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MacLean Center for Clinical Medical Ethics For the past twenty years, under the direction of Dr. Mark Siegler, faculty at the MacLean Center for Clinical Medical Ethics have been national leaders in conducting and publishing sponsored research that integrates empirical clinical data and ethical analysis. This research has focused on ethical aspects of pediatric and adult intensive care outcomes, end of life care, the doctor-patient relationship, organ transplantation, medical errors, and the teaching of ethics and medical professionalism. This research has been published in leading medical journals and in the more than twenty books authored by MacLean Center faculty. . In addition, since 1981, the MacLean Center has organized twenty interdisciplinary faculty seminar series that examine issues at the intersection of medicine, ethics, and public policy. Each year-long seminar series meets twenty times and is attended by University faculty from medicine, law, economics, business, social sciences, history, and public policy. In recent years, the seminar series topics have included "Quality and Cost of Health Care", "the Doctor-Patient Relationship", "Social Determinants of Health and Disease", "Disparities and Discrimination in Health Care and Health Outcomes", and "Pharmaceutical Innovation and Regulation." Diabetes Outcome Research Program Faculty in the Section of General Internal Medicine are national leaders in diabetes health services research. Investigators aim to develop and evaluate ways to improve diabetes care and prevention in real-world settings, particularly among vulnerable groups such as African Americans, indigent patients in community health centers, older adults, and minority children. The University of Chicago has one of six NIH Diabetes Research and Training Centers, and section faculty play leadership roles in the Prevention and Control (P & C) Core. The University of Chicago P & C Core takes the view that the patient, provider, health care system, and social system factors affect the quality of diabetes care and patient outcomes, and thus each of these elements must be targeted to maximize the chances of improving care. In addition, as patients grow from children to adolescents to adults to older persons, each developmental stage of life brings specific issues and challenges that must be addressed to optimize health outcomes. The University of Chicago P & C Core draws upon a longstanding history of innovation in educational and behavioral interventions, special strengths in community-based participatory research through collaborations with a consortium of Midwestern community health centers and local Chicago partners, and the unique strengths of a university with world-class strengths in the social sciences and biomedical sciences relevant to diabetes care. Major areas of interest for section researchers include:
The faculty members from the Section of General Internal Medicine who collaborate on diabetes research projects include Marshall Chin, Deborah Burnet, Elbert Huang, David Meltzer, and Lorrie Elliott. Hospitalist Program The Hospitalist Program at The University of Chicago, under the direction of Dr. David Meltzer, focuses on clinical care, quality improvement, research, and medical education relating to the inpatient general medicine services. At the core of the program are its hospitalist physicians, internists who focus their clinical and other academic interests on issues relating to hospital care of general medicine patients. The Section of General Internal Medicine began its hospitalist program in 1997, making it one of the earliest programs of its type in the nation. Clinical Care: Hospitalist physicians are physicians who spend the majority of their clinical time engaged in activities related to the care of hospitalized patients. The rationale for this arrangement is that physicians who spend a larger amount of their time in inpatient care may gain experience with common inpatient problems that will allow them better care for patients and to serve as a resource to assist the hospital in addressing systems issues that can improve the quality of care provided for all patients. Hospitalist physicians care for approximately one sixth of the general medicine patients at The University of Chicago Hospitals. In addition to inpatient service, hospitalist physicians also staff the general medicine consult service, which provides general medicine consultative care for patients hospitalized on surgical and obstetric services. Quality Improvement: A major focus of the hospitalist physicians at The University of Chicago is their involvement in quality improvement activities. Hospitalist physicians chair the General Medicine Service Care Center team, serve on the Pharmacy and Therapeutics Committee that makes hospital formulary decisions, and play important roles in innovation in medical informatics at The University of Chicago Hospitals. Currently, the hospitalists are beginning a multi-year effort to assist the hospital in the implementation of computerized physician order entry. Research: From its inception, the program has been formally evaluated to understand its effects on the quality, outcomes, and cost of care. Results of that evaluation we have published in the Annals of Internal Medicine have shown some improvements in the cost and outcomes of care, and provided insight into the role of clinician experience in generating those improvements. Research concerning our hospitalists and inpatient general medicine service has been supported by internal sources as well as outside support from the Charles E. Culpeper Foundation, the Academic and Managed Care Forum, the Robert Wood Johnson (RWJ) Foundation, the Agency for Healthcare Research and Quality (AHRQ), the Reynolds Foundation, and the Accreditation Council for Graduate Medical Education. Major current research activities include:
