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We hope you enjoy the Spring 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 Scott Braithwaite, MD


SMDM Meetings



SMDM Annual Meetings

2013 North American Meeting
Call for Papers
Call for Short Course Proposals

2014 Asia-Pacific Meeting


Commentary

Commentary

Locally Relevant Decision Making in a Globalized Environment
by Joseph L. Mathew, MD
Sequestration Forever?
by Mark Liebow, MD, MPH
When Risk Communications Are Precise, Accurate, and Meaningless
by Brian Zikmund-Fisher, PhD
Framing Death in Medical Decision Making – a Hypothesis
by Dan Matlock, MD, MPH and Larry Allen, MD, MHS


Other News


Society and Other News

Medical Decision Making
Grants: Call for Proposals
Other Meetings: UMIT
Members in the News
Students 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.
2013 North American Meeting
Opportunities to Volunteer
Job Postings
Support SMDM
Join SMDM on Facebook
Renew Your Membership for 2013
Contact Us




Editors

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


Commentators

Joseph L. Mathew, MD, Post Graduate Institute of Medical Education and Research
Mark Liebow, MD, MPH, Mayo Clinic
Brian Zikmund-Fisher, PhD, University of Michigan School of Public Health
Dan Matlock, MD, MPH, University of Colorado Hospital
Larry Allen, MD, MHS, University of Colorado Hospital



Additional Contributing Authors

Scott Braithwaite, MD, New York University School of Medicine
Heather Taffet Gold, PhD, New York University School of Medicine
Elena Elkin, PhD, Memorial Sloan-Kettering Cancer Center





Scott LaJoieFrom the Editor

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

Welcome to the spring issue of the SMDM newsletter! We hope you find this edition as thought-provoking as we do. 

Society President Scott Braithwaite, MD, challenges us to think about the current trends in health decision making and how these trends are, and will be, shaped by healthcare reform in the United States. Mark Liebow, MD, continues to educate us on the effects of reform, and in this issue, shares his observations about sequestration. Joseph Mathew, MD, reflects on the challenges of bringing evidence-based practice to countries with developing healthcare systems. He offers insights on how SMDM can provide technical assistance and training for these countries. Given the upcoming meeting in Baltimore, the training opportunities, such as SMDM short-courses and mentoring of new decision scientists and trainees, and the newly-formed Concierge program, SMDM is in a good position to help Dr. Mathew continue to address the challenges he has identified.

Brian Zikmund-Fisher, PhD, confronts the problem of being too precise. He reinforces the notion that risk communication is most effective when it provides the intended audience with the right type and amount of information needed. Drs. Matlock and Allen write about risk communication and decision making in an article that addresses the impact of framing on life-and-death decisions. They motivate us to reconsider how we think about such decisions: are we nudging patients to take more risky procedures than they would if we had framed our message in less black-and-white terms?

We hope you take the time to read this newsletter and reflect on the insights that our authors are offering. Moreover, we hope that something in this newsletter spurs you to continue the conversations begun here. We welcome you to contribute your insights to the next edition.

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Scott BraithwaiteFrom the President

by Scott Braithwaite, MD, New York University School of Medicine

Happy Spring! I think we all get a little cheerier as the days start to last longer, even those of us who are cloistered away in front of dimly lit screens much of the time.

Speaking of illumination, SMDM’s new methods concierge program is casting considerable light on the areas of SMDM methodological expertise that are in particularly high demand. This is an exciting time - the U.S. is thinking about the specifics of implementing health care reform, European health technology authorities are using even more rigorous methods, and low-to-middle-income countries are thinking more about healthcare resource allocation. The hungering for methods seems to be clustering in the following 4 areas:
  • Shared Decision Making (especially how to embed within Health Information Technology)
  • Population Health Modeling (especially how to inform resource allocation by health authorities)
  • Composite Quality Metrics (especially how to use modeling to assess magnitude of health benefit)
  • Value of Information (especially how to inform research portfolio design)
Some of these areas will be highlighted in SMDM’s Singapore meeting in January 2014, which is itself a harbinger of the increasing worldwide appetite for our methodological expertise. If you would like to be more involved in the Singapore meeting, please contact Jeremy Goldhaber-Fiebert, PhD. If you would like to get more involved in the concierge program, please contact Jill Metcalf. Also, be sure to submit abstracts for this year's annual meeting in Baltimore, USA (deadline for submission, May 17, 2013). Under the meticulous stewardship of Heather Taffet Gold, PhD, and Elena Elkin, PhD, the Baltimore meeting will be nothing less than fabulous.

Saving the best for last, and continuing with the new tradition of highlighting a SMDM unsung hero each quarter, this quarter’s unsung hero is. . .

Elbert Huang
HuangElbert Huang, MD, is an unsung hero of Strategic Goal 5, Policy Influence. Elbert is Associate Professor of Medicine, Research Associate of the Center on Demography and Economics of Aging, and Associate Director of the Chicago Center for Diabetes Translation Research at the University of Chicago. From 2010-11, he served as a Senior Advisor in the Office of the Assistant Secretary for Planning and Evaluation, Department of Health and Human Services.

