Real patients sharing their personal stories--and a little advice--about the benefits of reducing the levels of opioids they take for chronic pain
The increased use of opioids for chronic pain over the last two decades has led to a rapid rise in serious opioid-related harms--including accidental deaths--without clear evidence of any corresponding patient benefit. Nevertheless, patients can find it difficult to initiate tapering down the dosage of these drugs to safer, yet still effective, levels.
In this video, real patients share their (sometimes scary) reasons for tapering, and describe some of the difficulties and the many benefits they have experienced from doing so.
The video comprises results from NIH-funded research into methods primary care physicians could use to help their patients with the tapering process, research conducted by Stephen Henry, MD, an assistant professor in the Department of Internal Medicine and a core faculty member with the Center for Healthcare Policy and Research (CHPR) at UC Davis. It was produced by Susan Verba and the UC Davis Center for Design in the Public Interest, in collaboration with CHPR.
UC Davis Co-Author of New Federal Climate Assessment Report Responds to President Trump's Comment
Helene Margolis, Ph.D., co-author of the Southwest section of the Fourth Climate Assessment report (released by the White House the day after Thanksgiving), told KCRA Channel 3 in Sacramento that the "science would refute" the comment President Trump made about the report.
The evidence-based report, produced every few years as mandated by federal law, details how climate change has impacted each region of the U.S. and various sectors of the economy. It describes how climate change "presents growing challenges to human health and quality of life," such as heart and lung problems, more diseases from insects, and increased numbers of deaths resulting from heat waves or other natural disasters. The report also noted that since 2015 a record-breaking nearly $400 billion has been spent responding to damage from extreme weather in the United States.
When asked about the report's findings, Trump told reporters in Washington, "I don't believe it."
Margolis is a member of the Department of Internal Medicine at UC Davis Health and affiliated with the UC Davis Center for Healthcare Policy and Research (CHPR). She is an expert on the health impacts of climate change and environmental factors, particularly heat and air pollution, on vulnerable populations, including children and older adults.
When asked about President Trump's comment on the report, Margolis said, "Thirteen federal agencies, their scientists and [300 scientists from universities across the nation] worked on this and there's not one of us who do not believe it. The data is there. We're past the point of debating it with folks who don't want to believe it. We need to take action regardless. The science is there."
Margolis said that higher rates of chronic respiratory diseases, like asthma and chronic obstructive pulmonary disease (COPD), and increased risk of heart attacks, especially in those who already have underlying cardiovascular disease, will be among the most frequent human health-related consequences of climate change.
Healthy UC Davis Kickoff Celebration! Smoke and Tobacco Free UC Davis
When: Thursday, October 11, 2018 11:00 a.m. - 1:30 p.m.
Where: Vanderhoef Commons
CHPR Director, Associate Director and Community Engagement Lead to Weigh In on Treatments for Hereditary Angioedema, a Rare and Debilitating Disorder
After a deliberative session centered on a Draft Evidence Report prepared by the Institute for Clinical and Economic Review (ICER), CTAF's 19-member panel of experts will vote on recommendations for how stakeholders can apply the relevant evidence to improve the quality and value of healthcare provided for those with this debilitating disorder.
Joy Melnikow, Director of the UC Davis Center for Healthcare Policy and Research (CHPR), Jeffrey S. Hoch, CHPR's Associate Director, and Patricia E. Powers, who heads CHPR's efforts in Community Engagement, are all members of the CTAF Voting Body.
Hereditary angioedema causes recurrent episodes of severe swelling (angioedema), commonly to the face, limbs, intestinal tract and airway of sufferers. Swelling of the intestinal tract causes severe abdominal pain, nausea and vomiting, and of airways can be life-threatening. The disorder affects approximately 1 in 50,000 people.
ICER's report assesses both the comparative clinical effectiveness and the economic impacts of long-term prophylaxis with various therapies developed to treat angioedema. CTAF's panel of experts will consider the net health benefits of the prophylactic treatments, other possible benefits (such as reducing the complexity of treatment, reducing caregiver or family burden and improving the productivity of patients or their caregivers), and a value-for-money analysis. Treatment of a single acute episode of angioedema can cost $5-12K; treatment with medications for long-term prophylaxis could cost more than $500K per year.
ICER is an "independent non-profit research organization that evaluates medical evidence and convenes public deliberative bodies to help stakeholders interpret and apply evidence to improve patient outcomes and control costs." CTAF is a core program of ICER which aims to "help patients, clinicians, insurers, and policymakers interpret and use evidence to improve the quality and value of health care" and "provides a public venue in which the evidence on the effectiveness and value of health care services can be discussed with the input of all stakeholders."
CHPR's Joy Melnikow and Maria Marois Join the UC Davis Quarter Century Club
Joy Melnikow, the Director of the UC Davis Center for Healthcare Policy and Research (CHPR), and Maria Marois, Ph.D., M.P.H., a CHPR project manager, are among the new members of the University of California, Davis Quarter Century Club. They, along with all of this year's new crop of members--those who have worked at UC Davis for 25 years or for 50 years!--will be welcomed into "the Club" at its 79th Dinner and Annual Meeting being held Thursday, October 25, 2018.
Congratulations Joy and Maria!
CHPR Associate Director Leads International Team Investigating the Cost-Effectiveness of New Drugs for Treating Hereditary Transthyretin Amyloidosis, a Rare and Devastating Disease
The Institute for Clinical and Economic Review (ICER) recently published a report (PDF) on the effectiveness and value of two new drugs for treating patients suffering from hereditary transthyretin amyloidosis (hATTR). hATTR is a rare, progressive, and ultimately fatal disorder that is passed from an afflicted parent to 50% (on average) of their children. The US Food and Drug Administration (FDA) recently approved patisiran (OnpattroTM) for the treatment of adult patients with peripheral nerve disease caused by hATTR and the agency’s decision on the other drug, inotersen (investigational, Akcea Therapeutics), is expected in late October 2018.
Jeffrey S. Hoch, Associate Director of the Center for Healthcare Policy and Research (CHPR) and Chief of the Division of Health Policy and Management (HPM) at UC Davis, headed the international team of researchers from Canada, the US and the UK that developed the cost-effectiveness model used to evaluate these new drugs. Yi Zhang, a post-doctoral fellow in the UC Davis Department of Public Health Sciences, and Elise Evers, a graduate student at the University of York, England and summer intern at CHPR, were also members of the UC Davis cost-effectiveness modeling group. Professor Hoch presented the results at the September 13, 2018 ICER meeting.
