Emily Tuong-Vi Nguyen, a Stanford student studying human biology, writes about the Asia Health Policy Program’s international conference on diabetes

The Asia Health Policy Program at the Shorenstein Asia-Pacific Research Center hosted the Net Value in Diabetes Management Workshop in March to discuss progress on an international research collaboration. Research teams from Hong Kong, Singapore, China, Taiwan, South Korea and the United States convened at the Stanford Center at Peking University (SCPKU) in Beijing to work on research that compares utilization and spending patterns on diabetes across different countries and to develop a method for measuring the net value of diabetes internationally, based on previous methods discussed in a Eggleston and Newhouse et al. 2009 study with Mayo Clinic Data for Type 2 diabetes.

The research teams from various Asian countries are attempting to calculate the net value of diabetes in those countries by observing the changes in diabetes value and spending. These calculations include monetizing the value of health benefits of new treatments and improvements in health, as well as avoided spending on treatments when prevention was effective, and associated mortality and probability of survival. Previous models used to measure diabetic values and risks, such as the United Kingdom Prospective Diabetes Study (UKPDS) risk engine that was created from U.K. data and populations, are not very relevant for Asian populations. The goal is to create separate risk models specifically suited for populations from Hong Kong, Singapore, China, Taiwan and South Korea.

During the workshop that spanned two days, the research teams had an opportunity to share updates on their individual projects and to discuss methods and ideas for future collaboration.

On the first day, each research team presented its work, describing data sets and explaining the risk models that were used or developed. Karen Eggleston, director of the Asia Health Policy Program, delivered introductory remarks and shared current progress by the Japan and Netherlands research teams on calculating value and risk for diabetes with data from the Netherlands and Japan. The data sets from those two countries were best estimated by the JJ Risk Engine for the Japan data and the UKPDS model for the Netherlands data.

Chao Quan of the University of Hong Kong presented the risk model used for Hong Kong populations. His work primarily looked at how the UKPDS risk engine predicted risk in Hong Kong populations as compared to a local Hong Kong risk engine and how to best calibrate the Hong Kong risk engine. His next step will be to monetize the value for improved survival in diabetes in Hong Kong. He offered to re-estimate the model using the risk factors available on others’ datasets so that the Hong Kong risk model could potentially be used by other teams as well.

Stefan Ma and Zheng Li Yau of the Ministry of Health of Singapore discussed the 5-year prediction model and statistical methods they used for all-cause mortality of Singaporean individuals with diabetes. Their work is based on Singapore’s extensive administrative and claims data as well as data provided by the national health surveys conducted every six years by the National Health Service of Singapore. The researchers plan to look into how their overall risk model compares with models for specific subpopulations, such as Chinese, Malay and Indian populations in Singapore.

Katherine Hastings from the Stanford University team, led by principal investigator Latha Palaniappan, presented preliminary ideas about measuring cardiovascular risk with the Atherosclerotic Cardiovascular Disease Risk Score in analyses of Stanford health system diabetic patients. The researchers are collaborating with a clinical bioinformatics team at Stanford to use machine learning to expedite the analysis.

Min Yu and Haibin Wu of the Zhejiang Center for Disease Control and Prevention shared results from their analysis of health data collected from community health centers for diabetes management, diabetes surveillance data, cause of death data and insurance claims data that showed relationships between different patient characteristics and insurance types. The researchers then estimated the annual cost of Type 2 diabetes and its complications in Tongxiang province, China.

Hai Fang and Huyang Zhang of Peking University worked with claims data of diabetic patients insured by the New Cooperative Medical Scheme in Beijing, and at the workshop, shared regression analyses on the relationship between outpatient visits and inpatient admissions.

Jianqun Dong of the People’s Republic of China Center for Disease Control and Prevention presented ongoing research about diabetes management in China, including preliminary results of a randomized control trial of diabetes self-management strategies.

Wankyo Chung of Seoul National University shared preliminary estimates of a risk model for mortality among diabetic patients in South Korea and discussed next steps for estimating net value of diabetes management using the detailed clinical and claims data available in South Korea.

On the second day, the workshop concluded with a videoconference between workshop participants in Beijing and collaborators at Stanford Graduate Business School, including Stanford professor Latha Palaniappan and Harvard visiting professor Joseph P. Newhouse, using the Highly Immersive Classroom.

The workshop was a good opportunity for the research teams to discuss preliminary models, to offer each other suggestions regarding research methods, and to discuss the future direction of the international collaboration on the net value of diabetes. All research teams are preparing comparative research papers that will be included in the working paper series of the Asia Health Policy Program. A follow-up event will be held at Stanford in November 2017 in recognition of World Diabetes Day.