His main research focus is in the area of medical decision making for elderly patients with type 2 diabetes, in which uncertainty exists regarding how to best individualize diabetes treatments based on clinical parameters and patient preferences. He performed the economic analyses of the Health Resources and Services Administration’s Health Disparities Collaboratives initiative of diabetes quality improvement in community health centers that serve the indigent, performing one of the first business case analyses from the perspective of the community health center, as well as one of the first societal cost-effectiveness analyses of a quality improvement initiative. He has received numerous honors including the Research Paper of the Year Award from the Society of General Internal Medicine and elected membership to the American Society for Clinical Investigation.

Next column will feature another unsung hero of another Strategic Goal. Who could it be? Find out in the next Newsletter!


Strategic Plan



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2013 North American Meeting
Bench, Bedside and Beyond:
Medical Decision Making and Public Policy

by Heather Taffet Gold, PhD, New York University School of Medicine and Elena Elkin, PhD, Memorial Sloan-Kettering Cancer Center

Gold and ElkinMark your calendar – the 35th Annual Meeting of the Society for Medical Decision Making will be held October 20-23, 2013, in Baltimore, Maryland. The theme of this year’s meeting is Bench, Bedside and Beyond: Medical Decision Making and Public Policy. Abstracts and short-course submissions are due May 17.

In addition to stellar scientific sessions, the meeting will feature a keynote address by David Eddy, MD, PhD. Founder and Chief Medical Officer Emeritus of Archimedes, Inc, and former professor at Stanford and Duke, Dr. Eddy’s work has influenced both US and international approaches to informed clinical decision making and health policy development. 

Other special symposia will address decision making and decision support for older adults, and strategies for communicating with the press and the public, each featuring a diverse panel of experts who will present unique perspectives on these important topics in medical decision making. New pre-meeting short courses and networking opportunities will enhance the variety of educational and career development activities available to meeting attendees.

Check the SMDM website for continual updates. For more information or to help with planning, please contact Elena Elkin or Heather Taffet Gold.

2013 Annual Meeting Planning Committee:
Meeting Co-chairs: Elena Elkin, PhD, (elkine@mskcc.org) and Heather Taffet Gold, PhD, (Heather.Gold@nyumc.org)
Scientific Review Committee Co-chairs: Eran Bendavid, MD, and Tanya Bentley, PhD
Short Course Committee Co-chairs: Stacey Sheridan, MD, MPH, James Stahl, MD, MPH, and Ahmed Bayoumi, MD, MSc
Career Development co-chairs: Natasha Stout, PhD, and Beate Sander, PhD

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Asia-Pacific Meeting

Asia-Pacific Meeting


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Commentary


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.


Joseph MathewLocally Relevant Decision Making in a Globalized Environment

by Joseph L. Mathew, MD, Chair, Health Technology Assessment international Interest Sub Group (HTAi ISG) on Developing Countries

In an ideal world, each healthcare decision making stakeholder—policymaker, healthcare professional, or patient—would be able to access and appraise the evidence pertaining to healthcare interventions and make informed decisions relevant to the local setting. In practice, evidence-based decision making occurs routinely in countries with well developed healthcare systems, but rarely in the rest of the world. In low-income, resource limited countries, stakeholders face a variety of nonscientific influences that often result in inappropriate decisions. This brief essay outlines some of the factors that influence local decision making in the current globalized environment and proposes a possible way forward.

The consensus curse
In most healthcare settings, practice guidelines assist healthcare professionals and consumers to make appropriate decisions. In countries with developed healthcare systems, such guidelines are formulated by professional societies through a rigorous scientific process that factors in the available evidence, as well as locally relevant issues related to population dynamics, disease epidemiology, implementation issues, and so forth. The immunization guidelines published periodically by the American Academy of Pediatrics provide a typical example. In contrast, countries with developing healthcare systems often lack the expertise and/or the local data to develop contextually appropriate guidelines. As a result, they may resort to the practice of publishing consensus guidelines under the aegis of professional/scientific societies. Although "consensus guidelines" suggests that a group of experts has gotten together to appraise external evidence and judge its suitability to the local context, the reality is often different. What actually happens is that one or more members of the group conduct a limited literature search and present data acquired from very different healthcare settings to the full group, which formulates a recommendation by extrapolating the results to the local setting. Unless there are serious objections, the recommendation is accepted as a consensus. Such guideline development meetings are sometimes financed by pharmaceutical industries having a direct stake in the marketing of products featured in the guidelines.

External influences and pressures
Healthcare decision making in developing healthcare systems can also be skewed by external influences and pressures. These pressures may be subtle, taking the form of recommendations contained in position papers from reputable international bodies such as the World Health Organization. When published in the WHO Bulletin, these recommendations almost always favour interventions (for example newer vaccines) in developing healthcare settings where it is not possible to make an independent scientific assessment of the benefits of the intervention. In such a situation, the WHO position paper carries great weight and tilts the balance towards recommending the intervention, although careful scrutiny of the position papers may reveal a lack of compelling evidence.

