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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 National Institutes of Health

Funding years: 2011-2015

Colorectal cancer has a major impact on Americans, yet its screening rate remains suboptimal. This study aims to improve colorectal cancer screening rate by using an innovative and interactive decision aid that helps patients choose among colorectal cancer screening options. The study will also elucidate how patients and physicians discuss colorectal cancer screening options. for more information visit NIH Reporter.

PI: Masahito Jimbo

Co-I: Sarah Hawley

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

Funding Years: 2014 - 2016.

Mexican Americans (MAs) suffer more from stroke than non-Hispanic whites (NHWs). Ischemic stroke is more common in MAs and their neurologic, functional and cognitive outcomes after stroke are worse than in NHWs. The reasons for the disparity in post-stroke outcome are unclear. Pre-stroke function and initial stroke severity are similar between the two groups as are ischemic stroke sub-types. One potential explanation for the worse post-stroke neurologic, functional and cognitive outcome in MAs compared with NHWs is allocation and effectiveness of post-stroke rehabilitation. There is remarkably little data demonstrating whether rehabilitation is dosed differently for MAs compared with NHWs, and still less information about whether, for a given dose of rehabilitative services following stroke, there is differential benefit by ethnicity. The current application will utilize the existing population-based Brain Attack Surveillance in Corpus Christi (BASIC, NSR0138916) project's infrastructure and strong community relations to develop and pilot a method to collect the necessary data to determine the role of rehabilitation in ethnic disparities in post-stroke outcomes. Previous studies have suggested that looking at overall time spent in rehabilitation does not predict post-stroke outcome. However, specific components of physical, occupational and speech therapy, a practice-based approach, has been shown to be associated with stroke outcomes, and these associations have been shown to vary by race. However, this practice-based approach has not been implemented in a population-based manner across the range of settings where stroke patients receive rehabilitation services, and no study has used this approach in an ethnically diverse population. Therefore, our plan is to build on previous work by developing and utilizing a practice-based design in our population-based stroke study. Specifically, we will 1) continue to build the needed relationships with rehabilitation service providers in the community;2) work with local rehabilitation therapists to refine data collection instruments as part of the practice-based design;3) pilot test data collection of specific rehabilitation components of post-stroke rehabilitation across all rehabilitation settings;and 4) analyze this data to determine the feasibility of this approach for a larger study and to provide preliminary data on differences in access and effectiveness by ethnicity. In total, our infrastructure development, refinement of tools to measure specific therapy modalities and pilot testing will position us perfectly to submit an R01 application to identify ethnic differences in access to rehabilitation and specific rehabilitation services associated with improved functional outcome in MAs and NHWs.

PI(s): Lynda Lisabeth, Lewis Morgenstern

Michael Fetters has been named a 2016 Fulbright Distinguished Chair in Social Sciences. He will spend five months in Beijing teaching and leading a joint research project with colleagues at Peking University Health Science Center (PUHSC), U-M's partner school in the Joint Institute for Translational and Clinical Research.

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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, Lewis Morgenstern & Ken Langa

Funded by the NIH

In the past 30 years, the incidence of thyroid cancer has tripled. The majority of the rise in thyroid cancer incidence is attributed to an increase in low-risk, well-differentiated thyroid cancer, a disease that has a 10-year mortality close to zero. Our previous work suggests that patients with low-risk thyroid cancer are at risk for overtreatment, defined as the use of surgical and medical interventions in the absence of a clear survival benefit. The overtreatment of thyroid cancer has inherent costs, both to patient health and to society. The reason for the intensive management and potential overtreatment of low-risk thyroid cancer remains unclear. By using SEER-linked patient and physician surveys, we plan to understand the treatment decision making in low-risk thyroid cancer. We hypothesize that knowledge and attitudes influence decision making. Specifically, we anticipate that lack of knowledge of risks of death, recurrence and treatment complications is associated with treatment that is more intensive. In addition, we postulate that a general preference for active treatment will also be associated with more intensive cancer treatment. Although both patient and physician perceptions of treatment need (i.e., knowledge and attitudes) likely contribute to treatment intensity, we anticipate that the primary driver will be physicians, even after controlling for their patients' perceptions. This study will serve as the foundation for future intervention studies. By identifying the specific role of physician and patient knowledge and attitudes toward thyroid cancer treatment, we will be able to create tailored educational interventions to personalize surgical and medical care for thyroid cancer patients, thus minimizing overtreatment and its inherent risks and costs. As the rising incidence, low mortality, and pattern of intensive treatment make thyroid cancer arguably the best cancer model for overtreatment, this proposed study will also serve as a model to understand overtreatment in other malignancies. For more info: http://grantome.com/grant/NIH/R01-CA201198-01A1

