SDS-CSM: Research
The breadth of research topics considered by SDS-CSM researchers mirrors our interdisciplinary membership.
Click on a topic for more detail about individual lines of research and for examples of current studies.
Statistical/Analytic Methods for Decision Making
Mathematical Modeling of Diseases
Psychology of Medical Decision Making
Health State Utilities and Patient Preferences
Cost-Effectiveness Analysis
Health Services Research
Educational Programs
Statistical/Analytic Methods for Decision Making
Mathematical models require numerical data for calibration. Some kinds of simulation models, such as individual microsimulation and agent-based or discrete event models, require estimates of individual behaviors, while more aggregated models require estimates of average behavior. The SDS-CSM collaborates with the Department of Biostatistics to develop robust survival estimates for simulation models. It collaborates with the Department of Industrial Engineering on simulation modeling and operations research, and it works with the Department of Biomedical Informatics on bayesian inference and networks. Faculty efforts focus on advancing current knowledge and methodologic capabilities in terms of the operational characteristics of models, the calibration of models, and the use of models to inform practical policy questions.
Subject: Using Markov Decision Processes to Optimize Living-Donor Liver Transplants.
- Role: Mark S. Roberts, MD, MPP, Principal Investigator.
- Sponsoring Agency: National Institutes of Health and National Library of Medicine.
- Purpose: The study uses Markov decision processes to analyze questions concerning the optimal timing of living-donor liver transplantation.
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Mathematical Modeling of Diseases
Our section is actively involved in the application of multiple types of modeling and simulation techniques to represent biologically or clinically based disease progression. Traditional descriptions of "natural history" that are found in textbooks are not useful for mathematical representations. For most analytic models, diseases need to be represented by the longitudinal progression of the predictors of important clinical outcomes. We have expertise in using discrete event simulation, integer programming, Markov models, Markov decision processes, and infectious disease modeling techniques to represent various illnesses and their progression.
Subject: A Computer Simulation of the Sub-Saharan HIV Pandemic That Can Estimate Benefit and Value from Interventions to Reduce Alcohol Use.
- Role: Joyce (Chung-Chou H.) Chang, PhD, and Mark S. Roberts, MD, MPP, Co-Investigators (R. Scott Braithwaite, MD, Principal Investigator).
- Sponsoring Agency: National Institute of Alcohol Abuse and Alcoholism.
- Purpose: The study uses a computer simulation of the sub-Saharan HIV pandemic to predict the effect that interventions to reduce alcohol use have on the HIV epidemic and on HIV treatment in resource-poor settings.
Subject: Identifying Computed Tomography (CT) Imaging Biomarkers Associated with Prognosis of Pulmonary Embolism.
- Role: Joyce (Chung-Chou H.) Chang, PhD, and Mark S. Roberts, MD, MPP, Co-Investigators (Bae Kyongtae, MD, Principal Investigator).
- Sponsoring Agency: National Heart, Lung, and Blood Institute.
- Purpose: The project will assess the accuracy and reliability of CT-derived biomarkers of clot volume and distribution in pulmonary embolism and will evaluate the ability of these biomarkers to predict short-term and long-term outcomes (recurrence and death).
Subject: Models of Infectious Disease Agent Study (MIDAS).
- Role: Bruce Y. Lee, MD, MBA, Project Principal Investigator.
- Sponsoring Agency: National Institute of General Medical Science.
- Purpose: This research and informatics network study is developing computer models to better understand the behavior and impact of infectious diseases and the strategies to prevent and control their spread.
Subject: The Prevention and Control of Antibiotic-Resistant Bacterial Infections.
- Role: Bruce Y. Lee, MD, MBA, Co-Investigator.
- Sponsoring Agency: Pennsylvania Department of Health.
- Purpose: The goals are to design computer models and simulations to better understand the spread and impact of antibiotic-resistant bacteria and to develop interventions to prevent the spread of these bacteria.
Subject: Computer Simulation Modeling to Characterize the Spread of and Optimize the Response to Influenza.
- Role: Bruce Y. Lee, MD, MBA, Clinical Research Scholar.
- Sponsoring Agency: National Institutes of Health, Clinical Research Scholars Program, Institutional K12.
- Purpose: The study involves designing and developing agent-based computer models to better understand the behavior and impact of infectious diseases and the strategies to prevent and control their spread.
Subject: Vaccine Modeling Initiative.
- Role: Bruce Y. Lee, MD, MBA, Co-Investigator.
- Sponsoring Agency: Bill and Melinda Gates Foundation.