Findings from the economic modeling suggest that a big driver of the value of both new treatments is drug cost. In most cases analyzed, the incremental cost-effectiveness ratios were far beyond levels normally considered good value for money. At the current assumed prices, e.g., $345,000 each year in drug costs alone, neither treatment option is economically attractive at either conventional or the higher cost-effectiveness thresholds often utilized in conjunction with ultra-rare diseases. As a result, the report concludes that substantial price discounts and additional study are indicated.
Dr. Dan Ollendorf, ICER’s Chief Scientific Officer, noted that the available evidence on these therapies was discussed “with a policy roundtable of experts, working to identify policy solutions to ensure appropriate patient access despite the extremely high costs.” More details about the report and the meeting are available at the website for ICER’s Midwest Comparative Effectiveness Public Advisory Council (Midwest CEPAC).
Study Demonstrates Feasibility of Using Mobile Apps to Facilitate Individualized Pain Treatment
In a study published September 4th in JAMA Internal Medicine, Richard L. Kravitz, M.D., M.S.P.H., and colleagues reported that 88% of patients in a randomized clinical trial assigned to use a mobile app to conduct their own personalized experiment found the app helpful to people like them for managing pain. The mobile app helped patients engage in medication-related shared decision-making, and sent them reminders to take designated treatments on assigned days and to upload responses to daily questions on pain and treatment-associated adverse effects. The study, which compared participation in an individualized, mobile app-supported “N-of-1” trial versus usual care for treatment of chronic musculoskeletal pain, also has been called the “most ambitious investigation of the N-of-1 approach to date.”
Dr. Kravitz, and co-authors Anthony Jerant, M.D., and Maria Marois, Ph.D., M.P.H., are researchers at the UC Davis Center for Healthcare Policy and Research. Deborah Ward, Ph.D., R.N., and Scott MacDonald, M.D., of UC Davis Health, also co-authored the study.
The N-of-1 (or individually designed single-patient multi-crossover) trial design permits researchers to estimate treatment effects for each individual participant. But while ability to draw conclusions about treatment effects in individuals is an obvious advantage, N-of-1 trials have not been widely adopted, partly due to perceptions of the time and effort required. Nevertheless, Kravitz et al. hypothesized that participation in an N-of-1 trial might benefit patients with chronic musculoskeletal pain “either by steering patients toward more personally effective therapies or by expanding patient involvement in care.”
Their results indicated that pain-related outcomes for the 108 patients who received individualized treatment plans via the N-of-1 intervention were not significantly different from those of the 107 patients who received care as usual. But the data also demonstrated that conducting these types of trials with mobile health apps is feasible and can provide a highly satisfactory patient experience. The authors therefore concluded that additional research should be carried out to clarify which patients are most likely to benefit from participating in them.
Elisa Tong Awarded $6M for CA Quits Program
Elisa Tong, M.D. and founding Project Director for "UC Quits," has been awarded additional funds from the California Tobacco Control Program of the California Department of Public Health (CDPH) to expand her work helping Californians kick their tobacco habits.
UC Quits is a UC-wide Tobacco Cessation Network designed to encourage health providers to address tobacco-related issues at every clinical encounter and to connect patients with the free California Smokers' Helpline at UC San Diego. To date, UC Quits has referred nearly 12,000 patients (some 2,400 from UC Davis) to the California Smokers' Helpline and services that can dramatically improve their chances of quitting.
The new CDPH agreement provides nearly $6 million over five years to expand this successful program beyond UC and into additional health systems across California. The expanded version has been dubbed "CA Quits." More details about the CA Quits program can be found on the UC Davis Comprehensive Cancer Center website.
Dr. Tong is an Associate Professor in the Department of Internal Medicine at UC Davis Health and a Core Faculty Member with the UC Davis Center for Healthcare Policy and Research. Congratulations Dr. Tong!
Register Now for the 11th Annual Conference on the Science of Dissemination and Implementation in Health
This conference, co-hosted by the NIH and AcademyHealth, is meant to help realize the full potential of available evidence to optimize health and healthcare by bridging the gaps between research, practice, and policy. Its agenda includes outlining priorities in the field to ensure that evidence is used to inform decisions that will improve the health of individuals and communities. It will be held December 3-5, 2018 at the Renaissance Washington, D.C. Register by October 8 for the best rates.
UC Davis CHPR-Led Research Informs New National Cervical Cancer Screening Recommendation
A comprehensive analysis of eight clinical trials and four cohort studies on cervical cancer screening by researchers from UC Davis and Kaiser Permanente Northwest has found that while Pap smears are still highly effective for detecting pre-cancerous cells and cancer, testing for the virus that causes these cancers also is an excellent screening tool.
The research was led by Joy Melnikow, director of the UC Davis Center for Healthcare Policy and Research (CHPR), a family and community medicine physician and expert on evidence-based cancer screening.
The findings, published August 21 in the Journal of the American Medical Association (JAMA), were used to inform the U.S. Preventive Services Task Force, which published its updated recommendation on cervical cancer screening in the same issue of the journal. The Task Force is an independent panel of experts that makes evidence-based recommendations on disease prevention. The Task Force also provides an annual report to Congress on the evidence base for clinical preventive services and recommends priority areas that deserve further examination.
"Our work demonstrated that there is now strong evidence for the effectiveness of high-risk HPV testing used alone as a cervical cancer screening test," said Melnikow.
Melnikow added that researchers found that regular screening with any method will lead to lower cervical cancer rates. "In the U.S., where most women are not part of an organized screening program, our biggest challenge is reaching women who have not been screened," she said.
More information about specific findings from this research are posted in the UC Davis Health Newsroom.
CHPR Welcomes a New Administrative Manager
CHPR is happy to announce that Monica Steinhart has joined our staff as the Administrative Manager. Monica D. Steinhart has worked for UC Davis since November 1997, 20 years. Her career started in the Department of Psychiatry, as an Administrative Assistant II for their Residency Program. From there she worked on the Davis Campus in Mrak Hall in the Campus Administrative Offices. In 2002 she became the MSO of the Division of Hematology/Oncology. She then moved on to work in the Business Office of the Cancer Center Clinical Trials Unit. During the 8 years before she joined CHPR, Ms. Steinhart worked as a UCD contract employee of the California Department of Public Health (CDPH). There she managed the CDC-funded Hospital Preparedness Program (HPP) and the Public Health Emergency Preparedness (PHEP) grants.
