Stanford Health Policy researchers, led by Josh Salomon, have been awarded a five-year grant from the Centers for Disease Control and Prevention (CDC) to conduct health and economic modeling to guide national and local policies and programs focusing on some of the most important infectious diseases in the United States.

The CDC grant establishes the Prevention Policy Modeling Lab at Stanford, continuing a multi-institution collaboration that began when Salomon was a professor at Harvard prior to joining Stanford in 2017.

“The overall mission of the Prevention Policy Modeling Lab is to leverage the best available evidence to inform strategic decision-making about major public health problems,” Salomon said. “We do this by combining techniques from decision science, simulation modeling and health economics to estimate and project major patterns and trends in these diseases and to evaluate different clinical and public health strategies to address them.”

The initiative will focus on policy and practice in the areas of tuberculosis, HIV, hepatitis, sexually transmitted infections and adolescent health. The grant from the Centers for Disease Control and Prevention supports a wide range of modeling activities, including those that assess: 

• Projections of future morbidity and mortality
• Burden and costs of diseases
• Costs and cost-effectiveness of interventions
• Population-level program impact
• Optimized resource allocation

Stanford researchers who are involved in the Modeling Lab include Douglas K. Owens, Margaret Brandeau, Eran Bendavid, Jeremy Goldhaber-Fiebert, Jason Andrews, Samuel So and Mehlika Toy. The consortium also includes partners at Harvard, Yale, Michigan, Boston University, Boston Medical Center and the MA Department of Public Health.

“As a multi-institution consortium, on any given problem we’re able to assemble a team that includes both subject matter experts and collaborators who specialize in statistics, epidemiology, data science, economics and decision analysis,” Salomon said. “The policy models that we develop allow us to synthesize a wide array of different types and sources of evidence to shed light on the essence of the problem and to weigh the likely benefits and costs of responding in different ways.”

Prior work from the consortium on the potential impact and cost-effectiveness of expanding testing for hepatitis C virus was cited in the recent decision by the U.S. Preventive Services Task Force to revise their screening recommendations to cover all adults. The Modeling Lab has also examined prospects and strategies for eliminaitng tuberculosis in the United States and policies relevant to the rising threat of antimicrobial-resistant gonococcal infection among other topics.

This fall, the Stanford Program on International and Cross-Cultural Education (SPICE) began its ninth offering of Stanford e-Japan, an online course that introduces U.S. society and culture and U.S.–Japan relations to high school students in Japan. Stanford e-Japan is made possible through the support of the Yanai Tadashi Foundation, Tokyo. The fall 2019 Stanford e-Japan online course has continued the tradition of enrolling students from various parts of Japan; engaging students with leading American and Japanese academics, entrepreneurs, and community leaders as guest speakers; and encouraging students to study in the United States.

The 28 students of the fall 2019 cohort were selected from among a competitive group of applicants from throughout Japan. The selected students represent the prefectures of Chiba, Ehime, Gunma, Hiroshima, Hyogo, Ibaraki, Kanagawa, Kyoto, Mie, Miyagi, Nara, Okayama, Saitama, and Tokyo. Stanford e-Japan Instructors Meiko Kotani and Waka Brown have noted that their students not only continue to learn important content and perspectives from the guest speakers but also important perspectives from their fellow students. Brown recalled, “…last year, I was particularly struck by the impact a student from Okinawa had on the other students in his cohort as he shared insights on the U.S. military presence in Okinawa from his personal experiences.”

The fall 2019 course recently featured guest speaker Suzanne Basalla, who has become a regular speaker for Stanford e-Japan. Basalla is Chief of Staff at the Toyota Research Institute in Silicon Valley and a former officer (Lieutenant Commander) of the U.S. Navy. Following her naval career, Basalla served as Director for Japan in the Office of the Secretary of Defense and as Senior Advisor to U.S. Ambassador to Japan John Roos, serving at the U.S. Embassy in Tokyo from 2010 to 2012. During her talk with the students, she touched upon her work with security-, economic-, political-, and cultural-related issues in the U.S.–Japan relationship and also offered keen insights into her current work as a leading entrepreneur in Silicon Valley.

