The 2016 Quality Improvement Summit was held at the AUA headquarters on Saturday, April 2, 2016. The summit, co-sponsored by the AUA and Society for Medical Decision Making (SMDM), focused on shared decision making and prostate cancer screening. The AUA’s white paper on shared decision making was the basis for the Quality Improvement Summit.
Speakers included a combination of urologists, primary care providers, nurses, other clinicians, patients, and noted shared decision making researchers. Their discussions throughout the day focused on four primary topics:
Keynote Speaker: The Balance of Harms and Benefits of Screening for Prostate Cancer
Group discussion (54:24)
Saturday, April 2, 2016
Shared Decision Making and Decision Aids
Working Lunch/The Patient Perspective
Federal Government Perspective
Timothy D. Averch, MD
Timothy D. Averch, MD, is a professor of urology and director of Endourology at the University of Pittsburgh School of Medicine. He is also director of the UPMC Kidney Stone Center, whose members treat and manage kidney stone disease over the long term. Dr. Averch earned his medical degree from the University of Pittsburgh in 1989. Between 1989 and 1996, he completed surgical and urologic residencies at New York Medical College, and a fellowship in endourology at the Brady Urological Institute of Johns Hopkins Hospital. Before joining with UPMC in 2000, Dr. Averch was assistant professor of urology and director of Endourology at the Medical College of Virginia. His clinical interests include endourology, stone disease, and laparoscopic surgery. Additionally, Dr. Averch currently serves as Vice Chair of the AUA's Quality Improvement and Patient Safety Committee.
Michael Barry, MD
Michael became president of the nonprofit Informed Medical Decisions Foundation in 2009. In 2014, the Foundation became a division of Healthwise, another mission-driven nonprofit. Michael remains president of the Foundation and adds the title of Chief Science Officer at Healthwise. Healthwise's mission is to help people make better health decisions. He is a past president of the Society for Medical Decision Making (SMDM) and the Society of General Internal Medicine in the United States. His research interests have included defining the outcomes of different strategies for the evaluation and treatment of prostate diseases, decision analysis, health status measurement, clinical quality improvement, and the use of decision aids to facilitate patients' participation in decision making. Michael has led many prominent research studies including the Patient Outcome Research Team for Prostatic Diseases. He has served on practice guideline committees for the American Urological Association and the American College of Physicians. Michael continues to practice primary care and serves as medical director of the John D. Stoeckle Center for Primary Care Innovation at MGH. He is also a professor of medicine, part time, at Harvard Medical School and a Master of the American College of Physicians.
Kristin Chrouser, MD, MPH
Dr. Kristin Chrouser is experienced in treating patients with a variety of urologic conditions, including stones, incontinence, BPH, neurogenic bladder, erectile dysfunction, and urologic cancers. She is particularly interested in reconstruction of the urethra after damage by stricture disease or vesicovaginal fistulae. Her research focuses on developing innovative ways to insure high quality, efficient, and safe surgical services both in developing nations with limited resources as well as here at home. She provides technical support for organizations and governments providing male circumcision services for HIV prevention in sub-Saharan Africa and also volunteers her reconstructive skills in underserved nations where many patients have no access to surgery for strictures and fistulas.
Dr. Chrouser received her medical degree from the Mayo Medical School and completer her residency through the Mayo Clinic College of Medicine.
Angela Fagerlin, PhD
Angela Fagerlin, PhD, is the first permanent chair of the University of Utah School of Medicine's new Department of Population Health Sciences. She previously served as a professor of internal medicine and co-director of the U of Michigan's Center for Bioethics and Social Sciences. Dr. Fagerlin is also president-elect of the Society for Medical Decision Making.
William F. Gee, MD, FACS
William F. Gee, MD, FACS, is Clinical Professor of Surgery (Urology), Voluntary Faculty, at the University of Kentucky College of Medicine and Emeritus Urologist at Commonwealth Urology, Lexington, Kentucky. He has spent much of his career training University of Kentucky PGY-4 urology residents during their six-month rotation with private practice urologists at St. Joseph Hospital. He received his medical degree from the University of Wisconsin in Madison and did his urology residency in Seattle at the University of Washington, which included a year as an NIH Senior Research Fellow. Additionally, Dr. Gee served two years on active duty as a medical officer in the United States Naval Reserve, which included service in Vietnam.