Occasionally, indirect pressure is exerted by donor agencies and institutions that provide financial support for healthcare programmes, local research, or other needs. Such organizations have, for example, offered financial support to developing countries by promising expensive vaccines at highly subsidized rates, but they may offer the subsidy only for a limited period of time. Although many developing countries in Asia—India, for example—lack reliable local data about disease epidemiology, local dynamics of disease transmission, vaccine efficacy, effectiveness, and cost-effectiveness, promotions by international agencies, while presumably well-intentioned, may exert strong pressure on resource-limited healthcare systems to adopt a measure without adequate supporting evidence.

The way forward
What is the way forward? It would be ideal if all healthcare stakeholders were empowered with the knowledge and skills to access, appraise and apply evidence in order to make locally relevant and contextually appropriate decisions. Although this is a desirable goal, it is unlikely to happen in the immediate future. Likewise, it would be ideal if each healthcare system—country, state, organization, or institution—had a group of professionals with expertise to provide health technology assessment reports to the decision making stakeholders. This should be a medium-term goal, but the following  actions can be initiated immediately through the global presence and reach of SMDM: (i) encouraging the exchange of ideas and experiences such as the ones highlighted above, (ii) fostering capacity building through training opportunities, initially at the international level, and in stages, at the local level, (iii) developing toolkits for adaptation of global evidence for local needs, (iv) providing a platform for developing healthcare systems to present their unique needs and challenges, and (v) supporting research into appropriate decisionmaking methods despite absence of locally applicable evidence.


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Mark LiebowSequestration Forever?

by Mark Liebow, MD, MPH, Mayo Clinic
 
In 2011, as part of a deal to increase the U.S. government’s debt ceiling, Congress passed a law requiring the Federal government to reduce spending by about $1 trillion over 10 years. To ensure that this would happen, the law included a default plan to take effect January 1, 2013, if Congress failed to implement the spending cuts. The default plan would cut by equal amounts defense and domestic spending requiring annual appropriations and would also cut Medicare payments to providers by 2 percent. This default, or "sequester," was thought to be so horrible that Congress would come up with an alternative.

In fact, a deeply divided Congress couldn’t come up with an alternative and, as New Year’s Day approached, it looked as if the sequester would kick in. However, as part of the deal to extend many of the Bush tax cuts, the sequester was delayed for two months. In the interim, a new but still deeply divided Congress again failed to enact an alternative cost-cutting plan, so the sequester went into effect March 1. The reduction in spending this year will total $85 billion. The National Institute of Health (NIH) will absorb about $1.5 billion of the cut. The loss will hurt those seeking new grants and continuation of existing grants the most, as there will be far less money than usual for them. The Agency for Healthcare Research and Quality (AHRQ) is exempt from the cuts because it is funded through intergovernmental transfers. Such transfers were exempted in the initial default plan, which also exempted the Department of Veterans Affairs. The sequester does affect the Patient-Centered Outcomes Research Institute (PCORI) through the amount collected by the tax on Medicare and insurance companies, which could result in a $25 million loss according to one estimate.

Late in March, Congress passed another continuing resolution to fund the government through September, the end of the Federal fiscal year. This resolution did not substantially mitigate losses for most health research areas. For example, NIH got an extra $71 million or about 5% of what it lost in the sequester. It’s too early to know whether the sequester amounts will become the new baseline for budgeting or whether the effects of the sequester will become too painful politically for it to last. At least we have another six months before we have to worry about the government shutting down. Attempts to repeal the Affordable Care Act in Congress will continue, but that won’t happen.

The second term of a President’s administration often sees substantial turnover in the political leadership of departments and agencies. While Carolyn Clancy is stepping down as Director of AHRQ after ten years, most of the other leadership in the Department of Health and Human Services is staying put for now.


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Brian Zikmund-FisherWhen Risk Communications Are Precise, Accurate, and Meaningless

By Brian Zikmund-Fisher, PhD, University of Michigan School of Public Health

How is it possible that risk communications could be accurate yet meaningless?

Isn't the whole point of risk communication to help people to quantify the uncertainty in their lives? Isn't it better to know the chance that I will get cancer or have a car accident or develop Alzheimer's disease more and more precisely?

How could more data, better data, be less helpful?

Perhaps it will be clearer if I rephrase the question: How is it possible that risk data could be precise estimates of the likelihood of events happening yet simultaneously unhelpful for decision making? The answer is simple:

Risk communications can provide accurate, precise, and yet meaningless representations of risk likelihoods when their quantitative precision is both (a) unnecessary for effective decision making and (b) distracting from the cognitive task at hand. In that case, the risk information will interfere with a decision maker's ability to understand the simpler "gist" of the problem that is essential for informed decision making.

