Center for Health Care Research & Policy

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Focus on Faculty

To Induce or Not to Induce?
With increasing numbers of expectant mothers choosing their delivery dates based on the convenience for family and the physician, Center Senior Scholar Jennfier Bailit, MD, MPH worked with the NIH to explore whether the type of delivery can impact motherand baby: in particular, whether elective inductions – performed for nomedical reason – provided an increased risk to mother or baby. The risks are increased for mom, according to Dr. Bailit, who is a high-risk obstetrician at MetroHealth. The study in the March issue of the American Journal of Obstetrics and Gynecology revealed that the chances of women needing a hysterectomy after giving birth were three times higher for women undergoing elective induction than for those who went into labor spontaneously.

The research also reinforced the data from recent smaller studies that neonatal outcomes are best at 39 weeks or later. “Given the advantages of an elective delivery are primarily social or logistical – whether Grandma can come in from out of town or when your OB is available and not on vacation – this study presents some hard data that an elective delivery has risks,” says Bailit. “At thevery least, women should be well-informed about the risks and benefits of the procedure.”

An Economic Perspective on U.S. Health Care Reform -- September 10th
Mark E. Votruba, Ph.D. presented Medical Grand Rounds on September 10th at MetroHealth`s Scott Auditorium The topic: An Economic Perspective on U.S. Health Care Reform. [Slides] Dr. Votruba is Director of the Center’s Health Economics Research Unit and CWRU Associate Professor of Economics.

Center Faculty and Colleagues Well Represented at SMDM Meeting
Center faculty, co-investigators, and students were well represented at the annual meeting of the International Society for Medical Decision Making meetings in Boston, October 15-18th. Collectively, Center faculty and colleagues presented 11 abstracts, two short courses, and chaired the plenary symposium that focused on the meeting’s theme: “Real-Time Clinical Decision Support to Improve Quality of Care”. Of special note, the pre-meeting course: “Methods for Cluster Randomized Trials of Clinical Decision Support”, directed by Randall Cebul along with Center colleagues Neal Dawson and Tom Love, won the “Best Short Course” award from among 19 courses offered by SMDM members worldwide.(posted 10/2006)

Katzan Receives Pessin Prize for Stroke Research
Center faculty member Irene Katzan, MD, MS, Assistant Professor of Neurology, received the 2006 Michael S. Pessin Stroke Leadership Prize for her work in stroke management during the American Academy of Neurology’s 58th Annual Meeting in San Diego, held April 1 – 8. The American Academy of Neurology, an association of more than 19,000 neurologists and neuroscience professionals, is dedicated to improving patient care through education and research.

The Pessin Stroke Leadership Prize recognizes emerging neurologists who have demonstrated a passion for learning and expanding the field of stroke research. “My research interests are in evaluating and optimizing care of patients hospitalized for stroke,” said Katzan. “Much of it focuses on stroke management in the community setting, where the majority of stroke patients receive care. Identifying factors that positively or negatively impact the outcomes of stroke patients and ways to optimize care has implications for all stroke victims. “I am grateful to have been nominated and am absolutely thrilled to receive the Pessin Stroke Leadership Prize,” said Katzan. Sponsored by the AAN, this prize is endowed by Dr. Pessin’s family, friends, and colleagues. (posted 3/2006)

Dr. Katzan “Lady in Red” in Cleveland Magazine
(February 2004 & 2006)
Center member Irene L. Katzan, MD, MS was featured for the second time as the "Lady in Red" in the February, 2006 issue of Cleveland Magazine. The magazine also featured American Heart Association funded research led by Dr. Katzan that is evaluating racial differences in stroke severity and management The magazine partnered with the American Heart Association to highlight February’s "Go Red for Women" campaign to make women more conscious of their risks for cardiovascular disease and stroke. Irene leads the citywide Stroke Outcomes Research Program and has been a leader in Northeast Ohio’s Operation Stroke for more than 7 years. (posted 2/2006)