Ms. Steinhart is engaged to be married (Jason), no date has been set, and has one daughter, Maya, who will be a senior in high school next academic year. She is a great lover of animals and the outdoors.
QSCERT Fellow Ethan Evans Named Editor of Health & Social Work Column
Ethan J. Evans, Ph.D., a recent graduate of the Center for Healthcare Policy and Research's (CHPR's) Quality, Safety and Comparative Effectiveness Research Training (QSCERT) postdoctoral program and incoming assistant professor in the Division of Social Work at California State University, Sacramento, has been named the new editor of the National Health Line (NHL) column in the journal Health & Social Work.
As he described in his initial NHL column (available online) now and in print in the August 2018 issue of Health & Social Work), since its inception in 1978, NHL editors have used the NHL to link practice and policy, digest social policy reforms and identify opportunities for social workers to apply their professional skill and expertise. NHL editors have also disseminated "information on health insurance, new legislation, and resource and staffing trends, with an emphasis on federal policies." Over the years, NHL editors and other contributors have opined on topics such as the dismantling of the Aid to Families with Dependent Children program, end-of-life care, disparities in health care access and utilization, termination of benefits for immigrants, universal health care and the Affordable Care Act.
Evans believes that "consistent attention from social workers toward national health policy" is necessary, especially in our "contemporary moment," and he is excited about taking on this editorial role at Health & Social Work at this point in history. He also wrote a guest editorial for the August 2018 issue of the journal: "Blended Roles under Health Reform: Where Does Social Work Fit?" Congratulations, Ethan!
Dr. Miglioretti, Ph.D., Dean's Professor in Biostatistics in the Department of Public Health Sciences at UC Davis, has been selected as a Fellow of the American Statistical Association (ASA), the world's largest community of statisticians, which publishes the premier journals of statistical science. This extremely prestigious designation is a significant honor, as only one-third of one percent of the approximately 18,000 members are chosen as fellows each year. They are nominated by their ASA-member peers, in this case Distinguished Professor Dr. Laurel Beckett, Chief of the PHS Division of Biostatistics.
Fellows are evaluated on their contributions to the advancement of statistical science. The committee considers a candidate's published works, position held with employer, ASA activities, membership and accomplishments in other societies, and professional activities.
Dr. Miglioretti joins Dr. Laurel Beckett and Dr. David Rocke as fellows of the ASA in the UC Davis Division of Biostatistics. She will be presented her award this summer at the Joint Statistical Meeting, the largest gathering of statisticians and data scientists in North America.
Dr. Miglioretti has been awarded “Best Scientific Paper Presentation award 2018” with the topic of “breast” for her presentation “Risk-based strategies for supplemental breast cancer screening” at the 2018 European Congress of Radiology (ECR) held in Vienna, Austria from 2/28-3/4. Her award was “based on the evaluation of the subcommittee and the session moderators. The selection criteria have comprised scientific content, quality of presentation and overall impression of the performance,” according to Johanna Kruse of the ECR Scientific Program Department.
The European Society of Radiology (ESR) is the largest radiological society in the world and its annual international conference is one of the leading events in radiology with nearly 30,000 participants from 137 different countries in 2018. It is one of the largest medical meetings in Europe and the second-largest radiological meeting in the world.
New CHPR Issue Brief (PDF) to Inform Medi-Cal Budget-related Decision-making
Karen Shore, Ph.D., and Patricia Powers, M.P.A., with the Center for Healthcare Policy and Research’s Center for Health Decisions, analyzed the impacts on the state’s Medi-Cal program budget of various revenue-generating and expenditure-reducing policies enacted in California over the course of the last decade. Their analysis of this 10-year period, encompassing a major economic downturn as well as more prosperous years, provides valuable lessons in how to maintain this core public program that provides health insurance coverage to 13.5 million people, nearly one of every three Californians. The report describes five major types of policy changes California deployed during this period to manage Medi-Cal program costs and provides examples of each with magnitude estimates:
- Changes in benefits
- Eligibility changes
- Changes to provider/health plan payments
- Delivery system changes
- Other revenue augmentations
One of the major findings is that the proportion of the Medi-Cal budget funded by California’s General Fund declined dramatically, from a high of 39% in fiscal year (FY) 2007-08 to 18% in FY 2017-18. Other, likely less volatile, revenue sources helped to sustain and grow the Medi-Cal program during this period.
Medi-Cal Budget: Lessons Learned from a Review of Policy Changes with Significant Budgetary Impact, 2007-2017 (PDF), seeks to inform a variety of audiences including state and federal policymakers and staff, state agency staff, health policy analysts and researchers, health care advocates, and beneficiary representatives. To ensure the usefulness of the report to these audiences, a committee composed of current and former budget staff experts from the state legislature, the Legislative Analyst’s Office, the Department of Finance, and the California Budget & Policy Center advised the authors as they designed and conducted the analysis. The committee recommended, for example, that the analysis emphasize long-term structural changes rather than policies that generate one-time savings to achieve a balanced budget in a given year. The final list of major budget policies analyzed includes some that were state-initiated, some that were implemented in response to opportunities made available by the federal government, and others that resulted from ballot initiatives.
The California Health Care Foundation provided funding for this project.
QSCERT Fellow Creating Valuable Research Networks
Ethan J. Evans, CHPR QSCERT postdoctoral fellow, and several other researchers from UCD & CSUS are starting a local Sacramento Chapter of the Scholars Strategy Network (SSN). SSN is dedicated to “connecting researchers with journalists, policymakers, and civic leaders to improve policy and strengthen democracy.” Visit www.scholars.org to learn more about the organization and the local chapter.
Dr. Evans joined a team of researchers on May 18th, 2018 to launch the chapter at an event sponsored by the UC Davis Institute for Social Sciences entitled "Training Researchers to Inform Policy.” Workshop participants were instructed by the national staff from the Scholars Strategy Network. The workshop provided attendees valuable resources and instruction on how to ensure that their research will be used for informing policy. Trainers stressed the importance of networking and utilizing networks already available through the university system, and offered "Best Practices” for communicating with legislators, their staffs, and regulatory agencies.
