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CBSSM Researchers: 

Patient-physician racial discordance is strongly associated with patient dissatisfaction and mistrust in physicians, which is further associated with poor treatment adherence and suboptimal healthcare utilization. This poses serious public health challenges because approximately 80-90% of Black patients see physicians from different racial groups. Patient dissatisfaction and mistrust have been recently found to be particularly magnified when physicians hold high levels of automatic, implicit bias toward Black Americans, suggesting that physicians’ implicit racial bias impacts physician communication behaviors during medical interactions and ultimately Black patient outcomes. The overall goal of this research is to identify physicians’ communication behaviors during medical interactions that are associated with physicians’ implicit racial bias and Black patients’ immediate (satisfaction, trust) as well as clinically important longer-term outcomes (adherence, healthcare utilization). To achieve this goal, we target medical interactions involving Black patients with Type 2 diabetes mellitus (T2DM) because nonadherence in Black patients with T2DM is particularly prevalent. Additionally, the patient-physician communication quality has been found to predict patient adherence to T2DM treatment regimens. We will use a mixed-methods design that integrates the strengths of inductive reasoning to explore which physicians’ communication behaviors during medical interactions matter from Black patients’ perspectives and deductive reasoning to identify theoretically and clinically important behaviors.

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.

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.

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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.