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We hope you enjoy the Fall edition of the Society for Medical Decision Making Newsletter
SMDM Newsletter
Welcome

Welcome

From the Editor
by A. Scott LaJoie, PhD, MSPH
From the President
by Anne Stiggelbout, PhD


Society Updates


Society Updates

Elections Results: Officers & Trustees
Education Committee

Awards Committee
Career Development
SMDM Journal


SMDM Meetings


SMDM Meetings

2012 North American Meeting

Decision Analysis Society




Commentary



Commentary

Newborn Screening Decisions
by Scott Grosse, PhD and Lisa Prosser, PhD
Comparative Effectiveness Research
by Mary Politi, PhD
The Importance of Cultural Tailoring
by Dana L. Alden, PhD and John Friend, PhD Candidate


Other News


Other News

Members in the News
Recognition of Lifetime Contributors






Events and Opportunities

Be sure to take advantage of all of the events and opportunities SMDM has to offer.
2012 North American Meeting Registration
Opportunities to Volunteer
Job Postings
Support SMDM
Join SMDM on Facebook
Contact Us




Editors

A. Scott LaJoie, PhD, MSPH, Editor-in-chief, University of Louisville
lajoie@louisville.edu
Donald A. Brand, PhD, Senior Editor, Winthrop University Hospital
dbrand@winthrop.org
Scott B. Cantor, PhD, Senior Editor, The University of Texas MD Anderson Cancer Center
sbcantor@mdanderson.org


Contributing Writers

Ahmed Bayoumi, MD, MSc, University of Toronto
John Wong, MD, Tufts Medical Center
Natasha Stout, PhD, Harvard Medical School/Harvard Pilgrim Health Care
Mark Helfand, MD, Oregon Health & Science University
Jeffrey Keisler, PhD, University of Massachusetts Boston
Scott Grosse, PhD, National Center on Birth Defects and Developmental Disabilities
Lisa Prosser, PhD, University of Michigan Health System
Mary Politi, PhD, Washington University in St. Louis
Dana L. Alden, PhD, University of Hawai‘i
John Friend, PhD Candidate, University of Hawai‘i






From the Editor

by A. Scott LaJoie, PhD, MSPH, Editor-in-chief, University of Louisville

A. Scott LaJoieGreetings and welcome to the fall issue of the SMDM newsletter.

With our annual meeting in Phoenix, Arizona, just around the corner, it is our hope that this issue brings you resources to make the meeting enjoyable and informative. More importantly, the contributing authors have provided some tantalizing stories and ideas. From a thematic perspective, shared decision making takes center stage. Dana Alden, PhD, pictured in a very handsome shirt from Hawai’i, tells how decision aids can be improved with a better understanding of, and respect for, cultural diversity. Mary Politi, PhD, who co-hosted a conference at her university (Washington University in St. Louis) on comparative effectiveness research (CER), writes a summary of the conference and identifies similarities in challenges of implementing CER and shared decision making. Scott Grosse, PhD, and Lisa Prosser, PhD, outline efforts of SMDM members to incorporate decision modeling in the federal policy decision making process, illustrated by the example of newborn screening decisions. Lastly, Peter Ubel, MD, proudly announces the publication of a new book, Critical Decisions, that explores the history of shared decision making and its impact on bedside care. Read his story – in it, he tells how you can get a free copy of his book!

The SMDM annual meeting will highlight the state of science of health information technology. Program chairs, Scott Braithwaite, MD, and Liana Fraenkel, MD, have assembled a collection of experts for the keynote and panel discussions and promise us that the meeting will offer value to all attendees. As the meeting is being held only a short drive from the Grand Canyon, attendees have the opportunity for intellectual growth, inspiration and visual mesmerization! Moreover, with the meeting overlapping the Decision Analysis (DAS) and Health Application (HAS) Societies of the INFORMS (Institute for Operations Research and Management Science) conference, attendees will be able to interact with like-minded colleagues and explore new collaborations. If you’re not familiar with DAS, we’ve included an article to facilitate introductions.

Lastly, with this issue, we acknowledge the service and excellent leadership of SMDM members who are transitioning out of officer and board member positions. A hearty thanks goes to outgoing president Anne Stiggelbout, PhD, and her leadership team and we extend our appreciation to Mark Helfand, MD, MPH, for his excellent editorial management of our journal, Medical Decision Making.

Fall is a season of change, and the incoming board members and officers bring excitement and promise of good things to come.

See you in Arizona! As always, if you’d like to contribute an article to the newsletter, please contact me at lajoie@louisville.edu.


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From the President

by Anne Stiggelbout, PhD, Leiden University Medical Center
Anne Stiggelbout, President
Fall is always a special season! I like the fresh start of the academic year. People are not only relaxed after a good summer break (particularly in Europe!), but are bubbling with new ideas and looking forward to upcoming meetings (especially SMDM’s Annual Meeting!). But fall is also a period of reflection, which comes with it the realization that the summer is over, the days will shorten, the evenings will lengthen, the leaves are falling, and the animals are foraging for winter. I tend to be ambivalent about the realization that there will be more indoor time, for I am an outdoorsy person. But it is nice to have more time to do all the work that I didn’t get to do over summer.

Saying goodbye to summer and starting a new academic year also means we have to say goodbye to those board members who will step down at the Annual Meeting. Fortunately, I still have a year as Past President, and some others will also stay on the board in a new function.

On behalf of SMDM, I would like to express my thanks to all who step down in some capacity:

First to Marilyn Schapira, MD, MPH, our Past President, who has continued the implementation of the strategic plan, which started with Kathy McDonald, MM. She will remain as the lead in the collaborative effort with Health Technology Assessment international (HTAi) on joint papers related to the common ground between the two Societies.

Next to Ahmed Bayoumi, MD, MSc, our current Vice-President, who has helped build the SMDM fellowship program, and is leading the exciting curriculum development for core short courses.

And to Amber Barnato, MD, MPH, who as Trustee led SMDM to transition the Technology Assessment working group into a focus on policy, and who, together with John Wong, MD, reworked the Lusted Awards. Fortunately she will stay on board, as Vice-President Elect!

Also thanks to Seema Sonnad, PhD, who as Trustee built the Dinners with Experts program (and who, at the Spring Board meeting, invited the full Board to her home in Philadelphia for a great wine and cheese evening!).

