Article in JAMA by CHPR Researchers Informs Prostate Cancer Screening Recommendations
The U.S. Preventive Services Task Force based its new national recommendations about prostate cancer screening on the systematic review of 63 research studies conducted by a team of UC Davis researchers from the Center for Healthcare Policy and Research (CHPR). Led by CHPR faculty member Joshua Fenton, M.D., Professor of Family and Community Medicine, the team’s findings on prostate-specific antigen-based (PSA) screening were published in the Journal of the American Medical Association (JAMA) on May 8, 2018.
Fenton said the USPSTF process is painstaking, methodical and was rigorously vetted with public and expert review prior to, during and after completion of the research. “I’m very proud of our team,” he said, “…and I think we achieved our goal of conveying complete and unbiased information based on current evidence.”
Fenton and his team found, for example, that PSA screening results in false positives in 10-18 percent of all men screened, with higher risk of false positives incurred by men older than 70. Additional harms related to diagnostic biopsies and from treatment are also greater in men older than 70 than in younger men.
Based on these and other findings, the Task Force now recommends against PSA screening for men 70 and older. For men ages 55-69, the Task Force now recommends that the decision to undergo periodic PSA-based screening for prostate cancer should be an individual one that includes a discussion with a clinician about both the potential benefits and the potential harms of screening. Other harms resulting from screening and subsequent treatment can include incontinence and erectile dysfunction.
In addition to Dr. Fenton, authors of the evidence report in JAMA include Heejung Bang, Ph.D., Joy Melnikow, M.D., M.P.H., Meghan Weyrich, M.P.H., and Shauna Durbin, M.P.H., from CHPR and Yu Liu, M.S., from the Dept. of Public Health Sciences at UC Davis.
QSCERT Postdoctoral Fellow Wins Best Presentation Award
Anne White, Ph.D., a postdoctoral fellow in the Quality, Safety, and Comparative Effectiveness Research Training (QSCERT) program at CHPR whose research focuses on doctor-patient communication, received a Best Presentation Award at the 4th Annual UC Davis Postdoctoral Research Symposium held this month on the UC Davis campus.
In a talk titled “Surgeon Noticings of Additional Concerns,” Dr. White, a medical sociologist, used the qualitative methods of Conversation Analysis and ethnography to describe how general surgeons initiate discussions about new concerns they notice while examining patients that are unrelated to the reason for the visit. The data used were 281 video-recorded medical encounters from a rural Texas private practice, and ultimately 22 cases of surgeon noticings were found in 17 visits. While infrequent, Dr. White found that beyond alerting patients to new medical problems, such “noticings” serve to build and maintain physician-patient relationships across time and to curtail future patient worry. She also documented issues surgeons grapple with in relation to sharing their noticings, such as the extent of the patient’s awareness of the additional concern, and how these contribute to how surgeons frame their noticings. While previous studies have focused on patients initiating conversations about their additional concerns, Dr. White’s research is novel in examining how physicians themselves introduce new concerns to patients.
As a QSCERT Fellow, Dr. White is currently studying how pain medication requests are negotiated during patient visits.
CHPR Welcomes a New Financial Manager
CHPR is happy to announce that Maria Shrestha has joined our staff as a financial manager. Shrestha earned her B.A. in Political Science from UC San Diego and her Master of Public Administration from the Cornell Institute for Public Affairs at Cornell University. She worked most recently as a Senior Financial Analyst at New York University’s School of Medicine.
In her new position at CHPR, she will be primarily responsible for managing pre- and post-award financial aspects of grants applied for by CHPR-affiliated faculty. Faculty members in need of her assistance can contact her at email@example.com.