Personal Computer Tablets Use Reduces Cost, Error and Time Spent in Data Collection
In the February issue of Journal of Public Health Dentistry Joseph Sudano PhD and colleagues describe how tablet PC computers can be used in data collection. Using PC tablets eliminates intermediate data collection steps and error from data transfer. This technique also reduces study costs. Dr. Joseph Sudano and his colleagues concluded that the use of the PC tablets as direct entry devices may be useful in research and direct patient care in a broad spectrum of disciplines.
Sudano, JJ, Kofford B, Wotman, S. Using tablet PC’s in dental practice research: technology, cost savings, and direct data entry “On the Go”. J Publ Health Dentistry 2005;65(4): 244-245. (posted 2/06)

The Cleveland Department of Public Health (CDPH) Welcomes Ashwini Sehgal, M.D. New Co-Medical Director Physician to focus on Reducing Health Disparities
Ash Sehgal, MD, an experienced physician and researcher in the areas of health disparities and quality improvement, joins the Cleveland Department of Public Health in a shared role as co-medical director. Dr. Sehgal is the Duncan Neuhauser Associate Professor of Community Health Improvement and Director of the Center for Reducing Health Disparities at Case Western Reserve University in Cleveland, Ohio. He is also a practicing nephrologist at MetroHealth Medical Center.

"Dr. Sehgal is prepared to enhance the Department’s efforts to reduce health disparities," says Matt Carroll, interim public health director." As a researcher Dr. Sehgal focuses on quality improvement and has worked to identify and overcome barriers for effective care of all patients. We took forward to his expertise as Mayor Jackson and CDPH work to bridge health gaps for all Clevelanders."

Dr. Sehgal will serve Cleveland along with his counterpart co-medical director Ann Avery, MD, Infectious Disease physician at MetroHealth Medical Center. Avery`s responsibilities will remain focused on emergency preparedness, communicable and sexually transmitted disease as Dr. Sehgal focuses on health disparities, maternal and child health and chronic disease prevention. Quoted from CDPH Press Release of 1/9/06, (posted 1/2006)

Thomas E. Love, Ph. D. has been selected to receive a 2005 Scholarship in Teaching Award from Case`s School of Medicine.
Dr. Love received this award for his work on teaching statistical methods for observational studies, primarily in Case`s Clinical Research Scholars Program, and also in workshops at national and international meetings. The Scholarship in Teaching Award (now in its second year) is designed to encourage the application of scholarship to efforts in education. Dr. Love also received this award (previously called the Best Educational Contribution Award) in 2004.

Thomas E. Love, Ph. D., will join the Editorial Board of The American Statistician in January 2006 as an Associate Editor
The American Statistician, a quarterly publication of the American Statistical Association, strives to publish articles of general interest to the statistical profession that are clearly written, address topics of broad importance, and are ordinarily not highly technical. Articles focus on current national and international statistical problems and programs, state-of-the-art surveys of the discipline, public policy matters of direct interest to the statistical profession, statistical computing and graphics, and the history and teaching of statistics and probability.

Faculty Win Case Presidential Research Initiative Award, 2005
For many important medical conditions, providers can improve outcomes by offering services that reduce the future likelihood of costly complications - such as disease management for chronic conditions, treatments for obesity or tobacco use, and certain kinds of primary prevention. Yet these services often are not covered by health insurance plans, and providers frequently don`t provide them. In a partnership between Center faculty in Medicine and Economics, investigators Cebul, Rebitzer, and Votruba seek to examine the economic and health effects of enrollee turnover rates, or insurance "churn", on this impediment to better quality of care. The two-year grant was one of eight awarded by CWRU - with matching funds from the Weatherhead School of Management and MetroHealth Medical Center - to foster interdisciplinary research across schools at CASE.

Irene L. Katzan, M.D., M.S. Awarded AHA Grant to Study Racial Disparities in Stroke Care and Outcomes
Dr. Katzan MD and others of the Cleveland Stroke Outcomes Research Program received the $120,000 grant from the American Heart Association`s Ohio Valley Affiliate. The two-year study will collect data at 17 hospitals in Cuyahoga and Geauga Counties to provide information that will address ways to reduce the excess mortality observed in black stroke victims. Currently, stroke mortality is approximately twice as high in blacks as in whites, making it the single most important contributor to excess mortality among blacks.