- Purpose: The purpose is to design and develop computer models and simulations to improve vaccine development, manufacturing, distribution, and administration in countries throughout the world.
Subject: Computer Modeling to Aid Influenza Vaccine Strain Selection.
- Role: Bruce Y. Lee, MD, MBA, Co-Investigator.
- Sponsoring Agency: National Science Foundation.
- Purpose: This study involves designing computer models and simulations to improve vaccine development and manufacturing.
Subject: Optimizing Flu Shot Design under Uncertainty.
- Role: Mark S. Roberts, MD, MPP, Co-Investigator (Principal Investigator, Andrew J. Schaefer, PhD).
- Sponsoring Agency: National Science Foundation.
- Purpose: This project uses mathematical optimization methods from industrial engineering to evaluate the timing and strain selection decision for influenza vaccines.
Subject: Modeling Stockpile Quantities.
- Role: Bruce Y. Lee, MD, MBA, Principal Investigator.
- Sponsoring Agency: U.S. Veterans Administration.
- Purpose: This study involves designing computer models and simulations to understand and improve the logistics and distribution of vaccines and antibiotics.
Subject: Decision Making and Economics of Biosurveillance.
- Role: Bruce Y. Lee, MD, MBA, Co-Investigator.
- Sponsoring Agency: National Library of Medicine.
- Purpose: The goal is to design computer-aided decision tools to help interpret biosurveillance data.
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Psychology of Medical Decision Making
An area of growing interest to our section is the psychological foundation of how patients and health care providers actually make decisions. In exploring patients' judgments of risk and uncertainty, members of the section seek to improve decision making by studying the underlying cognitive and emotional processes that interfere with or promote optimal decision making.
Subject: Provider and Organizational Norms and Care at the End of Life (PONCEL).
- Role: Amber Barnato, MD, MPH, MS, Principal Investigator.
- Sponsoring Agency: National Institute of Nursing Research.
- Purpose: The goal of this project is to conduct an intensive case study of two hospitals—one with high-intensity and one with low-intensity end-of-life care—and to identify and describe norms of decision making regarding the use of life-sustaining treatments in the medical intensive care unit.
Subject: Social Norms Governing Intensive Care Unit (ICU) Triage for Critically Ill Elders with Terminal Illness.
- Role: Amber Barnato, MD, MPH, MS, Principal Investigator.
- Sponsoring Agency: National Cancer Institute and the Greenwall Foundation.
- Purpose: The goal of this project is to identify norms of triage decision making among physicians from two hospitals, one with high-intensity end-of-life treatment and another with low-intensity end-of-life treatment. Data from the project will be triangulated with direct observations of patient care.
Subject: Intensive Care Unit (ICU) Triage Communication and Decision Making: The Role of Race.
- Role: Amber Barnato, MD, MPH, MS, Principal Investigator.
- Sponsoring Agency: National Cancer Institute and American Cancer Society.
- Purpose: This project will use high-fidelity simulation to explore provider sources of differences in end-of-life use of intensive care facilities by black patients and white patients.
Subject: Surrogate Decision Making in the Intensive Care Unit: A Study to Examine Decisional Regret.
- Role: Cindy Bryce, PhD, Principal Investigator.
- Sponsoring Agency: Greenwall Foundation.
- Purpose: The project uses interviews and questionnaires to explore the role of surrogate family members in making end-of-life decisions on behalf of a loved one, to assess whether participants in the decision-making process are more likely to experience decisional regret and prolonged bereavement, and to determine whether surrogate experiences vary according to sociodemographics and other characteristics. The goal is to develop a better understanding of the end-of-life decision-making process and to collect much-needed data concerning the prevalence and effects of decisional regret in bereaved families.
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Health State Utilities and Patient Preferences
Since a decision can be termed "optimal" only in the context of a specified goal or value of an outcome, a major area of focus of several members of the section is on improving methods to evaluate and measure individual patient preferences for outcomes. In addition to research on the technical aspects of measurement tools such as the standard gamble and time trade-off, section members play active roles in developing and evaluating measures of patient and societal quality of life and utility for alcohol use disorders, drug problems, chronic health conditions, and end-of-life care.
Subject: Does Menopause Matter?
- Role: Joyce (Chung-Chou H.) Chang, PhD, Statistician (Rachel Hess, MD, Principal Investigator).
- Sponsoring Agency: National Institutes of Health.
