The mission of the Center for Health Care Research and
Policy is to: (1) improve the health of the public by conducting
research that examines access to health care, increases the quality of
health care services, and informs health policy and practice; and (2)
lead educational programs that promote these goals.
Director's Report, 2014,
CHRP Grants and Contracts
|Disentangling Multiple Sclerosis and Depression for Better Care|
Due to the overlap of symptoms in clinical depression and multiple sclerosis, clinicians and researchers can be misled when caring for patients with MS who report fatigue and functional or cognitive impairment. Seeking to disentangle these complex relationships to improve care, Center faculty Douglas Gunzler, PhD, Adam Perzynski, PhD, Steven Lewis, MS, MBA, along with others at Case Western Reserve University and the Cleveland Clinic Mellen Center for Multiple Sclerosis, recently studied 3,507 patients with MS who also completed a self-reported depression screening tool (PHQ-9). Using a sophisticated causal modeling approach, the team found that overlap in symptoms was especially large for symptoms of fatigue. The team is developing an adjusted PHQ-9 screening tool for MS patients, as reported in the June 2014 issue of the Journal of Behavioral Medicine. Dr. Gunzler is a KL2 Scholar in the Cleveland CTSC’s Multidisciplinary Clinical Research Training Program.
|Engaging Patients in Care Improves Blood Sugar Control in Patients with Diabetes|
Center member Shari Bolen, MD, MPH and colleagues recently performed a systematic review of over 100 studies of “patient activation” strategies for adults with diabetes, and found that these programs improve blood sugar control almost as much as taking a diabetes medication. The study team also found improvements in cholesterol, blood pressure, and weight. Interventions often were relatively simple - such as diabetes group visits, use of pedometers and activity journals, or use of a portion-controlled plate at meal time in conjunction with nutrition visits. Programs that lasted longer, incorporated clinical pharmacists, and enrolled patients with higher blood sugars had greater improvements. While many patient activation programs exist to help adults with diabetes improve their health, about 50% of insurers do not yet support these programs. Study findings provide evidence for insurers who do not yet cover these programs. This study should revolutionize care by encouraging primary care providers and their staff to offer these programs consistently to engage patients in improving their health. Also participating in the current study were MetroHealth researchers Dr. Corinna Falck-Ytter; Adam Perzynski and Steven Lewis of the Center for Health Care Research and Policy; Cleveland Clinic family medicine physician Carl Tyler, and two Clinic Lerner College of Medicine students. The article was published recently in the Journal of General Internal Medicine and was highlighted in the May 15 issue of the Cleveland Plain Dealer.
|Bolen to Serve as Deputy Editor for the Journal of General Internal Medicine|
Shari Bolen MD, MPH, Assistant Professor of Medicine in the Center for Health Care Research and Policy, has recently accepted a 3-year Deputy Editor term at the Journal of General Internal Medicine (JGIM). “JGIM is a high impact primary care journal for academic general internists, disseminating innovative clinical, research, and policy findings to improve the health of the U.S. population. We are delighted that Shari has accepted this post. ”, said Center director Randy Cebul. Dr. Bolen will review manuscripts monthly to determine those articles most relevant to JGIM’s broad clinical and policy-oriented audience. She will provide expertise in hypertension, diabetes, quality improvement, and systematic review methodology at the monthly editorial board meetings.
|T.R. Reid Featured at City Club, February 7, 2014|
In conjunction with Better Health Greater Cleveland’s 12th report on quality of care in northeast Ohio, internationally recognized reporter T.R. Reid presented on February 7th at Better Health’s public convening session and at the City Club of Cleveland’s Friday Forum. Reid is one of the nation`s best-known reporters through his books and articles, documentary films, reporting for the Washington Post, and lighthearted commentaries on NPR`s "Morning Edition." His 2009 book, "The Healing of America," instantly became a national best-seller. Reid has made documentary films for the National Geographic Channel, PBS and the A&E Network. His latest film, "U.S. Health Care: The Good News," premiered on the national PBS network in 2012. Watch Reid`s City Club talk here.