PI: Megan Haymart

CBSSM Co-Is: Sarah Hawley & Brian Zikmund-Fisher

Funded by the NIH

PROJECT SUMMARY Differences (or Disorders) of Sex Development (DSD) is a superordinate term encompassing congenital conditions in which chromosomal, gonadal, or anatomic sex development is atypical. Adopting an inclusive definition, between 1 in 200 to 1,000 people are born with some degree of atypical sex development. Clinical management of DSD is in a state of flux with disagreements within and between professional, advocacy, and patient communities regarding optimal care. Advances in molecular diagnosis and surgical techniques, findings regarding psychological outcomes in affected persons, and patient advocacy group engagement, led to a consensus conference attended by international experts in the DSD field and patient advocacy. Consensus recommendations included changes to diagnostic and clinical management strategies and in nomenclature that eliminated terms considered confusing and stigmatizing; e.g., “intersex,” “hermaphroditism,” “pseudohermaphroditism,” and “sex reversal.” While scientific and medical communities rapidly adopted the new nomenclature, vocal patient community elements strongly opposed the word “disorder” - experiencing it as unnecessary pathologization of atypical bodies that contributes to the perceived need for potentially harmful surgical “normalization” procedures. Some affected adults now prefer the term “intersex” - referring to an identity, rather than a medical condition. Further, little agreement exists across provider, advocacy, and patient communities regarding what constitutes optimal care for patients and families. Clinical management topics triggering contentious debate include decision- making over gender of rearing, genital surgery and its timing, gonad removal, and disclosing diagnostic details to patients. Evidence of these controversies exists in medical literature, social media, and courts of law, yet a remarkable lack of discussion, much less consensus, exists on how stakeholders value various outcomes. There has yet to be a study designed to systematically examine how patients, parents, healthcare providers, and other stakeholders differentially define and value optimal DSD health care delivery. The proposed study has the following aims: (1) Assess the importance ascribed by stakeholders to DSD clinical management options (i.e., identify what constitutes a “successful outcome”), both immediately and in the future; (2) Identify differential trade-off preferences (e.g., trade-offs between genital appearance, preserving fertility, sexual function, privacy, patient autonomy) and choice processes made by different stakeholder groups; (3) Design and pilot evidence-based curricula for stakeholders that clarify priorities, and integrate these with evidence to facilitate informed and shared decision-making. The proposed approach to understanding differential valuation of clinical management elements and developing data-driven curricula is potentially generalizable to other congenital or chronic conditions involving multidisciplinary care in which treatments are elective and dependent on patient/family values and preferences.

PI: David Sandberg

Bioethics Grand Rounds

Wed, September 28, 2016, 12:00pm
Location: 
UH Ford Amphitheater & Lobby

Carl Schneider, JD -- “Can Informed-Consent Laws Work? Evaluating Compelled Disclosure as a Method of Regulation”

Abstract: The law of informed consent is an example of a form of legal regulation called mandated disclosure.  In such regulation, one party to a transaction is required to give the other party to the transaction information to use in making decisions about the parties’ relationship.  There are hundreds of examples of such legal rules besides medical informed consent. This talk asks how well these rules have worked outside medicine. It concludes that there is little evidence that those rules ever work, explores some of the reasons for this surprising failure, and asks what the failure of mandated disclosure outside medicine tells us about the success of informed-consent laws in medicine.

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.

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