- Purpose: The project is designed to investigate the effect of menopause progression on health-related quality of life. It will quantify the use of complementary and alternative medicine for menopause management in a general medical population and will examine the effect of menopause and quality of life on health services utilization.
Subject: Health Beliefs about Osteoporosis and Osteoporosis Screening in Older Women and Men.
- Role: Smita Nayak, MD, Clinical Research Scholar.
- Sponsoring Agency: National Institutes of Health, Clinical Research Scholars Program, Institutional K12.
- Purpose: This study was designed to examine older adults' health beliefs about osteoporosis and osteoporosis screening and to reveal beliefs that may be barriers to screening.
Subject: Assessing Individual Preferences for End-of-Life Care.
- Role: Cindy Bryce, PhD, Principal Investigator.
- Sponsoring Agency: National Institute on Aging.
- Purpose: A growing body of research has identified domains of good end-of-life care, but almost no research has undertaken a quantitative examination of the value that people place on the quality of death and dying. The value of good end-of-life care may be underestimated if its effects are assessed using the standard metric of quality-adjusted survival, especially if the time horizon is limited to the duration of the care. This study builds on previous pilot work to test whether people would trade some of their healthy life expectancy for better end-of-life care, how much they would trade in exchange for various domains of good care, and whether the amount traded exceeds the duration of care.
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Cost-Effectiveness Analysis
Our section has significant expertise in building integrated models of resource use and effectiveness for conducting cost-effectiveness analyses.
Subject: Diabetes Prevention and Treatment Programs of Western Pennsylvania: Cost-Effectiveness Analyses of Community-Based Efforts to Prevent Diabetes.
- Role: Cindy Bryce, PhD, Kenneth J. Smith, MD, MS, and Mark S. Roberts, MD, MPP, Co-Investigators (Principal Investigator, Janice C. Zgibor, PhD).
- Sponsoring Agency: U.S. Air Force, Department of Defense.
- Purpose: This project is designed to develop economic models of the use of various outpatient interventions in the prevention and treatment of diabetes. It is examining the cost-effectiveness of a curriculum that is similar to that of the Diabetes Prevention Program (DPP) but imposes fewer exclusionary criteria than the original DPP and is being administered to several community practices.
Subject: Cost-Effectiveness of Alternative Osteoporosis Screening Strategies for Postmenopausal Women.
- Role: Smita Nayak, MD, Clinical Research Scholar.
- Sponsoring Agency: National Institutes of Health, Clinical Research Scholars Program, Institutional K12.
- Purpose: The study is designed to determine the most cost-effective osteoporosis screening strategies for postmenopausal women. Methods involve comprehensive cost-effectiveness modeling to evaluate multiple tests and strategies.
Subject: Generic Fosamax: The Effect of Price Reduction on the Cost-Effectiveness of Alendronate Therapy.
- Role: Smita Nayak, MD, Clinical Research Scholar.
- Sponsoring Agency: National Institutes of Health, Clinical Research Scholars Program, Institutional K12.
- Purpose: The goal of this study is to determine the effect that various degrees of price reduction of alendronate have on the cost-effectiveness of treatment for osteoporosis.
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Health Services Research
Optimal decision making at a societal or health policy level is a major area of interest for our section. The section members participate in many health services research projects, examining the organization, delivery, and financing of health care from the perspectives of patients, caregivers, and providers. Faculty interests range from assessments of health disparities and system-level outcomes, such as cost and access to care, to the development of evidence-based health care delivery systems.
Subject: Protocolized Care for Early Septic Shock (ProCESS).
- Role: Amber Barnato, MD, MPH, MS, Project Director (Derek Angus, MD, Principal Investigator).
- Sponsoring Agency: National Institute of General Medical Sciences.
- Purpose: The goals of this project are to conduct a multicenter randomized clinical trial of early goal-directed therapy (EGDT) for septic shock, to explore the immunologic mechanisms underlying outcomes, and to assess the costs and cost-effectiveness of EGDT.
Subject: Hospital-Level Variations in Treatment Intensity at the End of Life.
- Role: Amber Barnato, MD, MPH, MS, Principal Investigator.
- Sponsoring Agency: National Institute on Aging, with additional support provided by the Design, Biostatistics, and Ethics Core of the University of Pittsburgh Clinical and Translational Science Institute.
- Purpose: This project is designed to explore the organizational correlates and outcomes of variations in admissions to intensive care units and the use of mechanical ventilation, hemodialysis, feeding tube insertion, and other life-sustaining treatments. The research involves qualitative case studies of a sample of Pennsylvania hospitals, a Web-based survey of all nonfederal acute care hospitals in Pennsylvania, and analysis of Pennsylvania Health Care Cost Containment Council (PHC4) clinical and administrative data from the hospitals.
