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Better Health through Better Decisions
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PULSE ON U.S. POLICY:

Joshua A. Hemmerich, PhD, Editor-in-chief,
The University of Chicago
jhemmeri@medicine.bsd.uchicago.edu

Dana Alden, PhD, Deputy Newsletter Editor, University of Hawaii at Manoa, dalden@hawaii.edu

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From the President

by Ahmed Bayoumi, MD, MSc, University of Toronto

It may be 2015 but, as befits a forward-looking society, let’s think about SMDM in 2016. Among the many firsts that the Society will experience that year, 2016 is the first year  we will hold three meetings and each is outside of the United States. The 38th Annual North American meeting will be held in Vancouver, Canada from October 22 to 26, 2016, the 2nd Biennial Asia-Pacific Conference will be held in Hong Kong from January 8 to January 10, and the 16th Biennial European Meeting will be held London, UK from June 12 to 14. That is a lot of activity for a society of our size and speaks to our growth and international reach. We should all be pleased.

This is also a good time for me to remind you about our upcoming meeting in St. Louis from October 18 - October 21, 2015. The theme of Implementation is highly relevant to our membership. I hope to see as many of you there as possible.

But, back to 2016 and our international presence. Murray Krahn, our immediate past president, elaborated on our international character in the Fall 2014 Newsletter and in his presidential address. He pointed out that 35% of our members are from outside the U.S. and 29% from outside of North America. We have partnerships with agencies interested in Health Technology Assessment to support research fellows in Canada, Australia, Germany, and most recently, Singapore. We have offered international scholarships for people to attend our meetings from around the world. We have a new board structure that ensures a non-North American member is represented. We have an outstanding journal that regularly publishes the best science from around the world.

These are important observations and they represent the result of a lot of hard work by many society members and staff. To continue growing, these initiatives need energy, time, enthusiasm, and money.

There are concrete steps that Society members can take to keep this energy level high but they need you to give some time. Come to the meetings. Sign up to help with meeting organization or abstract reviews. Volunteer for the Global Health Interest Group. Start a Regional Community (http://smdm.org/hub/page/regional-communities/networking). Support someone from another country through one of our many networking or mentoring programs. It is hard to overstate the importance of building upon individual relationships as the starting point for long-term institutional relationships across countries. Accordingly, the efforts of individual members in these initiatives are crucial.

I’m also hoping that we can keep the enthusiasm going by highlighting our international work in the new strategic plan (many of our current initiatives grew out of the last strategic plan). If you have thoughts for items we should prioritize, please send them along. The strategic plan meeting is coming up quickly in May.

Despite these successes, we have more work to do. We have a large concentration of members in North America but relatively few members from Central or South America. We need to ensure that all meetings are self-financing. This requires careful consideration of elasticities around fees as well as outreach internationally to multiple stakeholders for each of our meetings, including academics, clinicians, and policy makers. And, we will need additional money to keep these initiatives going, which will require fundraising from diverse sources and demonstrating the value of our work  across countries and contexts. We should recognize that one of our core strengths is our reputation for highly rigorous and unbiased research, whether in health technology assessment, shared decision making, preference elicitation, or the many other areas of research represented by our Society. That reputation offers considerable opportunities for SMDM-branded educational and training initiatives (we have done several of these but can do more) and consultations.

I hope to see you in St. Louis and after that in Vancouver, Hong Kong, or London (perhaps all three!). I am confident that we can have an SMDM presence around the world in the next 10 years. It is time for us to think globally.


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Meeting News

37th Annual North American Meeting:

October 18-21, 2015
St. Louis, Missouri


by Scott LaJoie, PhD, MSPH, Co-Chair, North American Meeting

The theme of the 2015 meeting is Implementation. The National Institutes of Health (NIH) define Implementation science as, “the study of methods to promote the integration of research findings and evidence into healthcare policy and practice.” SMDM is positioned to bring experts from a broad range of health science disciplines together to explore implementation and exchange ideas on how to improve the translation of research findings into better bedside care and health care utilization.

The combination of short-courses, symposia and research presentations will continue to foster lively debates and deeper understandings of how our scientific efforts improve care. Whether through basic decision modeling approaches, bedside studies of patient preferences, or exploration of decision psychology, SMDM can bring innovative and disruptive changes to healthcare. This meeting intends to help talented researchers, physicians, and trainees communicate their findings to a broader audience. Meeting attendees will enjoy opportunities to interact with leaders in implementation and communication. Individuals, corporate and governmental entities interested in implementation and the science behind it will have the opportunity to interact with leaders in the field.  Attendees will be exposed to new ideas, hear from thought leaders and will be able to share their own insights with a receptive audience. 

The spirit of the Show Me state is the spirit of implementation. Implementation is, ultimately, how we show others how our work applies in practice. This meeting will be a gateway to new frontiers in healthcare science.

This year, SMDM and Society for Behavioral Medicine (SBM) are engaging in a Crosstalk symposium titled, What is a “good” medical decision? Perspectives from multiple stakeholders. SMDM members will be part of a similar symposium during SBM’s annual meeting, April 22-25, 2015.

Follow the Twitter hashtag, #SMDM15, for information throughout the year. Holly Witteman, PhD, Twitter: @hwitteman, is leading the social media efforts on this meeting. Be sure to follow her too!

 

Book Your Hotel Room Now!

The conference hotel is the Hyatt Regency St. Louis at the Arch and reservations are now open. http://smdm.org/meeting/page/2015-st.-louis-hotel-information-and-reservations/37th-annual-north-american-meeting  Note, there is a marathon in St. Louis the weekend of the meeting and this impacts hotel availability outside of the SMDM room block. Please book your hotel room NOW!


