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Funded by the U.S. Centers for Medicare and Medicaid Services

Funding Years: 2015-2016

The central objective of the Healthy Michigan Plan is to improve the health and well-being of Michigan residents by extending health care coverage to low-income adults who are uninsured or underinsured. The program also introduces a number of reforms, including cost-sharing for individuals with incomes above the Federal Poverty Level, the creation of individual MI Health Accounts to record health care expenses and cost-sharing contributions, and opportunities for beneficiaries to reduce their cost-sharing by completing health risk assessments and engaging in healthy behaviors. This project conducts the evaluation of Michigan's Medicaid expansion, the Healthy Michigan Plan (HMP).

PI(s): John Ayanian

Co-I(s): Tammy Chang, Sarah Clark, Matthew Davis, A M Fendrick, Susan Goold, Adrianne Haggins, Richard Hirth, Edith Kieffer, Jeffrey Kullgren, Sunghee Lee, Ann-Marie Rosland

Brian Zikmund-Fisher, PhD, is the featured guest editor for a special supplement to Medical Decision Making's September/October 2010 issue, highlighting the DECISIONS study, a nationwide survey of adults in the US regarding common medical decisions.  Lead author on the main paper of the supplement, Zikmund-Fisher and co-authors (including CBSSM faculty Angela Fagerlin, PhD and Mick Couper, PhD) describe the DECISIONS study, a telephone interview of a nationally representative sample of 3010 adults age 40 and over faced with making a medical decision in the past two years.  Researchers defined medical decisions as the patient having initiated medications, been screened, or had surgery within the past 2 years or having discussed these actions with a health care provider during the same interval.  Key findings from the study:

Although patients frequently receive information about the benefits of a procedure or medication, they don't always learn about the disadvantages.

Healthcare providers don't always ask patients what they want to do.

Most patients don't use the Internet to help them make common medical decisions; healthcare professionals remain the most important source of information.

Patients often don't know as much as they think they do.  Many patients feel well informed even when they don't know key facts that would help them make a better decision.

African-Americans and Hispanics were less knowledgeable than other patients about medications to treat high cholesterol.  In addition, they were more likely to say their doctor made decisions about cholesterol medications for them.

Most patients think they are more likely to get cancer than they really are, and tend to view cancer screenings as more accurate than they are.

Men and women think about cancer risks differently.  Women are more active participants in cancer screening decisions regardless of their perception of risk, whereas men tended to get involved only if they felt at higher risk.

Funded by Society of Family Planning.

Funding Years: 2013-2015.

Reproductive autonomy (RA) means having control over one’s own fertility desires. Identification in a religious community may affect women’s decision-making abilities surrounding family planning. Upadhyay et al. developed a scale consisting of three domains that measure RA as it applies to a woman and her partner: freedom from coercion, communication and decision making. However, little is known about how religious norms influence RA. We aimed to expand the current RA scale to capture religious influences and assess the relationship between RA and unprotected sex among religious women.

 

The novelty of risk and vaccination intentions (May-12)

It's 2009.  Early in the year, a 9-year-old girl from California became the first person with a confirmed case of H1N1 ("swine") influenza in the United States.  Shortly thereafter, the U.S. declared a public health emergency and the World Health Organization declared a phase 6 pandemic (the highest level possible).  By September 2009 a vaccination was developed and was available within a month.

You've been following the news about the H1N1 influenza as developments have unfolded throughout the year, and you feel some concern.  You have been wondering about the risk of coming down with the H1N1 flu yourself and have been thinking about whether you should be vaccinated. 

Funded by Patient-Centered Outcomes Research Institute (PCORI)

Funding Years: 2014 - 2016.

Obesity is increasingly considered among the most important public health problems of our times. Bariatric surgery is arguably the only treatment that has proven effective in producing long-term weight loss for patients with morbid obesity. Bariatric surgery also results in resolution of obesity related comorbid conditions, improvements in quality of life, and increased survival.

There are currently four different bariatric surgical procedures in use: adjustable gastric banding, gastric bypass, sleeve gastrectomy, and duodenal switch. Bariatric surgery is considered a highly preference sensitive medical issue. Existing decision aids in bariatric surgery are limited in that they provide information about the average comparative risks and benefits of the treatment options, but do not provide customized estimates of the risks and benefits of the different procedures for individual patients. As a result of these draw-backs, decision aids are not frequently used in making treatment decisions in bariatric surgery.

Our proposal is highly innovative in that our decision support tool integrates data from a large clinical registry with individual patient data to provide patients with real-time, customized, accurate information regarding the risks and benefits of the treatment options to better inform decision making. This tool will be continuously updated to ensure that the data on risks and benefits that it provides are accurate and current. Our tool also provides information about other attributes of the treatment options that bariatric surgery patients and other relevant stakeholders feel are important for patients to consider in deciding whether and what type of bariatric surgery to have.

