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 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.
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.
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.
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.
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.
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 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.
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.
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.