IHPI’s goals and priorities and its future as an institute are founded upon the substantial accomplishments in health services research and health policy that have distinguished the University of Michigan’s history over the last two centuries. Discover more in this timeline of significant milestones compiled from across the university and IHPI’s local partners.
The Early Years
Founded in 1817, the University of Michigan established various health sciences schools and colleges during its first century, including the Medical School, School of Dentistry, College of Pharmacy, and the roots of the School of Public Health and School of Nursing. In 1869, U-M became the first U.S. university to own and operate its own hospital, and was the first major medical school to teach science-based medicine. Near the end of the 19th Century, research started to become central to the university’s mission, and U-M continues that tradition of excellence to this day.
The origins of the University of Michigan
The University of Michigan is founded in Detroit in 1817. In 1837, the Board of Regents held its first meeting in Ann Arbor and formally accepted the proposal by the town to locate the university there. The first college-level classes were held at U-M in Ann Arbor in 1841.
Beginnings of the U-M School of Dentistry
The U-M School of Dentistry is founded as the College of Dental Surgery, making U-M the first state university in the world and the second university in the U.S. to offer education in dentistry. The college was renamed the School of Dentistry in 1927.
Public Health moves to new graduate division
The Board of Regents highlights the interdisciplinary nature of public health by moving programs from the Medical School to a new Graduate School Division of Hygiene.
Fred J. Hodges joins the Medical School as head of roentgenology (radiology). Hodges will pioneer the idea of routine chest x-rays as part of hospital admission, a practice that becomes nearly standard everywhere and is credited with helping detect tuberculosis, heart trouble, and lung cancer.
“The Social and Economic Aspects of Public Health and Medicine”
“The Social and Economic Aspects of Public Health and Medicine,” believed to be first course on medical care organization and financing offered at a U.S. university, is taught at U-M.
The Hollerith punch card system is implemented at University Hospital, recording patient statistical information about diagnosis, treatment, and condition at discharge to facilitate research on various diseases, particularly cancer.
In 1952 the Atomic Energy Commission will be interested in these data in order to compare results from treatment by standard high voltage x-rays with treatment by radioisotopes (cobalt-60), leading to the establishment of the Alice Crocker Lloyd Radiation Therapy Center at the University of Michigan.
First master of social work degree
U-M offers its first master of social work degree (MSW) through the Institute of Public and Social Administration (later to become the Institute of Social Work in 1946).
Sinai helps develop voluntary health insurance plan
U-M’s Nathan Sinai, a professor of Hygiene and Public Health, develops a voluntary health insurance plan with the Michigan State Medical Society that later becomes a prototype for Blue Shield.
The Human Heredity Clinic is established to collect data and provide genetic counseling regarding hereditary disease, one of the first human genetics programs in the country connected to a university hospital.
“Public Health Economics and Medical Care Abstracts” published
Public Health Economics and Medical Care Abstracts [which eventually became Medical Care Review (1967) and subsequently Medical Care Research and Review (1995)] is published by the U-M Bureau of Public Health Economics in the School of Public Health [see next].
Regents approve Bureau of Public Health Economics
The Board of Regents approves the Bureau of Public Health Economics within the School of Public Health. Its Medical Care Reference Collection becomes the nation’s primary source of archival information on community aspects of medical care.
Institute for Social Research established at U-M
The Institute for Social Research (ISR), among the world’s largest and oldest academic survey research organizations, and a leader in the development and application of social science methods and education, is established at U-M. ISR’s portfolio of work includes a breadth of research examining the relationships between human health, behavior, and social factors. Rensis Likert, an organizational psychologist and developer of the Likert Scale, served as ISR’s first director (pictured at left with Angus Campbell, ISR’s co-founder and second director).
Thomas Francis Jr. concludes field trials of Salk polio vaccine
SPH Professor Thomas Francis Jr. concludes the two-year national field trials of the Salk polio vaccine, and on April 12 announces to the world that the vaccine developed by his former student Jonas Salk is “safe, effective, and potent.”
Tecumseh Community Health Study launches
The Tecumseh Community Health Study begins through the efforts of SPH and other U-M faculty, focusing on behavioral, environmental, and family factors associated with cardiovascular disease and other chronic conditions. The study focused on the entire community of Tecumseh, Michigan, rather than a representative sample. The investigators were able to quantify the role of a number of factors involved in the development of coronary heart disease.