Medical Education: Hospitalist physicians are highly rated and influential teachers on the general medicine service. They also play important roles in teaching physicians in training about how they can become more skilled in learning from the opportunities for improvement they see during their inpatient rotations and translating those observations into improved care. Hospitalists also play important roles in teaching medical students, residents, and other students about research. The faculty members from the Section of General Internal Medicine who play key roles in the Hospitalist Program include David Meltzer, Chad Whelan, David Lovinger, Elmer Abbo, and Vineet Arora (Fellow). For more information on the Hospitalist Program, e-mail jbarrera@medicine.bsd.uchicago.edu or call (773) 702-5035. General Internal Medicine Research Faculty and their Interests: Deborah Burnet MD, Associate Professor of Medicine Dr. Burnet conducts research on obesity and risk of type 2 diabetes in youth. Traditionally considered an “adult” disease, type 2 diabetes is becoming more prevalent among children and adolescents as rates of obesity steadily rise. Obesity and type 2 diabetes are both disproportionately found among minority youth in the U.S. Dr. Burnet has conducted focus groups with African-American children and families on Chicago’s South Side to assess community habits and preferences regarding nutrition and exercise behaviors. She has used these insights to develop and implement REACH-OUT, a community-based, family oriented program to decrease overweight and risk of type-2 diabetes among African-American youth. This study follows outcomes for children and their parents, including body habitus, glucose tolerance, and nutrition and exercise behaviors. Plans are underway to extend the scope of this study, and to implement similar programs in local schools. Caleb Alexander MD, Instructor of Medicine G. Caleb Alexander is a general internist and health services researcher at the University of Chicago. His research combines the fields of medical ethics, health policy, and clinical medicine to examine contemporary aspects of clinical decision-making and health care resource allocation. Dr. Alexander's earliest work examined barriers to the equitable allocation of transplantable organs. He remains actively involved in this area and most recently has helped to design and disseminate process of care measures across dialysis facilities as part of a multi-state effort to improve kidney allocation. A second focus has been to examine patient-physician communication and physician decision-making. During his fellowship as a Robert Wood Johnson Clinical Scholar, Dr. Alexander designed and executed a regional study of patient and physician experiences discussing out-of-pocket costs. This project has led to a follow-up national study focusing on physicians' experiences addressing patients' out-of-pocket prescription costs. In addition to these efforts, a final area of research has employed survey-based methodologies to examine contemporary challenges to physician professionalism and the changing nature of the patient-physician relationship. These examinations have included studies analyzing public and physician support for the deception of insurance companies, physicians' preparedness and beliefs in a duty to treat in the setting of bioterrorism, and physicians' attitudes and experiences with retainer or "boutique" clinical practices. Anirban Basu M.S. Ph.D, Instructor of Medicine Anirban Basu is a health economist who holds a master's degree in Biostatistics from the University of North Carolina, Chapel Hill and a PhD in Public Policy with Health Economics concentration from the University of Chicago. Dr. Basu's research interests are in cost-effectiveness of medical interventions, decision analysis methodology, health econometrics and applied health services research. Dr. Basu has keen interests in the theoretical and empirical foundations of cost-effectiveness analyses and the value of information analyses. He has substantial experience in these topics in the context of prostate cancer and schizophrenia. Dr. Basu has also worked extensively on the econometrics of modeling costs data and has published several papers in this area. Marshall Chin MD, Associate Professor of Medicine Dr. Chin’s research focuses on improving the care of vulnerable patients with chronic disease. He is funded