Brian Zikmund-Fisher, PhD
Ellen G. Engelhardt, PhD
Deputy Editor
by Brian Zikmund-Fisher , PhD; University of Michigan

One of my wishes for the SMDM Newsletter is to use the platform as an opportunity for people to share not just their knowledge but their beliefs, concerns, and passions. SMDM includes many amazing people, and I believe that each of us has important things to say to each other and to the world. I encourage all members to share their perspectives on issues that affect us individually and collectively, even if those issues are not about research or society business.

It was in that spirit that I replied to SMDM President Heather Taffet Gold’s first draft of her note for this issue of the Newsletter. Heather had provided a helpful, yet straightforward, summary of Board activity. While I was glad for the updates, I replied to her that she should feel free to use the President’s letter as a platform for whatever topics she wanted to discuss with the membership if she wished to do so. I was pleased when she took me up on that offer.

Readers can find a Board Update from the President note later on in the newsletter. However, President Gold’s letter to the membership is titled “It Starts with Me: Understanding and Addressing Inequities.” In it, Heather talks about her interest in learning about diverse perspectives, provides many excellent suggestions for reading or listening, and expresses clearly how improving our understanding of people’s different perspectives can have important implications for data analysis, use of terminology, and mentoring other scholars. I encourage everyone to read it and reflect on it.

Personally, I want to say two things about President Gold’s letter. First, I am grateful to Heather for her leadership on issues of diversity and inclusion. I am honored to serve as co-chair of the Special Committee on Conduct and Inclusion that is operating this year under her guidance. I am also thankful for the way she and her words prompted me to reflect on my own many privileges. While some of my privileges are commonly discussed (e.g., my gender and skin color), others are rarely noted yet nonetheless impactful (e.g., my height). It is also part of my privilege that much of my perspective is often the default in the world. I value being reminded to make the effort needed to try to see the world as others do.

Second, I want to state clearly as editor of this Newsletter that discussions of complicated and perhaps controversial topics such as diversity are not only acceptable but necessary for our society. I encourage any member wishing to write a commentary to the SMDM membership about an issue to contact me at any time.

The current issue of the SMDM Newsletter also includes:

  • President Gold’s update on activity by the SMDM Board

  • I present the results of the Winter Poll, which looked at perceptions of reproducibility of MDM science and attitudes regarding open science.

  • Fernando Alarid-Escudero, Rowan Iskandar, and Thomas Trikalinos discuss the value of mathematical policy models for situations where relevant evidence is incomplete or inadequate.

  • Joanna Siegel identifies some critical knowledge gaps that exist in our knowledge of shared decision making and our ability to support it in practice.

  • Lastly, Mark Liebow provides his update on news you can use in the health policy space.

Deputy Editor Ellen Engelhardt suggested the idea behind this issue’s Spring 2019 Scientific Issues in MDM Poll, which explores value of international research collaborations and the key barriers that researchers in our field face that may be limiting such collaborations. Please click the link below and share your thoughts, regardless of whether you have many international collaborations or have no interest in such. As you all know, the data are way more interesting when we have a larger sample size, so please participate!

Heather Taffet Gold, PhD
It Starts with Me:
Understanding and Addressing Inequities
by Heather Taffet Gold, PhD; New York University School of Medicine

I’ve been thinking a lot about privilege, the advantages I have merely because of where I was born and the color of my skin. We each have unique life experiences and different advantages and disadvantages that affect how we move through the world and interact with others. By listening to varying perspectives, particularly from people from historically marginalized groups, we can become better leaders and researchers. We can become more understanding, respectful, and compassionate in relation to our colleagues, friends, and strangers. In turn, this understanding can expand our view of the world, sometimes highlighting problems to address in our research or workplace. Others’ voices can inform decisions and interactions in both subtle and direct ways.

I would like to share several approaches I use to gather and absorb new viewpoints, including reading books and articles, listening to podcasts, and following thoughtful people on Twitter. I will note that the onus is on me to understand how people perceive and experience the world – sometimes in unique, and other times in universal, ways – rather than expecting someone will teach me directly. And I am fortunate in that I do most of this during my commute, so it is relatively easy to fit into my schedule.