Speakers like Basalla as well as Instructors Brown and Kotani have been encouraging Japanese students to consider studying in the United States. Many Stanford e-Japan alumni have enrolled in summer programs in the United States, spent a year studying abroad in the United States, and several have enrolled in four-year colleges in the United States. Among the latter are Jun Yamasaki (Fall 2017 Stanford e-Japan cohort) and Hanako “Hannah” Tauchi (Spring 2017 Stanford e-Japan cohort), who are recipients of Yanai Tadashi Foundation Scholarships. The following is noted on the scholarship’s website.

[The] Yanai Tadashi Foundation Scholarship aims to provide promising young people with leadership potential the opportunity to study at world-class universities in the United States. The scholarship enables recipients to mix with an internationally diverse student body to cultivate their entrepreneurial skills and enhance their global perspective, encouraging their development as future drivers of a better society.

Yamasaki, a freshman at Northwestern University, and Tauchi, a freshman at the University of California, San Diego, recently commented on how Stanford e-Japan helped them as high school students to prepare for undergraduate studies in the United States. Their comments follow.

Yamasaki: As an institution, Northwestern places a great emphasis on interdisciplinary studies and learning—a characteristic that is apparent in both its research and the academic interests and aspirations of its students. The structure of the Stanford e-Japan program itself encouraged me to examine the U.S.–Japan relationship through multiple perspectives, ranging from sports to entrepreneurship. In addition to furthering my understanding of the dynamics of the U.S.–Japan relationship, Stanford e-Japan helped me identify the intersection between my past interests and the potential future needs and topics pertaining to the U.S.–Japan relationship, and construct my future goals accordingly. This in turn has allowed me to better plan out how I can take full advantage of Northwestern’s unique characteristics and offerings, which I am extremely thankful for. 

Tauchi: The Stanford e-Japan Program was an amazing opportunity for me both to consider undergraduate studies in the U.S. as a realistic option and to improve my English skills overall. As a student who was schooled in Japanese for my entire life, the course—lectures, reading assignments, discussions, and essays—was at first quite challenging, but looking back the half a year I worked on the program, I would definitely say that the program is one of the most important experiences that I had during my high school life. Offered by one of the most renowned colleges in the world, I could feel and imagine how college life in the U.S. would be like. Of course, the contents of the course—things that students do not normally learn in Japanese high school—were all interesting and motivated me to learn more about the U.S.–Japan relationship and beyond. 

Kotani and Brown hope that Stanford e-Japan alumni like Yamasaki and Tauchi will continue to play roles in U.S.–Japan relations beyond their college years. Kotani recently shared that “the Stanford e-Japan guest speakers like Suzanne Basalla, with such fascinating careers, are such excellent role models for the students. My hope is that many alumni of Stanford e-Japan will consider working for businesses in places like Silicon Valley and other organizations in Japan and the United States that focus on the U.S.–Japan relationship.” Brown, who will be recognized with the Elgin Heinz Outstanding Teacher Award at a ceremony at Stanford University on December 5, 2019, has noted that, “I feel so honored to be recognized with the 2019 Elgin Heinz Outstanding Teacher Award for my work as the Instructor of Stanford e-Japan and am especially looking forward to seeing one of my former Stanford e-Japan students, Ryoga Umezawa, who is studying at the Minerva Schools at Keck Graduate Institute in San Francisco.”

Image

To stay informed of SPICE-related news, join our email list and follow SPICE on Facebook, Twitter, and Instagram.

• Honoring High School Students from Japan and the United States: A Glow for Global Peace
• SPICE’s Waka Takahashi Brown Receives 2019 Elgin Heinz Outstanding Teacher Award
• Yanai Tadashi Foundation and SPICE/Stanford University

Stanford Health Policy’s Kathy McDonald — one of the nation’s leading experts in patient safety and health-care quality — has been named a distinguished professor at Johns Hopkins University, and will soon be leaving the Stanford Cardinal for the Hopkins Blue Jays.

McDonald, PhD, is the founding executive director of the Center for Primary Care and Outcomes Research at the Stanford School of Medicine and the Center for Health Policy in the Freeman Spogli Institute for International Studies (CHP/PCOR). She has spent 25 years at Stanford and says it’s tough to leave the Stanford Health Policy community, whose members are like family.

“CHP/PCOR has given me a community of close colleagues who care about each other and what we do together,” McDonald said. “And we’ve done a lot together over the years, much more than the usual academic products of grants, publications and courses. We have built a reputation for being ahead of the curve of health-system concerns. We also keep doing a fabulous job pushing the science envelope, and coming up with insights for everything from big policy to every day practice decisions, in the U.S. and abroad.”

