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Funded by Michigan Department of Health and Human Services (Subcontract)

Investigators from University of Michigan’s Institute for Healthcare Policy and Innovation (IHPI), in partnership with the Detroit Health Department, the Southfield-Joy Community Development Corporation and five health plans insuring Detroit-based Medicaid and Healthy Michigan enrollees have collaboratively developed an innovative new model for a Community Health Worker-led (CHW) demonstration project in Detroit’s Cody Rouge neighborhood. The demonstration project will evaluate a potentially financially sustainable model targeting neighborhoods with high numbers of high- and under-health care utilizing Medicaid enrollees. The health plans will each deploy one of their CHWs to the project for a 12-month period. After undergoing joint training through the Michigan Community Health Worker Alliance (MICHWA) program and using assessment tools that cover shared domains, the CHWs will proactively reach out to identified beneficiaries to conduct an initial health and social needs assessment, develop an individualized ‘action plan’ with each beneficiary, work with neighborhood-based organizations to address each enrollee’s unique needs, and provide follow-up support as needed. CHWs will work closely with local organizations both to meet program participants’ needs and to strengthen community capacity to bridge gaps between healthcare services and community-level social determinants of health. The Detroit Health Department will provide office space for the CHWs to meet weekly in a neighborhood facility and provide ongoing booster support and mentorship. UM investigators will evaluate the program in a parallel, two-armed, randomized controlled pragmatic trial. We will evaluate effect on health care utilization among high-utilizing participants and zero-utilizing participants (ED visits, hospitalizations, primary care use) and health care costs at 6- and 12-months and compared to eligible individuals not yet enrolled in the project, on key patient-centered outcomes, and project costs, return on investment, and barriers and facilitators to adoption, implementation, maintenance, and potential spread.

PI: Michele Heisler, MD, MPA

CBSSM Co-I: H. Myra Kim, ScD

Julie Wright Nunes, MD, MPH

Faculty

Julie Wright Nunes is an Assistant Professor at the University of Michigan Department of Internal Medicine. Her research interests include Chronic Kidney Disease (CKD) and its prevention and also the development of methods and tools to help facilitate and optimize provider-directed CKD patient education.

Last Name: 
Wright Nunes

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.

CBSSM is soliciting applications from qualified individuals for 1-2 postdoctoral research fellow positions for the 2018-2019 academic year.

The mission of CBSSM is to be the premier intellectual gathering place of clinicians, social scientists, bioethicists, and all others interested in improving individual and societal health through scholarship and service.

Bioethics Post-Doctoral Research Fellow
Active projects in bioethics at CBSSM currently include the ethical, legal, and social implications of genomic medicine, human subjects research ethics, empirical research with relevance to clinical ethics, global bioethics, gender equity, reproductive justice, deliberative democratic methods in bioethics, resource allocation, ethical issues associated with learning health systems, and the sociology of medical ethics/bioethics, among others. Candidates' area of focus must be in bioethics, although their backgrounds may be in social or natural sciences, humanities, medicine, or law.

Decision Sciences Post-Doctoral Research Fellow
This fellowship focuses on understanding and improving the health care communication and decisions made by both patients and providers. Past postdoctoral fellows have included scholars whose research in health care communication and decision making has been approached using theories drawn from social cognition, motivation and emotion, risk communication, human factors, ethics, and economics.

Postdoctoral fellows are expected to collaborate on established projects and are encouraged to conduct independent research with an emphasis on study inception, manuscript writing, and applying for grants. CBSSM’s resources and collaborative support enable fellows to build their own research programs.

Please see: http://cbssm.med.umich.edu/training-mentoring/post-doctoral-fellowship for more details about these fellowship opportunities.

 

Bioethics Grand Rounds

Wed, March 22, 2017, 12:00pm
Location: 
UH Ford Amphitheater & Lobby

Autumn Fiester, PhD, Division of Medical Ethics, Department of Medical Ethics & Health Policy, Perelman School of Medicine University of Pennsylvania

Title –  The “Difficult” Patient Reconceived: Learning the Skills of Mediators in Managing Challenging Clinical Encounters.

Abstract: Between 15%-60% of patients are considered “difficult” by their treating physicians.  Patient psychiatric pathology is the conventional explanation for why patients are deemed “difficult.” But the prevalence of the problem suggests the possibility of a less pathological cause.  I argue that the phenomenon can be better explained as responses sourced in conflicts related to healthcare delivery and that the solution to the “difficult patient” is to teach better conflict management skills to clinical providers.


Objectives:

1. Apply the mediator's concepts of "positions" and "interests" to patient-provider conflicts
2. Identity the moral emotions and explain their significance in managing the "difficult" patient
3. Learn seven maxims for diffusing conflict in clinical encounters

Available via live stream at: https://connect.umms.med.umich.edu/bioethics_3_22_17

ASCO Connection recently highlighted Reshma Jagsi. Click here for the full article.

Research Topics: 

Bioethics Grand Rounds -Anna Kirkland, JD, PhD

Wed, June 28, 2017, 12:00pm
Location: 
UH Ford Auditorium

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.

Bioethics Grand Rounds -Scott Grant MD, MBE

Wed, May 24, 2017, 12:00pm
Location: 
UH Ford Auditorium

Scott Grant, MD, MBE, University of Chicago: "Dealing with complications and poor outcomes and surgical futility"

Scott Grant, MD, MBE, University of Chicago

Abstract: Surgical complications are ubiquitous and effect all surgeons. This talk will review how surgical ethics is distinct from traditional medical ethics in that surgeons have a greater and more direct responsibility for the outcomes of their patients than medical doctors. It will review how surgery harms before healing and the importance of weighing risks and benefits in decision making. Ways of assessing perioperative risk and preventing complications will be reviewed. Strategies for coping with complications will be described. Human error theory and the "Swiss cheese" model of human error will briefly be discussed. The SPIKES protocol for breaking bad news will be reviewed. Different definitions of futility will be described. Various procedural approaches to futility disputes will be analyzed. The best tool in approaching challenging "futility" situations will be described - open and honest communication between the patient or surrogate and the physician.

Lewis Morgenstern, MD

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