And last, but not least, James Stahl, MD, MPH, our Membership Committee Chair, who steps down as Trustee, but will hopefully stay involved in a meaningful way. We had a number of positive, yet challenging developments regarding membership this year, e.g. the transition to a calendar year renewal, and we’ve already seen a steady increase in membership!

And of course those stepping down make place for new board members. I’d like to welcome our new officers and trustees. Please learn more about them in the feature below. I'd also like to extend special thanks to all those who ran for office. We had some very close calls, so please make sure you run again in the near future! It is not only very gratifying, but fun to be involved in service to the Society!

And now I wish to express a very special and warm thanks to Mark Helfand, MD, MPH. Although he will not be leaving as Editor in Chief of MDM until January 1st, this is the last column in which I get a chance to thank him. And not just in my role as President, but also as a former Associate Editor, author, reviewer, and reader. Mark has put tremendous time and effort in our Journal MDM, and it has been a great success under his editorship. And with Mark we also say goodbye to his editorial assistants, Lauren Saxton and Camber Hansen-Karr, who have for so long been the ‘face’ of MDM for authors and reviewers. We will miss all of you tremendously!

When I became President, being only the second non-North American president in the history of the Society, I hoped that our international presence would grow and that the Society would become more visible internationally. And indeed, it has. Not only did we have the largest European meeting ever (in Oslo - thanks Ivar and Peder!), we have an active International Engagement Committee, and two of our Trustees, Jeremy Goldhaber-Fiebert, PhD, and Anirban Basu, PhD, are looking at opportunities to organize a regional meeting in Southeast Asia at the end of 2013 or in early 2014!

Further, with much work from Bruce Schackman, PhD, and others in the Global Health working group, we now have a very successful scholarship program. We had many scholarship recipients from all over the world attending and presenting their work in Chicago, Toronto, and Oslo. Many will be in Phoenix, so make sure you welcome them! Our program was already too full for an International Delegates reception, but we are trying to do something with (the infamous) ribbons, to make it easier to speak to internationals. I hope to meet many, so please come and chat with me!

To hear about all other developments this past year I invite you to my Presidential Address. It will be early on Friday, the morning after the Social Event, but I hope this will not prevent you from attending!

This past year of my Presidency has been exciting and fruitful. I've appreciated the dedication and hard work not only of our wonderful Board and committees, but of all of you! Special thanks to the professionals at PMA, particularly Marie and Shawna, and most importantly, to Jill Metcalf, our Executive Director. She has made my life so easy this year, and it has been great fun working together. I will truly miss it. Thanks to all of you! Heel vèèl dank!

This was my last column as President, and I feel sad already. But for the rest, I am only looking forward to meeting all of you in Phoenix!



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Congratulations New Officers!

SMDM New Officers

Congratulations to our newly elected officers! We hope you will enjoy reading excerpts of their personal ballot statements and join us in welcoming them to their new roles within the Society. From left to right:

President-Elect Murray Krahn, MD, MSc, FRCPC
Professor of Medicine, F. Norman Hughes Chair in Pharmacoeconomics, Director of THETA (Toronto Health Economics and Technology Assessment Collaborative), University of Toronto, University Health Network, Toronto

The Society has been my intellectual home since 1990, when I attended my first meeting. I still remember the shock of that first meeting - it was like hearing your native language spoken while traveling abroad. The Society is where I learned to present scientific papers, and where I met the great and the good of decision analytic and outcomes research. I grew up academically in the Society, and am trying to pass this along. I send most of my students and employees to SMDM. They present 5-10 papers at most meetings, and have served as newsletter editors, interest group founders (infectious disease modeling, global health), board members, and as the first AHRQ-SMDM fellow. Three have won Lee Lusted Awards. I have served on the editorial board of MDM, as the chair of the Membership Committee, and on the board of SMDM. The University of Toronto, with our help and encouragement, founded the SMDM International Travel Scholarship, and fully funded its first year. With Ahmed Bayoumi, MD, MSc, I co-organized the 2010 SMDM annual meeting in Toronto.


Vice President–Elect Amber E. Barnato, MD, MPH, MS
Associate Professor of Medicine, Clinical and Translational Science, and Health Policy and Management, University of Pittsburgh

SMDM is my principal professional society, and over the last decade I've had the opportunity to serve in many roles. I am honored to continue to serve on the board and to expand my involvement in trainee and member education. I will continue the work of Ahmed Bayoumi, MD, MSc, in support of a "core curriculum" offering at the national meeting in addition to cultivating courses on new/emerging topics. I will serve as the liaison between the Education Committee and the Board. And I will continue my work with John Wong, MD, on the Lee Lusted Award. We have expanded the conferral of awards to four topic areas and streamlined the judging process. Our next task is to increase the value and salience of the Lusted process for trainees by modifying the presentation format to become a more active and engaging format, such as an exclusive Lusted moderated poster session.


Secretary-Treasurer Elect Bruce R. Schackman, PhD, MBA
Associate Professor of Public Health Chief, Division of Health Policy, Weill Cornell Medical College

For the past 14 years, SMDM has been my intellectual and professional home. My career has been nurtured and enriched by the friends and colleagues I have met through the Society, by participating in the annual meeting, and by publishing in and reviewing for Medical Decision Making. I am currently Chair of the Finance Committee, which provides the Board of Trustees with an external review of SMDM's investment portfolio and the annual budget. As Chair of the Global Health Working Group, I have led the successful effort to raise funds for travel scholarships to the North American and European meetings for promising scholars from middle-income and low-income countries, with 26 full or partial scholarships awarded in total in 2011-2012 for the Chicago and Oslo meetings. As Secretary-Treasurer, I will build on this experience and my financial training to work with the Board, the Development Committee, and the Executive Director to plan for the short-term and long-term financial health of the Society. Despite a challenging financial environment, I am confident that we will be able to work together to ensure that the Society's funds are spent wisely and efficiently while creating fundraising opportunities for targeted programs, such as the travel scholarships, that expand the Society's global reach and impact. I am honored to serve as Secretary-Treasurer.


 

Congratulations New Trustees!

