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Jeremy Sussman, MD, MS

Faculty

Dr. Sussman is a Research Scientist in the Center for Clinical Management Research at the Veterans Affairs Ann Arbor Health System and an Assistant Professor in the Department of Internal Medicine at the University of Michigan Medical School. He attended medical school at the University of California, San Francisco, completed internal medicine residency at Yale-New Haven Hospital, and was a Robert Wood Johnson Foundation Clinical Scholar at the University of Michigan.

Last Name: 
Sussman
Fri, February 28, 2014

Drs. Scott Kim and Franklin Miller propose an integrated consent model for pragmatic trials in a recent NEJM Health Law, Ethics, and Human Rights article. 

Research Topics: 

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

Kayte Spector-Bagdady, JD, MBioethics

Faculty

Kayte Spector-Bagdady is an Assistant Professor in the Department of Obstetrics and Gynecology at the University of Michigan Medical School and is also the Chief of the Research Ethics Service in the Center for Bioethics and Social Sciences in Medicine (CBSSM). At UM she also serves as Chair of the Research Ethics Committee, a clinical ethicist through CBSSM’s Clinical Ethics Service, and a member of IRB Council.

Last Name: 
Spector-Bagdady

Thomas Valley, MD

Faculty

Tom Valley is an Assistant Professor in the Division of Pulmonary and Critical Care Medicine in the Department of Internal Medicine at the University of Michigan. He received his undergraduate degrees in history and chemistry from Emory University, and his medical degree from the University of Miami. He completed his internal medicine residency and chief residency at the University of Texas-Southwestern/Parkland Memorial Hospital.

Last Name: 
Valley

CBSSM's Elias Baumgarten, Raymond De Vries, Kayte Spector-Bagdady, Michele Gornick, & Adam Marks (no pictured) were judges at the 2017 A2Ethics High School Ethics Bowl January 28-29th. Click here for more details about this event.


Research Topics: 

The Diabetes Lobby (Dec-09)

Tell us what you think about certain public policies designed to reduce the incidence of diabetes in the US.

Please read this hypothetical news article and then answer a few questions at the end.

People with Diabetes Lobby Congress This Week

Washington, March 28 – About 1000 patients with type 2 diabetes (also commonly known as adult-onset or non-insulin-dependent diabetes) have converged here as advocates for the American Diabetes Association (ADA). They will be meeting with their members of Congress to discuss their condition and advocate for federal policies to address their disease. In addition, they will hold a rally on Thursday of this week on the National Monument grounds, to attract popular attention to their disease.
 
According to the Centers for Disease Control and Prevention, nearly 21 million Americans have diabetes, but one-third of these people do not yet know they have the disease. More than 90% of people with diabetes have type 2 diabetes, a form of diabetes which typically emerges when people are adults but which may develop during childhood. The number of people diagnosed with type 2 diabetes has been increasing every year. There were over 1 million new cases of diabetes diagnosed in 2005 among adults. Researchers believe that the conditions in the neighborhoods where people live increase their chances of getting type 2 diabetes. Rates of diabetes are highest among people living in poor neighborhoods.
 
People with type 2 diabetes develop a problem with the way their body secretes or responds to insulin, a hormone that regulates blood glucose levels. As a result, they have elevated blood sugar levels, which they must check multiple times per day and monitor their food intake. Researchers are working hard to understand more about what causes type 2 diabetes. Diabetes expert Dr. Howard Smith says, "People who live in neighborhoods where the majority of stores sell food with high calories and low nutritional value, such as fast food restaurants or convenience stores, are much more likely to develop diabetes." Several other scientific studies have supported the idea that people’s neighborhoods, including not having convenient or safe places to exercise, and being exposed to many advertisements selling high-calorie foods, are associated with the development of diabetes.
 
If left untreated, people with diabetes can become blind, have kidney damage, lose their limbs, or die. Physicians, health plans, employers, and policymakers are considering new ways to prevent diabetes, help patients manage their diabetes, and reduce this deadly epidemic. It is expected that the U.S. Senate Committee on Health, Education, and Labor will consider several bills about diabetes in the upcoming session of Congress.
 
Some people with diabetes check their blood sugar with a device called a glucometer.
 
Having read this news article, please tell us if you agree with the following policies:
 
The government should impose higher taxes on food high in calories and fat, like it does for cigarettes.
 
  • strongly disagree
  • disagree
  • neutral
  • agree
  • strongly agree
The government should provide financial incentives to encourage grocery stores to locate in areas where there are few.
 
  • strongly disagree
  • disagree
  • neutral
  • agree
  • strongly agree
The government should regulate advertisements for junk food like it does for cigarettes and alcohol.
 
  • strongly disagree
  • disagree
  • neutral
  • agree
  • strongly agree

Generally speaking, do you usually think of yourself as a Republican, a Democrat, an Independent, or what?

  • Strong Democrat
  • Not so strong Democrat
  • Independent, close to Democrat
  • Independent
  • Independent, close to Republican
  • Not so strong Republican
  • Strong Republican
  • Don't know, haven't thought much about it

How you answered: 

Researchers affiliated with CBDSM and the School of Public Health have found that "Americans' opinions about health policy are polarized on political partisan lines. Democrats and Republicans differ in the ways that they receive and react to messages about the social determinants of health."