Subject: Survival Effects of Admission to a "High-Intensity" Hospital.
- Role: Amber Barnato, MD, MPH, MS, Principal Investigator.
- Sponsoring Agency: University of Pittsburgh Department of Medicine.
- Purpose: The goal of this project is to extend marginal structural modeling techniques used in epidemiology to health services research using hospital discharge data.
Subject: Estimating End-Stage Liver Disease (ESLD) Prevalence and Treatment Variation.
- Role: Cindy Bryce, PhD, Principal Investigator.
- Sponsoring Agency: National Institute of Diabetes and Digestive and Kidney Diseases.
- Purpose: The research is designed to study variation in early access to liver transplantation services for underserved populations. To do this, the investigators are creating a "pseudo-registry" of patients with ESLD by linking the statewide hospital discharge database with several other data sources and examining how clinical, demographic, and economic factors influence referrals to transplant centers for specialty care.
Subject: Mild Cognitive Impairment: A Prospective Community Study.
- Role: Joyce (Chung-Chou H.) Chang, PhD, Co-Investigator (Mary Ganguli, MD, Principal Investigator).
- Sponsoring Agency: National Institute on Aging.
- Purpose: The project will describe the distribution of mild cognitive impairment and related entities, their associated features, their outcomes over time, and predictors of these outcomes.
Subject: Clinical Trial of Weight Reduction in Patients with Schizophrenia.
- Role: Joyce (Chung-Chou H.) Chang, PhD, Statistician (Rohan Ganguli, MD, Principal Investigator).
- Sponsoring Agency: National Institutes of Health.
- Purpose: The study aims to produce weight reduction in patients with schizophrenia.
Subject: Ethnicity and Culture in Unrelated Stem Cell Donation.
- Role: Joyce (Chung-Chou H.) Chang, PhD, Co-Investigator (Galen Switzer, PhD, Principal Investigator).
- Sponsoring Agency: National Institutes of Health.
- Purpose: This study examines the role that ethnic group membership and factors associated with ethnicity play in predicting potential donors' decisions about whether to donate hematopoietic stem cells and in predicting the health experiences of unrelated donors who actually donate these cells.
Subject: Clinical Trial of Lung Reduction Surgery for Patients with Emphysema.
- Role: Joyce (Chung-Chou H.) Chang, PhD, Co-Investigator (Frank Scuirba, MD, Principal Investigator).
- Sponsoring Agency: National Institutes of Health and Healthcare Financing Administration (Medicare).
- Purpose: This clinical trial of lung reduction surgery for emphysema is designed to compare the results in patients who were randomized to receive bilateral thoracoscopy plus rehabilitation, media sternotomy plus rehabilitation, or rehabilitation alone.
Subject: Alcohol-Associated Outcomes among HIV-Positive and HIV-Negative Aging Veterans.
- Role: Joyce (Chung-Chou H.) Chang, PhD, and Mark S. Roberts, MD, MPP, Co-Investigators (Principal Investigator, Amy C. Justice, MD).
- Sponsoring Agency: National Institute on Alcohol Abuse and Alcoholism.
- Purpose: This is a multicenter longitudinal study examining the impact of alcohol use on HIV infection. The long-term goal is to design and implement interventions to improve outcomes of aging patients who have HIV infection complicated by comorbid conditions.
Subject: Mechanisms of Cardiovascular Disease in HIV-Infected and Uninfected Veterans.
- Role: Joyce (Chung-Chou H.) Chang, PhD, Co-Investigator (Matthew Freiberg, MD, Principal Investigator).
- Sponsoring Agency: National Institutes of Health.
- Purpose: This study aims to determine whether HIV infection is an independent risk factor for cardiovascular disease endpoints and whether hepatitis C, substance use, and combination antiretroviral therapy (CART) modify the association between HIV infection and these endpoints. It also aims to determine whether biomarkers and measures of cardiovascular risk are increased among HIV-infected individuals with hepatitis C, substance use, or nonadherence to treatment with CART.
Subject: Factors Associated with Recommendation for Osteoporosis Screening or Prior Screening in Older Adults.
- Role: Smita Nayak, MD, Clinical Research Scholar.
- Sponsoring Agency: National Institutes of Health, Clinical Research Scholars Program, Institutional K12.
- Purpose: This study was designed to identify associations between patients' sociodemographic and health-related factors and their physicians' recommendation for osteoporosis screening.