First off, I highly recommend the book, So you want to talk about race , by Ijeoma Oluo. In it, Oluo examines issues of race in the United States in a simple, practical, and straightforward manner, giving the reader tools for thinking about and confronting racism in our lives. Ta-Nehisi Coates’ Between the World and Me speaks to issues of race in the United States, discussing his life experience with racism, both the personal and the national legacy of racism. Next on my to-read list is How Does It Feel to Be a Problem?: Being Young and Arab in America by Moustafa Bayoumi, stories of seven mostly Arab Muslim people in their twenties living in Brooklyn, New York, in the post-9/11 era. Reading realistic and historical fiction also has provided insights for understanding the problems of bias, prejudice, and racism by leading me through the experiences of characters facing these issues. Examples include Americanah by Chimamanda Ngozi Adichie, The Inexplicable Logic of My Life by Benjamin Alire Sáenz, and Girl in Translation by Jean Kwok.

I also have a list of podcasts so that I can soak up voices while on my walk or train ride. Most are about 30-minutes long and from National Public Radio in the U.S.: Nancy (LGBTQ issues), Code Switch (race/ethnicity issues), See Something Say Something (Muslim issues), United States of Anxiety (gender and power), and The Broad Experience (women in the workforce). I am sure there are many others in this sphere that are relevant for other cultural contexts (e.g., outside the United States).

Finally, I look at Twitter, with a primary purpose of seeking out different perspectives from insightful “tweeters”, even if I only “lurk” and do not post. (Note I also use Twitter for learning of scientific and policy issues.) Even if I do not agree with a Twitter post, and when it is uncomfortable to read untold examples of and responses to racism, sexism, homophobia, and prejudice of all varieties, I try to take a moment and reflect on how I feel and react, and then learn from those voices (as long as it’s not the voice of a troll). By intentionally reaching out and becoming aware of different viewpoints, I believe I have begun to feel more compassion for the life experiences of others. I have gained more understanding of people living at the intersection of multiple social categorizations, that is, those who are multiply oppressed or marginalized due to their association with multiple groups (e.g., queer and disabled, woman and black and Jewish).

I believe that the work and time I put into delving into these topics enriches my research and my thinking in work and everyday life. When I analyze a large, secondary dataset, I think about how the “race” and “ethnicity” variables were defined: who determined the race or ethnicity of the patient? Was it self-reported, or did a hospital administrator guess? How could I meaningfully collapse the variable categories, when I must, due to small sample sizes by group? What would broad categories such as “other” or “Asian” represent, and how should I interpret them?

When working with people from disadvantaged groups or studying those with a serious health condition, language matters. Using terms that perpetuate a negative stigma (e.g., “addict” vs. person with an addiction) or define a person merely by their health condition or social identity (e.g., “asthmatic” vs. someone with asthma) is disrespectful, can reinforce stereotypes, and may be offensive to people around us who are not forthcoming about their own condition or social identity.

In academia, as I have begun mentoring more young scientists with backgrounds from traditionally underrepresented groups, I aim to discuss mentorship needs tactfully and directly to make sure these new investigators get the diverse mentorship they desire, both by field of study and social identity. With each voice, tweet, or story, I am reminded of the effects of these issues in people’s lives and therefore the responsibility I have to keep learning and doing better.

My goal of sharing this experience is to encourage others to find and listen to voices different from their own and become even more thoughtful about how we make decisions in the workplace and beyond. Choices that may have seemed devoid of cultural, social, or historical context now may present as sensitive decisions with newly observed subtleties. These could be as simple as how we phrase something or address someone, or as complicated as developing mentoring committees for new investigators or policies to promote diversity and inclusion.

Here at the Society for Medical Decision Making, we have been thinking about these issues, too. We are proud of the gender representation on our Board and have had diverse leadership over the years. Our Special Committee on Conduct and Inclusion is working now to develop recommendations for how to create an ever-more welcoming space at SMDM meetings and in our on-going activities. I hope my ideas here have planted a seed for addressing prejudice and inequity in small and big ways.

Most sincerely,
Heather Taffet Gold , PhD
SMDM President

P.S. - If you are interested in whom I follow on Twitter, please see .
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 or the author's institution.
Brian Zikmund-Fisher, PhD
Results from the Winter 2019 Scientific Issues in MDM Poll: SMDM Members Substantially Concerned about Reproducibility and Interested in Sharing of Data and Materials
by Brian Zikmund-Fisher , PhD; SMDM e-newsletter Editor-in-Chief

The Winter 2019 Scientific Issues in MDM Poll focused on the issue of research reproducibility and members’ thoughts about how these issues apply to our field. We received 52 responses (thank you!) from SMDM members. Of these, about 1/3 reported working in health services / outcomes / policy research and 1/3 in decision psychology / shared decision making, with the rest spread among other areas of SMDM interest.

