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Funded by Blue Cross Blue Shield of Michigan Foundation

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
CBSSM Co-I: H. Myra Kim

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

Wendy Uhlmann, MS, CGC

Faculty

Wendy R. Uhlmann, MS, CGC is the genetic counselor/clinic coordinator of the Medical Genetics Clinic at the University of Michigan. She is a Clinical Professor in the Departments of Internal Medicine and Human Genetics and an executive faculty member of the genetic counseling training program. Wendy Uhlmann is a Past President of the National Society of Genetic Counselors and previously served on the Board of Directors of the Genetic Alliance and as NSGC’s liaison to the National Advisory Council for Human Genome Research.

Last Name: 
Uhlmann
Tue, July 26, 2011
The Department of Health and Human Services published an Advance Notice of Proposed Rulemaking to request comment on how current regulations for protecting human subjects who participate in research might be modernized and revised to be more effective.  Changes are proposed to seven aspects of the current regulatory framework:
 
  • refinement of the existing risk-based regulatory framework;
  • utilization of a single IRB review of record for domestic sites of multi-site studies;
  • improvement of consent forms and the consent process;
  • establishment of mandatory data security and information protection standards for all studies involving identifiable data;
  • establishment of an improved, more systematic approach for the collection and analysis of data on unanticipated problems and adverse events;
  • extension of Federal regulatory protections to all research, regardless of funding source, conducted at institutions in the U.S. receiving some Federal funding from a Common Rule agency for research with human subjects; and
  • improvement in the harmonization of regulations and related agency guidance

The paper, "Pruning the regulatory tree: For human subjects research, maximum regulation does not mean maximum protection," authored by CBSSM faculty Scott Kim, Peter Ubel, and Ray De Vries, was cited in the ANPRM.

 

Funded by the Agency for Health Care Research and Quality

Funding Years: 2010-2011

This study will evaluate a broad-based collaboration between the largest insurer in Michigan (BCBSM) and physician organizations throughout the state to implement components of the Patient-Centered Medical Home, and will provide valuable lessons for PCMH initiatives throughout the country. Because of the wide range of independent practices of varying structure, demographics, and geographic locations participating in this collaboration, the lessons learned from this study will provide greater external validity for the vast majority of primary care practices than do the experiences of large, integrated health systems with employed physician staff and centralized administrative control. Results from this study could also help primary care teams prepare for their journey toward a fully- functioning PCMH by preparing them in advance for challenges that may arise during PCMH implementation, and having information on how others have overcome those challenges.

UM Affiliated Investigators: Michael Fetters (PI), Lee Green (Co-I), Jeffrey Alexander (Co-I).

More details can be found at NIH Reporter.

Funded by University of Michigan Comprehensive Cancer Center Research Grants Program

Funding Years: 2011-2012

Pilot study research aims:

  1. Develop and optimize procedures for future studies that elicit informed, deliberative views of cancer patients regarding disclosure preferences that should be included in informed consent for genome sequencing.
  2. Examine how a multi-disciplinary team of experts, Precision Medicine Tumor Board, determines which test results should be returned to cancer patients and clinicians, and how that information is received by referring clinicians.
  3. Develop and pilot interview guides to identify barriers to effective communication of sequencing results to patients.

J. Scott Roberts (PI), Raymond De Vries (Co-I), Scott Kim (Co-I), Brian Zikmund-Fisher (Co-I), Sameek Roychowdhury (Co-I)

 

Funded by the Department of Veterans Affairs

Funding Year: 2011

A current priority for VA research is "Healthcare Informatics to Improve Veteran Care Healthcare." This priority area recognizes the critical importance of developing effective technological tools for Veterans to improve their understanding of and capacity to be actively involved in shared decision making about key health issues. Making The Choice - VA will develop new materials specifically for VA patients who have prostate cancer. The tool will help in shared and informed decision-making related to prostate cancer treatment options and outcomes. 

Aim 1. Develop a web-based platform that will support informed shared decision making for patients. The focus will be prostate cancer treatment options.

Aim 2. Use values clarification method, conjoint analysis, in this first iteration of the platform.

Angela Fagerlin (PI)

Center for Health Communications Research (CHCR)

 

Funded by Department of Veterans Affairs

Funding Years: 2009-2012

Because CRC-predictive genetic tests offer the potential to optimize CRC screening efforts, improving the communication and use of such tests by the millions of veterans who are screened for CRC each year could result in both improved cancer surveillance and more efficient (and potentially reduced) VA resource utilization. Our study will provide empirical data about practical risk communication methods that can be used in the future by VA clinicians to present genetic tests to veterans and about patient-level barriers which will inhibit acceptance of genetic tests that predict colorectal cancer risk within the VA patient population. By evaluating alternate methods of communicating genetic test results before such tests actually become available, we hope to identify optimal approaches that can be integrated into VA genomics initiatives from the very start.

Angela Fagerlin (PI)

Thu, July 25, 2013

Dr. Arul Chinnaiyan and his team have been awarded 1 of 4 research grants ($7.97 million pending) from the National Institutes of Health to explore the use of genome sequencing in medical care. The new grants are funded as part of the National Human Genome Research Institute's (NHGRI) Clinical Sequencing Exploratory Research (CSER) program. NHGRI is part of NIH.

The team will sequence the genomes of tumors from 500 patients with advanced sarcoma or other rare cancers to discover new information about genomic alterations, with the goal of eventually customizing therapies. Few clinical trials have been conducted in most rare cancers, and scientists would like to know more about the genetic underpinnings of these diseases. Investigators also plan to evaluate the patient consent process, and the delivery and use of genome sequencing results.

Several CBSSM-affiliated faculty are involved with this project, including Scott Kim, Scott Roberts, Raymond De Vries, Brian Zikmund-Fisher, as well as Post-Doctoral Research Fellow, Michele Gornick.

Erica Sutton, PhD

Alumni

Dr. Erica Sutton was a CBSSM Postdoctoral Research Fellow, 2013-2015. She is an interdisciplinary social scientist engaged in social and behavioral science research that explores the health care experiences of individuals living with rare genetic conditions; the manner in which biotechnologies shape personal experience and social life; and the ethical implications of these technologies for individuals, public health, social policy, health care institutions, and communities.

Last Name: 
Sutton

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