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 one of the first major medical schools 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.
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.
The CHEAR Unit receives initial funding from the National Institute for Child Health and Human Development for an HSR Fellowship program.
Michigan had the first (and for over 10 years the only) NIH-funded pediatric health services research fellowship in the U.S.
CHEAR Unit total extramural funding reaches $30M.
The Division of Pediatric Cardiology forms the Michigan Congenital Heart Outcomes Research and Discovery (M-CHORD) Program.
Origination of the C.S. Mott Children’s Hospital National Poll on Children’s Health – In 2007, Matt Davis, M.D., M.A.P.P., and his team in the CHEAR Unit began the National Poll on Children’s Health as a way to bring the public voice into the national dialogue about child health and health policy in the United States.
Through a unique combination of public-oriented monthly Reports released online in lay language, and over two dozen peer-reviewed scientific publications as well, the National Poll on Children’s Health has contributed a wide variety of public perspectives to national discussions and informed reports from the Institute of Medicine, and has also served as a unique shared research platform through which multiple UM faculty have accessed national household samples in which to investigate their research questions.
CHEAR Unit hosts the 1st Annual Meister Lecture in Child Health Policy.
CHEAR Unit establishes the National Poll on Children’s Health and publishes 1st report.
The Pediatric Comprehensive Weight Management Center is launched and collaborates with CHEAR to evaluate program outcomes.
The only fully comprehensive weight management center for pediatrics in the state of Michigan.
CHEAR faculty (Woolford) selected to Co-Chair the Healthy Kids Healthy Michigan Health Policy Action Team, a state wide coalition of 120 organizations dedicated to reducing childhood obesity in Michigan through strategic policy initiatives.
Division of Pediatric Gastroenterology participates in the creation of ImproveCareNow – an inflammatory bowel disease quality improvement network.
UM pediatric IBD remission rates have steadily increased from 66% in 2008 to 89% in 2014. Currently there are 71 care centers across the U.S.
Division of Pediatric Cardiology and MICHR awarded NICHD/NCRR funding to form multicenter Pediatric Cardiac Critical Care Consortium (PC4)
Division of Hospital Medicine’s UMHS Child Protection Team begins collaborations with Munson Medical Center and Traverse Bay Children’s Advocacy Center in creating a Telemedicine Program for victims of suspected child maltreatment.
First Telemedicine Program in the State of Michigan and region for victims of Suspected Child Abuse. Received FIGs award for $12,792 in order to purchase telemedicine equipment to be utilized for Telemedicine Child Abuse Evaluations.
CHEAR Unit receives funding from the Agency for Healthcare Research and Quality and establishes the Q-METRIC Consortium to test, evaluate and advance Pediatric Quality Measures.
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.
The Division of Pediatric Cardiology’s PC4 collaborates with CardioAccess, Inc and ArborMetrix, Inc. to create PC4 registry.
The Division of Pediatric Cardiology receives funding award (Pasquali NHLBI K08 transfers to UM – Case Ascertainment and Outcomes Assessment in Administrative vs. Clinical Data for Children Undergoing Heart Surgery)
The CHEAR Program in Pediatric Unscheduled Healthcare Delivery is launched.
Working in collaboration with the Center for Healthcare Engineering and Patient Safety to design safer, more efficient, cost-effective, and coordinated systems of care for the evaluation and treatment of children with acute illnesses and injuries.
Surveillance system is developed by the Healthy Kids Healthy Michigan Health Policy Action Team for use in the Michigan Care Improvement Registry to monitor body mass index received approval for use.
The Division of Pediatric Cardiology works with the Michigan Department of Community Health as participants of the newly founded Critical Congenital Heart Disease Advisory Committee.
In 2011 USHD Secretary Kathleen Sebelius and the American Academy of Pediatrics made the recommendation that newborns be screened for critical congenital heart disease using pulse oximetry.
The Division of Pediatric Cardiology works with the Michigan Department of Community Health to create the Michigan Alliance for Prevention of Sudden Cardiac Death in the Young (MAP-SCDY).
The Division of Pediatric Cardiology participates with the Michigan Department of Community Health in establishing protocols and educational documents for screening of newborns in Michigan.
Documents are housed on the MDCH web site. University of Michigan C.S. Mott Children’s Hospital and Von Voightlander Women’s Hospital faculty and staff formed a committee to address implementation of reporting process for U-M newborns and for support of birthing centers in the state.
“Decision Support for Parents Receiving Genetic Information about Child’s Rare Disease” – PCORI grant awarded to David Sandberg, Ph.D., et al
CHEAR awarded funding from the National Institute for Child Health and Human Development to study size-appropriate child passenger restraint use.
The Division of Pediatric Cardiology begins data submission to PC4 registry.
The Division of Pediatric Cardiology receives NHLBI funding (U10HL068270) to support formation of Pediatric Heart Network Health Services and Outcomes Collaboratory.
The Division of Pediatric Cardiology establishes a Project ADAM program at the University of Michigan.
Project ADAM (Automated Defibrillators in Adam’s Memory) is a program founded at the Children’s Hospital of Wisconsin that aims to prevent sudden cardiac death in children and teens through education and development of emergency response programs in schools and communities.
The Division of Pediatric Genomic Medicine and Division of Child Behavioral Health receive funding from the Patient Centered Outcomes Research Institute (PCORI) to develop, implement and evaluate a decision support tool for genetic testing in children with Disorders of Sex Development.
The Division of Pediatric Gastroenterology is awarded funding from Blue Cross Blue Shield Foundation of Michigan to study the epidemiology of Fistula’s in Crohn’s disease.