Dr. Joshua Fenton Awarded Access to OptumLabs Database for Study of Long-term Opioid Users
CHPR researcher Joshua Fenton, M.D., M.P.H., is one of seven Principal Investigators in the UC system recently awarded "research credits" providing complimentary access to the comprehensive, real-world, linked dataset of clinical and claims information available through OptumLabs. OptumLabs is an open, collaborative center housing a comprehensive dataset representing nearly 200 million de-identified lives, an extremely valuable asset for conducting population studies. These competitive awards for research credits are one means through which the 10-year partnership between OptumLabs and the University of California hopes to accelerate improvements in healthcare value and patient care. Dr. Fenton will utilize the OptumLabs dataset to conduct a study of the "Clinical Consequences of Dose Tapering in Long-term Opioid Users."
Study Reveals Value of the Student-Run Clinics Associated with UC Davis Health while Engaging Undergraduates in Research
Christy Meyer, a student at the UC Davis School of Medicine (SOM), is Co-Director of the Joan Viteri Memorial Clinic (JVMC), a clinic run by medical students that provides “Unbiased health care to intravenous drug users, sex workers and their families.” JVMC is one of seven student-run clinics (SRCs) associated with the UC Davis SOM, others serve the Latino, African-American, South Asian and Muslim, Asian and Pacific Islander, Filipino Veterano, and homeless communities of Sacramento.
Meyer teamed up with Patrick Romano, M.D., M.P.H., and Melissa Gosdin, Ph.D., of the UC Davis Center for Healthcare Policy and Research (CHPR), and 41 undergraduate students to find out what motivates patients to utilize SRCs, and to get patient input on how the clinics could better serve their under-served communities. Funded by the UC Davis SOM, no previous study had directly asked the patients of such clinics about their experiences with SRCs.
The undergraduate students completed human subject research protection training and were taught qualitative data collection and analysis research methods at CHPR prior to conducting 104 interviews with patients from all seven UC Davis SRCs and the Gender Health Center, a professionally managed clinic affiliated with JVMC that provides care for the LGBTQQI community. After the interviews were transcribed and translated from six different languages, students qualitatively coded all the transcripts and then Meyer and Gosdin identified the major themes among them.
The study’s results indicate that patients appreciate the accessibility to healthcare that the SRCs provide, being open on weekends and accepting patients with no health insurance, for example. Patients feel respected and not judged, and find the medical professionals at the SRCs to be thoughtful, compassionate and thorough. That SRCs break through language barriers for patients is also greatly appreciated. In terms of improvement, patients asked for more, i.e. more (and better) equipment, more doctors, more services—like dental and vision, and larger facilities so that the SRCs will be able to serve even more patients.
Meyer hopes her study will provide the foundation for future research and policies relating to SRCs. Toward that end, three of the participating undergraduate students are conducting follow-up research studies related to the original project.
Register Now for the Fourth UC Health Research Symposium
Interested in qualitative or mixed-methods health reseach? This symposium will provide demonstrations of qualitative research methods, examples of results that can be obtained, and networking opportunities for researchers who want to use them. An optional two-hour introductory workshop led by Kathy Charmaz, co-author of Five Ways of Doing Qualitative Analysis, is also available prior to the start of the symposium for those new to using these approaches to health research. This free even will be held on May 2, 2018, on the UC Davis Sacramento campus. Space is limited; please register by April 27, 2018.
For more information and to register, please go to http://sonrsvp.com/qualitative-health-research-symposium/event/. Contact Carolina Apesoa-Varano (firstname.lastname@example.org) or Stuart Henderson (email@example.com) for more information.
Apply Now for a QSCERT-PC Post-Doctoral Fellowship
The Quality, Safety, and Comparative Effectiveness Research Training in Primary Care (QSCERT-PC) Post-doctoral Fellowship Program administered by CHPR is now accepting applications: Deadline Feburary 28, 2018.