by the Agency for Healthcare Research and Quality (AHRQ) and Robert Wood Johnson Foundation to improve the quality of diabetes care in community health centers that serve the indigent. This multifactorial, community-based intervention includes rapid quality improvement, chronic disease management, provider training in behavioral change, and patient empowerment interventions. In addition, Dr. Chin is performing the national evaluation of the Bureau of Primary Health Care’s Health Disparities Collaborative. Dr. Chin also focuses on geriatrics issues, and he is funded by the National Institute on Aging to assess the treatment preferences of older patients with diabetes. He uses chart review, survey, Medicare claims analysis, utility assessment, and qualitative methods in his research. He is a member of the AHRQ Health Care Quality and Effectiveness Research Study Section. Farr Curlin, MD, Instructor of Medicine Dr. Curlin’s research focuses on the intersection of religion and medicine. His current research particularly examines the ways that patients and physicians understand and address religion in the context of illness, and the ways religion shapes physicians’ practice patients’ experiences. He is conducting a national study of physicians’ religious characteristics and of physicians’ attitudes and behaviors related to religion and spirituality in medicine. Recent projects have included studies of the unique characteristics of faith-based health centers serving poor communities. Finally, Dr. Curlin is studying the moral questions raised by the intersection of religious commitments and a secular profession. Elbert Huang, MD, Assistant Professor of Medicine Dr. Huang’s main research focus is in the area of medical decision
making for elderly patients with type 2 diabetes. The issue of how
to individualize the goals of diabetes treatments for elderly patients
based on clinical parameters and patient preferences has yet to be
formally evaluated. Dr. Huang is funded by the National Institute
of Aging to develop a simulation model of type 2 diabetes specifically
designed for elderly patients and to evaluate the impact of patient
heterogeneity on the effectiveness and cost-effectiveness of varying
levels of glucose control. In a concurrent study funded by the Centers
for Disease Control, the preferences of diabetes patients regarding
the various elements of diabetes care and the wide range of potential
complications are being collected among patients of different ethnicities
in 2 Chicago locations. Finally, Dr. Huang is leading efforts in the
evaluation of the costs and cost-effectiveness of Bureau of Primary
Health Care’s Health Disparities Collaborative, a national quality
improvement program for the nation's federally-funded community health
centers. Christopher Masi, MD, PhD, Assistant Professor of Medicine Dr. Masi’s primary research interest is in health disparities by ethnicity and socioeconomic status. As part of the University’s Center for Interdisciplinary Health Disparities Research, Dr. Masi is working with faculty from the School of Social Service Administration, the Department of Psychology and the Section of Hematology/Oncology to identify causes of ethnic differences in breast cancer mortality. Center colleagues from Hematology/Oncology have demonstrated that stress hormones can induce important changes in breast cancer cells, including increased resistance to chemotherapy-induced apoptosis. Utilizing focus groups among a population-based sample of healthy volunteers, Dr. Masi and colleagues are assessing community perceptions of breast cancer and its possible causes. Surveys of breast cancer patients regarding stress and social isolation as well as salivary assessment of stress hormones will also be used to complement and inform the Center’s multi-faceted approach to health disparities research. David O. Meltzer, MD, Ph.D., Associate Professor of Medicine Dr. Meltzer's research explores problems in health economics and public policy. A major area of emphasis is the theoretical foundations of medical cost-effectiveness analysis, which he has explored primarily in the context of diabetes and prostate cancer. Another major area examines the effects of managed care and medical specialization on the cost and quality of care, especially in teaching hospitals. He is currently principal investigator for a large multicenter study of the effects of hospitalist on the cost and quality of care that is funded by the Agency for Healthcare Research and Quality. Other work examines the role of mortality decline in the economic growth and the demographic transition of developing countries; the effects of prospective payment systems on the cost and quality of care, and the effects of FDA regulation on innovation in the pharmaceutical industry. Meltzer has served on a panel examining the "Future of Medicare" for the National Academy of Social Insurance, a panel examining U.S. organ allocation policy for the Institute of Medicine, and on the steering committees for the Health and Retirement Survey and for the Medical Expenditure Panel Survey. He is also a Research Associate of the National Bureau of Economic Research.
