Profiles of diverse health research at the University's medical school

Wednesday, July 13, 2016 - 11:42am

Last fiscal year, the University of Michigan Health System saw more than 2.1 million outpatient visits. The patients received a range of care with new and innovative technologies— from psychiatric to orthopedic, cardiovascular and surgical — and the University Hospital offered its services and resources in an attempt to find successful treatments and cures.

With a $466 million research budget, a campus larger than 11 million square feet, 1,000 licensed patient beds and more than 26,000 faculty, students and volunteers that make up the University Health System, it is no question why many of the Medical School’s departments consistently rank with those of other competitive schools nationwide. At the Medical School, researchers and professors continue to focus on constructing innovative solutions to society’s most troubling health problems. 

Today, researchers and administrators at the University Medical School continue to further the goals set forth since its opening in 1850 and the opening of the University's hospital in 1869 — the first program in the United States to have established and operated its own hospital at the time to learn and teach.

Depression Center — Veteran's Health

In 1906, one of the nation’s first psychiatry departments was established at the University. In 2001, the University's Depression Center became the nation’s first comprehensive center of its kind. Established to bring depression to the forefront of medical research and public discussion, the center has received multiple honors for research on adolescent brain development, substance use and more. Recent honors include the Center's selection as one of 13 sites to launch a landmark study on substance abuse and adolescent brain development, in addition to the induction of several faculty members into the University 2015 League of Educational Excellence. 

Housed in the Rachel Upjohn Building, the Depression Center is dedicated to multiple aspects of understanding mental illness, including research, treatment, education and public policy. Aimed at reducing the stigma that often accompanies mental illnesses, the center welcomes those suffering from depression, suicide survivors and college students.

There is also a distinct focus on veteran's mental health. Amy Kilbourne, University professor of psychiatry and director of the Veterans Affairs Quality Enhancement Research Initiative Program, said a focus on veteran mental health is crucial particularly due to the growing veteran population in the United States. According to the U.S. Census Bureau, the 2009 to 2013 American Community Survey revealed 21.3 million veterans live in the United States and Puerto Rico — a total of 9 percent of the population. Due to to this consistently increasing population, the VA changed its focus to strictly primary care services, and QUERI was established in 1998. 

Kilbourne, who represents the national QUERI program office in Ann Arbor, hopes to bridge the gap between her interest in psychiatry and veteran care. She added that sometimes the only provider of mental health services for veterans is the VA, and, consequently, QUERI often co-sponsors suicide prevention programs and evaluates the best strategies of implementation for suicide prevention.

However, this is not the only aspect of veteran health QUERI works to advance.

“The goal of QUERI is to improve veteran’s health, and, in order to accomplish that goal, QUERI promotes the more rapid implementation of research into routine care practice,” Kilbourne said. “We do that primarily by funding a national network of VA affiliated investigators who are devoted to this area of research called implementation science. The goal of implementation science is to figure out … what is keeping research from getting into routine care practice.”

In doing this, Kilbourne said QUERI is able to find the factors that either prevent or help the implementation of research. To adopt research into routine care, QUERI has two central areas of research: program evaluation and implementation strategies, Kilbourne said.

Program evaluation consists of interacting with more than 15 partnered evaluation centers nationwide, which are devoted to helping the VA understand which programs and practices are best to use, Kilbourne said. Implementation strategies, on the other hand, are designed to help providers use research evidence in practice to make care more efficient, applicable and veteran-centered.

Kilbourne said her concentration on implementation is crucial in modern medicine, especially because, on average, it takes 17 years for research to be executed in practice. 

“It’s not enough to disseminate information to providers and nor to change practice,” Kilbourne said. “It’s not enough to disseminate or provide education to both patients and providers and make a difference in their health care and their lives. And the reason is people are busy and there’s a lot of complicated factors in health care. Health care involves more and more complexities about teams of providers. It involves different providers, and it also involves ways in which the health care can be delivered. There’s new technologies being used like mobile health and mobile technologies.”