Membership to SSN is free; however, scholars must fill out a profile and write a two-page policy brief. Researchers are encouraged to write clearly and effectively for non-academic audiences. SSN currently has a network of nearly 1,000 scholars at universities nationwide who collectively work with leaders in a bipartisan effort to inform policy-makers.
If you are interested in the Scholars Strategy Network, you can contact Dr. Evans at firstname.lastname@example.org. The local chapter is planning two workshops over the summer to bring interested people together and advance the work of the Sacramento/Davis chapter of SSN.
QSCERT Fellows Leaders of Innovative Change in Our Community
The California chapter of the American College of Emergency Physicians (CalACEP) is urging the California Legislature to make a budget commitment to drug and alcohol counseling in California Emergency Departments (ED’s) to the tune of $20 million. The funding is requested to create a statewide pilot program that places a certified drug and alcohol counselor in each of the roughly 400 EDs throughout California. Data would be gathered during the pilot to measure the efficacy of treatment and the cost savings to the Medi-Cal program and other payers. The request comes as a result of a successful University of California Davis ED pilot funded through a grant from the Office of the President. The UCD pilot employed a certified drug and alcohol counselor to provide interventions in their ED and results were impressive. Over a 12-month period, the Medi-Cal patients who received a brief intervention and referral to treatment experienced a 60 percent decline in ED utilization.
On April 12, 2018, Dr. Aimee Moulin, a UC Davis Emergency Room Physician, and newly elected CalACEP President, testified before the Senate Appropriations Budget and Fiscal Review Subcommittee #3 that studies have shown that direct referrals to treatment have increased enrollment rates as high as 50 percent. Dr. Moulin stated that “offering assistance to these patients at a time when they are most vulnerable to their disease proved incredibly effective towards the patient’s acknowledgment of their need for treatment.” Similarly in New Jersey, the newly established Opioid Overdose Recovery Program which provides ED intervention for patients who experience alcohol and opioid overdose, confirmed that over 80 percent of patients accepted bedside intervention, 40 percent of those patients accepted recovery support services, and 45 percent accepted detox, substance use disorder treatment and/or recovery. These results were realized during the first six months of program implementation. Over 60 percent of the overdose patients seen under the Program were Medicaid beneficiaries.
Senator Richard Pan, M.D., Chairman of the Subcommittee, himself a UC Davis physician, encouraged Dr. Moulin and assured members of the Office of Finance and the Legislative Analyst’s Office that, “there are real cost savings here to be realized” and encouraged the organizations to work together to identify ways to report the cost savings. The request made its way through the Senate and is now awaiting a hearing to be affirmed by the State Assembly.
Aimee Moulin, M.D., is an emergency medicine physician with a research interest in Behavioral Health Emergencies and Health Policy. Dr. Moulin has a background in health policy and leadership and is dedicated to addressing disparities in healthcare access for patients with mental illness. She received her graduate degree in Genetics from the University of California at Davis and graduated from both medical school and residency at the University of Southern California. Dr. Moulin is board certified in emergency medicine and is the current President of California ACEP.
Most recently, Dr. Moulin completed a QSCERT postdoctoral fellowship supported by funding from the Agency for Healthcare Quality and Research (AHRQ).
The Quality, Safety, and Comparative Effectiveness Research Training (QSCERT) T32 Program is a multidisciplinary, postdoctoral training program in quality, safety and comparative effectiveness research with an emphasis on training future leaders in surgical, trauma, and urgent/emergency care and other areas of relevant outcomes research.
Dr. Moulin’s complete testimony before the California State Senate Budget and Fiscal Review Subcommittee No. 3 on April 12, 2018 (Part 2), can be found in the California State Senate's Media Archive.
Call for Planetary Health Student Ambassadors from all UC Campuses
The UC Global Health Institute's Planetary Health Center of Expertise is currently recruiting undergraduate and graduate level Planetary Health Student Ambassadors from all the UC campuses for the 2018-2019 academic year. This new program will introduce selected ambassadors to core concepts in Planetary Health and how they apply to real world problems; provide experience with and understanding of multi-sectoral solutions for sustainable development; develop ambassadors’ leadership, research, and advocacy skills; and enable ambassadors’ engagement with key faculty, researchers, and leaders in Planetary Health to further their understanding of Planetary Health and strengthen their professional networks.
For more information about the program and eligibility requirements, and to access the online application form, please visit: https://www.ucghi.universityofcalifornia.edu/news/call-student-ambassadors-planetary-health. The deadline for applications is July 16, 2018.
13th Summer Institute on Migration & Global Health to be Held June 18-21 in Oakland, CA
Want to receive training, gain skills, and share best practices in the arena of migrant health? The Summer Institute on Migration and Global Health, a collaboration among the UC Migration and Health Research Center, the UC-Mexico Health Working Group, and the Berkeley School of Public Health, will provide researchers, students and professionals the opportunty to engage and learn from world-renowned speakers on migration, refugees, and global health.
For more information on speakers, agenda, logistics and how to register, please check out the Institute's website.
CHPR Founding Director Receives Lifetime Achievement Award
Klea Bertakis, M.D., M.P.H., the founding director of the UC Davis Center for Healthcare Policy and Research (CHPR), received the Hibbard Williams Award for Extraordinary Achievement at the UC Davis School of Medicine (SOM) Student & Faculty Awards Luncheon held May 18th.
This award, named for the 2nd Dean of the UC Davis SOM, “recognizes exceptional faculty contributions beyond traditional teaching and research roles.” Dr. Anthony Jerant, CHPR member and chair of the Department of Family and Community Medicine at UC Davis, described recipients of this prestigious award as “those who have made lasting impact at the School and beyond, in areas such as program development, capacity building, leadership, and mentorship,” adding that Dr. Bertakis’ colleagues have long known that she has excelled in each of those roles.
Dr. Bertakis embraced all of those roles when she founded CHPR (then called the Center for Health Services Research in Primary Care) in 1994. CHPR is an interdisciplinary, collaborative Organized Research Unit that strives to improve the health of the public by: facilitating research about healthcare access, delivery, quality, outcomes, and costs; educating and mentoring health outcomes researchers, and informing health policy.
Article in JAMA by CHPR Researchers Informs Prostate Cancer Screening Recommendations
The U.S. Preventive Services Task Force based its new national recommendations about prostate cancer screening on the systematic review of 63 research studies conducted by a team of UC Davis researchers from the Center for Healthcare Policy and Research (CHPR). Led by CHPR faculty member Joshua Fenton, M.D., Professor of Family and Community Medicine, the team’s findings on prostate-specific antigen-based (PSA) screening were published in the Journal of the American Medical Association (JAMA) on May 8, 2018.
