Joseph joined CBSSM as a Research Area Specialist in November 2017. As a project manager, he coordinates the daily operations of Dr. Jeffrey Kullgren’s project “Provider, Patient, and Health System Effects of Provider Commitments to Choose Wisely,” a grant funded research project using novel approaches to reduce the overuse of low-value services in healthcare.
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The University of Michigan's Center of Excellence in Cancer Communications Research has been renewed for another five years, through August 2013, by the National Institutes of Health. The purpose of the $8.8 million award is to develop an efficient, theory-driven model for generating health behavior interventions that is generalizable across health behaviors and sociodemographic populations. The UM Center for Health Communicaitons Research, under principal investigator Victor Strecher, MPH, PhD, coordinates the core of this Center of Excellence. Former CBSSM Director Peter A. Ubel, MD, and current CBSSM Co-director Angela Fagerlin, PhD, are leading Project 3, in which they will conduct Internet studies to test several movel ways of tailoring a prostate cancer decision aid, with the goal of identifying interventions that increase the perceived salience of patient preferences. After they have determined the best interventions, they will modify the current prostate cancer decision aid and then test it in men with newly diagnosed localized prostate cancer. Co-investigators on Project 3 are John T. Wei, MD, and Brian Zikmund-Fisher, PhD, at the University of Michigan and James Tulsky, MD, and Stewart Alexander, PhD, at Duke University.
Dr. Jeff Kullgren and Dr. John Ayanian testified before the Michigan Health Care Cost and Quality Advisory Committee regarding the feasibility of and policy options for creating an All-Payer Claims Database (APCD) in Michigan.
Established by the Healthy Michigan Legislation (PA 107 of 2013), the Committee is composed of cabinet-level leadership from the state's Departments of Community Health and Insurance and Financial Services, as well as leadership from the Michigan House and Senate Health Policy Committees. The Committee is tasked with reviewing existing efforts across the United State to make health care cost and quality more transparent. Dr. Ayanian and Dr. Kullgren shared their research and practical expertise with the Committee by discussing a broad range of issues related to the feasibility of an APCD in Michigan, including governance structure; funding sources; data collection, storage, and security issues; and opportunities for research and innovation.
[ From IHPI Policy Corner]
[ From IHPI Policy Corner]
Dorene S. Markel, M.S., M.H.S.A
Director, The Brehm Center
Assistant Research Scientist, Department of Learning Health Systems
Announcement of Position: Faculty Ethicist
The Clinical Ethics Service within the Center for Bioethics and Social Sciences in Medicine (CBSSM) promotes a culture of patient-centered excellence by performing a comprehensive set of ethics-related activities. The aims of this service are to: liaise with and provide support to the adult and pediatric ethics committees; provide clinical ethics consultation and engage in preventative ethics endeavors; assist with ethics-related policy development on a regular and proactive basis; organize and administer structured educational programs in clinical ethics; and coordinate empiric research with relevance to clinical ethics within CBSSM.
The Clinical Ethics Service is led by Christian J. Vercler, MD MA and Andrew G. Shuman, MD. A dedicated clinical ethicist will manage the program on a daily basis. A cadre of faculty ethicists will rotate on service throughout the year and work closely with the clinical ethicist. Trainees and students will rotate as well. Dedicated administrative support is organized through CBSSM.
The Clinical Ethics Service employs a roster of faculty ethicists who are responsible for staffing ethics consultations arising from any of the clinical venues (inpatient and outpatient; adult and pediatric) within Michigan Medicine during their time on service. They will supervise and participate in the institutional educational endeavors and preventative ethics rounds in a regular and on-going manner. Faculty ethicists will also develop and provide clinical rotations for medical students and house officers on a cohesive ethics service. Each faculty member will be expected to rotate on service for four to six weeks per year, and attend/participate in committee meetings and other events throughout the academic year (this will not necessarily require suspension of other activities when on-service). Depending on the total number appointed, each faculty ethicist will receive $15,000-$20,000 of direct salary support annually, to be distributed and allocated in conjunction with their home department. The initial appointment will last two and a half years and is renewable. Additional appointments will last two years.
Candidates are expected to have faculty appointments at University of Michigan and be in good academic standing; any professional background is acceptable. Candidates are expected to have qualifications that meet the standards outlined by The American Society for Bioethics and Humanities (ASBH) for accreditation for clinical ethics consultants. Direct experience with clinical ethics consultation is required. Familiarity with ethics education and related clinical research would be helpful. Excellent organizational and communication skills across multidisciplinary medical fields are required.
