| Current Projects
Reducing Infection and
Mortality after Coronary Artery Bypass Graft (CABG) Surgery in
Michigan
The goal of this study is to assess
variability in the risk of infection and mortality by use of
allogeneic blood transfusion in Michigan Medicare beneficiaries
who underwent CABG surgery from 2003-2006.
Does the University of
Michigan's Claims Management Model Reduce Malpractice Costs?
The aim of this
project, funded by Blue Cross Blue Shield of Michigan Foundation, is
to assess whether the University of Michigan's claims management
model reduces three outcomes: (1) provider costs, (2) the time
between the report of a medical event to settlement, and (3) the
number of claims that enter the court system (as indicated by a
notice of intent to sue).
Translating
Infection Prevention Evidence into Practice (TRIP)
The goal of this project is to identify
facilitators and impediments to translating proven nosocomial
infection preventive methods into practice.
Click
here for a Study Update
Addressing Barriers to Translation for
Treatment of Hypertension
(1) Identify important clinician, organizational and
patient factors that contribute to inadequate treatment of elevated
blood pressure among patients with diabetes; and (2) understand the
relative contributions of these factors in the failure to initiate
appropriate treatment among patients with uncontrolled hypertension.
Infection Risk of
Urinary Collection Strategies
(1) To describe urinary collection device use over time in a
cohort of residents in long-term care facilities and determine the
antecedent and subsequent effects of such use. We will also describe
the extent of regional variation in the United States in the use of
urinary collection devices. (2) To assess the risks, both incident and
recurrent, of urinary tract infection and septicemia by bladder
management strategy (indwelling catheter, condom catheter,
intermittent catheter, or other) in incontinent residents of long-term
care facilities. Hospitalization rates due to urinary tract infection
and septicemia will also be determined. Effect modification by
cognitive skill level of the patient and presence of diabetes mellitus
will be evaluated.
Hospitalists as Emerging Leaders in
Patient Safety (HELPS) Consortium of Southeastern Michigan: Targeting
Few to Affect Many
(1) To identify best practices to prevent important adverse
events and errors in hospitalized patients. (2) To share these best
practices with Consortium members, including an explicit discussion of
both benefits and drawbacks. (3) To facilitate local implementation of
these best practices at each member institution. (4) To determine what
facilitates and what impedes best practice implementation. (5) To
evaluate successes and failures in each hospital’s attempt to
implement selected best practices. (6) To disseminate each
institution’s experience to others both within and outside the
Consortium through the peer-reviewed literature and via local,
regional, and national conferences.
Toward a Safety
Culture: Reducing Nosocomial Infections
The major goal of this project is to implement and evaluate
evidence-based methods for preventing nosocomial infection in the
intensive care units.
Targeting Interventions to Reduce Errors
Form a Development Center for Evaluation and Research in Patient Safety (DCERPS) that will (1) identify creative interventions that enhance patient safety by fostering new interdisciplinary collaboration; and (2) improve patient care by targeting interventions.
Enhancing Patient Safety by Preventing Catheter-Related Infection
Long-term directions for research are to (1) determine the types of problems commonly undermining the safety of patients in hospitals and long-term care facilities; (2) identify evidence-based, cost-effective methods for preventing these problems; and (3) understand and overcome the barriers to implementing the use of appropriate and cost-effective preventive methods.
Supporting Medical Residents: A Study of Medical Mishaps
Develop a model of how personal, professional, and systems factors interact in the production of medical errors.
Translating Infection Prevention Evidence Into Practice The primary aims of this study are: (1) to describe and compare the adoption and diffusion of evidence-based infection prevention practices across different health care systems, including VA and non-VA hospitals; (2) to identify and compare factors that facilitate or impede the adoption and implementation of evidence-based infection prevention practices in VA and non-VA hospitals; and (3) to develop and disseminate portable, deployable, and flexible interventions to facilitation adoption and implementation of proven infection prevention practices in both VA and non-VA hospitals. A secondary aim of this study is to examine the correlation between the adoption/implementation of several selected infection prevention practices and nosocomial infection rates for those facilities that are using a comparable surveillance system.
Recent Projects
Coronary artery bypass graft surgery (CABG)
mortality in men and women and the influence of hospital factors
To examine the association between gender and CABG hospital mortality
using adjustment for hospital volume, clustering within hospitals, and proxies
for socioeconomic status (SES) and geographic proximity.
Enhancing Patient
Safety by Reducing Urinary Catheterization
This project will (1) determine if a catheter stop-order is
effective in reducing the incidence of inappropriate indwelling
urethral catheterization in hospitalized patients; and (2) assess
the clinical and economic consequences of using the catheter
stop-order hospital-wide, if the stop-order is effective.
Which antiseptic solution should we use for vascular catheter site care? This project will determine if vascular catheter site disinfection with chlorhexidine rather than povidone-iodine provides clinical and economic benefits by decreasing infection and increasing patient safety in hospitalized patients.
Collaborative Center for Research
and Education in the Care of Older Adults
(1) Establish Education Advisory Committee. Meet
quarterly, two informal gatherings per year. (2) Deliver 20-hour
geriatrics clinical and teaching skills seminars to 12-16 General
Medicine faculty over two years. (3) Establish ongoing
collaborative relationships between four Lead Geriatrics Educators
(selected from seminar participants) and geriatrics faculty to
develop, integrate, and evaluate designed geriatrics curricula
into the teaching of the Lead Geriatrics Educators. (4) Develop a
method for Geriatrics Lead Educators to keep up with recent
geriatric literature and updating their curricula. (5) Integrate
core topics in geriatrics into the weekly clinical conferences for
General Medicine faculty.