Fenton said the USPSTF process is painstaking, methodical and was rigorously vetted with public and expert review prior to, during and after completion of the research. “I’m very proud of our team,” he said, “…and I think we achieved our goal of conveying complete and unbiased information based on current evidence.”
Fenton and his team found, for example, that PSA screening results in false positives in 10-18 percent of all men screened, with higher risk of false positives incurred by men older than 70. Additional harms related to diagnostic biopsies and from treatment are also greater in men older than 70 than in younger men.
Based on these and other findings, the Task Force now recommends against PSA screening for men 70 and older. For men ages 55-69, the Task Force now recommends that the decision to undergo periodic PSA-based screening for prostate cancer should be an individual one that includes a discussion with a clinician about both the potential benefits and the potential harms of screening. Other harms resulting from screening and subsequent treatment can include incontinence and erectile dysfunction.
In addition to Dr. Fenton, authors of the evidence report in JAMA include Heejung Bang, Ph.D., Joy Melnikow, M.D., M.P.H., Meghan Weyrich, M.P.H., and Shauna Durbin, M.P.H., from CHPR and Yu Liu, M.S., from the Dept. of Public Health Sciences at UC Davis.
QSCERT Postdoctoral Fellow Wins Best Presentation Award
Anne White, Ph.D., a postdoctoral fellow in the Quality, Safety, and Comparative Effectiveness Research Training (QSCERT) program at CHPR whose research focuses on doctor-patient communication, received a Best Presentation Award at the 4th Annual UC Davis Postdoctoral Research Symposium held this month on the UC Davis campus.
In a talk titled “Surgeon Noticings of Additional Concerns,” Dr. White, a medical sociologist, used the qualitative methods of Conversation Analysis and ethnography to describe how general surgeons initiate discussions about new concerns they notice while examining patients that are unrelated to the reason for the visit. The data used were 281 video-recorded medical encounters from a rural Texas private practice, and ultimately 22 cases of surgeon noticings were found in 17 visits. While infrequent, Dr. White found that beyond alerting patients to new medical problems, such “noticings” serve to build and maintain physician-patient relationships across time and to curtail future patient worry. She also documented issues surgeons grapple with in relation to sharing their noticings, such as the extent of the patient’s awareness of the additional concern, and how these contribute to how surgeons frame their noticings. While previous studies have focused on patients initiating conversations about their additional concerns, Dr. White’s research is novel in examining how physicians themselves introduce new concerns to patients.
As a QSCERT Fellow, Dr. White is currently studying how pain medication requests are negotiated during patient visits.
CHPR Welcomes a New Financial Manager
CHPR is happy to announce that Maria Shrestha has joined our staff as a financial manager. Shrestha earned her B.A. in Political Science from UC San Diego and her Master of Public Administration from the Cornell Institute for Public Affairs at Cornell University. She worked most recently as a Senior Financial Analyst at New York University’s School of Medicine.
In her new position at CHPR, she will be primarily responsible for managing pre- and post-award financial aspects of grants applied for by CHPR-affiliated faculty. Faculty members in need of her assistance can contact her at email@example.com.
Dr. Joshua Fenton Awarded Access to OptumLabs Database for Study of Long-term Opioid Users
CHPR researcher Joshua Fenton, M.D., M.P.H., is one of seven Principal Investigators in the UC system recently awarded "research credits" providing complimentary access to the comprehensive, real-world, linked dataset of clinical and claims information available through OptumLabs. OptumLabs is an open, collaborative center housing a comprehensive dataset representing nearly 200 million de-identified lives, an extremely valuable asset for conducting population studies. These competitive awards for research credits are one means through which the 10-year partnership between OptumLabs and the University of California hopes to accelerate improvements in healthcare value and patient care. Dr. Fenton will utilize the OptumLabs dataset to conduct a study of the "Clinical Consequences of Dose Tapering in Long-term Opioid Users."
Study Reveals Value of the Student-Run Clinics Associated with UC Davis Health while Engaging Undergraduates in Research
Christy Meyer, a student at the UC Davis School of Medicine (SOM), is Co-Director of the Joan Viteri Memorial Clinic (JVMC), a clinic run by medical students that provides “Unbiased health care to intravenous drug users, sex workers and their families.” JVMC is one of seven student-run clinics (SRCs) associated with the UC Davis SOM, others serve the Latino, African-American, South Asian and Muslim, Asian and Pacific Islander, Filipino Veterano, and homeless communities of Sacramento.
Meyer teamed up with Patrick Romano, M.D., M.P.H., and Melissa Gosdin, Ph.D., of the UC Davis Center for Healthcare Policy and Research (CHPR), and 41 undergraduate students to find out what motivates patients to utilize SRCs, and to get patient input on how the clinics could better serve their under-served communities. Funded by the UC Davis SOM, no previous study had directly asked the patients of such clinics about their experiences with SRCs.
The undergraduate students completed human subject research protection training and were taught qualitative data collection and analysis research methods at CHPR prior to conducting 104 interviews with patients from all seven UC Davis SRCs and the Gender Health Center, a professionally managed clinic affiliated with JVMC that provides care for the LGBTQQI community. After the interviews were transcribed and translated from six different languages, students qualitatively coded all the transcripts and then Meyer and Gosdin identified the major themes among them.
The study’s results indicate that patients appreciate the accessibility to healthcare that the SRCs provide, being open on weekends and accepting patients with no health insurance, for example. Patients feel respected and not judged, and find the medical professionals at the SRCs to be thoughtful, compassionate and thorough. That SRCs break through language barriers for patients is also greatly appreciated. In terms of improvement, patients asked for more, i.e. more (and better) equipment, more doctors, more services—like dental and vision, and larger facilities so that the SRCs will be able to serve even more patients.
Meyer hopes her study will provide the foundation for future research and policies relating to SRCs. Toward that end, three of the participating undergraduate students are conducting follow-up research studies related to the original project.
Register Now for the Fourth UC Health Research Symposium
Interested in qualitative or mixed-methods health reseach? This symposium will provide demonstrations of qualitative research methods, examples of results that can be obtained, and networking opportunities for researchers who want to use them. An optional two-hour introductory workshop led by Kathy Charmaz, co-author of Five Ways of Doing Qualitative Analysis, is also available prior to the start of the symposium for those new to using these approaches to health research. This free even will be held on May 2, 2018, on the UC Davis Sacramento campus. Space is limited; please register by April 27, 2018.