Consider Robert, a middle-aged man interested in his future disease risk. Robert goes to an online cardiovascular risk calculator, enters his information, and learns that his 10 year risk of cardiovascular disease is 14.523%. This number may be completely accurate (it is derived from the best clinical algorithm known to medical science). It is certainly very precise, down to the thousandth of a percent.
But, consider these key questions:
  • Does Robert know if he is at higher than average risk? (No.)
  • Does he know whether this value should be taken as a signal to act, e.g., by seeing his doctor? (No.)
  • Does it accomplish the single most important goal of risk calculators, i.e., motivating behavior change among high risk users? (I really doubt it!)
  • Is Robert informed of his risk? (Not in my book.)

The 14.523% risk estimate lacks what Christopher Hsee termed "evaluability." It may be numerically accurate but lacks sufficient context to be seen as good or bad. I and others have written before (e.g., here) about how the lack of evaluability can lead people to not use different types of numerical data.(And, see here for a paper arguing that unnecessary precision undermines trust in risk calculators.)

We must acknowledge that we often provide risk data to people who need risk understanding and personally relevant meaning without actually translating the former into the latter.

As medical and public health professionals, we spend much of our lives in pursuit of data to inform the estimation and management of health risks. These data are incredibly important to have at our disposal, in part because our professional lives are filled with other data that provide context.

The problem is, most of the people we are trying to communicate with lack the very experience and knowledge that made the data meaningful to us in the first place.

The definition of "risk communications" encompasses a broad range of statements. Stating "it is possible that the vaccine will cause febrile seizures" is very different than saying "the risk of febrile seizures goes up by 0.001%" (or whatever the number might be) if a person has a vaccine. We need to recognize that these messages are fundamentally different, even if both are accurate risk communications.

I make this argument in fuller detail in a paper titled The Right Tool Is What They Need, Not What We Have: A Taxonomy of Appropriate Levels of Precision in Patient Risk Communication. It appeared in the February 2013 supplement to the journal Medical Care Research and Review.

In the paper, I outline a taxonomy of seven levels of precision in quantitative risk communications, ranging from possibility statements (e.g., "X could happen") through relative possibility statements ("X is more likely than Y"), categorical possibility statements (e.g., "you have a high chance of X happening"), to precise quantitative concepts like comparative probability statements ("there is an A% chance of X happening, compared to a B% chance of Y happening") and incremental probability statements (e.g., "the risk of X will change by A% if I do Z").

Just to be clear, I do not argue that risk data communications are never valuable. Far from it.

My point is that it is the responsibility of every risk communicator to have a specific purpose in mind at the time of a communication AND to select the risk format that is most congruent with the recipient's informational needs.

Sometimes those needs can be met with simple statements that raise awareness of the existence of risk, order risks, or categorize them. Other times those needs can only be met through more precise, quantitative data regarding probabilities that quantify magnitude-dependent tradeoffs.

The fact that people may have multiple needs at various points in time does not change the requirement to design our communications to match our primary objective.

Put another way, just because we have a precise risk number does NOT imply that providing that number to the patient, policy maker, or community member is necessarily the best way at that particular moment to inform that person about this risk.

In Robert's case, our primary objective is to have him understand whether his risk is “high” and, if so, to have that information motivate him to modify his behavior accordingly. Everything else is secondary.

Because, sometimes, imprecise risk information can be perfectly meaningful.


Brian J. Zikmund-Fisher is an Assistant Professor of Health Behavior & Health Education at the University of Michigan School of Public Health and a member of the University of Michigan Risk Science Center and the Center for Bioethics and Social Sciences in Medicine. He specializes in risk communication to inform health and medical decision making. This article is adapted from a posting January 30, 2013, on RiskSense.org, the blog of the University of Michigan Risk Science Center.



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Framing Death in Medical Decision Making – a Hypothesis

By Dan Matlock MD, MPH and Larry Allen MD, MHS, University of Colorado Hospital

“The real voyage of discovery consists not in seeking new landscapes but in having new eyes.” Marcel Proust

In their prospect theory, Kahneman and Tversky taught us that the way options are framed influences the decisions we make. In a classic example, respondents were asked to imagine that an unusual Asian disease is expected to kill 600 people. They were given the choice of two alternative programs which are mathematically identical. In option A 200 people will be saved, and in option B there is 1/3 probability that 600 people will be saved and 2/3 probability that no people will be saved. When option A is presented as a gain (“people will be saved”), 72% of the respondents chose to save the 200 people rather than take risky option B. However, if option A was presented as a loss (“400 people dying”) 78% of the respondents chose the riskier second program. This experiment elegantly demonstrates one of the fundamental premises behind prospect theory - that when options are presented as gains, people tend to be risk averse and when options are presented as losses, people tend to be risk seeking.

With that in mind, consider the challenges we currently face in modern medicine. The past 50 years we have seen a change in how and where people die, with fewer people dying at home and more people dying in institutions such as the hospital or the nursing home. Consequently, as a society we have less tangible experience with death and dying. Likewise, we have seen a rapid growth in potentially beneficial but increasingly expensive and invasive medical interventions. The availability of many of these advances combined with a society that has less experience with death and dying can have the effect of making death seem optional.