Candidates will be vetted and chosen by a selection committee. Candidates are asked to submit:
- Curriculum vitae or resume
- One page maximum summary of (1) education/training related to ethics consultation; (2) clinical ethics consultation experience; and (3) motivation/interest in the position
- Letter of support from Department Chair/Division Head/Center Director or equivalent
- Submit formal application via email to: email@example.com
- Application is due September 25, 2017
- Appointment will take effect January 1, 2018
- Leaders of the Clinical Ethics Service: Christian J. Vercler, MD MA & Andrew G. Shuman, MD
- Administrative contact: Valerie Kahn – firstname.lastname@example.org 734 615 5371
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:
- Jeffrey P. Bishop, MD, PhD -- “The Good Physician: Maintaining Moral Integrity in the face of Technocratic Goals" (March 2016)
- Kunal Bailoor, MD Candidate -- "Advance Care Planning: Beyond Durable Power of Attorney (DPOA)" (July 2016)
- Carl Schneider, JD -- “Can Informed-Consent Laws Work? Evaluating Compelled Disclosure as a Method of Regulation: Carl Schneider JD" (Sept. 2016)
- Charlotte DeVries, Jeanne Mackey, Merilynne Rush, & others --"When Death Comes Callin': A Musical Event" (Oct. 2016)
- Paul Lichter, MD -- "Follow the Money: Ethics and Morality in Physician-Industry Relations" (Nov. 2016)
- Andrew Shuman, Edward Goldman, & Christian Vercler -- "Futility Revisited: UMHS Policy on Non-Beneficial Treatments" (Dec. 2016)
- Meredith Walton -- "The Ethical Principles Underlying Two Methods of Organ Donation" (Jan. 2017)
- Devan Stahl, PhD -- "Responding to Hopes for a Miracle" (Feb. 2017)
- Autumn Fiester, PhD -- "The Difficult Patient Reconceived" (March 2017)
- Scott Grant, MD, MBE -- "Dealing with Complications and Poor Outcomes and Surgical Futility" (May 2017)
- Anna Kirkland, JD, PhD -- "The Vaccine Injury Compensation Court and Its Critics" (June 2017)
- Susan Goold, MD, MHSA, MA, FACP -- "Trust me, I'm an Accountable Care Organization" (July 2017)
- Nicholson Price, JD, PhD -- "Black-Box Medicine" (Sept. 2017)
- Reshma Jagsi, MD, DPhil -- "Ethical Issues Related to Fundraising from Grateful Patients" (Oct. 2017)
- Lauren Smith, MD -- "Ethical Issues in Tranfusion Medicine" (Nov. 2017)
- Janice Firn, PhD, MSW & Tom O'Neil, MD -- "Professionalism, Ethical Obligations, and the Moral Imperative of Self-Care" (Dec. 2017)
- Marschall S. Runge, MD, PhD; Reshma Jagsi, MD, DPhil; David J. Brown, MD (Panel Discussion) -- "Examining the Ethics of Victors Care" (Feb. 2018)
- Katelyn Bennett, MD -- "Social Media and the 'Medutainment' Phenomenon" (March 2018)
- Andrew Shuman, MD -- "Ethical and Practical Approaches to Drug Shortages" (April 2018)
- Naomi Laventhal, MD -- "Pediatric Care Before Birth: Complex Perinatal Care Coordination and Decision-Making at Michigan Medicine" (May 2018)
Funded by VA Health Services Research and Development Career Development Award
Funding Years: 2015-2019
Heart attack and stroke, which together are called cardiovascular disease, cause over 1/3 of all deaths in VA patients. The current guidelines for the prevention of these conditions focus on lowering patients'blood pressure and cholesterol levels. A new treatment strategy, which I call benefit-based tailored treatment, that instead guides treatment decisions based on the likelihood that a medication would prevent a heart attack or stroke could prevent more cardiovascular disease, with lower medication use, and be more patient centered. The purpose of this Career Development Award is to develop and assess tools and approaches that could enable the implementation of benefit-based tailored treatment of cardiovascular disease, in particular a decision support tool and educational program for clinicians and a performance profiling system. The decision support tool will enable better care by showing clinicians patient-specific estimates of the likelihood that their medication decisions will prevent a cardiovascular disease event. The performance profiling system will encourage better care by assessing the quality of care provided at VA sites and in PACT teams based on how well the medical care provided follows this treatment strategy. The project will have three aims:
Aim 1 : In the first aim, I will seek to understand clinicians' and patients' perceptions of and receptivity to the use of benefit-based tailored treatment for cardiovascular disease. Information gained from qualitative research with clinicians will help assess and improve the usability and effectiveness of the decision support tool and educational program for clinicians, along with the acceptability of the treatment strategies in general. Information gained from focus groups with patients will help learn their priorities in cardiovascular disease prevention, to help identify ways to make the interventions and their assessments more patient-centered.
Aim 2 : In the second aim, the decision support tool and educational program will be assessed in a real-world randomized pilot study involving thirty clinicians. Half of the clinicians will be provided the decision support tool and education intervention for ten patients each, the other half will receive a traditional quality improvement program and treatment reminders. The study will have formative goals of ensuring that clinicians and patients believe the tool is valuable and does not disrupt care processes or workflow for anyone in the PACT team. This will be studied with qualitative and survey assessments. The primary summative outcome will be the influence of the intervention on clinicians'treatment decisions. Secondary outcomes will assess patients'satisfaction with their visits and their clinicians.
Aim 3 : The third aim will develop and evaluate a novel performance measurement system based on benefit- based tailored treatment. First, the performance profiling system will be developed. Then the profiling system's ability to reliably differentiate high quality from low-quality care will be evaluated.