SMDM New Trustees 2012

Three new trustees join the Society's Board of Directors! Congratulations! We hope you enjoy these excerpts from their ballot statements. From left to right:

Michael W. Kattan, MBA, PhD
Chairman, Department of Quantitative Health Sciences, Cleveland Clinic

I joined the Society in 1993 and have attended every meeting since. I moderated the Society's listserv from 1996 to 2003 and taught multiple short courses at the Annual Meeting. I was awarded the Eugene L. Saenger Award for Distinguished Service to SMDM, served as the Scientific Review Committee Chair for the 1997 Annual Meeting and presently serve on the SMDM Education Committee. I have also been an ad hoc student competition judge at the Annual Meeting. Along with Mark Cowen, I recently edited the Encyclopedia for Medical Decision Making. I find it a privilege to serve the Society as a trustee. SMDM is my professional home and has been for nearly two decades. I thoroughly enjoy the intersection of methods and application that characterizes our Society so well. We are passionate about what we do and how we can make an impact in health care. As a trustee, I will do my best to serve the needs of the Society.


Mary C. Politi, PhD
Assistant Professor, Division of Public Health Sciences, Department of Surgery, Washington University in St. Louis School of Medicine

SMDM has become a major part of my academic identity. SMDM provides an intellectual home that spans diverse disease categories and disciplinary specialties. We are truly a transdisciplinary group of members devoted to a shared mission-improving health outcomes through systematic approaches to clinical decision making and health policy-formation. As Trustee, I will continue to seek out collaborations with relevant groups such as SBM, SJDM, INFORMS, and Academy Health to expand our reach and impact as a society. I will also continue to work on our training and career development activities to help members benefit most from their affiliation with the Society and form connections with more senior collaborators who understand both the joys and challenges of transdisciplinary work. Finally, I will encourage us to offer diverse presentations at the annual meeting that not only report the latest research findings, but also identify how best to translate these findings to practice so our science has clinical and population impact. I am honored to continue to serve the Society.


Beate Sander, RN, MBA, MEcDev, PhD
Scientist and Assistant Professor, Public Health Ontario Institute of Health Policy, Management and Evaluation, University of Toronto

Many of you may know me from many years of attending the North American SMDM meetings; first as research assistant, then (for most years) as a PhD student and finally as scientist. However, my very first SMDM experience was the 2002 European meeting in Sicily. Attending (and nervously presenting at) this meeting had a tremendous impact on my professional life. Right from the start, I was impressed not only by the exceptionally high academic standards, but also by the friendliness and inclusiveness of the group. I was inspired to pursue an academic career, which was facilitated by highly supportive SMDM members I met in Sicily. Within a year I had relocated from Germany (where I worked as an consultant) to Toronto to embark on what would become an academic career. I ran for trustee because I have a genuine interest in the future of SMDM. I am particularly interested in supporting the professional development of the next generation of researchers and to increase international participation and visibility while maintaining and strengthening the society's strong core values. I have served the society in several roles over the years, including newsletter editor, infectious disease modeling interest group leader, and, most recently, as interest group chair and career development chair. Serving in these roles has been and is an honor. I am thrilled to serve the society as a trustee and be part of shaping the future of SMDM on behalf of its terrific members.
 


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Education Committee

by Ahmed Bayoumi, MD, MSc, Education Committee Co-Chair
Ahmed Bayoumi, Education Committe Co-Chair

Junior and Mid-level Faculty Awards to Present at AHRQ Research Seminar Series


Are you an SMDM member?
 
Is your research relevant to health care policy?
 
If so, here is an exciting opportunity to present your work to research staff at the Agency for Healthcare Research and Quality (AHRQ) located in Rockville, MD. Your presentation should specifically identify the research usefulness to AHRQ’s mission to improve the quality, safety, efficiency, and effectiveness of health care and to help people make more informed decisions and improve the quality of health care services.
 
If you are interested in presenting your research at AHRQ, please email Negin Hajizadeh, MD, at Negin.Hajizadeh@nyumc.org with your topic of research.
 
Junior and mid-level faculty SMDM members interested in giving a lecture have the opportunity to get their travel and one night of lodging supported through the “SMDM-AHRQ speaker award." Email Negin.Hajizadeh@nyumc.org for more information.

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Awards Committee

by John Wong, MD, Awards Committee Co-Chair

John Wong

Lee Lusted Prize Competition

As you read in the Spring Newsletter, the Lee Lusted Student Prize Competition has changed. The Awards Committee has decided to split Applied Health Economics, Services and Policy Research into two categories and to remove the meeting theme, thereby emphasizing and promoting one of the strongest areas of multidisciplinary scholarship within our society, and as a consequence, we will select a Lusted Award in 4 categories: Quantitative Methods and Theoretical Developments; Decision Psychology and Shared Decision Making; Applied Health Economics; and Health Services and Policy Research. On behalf of the Society, we congratulate all Lusted nominees and applaud their efforts. Out of 96 nominated abstracts for the Lusted Award, 60 have moved on to be considered as finalists for the awards in each of the four categories. Separate judges for each category will evaluate the abstracts on several review criteria, including significance, innovation, scientific quality, relevance, and presentation. Awards of $600 each will be given to the top scoring finalists in each of the four categories on the final day of the Annual Meeting. Amber Barnato, MD, MPH, MS, FACPM, and I continue as co-chair stewards for the Lusted Award Committee whose nominees constitute the future lifeblood of our organization. As you have in the past, do continue to engage and enrich the educational experience for all our student attendees.

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Career Development

by Natasha Stout, PhD, Career Development Liaison

Natasha Stout

Opportunities at the Annual Meeting

One-to-One Mentoring Program
One-to-One Mentoring is a great opportunity for students, trainees, junior faculty, and other newer members of SMDM to meet individually and informally with long-standing members of the Society. Check the SMDM website at http://www.smdm.org/mcd.shtml for information about participating and to view a list of the SMDM mentors who have volunteered for the One-to-One sessions. The purpose of the program is to provide mentoring about career trajectory and research topics and to establish new networks of colleagues. Other potential discussion topics could include navigating the Annual Meeting and discussion about presented research, perceived strengths and weaknesses in your work, or advice on improvement.

CVs and Job Announcement Book
The Annual Meeting’s CV/Job book will be available for prospective job seekers and employers at the meeting registration desk. For those on the job market or those looking to hire, be sure to pick up a copy. It's a great resource to schedule informational and formal interview sessions during the conference.

