Health Services Research: Bridging the gap between policy and patients

As the nationwide health care debate roars on, lauded U-M health policy researcher John Z. Ayanian, M.D., M.P.P., reflects on research's role

Not many young doctors step out of their intense training paths to pursue a master's degree in public policy. Yet the laws and regulations made in Washington, D.C., and state capitals deeply affect how doctors and other health professionals care for patients, and how they get paid to do it.

For John Z. Ayanian, M.D., M.P.P., that extra training in the ways of Washington has led to a career bridging the worlds of medicine and policy ---- and trying to improve both through research.

On the horizon: Precision disease management for Crohn's disease

Crohn's Disease (CD), which is estimated to affect nearly 1 million people in North America, can cause a range of debilitating symptoms, including abdominal pain, severe diarrhea, fatigue, weight loss, and potentially permanent structural damage to the intestine. 

Now, a team of U-M researchers led by  Ryan Stidham, M.D., M.Sc., a University of Michigan gastroenterologist, is developing a computer-based tool that could rapidly assess CT scan images, laboratory data, and prior treatment history to help provide a more customized individual treatment plan for anyone with a Crohn's diagnosis, even those living at a great distance from specialty care, and at low cost.

How decision-making habits influence the breast cancer treatments women consider

A new study finds that more than half of women with early stage breast cancer consider an aggressive surgery to remove both breasts. 

Contralateral prophylactic mastectomy ---- a procedure to remove both breasts when cancer occurs in only one breast ---- has become increasingly popular in recent years, with more than 20 percent of patients opting for it. For most women, removing the unaffected breast does not improve survival. "The decision-making process is complicated. We found there are a lot of values that come into play," says lead study author Sarah T. Hawley, Ph.D., M.P.H., professor of internal medicine at U-M's Medical School.

How cardiac ICU patient composition is changing over time

The cardiac intensive care unit is  no longer a place only for patients recovering from heart attacks, like the coronary care units of decades past. A new U-M study finds slightly more than half of heart patients are admitted to the CICU for noncardiac conditions, such as sepsis or renal failure, rather than for a heart condition.

"It's useful to understand what types of patients are now getting admitted to the ICU to ensure that all staff, from nurses to respiratory support to physicians, are appropriately trained to manage them," says co-author and IHPI member Michael Sjoding, M.D., M.Sc., an assistant professor of internal medicine and pulmonologist at Michigan Medicine. The study was recently published in Circulation: Cardiovascular Quality and Outcomes.

The Great Health Divide

Life expectancy for women in the United States is 81 years. Men average 76 years. So why do men live five years fewer than women?

"Gender differences in mortality are mainly behavioral, and thus preventable, as they are learned in society and manifested in high-risk behaviors," said Shervin Assari, M.D., M.P.H., a U-M research investigator who explores how gender, race and socioeconomic resources influence health. He has pored through several national surveys to identify health disparities among men and women, whites and blacks, rich and poor. His findings, which have been published in nearly 200 journal articles over the past decade, help shape how society looks at health.

More headlines

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The Institute brings great minds together to address healthcare's biggest challenges. More than 500 investigators come to IHPI from U-M's top-ranked schools of medicine, nursing, public health, engineering, social work, law, business, and public policy, among others, as well as members of affiliated local research organizations.
New CDC funding for U-M Injury Center probes solutions to the opioid epidemic and injuries nationally

"Injury is the leading cause of death for people from 1 year old to 44 years old, with opioid overdose surpassing motor vehicle deaths in our state and across the nation," says Rebecca Cunningham, M.D., director of the U-M Injury Center and professor in the Department of Emergency Medicine and the Department of Health Behavior and Health Education. The U-M Injury Center is one of only 10 nationwide funded by the Centers for Disease Control and Prevention that focuses on creating cutting-edge injury science and initiatives to prevent injuries.

At U-M, the center focuses on prevention of prescription drug overdoses, concussion, youth violence, motor vehicle crashes, sexual violence, falls and other injuries. It just received $2.5 million from the CDC to continue its research over the next two years.