Application materials and more information about this program can be found at:
$1 Raise in Minimum Wage Can Result in Significant Health Benefits
Paul Leigh, CHPR affiliate and professor of public health sciences at UC Davis, and co-author Juan Du of Old Dominion University, studied the effects a $1 raise in the minimum wage has had on absences from work due to illness. They found that this small increase resulted not only in a 32% decrease in absences due to employee illness but also in an increase in workers self-reporting that their health was good or excellent. Importantly, they also found that this increase had no effect on lay-offs or total work hours, which contradicts claims that increasing minimum wages will lead to increased unemployment. Dr. Leigh also hopes that the innovative statistical analysis he and Dr. Du used for this project will be used to study other public health issues like smoking and obesity. Study results were published in the January 2018 issue of The B.E. Journal of Economic Analysis & Policy. More information about this study can be found by following this link.
CHPR Affiliates Among Awardees of Improving Diagnosis in Health Care Seed Grants
CHPR Director Joy Melnikow is pleased to announce that three CHPR members, Bryn Mumma, Elisa Tong and Nathan Kuppermann, have been awarded seed grants from the UC Davis Health Collaborative for Diagnostic Innovation. A multidisciplinary effort convened by the Department of Pathology and Laboratory Medicine, the Collaborative is intended to address the issues and challenges of accurate diagnosis in the practice of medicine, such as those raised in the National Academy of Medicine’s 2015 landmark report “Improving Diagnosis in Health Care” (National Academies Press).
Dr. Mumma will serve as PI of a team investigating clinical implications of how heart attacks are diagnosed, while Drs. Tong and Kuppermann will be Co-Investigators on other multi-disciplinary teams researching lung cancer screening methods and diagnosis of acute respiratory distress syndrome (ARDS), respectively.
CHPR contributed funding to the seed grant program, partnering with many other departments and centers. The program originated with a generous gift from Brook and Shawn Byers. A total of more than $367,000 was awarded to support 17 multi-disciplinary projects over 12 months. Dr. Melnikow said, “We are excited to have contributed to this innovative, multidisciplinary pilot program supporting so many exciting research proposals.”
More information about the Collaborative for Diagnostic Innovation can be found at: https://www.ucdmc.ucdavis.edu/pathology/collaborative-for-diagnostic-innovation/index.html
Senior writer Belinda Martineau joined the Center for Healthcare Policy and Research (CHPR) in October 2017. Belinda has been working at UC Davis since 2006, first as a principal editor with the Genome Center and, more recently, as the grant writer for the UC Davis Institute for Social Sciences. She has extensive experience helping researchers write grant applications, journal manuscripts, theses, and articles about scientific issues for lay audiences. She is available to help faculty affiliated with CHPR to identify funding opportunities appropriate for their research and to write the narratives of their grant applications.
Belinda earned her B.A. in biology from Harvard University and her Ph.D. in genetics from UC Berkeley.
Dr. Anthony Jerant has been selected as Chair of the Department of Family and Community Medicine at UC Davis. Dr. Jerant joined UC Davis in 1998. Dr. Jerant's research interests focus on enhancing patient-physician communications improving the care of mental health conditions in primary care. As chair, Dr. Jerant will collaborate with UC Davis Health leaders to improve recruitment practices and assure diversity in the workforce. Dr. Jerant graduated from St. Louis University School of Medicine, completed his residency at Madigan Army Medical Center in Tacoma, and internship at Silas B. Hayes Army Community Hospital in Fort Ord.
Dr. Stephen Henry has received funding from R01 NIH grant titled " Developing Patient-Level Risk Prediction Models for Prescription Opioid Overdose." CHPR's Shauna Durbin, Project Manager, will be providing assistance with this research along with UCDavis Co-PI's, Dr. Magdalena Cerda, Dr. Patrick Romano, Dr. Susan Stewart, Dr. Garen Wintemute, and Dr. Daniel Tancredi.
Dr. Jeffrey Hoch leads a team studying the use of cost-effectiveness analysis to inform decisions about expensive cancer drugs
CHPR Associate Director, Jeffrey Hoch, PhD, worked with Canadian researchers to analyze how economic evidence influences funding decisions in British Columbia. Results are published online in the International Journal of Technology Assessment in Health Care. The main findings were that 1) Economic evidence appears to play a role in cancer funding decisions; and 2) Other decision-making criteria may also have an important role in recommendations and subsequent funding decisions.