As immigration policy ideas dance around Washington, children’s health rarely enters the discussion. According to Stanford pediatrician Fernando Mendoza, new policies could have a huge impact on the well-being of children with immigrant parents.
 
“If you make them fearful on a day-to-day basis that their parents are going to be taken away, it causes tremendous stress on children and families,” said Mendoza, a professor of pediatrics at the Lucile Packard Children’s Hospital.

Mendoza has gathered experts across Stanford University and throughout California and the United States to address these issues at the Child Health and Immigration Conference on May 25. The panelists will discuss potential impacts at the federal, state and local level and advise communities on how to navigate the effects on children.
 
“All immigrants are having their place in this country challenged,” said Mendoza. “Whether or not you have a parent who is undocumented, that is detrimental to the well-being of the children of all immigrants.”
 
According to a study at the Pew Research Center, one out of every eight children in California lives with an undocumented parent.
 
“Policies that would remove those parents would probably be the biggest social disruption that we’ve seen in this country,” said Mendoza. “We need to have experts discuss these things so that we can have clarity about what the effects of national immigration policies might be.”
 
Immigration experts Jeffrey Passel, a senior demographer at the Pew Research Center, and Bill Hing, a professor of law at the University of San Francisco, will kick off the conference by outlining immigrant family demographics and the legal system for enforcing immigration policy.
 
They will be followed by panels of experts from Stanford and other academic institutions, policy-makers, and leaders in local health and educational systems.
 
U.S. Rep. Zoe Lofgren (D-San Jose) will bring the on-the-ground Washington perspective with a short appearance via video. A former immigration attorney, she will discuss congressional movement on immigration policy.
 
Mendoza said, “We all value children. This conference is trying to create common ground around that American value.”
 
The conference will be held May 25 at Stanford University in Encina Hall’s Bechtel Conference Center from 8:30 a.m. to 5:15 p.m. To attend, please RSVP here.
 
The conference is sponsored by Stanford’s Division of General Pediatrics; the Center for Policy, Outcomes and Prevention; and the Lucile Packard Foundation for Children’s Health.
 


MEDIA CONTACTS:

Fernando Mendoza, General Pediatrics: (650) 725-8314, fmendoza@stanford.edu

Nicole Feldman, Stanford Health Policy: (650) 725-3389, nicoletf@stanford.edu

When one thinks of the casualties of war, it is easy to imagine severed limbs, bullet holes, shrapnel, perhaps even sarin gas or Agent Orange. But in a recent Daedalus essay, Paul Wise argues that the most damaging health impacts of war are often indirect. Losing access to food supplies, medication and electricity can kill more people than battle itself. In this video by the American Academy of Arts and Sciences, Wise, a professor of pediatrics and Stanford Health Policy core faculty member, explains how fatal the indirect costs of war can be.

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Yiqun Chen and Tess Ryckman are the first students in the Stanford Health Policy PhD program to win research grants. Their projects could improve health outcomes in the United States and in the developing world.

“Awards like these are a recognition of the quality of our very young PhD program,” said Corinna Haberland, director of education for the PhD program that launched in 2015.

Yiqun Chen, Predoctoral Student

A member of the first class of doctoral candidates and currently in her second year, Chen received a seed grant from the Center on the Demography and Economics of Health and Aging (CDEHA). Funded by the National Institute on Aging (NIA), CDEHA studies how best to modify health care systems to adapt to aging populations.

Chen will study the Hospital Readmission Reduction Program. A component of the Affordable Care Act (ACA), the program encourages hospitals to keep readmission rates low, but the financial incentives do not extend to doctors. Chen will evaluate the program’s effectiveness for Medicare patients.

“Yiqun is well positioned to offer new insights into the ways that the organization of physicians and hospitals will influence quality improvement programs,” said Laurence Baker, chair of the Department of Health Research and Policy and the grant’s primary investigator.

Tess Ryckman, Predoctoral Student

She plans to study nutrition in developing countries, focusing on the cost-effectiveness of programs that address stunting as compared to wasting. Two important public health indicators, stunting measures short height for age and wasting measures low weight for height.

“Wasting is more likely to result in death, but in a lot of countries the prevalence of wasting isn’t actually that high,” said Ryckman. “I suspect that in some cases they’re sacrificing funding that could go for stunting because wasting is more visible.”

The fellowship will allow Ryckman to focus on the research that inspires her. Instead of working as a TA or research assistant, she can pursue her own project while still drawing on faculty expertise.

“All of the faculty are really supportive,” she said. “They’re a helpful sounding board and give good advice.”