April 17, 2015 Andrew Olshan PhD Department Chair Barbara Sorenson Hulka Distinguished Professor in Cancer Epidemiology 2101B Mcgavran- Greenberg Hall 135 Dauer Drive Campus Box 7435 Chapel Hill 27599-7435 Re: Chair of the Department of Health Policy and Management Dr. Olshan, I am very interested in being considered for the role of Professor and Chair of the University of North Carolina Chapel Hill s Department of Health Policy and Management (HPM). I believe that I bring the needed vision, leadership, administrative skills, scholarship, and a national/international reputation which would allow me to build off of HPM s past and current accomplishments and to effectively lead HPM moving forward. I have attached my current curriculum vitae and below highlight some of the key components of my background and expertise. Educational Background: I received a Bachelor of Arts degree in Mathematics from Princeton University in 1993 and my PhD in Medical Information Sciences from Stanford University in 1998. In 1998 I joined the Faculty of Stanford University as an Assistant Professor (Research) in the Department of Medicine (Center for Primary Care and Outcomes Research). In 2003, I accepted a faculty position at Duke University as an Associate Professor (nontenured) in the Department of Medicine within the Division of Clinical Pharmacology and was promoted to Associate Professor (tenured) in 2014. At Duke I am a core faculty member of the Outcomes Research and Assessment Group within the Duke Clinical Research Institute (DCRI). Scholarship: My research focuses on the development of evidence- based decision models to evaluate the comparative effectiveness of alternative prevention, treatment, and management strategies for chronic diseases and the translation of such models into formats/tools that patients, healthcare providers, and policymakers can use in their decision- making process. Specifically I have made significant contributions to academic scholarship in 3 distinct areas: (1) systematic reviews of the evidence, (2) development and evaluation of decision models in chronic diseases, and (3) development of tools to help key stakeholders use such evidence- based decision models to make informed decisions. This research has been performed through funding from AHRQ, the Patient- Centered Outcomes Research Institute (PCORI), the National Cancer Institute, the National Heart, Lung, and Blood Institute, the National Institute of Aging, the National Institute on Drug Abuse, the Department of Veterans Affairs, and commercial sponsors. As of the April 2015, my work has resulted in 128 publications in major peer- reviewed journals including 2 first- authored cost- effectiveness analysis articles in the New England Journal of Medicine. I am the first author of 20 publications and the senior author of an additional 28 publications. A summary of the 3 areas of my research focus follows. 1
(1) Systematic Reviews of the Evidence Development of an evidence- based decision model requires a systematic review of the literature and formal synthesis (using meta- analysis when appropriate) of the available literature. I have contributed to the field both through performing and publishing high- quality and clinically important systematic reviews of the evidence, and in development of methods to help support these reviews. As Director of Duke s Evidence- based Practice Center (EPC III [2009-2012], EPC V [2014- present]) and Director of Duke s Evidence Synthesis Group I have served as Principal Investigator or Co- Investigator on over 28 systematic reviews, 17 topic refinement projects, 40 topic brief projects, and 10 future research prioritization projects. I have worked with key stakeholders which span a broad set of perspectives including: clinicians (both general and specialist), consumers/patients, self- insured employers, Federal and state partners, health care industry representatives, public and private payers, researchers, and relevant professional organizations. Through work with the AHRQ EPC Program and PCORI, I have contributed to the development of standards for assessing the strength of evidence, methods related to topic identification for systematic reviews, methods for prioritizing future research needs, and methods for incorporating decision models and specifically value- of- information analyses in to systematic reviews and the research prioritization process. (2) Development and Evaluation of Decision Models in Chronic Diseases Throughout my academic career, my research has consistently focused on the development of evidence- based decision models to explore the comparative safety, effectiveness, and cost effectiveness of prevention, diagnosis, and treatment strategies for patients with chronic diseases. Clinically these models have focused on cardiac disease (sudden cardiac death), cancer (lung, breast, cervical, and ovarian cancer), and infectious diseases (HIV, HPV, and tuberculosis). The goal of decision analysis is to clarify the dynamics and trade- offs involved in selecting one strategy from a set of alternatives. Decision analysis is most useful if the decision is complex (e.g., large number of factors, multiple attributes, more than one decision- maker), time- dependent, and of uncertain effectiveness. Each of these clinical domains where I have focused my research fits each of these requirements. In addition decision analyses provide a method for evaluating alternative strategies beyond the immediate results of any particular trial or study. Each clinical domain I have studied during my career presents different challenges in terms of the modeling of the natural history of disease, the presence of needed population dynamics, the underlying state of the available evidence, the needed time horizon and extrapolation methods, and the influence of patient preferences and perspectives on optimal decisions. In each project I have collaborated with clinical investigators and statisticians as appropriate to explore the key uncertainties in the evidence and to ensure that the model provides a framework for exploring timely clinical and policy questions. (3) Development of Tools to Help Key Stakeholders use such Evidence- based Decision Models to make Informed Decisions A theme throughout my research career has not only been the development of high- quality disease models using decision analytic methods but development of methods for communicating these model to decision makers. In past research, I developed ALCHEMIST, a web- based tool for communicating the assumptions and evidence underlying a decision model, and its clinical and policy implications to users. ALCHEMIST was originally developed as an automated tool for creating clinical- practice guidelines from evidence- based decision models. Current clinical- practice guidelines, although promoted by policy makers and health- care 2