Co-Chairs:
Scott LaJoie, PhD, MSPH (Twitter: @aslajoie)

James Stahl, MD, CM, MPH (Twitter: @jstahl11111)
 
 Tweet #SMDM15


 

 

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Call for Abstracts: Deadline May 22

 

The call for abstracts and short course is now open and will run through May 22, 2015.  http://smdm.org/meeting/page/37th-annual-meeting-call-for-abstracts/37th-annual-north-american-meeting
 
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2nd Biennial Asia-Pacific Conference:
January 8-10, 2016
Hong Kong 


Theme: Making Difficult Clinical and Policy Decisions: The Example of Ageing and End of Life Care in Asia‐Pacific


Much of modern medical education and research has been devoted to preventing and treating illnesses and delaying death. In comparison, there has been little attention in teaching, practising, policy making and research into patients’ death and dying – something that most health professionals face in their work; and ultimately, a reality that we all face. In medicalising the aging, terminally ill, death and dying, many discussions of end of life (EOL) decisions are ‘medicine’ focused resulting in aggressive therapies that shorten patients’ lives instead of improving them, particularly when surrounded by many uncertainties. Instead, having the best practices to adopt, implement and enable ‘person’ or ‘patient’‐ oriented decision making, can enhance people’s EOL with fulfilment, satisfaction, autonomy and dignity.
 

What, When, and Where:

The Society for Medical Decision Making (SMDM), in conjunction with the faculty at the Jockey Club School of Public Health, will hold its second biennial Asia-Pacific conference on January 8 – 10, 2016, at The Chinese University Hong Kong. The conference, Making Difficult Clinical and Policy Decisions: The Example of Ageing and End of Life Care in Asia‐Pacific, will join the annual SMDM meetings, held in North America, and the biennial SMDM-European conferences, as venues to promote medical decision making principles and skills internationally, to delve deeply into region-specific priority areas, and to build both a regional and international network of colleagues working in this area. 
 

Who and How: 

SMDM bridges the communication gap between academic researchers, practitioners, consumers and policy makers, facilitating intellectual exchange between these stakeholders. The SMDM Asia-Pacific conference (SMDM-A) will have short-courses, symposia, panels, and research study presentations focused on decision making in the context of public health and medicine geared towards the interests of:
 
Clinicians and health professionals: Clinicians and health professionals lead in important ways by advising patients, influencing their colleagues, writing guidelines for their professional societies, and making important management decisions in the health care fields in which they practice. They are focused on achieving better outcomes for their patients while facing challenging uncertainties and very real budget constraints. SMDM-A will provide clinicians and health professionals the tools to further improve their patient communication, decision making, and guideline setting roles and will connect them with a network of like-minded individuals and academic researchers focused on the problems they care most about solving.

Government policymakers, regulators, and funders: Organizing systems of health care and health insurance, determining key coverage decisions, prioritizing population health priorities, proactively planning for future shifts in the health environment, and collecting key data are the domains of government policymakers. To do so, they must consume available information critically and make strategic decisions about new information to collect. Ultimately making tough policy decisions involving necessary trade-offs is key to bettering the health of the populations they serve. SMDM-A will provide training and support for high-level policymakers who must quickly consume available information as well as detailed technical capacity building support in state-of-the-art techniques for those in government who carryout supporting analyses.

Researchers and consumers interested in health policy and medical decision making: The best applied research agendas are those that engage in an iterative two-way dialogue with the key consumers of that research – both refining the research questions based on the needs of the key consumers and helping to inform the consumers who will ultimately make critical decisions. SMDM-A is a venue that will bring research practitioners and consumers together to showcase all that is available and will drive meaningful research agendas focused on the key problems of the future.

 

Why:

1. Because the Asia-Pacific region must make a set of challenging health decisions, under very real budgetary constraints, and in dynamic epidemiological and economic environments.
 
2. Because the Asia-Pacific region should play an increasingly important role in defining and carrying out the global Medical Decision Making agenda.
 
3. Because the Society for Medical Decision Making has a unique combination of multidisciplinary strengths on which to build.
 
 

To the Future: 

The SMDM Asia-Pacific meeting in 2016 represents an important step in a long-term strategic commitment on the part of SMDM to building stronger connections with the medical and health policy and decision making, research, and education communities located in the Asia-Pacific region. Each conference serves as a launch pad for ongoing regional coordinating activities. You are cordially invited to be a part of this effort. 
 
Click here for Asia 2016 updates and more information
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The opinions stated in the following commentaries are solely those of the authors and do not reflect the opinions of the Society for Medical Decision Making.

PULSE ON POLICY

Reports on U.S. Governmental Health Policy Relevant Proceedings:

 

Big Changes in Congress, 
but Little Change in US Policy


by Mark Liebow, MD

Republicans did very well in U.S. Congressional elections last November. They increased their margin in the House of Representatives and reached the biggest majority they had had in over 80 years. They took 9 seats from Democrats in the Senate and regained control for the first time in eight years.  However, the old Congress still had two months in office and used that time to pass funding bills for almost all of the government through September 30. The funding for most research agencies did not change much from the amounts they had in Fiscal Year 2014. 

President Obama presented his Fiscal Year 2016 budget in February. It requests $31.3 billion for NIH, $479 million for AHRQ (including the transfer from PCORI), and $589 million for VA medical and prosthetic research. Republican control of Congress means appropriations for domestic spending will be under pressure. It will be months before we know what Congress will appropriate. Recently, most appropriations bills have not been adopted one-by-one but have been swept up at the last minute into continuing resolutions or omnibus bills where almost the whole Federal discretionary budget is passed at once. Even if appropriations are at the level the President requests, only a small percentage of grant applications will be funded. 

Once it became clear Republicans would control the Senate in 2015, speculation began on whether further attempts would be made to repeal the Affordable Care Act (ACA). The House has already passed another repeal bill. There has been discussion of using budget reconciliation, a legislative process where filibusters are not allowed, to keep Senate Democrats from preventing a repeal bill passing the Senate. However, President Obama has made clear that he will veto any repeal bill that makes it to his office. Whether there will be enough votes to override his veto remains to be seen. 