Our research group has been exploring the factors important in decision making around two major technologies with direct life and death implications. One technology is the implantable cardioverter-defibrillator (ICD) and the other, the left ventricular assist device (LVAD). The ICD is a device implanted under the skin of the chest and is designed to abort potentially lethal cardiac arrhythmias. The LVAD sucks blood from an otherwise failing heart and pumps it to the body with enough force to sustain life. In populations of appropriately selected patients, both of these therapies significantly extend life. In randomized studies, the ICD conferred a 7% absolute risk reduction in mortality at 5 years (36% vs. 29%) and the LVAD conferred a nearly 50% absolute risk reduction at 2 years (60% vs. 10%). At the same time, both therapies have significant risks. Studies suggest that patients with ICDs have more hospitalizations than those without ICDs, and for those who are shocked, an increased incidence of anxiety, depression, and post-traumatic stress disorder and a lower quality of life. Further, if not deactivated in a timely manner, ICDs can cause significant suffering through unwanted shocks at the end of life. For the LVAD, only 46% of patients are free from a major adverse event at 2 years post implantation, including reoperation to replace a malfunctioning or clotted pump (10%), disabling stroke (11%), and death (33%). Beyond those major events, infection of the device, gastrointestinal bleeding, and frequent hospitalizations occur in the majority of patients.

When we interviewed patients who had gone through the above decisions, we found that these significant risks and burdens mattered very little in their decision making. Many patients did not consider forgoing the therapy to even be an option: “The doctor said your heart could run away and you’d be dead. I’m like . . . oops! Ok, that was it [decision]!” Likewise, clinicians involved in both decisions told us that they did not want to accentuate the risks because they did not want to scare patients. As one physician told us surrounding ICD decision making: “I think my biggest concern is if I convey the risks to them too strongly, that they will choose or make an unwise decision and not proceed with therapy.” At the same time, patients largely overestimate the benefits and underestimate the risks of the therapies.

Our work with ICDs and LVADs has caused us to rethink our approach to shared decision making. Much of the literature on shared decision making focuses on helping patients understand the cognitive aspects of the decision. The reality is that medical decision making is complex, colored by predictable patterns of human behavior that can pervasively and persistently undermine a patient’s ability to make rational choices that best align with their values, goals, and preferences. Specifically related to late life decisions, prospect theory teaches us that people will be risk seeking when conservative medical choices such as not pursuing an aggressive therapy are framed as a certain loss (death).

We hypothesize that as long as invasive technologies such as ICDs and LVADs are presented as black and white alternatives to death, interventions will continue to be utilized with little consideration of the risks or consequences involved.

If true, our hypothesis has implications for researchers trying to find ways of optimally supporting patients making complex life and death decisions. Rather than simply outlining the risks and benefits of a therapy (the traditional informed consent process), decision support needs to pay considerable attention to how options are framed specifically avoiding framing death as a failure. Whether we like it or not, death eventually comes to all of us. As long as we continue to frame conservative choices as certain death and death as a failure, then no amount of risk is too great. Only when we figure out how to frame death appropriately will we begin to understand how to help patients with advanced illness make informed, patient-centered decisions around invasive technologies.

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February Issue Released

We hope you enjoy the latest issue of our journal

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Other News

 

Grants: Call for Proposals

Applying Behavioral Economics to Perplexing Health and Healthcare Challenges


The  Robert Wood Johnson and Donaghue Foundations are seeking innovative proposals that apply the principles and frameworks of behavioral economics to persistent and perplexing health and health care problems.

They hope to discover new interventions and insight that have potential to dramatically improve the way health care is delivered and health is promoted and preserved. They are particularly interested in supporting experiments that test innovative solutions to the challenge of reducing the use of low-value services in health care. This problem is particularly important given the rising costs and unaffordability of health care in the United States, but has been difficult to impact in part due to perverse incentives in a fee-for-service environment.”

Five awards of up to $200,000 each are expected to be granted under this call for proposals. Projects will last for up to two years.
.
Applicants are asked to submit a 1500 character brief proposal that describes their idea by April 17, 2013 (3:00 pm, EST) to be considered. Visit www.rwjf.org/cfp/pi2 and use the “Apply online” link to submit your proposal.

For complete information on this grant and proposal submission requirements, please visit
http://pweb1.rwjf.org/files/applications/cfp/cfp_BE%20round%202.pdf


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Other Meetings

Modeling Approaches for Health Technology Assessment (HTA):
A Practical Hands-On Workshop

UMITThis 3-day certificate course will be held June 6-8, 2013, in Hall in Tyrol, Austria. The workshop combines theoretical concepts with practical hands-on exercises comprising five different modeling techniques applied in Public Health and HTA. Real-world case examples from different acute and chronic diseases will be discussed. Course Directors, Prof. Dr. Uwe Siebert, MPH, MSc, and Prof. Ron Goeree, MA, as well as Mirjam Kretzschmar, PhD, are pictured above. Additional faculty members include Beate Jahn, PhD, Gord Blackhouse, BComm, MBA,MSc, and Martina Kluibenschädl, Bakk.

