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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, MD & Ken Lenga, MD. PhD.

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CBSSM acts at the premier intellectual gathering place of clinicians, social scientists, bioethicists, and all others interested in improving individual and societal health through scholarship and service.

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Members of the media interested in interviewing Center members can call the UMHS Public Relations office at 734-764-2220 between the hours 8 a.m. and 5 p.m. Eastern Time, or email us directly at cbssm-mgr@umich.edu

Funded by Robert Wood Johnson Foundation

Funding Years: 2015-2016

The researchers will examine the extent to which consumers who are in high-deductible health plans (HDHPs) engage in behaviors that help them optimize value. Employing a nationally representative survey, the researchers will explore: (1) how often and in what situations consumers engage in key value-promoting behaviors such as budgeting for health services, choosing settings of care based on price and/or quality, engaging in shared decision-making with providers that considers cost, and negotiating prices for services; (2) which consumers are most likely to engage in these behaviors; (3) which behaviors consumers find most beneficial in maximizing the value of their out-of-pocket (OOP) expenditures; (4) what are the facilitators of and barriers to consumers’ engagement in value-promoting behaviors; and (5) what are consumers’ attitudes and intentions towards engaging in value-promoting consumer behaviors in specific clinical situations. The goal of this project is to inform policymakers, payers, health systems, providers and consumers about the frequency and perceived effects of value-promoting consumer behaviors in HDHPs.

PI(s): Jeffrey Kullgren

Co-I(s): Angela Fagerlin, Helen Levy, A. Mark Fendrick

Funded by the NIH (R01-MH075023)

Funding Years: 2005-2010

This project examines whether persons with Alzheimer’s Disease (AD) who are incapable of providing independent informed consent to enroll in research still retain other important ethically relevant abilities—in particular, the capacity to appoint a proxy for research decision-making.

UM Affiliated Investigators: Scott Kim (PI), H. Myra Kim (Co-I)

More details can be found at NIH Reporter.

Geoff Barnes wrote a recent perspective piece and was featured in a UM Health Lab blog about anticoagulation clinic and assisting patients and providers with decision making.

Research Topics: 

PIHCD: Jacob Solomon

Wed, March 09, 2016, 2:00pm
Location: 
B004E NCRC Building 16

Jacob Solomon will be brainstorming about several ideas to study how users' ability to control decision aids affects their decision making.

Mon, October 23, 2017

In a recent blog post, Brian Zikmund-Fisher writes about the often unrecognized problem of finding meaning in the flood of health data.

Research Topics: 

Beth A. Tarini, MS, MD

Alumni

Beth A. Tarini is an Associate Professor of Pediatrics & Division Director of General Pediatrics and Adolescent Medicine at the University of Iowa. Before that, she was an Assistant Professor in the UM Department of Pediatrics and Communicable Diseases. She received her MD from Albert Einstein College of Medicine (2001) and a master's degree from the University of Washington (2006), where she was a Robert Wood Johnson Clinical Scholar. In addition to her clinical interest in preventative care, she pursues an active research program on issues of newborn screening and genetic testing.

Last Name: 
Tarini

The article, "The DECISIONS Study: A Nationwide Survey of United States Adults Regarding 9 Common Medical Decisions," authored by Brian Zikmund-Fisher et al. in Medical Decision Making (September-October 2010) was recently identified as the most downloaded article in the journal of all articles published in 2009 and 2010. 

Patients’ Attitudes toward Considering Cost When Making Medical Decisions (Oct-13)

Imagine that for the last three months, you have had a very bad headache – the worst in your life – that won’t go away, even when you take aspirin. In addition to the headache you have also been feeling dizzy. Your doctor tells you that you need to get a brain scan to test whether the headache is being caused by something serious. There are two possible scans you can get: a Magnetic Resonance Imaging (MRI) or a Computerized Axial Tomography (CT) scan.  The MRI provides a slightly more detailed picture and might find something that the CT misses, such as an extremely uncommon blood vessel problem, but nearly all problems serious enough to need treatment would be seen on either the MRI or the CT.

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