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Susan Goold presented a talk entitled, "Transforming public health: Deliberation, simulation, prioritization" at TEDxUofM, a university-wide initiative to galvanize the community for an event like no other: filled with inspiration, discovery and excitement. TEDxUofM takes place on Thursday, March 29, at the Power Center, 10 am - 5 pm.  Click here for more information.

Borrowing the template of the world-renowned TED conference, TEDxUofM aims to bring a TED-like experience to the University of Michigan. The vision is to showcase the most fascinating thinkers and doers, the "leaders and best" in Michigan terms, for a stimulating day of presentations, discussions, entertainment and art that will spark new ideas and opportunities across all disciplines.

TED is a nonprofit organization devoted to Ideas Worth Spreading. Started as a four-day conference in California 26 years ago, TED has grown to support those world-changing ideas with multiple initiatives. At TED, the world’s leading thinkers and doers are asked to give the talk of their lives in 18 minutes. Talks are then made available, free, at TED.com. TED speakers have included Bill Gates, Jane Goodall, Elizabeth Gilbert, Sir Richard Branson, Benoit Mandelbrot, Philippe Starck, Ngozi Okonjo-Iweala, Isabel Allende and former UK Prime Minister Gordon Brown.

Funded by Health and Human Services, Department of-National Institutes of Health

Funding Years: 2014 - 2019.

The Brain Attack Surveillance in Corpus Christi (BASIC) Project is an ongoing stroke surveillance study that began in 1999. BASIC is the only ongoing stroke surveillance project focusing on Mexican Americans. Mexican Americans are the largest segment of the Hispanic American population, the United States' largest minority group. Since the inception of this project, we have assembled a cohort of over 4,992 cerebrovascular disease patients whom we are able to follow for recurrent cerebrovascular events as well as mortality. This gives us tremendous power to detect associations with biological and social risk factors for stroke, important to Mexican Americans as well as the broader United States population. We have demonstrated increased stroke incidence and recurrence in Mexican Americans. Stroke severity and ischemic stroke subtypes are similar between Mexican Americans and non-Hispanic whites. Mortality following stroke appears to be less in Mexican Americans. In the next five years we are positioned to delineate trends in stroke rates, and to explore the potential reasons for the increased stroke burden in Mexican Americans, as well as their improved survival. This information will be critically important to all populations to reduce the devastation of stroke. We will continue to make important observations useful for planning delivery of stroke care in communities. For the first time we will investigate functional and cognitive outcome following stroke in Mexican Americans and non-Hispanic whites.

PI(s): Lynda Lisabeth, Lewis Morgenstern

Co-I(s): Brisa Sanchez

ELSI-LHS Symposium

Wed, November 15, 2017, 8:00am to 4:00pm
Location: 
Palmer Commons, 100 Washtenaw Ave

Join us for our 2nd annual symposium and workshop on the ethical, legal and social implications of learning health systems (ELSI-LHS).


This year's focus will be on data and knowledge sharing.


NOV 15 - 8:00 am - 4:00 pm: The symposium will lay out the ELSI of data sharing and translation in learning health systems that strive to be both FAIR (findable, accessible, interoperable, and reusable) and fair. The day will interactively address critical issues on data and knowledge sharing.


Speakers include John Wilbanks, Elizabeth Pike, Kenneth Goodman, Debra Mathews, Peter Embi, Peter Singleton, Warren Kibbe, Joon-Ho Yu and more to come!


Proceeds will be synthesized into draft recommendations for data and translation to practice & streamline future ELSI-LHS research.


We have issued a Call for Poster Abstracts to be included in the 2nd annual symposium. Poster displays should relate to the conference theme, "Data and Knowledge Sharing," and may relate to either ELSI or technical aspects of learning health systems. Abstracts and posters should be developed for an interdisciplinary audience including social scientists, informaticians, health care providers, and community members.


To submit an abstract, please go to: 2017 ELSI Abstract Submission
#elsilhs

CBSSM is a co-sponsor of this event.

Timothy R. B. Johnson, MD

Faculty

Timothy R. B. Johnson, M.D. served as Chair of Obstetrics and Gynecology at the University of Michigan from 1993-2017.  He is Bates Professor of the Diseases of Women and Children; and also Arthur F. Thurnau Professor; Professor, Women’s Studies, and Research Professor, Center for Human Growth and Development.  His education and training have been at the University of Michigan, University of Virginia and Johns Hopkins.

Research Interests: 
Last Name: 
Johnson

Bioethics Grand Rounds

CBSSM’s Clinical Ethics Service sponsors the monthly Bioethics Grand Rounds, focusing on ethical issues arising in health care and medicine. This educational session is open to Michigan Medicine faculty and staff and CME credit is available.