Others have thought Republicans might pick off small pieces of the law. They might attach a repeal provision to important legislation, try to get enough Democratic support to break a filibuster, then try to get Obama to sign the legislation, based on the 2011-12 experience where a few small pieces of the ACA were repealed with bipartisan support. Since the part of the law that created PCORI was one of the more controversial and prompted vocal Republican opposition, it's possible there could be a move to eliminate PCORI, though there is not a proposal to do so yet. 

The current “doc fix” expires March 31. Unless the hopelessly out of date Sustainable Growth Rate formula is repealed or there is another temporary suspension of the formula taking effect, fees for professional services for Medicare beneficiaries will fall by 21% on April 1. Repeal is very unlikely and while there have been many postponements over the last dozen years the dysfunction in Congress raises concern about whether another postponement can be negotiated. If the fee cut goes into effect, clinician-researchers likely would face pressure to spend more time on clinical activities to restore levels of clinical revenue. 


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Health Policy Relevant Initiatives and Calls for Research from PCORI and AHRQ


by Lori Grover, OD, PhD
 

Agency for Healthcare Research and Quality (AHRQ)


Interest in Research About the Epidemiology of Patient Safety Risks and Harms in Ambulatory Health Care Settings
Research that expands knowledge of the adaption, refinement, or development of methods aimed at understanding the epidemiology of safety events and harm in ambulatory settings; (1) propose an adaption or refinement to an existing method for studying the epidemiology of safety and harm in ambulatory settings, including approaches to validate and assess the proposed method, or (2) apply a proposed method for conducting epidemiologic studies of patient safety in ambulatory settings.

Interest in Research on Health IT Safety
Research on safe health IT practices specifically related to the design, implementation, usability, and safe use of health IT by all users, including patients; generate new evidence on safe health IT practices that could be used by the Office of the National Coordinator for Health IT, the Food and Drug Administration, the Centers for Medicare and Medicaid Services and others to inform health IT certification and other forms of policy guidance.

Request for Applications to Disseminate Patient-Centered Outcomes Research (PCOR) through Clinical Decision Support 
Promote a new initiative that will promote the dissemination of patient-centered outcomes research (PCOR) findings through clinical decision support (CDS); purpose to establish a Center to gather input from stakeholders and that will conduct collaborative projects aimed at disseminating PCOR findings through CDS in clinical practice. Stakeholders will include but not be limited to physicians, health care providers, patients, vendors of health information technology focused on CDS, professional associations, and Federal and private health plans. Collaborative projects will span settings, time frames, and target audiences (e.g., clinicians and patients).

Patient-Centered Outcomes Research (PCOR) Career Development Awards
Continued interest in supporting individual Patient Centered Outcomes Research (PCOR) career development awards.

 

Patient-Centered Outcomes Research Institute (PCORI)


The National Patient-Centered Clinical Research Network: Clinical Data Research Networks (CDRN)—Phase II
Fund up to 13 clinical data research networks (CDRNs) as part of Phase II of the National Patient-Centered Clinical Research Network (PCORnet); complementary PFA seeks to fund to up 22 patient-powered research networks (PPRNs); provide infrastructure funding to CDRNs to expand on the infrastructure built during Phase I of PCORnet. PCORnet is intended to be a large, highly representative national network composed of CDRNs and PPRNs for conducting clinical research and includes both current Phase I CDRNs and new CDRN applicants.
 


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Recent US HealthCare and Research Initiatives/Movements of Relevance to SMDM


by Sorapop Kiatpongsan, MD


1. Precision Medicine
“Tonight, I'm launching a new Precision Medicine Initiative to bring us closer to curing diseases like cancer and diabetes — and to give all of us access to the personalized information we need to keep ourselves and our families healthier.” â€” President Barack Obama, State of the Union Address, January 20, 2015

SMDM should be aware of this new Initiative and related funding opportunities. 

More information:
www.whitehouse.gov/precisionmedicine
http://www.nih.gov/precisionmedicine/ 
http://www.nejm.org/doi/full/10.1056/NEJMp1500523 


2. Availability of patient data from clinical trials
This new movement would offer opportunities for cost-effectiveness analysis studies and disease simulation modeling studies.

More information:
http://www.nih.gov/about/director/01142015_statement_iom.htm 
http://www.iom.edu/Reports/2015/Sharing-Clinical-Trial-Data.aspx 
http://www.iom.edu/Activities/Research/SharingClinicalTrialData.aspx 
http://www.nejm.org/doi/full/10.1056/NEJMp1415160 
http://www.nejm.org/doi/full/10.1056/NEJMsr1414226 


3. Healthcare.gov 3.0  
SMDM community should be aware of role of behavioral economics at insurance exchanges and other challenging issues. 

More information:
http://www.nejm.org/doi/full/10.1056/NEJMp1414771 
http://www.nejm.org/doi/full/10.1056/NEJMp1411376  


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Report from Academy Health National Health Policy Conference 


by Negin Hajizadeh, MD

Academy Health explores the intersections between Policy, Politics, Advocacy and Research. Their National Health Policy Conference (Washington, DC, Feb 2015) focused on the Affordable Care Act (ACA) and its’ implementation. What follows is a summary of my notes from the meeting:

The two major themes of the conference were the Affordable Care Act - how it has been implemented so far and suggestions for ‘fixes’; and Population Health and the social determinants of health. 

Notable quotes:
  • “Health and disease is a patterned response of populations to their social and physical environment” (Ana Diez Roux, Dean of Drexel University School of Public Health)
  • “Moving from patient engagement to patient activation” (Aparna Higgins, America’s Health Insurance Plans)

The Administration’s Health Policy Priorities - William Corr – Deputy Secretary of US Department of Health and Human Services.
Outlined the move towards a reimbursement system that rewards value and care coordination – specifically as CMS is moving from a system that incentivizes increased volume of service to a value based payment model. He also touched on the emphasis on precision medicine; as well as quality as being a combination of good outcomes plus efficiency.
 

