Investigator Awards In Health Policy Research 53 Bay State Road
Boston University Health Policy Institute
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Email: rwjfihp@bu.edu
www.investigatorawards.org
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Investigators And Their Projects » Areas of Expertise:
Section Info
This section contains information about all of the projects and researchers that have been funded through the Investigator Awards program since the first grants were made in 1993. The indexes in this section can be used to identify investigators by name, area of expertise, or year of award. Throughout the site, you will find that each investigator’s name links to details including contact and project information.
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Experts on Palliative Care:
Investigator names link to complete details.
Joseph J. Fins, M.D.

Expertise:
Medical Ethics; Neuroethics; Palliative Care

Minds Apart: Severe Brain Injury and Health Policy
Award Year: 2006

»Show Abstract
The two very public court cases of Karen Ann Quinlan and Terri Schiavo have colored much of the debate about the persistent vegetative state and futile medical treatment. But another recent case, that of Terry Wallis, a man with severe brain damage who began to speak after spending 19 years in a nursing home in a minimally conscious state, provides a different example - one of possible improvement, although not full recovery. Joseph J. Fins, M.D. tackles a host of thorny problems and policy issues raised by severe brain injury, a leading cause of disability among young people. These include obstacles to accurate diagnosis, coverage for life-long medical and rehabilitation services, research in subjects who lack decision-making capacity, impact of caregiving on families, and a general lack of scientific interest among medical professionals. Fins' project, Minds Apart: Severe Brain Injury and Health Policy, aims to provide information about the effects of brain injury, promote a public dialogue about the needs of these patients and their families, and explore options for improving care and broadening clinical research.
Carla C. Keirns, M.D., Ph.D., M.S.

Expertise:
History of Medicine; Palliative Care

Regional Variations in End of Life Care and Costs: Cultures of Medicine or Structures of Caregiving?
Award Year: 2011

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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.