Thomas E. Love, Ph. D. has been elected Secretary of the American Statistical Association`s Health Policy Statistics Section
The American Statistical Association is a world leader in promoting statistical practice, applications, and research; publishing statistical journals; improving statistical education, and advancing the statistics profession. The Health Policy Statistics Section focuses on strategies for improving the quality and reducing the cost of health care in the US and abroad through the systematic use of quantitative statistical methods. Dr. Love will serve beginning January, 2006, and he also will serve two years on the Section`s Executive Committee. Dr. Love is the current Vice President of the Cleveland Chapter of ASA.

Joseph J. Sudano, Jr., PhD, Awarded $1.4 Million to Study Racial/Ethnic Measurement Bias in Health Surveys
Center faculty member Joseph J. Sudano, Jr., PhD, Assistant Professor of Medicine and Epidemiology and Biostatistics, has been awarded a 3-year grant from the National Institutes on Aging to investigate racial/ethnic measurement bias in the most commonly used health survey tools. Along with co-Investigators Patrick Murray MD, Thomas Love PhD, and Neal Dawson, MD, 1320 whites, blacks, English-speaking and Spanish-speaking Hispanics will take a standard health survey and then asked to perform a series of tests to measure physical functions related to the concepts in the survey. Comparisons between the subjective assessments of health and the objective tests of physical performance will be made to determine if there are differences in these measures across the 4 groups. Results will help in designing future health surveys and more accurately understand differences in health status across racial/ethnic groups. Joining Dr. Sudano in this study are consortium researchers from Northwestern University`s Feinberg School of Medicine, including David W. Baker, MD and Gail Huber, PT.

Andrew O`Connor, DO, MPH, awarded Pfizer Scholars Grant in Clinical Epidemiology to Study the Role of Chronic Lead Exposure in Diabetic Kidney Disease
Center faculty member Andrew O`Connor will undertake a 3-year project to investigate the role of chronic environmental lead toxicity as a factor in the progression of diabetic nephropathy. The research will take advantage of a longitudinal cohort of over 300 diabetic subjects who are being recruited to study genetic factors in diabetic kidney disease. Rather than using blood lead levels, lead exposure will be measured using a novel radiologic technique that allows quantification of long term lead exposure. Decline in kidney function will be assessed annually in the cohort. This will be the first study to examine the role of ambient low level environmental lead toxicity as a factor in chronic diabetic kidney disease. O`Connor`s application ranked first in a nationwide competition for the 3-year career development award, given to two junior medical school faculty each year.

Center Faculty Member Publishes Paper "Health Insurance Coverage During the Years Preceding Medicare Eligibility" in the Archives of Internal Medicine
Center faculty Joseph Sudano, PhD co-authored a paper with former Center member David Baker, MD, MPH in the April 11th, 2005, issue of the Archives of Internal Medicine. "Health Insurance Coverage During the Years Preceding Medicare Eligibility" describes the prevalence of uninsurance in a longitudinal cohort of over 6000 US adults 51-57 years old in 1992. Baker and Sudano used data from the Health and Retirement Study that enabled follow-up from 1992 through 2000. They found that the proportion of late-middle aged adults at risk of being uninsured over the follow-up period was 2-3 times higher than current estimates of uninsurance that are based on cross-sectional data. At least one quarter of older adults will be uninsured at some point during the years preceding Medicare eligibility.

Senior Scholar James R. Rebitzer, Ph.D. Receives Award for Excellence in Health Care Research
Dr. Rebtizer, the Frank Tracey Carlton Professor and Chair of Economics at Weatherhead School of Management, received an award for excellence in original and creative health care research from the National Institute for Health Care Management Research and Educational Foundation at its Eleventh Annual Award dinner in Washington, D.C. on November 1st. The award was given to Professor Rebitzer and his co-authors Martin Gaynor and Lowell Taylor of Carnegie Mellon University for their paper "Physician Incentives in Health Maintenance Organizations", which appeared in the August 2004 issue of the Journal of Political Economy. The paper examines how physicians respond to financial incentives to reduce health care costs. The winning paper was selected by a panel of leading health care experts and was accompanied by a $5,000 prize.