Plenary Session State Health Policy:

State representatives from Oklahoma, Indiana and Delaware discussed innovative methods for expanding coverage and improving access, quality and cost. Key points:
  • States pay more on Medicaid than any other services.
  • There are as many people in Medicaid as in Medicare programs.
  • Governors regulate health care insurance using their anti-trust powers, and their power to determine the supply of healthcare both in terms of places where it is provided and the training of providers.
  • The triple aim of states with respect to healthcare is: better outcomes; better patient experience and lower cost.
  • Health Indiana Plan is an alternative to Medicaid that Indiana has recently received a waiver to expand. This plan reimburses providers at Medicare rates. It has a health savings account that people in the health plan contribute to for the growth of the plan to promote a sense of ownership of the health plan. There is also a copay for inappropriate use of the ER. 

Separating the Buzz from the Boon in Population Health: Keynote: Elizabeth Bradley, Yale University. Key points:
  • Health does not equal healthcare.
  • Approximately 60% of health is based on the social determinants of health. 
  • The US spends $1 for every $ 0.90 spent of social services, as compared to the rest of the OECD where $1 healthcare is spent for $2 on social services.
  • In OECD countries health care and social services arose independently whereas in the US health care grew from a market model and social services were thought of as a service for the poor.
  • Bradley et al. world values survey is described in their recent book (The American Health Care Paradox: Why Spending More is Getting Us Less) which was a study to understand the difference between the US and Scandinavian values and attitudes about government investments in improving the social determinants of health: In the US ‘good’ government responsible for security (national and personal) and spurring a vibrant economy. Vs. in Scandinavia ‘good government’ is believed to be responsible for mitigating inequality, elevating the health and education of the population. 
  • 28% of GDP is spent on health and social services vs. 34% in Scandinavia.

Suggestions for addressing the social determinants of health were to:                                     
  1. Incentivize collaboration on health instead of on healthcare – examples included C-Train OHSU and Central City Concern partnership ; as well as 10th decile project which identifies and supports the 10% of homeless people with the highest hospital cost; WIN for asthma.                
  2. Mitigate financial incentives to medicalize health as opposed to a more holistic model that includes social services. 
  3. Establish common metrics for health and social services to rewarded eg decreasing the % obese, % depressed, % on target to finish high school. 
  4. Talk differently about health and healthcare in that healthcare is only one component of health.

Christopher Koller (Millbank Memorial Fund)
Population health is the new black but needs three components:                                                
  1. Collaborate and communicate between organizations
  2. Investments in creative approaches to improve outcomes even if no direct benefits
  3. Investments in work to address the cause of disease.       


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New Interest Group: Connecting Operations Research and Medical Decision Making

 
by Muge Capan, PhD, Christiana Care Health System

The transformation of health care from reactive and disease-centered to proactive and patient-centered care has been an emerging focus of health systems worldwide. With this transformation come many challenges, particularly the integration of analytic methods across diseases and care locations. The need for a systematic approach to inform medical decision making has been recognized by organizations such as the President’s Council of Advisors on Science and Technology (PCAST), the National Research Council (NRC), the Institute of Medicine (IOM), and the National Academy of Engineering (NAE).   

There is a growing interest in methods and models that use operations research (OR) in clinical, health policy and administrative decision making. Leading organizations, such as IOM, recommend that health care systems utilize OR to become more efficient. Research opportunities at the intersection of medical decision making and OR require integrated approaches across diseases and care locations to provide innovative health care solutions while addressing system-based challenges, e.g., limited resources, dynamically changing patient needs, and stochastic clinical trajectories.

I am pleased to announce the new SMDM OR Interest Group. The objective of the OR Interest Group is to integrate the wide range of the methods and applications that define OR in health care instead of focusing on specific methodologies (e.g., discrete event simulation) or specific disease areas (e.g., infectious disease modeling). The new OR Interest Group will serve as a forum to share ideas and experiences regarding OR applications in health care, including decision analytical modeling for screening, diagnosis and treatment of diseases, predictive analytics for risk stratification, personalization of medicine, and health system optimization such as staffing, scheduling, and patient flow related topics. Our objective aligns with the mission and vision statements of SMDM, which emphasize the promotion of an integrated approach to health care decision making to improve health outcomes through the advancement of proactive systematic approaches. 

Our goal for the first Interest Group meeting is to bring together the OR community at SMDM including practitioners, researchers, educators, and students who are interested in OR methodologies and their application to health care. We will address the current practices and challenges associated with using OR methodologies to support medical decision making. We will discuss the potential of new research areas. Our Interest Group meeting will promote research on medical decision making by providing an opportunity to meet our colleagues and enhance collaboration opportunities. 

We invite everyone who is interested to join our group via the SMDM Connect site and attend our inaugural group meeting in St. Louis. 

Email:  Muge.Capan@ChristianaCare.org
Phone: 302-733-5147

 
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Networking Committee: 
Dissemination and Implementation Webinar: Tips for Successful Grant Applications


by Mary C. Politi, PhD, SMDM Networking Committee Chair

SMDM Networking committee is pleased to announce an SMDM sponsored webinar entitled, ‘Dissemination and Implementation: Tips for Successful Grant Applications,’ which will be held on Wednesday, May 13, 2015, from 12:00 noon-1:30 pm Eastern Time. Speakers will share their expertise and provide pointers on everything from developing dissemination and implementation research to completing the dissemination and implementation sections of your next grant application. Mary C. Politi, PhD, SMDM Networking Committee Chair, will serve as the moderator.