C.S. Mott — Children’s Health

Technology is applied to multiple areas of the medical field, according to Joyce Lee, University professor of pediatrics and a Child Health Evaluation and Research Unit doctor. This is evidenced by Lee’s work to make patient care more consumer-focused, virtual and outside of the clinic.

Introduced to the hospital only five years ago, the C.S. Mott Children’s Hospital at the University Health System has combined quality care for newborns and children in what was a $754 million construction project. Here, patients receive care in what is called a “teaching hospital," in which recent medical school graduates engage in training and the treatment process, along with doctors and specialists.  

According to its website, the CHEAR Unit is dedicated to investigating social concern of child welfare. The CHEAR Unit is multifaceted, with an advisory board that interacts with those from the University’s business, dentistry and law schools to establish programs that encourage interdisciplinary research on children’s health.

Lee, an endocrinologist, said she particularly is interested in childhood obesity and diabetes. In 2012, about 17 percent of children and adolescents aged 2 to 19 years old were obese, which translates to about 12.7 million individuals. It was also estimated in 2012 that approximately 1.25 million children and adults in the United States had type 1 diabetes. These facts indicate that obesity and diabetes are medical epidemics. 

“(Diabetes is) really the poster child for digital health in that there’s a lot of patients who are already collecting a lot of patient-reported outcomes at home, which is essentially their blood sugar and their insulin doses,” Lee said. “Technology has a big role to play in trying to help … change the paradigm of how health care delivery happens for patients with diabetes and their physicians.”

Because of this, Lee said her interests tie together clinical care and quality improvement with developing “immersion technology,” which includes human-centered design for data visualization in mobile technology. Lee, who is known as “Doctor as Designer" online, uses her blog and Twitter account to communicate that technology can be integrated into patients' lives to improve the health care delivery system.

“We’re trying to develop more modern systems to help kids better self-manage their diabetes,” Lee said.

An example of this innovation in patient care is Lee’s interaction with Nightscout, an online, do-it-yourself community developed by parents of children with Type 1 Diabetes. According to its website, Nightscout’s goal is to allow remote monitoring of the glucose levels of a type 1 diabetes patient. The service uses modern technology such as websites, Smartwatch viewers or Smartphone applications, many of which can send glucose readings from a receiver to an online “cloud” to notify a doctor or parent.

“We’re trying to tap into: one, a community that’s very activated and very passionate about helping others; two, to take advantage of the fact that everyone has adopted global technology and is collecting real-time glucose levels for their kids or for themselves; and three, try to take advantage of the fact that they’re all connected by a social media and think about trying to use that medium to accelerate the development of research and the participation of patients and caregivers in the research," Lee said. 

Ultimately, Lee said she wants to use the opportunities technology avails to improve the care of chronic childhood obesity. 

Comprehensive Cancer Center — Women’s Health

Alongside a dedication to the health of children and women at C.S. Mott Children’s Hospital and Von Voigtlander Women’s Hospital, the Comprehensive Cancer Center places a particular emphasis on women’s health.

One of just 45 centers in the United States to earn the National Cancer Institute’s “comprehensive” designation, the Comprehensive Cancer Center is also the only hospital in Michigan that ranks in the top 50 U.S. News list of best hospitals for cancer care, according to its website.

In 2015, the Center accounted for more than 97,000 of the hospital’s total outpatient visits. Patients were treated in any of 13 programs, including those focusing on bone cancer and brain cancer.

Karen McLean, University assistant professor of Obstetrics and Gynecology, focuses her research on ovarian cancer as one of many University researchers dedicated to women’s health management at the hospital.

Though ovarian cancer accounts for about 3 percent of cancers among women, it causes more deaths than any other cancer of the female reproductive system, such as uterine or cervical cancer. This fact suggests that ovarian cancer is more difficult to treat and cure. Because of this, McLean collaborates with other researchers who study early detection of the disease and focuses her work on developing better treatments for ovarian cancer. 

Having studied in the Medical Scientist Training Program at the University, McLean said she feels she received an education that granted her knowledge of the basic cores of science and research. She said the Cancer Center's specific focus on research and care has allowed her to conduct research in the best way possible. 