This course is module 3 of the International Health Technology Assessment Decision Sciences Continuing Education Program (HTADS) developed by the Institute of Public Health, Medical Decision Making and Health Technology Assessment, Department of Public Health and Health Technology Assessment at the University for Health Sciences, Medical Informatics & Technology (UMIT).

HTADS was designed to provide excellent quality education and comprehensive training in the key issues of health technology assessment and decision sciences for anyone involved in the health sector. Detailed information about the course and study programs is available at www.umit.at/htads, via e-mail htads@umit.at or by phone +43 (0)50 8648-3901.



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Member News

Murray KrahnMurray Krahn, MD, Director of the Toronto Health Economics and Technology Assessment Collaborative (theta.utoronto.ca), has been awarded a five-year Canada Foundation for Innovation (CFI) New Initiatives Fund. This CFI award will allow Dr. Krahn to establish the Centre for the Evaluation of Technological Innovation (CETI), which will draw together the University of Toronto’s resources to become a leading international methods and policy centre for Early Health Technology Assessment (HTA).

Early HTA is a new research paradigm in which scientists, payers, and innovators work together early in the development process to ensure that the clinical evidence will meet the needs of payers (e.g. Ministries of Health) and regulators (e.g. FDA, Health Canada) before new technologies and innovations are brought to market. CETI will be distinctive in North America, and one of only a few centres in the world to pioneer a comprehensive model of Early HTA that addresses the twin challenges of innovation and sustainability. Working with both the private sector and the government earlier in the development process, CETI will bring drug and non-drug technologies to market faster. This type of collaboration will ultimately lead to an improved pipeline, shaping how products and innovations get into the system, become licensed, and are eventually purchased and incorporated into the health care system. By working with the health care industry early in the development process, CETI will identify product shortcomings sooner, build better and more mature evidence portfolios to be brought to provincial drug plans for consideration faster, and encourage promising drugs and technologies to come to market more rapidly.

CETI will bring together more than thirty-five investigators and students, and will produce tangible benefits, including facilitating the development of new drugs and technology, generating new policy-relevant knowledge, training, and enhancing decision support for public policy decision makers.


Elizabeth Adams, MPH, is pleased to announce the establishment of her new consulting business, Elizabeth Adams Consulting, LLC. She will offer systematic review and medical writing services to clients in the health care industry and wellness communities. With more than 20 years' experience in federal  and global health policy and health technology assessment, Liz is uniquely positioned to assist both evidence users and producers in applying evidence-based principles to inform decisions and improve health, well-being, and organizational performance. You can find out more information about Liz and the services she offers in the SMDM membership directory or at www.elizabethadamsconsulting.comejadamsconsulting@verizon.net


Scott B. Cantor, PhD, is pleased to announce his move to the new Department of Health Services Research at The University of Texas MD Anderson Cancer Center. The new Department offers opportunities to expand the application of quantitative methods for determining best clinical practice and policy with a particular focus on the prevention and treatment of cancer. Scott has been in Houston since 1994, most recently in the Department of Biostatistics. He is on the search committee to fill two tenure-track positions of any rank; please contact him at sbcantor@mdanderson.org for more details.


Richard Chapman, PhD, has accepted a position as Vice President in the Data Analytics Practice of Avalere Health, in Washington, DC. In this role, he will be responsible for leading a variety of studies involving retrospective database analyses, prospective surveys, and budget impact and cost-effectiveness models across a broad range of therapy areas and products. Avalere focuses on the intersection of business and policy in consulting for a diverse customer base, including commercial healthcare companies, non-profits, foundations, and government.  http://www.avalerehealth.net/  RChapman@avalerehealth.net


Nananda Col, PhD, and Geri Baumblatt, MA, co-wrote the first chapter of the Dorland Special Report on Shared Decision Making.The full report is available here: http://store.dorlandhealth.com/special_reports/Shared-Decision-Making-A-Tool-to-Ensure-Patient-Centered-Care-PDF_383.html.  A free PDF of the article is also available. Nananda Col also collaborated with Emmi Solutions, LLC, on 4 new web-based multimedia Emmi decision aid programs to help patients understand treatment options for: Uterine Fibroids, Coronary Artery Disease, Early Stage Breast Cancer, and Low-Risk Prostate Cancer. If anyone would like to view these programs or is interested in using them for any research projects (they contain a tracking component that makes them ideal for this) they can contact Geri at: geri@emmisolutions.com


Congratulations to Kimberly B. Garza (formerly Blake) PharmD, PhD, Auburn University Harrison School of Pharmacy, on her marriage to Ray A. Garza, December, 2012. kbl0005@auburn.edu