Dinners with Experts
Continue your career development over dinner!  This year we invite you attend informal group dinners hosted by senior members of the Society. Many of the dinners will be topical to career development issues. Dining opportunities are planned for Wednesday October 17th and Friday October 19th. All meeting attendees are invited to sign up. The dinners are self-pay. Be on the lookout for dinner options and sign-up information at the registration desk.

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MDM Sept/Oct Issue: Modeling Good Research Practices and More

by Mark Helfand, MD, Editor, Medical Decision Making

Mark HelfandThe history of decision and economic modeling to support health policy is riddled with missed opportunities and political grandstanding as well as legitimate concerns about transparency and conflict of interest. An international panel released comprehensive guidance for designing, implementing, and validating model-based studies to inform health care decision making. The guidelines were developed by leading experts in decision analysis, economics, simulation, and health policy appointed jointly by the Society for Medical Decision Making and the International Society for Pharmacoeconomics and Outcomes Research. One of the articles, by David Eddy and others on behalf of the Task Force, offers the first comprehensive guidance for transparency in reporting and validating models. As noted in an editorial by investigators at several leading cancer centers, the recommendations “provide modelers with guidance on building more useful models and consumers with benchmarks to judge the quality of the models.”

The articles and related editorials are available here from the journal Medical Decision Making. For reference, here are links to the articles:

Modeling Good Research Practices--Overview: A Report of the ISPOR-SMDM Modeling Good Research Practices Task Force-1. J. Jaime Caro, Andrew H. Briggs, Uwe Siebert, and Karen M. Kuntz Med Decis Making 2012;32 667-677 http://mdm.sagepub.com/cgi/content/abstract/32/5/667?etoc

Conceptualizing a Model: A Report of the ISPOR-SMDM Modeling Good Research Practices Task Force-2. Mark Roberts, Louise B. Russell, A. David Paltiel, Michael Chambers, Phil McEwan, and Murray Krahn Med Decis Making 2012;32 678-689 http://mdm.sagepub.com/cgi/content/abstract/32/5/678?etoc

State-Transition Modeling: A Report of the ISPOR-SMDM Modeling Good Research Practices Task Force-3. Uwe Siebert, Oguzhan Alagoz, Ahmed M. Bayoumi, Beate Jahn, Douglas K. Owens, David J. Cohen, and Karen M. Kuntz Med Decis Making 2012;32 690-700 http://mdm.sagepub.com/cgi/content/abstract/32/5/690?etoc

Modeling Using Discrete Event Simulation: A Report of the ISPOR-SMDM Modeling Good Research Practices Task Force-4. Jonathan Karnon, James Stahl, Alan Brennan, J. Jaime Caro, Javier Mar, and Jorgen Moller Med Decis Making 2012;32 701-711 http://mdm.sagepub.com/cgi/content/abstract/32/5/701?etoc

Dynamic Transmission Modeling: A Report of the ISPOR-SMDM Modeling Good Research Practices Task Force Working Group-5. Richard Pitman, David Fisman, Gregory S. Zaric, Maarten Postma, Mirjam Kretzschmar, John Edmunds, and Marc Brisson Med Decis Making 2012;32 712-721 http://mdm.sagepub.com/cgi/content/abstract/32/5/712?etoc


Please be sure to check it out here.


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2012 North American Meeting


2012 North American Meeting

October 17-20 in Phoenix, AZ

With the 2012 North American Meeting just a few days away, anticipation is running high! From October 17-20, attendees will have the opportunity to interact with international leaders in Health Information Technology and be exposed to the latest research methods and medical decision making. And, as always, the networking opportunities will be unparallelled. Many have described the meeting as the premiere event in the field, so if there is any chance of you being there, we encourage you to take advantage of this opportunity. It's a decision you won't regret.

Agenda
CoChairs, Scott Braithwaite, MD, MS, FACP, and Liana Fraenkel, MD, MPH, have put together an outstanding program. You can check the agenda at a glance here.

Keynote
New York State Commissioner of Health, Nirav R. Shah, MD, MPH, will be featured as the keynote speaker with his presentation Building a Healthcare Ecosystem. Shah sees the current healthcare delivery "system" largely existing as a series of distinct niches. Yet there is a convergence of forces that promote organization around outcomes and value, radically transforming our approach to health and wellness. This ecosystem will ensure the smooth operation, resiliency, and survival of a healthcare system that is patient-centered, cost effective, and integrates data and evidence into practice.

SMDM Committees, Working Groups and Interest Groups
Many of the SMDM Committees, Working Groups and Interest Groups will meet during breakfast or lunch at the annual meeting and invite all attendees to join them. Click here for a schedule of these meetings.

Travel
Phoenix is a wonderful backdrop for this conference. Be sure to bring some walking shoes and take advantage of this beautiful area. Last minute travel and hotel information can be found here.

Safe travels to everyone. We look forward to seeing you all there.



2012 Annual Meeting Planning Committee

Meeting Co-Chairs: Scott Braithwaite, MD, MS, FACP, and Liana Fraenkel, MD, MPH
Scientific Review Committee Co-Chairs: Mary Politi, PhD, Eran Bendavid, MD, MS, and Paul K. Han, MD, MA, MPH
Short Course Co-Chairs: Katia Noyes, PhD, MPH, Claire Wang, MD, ScD, and Stacey Sheridan, MD, MPH
Awards Committee Chair: M.G. Myriam Hunink, MD, PhD
Lee Lusted Awards Co-Chairs: John Wong, MD, and Amber E. Barnato, MD, MPH, MS, FACPM
Career Development Chair: Natasha Stout, PhD, and Beate Sander, PhD
Dinners with Experts Co-Chairs: Ava John-Baptiste, MHSc, PhD, and Beate Sanders, PhD
Mentoring Co-Chairs: Ava John-Baptiste, MHSc, PhD, and Amy Tawfik, HBSc, PhD Candidate
CV/Job Book Co-Chairs: Djora Soeteman, PhD, and Jesse Ortendahl, MS

For additional details on the meeting, click here.


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Decision Analysis and
the Decision Analysis Society:

An Introduction and Invitation for the Medical Decision Making Community

by Jeffrey Keisler, PhD, Department of Management Science & Information Systems, University of Massachusetts Boston, and President-Elect, INFORMS Decision Analysis Society
Jeffrey Keisler


Introduction

The Decision Analysis Society (DAS) of the Institute for Operations Research and Management Science (INFORMS) supports and promotes the interests of scholars, practitioners and students of decision analysis. It provides venues for its 1000+ members to discuss developments and applications in the field, advance the field, and manage their own careers.