For more information please contact Carolina Apesoa-Varano (firstname.lastname@example.org) or Stuart Henderson (email@example.com).
Apply Now for a QSCERT-PC Post-Doctoral Fellowship
The Quality, Safety, and Comparative Effectiveness Research Training in Primary Care (QSCERT-PC) Post-doctoral Fellowship Program administered by CHPR is now accepting applications: Deadline Feburary 28, 2018.
Application materials and more information about this program can be found at:
$1 Raise in Minimum Wage Can Result in Significant Health Benefits
Paul Leigh, CHPR affiliate and professor of public health sciences at UC Davis, and co-author Juan Du of Old Dominion University, studied the effects a $1 raise in the minimum wage has had on absences from work due to illness. They found that this small increase resulted not only in a 32% decrease in absences due to employee illness but also in an increase in workers self-reporting that their health was good or excellent. Importantly, they also found that this increase had no effect on lay-offs or total work hours, which contradicts claims that increasing minimum wages will lead to increased unemployment. Dr. Leigh also hopes that the innovative statistical analysis he and Dr. Du used for this project will be used to study other public health issues like smoking and obesity. Study results were published in the January 2018 issue of The B.E. Journal of Economic Analysis & Policy. More information about this study can be found by following this link.
CHPR Affiliates Among Awardees of Improving Diagnosis in Health Care Seed Grants
CHPR Director Joy Melnikow is pleased to announce that three CHPR members, Bryn Mumma, Elisa Tong and Nathan Kuppermann, have been awarded seed grants from the UC Davis Health Collaborative for Diagnostic Innovation. A multidisciplinary effort convened by the Department of Pathology and Laboratory Medicine, the Collaborative is intended to address the issues and challenges of accurate diagnosis in the practice of medicine, such as those raised in the National Academy of Medicine’s 2015 landmark report “Improving Diagnosis in Health Care” (National Academies Press).
Dr. Mumma will serve as PI of a team investigating clinical implications of how heart attacks are diagnosed, while Drs. Tong and Kuppermann will be Co-Investigators on other multi-disciplinary teams researching lung cancer screening methods and diagnosis of acute respiratory distress syndrome (ARDS), respectively.
CHPR contributed funding to the seed grant program, partnering with many other departments and centers. The program originated with a generous gift from Brook and Shawn Byers. A total of more than $367,000 was awarded to support 17 multi-disciplinary projects over 12 months. Dr. Melnikow said, “We are excited to have contributed to this innovative, multidisciplinary pilot program supporting so many exciting research proposals.”
More information about the Collaborative for Diagnostic Innovation can be found at: https://www.ucdmc.ucdavis.edu/pathology/collaborative-for-diagnostic-innovation/index.html
Senior writer Belinda Martineau joined the Center for Healthcare Policy and Research (CHPR) in October 2017. Belinda has been working at UC Davis since 2006, first as a principal editor with the Genome Center and, more recently, as the grant writer for the UC Davis Institute for Social Sciences. She has extensive experience helping researchers write grant applications, journal manuscripts, theses, and articles about scientific issues for lay audiences. She is available to help faculty affiliated with CHPR to identify funding opportunities appropriate for their research and to write the narratives of their grant applications.
Belinda earned her B.A. in biology from Harvard University and her Ph.D. in genetics from UC Berkeley.
Dr. Anthony Jerant has been selected as Chair of the Department of Family and Community Medicine at UC Davis. Dr. Jerant joined UC Davis in 1998. Dr. Jerant's research interests focus on enhancing patient-physician communications improving the care of mental health conditions in primary care. As chair, Dr. Jerant will collaborate with UC Davis Health leaders to improve recruitment practices and assure diversity in the workforce. Dr. Jerant graduated from St. Louis University School of Medicine, completed his residency at Madigan Army Medical Center in Tacoma, and internship at Silas B. Hayes Army Community Hospital in Fort Ord.
Dr. Stephen Henry has received funding from R01 NIH grant titled " Developing Patient-Level Risk Prediction Models for Prescription Opioid Overdose." CHPR's Shauna Durbin, Project Manager, will be providing assistance with this research along with UCDavis Co-PI's, Dr. Magdalena Cerda, Dr. Patrick Romano, Dr. Susan Stewart, Dr. Garen Wintemute, and Dr. Daniel Tancredi.
Dr. Jeffrey Hoch leads a team studying the use of cost-effectiveness analysis to inform decisions about expensive cancer drugs
CHPR Associate Director, Jeffrey Hoch, PhD, worked with Canadian researchers to analyze how economic evidence influences funding decisions in British Columbia. Results are published online in the International Journal of Technology Assessment in Health Care. The main findings were that 1) Economic evidence appears to play a role in cancer funding decisions; and 2) Other decision-making criteria may also have an important role in recommendations and subsequent funding decisions.
“A statistically significant difference of nearly $115,000 was observed for funded vs. unfunded drugs. Poor cost-effectiveness was associated with a lower probability of a drug being funded,” remarked Hoch. Healthcare payers throughout the world are being challenged by high costs and this work shows that research can inform and influence healthcare policy decisions.
For more information, please see:
Dr. Melnikow leads team reviewing long-term consequences of peripheral neuropathy after chemotherapy for breast cancer
CHPR Director, Joy Melnikow, MD, MPH, led a systematic review published in the Journal of the National Cancer Institute exploring the impacts of peripheral neuropathy on breast cancer patients one or more years after treatment. The review identified only five papers on studies that followed patients for a year or more, with widely variable results. “The most striking finding from the review was how little data was out there,” Melnikow said. She continued, “This is a call to action. We can’t definitively define the frequency of peripheral neuropathy or understand the differences between chemotherapy regimens with the data we have.”