Dr. Mohr’s interests involve building a series of collaborative relationships around improving the safety and quality of health care through teaching, research, and clinical improvement. Current research projects at the University of Chicago Hospitals include a study of pediatric congenital heart disease surgical patients which is funded by the American Heart Association. This is an observational study of all medical team members in and around pediatric cardiac surgery. The purpose of this study is to focus on positive and negative factors that play a part in medical outcomes and to learn to improve the current medical environment. Another study, funded by AHRQ as part of the University of Chicago’s Developing Center of Patient Safety, is using focus group methodology to understand communication patterns during patient hand-off from inpatient care to the primary care physician. Building on Dr. Mohr’s previous research on how clinical microsystems function, she has designed an opportunity to assess the effectiveness of “academic clinical microsystems” in training physicians. In addition to research within the University of Chicago, Dr. Mohr is the PI of an AHRQ funded study of medical errors in ambulatory pediatric settings. This project is being conducted in conjunction with the American Academy of Pediatrics and the Pediatric Research in Office Settings (PROS) Network. Dr. Mohr is a member of the Board of Examiners for the Malcolm Baldrige National Quality Award and is an Associate Editor of Quality and Safety in Health Care. Mark Siegler MD, Professor of Medicine In the 1970’s, Dr. Siegler pioneered in developing clinical medical ethics, a field which examines the ethical aspects of clinical medicine. His research has studied how empirical clinical data can be integrated with ethical theory to study such issues as end of life care, informed consent, medical error, outcomes in intensive care, and organ transplantation policy. In recent years, he has focused on ethical issues in clinical research (with a special emphasis on immune tolerance), in living donor liver transplantation, and in the doctor-patient relationship and medical professionalism. His research has been supported by the NIH, the Robert Wood Johnson Foundation, the Henry J. Kaiser Family Foundation, the Pew Charitable Trusts, and the Andrew W. Mellon Foundation. Dr. Siegler has written or co-authored more than 170 peer-reviewed articles, fifty chapters, and five books. His latest text, co-authored with Drs. A. Jonsen and W. Winslade and widely used by health professionals in the United States and Europe, is Clinical Ethics: A Practical Approach to Ethical Decisions in Clinical Medicine, 5th Edition, 2002. In 1992, Dr. Siegler’s research contributions were recognized by his election to the Association of American Physicians (AAP). Ben Van Voorhees, MD, Assistant Professor of Medicine The focus of Dr. Van Voorhees research is the development and implementation of feasible primary care based depression prevention interventions for adolescents and young adults. Project CATCH-IT, Competent Adulthood Transition with Cognitive, Humanistic and Interpersonal Teaching, is a combined primary care/web-based depression prevention intervention developed by Dr. Van Voorhees and collaborators. Depression prevention interventions during the transition to adulthood could reduce the long-term morbidity, personal suffering, and social costs associated with depression. Cognitive Behavior Psychotherapy (CBT) and individual Interpersonal Psychotherapy (IPT) reduce the incidence of major depression in adolescents or recurrent depression in adults, respectively. However, stigma and negative attitudes with regard to face-to-face psychotherapy may make many promising interventions unacceptable to at-risk individuals who use only primary care services. Self-directed psychotherapy (using books or internet sites) can reduce depression symptoms, but most individuals in community settings lack the motivation to complete such programs independently. Project CATCH-IT incorporates access to the at-risk population in primary care, motivation for participation provided by the physician, and low cost of delivery and acceptability of web-based education in this age group. To realize the goal of primary care based depression prevention, we are planning the a series of studies: (1) a randomized controlled trial of primary care based depression prevention intervention, (2) an analysis of a longitudinal, observational study to determine the social and economic costs of a depression episode in adolescence, (3) development of a cost-effectiveness model for depression prevention, and (4) construction of a risk prediction index for identifying those most likely to progress to major depression. |
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