The speakers will be:
 
Dr. Jeremy Grimshaw (Professor, Canada Research Chair in Health Knowledge Transfer and Uptake, Ottawa Hospital Research Institute)

Dr. Rachel Tabak (Research Assistant Professor, George Warren Brown School of Social Work, Washington University in St Louis)

Dr. Sharon Straus (Professor, Canada Research Chair in Knowledge Translation and Quality of Care, University of Toronto)

Dr. Christina R. Studts (Assistant Professor, Department of Health Behavior, University of Kentucky College of Public Health)
 
There will be a question period during the webinar, but we will also ask all attendees to send questions in advance of the webinar in order to give our speakers the best chance of being able to respond to all questions.
 
Registration is limited and must be submitted no later than May 1.
 
For questions please contact Mary Politi (mpoliti@wustl.edu) or Holly Witteman (holly.witteman@fmed.ulaval.ca).
 
Click here to Register for the Webinar by May 1st
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Top Ranked Short Courses Announced

 
by James Stahl and Robert Hamm, 2014 Annual Meeting Short Course Co-chairs

The SMDM short course co-chairs would like to announce the top ranked short courses of the 2014 Annual Meeting in Miami. The top ranked courses had the highest overall scores, individual faculty scores and had over 6 responses from the students in the class.

The courses were in descending order:

FD2, ADVANCED EVIDENCE-BASED DIAGNOSIS (ROC CURVES, INTERVAL LIKELIHOOD RATIOS, AND BIAS IN TEST ACCURACY STUDIES), taught by Michael Kohn, Tom Newman.

PM11, MARKOV DECISION PROCESSES - ANALYTIC METHODS FOR SEQUENTIAL DECISIONS, taught by Andrew Schaefer, Lisa Maillart and Mark S. Roberts.

PM12, WHY TALK RISK?: EXPLORING THE GOALS AND ETHICS OF RISK COMMUNICATION, taught by Brian Zikmund-Fisher and Peter H. Schwartz.


Honorable Mentions
However, there were many high ranking courses. We would also like to acknowledge several honorable mentions whose scores were as high or higher, but had fewer students and/or student responses. The top three in this category were in order:

PM14, How-To Hands-On Workshop: Presentation Skills, taught by Miriam Hunink and Jef Van den Ende.

AM11, PROBABILISTIC DECISION ANALYTIC MODELS IN EXCEL, taught by Gregory Zaric, David W. Hutton, Eva Enns, and Lauren Cipriano

AM7, INTRODUCTION TO STRUCTURAL EQUATION MODELING, taught by Adam T. Perzynski, Douglas D. Gunzler, and Joseph J. Sudano 
 
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MDM Call for Papers:
Methods for Extrapolating Survival in Cost-Effectiveness Analyses


by Guest Editors: Drs. Richard Grieve, MDM Associate Editor (richard.grieve@lshtm.ac.uk), and Neil Hawkins (neil.hawkins@lshtm.ac.uk)

Medical Decision Making, the official journal of the Society for Medical Decision Making, encourages submissions for a special theme issue, or section, on methods for extrapolating survival in cost-effectiveness analyses (CEA).

Methods guidance for CEA encourages studies to use a lifetime time horizon. The key challenge for researchers is that observed data (e.g., from randomized controlled trials [RCTs]) generally have a follow-up period of insufficient duration. Therefore, the choice of analytic model(s) for predicting the endpoints required for lifetime cost-effectiveness is an important methodological concern.

The goal of this special issue is to collate research, bringing wider attention to methodological advances in this area, and to provide a resource for future research and policymaking. Relevant communications for this special issue are those that present extrapolation approaches for mortality and other endpoints, such as disease progression or cost. In addition, manuscripts submitted for consideration in this special issue may address new approaches to extrapolation from RCTs and methods for predicting lifetime cost-effectiveness that synthesize data from several sources, including observational studies. The focus of submitted manuscripts should be on extending analytic approaches for addressing extrapolation problems in CEA rather than applying existing methods.

Recently published articles that illustrate the editors' interest in approaches to extrapolation in CEA are listed below. If you are unsure whether the work you have in mind would be appropriate, please do not hesitate to contact the guest editors.

All manuscripts are subject to MDM's usual criteria and peer review process, managed by MDM editors. There is no guarantee that any manuscripts submitted for the special issue will be accepted.

Important Dates: Deadline for manuscript submissions: May 31, 2015; deadline for final revised manuscript: December 18, 2015; expected print publication: April 2016 (online publication on acceptance)

References
Bagust A, Beale S. Survival analysis and extrapolation modeling of time-to-event clinical trial data for economic evaluation: an alternative approach [Epub 2013 Jul 30]. Med Decis Making. 2014 Apr;34(3):343-51. doi: 10.1177/0272989X13497998.

Davies C, Briggs A, Lorgelly P, Garellick G, Malchau H. The "hazards" of extrapolating survival curves [Epub 2013 Mar 3]. Med Decis Making. 2013 Apr;33(3):369-80. doi: 10.1177/0272989X12475091. http://mdm.sagepub.com/content/33/3/369.full.

Grieve R, Hawkins N, Pennington M. Extrapolation of survival data in cost-effectiveness analyses: improving the current state of play. Med Decis Making. 2013 Aug;33(6):740-2. doi: 10.1177/0272989X13492018. http://mdm.sagepub.com/content/33/6/740.long.

Latimer NR. Survival analysis for economic evaluations alongside clinical trials--extrapolation with patient-level data: inconsistencies, limitations, and a practical guide [Epub 2013 Jan 22]. Med Decis Making. 2013 Aug;33(6):743-54. doi: 10.1177/0272989X12472398. http://mdm.sagepub.com/content/33/6/743.long.