|Dr. Adler-Milstein provides two lectures on Health IT |
Julia Adler-Milstein is an Assistant Professor at the School of Information with a joint appointment in the School of Public Health (Health Management and Policy) at the University of Michigan. Her research focuses on policy and management issues related to the use of IT in healthcare delivery. Her expertise is in health information exchange and she has conducted four national surveys of health information organizations. Her work also focuses on the impact of electronic health records on healthcare cost and productivity. Julia graduated with a PhD in Health Policy from Harvard University. Her topic for Thursday December 12th`s Medical Grand Rounds was “Exchanging Clinical Data Electronically: Progress and Remaining Challenges”. At Friday’s HSR Seminar, Julia’s topic was “The Impact of EHRs on Healthcare Costs: Evidence from Massachusetts”.
|HIE Across Unaffiliated Systems Perceived as Cost-Saving but May be Inhibited by Financial Incentives and Market Competition. |
Research conducted by Center faculty and Senior Scholars reported the early adoption and perceived benefits of health information exchange (HIE) across unaffiliated health care systems in the November 2013 issue of the American Journal of Managed Care. Over 9000 MetroHealth patients had data obtained from other hospitals and clinical practice sites during the first 7 months of HIE availability through Epic’s Care Everywhere HIE system. As compared to patients for whom HIE was not requested, patients with HIE were older and had more medical conditions. By insurance type, commercially insured patients were least likely to have HIE requested. In a related survey, MetroHealth physicians reported that requesting outside clinical information was highly acceptable to patients and resulted in less redundant testing, reduced hospitalizations, and improved efficiency. “Lower HIE use among commercially insured patients reinforces concerns raised by others that financial incentives and market competition may be inhibiting widespread use” said Center Director Randall Cebul, senior author on the report. “This may slow the demonstration of HIE’s benefits to patients and other payers for health care.”
|Remembering Elizabeth McKinley|
It is my sad duty to share that Elizabeth “Lissa” McKinley, M.D.,M.P.H., founding dean of the Emily Blackwell Society and a treasured member of our school community, died Saturday after a long and courageous battle with cancer. She is survived by her husband, Robert “Chip” Gilkeson, M.D., a professor of radiology at Case Western Reserve, son, Will, and daughter Katie, as well as legions of physicians whom she taught to listen, hear, and heal. More.
|Love Named Fellow of the American Statistical Association|
Thomas Love, Director of the Center`s Biostatistics & Evaluation Unit, and Professor of Medicine, Epidemiology & Biostatistics at CWRU has been named a fellow of the American Statistical Association (ASA), the nation’s preeminent professional statistical society, announced ASA President Marie Davidian.
“I congratulate Thomas on being honored as a new ASA Fellow,” said Davidian. “His accomplishments have contributed greatly to the advancement of statistical science and have rightfully earned him the respect and admiration of his ASA peers.”
Love was honored for exemplary service and significant leadership in the statistical community, for notable contributions to statistical education, and for extensive collaborative efforts in clinical and health services research. He will be honored for his achievements at a ceremony August 6 at the annual Joint Statistical Meetings in Montréal, Québec, Canada.
|Bariatric Surgery Does Not Reduce Total Health Care Costs Over Time|
With colleagues at Johns Hopkins University, Center faculty member Shari Bolen, MD, MPH recently published an article in JAMA-Surgery that evaluated costs after bariatric surgery using insurance claims data from 7 different states in the U.S. (first article). As compared with obese individuals who did not undergo surgery, costs were not different for individuals undergoing bariatric surgery after 6 years of follow-up. According to Dr. Bolen, “while bariatric surgery may not reduce health care costs in the short-term, we still do not know the longer term effects, say after 15 to 20 years, when cost savings might accrue as a result of better control of diabetes and other cardiovascular diseases, as we have shown in the past (second article). In my opinion, we should continue to focus on lifestyle management of obesity, saving bariatric surgery for those individuals with severe obesity that affects their quality of life or for those with poorly controlled co-morbid illnesses.”
|Corlett Presented on the Likely Effects of Medicaid Expansion in Ohio, February 22nd. |
Center Senior Scholar and former Ohio Medicaid Director John R. Corlett, Vice President, Government Relations and Community Affairs for The MetroHealth System, will present the results of an important new study that has found that Ohio would net $1.4 billion over the next decade if Ohio were to expand Medicaid as allowed under the Affordable Care Act. Governor John Kasich revealed his administration’s Medicaid proposals with his proposed budget on February 5, 2013. Get HPIO (Health Policy Institute of Ohio) study here.