Carla C. Keirns Ph.D., M.D., M.S.

Assistant Professor
Department of History and Philosophy of Medicine
University of Kansas Medical Center
Email: ckeirns@kumc.edu Discipline: Medicine, History Expertise: History of Medicine, Palliative Care

Investigator Award

Regional Variations in End of Life Care and Costs: Cultures of Medicine or Structures of Caregiving?
Award Year: 2011 Americans facing serious illness receive different care, at different costs, and with different outcomes based on where they live. Since the 1970s researchers from a number of groups, most notably John Wennberg, Elliott Fisher and David Goodman at the Dartmouth Institute for Health Policy & Clinical Practice, have made a compelling case that the use of medical services and procedures varies widely from community to community for reasons not fully accountable by medical need, not clearly related to evidence or medical outcomes, and likely substantially influenced by supply. Carla C. Keirns, M.D., Ph.D., draws on her clinical experience and her scholarship in her Investigator Award Project, Regional Variations in End of Life Care and Costs: Cultures of Medicine or Structures of Caregiving? Exploring how individuals and families navigate health care, Dr. Keirns studies source of regional variation in end of life care and costs not only in the local structures and cultures of medical practice, but also in patterns of housing, employment, and family structure that impact the choices available to patients at the end of life - particularly the feasibility home hospice care. This work draws from both a growing literature on decision-making, costs, and patterns of end-of-life care, and a deep and extensive literature on local cultures of medical practice from many disciplines. Drawing on her experience as a historian, sociologist, and health services researcher, as well as a practicing palliative care physician, she uses health utilization data, interviews and community studies to make sense of individual choices and regional patterns which are fundamental to understanding how to empower patients, improve care and reduce costs.

Background

Carla C. Keirns is Assistant Professor of Medical Ethics at the University of Kansas Medical Center. Previously, she acted as Assistant Professor of preventive medicine, medicine and history at Stony Brook University. She received her undergraduate education at Cornell University, her medical degree (2003) and doctorate in History & Sociology of Science from the University of Pennsylvania (2004). She received her masters in health services research from the University of Michigan (2008) working in partnership with communities in Detroit, Michigan on the impact of childhood asthma on entire families and communities. Her first book, Measured Breath: A Short History of Asthma, will be published by Johns Hopkins University. She has taken that interest in the impact of illness on families and communities into her work on end-of-life care at Stony Brook University, where she serves as an attending physician in hospital medicine and palliative care, as co-chair of the Institutional Ethics Committee, and teaches history, ethics, health disparities and health policy in the M.D. curriculum. Among Keirns' honors are fellowships and awards from the Robert Wood Johnson Foundation, the National Center for Minority Health and Health Disparities (NIH), the Dewitt Stetten Jr. Museum of Medical Research and the NIH Office of History. She has worked in health care settings in the United States, Australia, Mexico and Botswana, and taught public health in Jamaica.