Sharon Gilbert, PhD, MS, MBA, George Washington University, recently published an article, "Cost-effectiveness of Trial of Labor after Previous Cesarean in a Minimally Biased Cohort" in the American Journal of Perinatology (30 (1):11-20) followed by a January 28, 2013 press releaseSGilbert@bsc.gwu.edu


Eberechukwu Onukwugha, PhD, MSc, University of Maryland School of Pharmacy, Department of Pharmaceutical Health Services Research, published an editorial in Pharmacoeconomics titled, "Improving Confidence in Observational Studies: Should Statistical Analysis Plans be Made Publicly Available?" eonukwug@rx.umaryland.edu


As part of the state of California's LGBTQ Strategic Planning Workgroup (SPW), Seth T. Pardo, PhD, Alliant International University, co-authored the California LGBTQ Reducing Mental Health Disparities Project Report. Seth also published an original research article on measures of clinical health among female-to-male transgender persons. The Archives paper is in the January 2013 issue.  seth.pardo@gmail.com


Charles Phelps, PhD, University of Rochester reports: I just got back into action with SMDM after a long hiatus while serving as Provost of the University of Rochester, presenting a poster in Phoenix on the cost-effectiveness of a new gene-expression (blood sample) diagnostic test for coronary artery disease, thereby re-kindling my long standing work in the economics of diagnostic technologies. This is work as a consultant with CardioDx, Inc., in Palo Alto, CA. I also published an economic analysis of an anti-angina drug (ranolazine) in 2011. Fun to be back in the saddle! I have also worked closely with Denny Fryback on an IOM committee to create a model to establish priorities for new preventive vaccines, now in the middle of Phase II. The Phase I report is available from the IOM.  charles.phelps@rochester.edu


University of Texas at El Paso held their first interdisciplinary decision-making research symposium February 14-15, 2013, with Valerie Reyna, PhD, and James Stahl, MD. lsgarbayo@utep.edu


Four main types of prognosis research were defined by a consortium of methodologically interested researchers in a series of papers published in February 2013. The PROGnosis RESearch Strategy (PROGRESS) consortium set out a framework for researching clinical outcomes in 2 papers in BMJ and 2 in PLOS Medicine, considering  1) fundamental prognosis research;   2) prognostic factor research;   3) prognostic model research;   4) stratified medicine research.  The 4 papers are available as Open Access publications and likely relevant to the field of medical decision making, where more individualized approaches are gaining in importance. http://www.bmj.com/content/346/bmj.e5595  http://www.plosmedicine.org/article/info%3Adoi%2F10.1371%2Fjournal.pmed.1001380  http://www.plosmedicine.org/article/info:doi/10.1371/journal.pmed.1001381  http://www.bmj.com/content/346/bmj.e5793    e.steyerberg@erasmusmc.nl


A tool to help guide formulary decision-making regarding what drugs to add, restrictions to impose, special warnings, etc., has been published by the UIC and Brigham and Women's Hospital AHRQ Centers for Research and Education in Therapeutics (CERT). The UIC Tools for Optimizing Prescribing, Monitoring, and Education (TOP-MED) CERT initially developed and refined the tool working with two institutions' formulary committees (UIC and Cook County Stroger Hospital) in Chicago. It is envisioned to be a useful decision-making tool for a) orienting new members to formulary committees, b) preparation of new drug application monographs,c) guiding decisionmaking discussions at P&T Committees, and d) evaluating the quality of committee decisionmaking processes and outcomes. It was published in PLOS Medicine and is available for free access: http://www.plosmedicine.org/article/info%3Adoi%2F10.1371%2Fjournal.pmed.1001220  Gordon D. Schiff, MD, Brigham and Women's Hospital Center for Patient Safety Research and Practice  gschiff@partners.org


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Students in the News

Vishal Ahuja, vahuja@chicagobooth.edu, http://home.uchicago.edu/vahuja/
Degree: PhD
Expected Graduation Date: 06/01/2013
Area: Business, Operations Management
Advisor: Dr. John Birge
Dissertation Title: "Determining Optimal Treatments for Patients: Clinical Trials and Beyond"
Presented at the SMDM Annual Meeting: "Fully Adaptive Designs for Clinical Trials: Simultaneous Learning from Multiple Patients"
Position Seeking: academic faculty

Kirsteen Burton, MSc, MBA, MD, kirsteen.burton@utoronto.ca
Degree: PhD (candidate)
Expected Graduation Date: 06/01/2014
Area: clinical epidemiology, decision analysis
Advisor: Dr. Andreas Laupacis
Dissertation Title: "Optimizing Neuroimaging of Patients with Suspected Acute Ischemic Stroke"
Position Seeking: academic

Robert Dunlea, MD, robert.dunlea@utah.edu, www.healthyit.org
Degree: Masters
Expected Graduation Date: 08/01/2012
Area: Biomedical Informatics
Advisor: Leslie Lenert, MD, MS
Dissertation Title: "A System to Capture and Integrate Patient Values into Clinical Decision Support Systems"
Position Seeking: any