The CDC’s Chronic Kidney Disease Surveillance project tracks the national burden of chronic kidney disease and the epidemiology of risk factors associated with CKD. In 2014, the CKD surveillance steering committee endorsed the proposal to expand the perspective of risk factors from onset in childhood that influences the incidence of CKD in childhood and in adulthood.
Hypertension worsens health outcomes in the pediatric intensive care unit.
The impact of low blood pressure (hypotension) in the intensive care unit setting has long been understood. In 2014, a UMHS wide analysis of chidren admitted to the pediatric critical unit identified a link between high blood pressure (hypertension) and longer hospitalizations, acute kidney injury and increased risk of mortality. Citation: Ehrmann BJ, Selewski DT, Troost JP, Heiber SM, Gipson DS. Hypertension and Health Outcomes in the Pediatric Intensive Care Unit. Pediatric Critical Care Medicine. Pediatr Crit Care Med. 2014 Jun;15(5):417-27. PMID: 24717906
The Division of Pediatric Cardiology is awarded funding (Gaies NHLBI K08) for “Explaining Variation in Mortality after Pediatric Cardiac Surgery” using PC4 infrastructure.
The Division of Pediatric Cardiology is awarded funding (Pasquali NHLBI R01) for Understanding Quality and Costs in Congenital Heart Surgery, which will support ongoing collaboration between UM and national partners from the Society of Thoracic Surgeons and Children’s Hospital Association.
The Division of Hospital Medicine and the Traverse Bay Children’s Advocacy Center establishes a contract with two Munson HealthCare SANEs (Sexual Assault Nurse Examiners) to conduct telemedicine abuse evaluations under the direction of Dr. Bethany Mohr, CPT Medical Director. Provision of Child Abuse training to SANEs. Provision of space for exams by Munson HealthCare.
Equipment purchased with FIGs funding. First mock examination in the CPT Telemedicine Clinic involving mock patient, SANEs, and CPT. Services Agreement between Traverse Bay Children’s Advocacy Center and the Regents of the University of Michigan completed. Telemedicine Pamphlet finalized and printed to provide to patients/family in the telemedicine clinic. Treatment agreement finalized and approved by UMHS HSLO.
The Department of Pediatrics and the Divisions of Pediatric Cardiology and Neonatology implement reporting of results of newborn critical congenital heart disease screening from U-M and support of the process for other birthing centers in the state.
A process of extracting data from the EMR and submitting to the state electronically was established for UMHS. Education for practitioners in the state was provided by UMHS faculty and staff. The Division of Pediatric Cardiology is establishing a process for exploring Society of Thoracic Surgeons Congenital Heart database compared to the CCHD screening data for quality assessment purposes. This is a unique feature of the Michigan process compared to other states.
The Division of Pediatric Endocrinology participates in the creation of a collaborative care network focused on quality improvement in Type 1 Diabetes.
The Division of Pediatric Genomic Medicine is awarded funding from the National Institutes of Health and the National Institute for Child Health and Human Development to study parental perceptions of Next Generation Sequencing and informed consent in newborns.
The Division of Pediatric Gastroenterology is awarded funding from the Crohn’s and Colitis Foundation of America to study mobile text messaging for improving symptoms and quality of life for patients with inflammatory bowel disease.
The Divisions of Pediatric Cardiology and Pediatric Genetics establish a DNA bio-repository for the CDC-NIH sponsored Sudden Death in the Young (SDY) Registry.
CHEAR faculty (Susan Woolford, M.D., M.P.H.) selected to co-lead the new Children’s Hospital /American Academy of Pediatrics Expert Exchange, which brings together pediatric obesity providers from across the country with a goal of improving the delivery of obesity care for children and adolescents.
CHEAR faculty (Woolford), with support from Project Healthy Schools, obtains funding from the National Institutes of Health to develop geo-location triggered system to prompt healthy food choices at the point of sale among African American adolescents in Southwest Michigan.
The Division of Pediatric Cardiology works with the Michigan Department of Community Health’s Michigan Alliance for Prevention of Sudden Cardiac Death in the Young (MAP-SCDY) in establishing a new school award and responding to new legislation about cardiac emergency plans in schools.
Facilitates the first MiHEARTSafe School awards as schools meet defined criteria. Participates in development of tools for schools to utilize in complying with HB 4713 requiring schools to have a cardiac emergency plan.
The Division of Pediatric Cardiology initiated and completed the project to make Michigan only one of several states with advanced care for children experiencing a sudden cardiac arrest. This work was a major component of the approved state house bill 4713, and was recognized by the national organization “Project Adam”, certifying Michigan as an affiliate state.
CHEAR faculty (Joyce Lee, M.D., M.P.H.) in conjunction with the faculty from the Schools of Art and Design, Public Health, Medicine, and School of Information, holds the inaugural “We #Make Health Fest”. The event promoted patient-centered participatory design in healthcare and the application of the “maker” movement for health.
Promotes collaboration and bridges the gap between the technical and design communities whose members want to work on health projects but need a health partner and health partners who have ideas but need a technical collaborator to bring them to life.
CHEAR Unit and The Patient and Family-Centered Care program (PFCC) launch the first Patient and Family Research Council. The new initiative aims to better integrate the voices of pediatric patients and families into the development of child health research projects.
The committee is a mechanism for patients and families to contribute their perspectives on research at the initial stages of development while also providing an opportunity for patients and families to engage as partners in research once proposals have been funded.