To start, the issue of replication and research reproducibility is clearly of interest to our respondents: 92% reported having followed reports of issues involving replication / reproducibility in psychology and/or medical science.

We next asked, “to what degree do you believe that there are problems involving replication / reproducibility in the following domains of medical decision making research:” Responses are in the figure below.
Clearly, while most respondents do not believe reproducibility problems are widespread in our field, many people believe there are significant problems in all SMDM subfields. The notable outlier is quantitative methods / theoretical developments, which had significantly (p=.01 or lower in unpaired t-tests) lower concern ratings than the other subfields. Furthermore, about two-thirds of respondents at least slightly agreed with the statement, “journals that publish medical decision making research are biased in favor of publishing studies that ‘worked’ (i.e., significant results in the predicted direction).”

Given this level of concern, it is not surprising that 88% of respondents have a positive attitude towards the concept of open science, and that 78% support the idea that whenever possible SMDM members should make their data, analysis code or even all study materials open (accessible to the public). Finally, 69% of respondents reported some degree of agreement with the idea that journals should adopt “badges” indicating when an article has open data, code, and/or materials.

SMDM is a society deeply interested in high quality research methods, and it is not surprising therefore that our members care about reproducibility and data sharing. Yet, these data suggest that more could be done. I hope you find these data of interest in your discussions! (Survey materials, raw data, and analysis code available upon request.) 
Fernando Alarid-Escudero, PhD
Rowan Iskandar, PhD
Thomas Trikalinos, MD, PhD
Mathematical Policy Models as a Tool to Improve Decision Making in Settings when Evidence is Not Sufficient
by Fernando Alarid-Escudero , PhD
Drug Policy Program, Center for Research and Teaching in Economics (CIDE) – CONACyT, Aguascalientes, Mexico

Rowan Iskandar , PhD
Department of Health Services, Policy, and Practice, and Center for Evidence Synthesis in Health, Brown University, Providence, Rhode Island, USA

Thomas Trikalinos , MD, PhD
Department of Health Services, Policy, and Practice, and Center for Evidence Synthesis in Health, Brown University, Providence, Rhode Island, USA

Ideally, evidence-based policy making requires that policymakers have access to solid evidence of population health benefits and implications for resource allocation when making decisions regarding the comparative merits of a range of policies. In practice, quality and quantity of evidence is far from solid and not enough.

For example, unbiased evidence on disease epidemiology or the long-term effectiveness of prevention and treatment policies is scarce. The main reasons for this are: 1) no randomized controlled trials (for practical or ethical reasons), 2) short follow-up period for observational studies, 3) outcomes of interest are rarely measured, and 4) at best little information on disease prevalence. The aforementioned problems are even more pronounced in the context of low- and middle-income countries (LMIC), especially for diseases where major epidemiological studies and their associated burden were mostly conducted in developed countries.

Mathematical policy models (MPMs) are structured representations of disease processes (e.g., natural history of diseases) at a population level. They may assist policy making when evidence is lacking by 1) assessing the population impact of partially or yet to be observed policies, 2) extrapolating short-term or intermediate outcomes of policies into long-term effects on population health endpoints such as life years saved, or quality-adjusted life years gained, 3) synthesizing data from disparate sources, 4) generating counterfactuals where one or more factors are changed based on a policy to calculate expected benefits, harms and costs in the population of interest, and 5) propagating uncertainty on disease dynamics and the effects of policies on decisions and into the future to assist prioritization of future research.

As part of this year’s SMDM Annual Meeting, we will devote part of the session of the Global Health Interest Group to discuss this topic. If you are interested in issues related to developing and using MPMs in specific contexts, please come and join us in Portland!
Joanna Siegel,
Shared Decision Making:
New Opportunities for SMDM?
by Joanna Siegel , SM, ScD; Patient-Centered Outcomes Research Institute (PCORI)

SMDM members have long been active in the area of shared decision making. SMDM meetings frequently include plenaries and abstract sessions on decision aids or shared decision making (SDM) strategies, as well as delving into SDM components – research on risk perception, methods for preference assessment, and risk prediction tools. SMDM is now offering onsite SDM courses and trainings. Interest appears to be increasing steadily!