Should patients have the 'right to try' untested treatments? They already do

Earlier this month, the Senate unanimously passed the "Right-to-Try" bill that, if enacted, would allow terminally ill patients nationwide access to unproven therapies outside of the existing U.S. Food and Drug Administration clinical trials framework. The legislation would extend "right to try" beyond the 37 states ---- including Michigan ---- that already have such laws in place, and provide a uniform framework for access.

But in fact, such a system already exists. The well-established Expanded Access program offered by the FDA is used to provide treatment to patients outside of clinical trials at U-M and elsewhere. The program allows physicians to apply on behalf of patients for access to drugs and devices that aren't yet ready for clinical trials, or that are in trials that the patients don't qualify for, U-M experts, including Andrew Shuman, M.D., explain.

Taking action: Profile of Dr. Ella Kazerooni

When Ella Kazerooni, M.D., M.S., was a resident, she presented an abstract at an abdominal radiology meeting and caught the attention of a leader in the field. He was impressed by her research and wanted to know if she had decided on a specialty. Kazerooni's response of "chest radiology" garnered a less-than-enthusiastic reaction, she remembers, but she was unfazed. "Most of the action, in terms of impacting public health," she recalls telling him, "is here in the heart and lungs."

This area, to which "the leading causes of mortality in the U.S. can be attributed," is where Kazerooni, now professor of radiology and of internal medicine at U-M, has established herself as an innovator and advocate. In fact, she helped design, initiate and implement one of the nation's most comprehensive studies on lung cancer screening, a disease burdened by misinformation and stigma.

See all upcoming events on our Events page

Families, communities, law enforcement, and correctional facilities struggle with the fallout of addiction, impairment and loss of life. Meanwhile, health systems and clinicians struggle to change clinical practice and implement prevention strategies that can address this epidemic, while state and federal policymakers struggle to identify solutions.

Studying the many complex issues related to opioid overuse and overdose is extremely important in developing policy proposals. The University of Michigan has a number of state and national experts focused on opioid overuse trends, interventions, and policy options, and we are pleased to host several who will enlighten us on this sobering topic.

Opioid Medication Take-Back Event---- September 30

Location: Ann Arbor Pioneer High School, 601 W. Stadium Blvd.
Time: 10:00 a.m. --- 2:00 p.m.

The Michigan Opioid Prescribing Engagement Network (Michigan-OPEN) is partnering with hospitals, community organizations, and police departments around the state to host a medication take-back event in several locations on Saturday, September 30. The Washtenaw County event in Ann Arbor is made possible by Michigan Medicine's Department of Anesthesiology and the Ann Arbor Police Department. These events give people the opportunity to dispose of unused, unwanted, or expired medications safely and without cost. Watch for announcements of other take-back locations throughout the state.


A consortium of more than 100 faculty and staff, including clinician scientists, economists, biostatisticians, epidemiologists and other social scientists from the U-M Medical School and School of Public Health, the Center for Healthcare Outcomes & Policy (CHOP) aims to improve the efficiency of healthcare in the United States by optimizing clinical practice and informing health policy.
The Institute for Healthcare Policy and Innovation is committed to improving the quality, safety, equity, and affordability of healthcare services.

To carry out our ambitious mission, our efforts are focused in four areas:
  • Evaluating the impact of healthcare reforms
  • Improving the health of communities
  • Promoting greater value in healthcare
  • Innovating in IT and healthcare delivery

If you are interested in supporting health services and health policy research at the University of Michigan, click here

IHPI Informs is published monthly by the University of Michigan Institute for Healthcare Policy & Innovation.
U-M Institute for Healthcare Policy & Innovation
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Eileen Kostanecki
IHPI Government & External Relations Director

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IHPI Communications Manager

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IHPI Research & Policy Media Relations Manager
Patrick Cliff
IHPI Associate Director of Development

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