This article introduces the SMDM community to DAS to enrich the dialogue between our communities. This year, DAS and SMDM are having joint sessions on October 17, the last day of the INFORMS annual meeting and the first day of the SMDM annual meeting in Phoenix.

Decision Analysis
 

MDM aligned with DAS

Many medical decision making applications use decision analysis (DA) methodology (such as decision trees), where treatment alternatives are identified, probabilities are assessed for outcomes, and the relative values of outcomes are found. Important work consists of developing this kind of decision analysis model for specific medical conditions and diseases. Other applications involve the use of value of information in order to prioritize costly diagnostic tests.

DAS features theoretical and applied work that may be of interest to SMDM. This work includes methods for structuring alternatives, for assessing probabilities, for representing probability distributions, for calculating solutions to large models, and for assessing preferences for outcomes. DAS also focuses on many non-medical applications of decision analysis, ranging from business strategy and research and development management to environmental policy.


MDM on the cutting edge of DA

The difficulty of valuing medical outcomes gave rise to the construct of quality adjusted life years (QALYs). While QALYs are almost always used in medical or health applications, the construct is well-known within DAS, and provides an important link for members of the DAS community to dabble in MDM. Additionally, MDM problems often require careful consideration of how outcomes with trajectories that span many years should be valued. DAS members have experience with this type of modeling.

Large scale Bayesian inference models used for medical diagnosis motivate the development of such models in the field of DA and draw on the work of computer-science and analytics-based members of DAS. Markov models are used commonly in the modeling of medical decisions as the patient’s health state is tracked over time. These models are able to efficiently represent and analyze much more detailed dynamic options for simulating a disease process.

Health policy decision analysis often incorporates population models and may require consideration of societal values such as equity. Again, this fits well with the rest of DA.


What else will you find at DAS?

DAS members conduct research in multi-attribute utility theory that is of interest for government and societal applications, while work involving utility functions that capture attitudes toward risk is of importance in financial investment. DA methods allow for efficient elicitation of expert knowledge and flexible representations for purposes of computation. Influence diagrams are especially useful tools for decision problems where multiple experts and stakeholders must identify key uncertainties and provide judgments about them.

Because many DA applications occur in organizations, DAS members give thought to complications that may arise and processes that mitigate them. For example, graphical representations of decision model inputs and outputs aid in communicating results and insights to stakeholders. Many real-world applications emphasize the role of DA in facilitating dialogue en route to the final decision, a process that contributes to decision quality. Other DA tools and methods such as strategy tables and value-focused thinking help to generate alternatives and aggregate ideas from varied sources in development of strategies.

In business, a wide range of companies use decision analysis, and certain industries – especially energy and pharmaceuticals – have very well-developed DA programs. Some DA applications involve many decisions that must be joined together. For example, a business strategy coordinates numerous decisions about product, marketing, production, and finance. Many in DAS study the psychology of decision making and conduct behavioral research that informs decision analytic practice.

The reader is encouraged to visit our website to learn more, http://www.informs.org/Community/DAS




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Commentary


Decision Analysis and Newborn Screening Decisions in the United States

by Scott Grosse, PhD, National Center on Birth Defects and Developmental Disabilities and Lisa Prosser, PhD, University of Michigan Health System

Scott Grosse and Lisa ProsserIn the United States, decisions about which disorders to include in public health newborn screening testing panels are made by state governments, but federal recommendations carry a great deal of weight. In 2003, the US Congress chartered the Secretary’s Advisory Committee on Heritable Disorders in Newborns and Children (SACHDNC) to make screening recommendations (http://www.hrsa.gov/advisorycommittees/mchbadvisory/heritabledisorders/about/index.html). The Secretary of Health and Human Services decides which of those recommendations to endorse, adding them to the Recommended Uniform Screening Panel.

The process begins with a nomination of a disorder, which is then considered by a SACHDNC subcommittee to assess the availability of evidence of an accurate screening test, feasibility of its use in a population setting, and evidence of improved outcomes with early detection. If the subcommittee and full committee approve, the condition is forwarded to an external Condition Review Workgroup, supported by the Health Resources and Services Administration, to conduct a systematic evidence review of screening criteria. Although evidence of cost-effectiveness is not a required criterion, economic evaluations are considered in the review process. The Workgroup presents the evidence summary to the full SACHDNC, which votes on whether a condition should be recommended. Since establishment of the Recommended Uniform Screening Panel in 2005, two disorders have gone through the process and been added to the panel after endorsement by the Secretary of Health and Human Services: severe combined immune deficiency and critical congenital heart disease.

Members of the Society for Medical Decision Making (SMDM) have been actively involved in this process. Lisa Prosser of the University of Michigan is a member of the Condition Review Workgroup, and Scott Grosse of the Centers for Disease Control and Prevention (CDC) is a consultant to the Workgroup. Dr. Prosser, Dr. Grosse, and other members of the Workgroup authored a newly published article in the journal Genetics in Medicine that discusses the value of using decision analysis and cost-effectiveness modeling to inform policy decisions on newborn screening (doi: 10.1038/gim.2012.24).

Modeling is essential when weighing evidence from different empirical studies and integrating evidence (and uncertainty) across multiple endpoints. SACHDNC has approved the use of modeling of health outcomes by the Condition Review Workgroup to supplement systematic evidence reviews, and this technique was used by Dr. Prosser in a recently completed review of a nominated condition. Dr. Prosser is Principal Investigator on a recently funded project from the Agency for Healthcare Research and Quality to evaluate health and economic outcomes for three metabolic disorders. One of those disorders, Pompe disease, is currently being considered by the Workgroup at the request of the SACHDNC.

A federal decision to recommend screening for a given disorder is not the end of the policy decision making process. The cost of screening and the balance between costs and health gains are of concern to certain jurisdictions and stakeholders that need to decide whether and how to implement screening. For both severe combined immune deficiency and critical congenital heart disease, formal economic evaluations that incorporate data from pilot screening programs are underway. The Secretary of Health and Human Services specifically charged CDC with undertaking cost and cost-effectiveness analyses of newborn screening using pulse oximetry for critical congenital heart disease; Dr. Grosse is providing technical guidance for those analyses.