Walter McNerney, a professor of Hospital Administration in the School of Business, directs an unprecedented study of costs, reimbursement, utilization, and hospital economics in the state of Michigan, commissioned by the governor. McNerney went on to help design the Medicare and Medicaid programs, and oversaw the merger of Blue Cross and Blue Shield in the late 1970s.
The 1,492 page report showed what data could do for health management–such as develop treatment norms for different diagnoses, the logic that came to underpin most health care payments in the United States. One result was that Blue Cross became independent of the American Hospital Association in 1961 and McNerney became president of the Blue Cross Association that year. Others in the Department of Medical Care Organization took it up and continued with the Medical Care Chart Book, published 1962-1991. Gradually, federal and state governments had begun to publish the kind of systematic data it contained.
The Formative Years
The 1960s saw the beginnings of significant changes in the American healthcare system. The period was marked by the rapid expansion of social programs, including the establishment of Medicare and Medicaid in 1965, and the concomitant blossoming of social sciences and federal support for this research. HSR came into greater prominence as a field over the next 50 years, helped by various shifts in healthcare financing that incentivized interdisciplinary research on how healthcare was organized, delivered, and paid for.
Axelrod expands SPH program in Medical Care Organization
SPH Professor S.J. “Sy” Axelrod expands the SPH program in Medical Care Organization, which soon takes on a central role in educating administrators for the Social Security Administration, established by Congress in 1965.
CRUSK begins at ISR
The Center for Research on the Utilization of Scientific Knowledge (CRUSK) is established at ISR; undertakes a variety of HSR and other research until 1985, when its work was largely absorbed into ISR’s three other research centers.
Donabedian publishes “Evaluating the Quality of Medical Care”
Avedis Donabedian’s landmark article “Evaluating the Quality of Medical Care” is published in the Milbank Quarterly, establishing the widely used structure-process-outcome framework. The papers were commissioned by NIH’s Health Services Research Study Section from carefully selected authors as a means of defining the scope, methods, and standards of the field.
Hospital Economics, as well as “The Economic Effects of National Health Insurance,” are published by Sylvester Berki.
Our understanding of the economics and law of the broader healthcare system were shaped by scholars working in the School of Public Health’s Health Management and Policy Department. Sylvester Berki authored the first major works on the topics of antitrust law and hospital economics. Berki and HMP colleagues went on to pioneer the study of crucial questions, such as when and why people choose health insurance plans, and how to calculate the appropriate amount of healthcare resources for a given patient (thereby contributing to the basis of the prospective payment system for healthcare).
Quantitative Techniques for Hospital Planning and Control is published by J.R. Griffith, a professor of Health Management and Policy and Medical Administration.
The book sold about 10K copies in its first edition (an academic bestseller), and led to a series of authorized additional editions. More to the point, it was a monument in the development of more precise, informed, quantitative provider management. Griffith followed in 1987 with The Well-Managed Community Hospital, now in its 7th edition, and titled The Well-Managed Healthcare Organizatio. It is a recommended reference for American College of Healthcare Executives’ Fellowship Examination.
Future Directions in Health Services Research Conference
U-M hosts conference on “Future Directions in Health Services Research,” organized by the newly formed Health Services Research Group, a cross-campus organization of health services researchers.
U-M establishes Health Services Research Center
U-M establishes the Health Services Research Center, located within the Office of the Vice President for Research, after receiving one of five original awards from the National Center for Health Services Research (a predecessor of the Agency for Healthcare Research & Quality). U-M’s center continued through 1979.
Health Services Research Comes of Age
Interdisciplinary collaborations flourish in health services research, as investigators organize themselves and develop new partnerships around pressing questions related to healthcare quality, costs, access, and equity. Beginning in the 1990s, U-M’s own health system developed and implemented innovative health programs with high intensity medical and disease management (first used in pilot insurance products with Ford and General Motors—Partnership Health and ActiveCare), and many of these are still used in UMHS initiatives.
U-M creates M-CARE
In response to the need to contain medical costs, U-M establishes M-CARE, becoming the second university in the U.S. to create its own managed care program. M-CARE also reviewed, facilitated, and supported clinical and health services research activities and provided a rich source of healthcare data for analysis. It was acquired by Blue Cross Blue Shield of Michigan in 2006.
The Scientific Registry of Transplant Recipients is established through a contract to Arbor Research by HRSA (AHRQ’s predecessor). The SRTR is an ever expanding national database of transplant statistics that supports ongoing evaluation of the scientific and clinical status of solid organ transplantation.