From 2005 to 2009 Dr. Gee was AUA treasurer and a member of the Executive Committee and Board of Directors. He has held numerous leadership positions, including president and secretary-treasurer of the American Association of Clinical Urologists, and president of both the AUA's Southeastern Section and the Kentucky Urological Association. Dr. Gee represented the AUA as a delegate to the AMA House of Delegates prior to becoming AUA president-elect. In addition, he served as AUA representative to the "RUC" (AMA Relative Value Update Committee) for over 15 years; the RUC determines the Relative Values for the Medicare Fee Schedule. Over the years, Dr. Gee has served on numerous AUA committees, including Urology Core Curriculum, Investment, and Future of Urology Residency Training Task Force. He has also been chair of the AUA Health Policy Council and has testified before Congress on urology issues. Dr. Gee has received several AUA awards, including the AUA Distinguished Service Award and the AUA Presidential Citation. He has been a member of the AUA since 1980, and was awarded Honorary AUA Membership in 2011.
Kate Goodrich, MD
Dr. Kate Goodrich joined the Centers for Medicare and Medicaid Services in September of 2011 where she serves as Director of the Center for Clinical Standards and Quality (CCSQ). This Center is responsible for over 20 quality measurement and value-based purchasing programs, implementation of the new Merit-based Incentive Payment System and the Improving Medicare Post-Acute Care Transformation Act, quality improvement programs in all 50 states, clinical standards and survey and certification of all providers across the nation, and all coverage decisions for treatments and services for CMS. The Center budget exceeds $1.3 billion annually.
Previously, Dr. Goodrich served as the Director of the Quality Measurement and Value-based Incentives Group in CCSQ where she oversaw the implementation of over 20 quality, value-based purchasing and public reporting programs across multiple settings. She also co-lead an HHS-wide group to align quality measures across programs, and more recently has worked with numerous private payers to align measures across the public and private sectors. From 2010 – 2011 she served as a Medical Officer in the office of the Assistant Secretary for Planning and Evaluation (ASPE) at DHHS where she managed a portfolio of work on comparative effectiveness research and quality measurement and improvement.
Dr. Goodrich is a graduate of the Robert Wood Johnson Clinical Scholars Program at Yale University where she received training in health services research and health policy from 2008-2010. From 1998 to 2008, Dr. Goodrich was on faculty at the George Washington University Medical Center (GWUMC) and served as Division Director for Hospital Medicine from 2005-2008 and was chair of the Institutional Review Board from 2004 – 2008. She went to medical school at Louisiana State University in Shreveport, LA, and completed her internal medicine residency and chief medical resident year at GWUMC. She continues to practice clinical medicine as a hospitalist and Associate Professor of Medicine at GWUMC.
Widely recognized as one of the greatest defensive backs, Mike Haynes played for the New England Patriots and the Los Angeles Raiders. His professional football career began when he was selected in the 1976 NFL Draft by the New England Patriots. He was elected to the Pro Football Hall of Fame in 1997. He is a prostate cancer survivor and spokesperson for the Urology Care Foundation's Know Your Stats About Prostate Cancer® campaign. Haynes discovered he had prostate cancer during a 2008 screening event conducted by the Urology Care Foundation and supported by the National Football League (NFL) Player Care Foundation. Now a prostate cancer survivor, he encourages men to be proactive about their prostate health and to talk with their doctor about whether prostate cancer screening is right for them.
Margaret Holmes-Rovner, PhD
Margaret Holmes-Rovner, PhD received her PhD in curriculum and sociology from the University of Wisconsin. She joined the Michigan State University College of Human Medicine in 1980 in Medical Decision Making research under the direction of Arthur Elstein. She served there as Professor and Chief of Health Services Research in the Department of Medicine and is currently Professor Emerita in the Center for Ethics. Dr. Holmes-Rovner has served in a national leadership capacity in the field of medical decision-making and technology assessment. She has worked to establish international standards for patient educational materials designed to support informed, shared patient decision-making. She is a founding member of the International Patient Decision Aid Standards (IPDAS) Collaboration and has developed decision support tools, and decision aid evaluation measures that are widely used nationally and internationally.
Dr. Holmes-Rovner's present research focuses on implementing shared decision making in clinical practice. This includes empirical studies of patient-provider communication in decision making about early stage prostate cancer treatment and of shared decision making in the primary care/cardiology referral process following stress testing. The empirical work provides background to establish new models of provider-led shared decision making encounters that are relevant to trainees and to practicing clinicians.