In summary, the future of modeling to inform newborn screening decisions in the United States by providing policy makers with projected population outcomes and cost-effectiveness evidence appears bright, and SMDM is at the forefront.

 

The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention or the Department of Health and Human Services.

 

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Shared Decision Making:
Opportunities to Implement Comparative Effectiveness Research in Clinical Practice

by Mary Politi, PhD, Washington University in St. Louis

Mary PolitiFor decades, SMDM members have been involved in innovative research on shared decision making (SDM). This research has investigated ways to help patients and clinicians discuss health decisions and combine evidence with patients’ preferences and values. In addition, members have developed and used rigorous methods for conducting comparative effectiveness research (CER), which compares the benefits and risks of different interventions in real world settings with outcomes that matter to patients and other stakeholders. The goals of both SDM and CER are to answer practical questions about benefits and risks of interventions for specific patients in specific contexts and, ultimately, to improve the quality of health care delivery.

On March 13-14, 2012, several SMDM members (including Marla Clayman, Jamie Studts, Victor Montori, Angie Fagerlin, Steve Kymes and me) hosted a conference at Washington University titled “Shared Decision Making: Opportunities to Implement Comparative Effectiveness Research in Clinical Practice.” The goal of the meeting was to bring together CER and SDM investigators to collaborate on ways to conduct and disseminate research about the implementation of CER through SDM. The symposium featured two keynote speakers: Dr. Michael Lauer, Director, Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute and Dr. France Légaré, Professor, Department of Family Medicine, Université Laval and Canada Research Chair, Implementation of Shared Decision Making in Primary Care. There were four scientific abstract sessions (Development and Evaluation of SDM Processes and Tools, Implementation and Impact of SDM Tools, SDM and Unique Populations, and SDM for Translating CER into Practice: Mayo Clinic Example), one-one-one mentoring opportunities for trainees, break-out discussions sessions continuing the idea exchange, and a poster session highlighting research in these areas.

Meeting attendees agreed that SDM and CER have very similar goals, but differ in their approach to improve healthcare delivery. The goal of CER is to conduct research by comparing interventions for specific patients under specific conditions, while the goal of SDM is to communicate the evidence and any uncertainty that accompanies that evidence in order to help facilitate decision making. There are similar challenges when implementing both CER and SDM in practice, including the public’s misconception about goals of each, institutional and cultural norms that might create barriers to implementing CER and SDM, and the need for additional time and resources for clinicians to learn CER and SDM skills. Several solutions to overcoming these challenges were proposed, and Mayo Clinic investigators presented examples of successful implementation of CER and SDM in specialty clinics, hospitals, the emergency department, and primary care practices in rural, suburban, and urban settings. Each of the presentations (including pdfs of the presentations and video recordings) can be found on our website (http://cer.wustl.edu/index.php/training-resources/symposiums/2012-symposium). We are currently drafting a manuscript summarizing the rich discussion that took place during the two-day meeting. Meeting attendees also suggested several areas for future research and discussion that could take place at the International Shared Decision Making (ISDM) meeting next spring (http//isdm2013.org).

Acknowledgements: The conference was primarily supported by the Agency for Health Care Research and Quality (1R13 HS020933-01), and was co-supported by the National Cancer Institute of the National Institutes of Health (1KM1CA156708-01), Washington University School of Medicine in St. Louis, Barnes-Jewish Hospital Foundation, and the Clinical and Translational Science Award program of the National Center for Research Resources at the National Institutes of Health (UL1 RR024992, KL2 RR024994, TL1 RR024995).


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Shared Decision Making and Decision Aids: The Importance of Cultural Tailoring

by Dana L. Alden, PhD, William R. Johnson Jr. Distinguished Professor, University of Hawai‘i and John Friend, PhD Candidate, University of Hawai‘i

Dane AldenBefore meeting with her oncologist to discuss alternative treatments for second stage breast cancer, Carmen G., a 46 year old Hispanic American woman who lives in Los Angeles, reviews a decision aid in her physician’s clinic. Already feeling anxious, Carmen reads through the evidence-based options to the next section that asks her to consider her value and lifestyle preferences as she responds to several measurement scales.  At the end of the values/lifestyles section, she feels more anxious than when she started.  She wonders why the decision aid didn’t ask about her family.  She worries about how her choice might affect them. It’s not just about me she thinks. She closes the decision aid and waits to meet with her oncologist.

A recent Cochrane Review (2011) involving 86 randomized controlled trials of patient decision aids (DAs) identified numerous usage benefits such as greater patient participation in decision making and more frequent choice of options that matched patient values. Despite significant progress, limited research is available on tailoring DAs in ways that optimize the congruency of their information content with patients’ cultural values and lifestyle preferences. This is the case despite the fact that ethnic minorities in the US and Canada are among the fastest growing segments in those countries. Furthermore, if DAs are to successfully diffuse into non-Western cultures outside North America and Europe, consideration of cross-cultural differences will become increasingly important. 

Research demonstrates that culturally tailored information tends to feel better and make more sense. On the other hand, information that is incongruent with cultural mindsets may feel wrong and may hinder processing effectiveness. As a result, theory and related empirical evidence suggest that more positive outcomes will result when the patient’s cultural mindset matches the nature and framing of information in the decision aid.

One cultural dimension that has attracted a great deal of attention because of its potential importance to improving cross-cultural communication effectiveness is individualism-collectivism. Individualist cultures place relatively more value on independence, personal freedom and standing-out. Collectivist cultures place relatively more value on interdependence, group goals and standing-in. Exposure to these varying cultural orientations may significantly impact patient responses to health information.

For example, cross-cultural researchers have found that gain versus loss framed health-related information may differentially impact people whose independent versus interdependent mindsets are relatively more accessible. However, most studies of health communication and culture have taken place within a persuasion rather than a decision making context. Thus, there is much work to do and numerous opportunities for important contributions to shared decision making theory and practice. 

Within the medical decision making context, cultural congruency may be enhanced through tailoring sections of the DA that ask patients to consider their values and lifestyles relative to screening and treatment alternatives. In many DAs, such statements focus on self-related preferences, e.g., “I want to have a test that is going to see as much as possible even if that involves putting a scope into my colon” versus “I feel very uncomfortable about a test that involves putting a scope into my colon.” However, for cultures that emphasize family and in-group harmony, decision aids that include consideration of collective benefits and consequences may prove to be more effective.

