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Funded by National Institutes of Health (NIH), National Heart, Lung, and Blood Institute (NHLBI)

Description: Each year, an estimated 10,000 U.S deaths from pneumonia could have been avoided if the ICU had been used. Efforts to prevent those deaths are limited by the 20-fold variation in ICU admission rates across U.S. hospitals. Thus, there is a critical need to identify the patients who will benefit from ICU care and ensure they receive it. The overall hypothesis of this proposal is that there are definable characteristics of patients who could benefit from ICU care but do not receive it, that those characteristics are often not incorporated into existing physician models of decision-making around ICU care, and that even when those models are accurate, there are hospital factors that prevent physicians from providing potentially life-saving ICU care to those patients. The overall goal of this proposal is to characterize the mechanisms driving the underuse of ICU care for select pneumonia patients—mechanisms at the patient-, physician-, and organization-level. To accomplish this, I propose to develop and validate a prediction model to identify patients with pneumonia who should be admitted to the ICU, but often are not; to empirically identify key decision-making models of physicians about ICU admission; and to characterize barriers and facilitators at the organizational-level to improving ICU use.    

PI: Thomas Valley, MD, MSc                                                                                                                                                                             

Wed, May 21, 2014

 Beth Tarini's 2009 study regarding use of newborn screening samples for research was cited in US News & World Report, which found only 28.2 percent of parents were “very or somewhat willing” to consent to research using their child’s blood samples if their permission were not obtained. In fact, without consent, 55.7 percent would be “very unwilling.” 

Research Topics: 

Tanner Caverly, MD, MPH

Faculty

Tanner Caverly has been a general internist and Health Services Research Fellow at the Ann Arbor VA Medical Center and a Clinical Lecturer at the University of Michigan Medical School since July 2013. He graduated from medical school at The Ohio State University School of Medicine and Public Health, and subsequently traveled to the University of Colorado, where he completed internal medicine residency training, a year as Chief Medical Resident, and a Primary Care Research Fellowship / Masters in Public Health.

Last Name: 
Caverly

Funded by the National Institute on Aging

Although the US spends far more on health care than other high-income countries, older Americans are sicker and have shorter lives than older adults in many other high-income countries, even after controlling for individual-level factors such as education and behavioral risks. Reasons for the US health disadvantage are not well understood. However, local amenities and resources have not been examined systematically in efforts to understand difference in older adults' health status across countries.

This project will assess the extent to which local contextual characteristics explain the worse health status of older Americans compared to their counterparts in England using data from the Health and Retirement Study (HRS) and English Longitudinal Study of Aging (ELSA). We will identify comparable local geographic areas in the HRS and ELSA and create a comparable contextual dataset to be linked to the ELSA at each geographic boundary. We will then assess the extent to which area-level contextual measures explain key health and mortality differences between the US and England, including comprehensive self-reported health measures, measures of physical performances (e.g., gait speed) and cognitive functioning, and biomarkers (e.g., HbA1c). We will also examine health gaps by age, education, and economic groups before and after the adjustments of local contextual characteristics.

PI: HwaJung Choi

CBSSM Co-Is: Michele Heisler & Kenneth Langa

Mon, January 06, 2014

Dr. Reshma Jagsi worked on a study detailing the decline of US research spending versus the increase in spending in Japan and China. In the UMHS article, she says, "The United States has long been a world leader in driving research and development in the biomedical science. It's important to maintain that leadership role because biomedical research has a number of long term downstream economic benefits, especially around job creation," 

Research Topics: 

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.

Funded by Holden Research Fund Award

Funding Years: 2011

 

PI: Naomi Laventhal

Holly Witteman, Research Fellow at CBSSM, has been awarded a $25,000 Robert Derzon Post-Doctoral Grant from the Foundation for Informed Medical Decision Making for her project entitled "Development and Evaluation of Interactive Interfaces for Values Exploration and Clarification." Pending IRB approval, the project is slated to commence in April 2010. Witteman has been working since fall 2009 under the mentorship of Angela Fagerlin. CBSSM extends its congratulations!

How old is too old for cancer screening? (Feb-11)

Cancer screening is generally recommended for people over the age of 50. Screening tests, such as colonoscopies, mammograms and PSAs (prostatespecific antigen), can help detect cancer at an early stage andprevent deaths. These screening tests, however, do have risks so,along with their doctor, people need to make a decision about howoften to get screened and when or if one should stop gettingscreened.

Consider the question:

Now, imagine that you were screened for cancer about a year ago and no cancer was found. You and your doctor are talking about when you should come back for screening in the future. Your doctor explains that cancer screening guidelines recommend that you do come back for more screening tests but as you get older, screening for cancer is no longer a good option. Your doctor states that you should follow this recommendation as you age. Now, imagine that you were screened for cancer about a year ago and no cancer was found. You and your doctor are talking about when you should come back for screening in the future. Your doctor explains that cancer screening guidelines recommend that you do come back for more screening tests but as you get older, screening for cancer is no longer a good option. Your doctor states that you should follow this recommendation as you age.

 
Would you plan to stop getting screening tests for cancer at a certain age?
  • Yes
  • No

How do your answers compare?

In a recent study published in the Journal of General Internal Medicine, CBSSM Investigators and Mick Couper and Brian J. Zikmund-Fisher, together with lead author Carmen Lewis (Department of Medicine, University of North Carolina) and several co-authors, explored decisions about stopping cancer screening tests. This study was part of the DECISIONS study, a large survey of U.S. adults about common medical decisions.
 
Recently, the US Preventive Services Task Force recommended against prostate screening for men aged 75 and older, and recommended against routine screening for CRC screening after age 75 and any CRC screening after age 85. Cancer screening for prostate cancer, CRC and breast cancer helps to detect cancer at an early stage when they are easier to treat. However, as a person gets older, the risks of these tests become larger than the benefits.
Data was collected from 1,237 individuals aged 50 and older who reported having made one or more cancer screening decisions in the past 2 years. Participants were asked about their plans of whether or not to stop cancer screening as well as characteristics of themselves and their health care provider.
 
Only 9.8% of people planned to stop getting screened for cancer when they reached a certain age. This percentage varied by type of cancer, age and race of the participant and how much the participant was responsible for the decision apart from their health care professional.
 
Of the 119 people who gave a specific age that they planned to stop getting cancer screening the average age they did or plan to stop was 74.8 for breast cancer, 76.8 for colon cancer and 82.9 for prostate cancer.
 
The study authors concluded that “plans to stop screening were uncommon among participants who had recently faced a screening decision”. They also concluded that further research is needed to understand how people think about the risks and benefits of screening when life expectancy is short and that education around this topic may be beneficial.
 

To learn more about this study, see:

 

Brian J. Zikmund-Fisher, PhD

Associate Director

Brian J. Zikmund-Fisher is an Associate Professor in the Department of Health Behavior and Health Education, University of Michigan School of Public Health, as well as a Research Associate Professor in the Division of General Internal Medicine, University of Michigan Medical School. He has been part of CBSSM and its precursors at U-M since 2002 and acts as CBSSM Associate Director.

Last Name: 
Zikmund-Fisher
Press Coverage: 

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