This information is used to help develop evidence-based policy, to support analysis of transplant programs and organ procurement organizations, and to encourage research on issues of importance to the transplant community. From 2000 to 2010, Arbor Research, as the SRTR contractor, and in collaboration with U-M, developed Simulated Allocation Models (SAMs) to study and report on changes in kidney, liver, and lung transplant practices that followed changes in allocation policies. This research contributed to thousands of additional life-years saved by organ transplantation by evidence-based changes to deceased donor organ allocation in the U.S.
Warner’s work in tobacco and health
SPH Professor Kenneth Warner serves as senior scientific editor of the 25th anniversary Surgeon General’s report on smoking and health. His Congressional testimony in 1985 helped solidify federal taxation as a smoking disincentive.
The U.S. National Nursing Home Resident Assessment Instrument (V 1.0 and 2.0) is implemented.
The instrument was implemented in 1991 by Brant Fries and collaborators in every nursing home in the U.S. to improve care planning. Computerization was mandated in 1998 and, since then, 13 million assessments have been performed every year in the U.S. In addition, 13 assessment systems for frail, elderly, and disabled persons in other sectors that have been implemented around the world, ranging from palliative care assessment instruments adopted across Ontario to home care assessments used in 20 U.S. states as well as Iceland, Belgium, and Finland, and acute care assessment systems used throughout Australia and Belgium. Algorithms based on these assessment systems are being used for determining eligibility for nursing home care under Medicaid in Michigan, Arkansas, Louisiana, and New Jersey. Fries and collaborators also developed the Resource Utilization Groups (RUGs), Version III and Version IV: A case-mix system, based on the national nursing home Resident Assessment Instrument, used to categorize residents based on intensity of resource use. The system is used to pay all U.S. nursing homes under Medicare’s Prospective Payment System ($33 billion/year), acknowledging differences in the cost of caring for their patients. RUG-III was implemented nationwide in 1998, RUG-IV in 2010. These systems are also used in three other nations to adjust payment to nursing homes. Nine independent validations have shown it to predict the cost of care in other nations as well.
The Serious Mental Illness Treatment Resource and Evaluation Center (SMITREC) is established at the Ann Arbor VA in partnership with the Department of Psychiatry. SMITREC is now co-located with CCMR.
The Dialysis Outcomes and Practice Patterns Study (DOPPS) is established by Arbor Research. Now conducted in more than 20 countries, the DOPPS family of studies has illuminated the effects of dialysis practices on a wide range of patient outcomes.
DOPPS, developed by investigators at Arbor Research Collaborative for Health, and joined by co-investigators from U-M, has produced hundreds of peer-reviewed studies examining global dialysis practices and their impact on patient outcomes ranging from anemia management in end-stage renal disease to bone and mineral metabolism in dialysis patients. Variability in practice at the dialysis facility level and at the country level and a novel cohort study design incorporating randomly selected facilities and randomly selected incident dialysis patients, enabled DOPPS researchers to document the critical importance of native arteriovenous fistula over prosthetic graft or temporary catheter-based dialysis. More recently, the DOPPS Practice Monitor (DPM) has examined the effects of changing reimbursement systems (the so-called ESRD bundle) on dialysis practice, access to care, management of anemia, and a host of other outcomes important to patients, providers, and payers.
Arbor Research Collaborative for Health is founded
Arbor Research Collaborative for Health, a future IHPI local partner, was founded by U-M researchers as the University Renal Research and Education Association (URREA); it was renamed in 2006 to better reflect the breadth of its efforts to improve patient care and support the development of sound public healthcare policies.
Origins of the U-M Injury Center
The U-M Injury Center has its origins as the Injury Research Center (founded within the Department of Emergency Medicine by Ron Maio), which in 2010 merged with the Center for Injury Prevention among Youth (founded by Jean Shope in 2008). The Injury Center was designated a CDC-funded Injury Control Research Center in 2012.
Launch of first Collaborative Quality Initiative
A group of five hospitals in Michigan – led by U-M cardiologists and supported by the Blue Cross Blue Shield of Michigan Foundation and Blue Care Network – launches the Blue Cross Blue Shield Cardiovascular Consortium-Percutaneous Coronary Intervention (BMC2-PCI), an initiative to study variation in angioplasty. This first Collaborative Quality Initiative (CQI) paved the way for more than 20 other BCBSM initiatives, most of them led by U-M medical faculty, to collect, analyze, and share data to improve healthcare processes and outcomes across some of the most common and costly areas of healthcare in Michigan.