Link to previous Bioethics Grand Rounds:

Funded by National Institutes of Health; National Institute on Aging

Funding Years; 2011-2016

A cornerstone of the nation's social science research infrastructure, the Panel Study of Income Dynamics (PSID) is a longitudinal survey of a nationally representative sample of U.S. families. Begun in 1968, 36 waves of data have now been collected on PSID families and their descendents. Its long-term measures of economic and social wellbeing have spurred researchers and policy makers to attend to the fundamental dynamism inherent in social and behavioral processes. The PSID is increasingly being used to answer innovative social and behavioral research questions in the context of an aging society. This application proposes to collect, process, and disseminate three modules in the 2013 and 2015 waves of the PSID: 1. Health module: Including 15 minutes of survey questions on health status, health behaviors, health insurance coverage & health care costs. Linkages to the National Death Index and Medicare will be extended; 2. Wealth module: Including 10 minutes of survey questions on wealth, active savings, and pensions. Linkage to Social Security earnings and benefits records for active sample and decedents will be undertaken for the first time, and a new module to minimize errors in reports of wealth changes will be developed and implemented; and 3. Wellbeing module with related psychosocial measures: We will design and implement a mixed-mode (web/mail out) questionnaire to collect content from both respondents and spouses about their wellbeing and related psychosocial measures (e.g., personality, intelligence), with an experiment to identify (and allow researchers to adjust for if necessary) mode effects. After collection, the data will be processed and distributed in the PSID Online Data Center, which will allow users to create customized extracts and codebooks using a cross-year variable index.

PI(s): Robert Schoeni

Co-I(s): Charles Brown, James House, Mick Couper

Fri, July 26, 2013

Susan Goold is the senior author in a newly published study in JAMA, in which 2,500 U. S. physicians were asked about their views on 17 specific strategies to reduce health care spending, including proposed policies in the Patient Protection and Affordable Care Act. They were also surveyed on their perceived roles and responsibilities in addressing health care costs as care providers.

The vast majority of U.S. physicians (85 percent) agreed that trying to contain costs was a responsibility of every physician but most respondents prioritized patients’ best interests over cost concerns. Most surveyed physicians supported cost-containment initiatives aimed at improving the quality and efficiency of care, such as promoting chronic disease care coordination and limiting corporate influence on physician behavior. Substantial financing reforms, however, were much less popular among physicians. Examples include bundled payments, penalties for readmissions, eliminating fee-for-service reimbursement and other Medicare pay cuts. Physicians also believed that patients, pharmaceutical companies, and malpractice lawyers shared as much or more of the responsibility for containing escalating healthcare costs.

Jon C. Tilburt, M.D., M.P.H., of the Mayo Clinic, Rochester, Minn., was lead author of the study.

Tilburt JC, Wynia MK, Sheeler RD, Thorsteinsdottir B, James KM, Egginton JS, Liebow M, Hurst S, Danis M, Goold S (2013). Views of US Physicians About Controlling Health Care Costs. JAMA 310 (4): 380-388.

What is the price of life? (Aug-03)

Do you think that your life is worth more than the amount that the government usually uses as the maximum to spend to provide one year of life?

Imagine that you are a member of a government panel that is trying to decide how cost-effective a medical treatment must be in order for the government to cover the costs of the treatment. Suppose that a certain treatment could provide one additional year of life to an otherwise healthy person. What is the highest amount the government should be willing to pay per person for this treatment?

How do your answers compare?

For the past twenty years, the figure most often used as the maximum amount to spend to provide one year of life has been $50,000. This figure was originally proposed since it was the cost of a year of kidney dialysis, a lifesaving treatment that the U.S. government funds in Medicare.

Should the number be higher or lower than the current standard?

Conventional wisdom would suggest that the number be higher to take into account the inflation that has occurred in the years since the standard was developed. Current practices such as annual Pap smear screening for women with low risk for cervical cancer, which has a cost of $700,000 per year of life gained, also suggest that society is willing to pay more than the current standard for a year of life. The authors of the cited article recommend, based on current treatment practices and surveys of the general public, that the cost-effectiveness threshold should be revised to be around $200,000.

Should the number increase, decrease, or stay the same over time?

Again, it seems that the threshold amount should increase over time due to inflation. However, other factors come in to play that affect the value.

Since new technologies are emerging all the time, some of which will be deemed cost-effective, there will be more and more treatments to be offered in the future. Also, the rate of use of treatments is an important consideration, because even if a new treatment is more cost-effective than an old one, if it is used more often it will end up costing more to society overall. With more treatments becoming available and more people being given treatments, the threshold cost will probably have to decrease so that insurance companies and the government can keep up with the increasing availability and demand.

Why is this important?

Insurance companies and government health care entities face a continuing struggle when trying to determine which medical treatments to cover. Health care costs are increasing rapidly, so these groups will be facing even tougher decisions in the future. Establishing cost-effectiveness guidelines would be extremely helpful as an aid to making the decisions about treatment coverage. Evidence shows that the current threshold is probably not an accurate reflection of the desires of society or actual prescribing practices. It needs to be adjusted to become useful once again, and must be reevaluated periodically to make sure the value keeps up with trends in the health care market, rather than being left alone without question for two decades as is the current situation.