Although identification of culturally tailored DA processes and effects is a relatively new area of scientific inquiry, researchers have found that messages stressing interdependence and racial pride can enhance compliance with early screening and treatment options among ethnic groups in the US. For example, cancer communications culturally adapted on constructs such as religiosity, collectivism, racial pride, and time orientation, were more effective for African American women. Such studies speak to the potential benefits of culturally tailoring decision aids in order to increase accessibility to more familiar cognitive strategies, improve processing fluency, reduce anxiety, and increase patient confidence regarding shared decision making with health care providers.

Our research team is currently using experimental methods with cross-cultural samples to test cultural tailoring approaches that theory and investigations in related fields suggest should enhance decision aid effects on relevant outcomes. We welcome discussion with others who are interested in joint research on this important topic. Please feel free to contact us at:  dalden@hawaii.edu

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Other News

 

Critical Decisions Now Available for Your Reading and Even Teaching!


Critical DecisionsI’m really excited about my new book, Critical Decisions: How You and Your Doctor Can Make Better Medical Choices Together. The book is not an academic tome, but instead is written for an intelligent lay audience. In Critical Decisions, I tell the history of the shared decision making revolution that has taken place in medical care over the last few decades, and show the challenges of achieving true partnership between patients and their physicians when it is time to make important decisions. The book is a mixture of science — primarily the science of decision psychology and physician/patient communication — and stories that illustrate the aforementioned sciences. It will definitely be a great way to introduce your students to some of the controversies surrounding shared decision making. 

I just convinced my publisher, HarperCollins, to make my new book available to SMDM members free of charge if they are considering using it in their teaching — as in, assigning the book to their students. If you don’t teach, then I suggest you just get a copy for yourself. I’ve spent lots of weekends and 5 a.m. shifts working on this book, a real labor of love, and now I’m eager for people to read it. I promise you that even if you’re an expert in the field, this book will change your way of thinking. 

I think the book will be of greatest relevance for courses that cover topics such as: Shared decision making; Bioethics; Health law — especially informed consent; Decision psychology in medical settings; and Professionalism and doctor/patient communication.

I have already begun using Critical Decisions in my undergraduate courses. My students like the stories, or at least they tell me that, and enjoy the fact that the writing is more accessible than most academic articles I assign them. I’m also planning to use this book with medical students. Critical Decisions is a great complement to those drier readings students are exposed to when learning about the doctor/patient relationship. 

If you are thinking of using this book in a course, you can request a copy from my publisher by going to this link: http://harperacademic.blogspot.com/

And if you know of colleagues who might have interest in the book for their teaching, feel free to let them know. The book industry is struggling, which is a shame because not every important idea can be communicated in 2,000 word journal articles, much less (much, much less) in 140 character tweets!

Which reminds me: you can learn more about Critical Decisions on my blog (www.peterubel.com) or - irony alert! - by following me on Twitter: @peterubel, Peter Ubel, Duke University



 

Member News


Arthur Attema, PhD, Han Bleichrodt, PhD, and Peter P. Wakker, PhD, from Erasmus University Rotterdam have published a new paper: A direct method for measuring discounting and QALYs more easily and reliably. Medical Decision Making 32 (4), pp. 583-593.  attema@bmg.eur.nl


A new book on Bayesian methods in health economics by Gianluca Baio, PhD, University College London, Department of Statistical Science, is to be published by CRC Press. The book discusses the Bayesian approach applied to cost-effectiveness analysis and explains the application of this method to practical health economic evaluations. Examples are presented and discussed using specific software that allow to link R to standard Bayesian programmes (such as WinBUGS or JAGS) and standardize the post-processing of the modelling output.  gianluca@stats.ucl.ac.uk


Anirban Basu, PhD, is directing a new program at the University of Washington, Seattle, entitled Program in Health Economics and Outcomes Methodology (PHEnOM).  He has also recently published Estimating Person-Centered Treatment (PeT) effects using instrumental variables. 2012 National Bureau of Economic Research Working Paper No w18056.  Basua@uw.edu


Jagpreet Chhatwal, PhD, Assistant Professor of Health Policy & Management at the University of Pittsburgh, was recently awarded the National Institute of Health KL2 Career Development Award. Under this multidisciplinary award, Dr. Chhatwal will develop computational models to evaluate optimal treatment and screening strategies for hepatitis C in the era of direct-acting antivirals.  chhatwal@pitt.edu


SMDM Association Manager, Marie Cortsen, welcomed baby Nathan on September 25th weighing in at 7lbs, 11 oz. Mother and baby are doing well. Congratulations Marie!  marie@smdm.org


Charles Ezenduka, B.Pharm, MBA, MSc, PGD, Dept. of Clinical Pharmacy & Pharmacy Mgt, Nnamdi Azikiwe University, Awka Nigeria, published 2 articles this September: "Estimating the Costs of Psychiatric Hospital Services at a Public Health Facility in Nigeria" and "The Cost-Effectiveness Analysis of Leprosy Case Detection Methods in Northern Nigeria." He was also awarded an SMDM Travel Scholarship for the 34th Annual Meeting in Phoenix, Arizona.  ccezenduka@yahoo.co.uk


Krishnaj Gourab, MD, from the Oakland University William Beaumont School of Medicine in Royal Oak MI, was invited to the 2012 Stanford Medicine X conference to present a demo interactive session on his project titled "Automated Presentation of Medical Knowledge Objects from a Peer Generated Database During Clinical Encounter Documentation." This project introduces the concept of clinical association units as discreet clinical factoids, where each factoid indicates a distinct direction that the present clinical situation may evolve into. Subsequently, it explores if automated presentation of relevant clinical association units to physicians assessing a clinical situation could prompt a more comprehensive evaluation of the situation. This concept will find use as a cognitive training tool for physicians during simulated clinical encounters. gourab1@gmail.com


Yew Kong Lee, BA, was also awarded an International Travel Scholarship to attend the SMDM Meeting in Phoenix, Arizona. He is project coordinator for the 3-year Decision Making in Insulin Therapy (DMIT) Project at the Department of Primary Care Medicine, University of Malaya, Malaysia. This project is part of a cluster of patient decision aids being developed by the University of Malaya for insulin initiation, early stage breast cancer treatment and spinal cord injury.  leeyk@um.edu.my