Center for Managing Chronic Disease established
The U-M Center for Managing Chronic Disease (CMCD), dedicated to helping people control the effects of chronic illness by conducting research that develops new and better ways to support patients and their caregivers in disease management, is established at U-M.
Masters of Science in Health and Health Care Research program established
The Masters of Science in Health and Health Care Research program is established through Rackham Graduate School, designed for scholars who have been admitted to the Robert Wood Johnson Foundation Clinical Scholars Program. To date, 117 students have received degrees through the full HHCR MSc program, 55 of whom were RWJF Clinical Scholars.
Healthy Minds Study launches
The Healthy Minds Study (HMS), an annual survey examining mental health service utilization and related issues among undergraduate and graduate students, launches. HMS, based in the School of Public Health with significant involvement from the Institute for Social Research and the U-M Depression Center, has been fielded at more than 125 college and university campuses across the U.S. and internationally, with over 150,000 survey respondents.
V-BID principles incorporated into ACA
Incorporating research from the U-M Center for Value-Based Insurance Design (V-BID), comprehensive healthcare reform is enacted through the Affordable Care Act, including provisions to authorize health plans nationwide to remove barriers for high-value preventive medical services.
Clinical Database to Support Comparative Effectiveness Studies of Complex Patients, 2005-2010 -AHRQ grant is awarded to College of Pharmacy investigators.
This project developed a unique relational database, linking chronic disease clinical information from the electronic medical records (EMR) of the U-M Health System to multi-payer claims data. The database is dynamic, with most information available for between 2 and 5 years, and has strong potential for sustainability. The database can be used to evaluate the quality of clinical care as well as models of care delivery that are particularly important for complex patients, such as the patient-centered medical home, transitional care, and complex care coordination. This project concerned AHRQ priority populations, including low-income and uninsured patients, older adult patients, and patients with diabetes. The population of patients used consisted of those patients who were attributed to the UMHS as continuing care patients, who were also in adjudicated and validated chronic disease registries. These registries organize EMR diagnostic and management information for patients with physician adjudicated chronic disease diagnoses. Complete claims are available for most of the relevant patient population.
CHOP begins at U-M
The Center for Health Outcomes & Policy (CHOP), a consortium of more than 100 faculty and staff, including clinician scientists, economists, biostatisticians, epidemiologists and other social scientists from the Medical School and School of Public Health, is established at U-M.
The Center for Bioethics and Social Sciences in Medicine (CBSSM), supported by the Dean’s Office at the Medical School, the Department of Internal Medicine, the Department of Psychiatry, and the Ann Arbor Veterans Administration Medical Center (Center for Clinical Management Research), is established at U-M.
Looking Toward the Future
The early 21st century has seen previously unprecedented challenges and opportunities for the U.S. healthcare system. Recognizing the tremendous potential for providing a common home for the many rich veins of ongoing research, programs, and partnerships at U-M at a most critical time for healthcare in the U.S., the U-M Regents approved the creation of the Institute for Healthcare Policy & Innovation (IHPI) in 2011. This milestone paralleled the proliferation of large healthcare data sets, a continued focus on healthcare accessibility, safety, affordability, effectiveness, cost-transparency, patient-centered care, and an ever-growing demand for translating health services research to inform public policy.
Dialysis payment reforms implemented
The U.S. Centers for Medicare & Medicaid Services implement a new dialysis payment system developed by the U-M Kidney Epidemiology and Cost Center (KECC), which leads to a reduction of approximately $225 million per year in Medicare payments for dialysis.
The Center for Clinical Outcomes Development and Application (CODA), whose mission is to achieve excellence in measurement development, selection, and application to improve clinical health research and care, is established at U-M.
Path of Excellence in Health Policy and Economics launched
The Medical School begins offering medical students the choice to pursue a Path of Excellence in Health Policy and Health Economics, in collaboration with IHPI.
The need for innovation and critical evaluation within healthcare and health policy is at one of its greatest in history. IHPI focuses its vision firmly on the future, with its goals and priorities founded on the vibrant work in health services research that has preceded the institute and continues to thrive with new energy and direction.
Inaugural IHPI Clinician Scholars Program cohort
In collaboration with the National Clinician Scholars Program, IHPI’s first Clinician Scholars begin their two-year training program on addressing new and emerging issues related to healthcare delivery and improving the health of communities. IHPI’s inaugural CSP cohort includes nurse, physician, and pharmacist researchers.
Michigan Opioid Prescribing Engagement Network (Michigan-OPEN), an initiative to develop a novel preventative approach to the opioid epidemic in the state of Michigan, launches under IHPI leadership.