In many ways, it appears that the time has come for shared decision making. True shared decision making is, by definition, patient-centered decision making. It facilitates patient choices that reflect individual values and preferences. Moreover, shared decision making is informed decision making. SDM strategies require the presentation of evidence, so that patients are dealing with accurate and relevant information on benefits and harms of treatment or other healthcare choices – with the support of their clinicians and significant others. As such, SDM combines two of the most important goals we have for improving our healthcare practices: improving patient-centeredness and improving evidence-based care.

Despite the increased interest in shared decision making, however, there remain important – huge – gaps in our knowledge and our ability to support it. Among many questions that have not been adequately addressed are:

  • What are the most important opportunities for shared decision making -- preference-sensitive decisions where decision aids and SDM strategies more generally can provide the greatest help to patients?

  • What are the best ways to select and present evidence so that it is relevant and accessible to patients in the context of SDM?

  • How do we implement SDM in routine clinical practice effectively, practically, and reliably? 

  • How can we validly and reliably measure when shared decision making is occurring – and when it is not – and the extent to which it is helping people with their decisions?

  • Who will champion the changes in healthcare policy and delivery that will support a greater, more routine role for SDM across the health system?

SMDM members are widely respected for their scholarship and the rigor of their research. Where we have fallen short, frequently, is in mobilizing the expertise of our membership to have a greater influence on policy. A greater voice comes from understanding what policymakers need – the questions and concerns they have; the evidence, information, and analysis that will address those questions and concerns. With the promise of shared decision making and the broad interest in changing the culture of health care, it’s an opportune moment for us to reflect on the big questions that are impeding the progress of SDM and consider how we, as members of SMDM, can take a more active part in making it a reality.
Mark Liebow,
Not Much Happening in Washington on Health Policy
by Mark Liebow , MD, MPH; Mayo Clinic

Work on health policy issues has been even slower in the first quarter of 2019 than in most first quarters. There are a lot of new legislators trying to find their way in Washington. House Democrats are figuring out how to lead after eight years out of power. The five week partial government shutdown and efforts to deal with the President’s actions, including trying to overturn his national emergency declaration, took up a lot of Congress’s energy.

One of the consequences of the partial shutdown is that the Administration’s budget proposal was delayed by a month. When it came out early in March, it proposed deep cuts in medical research programs (including the absorption of AHRQ into NIH), billions of dollars in cuts to Medicare and to Medicaid, and plans to consolidate graduate medical education funding programs and have them go through the annual appropriations process. Only the Medicare cuts were new.

The proposal, like many Administration budget proposals, was pronounced dead on arrival in Congress, though it will certainly have some influence among Republicans. However, there is bipartisan support for medical research and Congress is quite unlikely to cut most programs, though increases that don’t keep up with inflation are possible.

With the Administration’s budget proposed, Congress can start on its budgeting process, which is typically done in the second and third quarters of a year. Having the House and Senate controlled by different political parties often leads to a budget that doesn’t change much from the previous year though the House is likely to want to spend more on domestic programs than the Senate will.

The sequestration caps that were lifted for two years are due to snap back into place. If the caps are not lifted again, the amount Congress can spend on domestic programs will fall by billions and funding for medical research would likely be affected. It’s not yet clear how much support there is Congress to lift the caps or whether the President would sign a bill to do that.

Scott Gottlieb, MD, recently resigned as Commissioner of the FDA. Ned Sharpless, MD, the head of the National Cancer Institute, will become acting commissioner. At the time this was written, no one had been nominated for the Commissioner position. 
SMDM 41st Annual Meeting
Call for Abstracts and Short Courses
Deadline: Tuesday, May 28, 2019
SMDM is now accepting abstract and short course proposals to be presented at the 41st Annual Meeting in Portland, Oregon. The deadline to submit proposals is Tuesday, May 28, 2019. All submissions will be reviewed and notifications will be sent out in late July 2019.

All health care decisions aim to optimize value; however, value is an elusive construct. First, “value” is both a noun and a verb, and it can relate to deeply held beliefs or a mathematical ratio of benefits and costs. The theme “Many Views on Value” rests on the idea that value is a function of the lens through which one sees the world. Inherent in this is an assumption that different stakeholders are necessary to understand the true value of any health care intervention. Members of SMDM are the academic leaders in understanding multiple stakeholder perspectives and in calculating value. The 2019 Annual Meeting aims to unite the robust behavioral science on perspectives with the rigorous analytical science of value.