Murray Krahn, MD, MSc, FRCPC
Dr. Murray Krahn is the Director of THETA (Toronto Health Economics and Technology Assessment Collaborative), and holds the F. Norman Hughes Chair in Pharmacoeconomics at the Faculty of Pharmacy, University of Toronto. He is a Professor in the Faculties of Medicine and Pharmacy, University of Toronto, a Senior Scientist at the Toronto General Research Institute, and an Adjunct Scientist at the Institute for Clinical Evaluative Sciences, Toronto. He is also an attending physician in the division of General Internal Medicine at the Toronto General Hospital.
Dr. Krahn obtained his Doctor of Medicine degree at the University of Manitoba and has a Specialist Certificate in Internal Medicine. He also holds a Master of Science degree in Clinical Epidemiology from McMaster University, and completed a postdoctoral fellowship in Clinical Decision Making at the New England Medical Center.
Danil Makarov, MD, MHS
Danil V. Makarov, MD, MHS is a board-certified urologist and a fellowship trained health services researcher. He received his undergraduate degree in economics from Yale University and his medical degree at the Johns Hopkins School of Medicine. He completed a surgical internship in the William S. Halsted Department of Surgery and a residency in urology at the James Buchanan Brady Urological Institute (both at Johns Hopkins). After completing his residency, Dr. Makarov continued on the faculty at Johns Hopkins as an Instructor in Urology. After this experience, Dr. Makarov completed a Masters in Health Sciences Research as a Robert Wood Johnson Foundation Clinical Scholar at Yale University School of Medicine. Dr. Makarov joined NYU 2010 as Assistant Professor of Urology, Population Health and Health Policy.
David Rovner, MD
David Richard Rovner M.D. is emeritus professor of Medicine and Endocrinology at Michigan State University College of Human Medicine.
He was graduated from Temple University School of Medicine and served a rotating internship in the University of California service at San Francisco Hospital. He then moved to the University of Michigan to begin a residency in 1959 where 12 years later he attained the rank of Professor of Endocrinology and Metabolism. He was a senior member of the team that first described Primary Aldosteronism and published many papers describing its important role in secondary hypertension. He first hypothesized that Primary Aldosteronism may be the cause of approximately 7% of cases of so called 'essential hypertension'. The importance of his work was recognized in 1985 when his article "Suppression of Plasma Renin Activity in Primary Aldosteronism" was chosen as a landmark article by JAMA. He moved to Michigan State University in 1971 where he was chief of Endocrinology and Metabolism till retirement with a time as interim chair of the department of Internal Medicine.
Since 1979 his research and teaching activities have encompassed Decision Analysis, Medical Decision Making, Cost Effectiveness Analysis, and Shared Medical Decision Making, especially in individuals with lower literacy and diverse ethnic characteristics. In 2000, together with Margaret Holmes-Rovner, and Angie Fagerlin he began a long running research project with early stage prostate cancer. In association with the Michigan Cancer Consortium the team produced a decision aid for patients with early stage prostate cancer, and analyzed the conversation between Urologists and patients in the decision making visit upon first discovering prostate cancer.
He is a past recipient of the Distinguished Faculty Award from Michigan State University and a founding member of the Society for Medical Decision Making. As Professor Emeritus he continues to consult in research design and analysis in the areas of cost effectiveness analysis and shared decision making.
Christopher Saigal, MD
Christopher Saigal, MD, MPH, FACS, currently serves as Vice Chair and Professor of the Department of Urology with the UCLA School of Medicine. He is also on the staff of the West Los Angeles Veterans Affairs Medical Center. Dr. Saigal has had a longstanding clinical interest in urologic cancers and the surgical treatment of benign prostatic hyperplasia. His research is focused on patient-centered decision support and quality of care for urologic conditions. He received his undergraduate degree from Stanford University and pursued his medical degree at the UCLA School of Medicine, where he also completed is surgical and urological residencies. Additionally he received a Masters of Public Health from the UCLA School of Public Health. In addition to his urologic practice, Dr. Saigal is well-published researcher, and since 2001 has served as a RAND Health Principal Investigator. Through this endeavor, he has led the National Institutes of Health-funded Urologic Diseases in America project, an ongoing effort to document quality of care and burden of illness for the major urologic conditions.