Julia Rose, PhD, MA, Awarded $2 Million for a National Center to Support Evaluation in Geriatrics Education
Julia Hannum Rose, PhD, MA, Associate Professor of Medicine and Bioethics and Co-Director of the Program for Research on Aging, and her Co-Investigators Diana Gurley, PhD, and Patrick Murray, MD, have been awarded a $2 million, 5-year contract by HRSA to establish a National Technical Assistance Center (NTAC) for geriatric education programs. The central office will be housed at Case in the Center for Health Care Research and Policy, with regional offices at UCLA and the New Jersey College of Osteopathic Medicine. The NTAC will provide support for education evaluation and research to 47 Geriatric Education Centers throughout the country. These centers offer training in geriatric medicine to students, faculty and practitioners across the full range of health professions, including physicians and nurses, social workers, allied health professionals, psychologists, health administrators, and first responders. It will provide online resources and access to individuals throughout the country with expertise in research, policy, health disparities, and education, and will offer two training seminars each year to coincide with national conferences.

AHRQ Grant Awarded to Study Decision Support in Diabetes
Center Director Randall D. Cebul, MD, along with other Center faculty and investigators at the Cleveland Clinic Foundation (co-PI C. Martin Harris, MD, MBA) and the Weatherhead School`s Department of Information Technology (Betty Vandenbosch, PhD) , were recently awarded a $1.5 million grant to study new approaches for improving the care and outcomes of patients with diabetes in Northeast Ohio. Altogether, the 3-year trial will enroll over 13,000 adult patients with diabetes who are cared for by 200 primary care physicians in 22 CCF and MetroHealth community-based practices. Two innovative decision support systems will be studied - one that helps physicians and facilitates a disease management approach, and a second that empowers patients by providing web-portal access to their physicians and their diabetes-related information. Funded by the Agency for Healthcare Research and Quality, this project is part of a major new federal initiative to inter-connect electronic health data to improve the quality and cost of health care [link]. Both MetroHealth and the Cleveland Clinic use the same commercially available electronic medical record system. To find out more about the federal initiative, visit this page on the AHRQ web site.

Mark E. Votruba, PhD (Economics), receives National Science Foundation grant to study disability insurance use and the role of social interaction effects
The two-year project aims to measure the magnitude of social interaction effects in DI use among neighbors, i.e. the extent that DI use among one`s neighbors affects one`s own decision to enter disability. Dr. Votruba is joined on this project by Co-PI Mari Rege (PhD, Economics), a colleague in the Economics Department at Weatherhead School of Management. The researchers will take advantage of a comprehensive longitudinal dataset (employment, socioeconomic, geographic, and program participation information for every person in Norway since 1992) to implement a novel instrumental variables strategy. Under this strategy, the magnitude of social interaction effects will be estimated using the relationship between past employment shocks and the current DI participation rate in a neighborhood. For more information about this study, please contact Dr. Votruba at mark.votruba@case.edu.

Patrick K. Murray, MD, MS, Receives the Prestigious 2004 Sydney Licht, MD Award
Patrick K. Murray, MD, MS, Co-Director of the Center`s Program on Research and Education on Aging, will receive the prestigious 2004 Sydney Licht, MD Award for Article of the Year on September 10th at this year`s annual meeting of the American Congress of Rehabilitation Medicine in Ponte Vedra Beach Florida. The paper, entitled: "Outcomes of rehabilitation services for nursing home residents", was published in the August 2003 issue of the Archives of Physical Medicine and Rehabilitation along with other Center faculty and staff Mendel Singer, Charles Thomas, Neal Dawson, and Randall Cebul. Congratulations Pat!