PI: Jeremy Sussman
Funded by: NIH
Funding Years: 2016-2021
There is a fundamental gap in understanding how Mild Cognitive Impairment (MCI) influences treatment and Decision Making for serious illnesses, like Cardiovascular disease (CVD), in older patients. Poor understanding of Clinical Decision Making is a critical barrier to the design of interventions to improve the quality and outcomes of CVD care of in older patients with MCI. The long-term goal of this research is to develop, test, and disseminate interventions aimed to improve the quality and outcomes of CVD care and to reduce CVD-related disability in older Americans with MCI. The objective of this application is to determine the extent to which people with MCI are receiving sub-standard care for the two most common CVD events, Acute myocardial infarction (AMI) and acute ischemic stroke, increasing the chance of mortality and morbidity in a population with otherwise good quality of life, and to determine how MCI influences patient preferences and physician recommendations for treatment. AMI and acute ischemic stroke are excellent models of serious, acute illnesses with a wide range of effective therapies for acute management, Rehabilitation, and secondary prevention. Our central hypothesis is that older Adults with MCI are undertreated for CVD because patients and physicians overestimate their risk of dementia and underestimate their risk of CVD. This hypothesis has been formulated on the basis of preliminary data from the applicants' pilot research. The rationale for the proposed research is that understanding how patient preferences and physician recommendations contribute to underuse of CVD treatments in patients with MCI has the potential to translate into targeted interventions aimed to improve the quality and outcomes of care, resulting in new and innovative approaches to the treatment of CVD and other serious, acute illnesses in Adults with MCI. Guided by strong preliminary data, this hypothesis will be tested by pursuing two specific aims: 1) Compare AMI and stroke treatments between MCI patients and cognitively normal patients and explore differences in Clinical outcomes associated with treatment differences; and 2) Determine the influence of MCI on patient and surrogate preferences and physician recommendations for AMI and stroke treatment. Under the first aim, a health services research approach- shown to be feasible in the applicants' hands-will be used to quantify the extent and outcomes of treatment differences for AMI and acute ischemic stroke in older patients with MCI. Under the second aim, a multi-center, mixed-methods approach and a national physician survey, which also has been proven as feasible in the applicants' hands, will be used to determine the influence of MCI on patient preferences and physician recommendations for AMI and stroke treatment. This research proposal is innovative because it represents a new and substantially different way of addressing the important public health problem of enhancing the health of older Adults by determining the extent and causes of underuse of effective CVD treatments in those with MCI. The proposed research is significant because it is expected to vertically advance and expand understanding of how MCI influences treatment and Decision Making for AMI and ischemic stroke in older patients. Ultimately, such knowledge has the potential to inform the development of targeted interventions that will help to improve the quality and outcomes of CVD care and to reduce CVD-related disability in older Americans.
PI: Deborah Levine
CO(s): Darin Zahuranec, Lewis Morgenstern & Ken Langa
The Michigan Medicine Committee advisory groups are appointed by the Hospital's Office of Clinical Affairs. They review ethical or moral questions that may come up during a pediatrics patient's care. The consultants facilitate communication among patients, their families and the treatment team to assist everyone in making appropriate choices when difficult decisions need to be made. The Committee's goal is to help everyone decide the right thing to do. The Michigan Medicine Ethics Committee is a sub-committee of the Executive Committee on Clinical Affairs as determined by the Medical Staff Bylaws.
The committee is available for consultation to family members, patients, staff, and health care providers. The committee may help you and your child’s medical team clarify facts, examine ethical issues, and assist in the resolution of disagreements about your child’s care. The committee includes people with additional training in medical ethics, doctors, nurses, social workers, a lawyer, a chaplain, an administrator, and members of the community
The University of Michigan has a Pediatric Ethics Committee because the best medical care requires not only medical skill but good moral judgment. The Committee’s main purpose is to offer help and guidance on moral and ethical questions, such as:
- Should treatment be started or stopped?
- How much should a child be told about his or her disease?
- Is the promise of treatment worth the suffering it may cause?
- What is the best thing to do when we must face the end of life?
- What happens when a meeting with the Ethics Committee is requested?
The consultants on call review the patient's medical situation and treatment options. In addition, concerns and feelings of the patient, family members, and the health care team are discussed. Members of the committee may visit with patients, families and medical personnel to discuss these concerns.
Ethics Committee members discuss the information which has been gathered. The Ethics Committee makes suggestions about the best course of action. Often there are a number of options available in the course of a patient's care. Final decisions are made by the patient, family and the health care team.
The Pediatric Ethics Committee meets on the first Tuesday of the month from 12-1:30pm at University Hospital in dining rooms C&D. If you would like to attend as a guest, please contact Amy Lynn @ email@example.com
Request a Consult
8:00 a.m. - 5:00 p.m. Call 734-615-1379
After normal business hours, please call 936-6267 and ask for the clinical ethicist on call to be paged.
For upcoming Bioethics Grand Rounds see Events