For more information, please see:
Dr. Melnikow Weighs in on Effect of ACA Uncertainty in Northern California
CHPR Director, Joy Melnikow, MD, MPH, recently responded to a public radio reporter’s inquiry about the 33% health insurance premium increase projected for 2018 in California’s northern counties. Proponents of an ACA repeal cites this burdensome increase as justification for a repeal; however, Dr. Melnikow notes that this increase is projected for enrollees with insurance through Covered California, and many of these enrollees are eligible for federal subsidies that will blunt the increased cost of premiums. “Even though the rates are slated to go up for premiums, if people are eligible for subsidized premiums, then those subsidies will compensate for the increased rates.” Adia White, reporter for North State Public Radio, states that north of the Sacramento suburbs, fewer than five percent of the population would likely pay the full premium hike because their income is above the subsidy threshold (income above 400% of the federal poverty line). The projected premium increases are related to uncertainty about the Trump Administration’s intention to continue federal subsidies. “If you are an insurance company and you are deciding whether to participate in the exchange and you’re not sure you’re going to get that support, you may decide to continue with higher premiums or to drop out,” observed Dr. Melnikow. Click here for the interview.
Nature Commentary by Dr. Daniel Tancredi Discusses Stunning Protective Effects of Probiotics for Newborns in Rural India
CHPR faculty member, Daniel Tancredi, PhD, published a commentary in Nature accompanying a groundbreaking clinical trial evaluating whether a probiotic/prebiotic intervention could prevent life-threatening infections early in life for a sample of mostly full-term newborns in rural India.
Read more >>
Center for Healthcare Decisions and Center for Health Policy and Research, University of California, Davis, to Join Up
The Center for Healthcare Policy and Research (CHPR), University of California, Davis, and the Center for Healthcare Decisions (CHCD) are pleased to announce their merger, effective September 2017. The two organizations have teamed on projects for many years, and leadership of both organizations are enthusiastic about combining their respective bodies of work going forward.
“CHCD’s board unanimously approved this transition. We are confident that our mission to bring complex health policy issues before the public and present their informed views to policymakers will be enhanced by integrating it with the Center for Healthcare Policy and Research. CHPR’s ‘big data’ analytics, along with CHCD’s ‘high touch’ deliberative methods, will significantly strengthen our joint research capabilities,” stated Patricia E. Powers, executive director.
“We are delighted that we will be joining forces,” said Joy Melnikow, MD, MPH, director, CHPR. “Both of our organizations have worked to inform health policy and improve healthcare for more than two decades; we look forward to providing more policy-relevant information that includes the views of an informed public.”
Lori Dangberg, who has served on CHCD’s board since its inception, will be joining CHPR’s newly formed external advisory board. Ms. Dangberg noted that “CHCD’s civic engagement work resulted in significant improvements in care at the end-of-life, as well as provided valuable policy recommendations regarding health benefits, cost, and quality. There are many more issues where thoughtful public input is essential, especially in these polarizing times.”
CHCD will be housed within CHPR, near the University of California, Davis, medical center:
Address: 2103 Stockton Blvd, Sacramento, CA 95817
Founded in 1994, CHCD is a non-partisan, non-profit organization based in Sacramento, CA. CHCD promotes civic engagement in health policy, capturing the public voice on contemporary, often controversial, local, state, or national health issues.
CHPR Members Contribute to AcademyHealth and AHRQ--NRSA Research Trainee Conferences
CHPR members and fellows contributed their health services and policy research to two national conferences in June 2017.
Seven of our members reported sharing their research findings at the 2017 Annual Research Meeting in New Orleans, where researchers excelling in health services research share methodological research advances and peer-reviewed research findings aimed improving health outcomes.
Dr. Patrick Romano chaired the workshop entitled “Publish or Perish: Meet the Editors.” As editor of Health Services Research journal, Dr. Romano led a panel of journal editors in a discussion of the peer-review process and helpful tips on writing solid research and policy papers.
Drs. Susan Perez, Melissa Gosdin, Jesse Pintor, and Patrick Romano presented a poster entitled “Ensuring Timely Access and Finding a Trusted Provider Is Key to Supporting Consumer Decision-Making.”
Dr. Pintor also moderated a session entitled "Caring for Our Future Generation: Innovative, Promising Approaches in Pediatric and Young Adult Care."
Dr. Katherine Kim was a discussant for a panel entitled “Patients First: Patient-Facing Technologies to Enhance Health Care Engagement” and presented a poster entitled “A Novel Stakeholder Engagement Approach for Patient-Centered Outcomes Research.”
Drs. Marc Schenker and Jesse Pintor presented a poster entitled “Assessing the Long-Term Impact of Expanding a Workplace Diabetes Intervention among Latino Immigrant Farmworkers: A Simulation Study.”
Dr. Michelle Ko presented a poster entitled “Educational Outcomes of School-Based Health Interventions for Children of Color.”
Five of our QSCERT Fellows were invited to present at the 23rd Annual AHRQ National Research Services Award (NRSA) Research Trainees Conference in New Orleans, where awardees of the National Research Service Award formally present research results from their fellowship training.
As part of the “Topics in Health Policy” panel, Ethan Evans, PhD, presented “The Challenge of Choice in the Individual Market: Learning from California’s Enrollment Assistance Infrastructure” and Brock Daniels, MD, MPH, presented “Physician in Triage Does Not Improve Patient-Centered Metrics in an Overcrowded, Academic Emergency Department.”
Jesse Pintor, PhD, MPH, took a public health perspective with her presentation on “Assessing the Long-Term Impact of Expanding a Workplace Diabetes Intervention among Latino Immigrant Farmworkers: A Simulation Study.”
Robert Doiron, MD, presented his poster “Successful Implementation and Improvements Identified with In-Situ Simulated Adult Trauma Resuscitation Scenarios.”
Aimee Moulin, MD presented on “County Variation in Mental Health Emergency Department and Hospitalization Use in California.”
CHPR Members serve on ICER’s California Technology Assessment Forum
Ms. Pat Powers and Professor Jeffrey Hoch will join Dr. Melnikow on the Institute for Clinical and Economic Review's (ICER) California Technology Assessment Forum (CTAF). Powers and Hoch were appointed as voting panelists this Spring and will have their first meeting this June. At that meeting CTAF will consider the clinical and economic evidence for two anabolic agents for treatment of osteoporosis in postmenopausal women who are at high risk for fracture.
ICER recently released a draft Evidence Report assessing the comparative clinical effectiveness and value of the two anabolic agents, and the team from CHPR will participate in reviewing the Evidence Report, the public comments responding to the draft report, and ICER’s written response to comments. The report will be the subject of a public meeting of CTAF this summer, during which voting members will vote on key questions raised in the report, and a policy roundtable of experts will discuss recommendations to apply the evidence to policy and practice.