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Deadline for Submissions: May 31st


Spotlight: Emeritus Member 
Stephen G. Pauker

 

by John B. Wong, MD, Tufts Medical Center

Steve Pauker, MD, MACP, FACC, FAHA, FACMI, FASCH, FSCEH, is SMDM's newest emeritus member. A founding member of SMDM and the Eugene L. Saenger Distinguished Service Awardee and the inaugural Distinguished Career Achievement Awardee, he has been a Trustee, Vice President, President and Historian for the Society. In 1976, he published the likely first application of decision analysis to individual patients in the Annals of Internal Medicine. As Associate Editor at Medical Decision Making, he introduced Clinical Decision Making Rounds at the then New England Medical Center to the journal “to illustrate the application of clinical decision analysis to individual cases.” In 1975 and 1980, he and Jerry Kassirer published their seminal threshold papers in the New England Journal of Medicine, establishing the concept of threshold probabilities of disease which clinicians use to determine when best to test, treat or do neither, the equivalent of Newton’s laws for many of us. With Barbara McNeil, he pioneered the importance of patient preferences and quality of life in treatment and testing decision making or what is now termed patient-centered care nearly 40 years ago in the New England Journal of Medicine. Notwithstanding innumerous awards and invited advisory positions, Steve may be most proud of his academic progeny. With Jerry Kassirer, he established the Division of Clinical Decision Making at Tufts Medical Center in 1980 and trained generations of physicians in the logical principles of decision analysis with a National Library of Medicine sponsored fellowship program. His trainees have gone on to leadership positions in medicine, including Deans, Chiefs, Vice Chairs, and Directors, and 7 of his former fellows and another 3 mentees have been President of the Society. 

A cardiologist by training, Steve has spent his entire professional career at Tufts Medical Center after college and medical school at Harvard where he graduated magna cum laude. He is also a Master of the American College of Physicians and has been elected a Fellow of the American College of Cardiology, the American Heart Association, the American College of Medical Informatics, the American Society of Clinical Hypnosis and the Society for Clinical and Experimental Hypnosis. Why hypnosis? It works he might answer. As a hypnotist, he has mastered both verbal and non-verbal trance induction. Because of this skill, one of his cardiology colleagues at Tufts Medical Center does not look at him for too long. Do say hi to Steve should you see him at SMDM, but perhaps you should not stare too long.
 
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Other Meeting News


ISDM-ISEHC 2015 invites you to register for the Shared Decision Making and Evidence-Based Practice upcoming conference in Sydney, Australia on 19-22 July 2015. Early bird registration fees will close on 17 April 2015. The quickest and easiest way to register is online through the conference website http://www.isdm-isehc2015.org/registration.php. Please click here to download the registration brochure.

ISDM ISEHC 2015 registration includes: entry to all conference sessions and exhibition, ticket to Welcome Reception, morning and afternoon teas and lunches, conference satchel with conference materials including conference program book.

 


The University of Warwick will be sponsoring a summer school on Medical and Ethical Decision Making, July 7 - 10, 2015, in Venice, Italy. For information regarding program schedule, registration, and accommodations,  please visit: http://www.wbs.ac.uk/events/view/4626

Member News



SMDM would like to congratulate all of its newest Emeritus members: Neal Dawson, MD, MetroHealth Medical Center, Case Western Reserve University, Parma Heights, OH; Robert A. Greenes, MD, PhD, Arizona State University, Scottsdale, AZ; Michael Hagen, MD, American Board of Family Medicine, Lexington, KY; Stephen Pauker, MD, Tufts Medical Center, Boston, MA; Michael Quinn, MD, Glendora Radiological Associates, Pasadena, CA; Jef Van den Ende, MD, PhD, Institute of Tropical Medicine, Antwerp, Belgium; Robert Wheeler, MD, BlueCross BlueShield of Vermont, Montpelier, VT; and Robert Wigton, MD, FACP, University of Nebraska Medical Center, Omaha, NE.

 

"Individualizing and Optimizing the Use of Early Warning Scores in Acute Medical Care for Deteriorating Hospitalized Patients" by Muge Capan, PhD, Christiana Care Health System, was accepted for publication in Resuscitation and appeared in the December 2014 issue.  Muge.Capan@ChristianaCare.org


News from Samuel Coenen, MD, PhD, University of Antwerp: The Belgian Antibiotic Policy Coordination Committee (BAPCOC) developed a comic on correct use of antibiotics as part of its most recent antibiotic awareness campaign. Auntie Biotica is a special edition of Spike and Suzy – the famous Belgian comics series (aka Luke and Lucy). More information on correct use of antibiotics as well as an online version of this comic can be found at www.correctuseantibiotics.be. This initiative is endorsed by the European Antibiotic Awareness Day, the Belgian scientific colleges for general practice and those for obstetrics and gynecology, and the Belgian National Institute for Health and Disability Insurance. Public awareness on correct use of antibiotics facilitates primary care clinicians’ decisions not to prescribe antibiotics for flu, common cold and bronchitis.  samuel.coenen@uantwerpen.be


John Denny, MPH, Principal Consultant, Knowledge Services-Health Research & Consulting, Capita India Pvt. Ltd, was an invited speaker at the Third International Conference of Pharmacoecomomics & Outcomes Research held Oct 17 -18, 2014, where he spoke on "Universal Health Coverage in India: Role of Health Economics & Outcomes Research".  He also recently co-authored the draft of proposed Pharmacoeconomic guidelines for India.  djohn1976@gmail.com