“Because Michigan is a comprehensive cancer center, patients come here specifically for their cancer care,” McLean said. “They’re coming here because they want the best cancer care that they can get, and I truly believe that Michigan offers that. Because I also practice clinical medicine, it allows me the bridge between seeing patients and taking care of them and translating that to the research side. One of the things that results in is the ability to specifically study my patients' cancers.”

Aside from clinical practice and research, McLean is part of the Translational Oncology Program, which encourages collaborative approaches to innovative cancer treatments, according to its website.

McLean said this program has been beneficial, with researchers from all disciplines able to work together toward the same goals, establish a network of collaborators and receive mentorship for establishing their own careers. She found this especially advantageous for women’s health, particularly because female cancers — such as breast cancer, ovarian cancer or uterine cancer — have not always been at the forefront of cancer research.

“Traditionally, women’s cancers were understudied, and, looking back historically, there were fewer women enrolled in clinical trials,” McLean said. “That’s changing now, but I don’t think we’re as far along with specifically women’s cancers.”

Because of this change, McLean hopes to improve clinical care and women's health. 

“Ultimately, what drives me to do research is the goal of improving care and outcomes for patients,” McLean said. “I hope that I’m able to make discoveries that ultimately do translate to new treatments that improve either longevity or quality of life for women who have these cancers.”

Geriatrics Center/Institute of Gerontology — Elderly Health

In 1965, the nation’s first state-funded center for geriatrics and aging was created at the University with the goal of facilitating top-notch geriatrics research, according to its website. Geriatrics focuses on health care of the elderly. After merging with the Institute of Gerontology in 2004, the University Geriatrics Center continues today aimed at studying geriatric medicine with the hopes of incorporating innovative medical treatment in all aspects of aging.

Kenneth Langa, Institute of Gerontology Associate Director and professor of internal medicine, said his work focuses on chronic diseases and aging-related issues, such as Alzheimer’s and dementia. Langa has a joint appointment within the Institute for Social Research and the Geriatrics Center at the University.

Langa has utilized the Health and Retirement Study, a University study that samples adults 50 years and older in the United States every two years, for his research. The survey — sponsored by the National Institute on Aging and the Social Security Administration — collects data about income, work assets, pension plans, insurance and other expenditures ultimately to make predictions about the roles of these factors for large health care programs such as Medicare and Medicaid.

“The main reason we think it’s important is because of the large growth in the older population that is starting to take place right now in the United States and actually many other countries around the world,” Langa said. “The proportion of people in the population is shifting toward a larger proportion of people that are 65 and older or even 85 and older.”

Langa said this shift points to increased life expectancy. Those born after World War II — the “baby boomers” — are now growing older, alongside veterans of the Korean and Vietnam Wars, and people are having fewer children. According to the U.S. Census Bureau, the population over 65 years old and older made up 4.1 percent of the total population in 1900, but in 2015, the elderly population made up 14.9 percent of the total population — indicative of this growing elderly population. 

“The number of children that people have had in families over the last 30 or 40 years is going down,” Langa said. “We’ve got this potentially problematic change in that there will be much more older people, which in general can mean more health problems, more disability, but then fewer children in families to take care of older adults.”

This research links seamlessly with Langa’s interest in public policy and the economic impact of an increasing older generation. Langa said it is estimated more than four million people in the United States are experiencing the symptoms of dementia, like cognitive decline.

“Because dementia is so closely linked to age, as you get more older people in the United States, we think that it’s likely that the number of people with Alzheimer’s disease and dementia will go up,” Langa said. “It’s quite a costly problem … we estimated it costs the United States about $200 billion every year taking care of people with Alzheimer’s disease and dementia.”

Ultimately, Langa said this is a growing field with much public attention. With the National Institutes of Health and Congress allocating more than $350 million to geriatrics research last year, a growing recognition of this issue is crucial to the future of medicine, particularly at the University.


Editor's note: a previous version of this article said Medical Scientists Training Program, which was corrected to say Medical Scientist Training Program.