Harold Sox, MD
Harold Sox is a general internist, editor emeritus of Annals of Internal Medicine, and Director of Research Portfolio Development at The Patient-Centered Outcomes Research Institute (PCORI). Dr. Sox spent most of his professional life at Stanford University and Geisel School of Medicine at Dartmouth, the latter as chair of the Department of Medicine. He practiced general internal medicine for 30 years. He chaired the U.S. Preventive Services Task Force, the Medicare Coverage Advisory Committee, and several Institute of Medicine Committees, including the committee that set national priorities for Comparative Effectiveness Research. He was President of the American College of Physicians and is a member of the National Academy of Medicine and a fellow of the American Association for the Advancement of Science. He is a member of the JAMA Editorial Board and a past member of the Editorial Board of the New England Journal of Medicine. His books include Medical Decision Making, a standard textbook in this field.
Dawn Stacey, PhD
Dawn Stacey, RN, PhD holds a Research Chair in Knowledge Translation to Patients and is a Full Professor in the School of Nursing at the University of Ottawa. She is the Scientific Director of the Patient Decision Aids Research Group at the Ottawa Hospital Research Institute. In 2015, she was inducted into the Royal Society of Canada in recognition of her research. She leads the Cochrane Review of Patient Decision Aids, co-chairs of the Steering Committee for the International Patient Decision Aid Standards Collaboration (IPDAS), and collaborates on the Cochrane Review of Interventions to Improve the Adoption of Shared Decision Making. More specifically, her research program focuses on: a) patient decision aids; b) decision coaching; c) implementation of evidence into practice; d) telephone-based care, and e) interprofessional approaches to shared decision making. She has given over 100 invited national and international presentations.
Christopher Tessier, MD
Dr. Christopher Tessier is Associate Professor of Urology and Medical Informatics at Oregon Health & Science University in Portland, OR. He has been active in the AUA serving on various committees and panels and currently serves as Chair of the AUA's Quality Improvement and Patient Safety Committee.
Robert L. Waterhouse Jr., MD, MBA
Dr. Waterhouse matriculated to Northwestern University for undergraduate and medical school education. At Northwestern medical school, he first developed an interest in urology and prostate cancer while doing research with Dr. John Grayhack and Dr. Chung Lee on the androgen axis and its' effect on stimulating prostate cancer growth. For residency and research fellowship, he moved to Case Western University in Cleveland, Ohio. Upon completion of training, he pursued a career in academic medicine at Mount Sinai Medical School. He transitioned to private clinical practice in Charlotte, North Carolina area where he is Medical Director of Carolina Urology Partners. He continues to have strong interest in prostate cancer through his clinical practice, through involvement as principal investigator in multiple prostate cancer clinical research studies, and through working in the Carolina Urology Partners Advanced Prostate Cancer Center. He is actively involved in creating evidenced based medicine protocols for the evaluation and treatment of prostate cancer for his organization. He, also, is a member of the leadership group of the R. Frank Jones Urology Society of the National Medical Association which is committed to addressing health care disparities for African Americans – of which prostate cancer is an important priority.
|Christopher Tessier, MD||Quality Improvement Summit Introduction|
|Harold C. Sox, MD, MACP||Keynote Speaker: The Balance of Harms and Benefits of Screening for Prostate Cancer|
|Michael J. Barry, MD||Patient Decision Aids to Support Shared Decision Making|
|Margaret Holmes-Rovner, PhD||Inside the Encounter: Shared Decision Making in Prostate Cancer Treatment Decisions|
|Christopher Saigal, MD, MPH||Values Clarification in Men with Prostate Cancer|
|Murray Krahn, MD, MSc, FRCPC||Patients’ Preferences in Prostate Cancer Screening|
|Kristin Chrouser, MD, MPH||Decision Coaching|
|Dawn Stacey, RN, PhD||Decision Coaching|
|Angie Fagerlin, PhD||Tips for Talking with Patients about PSA Screening|
|Robert L. Waterhouse, Jr., MD, MBA||Role of Cultural Diversity in Communication for Shared Decision Making|
|Kate Goodrich, MD, MHS||Shared Decision Making in Medicare Coverage|
Keynote Speaker: The Balance of Harms and Benefits of Screening for Prostate Cancer
Group discussion (54:24)
Patient Decision Aids to Support Shared Decision Making
Inside the Encounter: Shared Decision Making in Prostate Cancer Treatment Decisions
Group discussion (38:59)
Patients’ Preferences in Prostate Cancer Screening
Values Clarification in Men with Prostate Cancer
Group discussion (38:04)
Group discussion (1:05:10)
The Patient Perspective
Tips for Talking with Patients about PSA Screening
Group discussion (57:37)
Tips for Talking with Patients about PSA Screening
Group discussion (1:23:20)
Doing Shared Decision Making in Practice
Shared Decision Making in Medicare Coverage
Group discussion (53:48)