Variation in ICU Outcomes
Examines the human team and organizational factors
important in risk-adjusted outcome (hospital mortality and length of
stay-LOS) for ICU patients.
Long-term Care Requirements of Elderly
Patients Undergoing Coronary Artery Bypass Grafting Surgery in
Michigan
(1) Establish Education
Advisory Committee. Meet quarterly, two informal gatherings per year.
(2) Deliver 20-hour geriatrics clinical and teaching skills seminars
to 12-16 General Medicine faculty over two years. (3) Establish
ongoing collaborative relationships between four Lead Geriatrics
Educators (selected from seminar participants) and geriatrics faculty
to develop, integrate, and evaluate designed geriatrics curricula into
the teaching of the Lead Geriatrics Educators. (4) Develop a method
for Geriatrics Lead Educators to keep up with recent geriatric
literature and updating their curricula. (5) Integrate core topics in
geriatrics into the weekly clinical conferences for General Medicine
faculty.
Improving Patient Safety in Hospitals:
Implementing Change at Ground Zero
Develop a half-day conference and conference-based support
materials on ways to achieve a culture of safety in hospitals by
implementing (1) evidence-based best practices; (2) interdisciplinary
practice approaches; (3) root-cause analysis of medical errors; and
(4) changes in health care norms relevant to patient safety.
Long-term Care Requirements of Elderly
Patients Undergoing Coronary Artery Bypass Grafting Surgery
(1) To determine the association between age and discharge location
(home or long-term care facility) following CABG; and (2) to determine
the rates and predictors of extended (greater than 4 weeks) long-term
care stays among patients undergoing CABG.
Predicting Safe
Hospital Discharge for Children with Acute Bronchiolitis
The overarching goal of this project is to optimize the care provided
to children who are hospitalized with bronchiolitis at the University
of Michigan Health System (UMHS).
Supporting
Medical Residents: A Study of Medical Mishaps
Develop a model of how personal, professional, and systems
factors interact in the production of medical errors.
Translation failure research: Assessment
of specificity in quality indicators
This pilot project attempts to examine one specific
translation failure, namely the inability to control LDL levels in
diabetic patients and attempts to delineate the specific errors that
cause this failure to achieve goals shown in clinical trials to reduce
mortality. This project will serve as a pilot for a large
multi-center grant examining six translation failures.
Improving Patient Safety in Hospitals: Turning Ideas into Action
A half-day conference and conference-based support materials have been developed on ways to achieve a culture of safety in hospitals by implementing (1) evidence-based best practices; (2) interdisciplinary practice approaches; (3) root-cause analysis of medical errors; and (4) changes in health care norms relevant to patient safety. The conference occurred on November 22, 2002.
Long-Term Care Requirements of Elderly Patients Undergoing Coronary Artery Bypass Grafting Surgery
This study has two specific aims: (1) to determine the association between age and discharge location (home or long-term care facility) following CABG; and (2) to determine the rates and predictors of extended (greater than 4 weeks) long-term care stays among patients undergoing CABG. To achieve these aims, we will combine data from the inpatient Medicare files and MDS using unique patient identifiers.
Linking these databases will allow us to assess important processes and outcomes of health care in elderly individuals as they transition from hospital to long-term care facilities following CABG in the state of Michigan. This information will allow a better accounting of the risks and benefits associated with CABG in elderly individuals and identify potential patient characteristics that are associated with increased risk of post-operative institutionalization.
Translation failure research: Assessment of specificity in quality indicators
This pilot project attempts to examine one specific translation failure, namely the inability to control LDL levels in diabetic patients and attempts to delineate the specific errors that cause this failure to achieve goals shown in clinical trials to reduce mortality. This project will serve as a pilot for a large multi-center grant examining six translation failures.
Using the Survey Research Center Statistical Data
Enclave to Explore Medicare Home Care Use in the Health and Retirement Study
The proposed pilot project will use the Statistical Data Enclave at the Survey Research Center to analyze linked Medicare - HRS restricted data on the utilization of Medicare home care services. Specifically, we will 1) Determine the proportion of HRS/AHEAD respondents born in 1923 or earlier who have linked Medicare claims indicating the utilization of Medicare home care services in 1993, 1994, or 1995 2)Assess the concordance between Medicare home care utilization as determined using linked Medicare claims data, and as self-reported in the HRS survey. 3) Determine characteristics that are associated with discordance between self-report and Medicare records.
Pending Projects
Impact of Specialty Hospitals on
Procedure Utilization
(1) What impact does a specialty hospital’s opening have on
procedural volumes at competing general hospitals, and (2) how do
specialty hospitals affect overall utilization of procedures across a
population. We will use of national Medicare data (1994-2002) to
identify specialty hospitals and those general hospitals providing
similar services in the same hospital referral regions (HRRs).
Hospital Volume and Coronary Artery Bypass
Graft Mortality in Men and Women
The goal of this project is to compare in-hospital mortality after
CABG between men and women after adjustment for demographic and clinical factors
and hospital volume in the California CABG Mortality Reporting Program Registry
(CCMRP). It will also be determined if men and women undergo CABGs at different
rates in high- and low-volume hospitals.
| 
