase acute stroke treatment through both community stroke preparedness and Emergency Department readiness. The cornerstone of the pilot Stroke Ready intervention was a stroke music video which will now be adapted into a stand-alone intervention. For community stroke preparedness, the music video, mass multimedia circulation, interactive workshops, and print workbooks will all be delivered throughout the Flint community. We will also intervene in a Flint area safety net Emergency Department in great need of improved acute stroke care to optimize treatment pathways. The primary outcome of the project will be change in acute stroke treatments which will directly benefit the community by reducing post-stroke disability.

This project will benefit the Flint community and other urban communities with low acute stroke treatment rates. Sustainability will be achieved in Flint by training of peer leaders, wide dissemination of Stroke Ready materials, ease of re-administering the intervention, hospital improvements and continued commitment and engagement of the community advisory board. To assist other safety net-hospitals outside of Flint, we will create a protocol to assess barriers to optimal acute stroke care. More broadly, this project will address a central unanswered scientific question of the relative importance of interventions in the community and/or hospital to increase acute stroke treatments. Thus other communities with limited resources who are interested in increasing their acute stroke rates will have a better understanding of whether to invest in community stroke preparedness or hospital readiness.

PI(s): Lesli Skolarus

Co-I(s): Anne Sales, James Burke, Lewis Morgenstern, William Meurer, Marc Zimmerman

Funded by Health and Human Services, Department of-Agency for Health Care Research and Quality

Funding Years: 2014-2016

This grant aims to engage communities, particularly underserved communities, in informed deliberations about current and potential changes to Medicaid eligibility, coverage, and cost-sharing. Building on community-based research partnerships state-wide, we will convene a Steering Committee including community leaders, researchers, decision makers in private healthplans and the Michigan Department of Community Health (MDCH) and other stakeholders. We will adapt an innovative, award-winning web-based simulation exercise, CHAT (CHoosing All Together, usechat.org) in which individuals and groups make tradeoffs between competing needs for limited resources. Options in Medicaid-CHAT may include variations in covered benefits; out-of-pocket spending; population health and public health programs; rewards for healthy behaviors; and quality improvement activities. We will facilitate deliberations throughout the state, disproportionately sampling medically underserved communities and balancing locale (urban, suburban, rural and remote rural) and sociodemographic characteristics, ensuring inclusion of particular perspectives, e.g., those with chronic illness and those who are or will soon be eligible for Medicaid coverage or dually eligible.

We will prepare policy briefs describing the views of Michigan citizens about Medicaid eligibility, coverage, and cost-sharing and implications for policy. We aim to communicate Medicaid priorities of communities and the policy implications to state leaders, community leaders, insurers, and other stakeholders. We will examine the impact of public engagement on participants’ knowledge, attitudes, and priorities, and explore the impact on policy decisions.

We will also evaluate the effect of deliberations including a key element of deliberative procedures – representation.

PI(s): Susan Goold, MD, MHSA, MA

Co-I(s): A. Mark Fendrick, MD; Hyungjin Kim, PhD; Richard Lichtenstein, MD

Funded by the Informed Medical Decision Making Foundation

Funding Years: 2010-2012

The overall long-term goal of this research program is to develop values clarification exercises that improve decision quality.  The research funded by this grant aims to establish the feasibility of the development and evaluation of a dynamic interactive tool that explicitly encourages values exploration and clarification.  For this study, values exploration means that patients will be encouraged to “try on” different ideas, see immediate and dynamic visual feedback, adjust and re-adjust their values, and save settings at multiple time points in order to recall and compare thoughts and feelings.  It is hypothesized that by explicitly supporting a potentially circuitous path of values exploration, the resulting approach will be more reflective of the intuitive processes that people follow to arrive at states of greater clarity.

Angela Fagerlin (PI)

 

Jacob Solomon, PhD

Alumni

Dr. Jacob Solomon was a CBSSM Postdoctoral Research Fellow, 2015-2017.

Jacob Solomon completed a PhD in Media and Information Studies at Michigan State University in 2015. His research is focused on Human-Computer Interaction and Human Factors Engineering where he studies how the design of interactive systems affects users’ behavior. His research merges methods from social sciences with computer and information science to design, build, and evaluate socio-technical systems.

Last Name: 
Solomon

Funded by National Institutes of Health.

Funding Years: 2011-2016

 

Making decisions about the medical care of a loved-one with acute brain hemorrhage is a difficult and frightening time for families. This project will work to improve the processes that doctors and families use to make these decisions in the future. For more information, visit NIH Reporter

PI(s): Darin Zahuranec, Brisa Sanchez

Co-I(s): Renee Anspach, Angela Fagerlin, Lewis Morgenstern, Phillip Rodgers

 

 

Michael D. Fetters, MD, MPH, MA, Associate Professor, recently gave a talk at the 38th annual North American Primary Care Research Group (NAPCRG) meeting, held November 13-17, 2010, in Seattle, WA.

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CBSSM offers a variety of resources and tools that have broad applicability.

Please consider attending one of our working group meetings. These meetings provide a forum for project focused discussions and interdisciplinary collaborations. Presenters can receive feedback on a range of issues, from project inception and grant applications to manuscript drafts.

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Interactive Decision

At CBSSM, we perform the basic and applied scientific research that will improve health care policy and practice to benefit patients and their families, health care providers, third-party payers, policy makers, and the general public.  In our "Interactive Decision" web feature, we turn a recent research finding into an interactive decision that a patient or policy maker might face.  Read, decide, click—and see how your answers compare with our respondents.

Impact of the Vaccine Adverse Event Reporting System on Vaccine Acceptance and Trust (Aug-17)

Patient understanding of blood test results (Feb-17)

Attitudes toward Return of Secondary Results in Genomic Sequencing (Sep-16)

Moral concerns and the willingness to donate to a research biobank (Jun-16)

Liver Transplant Organ Quality Decision Aid: Would you consider a less than perfect liver? (Jan-16)

Blocks, Ovals, or People Icons in Icon Array Risk Graphics? (Sept-15)

Getting ahead of illness: using metaphors to influence medical decision making (May-15)

 

 

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