David Miller, M.D., M.P.H.

David Miller
Medical SchoolUrologyHealth Services Research
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Dr. Miller's research seeks to better understand how the healthcare delivery system influences quality and access to care for patients with urological cancers. His longitudinal research agenda focuses on physician-led collaborative quality improvement, and on understanding the relationship between physician organizations, integrated delivery systems, and the quality and cost of specialty care. Dr. Miller is the director of the Michigan Urological Surgery Improvement Collaborative (MUSIC).

  • M.D., Washington University
  • M.P.H., Epidemiology, University of Michigan
  • B.S., University of Michigan

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U-M Academic Affiliation(s)

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What are you thinking about?

Much of health services research focuses on examining and characterizing variations in care; I am interested in how to move from simply describing variations in care toward translating such observations into solutions that help patients get the best care possible across diverse clinical settings. I think quality improvement collaboratives provide an important opportunity for progress in this area.

Why is this interesting to you?

Quality improvement collaboratives engage key stakeholders: payers, physicians - and even patients - to achieve sustained and meaningful changes in care delivery. There are a number of these collaborative initiatives ongoing in the state of Michigan. One example that I am involved with is the Michigan Urological Surgery Improvement Collaborative (MUSIC - a partnership with Blue Cross Blue Shield of Michigan), which is using strategies built around comparative performance feedback and clinical guideline dissemination to improve the quality and value of prostate cancer care for men across the state.

What are the practical implications for healthcare?

As one example, many men with low-risk prostate cancer undergo staging evaluations with CT scans and/or bone scans. We have collected data in the MUSIC showing that there is substantial variation in the use of these studies across Michigan, but that these imaging tests almost never show evidence for spread of the cancer, or other findings that would change treatment decisions. Informed by these data, we partnered with colleagues from Industrial and Operations Engineering to develop better criteria for selecting patients for imaging, and we are now using tools to developed in the field of implementation science to apply these evidence-based recommendations across many, diverse clinical settings.

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