The proposed research promotes shared medical decision making for patients who are considering bariatric surgery for the treatment of morbid obesity. If our intervention proves effective, it will result in improved decision quality and outcomes of care for patients. It may also result in improved efficiency of care to the extent that it serves to augment or guide communication between the patient and physician to promote shared medical decision-making.

PI(s): Nancy Birkmeyer

Co-I(s): Lawrence An, Mousumi Banerjee, Angela Fagerlin, Sarah Hawley, Edward Norton, Lisa Prosser,

Funded by Patient-Centered Outcomes Research Institute (PCORI).

Funding Years: 2013-2016.

The birth of a child with a disorder of sex development (DSD) is stressful for parents and members of the healthcare team. The "right" decisions about gender assignment (is it a boy? a girl?) and the best course of action (e.g., should there be surgery? what kind? when?) are not obvious. While there have been large advances in diagnostic assessments like genetic and endocrine testing, the tests do not always show what caused the DSD. And, even when the tests do reveal an explanation for the DSD, knowing what happened genetically or hormonally does not usually lead to a single "correct" treatment plan. Instead, it is likely that there are different acceptable treatment options - and parents will need to make decisions based, in part, on their personal preferences, values, and cultural background. Adding more stress to the situation is knowledge that many of the decisions that need to be made by parents early in a child's life are irreversible and exert life-long consequences for the child and the family.

To support parents becoming actively involved in making such decisions, and to reduce the likelihood of future worry and regret about decisions that have been made, the investigators will create a decision support tool (DST). The DST will help educate families about typical and atypical sex development of the body, the process by which DSD are diagnosed (especially how to interpret genetic test results), and possible relationships between diagnostic/genetic testing, decisions about care, and known consequences of those decisions on their child and entire family. The DST will be used by parents of young children together with their child's health care provider.

The investigators will bring together a network of researchers, health care providers, representatives of patient support and advocacy organizations, and parents of children with DSD to share their experiences. Participants of this network will be involved at each stage of creating the DST, revising it, and putting it into practice. At the end of this project, the investigators will have a fully formed and tested DST that will be available for parents to use with their child's health care team as they are first learning their child may have a DSD.

PI(s): David Sandberg

Co-I(s): Edward Goldman, Catherine Keegan, Beth Tarini, Beverly Yashar

 

Wed, June 11, 2014

Carl Schneider, JD was quoted in a recent LA Times article titled "Scale of medical decisions shifts to offer varied balances of power" He discussed the role of doctors and patients in the process of medical decision making, "People want to know what's going on, but that doesn't necessarily mean they want to make the decision."

Research Topics: 

Funded by the Department of Health and Human Services, NIH.

Funding Years: 2010-2014.

The overarching goal of this proposal is to improve decision making about organ quality in Liver Transplantation, specifically by increasing transparency, improving patient knowledge and satisfaction, and maintaining patient and public trust in the transplant system. In addition, this research may improve patient outcomes by ensuring that high risk organs go to patients who are most likely to benefit from them. For more information, visit NIH Reporter.

PI(s): Michael Volk

 

Funded by the National Institutes of Health.

Funding Years: 2011-2016. 

While substantial progress has occurred recognizing community expertise in Research, and involving Communities in Decisions about Research aims and methods, community influence on Research Funding priorities remains limited. Building on experience with developing, Testing and using the successful CHAT (Choosing Healthplans All Together) tool, we plan to modify an existing priority setting simulation exercise to develop a tool to engage minority and underserved Communities in setting priorities for clinical and translational Research, evaluate it from the perspective of those who participate, and examine the extent to which it actually influences Research priorities. This tool could be valuable to Research Funding organizations, community-academic partnerships, community organizations asked to participate in Research, and others aiming to engage Communities in Research. For more information, visit NIH Reporter

PI(s): Susan Goold

Co-I(s): Kathryn Moseley 

 

Tue, September 20, 2011

The CBS News website recently featured 10 tips to make better decisions about cancer care from U-M’s Angela Fagerlin, Ph.D., associate professor of internal medicine. Below is an excerpt from the article:

Cancer is scary, and doctors sometimes sound as if they’re speaking a foreign language when talking about the disease and its treatment. But “people are making life and death decisions that may affect their survival and they need to know what they’re getting themselves into,” says Fagerlin “Cancer treatments and tests can be serious. Patients need to know what kind of side effects they might experience as a result of the treatment they undergo.”

 

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