A systematic review comparing the nutritional benefits and harms of organic and conventional foods published in Annals of Internal Medicine and conducted by SMDM members Crystal Smith-Spangler, MD, MS, Dena Bravata, MD, MS, and Margaret Brandeau, PhD, has been featured in numerous media outlets, including New York Times, CNN, NBC, ABC, National Public Radio, among others.  csmithsp@stanford.edu


In Nijmegen, the Netherlands, Peep F.M. Stalmeier, PhD, and Julia J. van Tol-Geerdink, PhD, performed a clinical trial with a newly developed decision aid for men with prostate cancer. The study showed that, compared to usual care, the decision aid left fewer patients undecided and more men choosing brachytherapy. They were pleased to note that the results, recently published in the British Journal of Urology International, aroused the interest of journalists of Reuters and that it was discussed on their Health news site.  j.vantol@rther.umcn.nl
 


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Lifetime Contributors

The Society for Medical Decision Making extends its heartfelt appreciation to the following members for their charitable contributions over the years. *

Pareto Level
(Contributions total $1,000 or more)
Michael Barry (’06, ’07, ’08, ’09, ’10)
Dennis Fryback (’05, ’06, ’07, ’08, ’09, ’10, ’11, ’12)
Mark Helfand (’05, ’07, ’10, ’11)
Joseph King (’06, ’07, ’08, ’09, ’10, ’11)
William Lawrence (’06, ’10, ’11)
Uwe Siebert ('11)
Frank Sonnenberg (’06, ’09)
Hal Sox (’10, ’11)
Sankey Williams (’06, ’07, ’08)
John Wong (’06, ’07, ’08, ’09, ’10, ’11, ’12)

Edwards Level
(Contributions total $750 - $999)
David Meltzer (’07, ’09)
Stephen Pauker (’06, ’09)
David Rovner & Margaret Holmes-Rovner (’05, ’06, ’07, ’08, ’09, ’11)
Marilyn Schapira (’07, ’08, ’09, ’10, ’11)
Joel Tsevat (’06, ’09, ’10)

Tversky Level
(Contributions total $500 - $749)
Robert Beck (’07)
Scott Cantor & Lisa Stone (’07, ’08, ’09, ’10, ’11)
Kate Christensen (’09)
Nananda Col (’05, ’06, ’07, ’08, ’09)
Neal Dawson (’05, ’06, ’07, ’08, ’09, ’10, ’11, ’12)
Kathryn McDonald (’07, ’09, ’10)
Jill Metcalf (’07, ’08, ’09, ’10, ’11, ’12)
David Paltiel (’07, ’09)
Mark Roberts (’08, ’09)
Bruce Schackman (’06, ’07, ’08, ’09, ’10, ’11)

von Neumann-Morgenstern Level
(Contributions total $250 - $499)
Ahmed Bayoumi (’06, ’09, ’10, ’11, ’12)
Dena Bravata (’06, ’09, ’10, ’11)
Randall Cebul (’06, ’08, ’10)
Mark Eckman (’06, ’09)
Arthur Elstein (’06, ’07, ’09, ’10)
Sara Knight (’05, ’06, ’07, ’08, ’09, ’10, ’11)
Karen Kuntz (’09, ’11)
Steven Kymes (’05, ’06, ’07, ’08, ’09)
Seema Sonnad (’06, ’07, ’09)
James Stahl (’06, ’09, ’10, ’12)
David Sugano (’07, ’09, ’10, ’11)

Markov Level
(Contributions total $100 - $249)
Amber Barnato (’05, ’07, ’08, ’11, ’12)
Cathy Bradley (’07)
Scott Braithwaite (’09)
Phaedra Corso (’06, ’07, ’08)
Elena Elkin (’07)
Alan Garber (’10)
Heather Taffet Gold (’08, ’11)
Peder Halvorsen ('11, ’12)
Robert Hamm (’06, ’08)
Myriam Hunink (’05, ’06, ’07, ’08, ’09, ’10, ’11)
Esther Kaufmann ('11)
Miriam Kuppermann (’06, ’07, ’08, ’09, ’10, ’12)
Lisa Maillart (’10)
Richard Orr (’05, ’06)
Brian Rittenhouse (’07)
Allison Rosen (’07)
Alan Schwartz (’07, ’10)
Joanne Sutherland (’08, ’09)
Thomas Tape (’10, ’11)
John Thornbury (’05)
George Torrance (’05)
Jef Van den Ende (’10)
Robert Wigton (’10, ’11)
Brian Zikmund-Fisher (’08, ’09, ’10, ’11, ’12)

Bayes Level
(Contributions total up to $100)
Hilary Bekker (’12)
Eran Bendavid (’11)
Denise Bijlenga (’08)
Kimberly Blake (’09)
Rowland Chang (’06, ’07)
Carmel Crock (’09)
James Dolan (’09)
Arna Dresser (’10)
Ted Ganiats (’05)
Lee Green (’07, ’09)
Amit Gupta (’06)
Michael Hagen (’10)
David Howard (’09)
David Katz (’08)
Job Kievit (’09)
Kerry Kilbridge (’05, ’07, ’08)
Sun-Young Kim (’07, ’08, ’09)
Ivar Sonbo Kristiansen (’10)
Joseph Ladapo (’12)
Andrew Scott LaJoie (’10)
Andreas Maetzel (’09)
Daniel Masica (’08)
Evan Myers (’12)
Thomas B. Newman (’10)
Jesse D. Ortendahl ('11)
Jane Pai ('10)
George Papadopoulos (’08)
Lisa Prosser (’08)
Michael Rothberg (’09, ’10, ’11, ’12)
Gillian Sanders (’07)
Jha Saurabh (’09)
Ewout Steyerberg (’06, ’09, ’11)
Anne Stiggelbout (’06)
Carol Stockman (’05)
Danielle Timmermans (’07)
Hugues Vaillancourt (’11)
Milton Weinstein (’09, ’11)
Robert Werner (’08)

*Donations received Oct. 2005 – September 20, 2012

Bold indicates a new donor or a donor who has advanced their level of recognition in 2012.



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Copyright © 2012 Society For Medical Decision Making, All rights reserved.