: The broad goal of this proposal is to further develop the candidate's skills as a health services researcher in the area of patient treatment preferences, cost and miscarriage management. The proposed program uses didactic course work, institutional resources and strong mentorship to provide training in claims analysis, survey methodology and cost-effectiveness analysis. The purpose of this proposal is to understand how early pregnancy failure (EPF) is currently managed and to examine the effect of using patient preferences to determine treatment on cost. Miscarriage management provides an ideal opportunity to study and encourage patient-centered care because it is a common event and there are several successful treatment options. Traditionally, management of pregnancy loss has been dilation and curettage (D&C), most often occurring in an operating room. This practice was established during a time when patients with EPF typically presented with acute hemorrhage and/or infection. Today, technological advances allow a non-viable pregnancy to be diagnosed well before the onset of these symptoms. Under these conditions, treatment options include expectant management and drug therapy to cause the uterus to expel the non-viable products. Alternatively, surgical management can be done in an office-based setting, which offers significant cost savings over the same procedure performed in an operating room. The few studies available suggest treatment patterns do not reflect contemporary clinical presentations, patient preference, cost burden or clinical outcomes. We propose to quantitatively describe treatment patterns, or usual care, for EPF management by using analysis of claims data. (Specific Aim I) Our preliminary data presented in this proposal demonstrate that patient treatment preferences may not support routine operative room management schemes. There are no data describing provider factors associated with treatment patterns or choices.
Specific Aim II uses population based surveys to examine provider and patient treatment preferences and factors associated with treatment choices. Finally, we use our findings Aims I and II to construct a hypothetical care model that includes all treatment options.
Specific Aim III compares the cost of this hypothetical care model which is driven by patient preferences with usual care defined in Aim I.

National Institute of Health (NIH)
Agency for Healthcare Research and Quality (AHRQ)
Clinical Investigator Award (CIA) (K08)
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Application #
Study Section
HSR Health Care Research Training SS (HCRT)
Program Officer
Anderson, Kay
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Fiscal Year
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University of Michigan Ann Arbor
Obstetrics & Gynecology
Schools of Medicine
Ann Arbor
United States
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Dalton, Vanessa K; Liang, Angela; Hutton, David W et al. (2015) Beyond usual care: the economic consequences of expanding treatment options in early pregnancy loss. Am J Obstet Gynecol 212:177.e1-6
Wallace, Robin; Dehlendorf, Christine; Vittinghoff, Eric et al. (2013) Early pregnancy failure management among family physicians. Fam Med 45:173-9
Pace, Lydia E; Dusetzina, Stacie B; Fendrick, A Mark et al. (2013) The impact of out-of-pocket costs on the use of intrauterine contraception among women with employer-sponsored insurance. Med Care 51:959-63
Dusetzina, Stacie B; Dalton, Vanessa K; Chernew, Michael E et al. (2013) Cost of contraceptive methods to privately insured women in the United States. Womens Health Issues 23:e69-71
Patel, Divya A; Zochowski, Melissa; Peterman, Stephanie et al. (2012) Human papillomavirus vaccine intent and uptake among female college students. J Am Coll Health 60:151-61
Dalton, Vanessa K; Harris, Lisa H; Bell, Jason D et al. (2011) Treatment of early pregnancy failure: does induced abortion training affect later practices? Am J Obstet Gynecol 204:493.e1-6
Kim, Catherine; Gebremariam, Acham; Iwashyna, Theodore J et al. (2011) Longitudinal influences of friends and parents upon unprotected vaginal intercourse in adolescents. Contraception 83:138-44
Dalton, Vanessa K; Harris, Lisa H; Gold, Katherine J et al. (2010) Provider knowledge, attitudes, and treatment preferences for early pregnancy failure. Am J Obstet Gynecol 202:531.e1-8
Wallace, Robin R; Goodman, Suzan; Freedman, Lori R et al. (2010) Counseling women with early pregnancy failure: utilizing evidence, preserving preference. Patient Educ Couns 81:454-61
Dalton, Vanessa K; Harris, Lisa H; Clark, Sarah J et al. (2009) Treatment patterns for early pregnancy failure in Michigan. J Womens Health (Larchmt) 18:787-93

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