Meeting co-chairs: Karen Eden , PhD, Carmen Lewis , MD, MPH and Dan Matlock , MD
Heather Taffet Gold, PhD
Board Update from the President:
SMDM Initiatives are Blooming!

by Heather Taffet Gold, PhD ; New York University School of Medicine

In the Northern Hemisphere, our thoughts are turning to Spring. Recently I woke and took the dog for her walk just before dawn, thrilled to hear the birds chirping and feeling hopeful for some warmer weather and exciting plans to blossom. For the Society for Medical Decision Making, we are in a period of growth, pushing our Strategic Plan (2015-2020) ever forward, sprouting new programs and initiatives.

As many of you know, our Executive Director, Jill Metcalf , now is focused almost entirely on strategic initiatives, leaving most administrative duties to our management company, PMA. This allows her to concentrate her time on building strategic relationships and fundraising. Jill works closely with the SMDM Board and membership to identify and develop opportunities to achieve our three strategic objectives: 1) support increased international growth and influence, 2) increase our engagement with both clinical and health decision-making organizations, and 3) develop and promote SMDM’s expertise in patient and public engagement.

In last Fall’s newsletter, our Past President, Uwe Siebert , announced two exciting new initiatives: the SMDM Fellowship in Medical Decision Making funded by the Gordon and Betty Moore Foundation, and the SMDM Onsite Training Program funded by the Hess Foundation. These innovative programs are now blooming.

Fellowship in MDM: We received 55 applications, including 18 from outside the United States/Canada. The review and selection committee, led by Scott LaJoie , has started evaluating applications, and we expect an announcement of fellowship recipients in April 2019. The goal of this new fellowship is to build and support a cohort of future leaders in decision sciences who will focus on research, practice, and health policy. The Fellowship provides three years of support to clinical research fellows, late-stage doctoral candidates, and post-doctoral fellows with a commitment to health decision sciences, with priority given to those who have financial barriers to their ongoing engagement in SMDM. We appreciate the leadership of Beate Sander , Ava John-Baptiste , and Mary Politi , and funding from the Gordon and Betty Moore Foundation to get the program established.

SMDM Onsite Training Program: Thus far, we have had 17 requests for this new program, which would focus on training healthcare providers in effective clinician-patient communication and shared decision making. These requests have come from all over the world. As of the newsletter deadline, one course is confirmed for mid-April 2019 at MD Anderson Cancer Center in Houston, Texas, USA; six others are in the planning stages. We sought funding for this program given the many conversations with SMDM meeting attendees and members who wanted to bring SMDM short courses to sites to provide an introduction to or continuing education in medical decision making. James Stahl , Hilary Bekker , Margaret Byrne , Beate Jahn , Jane Kim , and Beate Sander are on the Oversight Committee, and Jill Metcalf is driving the exploration and plans for planting the courses around the globe.

I am pleased to share other items related to the Strategic Plan that are germinating.

Patient Engagement: We are actively seeking funding to train patient reviewers for the SMDM journals and create materials that can be used by other journals interested in training patients to serve as reviewers. We also are excited to see what recommendations are proposed by the SMDM Special Committee on Patient and Stakeholder Engagement. That committee has formed and developed its scope of issues to address.

International Growth: Our updated Annual Meeting webpage includes new information for international travelers to our October 2019 meeting in Portland, Oregon, USA. Representing our concern that the US travel ban could affect potential meeting presenters, we are researching approaches to accommodating people who are unable to obtain US visas, such as remote presentations. SMDM is committed to international participation and has registered the 2019 Annual Meeting with the U.S. State Department, which should facilitate visa processing for international attendees. Please see this page for more information and contact the SMDM office if you foresee any travel issues.

With best wishes for a fruitful season,

Heather Taffet Gold , PhD
President, SMDM 
The i-HOPE Study: Top Research Priorities for Hospital Care

SMDM member Negin Hajizadeh, MD, MPH, served as the SMDM representative for the i-HOPE Study, which partnered a group of Society for Hospital Medicine hospitalist researchers with a variety of patient, caregiver, and stakeholder organizations to develop a list of research questions to improve care of hospitalized patients.

The i-HOPE Study team has summarized the resulting priority research questions and is sharing the results with the medical decision making community.