Sharon Gilbert, SGilbert@bsc.gwu.edu
Degree: PhD
Expected Graduation Date: 05/01/2013
Area: Epidemiology
Dissertation Title: "The MFMU Cesarean Registry: A Decision and Cost-Effectiveness Analysis of a Trial of labor Compared with an Elective Repeat Cesarean After a Previous Cesarean Using Propensity Scores"
Position Seeking: any

Ilya Ivlev, ivlev.i.v@gmail.com, http://www.linkedin.com/pub/ilya-ivlev/33/208/127
Degree: MD (Physician-Cyberneticist, First class degree); PhD (Biomedical and Clinical Technology)
Expected Graduation Date: PhD - 09/01/2013
Area: Biomedical and Clinical Technology
Advisor: Prof. Peter Kneppo
Dissertation Title: "The Concept of the System of Rational Choice of Medical Equipment"
Position Seeking: academic; post-doc; government; non-profit research
Presented at the SMDM Annual Meeting: The Concept of the System of Rational Choice of Medical Equipment by Example of MRI

Eric Nsiah-Boateng, nsiahboateng@gmail.com
Degree: MSc Public Policy and Human Development
Expected Graduation Date: 08/01/2013
Area: Social Protection Design and Financing
Dissertation Title: "Eight Years of National Health Insurance Scheme in Ghana: Evaluation of the Health Financing Elements"
Position Seeking: non-profit research
SMDM Committee Served: Abstract Review Committee, 2012
SMDM Interest Group: Policy Committee
SMDM Mentor: Oslo, Norway, 2012,  Andrew Briggs

Derek Tang, PhD, dtang@pharmacy.arizona.edu
Advisor: Terri L. Warholak
Expected Graduation: 2013 May
Area: Pharmaceutical Economics, Policy, and Outcomes
Dissertation Title: "Incidence and Healthcare Resource Utilization in the Arizona Medicaid Elderly Population"
Presentation Title at SMDM Annual Meeting: "Assessing Healthcare Provider Satisfaction of Services Provided by the Arizona Regional Extension Center (REC): A Cross-Sectional Survey (2012)"
Position Seeking: industry; consulting firms; government
SMDM Mentor: David Sugano, PhD

Benjavan Upatising, bupatising@gmail.com
Degree: PhD
Expected Graduation Date: 08/01/2013
Area: Industrial Engineering (Healthcare focus)
Advisor: Yuehwern Yih
Dissertation Title: "Home Telemonitoring Effects on Hospitalizations, Emergency Department Visits, Frailty Transitions, and Cost Among Older Adults: Evaluation of a Clinical Trial"
Position Seeking: any
SMDM Mentor: Nilay Shah
 

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SMDM Lifetime Contributors

SMDM extends its heartfelt appreciation to members for their charitable contributions over the years.
Donations received Oct. 2005 – Feb. 28, 2013.
Bold indicates a new donor or a donor who has advanced their level of recognition in 2013.

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)
David Rovner & Margaret Holmes-Rovner (’05, ’06, ’07, ’08, ’09, ’11, ’12)
Uwe Siebert ('11)
Frank Sonnenberg (’06, ’09)
Harold and Carol Sox (’10, ’11, ’13)
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)
Marilyn Schapira (’07, ’08, ’09, ’10, ’11, ’12)
Joel Tsevat (’06, ’09, ’10)

Tversky Level
(Contributions total $500 - $749)
Robert Beck (’07)
Scott Cantor & Lisa Stone (’07, ’08, ’09, ’10, ’11, ’12)
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)
Seema Sonnad (’06, ’07, ’09, ’12)

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)
Peder Halvorsen ('11, ’12)
Sara Knight (’05, ’06, ’07, ’08, ’09, ’10, ’11, ’12)
Karen Kuntz (’09, ’11)
Steven Kymes (’05, ’06, ’07, ’08, ’09, ’12)
James Stahl (’06, ’09, ’10, ’12)
David Sugano (’07, ’09, ’10, ’11)

Markov Level
(Contributions total $100 - $249)
Dana Alden (’12)
Amber Barnato (’05, ’07, ’08, ’11, ’12)
Cathy Bradley (’07)
Scott Braithwaite (’09)
Linda Canty (’12)
Phaedra Corso (’06, ’07, ’08)
Elena Elkin (’07)
Alan Garber (’10)
Heather Taffet Gold (’08, ’11)
Robert Hamm (’06, ’08)
Myriam Hunink (’05, ’06, ’07, ’08, ’09, ’10, ’11, ’12)
Esther Kaufmann ('11)
Miriam Kuppermann (’06, ’07, ’08, ’09, ’10, ’12)
Curtis Langlotz (’12)
Lisa Maillart (’10)
Richard Orr (’05, ’06)
Brian Rittenhouse (’07)
Allison Rosen (’07)
Alan Schwartz (’07, ’10, ’12)
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, ’12)
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)

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