McDonald soon heads East as the Bloomberg Distinguished Professor of Health Systems, Quality, and Safety. She will hold primary appointments in the Johns Hopkins schools of Nursing and Medicine and joint appointments in the Carey Business School and the Bloomberg School of Public Health, and affiliated with the Malone Center for Engineering in Healthcare. She will continue to explore what makes safe, affordable and high-quality health-care delivery systems, as well as the obstacles that prevent health organizations from achieving those goals.

McDonald told the Johns Hopkins University blog, the Hub, in a recent story that she intends to collaborate with faculty colleagues across the university and continue borrowing from other disciplines to optimize health-care delivery, just as she has done in her role at Stanford.

“All of us at CHP/PCOR owe Kathy an incredible debt,” said CHP/PCOR Director Doug Owens, who has worked alongside McDonald for more than a decade. “She helped found the centers, and we’ve benefited from her vision and extraordinary leadership for over 20 years. She is one of the top scholars in the nation in her areas of work, and her position at Johns Hopkins recognizes her exceptional accomplishments. We will miss Kathy greatly, but are thrilled with the opportunity she has to broaden her national leadership.”  

Image

For her PhD in health policy from the University of California, Berkeley, McDonald wrote her dissertation on diagnostic errors — an area McDonald believes is a critical blind spot of health-care providers. She was a member of the committee that issued a landmark report by the National Academy of Medicine, the medical arm of the National Academies of Sciences, which found that most Americans will get at least one faulty diagnosis in their lifetime. Despite dramatic improvements in patient safety in the last 20 years, the committee found, medical experts estimate that more than 12 million adults are misdiagnosed every year.

As Johns Hopkins pointed out in its release about her becoming the 46th Bloomberg Distinguished Professor, in addition to publishing more than 100 scholarly peer-reviewed studies and white papers, McDonald has published more than 40 government reports and developed tools for measuring patient safety and quality that have been used by private and public care providers alike. She was tapped by the federal Agency for Healthcare Research and Quality to create a series of reviews and seminal reports outlining practices for improving patient safety and health care quality, and also authored the Care Coordination Measures Atlas. 

Her research team also worked on a set of standardized health-care quality measurements called Quality Indicators for the agency, which can be used to analyze administrative data from hospitals to identify potential quality concerns and track changes over time.

Those Quality Indicators from the AHRQ were implemented at the Johns Hopkins Hospital in 2012. According to a case study published in May, McDonald and her team's Quality Indicators helped Johns Hopkins Hospital improve its postoperative ventilator procedures and reduce the incidence of perioperative pulmonary embolism, hemorrhage, and hematoma.

“Kathryn McDonald’s ideas have improved the lives of the patients, including here at Johns Hopkins,” said Paul B. Rothman, CEO of Johns Hopkins Medicine. “We’re thrilled to welcome her to Johns Hopkins, where she can help us continue to develop and innovate health care delivery, here and across the country.” 

McDonald is also the principal investigator of a project at the Society to Improve Diagnosis in Medicine that is addressing ways that a patient’s age, race and gender — particularly women, young adults and African-Americans — may contribute to errors in medical diagnoses and disparities in patient outcomes. And she’ll continue to examine how the growing time constraints on clinicians — conducting patient consults faster, logging results in EMRs sooner, keeping up with regulatory changes — are impacting patient safety as the shortage of health professionals sgrows larger each year in the United States.

In a study published last year in the American Public Health Association journal, Medicare Care, McDonald and her colleagues wrote that despite concerns about the impact of growing time pressures on clinicians and the delivery of health care, “scant evidence exists about types of time stress, the organizational factors that shape such stressors in routine care settings, and consequences for patients and practitioners alike.” 

Focusing on Quality of Care for Patients, Best Practices for Clinicians

“Kathryn McDonald is a pioneer in bringing systematic and evidence-based approaches to the study of health care delivery,” Patricia Davidson, dean of the Johns Hopkin’s School of Nursing, told the Hub. “She has a track record of collaboration and innovation across disciplines and will bring with her new insights into the best practices for measuring health care outcomes to ensure patient safety for all people.”