For more information see:

Ubel PA, Hirth RA, Chernew ME, Fendrick AM. What is the price of life and why doesn't it increase at the rate of inflation? Archives of Internal Medicine. 163:1637-1641, 2003.

Pictographs/Icon Arrays

Pictographs and icon arrays are two names for a type of risk communication graphic that CBSSM investigators have developed and extensively tested. Because pictographs are made up of a matrix of unique elements representing individual units (people) within the at-risk population, they accurately communicate exact percentages while simultaneously conveying “gist” impressions derived from the relative proportion of colored vs. uncolored area in the graph. Click here to learn more and create your own downloadable pictograph images.

 

Pictographs combine some of the best elements of alternate communication formats such as tables or bar charts. A pictograph is made up of unique icons representing individual units (people) within the at-risk population. As a result, it accurately communicates exact percentages the way a table does. However, pictographs also convey “gist” impressions derived from the relative proportion of colored vs. uncolored area in the graph. As such, they are similar in effectiveness to bar graphs and other area or height-based graphics. Furthermore, pictographs are like pie charts in that they represent the entire risk denominator visually, unlike bar charts which focus attention primarily on the risk numerator.

CBSSM researchers have shown that using pictographs in risk communication contexts can be used to effectively communicate the incremental benefit of risk reducing treatments (Zikmund-Fisher, 2008) and the risk of developing side effects from medications, especially when multiple colors are used to distinguish the incremental risk caused by treatment (Zikmund-Fisher, 2008). Pictographs can also limit the biases induced by the presence of powerful anecdotal narratives of former patients (Fagerlin, 2005) and incremental risk formats (Zikmund-Fisher, 2008). In a study that directly compared graphical formats, pictographs were also the only graphical format that supported acquisition of both verbatim and all-important “gist” knowledge (Hawley, 2008). Another study (2010) showed that simpler pictographs (ones that showed a single risk) appeared to be more effective than more visually complex pictographs that used multiple colors to show different risks simultaneously. In a similar vein, two studies (2011, 2012) have found advantages of using static pictographs instead of more complex animated or interactive versions (perhaps because these elements distract attention from the part-whole relationship that represents the risk being communicated).

CBSSM researchers are not alone in our use of pictographs. Other researchers have shown that image matricies of this type are easier to interpret quickly and accurately than other formats (Feldman-Stewart, 2007), are sometimes preferred by patients (Schapira, 2006), and may reduce side effect aversion in treatment decision-making (Waters, 2007). More recent work has shown that icon arrays overcome some of the barriers to comprehension caused by low numeracy (e.g., Galesic & Garcia-Retamero, 2009 & 2010; Garcia-Retamero & Galesic, 2009). In fact, it appears that high numeracy and low numeracy people use pictographs in different ways (Hess, et al, 2011).

To encourage broader use of pictographs in risk communication and medical decision-making in general, CBSSM has collaborated with the UM Risk Center to develop Iconarray.com, a web-based application that enables people to develop and download their own tailored icon array graphics. A companion site, clinician.iconarray.com, enables clinicians (or anyone else) to make side-by-side icon array displays for use in consultations in less than 1 minute.

 

About Us

About CBSSM

The Center for Bioethics and Social Sciences in Medicine (CBSSM) is supported by the University of Michigan Medical School Dean's Office, the Office of Clinical Affairs, and the Department of Internal Medicine. CBSSM is directed by Dr. Reshma Jagsi, MD, DPhil. CBSSM was established in July 2010 at the University of Michigan Medical School through the merger of the Bioethics Program with the Center for Behavioral and Decision Sciences in Medicine (CBDSM).

Mission

The mission of CBSSM is to be the premier intellectual gathering place of clinicians, social scientists, bioethicists, and all others interested in improving individual and societal health through scholarship and service.

CBSSM is a multidisciplinary unit integrating bioethics with key social science disciplines. CBSSM acts as a "home" for anyone interested in applying empirical social science methods to improve health. The primary research interests of CBSSM faculty focus on five overarching themes:

  • Clinical and research ethics
  • Health communication and decision-making
  • Medicine and society
  • Health, justice and community
  • Genomics, health and society

CBSSM attracts scholars from across departmental and disciplinary boundaries and in so doing, provides fertile ground for new synergies.  Our team includes:

  • Social and cognitive psychologists
  • Behavioral economists
  • Clinicians from many specialties
  • Bioethicists
  • Decision scientists
  • Survey methodologists
  • Sociologists
  • Public health researchers

Currently, CBSSM is housed in the North Campus Research Complex in Ann Arbor. Faculty investigators, project managers, and research associates are supported by a core administrative and financial staff. CBSSM gives considerable attention to training the next generation of interdisciplinary scholars, offering support to junior investigators who can collaborate with seasoned researchers in an umbrella organization.

 

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