Benjamin Djulbegovic, MD, PhD, University of South Florida; Jef van den Ende, Institute of Tropical Medicine; Robert M. Hamm, Department of Family and Preventive Medicine; Thomas Mayrhofer, Cardiac MR PET CT Program, Massachusetts General Hospital & Harvard Medical School; Iztok Hozo, Indiana University Northwest, Department of  Mathematics; and Stephen G. Pauker, Division of Clinical Decision Making, Tufts Medical Center, recently published "When is rational to order a diagnostic test, or prescribe treatment: the threshold model as an explanation of practice variation",  in the European Journal of Clinical Investigation. They summarize the existing literature on physicians' use of a threshold strategy for decision making, concluding that the observed variation in decision action thresholds is partially due to the way people integrate benefits and harms. That is, explanation of variation in clinical practice can be reduced to a consideration of thresholds. Limited evidence suggests that non-expected utility (non-EUT) threshold models, such as regret-based and dual-processing models, may explain current medical practice better. However, inclusion of costs and recognition of risk attitudes toward uncertain treatment effects and comorbidities may improve the explanatory and predictive value of the EUT-based threshold models. They finally conclude that the medical community has not yet fully defined criteria for rational clinical decision-making. The traditional notion of rationality rooted in EUT may need to be supplemented by reflective rationality, which strives to integrate all aspects of medical practice - medical, humanistic, and socioeconomic-within a coherent reasoning system.  bdjulbeg@health.usf.edu


Lori L. Grover, OD, PhD, was recently appointed Dean of the Pennsylvania College of Optometry at Salus University in Elkins Park, PA. lgrover@salus.edu


L. Robin Keller, PhD, has been named 2015 President of the Institute for Operations Research and the Management Sciences (INFORMS). With her UCI medical school colleagues and her doctoral student, Jiaru Bai, she has also recently completed a study using a Markov decision tree to examine the cost-effectiveness of treatments for advanced cervical cancer.  LRKeller@uci.edu


Syllene Nunes, MD, PhD, IHEA, reports on her work on the Primary Healthcare Project in private sector: Introduction of primary healthcare in private health plan in Brazil showed improvement in outcomes. In a population of 2000, lives exposed to the strategy during one year showed reduction in admissions and readmissions as well as ER visits. Patient education is an important part of the success in this initiative. We hope to publish the complete paper soon. sylgil@uol.com.br


Chander Sehgal, MD, was mentioned in the January 8, 2015, Healthy Debate article: "Regulators Grapple with Canada’s First Generic Biologic Drug" by Vanessa Milne, Andreas Laupacis & Mike Tierney. chanders@cadth.ca


For the past 18 months, Hal Sox, MD, has been working for the Patient-Centered Outcomes Research Institute (PCORI) as a program officer and as the director of research portfolio development. He is also celebrating the second edition of the introductory textbook, Medical Decision Making (with Mike Higgins and Doug Owens) hsox@comcast.net


Iakovos Toumazis, PhD Candidate, Department of Industrial & Systems Engineering, University at Buffalo, SUNY, won the 2015 Society of Health Systems Graduate Student Paper competition with his work titled "Scheduling Palliative Chemotherapy Treatments for Metastatic Colorectal Cancer Patients". Credit should be also given to the co-authors of the paper: Murat Kurt, Artemis Toumazi, Loukia G. Karacosta, and Changhyun Kwon.  iakovostoumazis@gmail.com


Mark Roberts, MD, chair of the department of Health Policy and Management, was named director of the Public Health Dynamics Laboratory (PHDL) at the University of Pittsburgh's Graduate School of Public Health. The PHDL is an interdisciplinary activity focused on the development of computational methods and simulation to improve the theory and the practice of public health.  mroberts@pitt.edu

 
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Student News


Carrie Flannagan, flannagan-c@email.ulster.ac.uk
Expected Graduation: 12/1/2015
Area: Nursing research; decision aids; shared decision making
Advisor: Professor Eilis McCaughan
Dissertation: Decision aid for reconstructive surgery after mastectomy: development and feasibility testing of the Option Grid
Position Seeking: Any

 

 

Sze-chuan Suenssuen@stanford.eduwww.stanford.edu/~ssuen
Expected Graduation: 6/1/2016
Area: Quantitative Healthcare Modeling
Advisor: Margaret Brandeau and Jeremy Goldhaber-Fiebert
Dissertation: Control of Drug Sensitive and Drug Resistant TB in Resource Constrained Settings
Position Seeking: Any
SMDM Presentations:
Cost-Effectiveness of Rapid Diagnostics and Care Systems Improvements for Tuberculosis in India (2014)
 
Check out CVs (or post yours) at SMDM Connect
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Job Postings


The following positions have been recently posted in the Resource Section of SMDM Connect

Assistant Professor - The University of Cincinnati Department of Biomedical Informatics, Cincinnati, OH
Research Division, Family Medicine - University of Oklahoma, Oklahoma City, OK
Senior Principal Scientist, Outcomes Research - Merck & Company Inc., Hertfordshire, UK
Principal Scientist, Outcomes Research - Merck & Company Inc., Gwynedd, PA
Associate Principal Scientist, Outcomes Research - Merck & Company Inc., Gwynedd, PA
Postdoctoral Fellow in Biomedical Ethics / Decision Science - McGill University, Montreal, Canada
Associate Director, Benefit-Risk/Epidemiology - Janssen Research & Development, Titusville, NJ
Assistant Professor, Research Faculty Appointment - MD Anderson Cancer Center, Houston, TX
Post Doctoral Training Program, Cancer Prevention and Control Research - Virginia Commonwealth University, Richmond, VA
Internal Medicine Physican/Health Services Researcher - Cedars-Sinai Medical Center, Los Angeles, CA
 
Check out all the details and the latest Job Postings Here

SMDM Lifetime Contributors


SMDM extends its heartfelt appreciation to members for their charitable contributions over the years!

Donations received Oct. 2005 – March 9, 2015. 
Bolded individuals made contributions since the last report.
Italicized individuals moved up a level of giving in 2015.