Learn more about the i-HOPE Study and priority research questions by clicking the blue button or by visiting the i-HOPE Study website.
Call for Regulations Committee Chair and Members

The SMDM Regulations Committee, as defined by SMDM Regulations, is a fact-finding and advisory committee on matters pertaining to the Regulations. The committee is currently chaired by John Clarke , MD, and meets on an ad-hoc basis to review Society Regulations and to consider amendments to the Regulations. The committee seeks additional members as well as a chairperson to succeed John Clarke. Experience with bylaws would be helpful. If you are interested in serving on the committee as a member or chairperson, please e-mail Trevor Scholl with your interest at .
Latest News From Your Fellow Members
Researchers at the University of Massachusetts Medical School - Baystate just published a study examining whether the use of Shared Decision-Making affects patients’ perceptions of blame and liability as well as trust in physician. Participants were randomized to vignettes with varying degrees of Shared Decision-Making, with all vignettes having an adverse outcome, a case of missed appendicitis. The participants who received vignettes with Shared Decision-Making rated their physicians better and had higher trust in those physicians, despite the adverse outcome. The use of Shared Decision-Making decreased the odds of a participant initiating a lawsuit by 80%.

Elizabeth M. Schoenfeld , MD, MS is an Assistant Professor in the Department of Emergency Medicine at the University of Massachusetts Medical School – Baystate, Springfield, MA, and a Research Fellow at the Institute for Healthcare Delivery and Population Science at Baystate Medical Center, Springfield, MA. ( )

Marc Probst , MD, MS is an Assistant Professor in the Department of Emergency Medicine at the Icahn School of Medicine at Mount Sinai, New York, NY.

Kathleen M. Mazor , EdD is a Professor in the Department of Medicine, University of Massachusetts Medical School, and Associate Director of the Meyers Primary Care Institute.
Danny van Leeuwen's patient/caregiver activist work currently focuses on men caregivers and making doctor visits more satisfying for all caregivers, the transition from pediatric to adult medicine for young adults with complex conditions, managing pain in this opioid crisis environment, and putting the patient into patient-facing clinical decision support. I'm now communicating my advocacy content through my blog, a new podcast, and my YouTube channel. These past few months I've participated in a National Academy of Medicine initiative, 'Generating Support and Demand for Health Data Sharing, Linkage, and Use.' I'm preparing for presentations at the Compassionate Care Coalition of California and the Aging in America conference in New Orleans. Check out my blog, podcast, and website at . ( )
The CDC periodically posts "I Am CDC" videos that profile the work of selected staff. Scott Grosse's video was featured on the CDC homepage from mid-January to mid-February and is archived on YouTube. In the brief video I discuss collaborating on various research studies that evaluated newborn screening for critical congenital heart disease, prior to, during consideration, and after implementation of public health screening policies. The last study mentioned was published in JAMA in December 2017 and in July 2018 it received a Shepard Award for outstanding CDC scientific publication in the area of Prevention and Control. ( )
Holly Witteman , PhD, Laval University and colleagues published the following paper: Witteman HO, Hendricks M, Straus S, Tannenbaum C. Are gender gaps due to evaluations of the applicant or the science? A natural experiment at a national funding agency. Lancet 2019; 393: 531–40. The paper was the lead article of three research articles accepted in a special issue of The Lancet that had received over 300 submissions from around the world. It was accompanied by a commentary and covered by Canadian (Globe & Mail, CBC, La Presse, The Canadian Press) and international (Agence France Presse, WIRED UK, Forbes) news outlets. The analysis contributed to policy changes at the funding agency. ( )
Rashikh Choudhury , MD, University of Colorado, presented a Markov model for Uncontrolled Donation After Cardiac Death Transplant at the Academic Surgical Congress in Houston. ( )
Douglas McKell , MS, Dartmouth, MSc, LSE, PgC HEOR, Elms College, School of Nursing, MSN & DNP Program, attended a recent (January 2019) 3-day course on Value-Based Health Care at the Harvard Business School supported by a scholarship from Partners Healthcare. This was a case-based seminar with 80 residents and fellows from Mass General Hospital and Brigham & Women's Hospital focused on defining and critically analyzing 6 cases of better healthcare (improved clinical outcomes plus increased patient and provider satisfaction) with higher patient value that, in all examples, also resulted in lower total cost of care. He will be adapting several of the cases for classroom learning by MSN and DNP APRN students in the beginning of their practitioner career.

