H. Myra Kim is a Research Scientist at the Center for Statistical Consultation and Research and and Adjunct Professor at the Department of Biostatistics. She received her Sc.D. in Biostatistics from Harvard University in 1995 and worked at Brown University as an Assistant Professor from 1995 to 1997. She has worked at UM since 1997 and has collaborated with various researchers from around the UM community as well as from other universities.
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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
Joel D. Howell is a Professor at the University of Michigan in the departments of Internal Medicine (Medical School), Health Management and Policy (School of Public Health), and History (College of Literature, Science, and the Arts), as well as the Victor C. Vaughan Professor of the History of Medicine. He received his M.D. at the University of Chicago, and stayed at that institution for his internship and residency in internal medicine. At the University of Pennsylvania, he was a Robert Wood Johnson Clinical Scholar, and received his Ph.D. in the History and Sociology of Science.
Oxford University Press has published Evaluation of Capacity to Consent to Treatment and Research, by CBSSM's Co-director Scott Kim, MD, PhD. The book is part of the series Best Practices in Forensic Mental Health Assessment. For further information about this volume, click here.
Andrew Shuman/Christian Vercler/Ed Goldman--Futility Policy/Advance Directives
Dr. Scherer was a VA and CBSSM Postdoctoral Research Fellow, 2010-2012. She received her PhD in social psychology in 2010 from Washington University in St. Louis.
Dr. Scherer is currently an Assistant Professor of Psychological Sciences at the University of Missouri.
Funded by National Institutes of Health
Funding Years: 2014-2016
Nearly half of patients undergoing coronary artery bypass grafting (CABG) nationwide are exposed to red blood cell (RBC) products. While large volumes (3+ units) of transfusions may be delivered to a given patient to preserve life in cases of acute blood loss, evidence suggests that even small amounts (1-2 units) of RBCs often transfused to address poor oxygen delivery are associated with a 16% increase in a patient's risk of mortality and a 27% increase in morbidity, even after case mix adjustment. It is vitally important to allocate RBC products appropriately, given both that cardiac surgery utilizes between 20-25% of the total national blood supply, and the Red Cross reports that 32 of their 36 regions had less than a day's supply available to meet hospital needs. In short, it is important to improve our understanding of how and in what context decisions are made regarding 1-2 units of RBCs, given its association with morbidity, mortality and resource utilization. Growing evidence suggests that some transfusions may be discretionary. In the state of Michigan, nearly 40% of CABG patients are exposed to 1-2 units of RBCs, although the absolute rate varies 32% across institutions. Center-specific variation in transfusion practices is likely attributed to thelack of consensus regarding the indications, setting and hematocrit trigger for transfusions. Given this uncertainty, transfusion rates may be the consequence of differences in organizational (e.g. protocols, types of decision-makers, lack of performance feedback regarding transfusion practice) and provider (e.g. knowledge, beliefs concerning the benefit/harm of transfusions, and inclination to transfuse) factors. Interventions to reduce the rate of unnecessary transfusions first require identifying the set of determinants (at the organizational or provider level) that mot fully explain the observed variation in RBC utilization across regional medical centers. We will use the prospective data and infrastructure of the Michigan Society of Thoracic and Cardiovascular Surgeons Quality Collaborative (MSTCVS-QC), a consortium of all 33 cardiac surgical programs in Michigan, to: (1) Develop, pilot, and implement surveys to hospitals and clinical providers within the state of Michigan to describe determinants of 1-2 units of RBC transfusions during cardiac surgery, and (2) Identify the primary organizational and provider characteristics contributing to variability in transfusions. Results from this study will set the sage for a behavioral modification study aimed at reducing the rate of RBC transfusions in the setting of cardiac surgery.
PI(s): Richard Prager, Donald Likosky
Co-I(s): Darin Zahuranec, Min Zhang, Marc Zimmerman, Milo Engoren
Anna Kirkland, JD, PhD Title – "The Vaccine Injury Compensation Court and Its Critics"
Presenter – Anna Kirkland, JD, PhD, Arthur F. Thurnau Professor of Women's Studies and Political Science, University of Michigan
Abstract: The so-called vaccine court is a small special court in the United States Court of Federal Claims that handles controversial claims that a vaccine has harmed someone. The government steps in as the defendant and vaccine manufacturers are protected from liability. In this court, lawyers, activists, judges, doctors, and scientists come together, sometimes arguing bitterly, trying to figure out whether a vaccine really caused a person’s medical problem. Drawing on her recently published book, Vaccine Court: The Law and Politics of Injury (NYU Press, 2016), Prof. Anna Kirkland will discuss the ethical controversies surrounding the vaccine court, from the perspective of anti-vaccine movement activists as well as from the mainstream.