institutions, have been hindered in effectiveness because they are difficult to keep up to date, the methods by which they are created may not be rigorous, their development requires extensive resources, and they may not account adequately for legitimate variation in clinical settings and populations. To help alleviate these problems with guideline development and translation of research findings into clinical practice, we proposed that developers create guidelines from evidence- based decision models. Our approach is designed to improve guideline applicability, relevance, and acceptance by local clinicians and guideline users, and thus to promote high- quality and cost- effective health care. Until now, however, despite the advantages of decision models, to use such models, people had to have extensive training, be familiar with highly specialized, often difficult- to- use software, as well as to have direct access to the models. We therefore developed a web- based guideline development and dissemination system, called ALCHEMIST, which creates a global guideline from an underlying decision model which can then be disseminated over the web to guideline users. ALCHEMIST s initial guideline reflects the average values for each of the variables found in the decision model for the population of interest (referred to as the model s base- case values) but it can be tailored to an individual patient or perspective as needed. We have explored the use of the ALCHEMIST system in both the prevention of sudden cardiac death and the management of patients with solitary lung nodules. In an era in which great importance is placed on defending clinical practice with rigorous supporting evidence, my research brings together decision analytic methods, comparative effectiveness research, systematic review methodology, and medical informatics tools to provide powerful methods to aid patients, providers, and policymakers in their decision making. Grant Support: My research activities at Stanford and Duke have been supported entirely through competitive grants and contracts. As listed in my curriculum vitae, I have received public or private funding for 30 research projects as Principal Investigator or Co- Principal Investigator and I have served or am serving as Co- Investigator on an additional 28 projects. These research projects include three federally- funded R01 grants (funded in 2000 by AHRQ, in 2005 by NCI, and in 2009 by AHRQ). In addition, as Director of the Duke EPC, in 2009 I successfully competed for and was awarded one of 8 three- year contracts through the American Recovery and Reinvestment Act to support Comprehensive Comparative Effectiveness Reviews for Effective Health Care. Under my leadership, Duke was recently named an EPC V center (12/2014-11/2019). The EPC III and V funding have supported since 2009 over 25 comparative effectiveness projects which have resulted in over 30 peer- reviewed AHRQ reports and more than 20 peer- reviewed journal publications. The EPC has also supported partial funding for over 80 investigators from the Departments of Medicine (Divisions of Cardiology, Medical Oncology, Pulmonary, Allergy, & Critical Care Medicine, Neurology, Endocrinology, Metabolism, and Nutrition, Nephrology, General Internal Medicine, Clinical Pharmacology), Pediatrics (Divisions of Primary Care Pediatrics, Rheumatology), Obstetrics & Gynecology (Divisions of Gynecology Oncology, Maternal & Fetal Medicine, General) Psychiatry (Divisions of Child and Adolescent Psychiatry, Social and Community Psychiatry, General), Biostatistics and Bioinformatics, Psychology, Community and Family Medicine, and the School of Nursing. As Director of the Duke EPC I am responsible for providing strong and consistent programmatic leadership across assignments and teams. As Director, I evaluate and assert performance expectations of all staff and investigators to produce timely and high quality contributions of each individual. We ve also established a successful IDIQ contract with PCORI through which the Duke Evidence Synthesis Group which I direct has completed 40 prioritization topic briefs, 7 future research prioritization projects (resulting in 3 Annals of Internal Medicine publications) and have two active PCORI contracts focusing on the use of value- of- information 3
analysis alongside pragmatic clinical trials and developing recommendations for their decision aid portfolio. Leadership: I serve in numerous leadership roles at the University, national, and international levels. Many of my professional leadership activities have been with SMDM an international society that develops and advances systematic approaches to clinical decision making and policy formation in health care by providing a scholarly forum that connects and educates researchers, providers, policy makers, and the public. As listed in my curriculum vitae, I have been actively engaged in this organization since 1995. Since that time I have served in numerous positions within the Society including being a member of several committees (Publications Committee, Awards Committee, Policy Committee), chairing committees (Medical Informatics Interest Group, Education Committee, Wed Committee, 2003 Annual Meeting Abstract Selection Committee, 2004 Annual Meeting Scientific Review Committee, Nominations Committee), co- chairing the 2005 Annual Meeting, and serving as an elected member of the board (Trustee, Vice President