Subject: Elderly Adults' Preferences for Osteoporosis Screening.
- Role: Smita Nayak, MD, Clinical Research Scholar.
- Sponsoring Agency: National Institutes of Health, Clinical Research Scholars Program, Institutional K12.
- Purpose: The purpose of this study was to determine elderly adults' preferences for different osteoporosis screening modalities and to determine the factors that are associated with these preferences.
Subject: Factors Associated with Diagnosis and Treatment of Osteoporosis in Older Adults.
- Role: Smita Nayak, MD, Clinical Research Scholar.
- Sponsoring Agency: National Institutes of Health, Clinical Research Scholars Program, Institutional K12.
- Purpose: The purpose of this study was to identify associations between patients' sociodemographic and health-related factors and the diagnosis and treatment of osteoporosis.
Subject: Systematic Review of Risk Assessment Tools for Osteoporosis Screening.
- Role: Smita Nayak, MD, Clinical Research Scholar.
- Sponsoring Agency: National Institutes of Health, Clinical Research Scholars Program, Institutional K12.
- Purpose: The study is designed to summarize the performance characteristics of risk assessment tools for osteoporosis screening. Methods involve systematic review and meta-analysis of available data on the sensitivity and specificity of instruments to assess the risk of osteoporosis in older adults and to predict future osteoporotic fracture.
Subject: Alternative Strategies for Adult Pneumococcal Vaccination.
- Role: Kenneth J. Smith, MD, MS, Principal Investigator, and Mark S. Roberts, MD, MPP, Co-Investigator.
- Sponsoring Agency: National Institute of Allergy and Infectious Diseases.
- Purpose: This project will use a dynamic simulation model of infectious disease transmission to forecast changes in adult pneumococcal serotype epidemiology resulting from childhood pneumococcal vaccination (PCV). It will also calculate the effectiveness and cost-effectiveness of alternative adult PCV strategies, incorporating forecasted PCV epidemiologic effects. The goal is to assist in PCV policymaking, particularly in prioritizing and allocating resources to future research efforts.
Subject: Distributed Radiology Dynamic Workload Allocation (DRDWA) System Development in the Air Force.
- Role: Mark S. Roberts, MD, MPP, Co-Investigator (Principal Investigator, Michael Becich, MD, PhD).
- Sponsoring Agency: U.S. Air Force, Department of Defense.
- Purpose: The goal is assess the ability of a distributed multiplatform system for picture archiving and communication (PACS) to improve workload and throughput in a military radiology environment.
Subject: Strategic Support of Telepathology Development in the Air Force.
- Role: Mark S. Roberts, MD, MPP, Co-Investigator (Principal Investigator, Brian Chapman, PhD).
- Sponsoring Agency: U.S. Air Force, Department of Defense.
- Purpose: This project was designed to assess the accuracy of two new technologies for the distributed reading of pathology slides in a military environment. One is a whole slide imaging digital pathology system, and the other involves pathologic diagnosis via a robotic microscope.
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Educational Programs
Through the Institute for Clinical Research Education (ICRE), our section faculty have developed and teach several courses related to the decision sciences. Independent study with members of the section is also available. In addition, section faculty teach national and international courses in decision sciences for the Society for Medical Decision Making, the International Society for Pharmacoeconomics and Outcomes Research, and other organizations.
Subject: Doris Duke Clinical Research Fellowship Program.
- Role: Investigator: Amber Barnato, MD, MPH, MS, Co-Program Leader.
- Sponsoring Agency: Doris Duke Foundation.
- Purpose: The goal of the fellowship program is to encourage medical students to pursue a career in clinical research by giving them an opportunity, during a year out from medical school, to experience clinical research firsthand.
Subject: University of Pittsburgh Clinical and Translational Science Institute (CTSI), Core C: Research Education, Training, and Career Development.
- Role: Mark S. Roberts, MD, MPP, Co-Principal Investigator (Principal Investigator, Steven Reis, MD).
- Sponsoring Agency: National Center for Research Resources.
- Purpose: The goal of Core C of the CTSI is to develop, nurture, and support a cadre of highly trained clinical and translational scientists by providing a series of educational activities and courses that build on the University's established record of translational research training. Dr. Roberts directs the degree-granting programs (certificate, master's, and PhD) contained within this core. Dr. Roberts and other members of the faculty in the Section for Decision Sciences and Clinical Systems Modeling are involved in the training and mentoring of individuals in CTSI programs.
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