QRU Faculty Scholars Program Wins National Association of Public Hospitals` Quality Improvement Award
On June 24, 2004, Ethel Smith, M.D., Director of the Center`s Quality Resource Unit (QRU), received an NAPH 2004 Honorable Mention award for the QRU`s Faculty Scholars Program. Since 1999, the QRU has conducted quality improvement training of health care professionals that has led to over 38 projects to improve the processes and outcomes of care for MetroHealth`s patients. Joining Dr. Smith at the NAPH National meeting were Sandra Amin, RN, who co-directs the QRU, and Steve Zepp, QRU`s Project Manager. Congratulations!

Irene Katzan, MD, MS, Receives AHA`s Distinguished Achievement Award
The American Heart Association Ohio Valley affiliate honored Center member Irene Katzan, M.D., M.S., on June 9th with it`s Distinguished Achievement Award for her leadership in the American Heart Association`s Get with the Guidelines - Stroke program. The hospital-based program has demonstrably improved acute stroke treatment and uses care protocols to prevent future strokes in northeast Ohio. Dr. Katzan also leads the regional Stroke Outcomes Research Program, housed at the Center.

Center Faculty Receive Awards for Teaching Excellence
Congratulations both to Thomas E. Love, Ph. D., and Douglas Einstadter, M.D. M.P.H., whose teaching contributions at the School of Medicine were recognized. Both received awards for "Best Contributions" by the SOM Teaching Excellence Awards Committee in this first year of the annual awards process. Dr. Love`s award is for his contributions and teaching of Biostatistics in the post-doctoral Clinical Research Scholars Program; Dr. Einstadter was recognized for his leadership and teaching in Fundamentals of Medical Decision Making, in the School`s Core Academic Program. Well deserved recognition - congratulations!

Center Faculty Present Northeast Ohio Stroke Research in Europe
On May 2-4, 2004, Dr. Irene Katzan participated as an expert panelist at a two-day International Expert Meeting on Best Practices in Stroke Management in Hamburg, Germany, sponsored by the Bertelsmann Foundation. The goal of the Expert Meeting is to identify and bring together best practices for stroke care throughout the world. On June 8, Dr. Randall Cebul presented two papers focusing on stroke care at the meetings of the European Society for Medical Decision Making in Rotterdam. Representing co-authors Drs. Patrick Murray and Neal Dawson, Dr. Cebul presented work describing the effectiveness of stroke rehabilitation in Ohio`s nursing homes; and, with Dr. Mark Votruba, the potential consequences of using volume-based hospital referral guidelines for patients with stroke in northeast Ohio.

Dr. Julia Hannum Rose Receives $2.2 Million from the National Cancer Institute to study "Aging and Supportive Care in Advanced Cancer," and an additional award of $560,000 from the Department of Veterans Affairs
This 5-year randomized control trial examines the effect of a coping and communication support (CCS) intervention for advanced cancer patients and their family members over a period of time when goals of care are expected to shift. Trained CCS practitioners will be continuously available to patients and their family caregivers to assist with coping and communication challenges as they arise. Clinical sites for the study include MetroHealth Medical Center and the Cleveland Veterans Administration Medical Center, CASE-affiliated medical centers with missions to serve low-income and other underserved populations. Dr. Rose is Associate Professor of Medicine and Oncology at CASE, Co-Director of CHRP`s Program of Research and Education on Aging (PREA), and Director of the Western Reserve Geriatric Education Center (WRGEC). Results of these combined studies will be disseminated in WRGEC-sponsored interdisciplinary training programs for health care professionals who provide care for cancer patients and their caregivers. For more information about this study, please contact Dr. Rose at jrose@metrohealth.org.

Katzan a "Lady in Red"
Center member Irene L. Katzan, M.D., M.Sc. was a featured "Lady in Red" in the February, 2004 issue of Cleveland Magazine. The magazine partnered with the American Heart Association to highlight February`s "Go Red for Women" campaign to make women more conscious of their risks for cardiovascular disease and stroke. Irene leads the citywide Stroke Outcomes Research Program and has been a leader in Northeast Ohio`s Operation Stroke for more than 5 years.

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