Funded by Blue Cross Blue Shield of Michigan Foundation
Funding Years (2016-2018)
PI: Michele Heisler
PI: Michele Heisler
Funding Years: 2013 - 2018.
PI(s): Devin Brown and Phillip Scott
Co-I(s): Lewis Morgenstern
This research study addresses two questions. How do social relationships and social support change with age? And when are social relationships most beneficial or harmful to health? To do this we examine three waves of the Social Relations, Age and Health study spanning more than 20 years, analyzing detailed changes in social relations using both monthly assessments and multiple informants.
Specifically, this study (1) tests competing theories about age, social relations and health; (2) specifies the direction and shape of change in social relations over time; (3) tests the relative strength of the three hypothesized mechanisms of social contagion: induction, homophily, and shared environmental factors; and (4) examines competing exchange theories, e.g. altruism, developmental stake, support bank, well as their association with health disparities.
Study findings will impact scholarship by identifying how social relations change with age; the links between social relations and health; and how specific characteristics of social relations – cross-sectionally and longitudinally – influence the stress-health link and social disparities. We also hope to impact public policy with attention to social relations intervention programs that reduce long-term risk and increase protective factors.
PI(s): Toni Antonucci
Co-I(s): Kristine Ajrouch, Kira Birditt, Kai Cortina, Mick Couper, Richard Gonzales,
Obstructive sleep apnea (OSA) is a well-recognized risk factor for serious health consequences and increased health care expenditures, but the impact of OSA under-recognition and under-treatment on outcomes and healthcare utilization patterns on a national level remains largely unstudied, particularly among the elderly. Research that characterizes the scope and impact of OSA under-recognition across the U.S. - and barriers to its diagnosis and treatment - is needed to develop strategies that will optimize medical outcomes for Americans with OSA. This proposal aims to identify critical gaps in the identification and treatment of OSA in the U.S., and determine the extent to which such gaps influence outcomes and healthcare utilization. This study will be facilitated though analysis of Medicare 5% datasets, and the National Health and Aging Trends Study - a newly available survey of Medicare beneficiaries that focuses on health outcomes in adults age 65 and older, linked to Medicare claims data. This approach will allow us to characterize national trends in OSA recognition and treatment, clarify relationships between OSA and health outcomes; and identify barriers to improving OSA-related consequences. Ultimately, this project will inform future research directed at improving cost-effective strategies to ameliorate medical and economic consequences of OSA.
PI(s): Tiffany Braley, James Burke
Institutional Review Boards (IRBs) provide oversight to clinical research involving human subjects to protect participants and ensure ethical research conduct. Local IRBs review research performed just at their own site, while Central Institutional Review Boards (CIRBs) review research being conducted at many sites. Regardless of whether reviews are performed locally or centrally, they must take into account any local context specific to the site where the research will be performed. CIRBs may provide more effective, equitable, and efficient review of large multicenter clinical trials, but whether CIRBs can effectively consider local context is unknown. Local context review is especially important in a kind of research called exception from informed consent for emergency research. In this kind of research, patients who are comatose or otherwise critically ill and unable to consent for themselves may still participate in trials if thir condition is life-threatening and the experimental therapy is only effective if given right away. To perform this kind of trial, researchers must also consult with the community and publically disclose information about the study. Information about those consultations must then be considered by an IRB as part of local context review. The purpose of this project is to explore, revise, and test measures of local context review of community consultation for this type of research, by local and central IRBs. We will work with key stakeholders to identify goals and processes, use these data to develop measures in domains such as trustworthiness and acceptability, and then use these measures to compare local IRB reviews to those of a simulated CIRB for a real trial. This project will be conducted within the Neurological Emergencies Treatment Trials (NETT) network and the Pediatric Emergency Care Applied Research Network (PECARN). These networks will serve as an "empirical ethics lab" in which best practices are developed.
PI(s): Robert Silbergleit
Co-I(s): Michael Fetters, Michael Geisser, Adrianne Haggins, Alan Sugar, Sacha Montas
Chronic kidney disease (CKD) affects 20 million Americans. CKD can lead to end stage renal disease and is associated with morbidity and mortality at all stages. Early management decreases complications and may ameliorate disease progression, but is often reliant on patient self-care. Research suggests that a large proportion of patients lack fundamental knowledge about kidney disease, its implications, and self-care necessary to attenuate CKD progression to end stages. Patient decision aids are designed to facilitate disease communication, increase patient knowledge, clarify patients'values and engage patients in care. There have been no studies using patient decision aids in pre-dialysis CKD. Moreover, there is a paucity of data available to guide development of CKD patient decision aids for use in practice. The primary goal of this research proposal is to elicit stakeholder (i.e. patient and provider) input on information needs and preferences for developing a CKD decision aid that will 1) support patient-centered CKD communication, 2) facilitate shared learning and decision making between patients and providers, and 3) optimize patient engagement in care. To accomplish this objective, I propose to conduct three inter-related but independent studies. First, I will determine information needs and factors that influence self-care in patients with pre-dialysis CKD using structured interviews and a survey in 250 patients seen in the University of Michigan nephrology outpatient clinics. Second, I will identify physician perspectives about what they need to support patient CKD education and to effectively engage patients in care by conducting structured interviews of fifty physicians (25 primary care, 25 nephrology) who practice in the University of Michigan Ambulatory Clinics. The interviews and survey questions in the first two aims will be grounded on two quality improvement methods namely, cause/effect analysis and quality function deployment. Informed by the first two aims, I will develop and test a patient- centered decision aid, designed to facilitate patient-physician communication and support patient decision making and self-care in pre-dialysis kidney disease. The aid will be tested in a randomized trial with the decision aid the exposure, and intermediate patient modifiable characteristics (knowledge, self-efficacy, and treatment decisional conflict), as co-primary outcomes. The proposed research is likely to improve our understanding about the needs and preferences of key stakeholders involved in CKD communication and care, and provide insight into the effectiveness of patient-centered education interventions on outcomes in pre- dialysis kidney disease.
PI(s): Julie Wright, Angela Fagerlin
Co-I(s): Eve Kerr, Akinlolu Ojo
The Center for Bioethics and Social Sciences in Medicine (CBSSM) Research Colloquium will be held Tuesday, May 1, 2018 at the Henderson Room, Michigan League, 911 N. University Avenue, Ann Arbor, MI 48109.
The CBSSM Research Colloquium will feature the Bishop Lecture in Bioethics as the keynote address. Barbara Koenig, PhD will present the Bishop Lecture with a talk entitled: “Does Enhancing Individual Choice and Control Promote Freedom? Challenges in Contemporary Bioethics."
The CBSSM Research Colloquium (9 a.m. to 2 p.m.) brings together presenters highlighting research related to bioethics, health communication, and medical decision making. Abstract submissions are welcome from all disciplines both within UM, as well as other institutions. For more details or to submit an abstract, please see the Abstract Submission form. Deadline for abstract submission is Friday, March 16, 2018.