Raiffa-Kahneman Circle
(Contributions total $5,000 or more)
John Clarke ('13, '14)
Jeremy Goldhaber-Fiebert ('13, '14)
Mark Helfand (‘05, ‘07, '10, '11)
Joseph King (‘06 - '14)

Pareto Level
(Contributions total $1,000 - $4,999)
Dana Alden ('12, '13, '14)
Michael Barry (‘06 - '10)
Dennis Fryback (‘05 -'14)
Michael Kattan ('13, '14)
Murray Krahn ('13, '14)
William Lawrence (‘06, '10, '11, '13)
David Rovner & Margaret Holmes-Rovner (‘05 - '14)
Bruce Schackman (‘06 -'14)
Marilyn Schapira (‘07 - '12, 14)
Uwe Siebert ('11, '13, '14)
Frank Sonnenberg (‘06, ‘09)
Harold and Carol Sox ('10 - '14)
Sankey Williams (‘06 - ‘08, '13, '14)
John Wong (‘06, - '13)

Edwards Level
(Contributions total $750 - $999)
Ahmed Bayoumi (‘06, '08 - ‘14)
Neal Dawson (‘05 - '14)
David Meltzer ('07, '09)
Jill Metcalf (‘07 - '14)
Stephen Pauker (‘06, ‘09)
Seema Sonnad (‘06, ‘07, ‘09, '12 - '14)
Joel Tsevat (‘06, ‘09, '10)

Tversky Level
(Contributions total $500 - $749)
Anirban Basu ('13)
Robert Beck (‘07) 
Scott Cantor & Lisa Stone (‘07 - '14) 
Kate Christensen (‘09)
Nananda Col (‘05 - ‘09)
Peder Halvorsen ('11 - '14)
Myriam Hunink (‘05 - '14)
Sara Knight (‘05 - '14)
Kathryn McDonald (‘07, '09, '10, '14)
David Paltiel ('07, '09)
Mark Roberts (‘08, ‘09, '13)
Alan Schwartz (‘07, '10, '12 – '14)
David Sugano (‘07, ’09 – '11, '13)
Jef van den Ende (’10, '14)

von Neumann-Morgenstern Level
(Contributions total $250 - $499)
Amber Barnato (‘05, ‘07, '11, '12, '14)
Donald Brand ('13, '14)
Dena Bravata (‘06, ’09 -  '11)
Andy Briggs ('14)
Randall Cebul (‘06, ‘08, '10)
Mark Eckman (’06, ‘09)
Elena Elkin (‘07, '14)
Arthur Elstein (‘06, ‘07, ‘09, ‘10) 
Angela Fagerlin ('14)
Heather Taffet Gold (‘08, '11, '14)
Don Husereau ('13)
Karen Kuntz (‘09, '11)
Miriam Kuppermann (‘06 - '10, '12, '14)
Steven Kymes (‘05 - ‘09, '12)
James Stahl (‘06, ‘09, '10, '12)
Thomas Tape ('10, '11, '14)
Robert Wigton ('10, '11, '14)

Markov Level
(Contributions total $100 - $249)
Cathy Bradley (‘07)
Scott Braithwaite (’09)
Linda Canty ('12)
Phaedra Corso (‘06, ‘07, ‘08)
Magdelena Flatscher-Thöni ('14)
Alan Garber ('10)
Robert Hamm (‘06, ‘08, '14)
Paal Joranger (‘14)
Esther Kaufmann ('11)
Sun-Young Kim (‘07, ‘08, ‘10, '13)
Joseph Ladapo ('12 - '14)
Curtis Langlotz ('12)
Lisa Maillart ('10)
Peter Neumann ('14)
Richard Orr (‘05, ‘06)
Jesse D. Ortendahl ('11, '12, '13)
Roy Poses ('14)
Brian Rittenhouse (‘07)
Ursula Rochau ('14)
Allison Rosen (‘07)
Natasha Stout ('14)
Verena Stühlinger ('14)
Joanne Sutherland (‘08, ‘09)
John Thornbury (‘05)
George Torrance (‘05)
Benjavan Upatising ('13)
Brian Zikmund-Fisher (‘08 - '14)

Bayes Level
(Contributions total up to $100)
Jessica Ancker ('14)
Hilary Bekker ('12)
Eran Bendavid ('11)
Tanya Bentley ('14)
Denise Bijlenga (‘08)
Kimberly Blake (‘09)
Cindy Bryce ('14)
Rowland Chang (‘06, ‘07)
Carmel Crock (‘09)
James Dolan (‘09)
Arna Dresser ('10, 12, '14)
Liz Fenwick ('14)
Ted Ganiats (‘05)
Lee Green (‘07, ‘09)
Amit Gupta (‘06)
Michael Hagen ('10)
Negin Hajizadeh ('14)
Sarah Hawley ('14)
Kristin Hendrix ('14)
David Howard (‘09)
David Katz (’08)
Job Kievit (‘09)
Kerry Kilbridge (‘05, ‘07, ‘08)
April Kimmel ('14)
Sarah Kobrin ('14)
Ivar Sonbo Kristiansen ('10)
Andrew Scott LaJoie ('10)
Sarah Lillie ('14)
Andreas Maetzel (‘09)
Daniel Masica (‘08)
Evan Myers ('12)
Thomas B. Newman ('10)
Jane Pai ('10)
George Papadopoulos (‘08)
Mary Politi ('14)
Lisa Prosser (‘08)
Valeria Reyna ('14)
Michael Rothberg (‘09 - '12)
Gillian Sanders (‘07)
Jha Saurabh (‘09)
Karen Sepucha ('14)
Ewout Steyerberg (‘06, ‘09, '11, '13)
Anne Stiggelbout (‘06)
Carol Stockman (‘05)
Danielle Timmermans (‘07)
Hugues Vaillancourt ('11)
Erika Waters ('14)
Milton Weinstein (‘09, '11)
Robert Werner (‘08)
Holly Witteman ('14)
Eve Wittenberg ('14)
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The Spring issue of our Journal, Medical Decision Making, is available for your review.

Copyright © 2015 Society For Medical Decision Making, All rights reserved.

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