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The development of Learning health systems is causing radical transformation of the environment within which the NCI pursues its Mission; understanding the Ethical and social implications of these changes is of paramount importance. In rapid Learning systems (RLS), routinely collected Patient data drive the process of discovery, which in turn becomes a natural outgrowth of clinical care. As the Institute of Medicine has noted, such systems have substantial promise for improving the quality of care and research, and ultimately the value of health care. As such systems develop, the blurring of the current distinction between clinical practice, quality of care, and research necessitates careful consideration of Ethical implications.

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.

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.

CBSSM Researchers: 

The theme of the University of Michigan Patient Safety Learning Laboratory ("M-Safety Lab") is to improve the delivery of inpatient care by cross-linking investigators from diverse disciplines - including engineering, medicine, nursing, architecture and design and computer science - who share a common interest in patient safety. Our overarching goal is to implement novel methods to enhance cognition and communication among care providers in order to reduce hospital-acquired complications.

CBSSM Researchers: 

This project will examine behavioral economic strategies for decreasing the use of low-value clinical services as listed in the Choose Wisely campaign. The proposed intervention, Committing to Choose Wisely (CCW), will ask clinicians to commit to avoid low-value services and provide resources to support adherence to this commitment. The intervention, which extends across two large health systems, will generate quantitative data from clinical automated data and focused medical record review data to examine rates of order before and after the intervention, as well as qualitative data from surveys and semi-structured interviews of both clinicians and patients to determine the effects of the intervention on their decision-making and experiences.

Every year, one in 10 older people fall and sustain injury requiring medical care. Fall-related injury is the number one cause of accidental death in older Americans. However, fall injury is rarely considered as a outcome in controlled trials, which have traditionally focused on death and cardiovascular events. Until recently, we lacked methods of capturing fall-related injury in large healthcare databases. We will first use the Health and Retirement Study, a national study of older Americans, to develop a method of classifying severe fall injury in found in Medicare claims data across acute, ambulatory, and long-term care. Next, we will study how a national healthcare system, the Veterans Health Administration (VHA), delivers aggressive hypertension care (AHC) and whether AHC results in net benefit or harm due to cardiovascular events and severe fall-related injury. Hypertension is the single most common chronic condition in older adults. Medication treatment prevents important cardiovascular events (strokes, myocardial infarctions and heart failure), however also contributes to risk of falls. We do not fully understand the net benefits and harms among our oldest patients in clinical practice, especially after age 75 - those most prone to severe fall-injury. Thus, we aim to study the net harms and benefits associated with AHC.

Research Topics: 
CBSSM Researchers: 

The purpose of the Fund to Retain Clinical Scientists is to provide supplemental, flexible funds to early-career physician-scientists working on clinical research projects and facing extraprofessional demands of caregiving. The goal of this program is to retain early-career physician-scientists in research.