The challenge to match the right care to the right patient at the right time also needs to include the highest value care with the best long-term outcome. Repeated failure to do so has created gaps in care, mistimed care, overlapping care, misuse, overuse, incorrect use of otherwise appropriate care choices, all resulting in wasted resources and prolonged poor care outcomes for the effected patients. ( )

Expert comment on ORBITA study of a double blind placebo-controlled trial that challenged long-held beliefs about the benefits of stents for patients with stable angina stressing the influence of concepts from behavioral economics to explain the rationalization of the negative results that enabled continued physician use of stents in these patients despite lack of evidence-based medical justification.
What Are You Working On?
Connect and collaborate with your fellow members on their latest projects:

Tanya Bentley , MS, PhD, The Health and Human Performance Foundation , is starting a non-profit research organization in the mind-body medicine space. She is bringing together experts and organizations from around the world who are passionate about mind-body approaches to health, human performance, and well-being. Together, they will study how breathwork, mindfulness, chronobiology, and other mind-body approaches can be used to optimize health, well-being, and physical and mental performance among broad populations and settings. ( )
Palak Patel , MS, PhD, has been working with Grady Health System, Atlanta for the past 4.5 years as a Sr. Application Coordinator in pharmacy. I have a very diverse background. I completed my Bachelors in Pharmacy and Masters in Pharmaceutical Science from India. After coming to United States, I completed my Masters in Pharmacy Administration from the Ohio State University and PhD in Clinical and Administrative Pharmacy through interdisciplinary toxicology program from the University of Georgia. I love doing quantitative research including estimating burden of illness, comparative effectiveness analysis, and cost-effectiveness analysis. I have worked with big databases including SEER, Medicare, and MEPS during my graduate training. At Grady Health System, I use my decision analysis skills learned during my graduate training and work with decision support and drug applications within electronic health record. I have been involved in developing, optimizing, and analyzing Best Practice Advisories that are targeted to healthcare providers. I work with multidisciplinary teams and have been involved in developing medication sections in various disease targeted protocols. I also use decision support within protocols. During this tenure, I have worked on numerous projects including but not limited to building electronic Bedside Prescription Delivery Program, analyzing impact of bedside prescription delivery program on 30 day hospital readmission rates, developing multiple scoring systems to help providers prioritize patients based on various acute conditions, and developing medication shortages dashboard. Recently I gave in-depth talk on drug shortage monitoring dashboard developed at Epic User’s Group meeting, 2018 in Wisconsin. I also presented on implementing automated reminders to notify pharmacists regarding a patient’s discharge status and analysis to show impact of this initiative on reducing hospital readmission rate at Epic User’s Group meeting, 2016. I try to utilize my research background at my current workplace and make my work more interesting. ( )
Douglas McKell , MS, Dartmouth, MSc, LSE, PgC HEOR, Elms College, School of Nursing, MSN & DNP Program, is in the early stages of evaluating and then implementing a course and curriculum approach (multiple action steps) to deliberately increase the clinical decision-making skills of DNP APRN students (2 tracks - Adult/Gerontology or Family Medicine) in the program that he also teaches in. This is a 3 year cohort-based graduate nursing degree and while our students have a current pass rate of 100% on the national certification exams, there is an increasing interest in the need to develop (and access) higher-order cognitive skills that form the majority of their 'real-world' applied practice environment.

Absent the traditional postgraduate residency experience of medical training, but with considerable pre-degree clinical experience (4-10+ years) and degree-required clinical placements (2000 hours), he is interested in embedding a progressive approach to teaching/learning clinical decision-making, especially diagnostic choice under conditions of uncertainty. Any comments, recommendations, and suggestions of assessment tools suitable for measuirng this dynamic process over time would be greatly appreciated. ( )
Student News
Congratulations to our upcoming graduates!

Emily Tucker , PhD in Industrial and Operations Engineering

Expected Graduation Date: May 2020
Area: Applied optimization; Public health
Position Seeking: Academic; government; non-profit research
Advisor: Mark Daskin

Dissertation Title: Modeling Pharmaceutical Supply Chains to Mitigate Drug Shortages

Here are the most recent job opportunities since our last newsletter. SMDM members can stay current on the newest opportunities in the Resources Section of SMDM Connect .
The SMDM Lifetime Contributors list acknowledges the SMDM members who have made contributions to the Annual Fund and acknowledges donations and in-kind donations, received from October 2005 - April 1, 2019. Our heartfelt appreciation goes out to everyone who has supported our Society!
University of Michigan
Deputy Editor
Netherlands Cancer Institute