McDonald told the Hub she believes it’s important to look at health care from a patient-centered point of view, where it’s often the easiest place to spot trends.

“There's a shift happening right now,” she said. “More people are accessing different entry points for health care, and we need to think about their journey to staying healthy or dealing with a health crisis.”

Image

California vaccine laws are among the toughest in the nation, particularly since the state did away with the personal belief and religious exemption in 2015 following a measles outbreak that began in Disneyland. 

Governor Gavin Newsom signed a new law in September that gives the state stronger powers to reject suspicious medical exemptions for vaccines.

But both laws are complicated, and antivaccination parents and advocates continue to resist. Some mothers — most of them white, well-educated and affluent — refuse to vaccinate their children as they believe they should be the ones who make the medical decisions for their children; some parents don’t believe vaccines are safe.

Stanford Health Policy’s Michelle Mello, a professor of law and professor of medicine, writes in this Annals of Internal Medicine editorial that California’s experience is a cautionary tale about what happens when vaccination exemption laws have holes.

“The key lesson from California and beyond, therefore, is not that laws tightening vaccination exemptions are unhelpful, but that suboptimal policy design and political compromises may keep them from achieving all they can,” Mello writes in the editorial, which accompanies a wide-ranging assessment of exemptions from vaccination in California by Paul Delamater at the Carolina Population Center.

Delamater, an assistant professor of geography at the University of North Carolina at Chapel Hill, and a team at Yale University found that although the 2015 California law eliminating personal belief exemptions improved overall rates of vaccination in the state, its projected impact would be less than anticipated due to substitution of medical exemptions and other loopholes.

“Lawmakers should anticipate that antivaccination groups will mobilize to assist parents in identifying ways to get around new requirements,” Mello writes. In California’s case, the legislature had to go back to the drawing board to patch the holes, again confronting bitter resistance. Antivaxxers were so incensed by the new law that they threw blood on California senators during the final night of the legislative debate on Sept. 13.

“Avoiding repeated skirmishes requires getting it right the first time,” Mello writes. She recommends that laws narrowing vaccination exemptions include five key provisions:

1.     They should require that medical exemptions come from a pediatrician or family physician whom the child sees for regular care. 

“The physician evaluating whether a child has a medical condition that precludes vaccination should be someone who has been treating the child and is trained in a relevant specialty—not the anesthesiologist who lives next door or the physician hundreds of miles away who offers exemptions on the internet,” Mello said.

2.     They should limit the justifications for medical exemptions to valid, recognized contraindications to immunization.

3.     They should provide for review of medical exemptions by the department of health, as well as action against physicians who do not provide a specific and valid clinical rationale.

4.     The laws should clearly task the department of health — not schools — with reviewing exemptions.

5.     They should avoid grandfather clauses that allow children with existing conditions to forgo their vaccines. 

“Other states can also learn from what California did right,” Mello writes, such as jettisoning personal belief exemptions of all kinds and applying the rules to private schools and daycare centers as well as public ones.

California also makes public an expansive list of required immunizations and makes annual data on school-level exemption rates public.

“In the wake of the recent measles outbreak, state legislatures have been active in considering how to ensure that their laws are up to the challenge of preventing future outbreaks,” Mello writes in the editorial. “To be dispirited about the prospects for legal reform to help improve immunization rates is an empirical mistake. 

“The devil, as Delameter and colleagues show, is in the details.”

For more than two weeks now, a stream of current and former U.S. officials, this week including Amb. Bill Taylor, have described to Congressional committees the White House’s sordid effort to outsource American foreign policy to the president’s lawyer, Rudy Giuliani, who sought to advance the personal political interests of Donald Trump. Faced with compelling testimonies to the effect that the president subverted U.S. national interests to his own, the White House has begun to trash those officials.

Even for this White House, that is a despicable new low.

The testimonies make clear that President Trump insisted on a quid pro quo, as his Acting Chief of Staff Mick Mulvaney confirmed in an October 17 press conference (he later tried to walk it back, but watch the video of the press conference). The president wanted Ukrainian President Volodymyr Zelensky to investigate a long-debunked charge about former Vice President Joe Biden, his possible opponent in the 2020 U.S. presidential election. President Trump also wanted the Ukrainians to check whether the Democratic National Committee’s e-mail servers might have ended up in, of all places, Ukraine (no one has offered evidence to suggest that they have).