Elect, Vice President, President Elect, President, Immediate Past President). During my time on the SMDM Board and specifically while President (2007-2008) some of the initiatives I led or collaborated on included hiring a new professional management company for the Society, hiring the Society s first Executive Director, working with the Society s Journal Editor to promote Policy Rounds to highlight medical decision making research which has an impact on policy making and decision making, developing the joint SMDM/AHRQ Health Policy Fellowship, forming an external funding committee, and forming four policy working groups. These working groups which focus on the areas of Technology Assessment, Public Health, Global Health, and Issues in Methodology seek to provide learning opportunities for SMDM members and for external audiences, to communicate with SMDM members about key issues, and to provide tools and knowledge to SMDM members so that they can be more fully engaged in policy. I continue to be actively involved in SMDM serving currently on the Policy and Nominations Committees and it remains my professional home. In addition to these leadership roles, I contribute to the comparative effectiveness research field through peer review and editorial activities. I currently serve on the editorial board of the American Heart Journal and have previously served on the editorial board of Medical Decision Making. I have served as a Special Emphasis Panel Study Section member and as a two- term Study Section member for Health Care Technology and Decision Sciences at the AHRQ. I have been an ad hoc reviewer for the National Institute on Aging, for the National Institute of Health s AIDS, Clinical Studies, & Epidemiology (ACE) Study Section, for the U.S. Army Medical Research and Material Command, and for the U.K. Department of Health. I have served as a reviewer for numerous peer- reviewed journals including Medical Decision Making, American Journal of Medicine, Lancet, Society of General Internal Medicine, JAMA, Heart Rhythm, American Heart Journal, JACC, Circulation, New England Journal of Medicine, Annals of Internal Medicine, and JAIDS. As an additional demonstration of my leadership in my discipline, I am currently Co- Chair of the Second Panel for Cost Effectiveness in Health and Medicine. This 16- member panel of leaders in the fields of decision and cost- effectiveness analysis is tasked with updating the original 1996 book, which is the de facto standard in the U.S. and many other countries for performing cost- effectiveness analyses and has been cited more than 6,000 times. The 2 nd Panel has received in- kind support from SMDM, the University of California San Diego, and Duke Clinical Research Institute as well as funding from AHRQ, Robert Wood Johnson Foundation, and the Gates Foundation. Under my leadership and in collaboration with the Panel, the updated book will be published in Spring 2016. 4
Training Activities: An integral part of being a faculty member within an academic healthcare research institution is the opportunity and responsibility to mentor and train future leaders in clinical research. Throughout my research career I have furthered the academic mission of first Stanford University and now Duke University by teaching and mentoring undergraduate students, graduate students, medical students, residents, fellows, and junior faculty members. At Stanford University I served on the admissions committee and the doctoral dissertation qualifying examination committee for the Medical Information Sciences Training Program. I also co- led a course within the Stanford Graduate School of Business on Analysis of Costs, Risks, and Benefits in Health Care. Since coming to Duke I have been a frequent lecturer in the Clinical Research Training Program Principles of Clinical Research course and developed and led a class for the Duke Fuqua School of Business Master of Management in Clinical Informatics on Decision Models. I have served as a mentor both formally and informally to students at all levels and junior faculty members and mentor junior faculty members with comparative effectiveness research K awards. Under my guidance, students and research fellows have published more than 40 first- author, peer- reviewed manuscripts including papers in the Annals of Internal Medicine, JAMA, and Emerging Infectious Diseases. I currently lead the Duke Comparative Effectiveness Seminar and listserv whose greater than 120 members include faculty members, students, fellows, and staff from the Duke School of Medicine, Fuqua Business School, Duke School of Nursing, Duke University, UNC School of Public Health, and Durham VA HSR&D. This seminar serves not only as a venue for our community to disseminate timely research findings, but also for senior members of our comparative effectiveness research group to provide feedback, mentorship, and guidance to the broader community. Over the coming decade I plan to continue to make significant contributions to the methods needed for performing high- quality comparative effectiveness research, the development of tools to effectively disseminate such research in to clinical practice and policy, and the training of new researchers in the field. I will as always remain committed to high- quality and methodologically rigorous research which targets timely and important clinical and policy uncertainties. I believe however that I am both ready and uniquely suited to lead a large and vibrant Department such as HPM and am looking for a leadership challenge and opportunity such as HPM. I believe that I have the needed leadership abilities, administrative skills, and research expertise to strengthen the current HPM Department and to provide HPM s Faculty members, students, and the extended HPM and UNC community with a strong and strategic vision moving forward. I believe that the Chair position within HPM is an ideal fit for my next phase and I look forward to exploring the potential match. Sincerely, Gillian D. Sanders- Schmidler Ph.D. Associate Professor of Medicine Duke Evidence Synthesis Group, Director Duke Clinical Research Institute Duke University 5