In the study, lead author Sarah Gollust, PhD, randomly assigned participants to read one of four hypothetical news articles about type 2 diabetes. Diabetes was used as an example of a common health issue that is widely debated and that is known to have multiple contributing factors, including genetic predisposition, behavioral choices, and social determinants (such as income or neighborhood environments).

The articles were identical except for the causal frame embedded in the text. The article that you read in this Decision of the Month presented social determinants as a cause for type 2 diabetes. Other versions of the article presented genetic predisposition or behavioral choices as a cause for type 2 diabetes, and one version had no causal language.

Dr. Gollust then asked the study participants their views of seven nonmedical governmental policies related to the environmental, neighborhood, or economic determinants of diabetes:

  • bans on fast food concessions in public schools
  • incentives for grocery stores to establish locations where there are currently few
  • bans on trans fat in restaurants
  • government investment in parks
  • regulating junk food advertisements
  • imposing taxes on junk foods
  • subsidizing the costs of healthy food

Dr. Gollust also asked participants their political party identification and a number of other self-reported characteristics.

The most dramatic finding of this study was that the news story with the social determinants as a cause for type 2 diabetes had significantly different effects on the policy views of participants, depending on whether they identified themselves as Democrats or Republicans. After reading the social determinants article, Democrats expressed a higher level of support for the proposed public health policies. Republicans expressed a lower level of support for the proposed public health policies. This effect occurred only in the group of participants who were randomly assigned to read the version of the news article with social determinants given as a cause for type 2 diabetes. Dr. Gollust summarizes: "Exposure to the social determinants message produced a divergence of opinion by political party, with Democrats and Republicans differing in their opinions by nearly 0.5 units of the 5-point scale."

The study suggests several possible explanations for these results:

"First, the social determinants media frame may have presumed a liberal worldview to which the Republican study participants disagreed or found factually erroneous (ie, not credible), but with which Democrats felt more comfortable or found more familiar. . . Second, media consumption is becoming increasingly polarized by party identification, and . . . the social determinants message may have appeared particularly biased to Republicans. . .Third, the social determinants frame may have primed, or activated, study participants' underlying attitudes about the social group highlighted in the news article. . . Fourth, participants' party identification likely serves as proxy for . . . values held regarding personal versus social responsibility for health."

Dr. Gollust and her colleagues conclude that if public health advocates want to mobilize the American public to support certain health policies, a segmented communication approach may be needed. Some subgroups of Americans will not find a message about social determinants credible. These subgroups value personal responsibility and find social determinants antagonistic to their worldview. To avoid triggering immediate resistance by these citizens to information about social determinants of health, public health advocates may consider the use of information about individual behavioral factors in educational materials, while working to build public familiarity with and acceptance of research data on social determinants.

For more details about this study:

Gollust SE, Lantz PM, Ubel PA, The polarizing effect of news media messages about the social determinants of health, Am J Public Health 2009, 99:2160-2167.
 

 

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

Funding Years: 2014-2018

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

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

Funding Years: 2014 - 2016

Nearly 800,000 people suffer a stroke each year in the US and the cost of stroke reaches $105 billion annually. Stroke is also a leading cause of disability in the US. Post-stroke disability is dramatically reduced among patients who receive tissue plasminogen activator (tPA). For clinical effectiveness, tPA must be administered within 4.5 hours from the start of stroke symptoms. Unfortunately, tPA is vastly underutilized with about 3% of stroke patients receiving tPA. The majority of patients fail to receive tPA because they arrive to the hospital after the treatment time window has elapsed (this barrier to tPA administration is known as prehospital delay). Researchers have shown that if 911 were called at the time of stroke onset, over 28% of all stroke patients would receive tPA. Therefore, translational research to increase stroke preparedness (defined as the ability to recognize stroke warning signs and call 911 immediately) is urgently needed. However, the field of stroke preparedness is severely limited by the absence of intermediate end points to test behavioral interventions. Before embarking on large scale, expensive, community intervention trials, phase 2 studies using intermediate end points are needed. An intermediate end point allows for testing of several interventions (phase 2 studies) before deciding on the most promising intervention that warrants phase 3 testing. Intermediate end points also facilitate testing interventions for selected populations such as high risk groups like racial/ethnic minorities or those with low socioeconomic status, rather than an entire community. In this project, we will develop and validate a psychometrically rigorous test of stroke preparedness using video vignettes - the video stroke action test (video-STAT). Because of the increased burden of stroke among African Americans, Hispanics and those with low socioeconomic status, we will oversample from these groups in development and validating of the video-STAT. At completion of this study, an innovative stroke preparedness intermediate end point will be created and critical steps toward validating it will be performed. As the US population ages, stroke will only claim more victims and at greater expense to individuals, families and society. It is critical that we rapidly develop rigorous scientific interventions that increase delivery of acute stroke therapy to decrease post-stroke disability and reduce the enormous impact of this devastating disease.

PI(s): Lesli Skolarus, Lewis Morgenstern

Co-I(s): Brisa Sanchez

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