For more information, see:
Dr. Hoch teaches about health technology assessment of cancer drugs
As part of the Annual Meeting of the American Society of Clinical Oncology (ASCO), Professor Jeffrey Hoch participated in a pre-conference, 2-day seminar dedicated to the Economics of Cancer Care. Professor Hoch's talk entitled, "Canadian Oncology Drug Health Technology Assessment: Lessons for the US eh" was featured in the session, "What Can We Learn from the International Experience?" Hoch's presentation drew on his experiences as Director of a Pharmacoeconomics Research Unit at a Provincial Cancer Agency in Canada. During this time, he supported Canada's efforts to set up the world's first and only health technology assessment (HTA) process solely for cancer drugs. The experiences have been published as a trio of freely available articles at http://tinyurl.com/hg7yekx and http://tinyurl.com/hv8gwzh and http://tinyurl.com/gm2bvfa . A copy of the presentation is available here.
CHPR welcomes Sun Y. Jeon, PhD
Sun joined the center as a statistician in 2017. Prior to joining the CHPR, she worked as a Presidential Doctoral Research Fellow at Utah State University from 2012 to 2017, and conducted research on socio-demographic contributors to health outcomes, particularly suicide, mental health, and obesity, using national health surveys such as National Health Interview Survey (NHIS), National Health and Nutrition Examination Survey (NHANES), and National Longitudinal Survey of Youth (NLSY) datasets. She also has experiences of studying the application of multivariate models, statistical machine learning techniques, and age-period-cohort (APC) models to health research.
She has Master’s degrees in Statistics and Sociology, and a Ph.D. in sociology from the Utah State University.
Rob Doiron, MD and Brock Daniels, MD, MPH are middle author's on the paper that was just accepted:
Dr. Richard Kravitz offers insight into patient-doctor communication as it relates to cancer and its prognosis. Methods and perspectives to consider.
"The Effectiveness of Standardized Handoff Tool Interventions during Inter- and Intra-facility Care Transitions on Patient-Related Outcomes: A Systematic Review" for publication in a future issue of the American Journal of Medical Quality.
Jennifer L. Rosenthal, MDa , Robert Doiron, MDb, Sarah C. Haynes, MPHc,
Brock Daniels, MD, MPHd , Su-Ting T. Li, MD, MPHa
In debate over iPhone vs. health care costc, Gavin Newsom's claims are Most True
Two health care policy experts pointed to the $10,345 figure as the best available.
"That’s an accurate number," said Joy Melnikow, director of the UC Davis Center for Healthcare Policy and Research. "That number is as good as any."
While the government and private business pay for the bulk of the nation’s health care costs, Melnikow noted the government gets its money from taxpayers: "That’s all of our money. We’re paying for it." Full Article >>
Revised guidelines recommended later screening for breast cancer Full Article >>
Terminally ill cancer patients fare poorly after surgery Full Article >>
Hormonal Contraception and Risk of Thromboembolism in Women With Diabetes Full Article >>
Could Raising the Minimum Wage Improve the Public's Health? Full Article >>
David Chin's publication in Health Affairs: Rethinking Thirty-Day Hospital Readmissions: Shorter Intervals Might Be Better Indicators Of Quality Of Care. Full Article >>
The Center for Healthcare Policy and Research is excited to introduce the following employees to our team:
- Melissa Gosdin, Ph.D., Qualitative Reseach Analyst: Coming to UC Davis from Albany State University in Georgia where she was an Assistant Professor of Sociology, she brings 12 years of qualitative research experience and expertise in qualitative and mixed methods studies. Read more >>
- Dusan Hutak, Programmer, Information Technology
Dr. Richard Kravitz offers insight into patient-doctor communication as it relates to cancer and its prognosis. Methods and perspectives to consider.
When the Price Is Not Right: State Options on Prescription Drug Pricing—a new issue brief authored by CHPR researchers.
In collaboration with the Center for Healthcare Decisions, Professor Jeffrey Hoch and his CHPR team co-authored an issue brief about potential strategies for California to control escalating costs of prescription drugs. The brief, sponsored by the California Health Care Foundation, provides background information about the cost of prescription drugs, describes the role of the rebate system and legal barriers to managing cost, and describes strategies pursued at the state and national levels, including California-specific strategies.
Prestigious National Dissertation Awards
Eduard Poltavskiy, PHS
Jacqueline Stocking, BIMSON
It is official – two of our CHPR-affiliated PhD students –Eduard Poltavskiy from the Graduate Group in Epidemiology and Jacqueline Stocking from the Betty Irene Moore School of Nursing and the Graduate Group in Nursing Science and Health Care Leadership – have received very prestigious national awards for their dissertation research. Eduard has received a $41,791 Health Services Dissertation Research Grant - R36HS024657 – from the US Agency for Healthcare Research and Quality for his work on “Reliability of Diagnosis Coding with ICD-9-CM and ICD-10-CM.” Jacqueline received a $50,000 Impact Research Grant – #20297 – from the American Association of Critical Care Nurses for her work on “A Case-Control Study to identify Potentially Modifiable Risk Factors for the Agency for Healthcare Research and Quality Patient Safety Indicator 11-Postoperative Respiratory Failure.”
Dr. Patrick Romano of UC Davis’ Center for Health Care Policy and Research is the lead on a Robert Wood Johnson Foundation grant “Understanding Consumers Views of Cost Sharing, Quality and Network Choice” to identify the experiences and needs of individuals who are enrolled in Covered California in comparison with those who are enrolled through employer-based coverage. The Center for Healthcare Decisions is working in partnership with Dr. Romano and colleagues. Using focus groups and surveys, the team will identify and compare differences in the needs and perspectives of both groups in terms of the attributes of health care quality; how provider choice and treatments are influenced by cost-sharing; and the resources that plan members use and trust to help make purchasing and treatment decisions. The goal of the study is to improve on ways to provide consumers with the information and tools they need to choose health plans and make treatment decisions consistent with their values.
Anthony Jerant, MD, Professor, Department of Family and Community Medicine has received funding from CDC (National Center for Injury Prevention and Control), UCD Behavioral Health Center of Excellence, and UCD Department of Family and Community Medicine for his work on This study will refine a previously developed computerized depression program to create (MAPS) Multimedia Activation to Prevent Suicide for Men, designed to support suicide prevention in the primary care setting. The study will examine the effect of the MAPS for men on suicide preparatory behaviors in middle-aged men in a randomized controlled trial.