“A statistically significant difference of nearly $115,000 was observed for funded vs. unfunded drugs. Poor cost-effectiveness was associated with a lower probability of a drug being funded,” remarked Hoch. Healthcare payers throughout the world are being challenged by high costs and this work shows that research can inform and influence healthcare policy decisions.
For more information, please see:
Dr. Melnikow leads team reviewing long-term consequences of peripheral neuropathy after chemotherapy for breast cancer
CHPR Director, Joy Melnikow, MD, MPH, led a systematic review published in the Journal of the National Cancer Institute exploring the impacts of peripheral neuropathy on breast cancer patients one or more years after treatment. The review identified only five papers on studies that followed patients for a year or more, with widely variable results. “The most striking finding from the review was how little data was out there,” Melnikow said. She continued, “This is a call to action. We can’t definitively define the frequency of peripheral neuropathy or understand the differences between chemotherapy regimens with the data we have.”
For more information, please see:
Dr. Melnikow Weighs in on Effect of ACA Uncertainty in Northern California
CHPR Director, Joy Melnikow, MD, MPH, recently responded to a public radio reporter’s inquiry about the 33% health insurance premium increase projected for 2018 in California’s northern counties. Proponents of an ACA repeal cites this burdensome increase as justification for a repeal; however, Dr. Melnikow notes that this increase is projected for enrollees with insurance through Covered California, and many of these enrollees are eligible for federal subsidies that will blunt the increased cost of premiums. “Even though the rates are slated to go up for premiums, if people are eligible for subsidized premiums, then those subsidies will compensate for the increased rates.” Adia White, reporter for North State Public Radio, states that north of the Sacramento suburbs, fewer than five percent of the population would likely pay the full premium hike because their income is above the subsidy threshold (income above 400% of the federal poverty line). The projected premium increases are related to uncertainty about the Trump Administration’s intention to continue federal subsidies. “If you are an insurance company and you are deciding whether to participate in the exchange and you’re not sure you’re going to get that support, you may decide to continue with higher premiums or to drop out,” observed Dr. Melnikow. Click here for the interview.
Nature Commentary by Dr. Daniel Tancredi Discusses Stunning Protective Effects of Probiotics for Newborns in Rural India
CHPR faculty member, Daniel Tancredi, PhD, published a commentary in Nature accompanying a groundbreaking clinical trial evaluating whether a probiotic/prebiotic intervention could prevent life-threatening infections early in life for a sample of mostly full-term newborns in rural India.
Read more >>
Center for Healthcare Decisions and Center for Health Policy and Research, University of California, Davis, to Join Up
The Center for Healthcare Policy and Research (CHPR), University of California, Davis, and the Center for Healthcare Decisions (CHCD) are pleased to announce their merger, effective September 2017. The two organizations have teamed on projects for many years, and leadership of both organizations are enthusiastic about combining their respective bodies of work going forward.
“CHCD’s board unanimously approved this transition. We are confident that our mission to bring complex health policy issues before the public and present their informed views to policymakers will be enhanced by integrating it with the Center for Healthcare Policy and Research. CHPR’s ‘big data’ analytics, along with CHCD’s ‘high touch’ deliberative methods, will significantly strengthen our joint research capabilities,” stated Patricia E. Powers, executive director.
“We are delighted that we will be joining forces,” said Joy Melnikow, MD, MPH, director, CHPR. “Both of our organizations have worked to inform health policy and improve healthcare for more than two decades; we look forward to providing more policy-relevant information that includes the views of an informed public.”
Lori Dangberg, who has served on CHCD’s board since its inception, will be joining CHPR’s newly formed external advisory board. Ms. Dangberg noted that “CHCD’s civic engagement work resulted in significant improvements in care at the end-of-life, as well as provided valuable policy recommendations regarding health benefits, cost, and quality. There are many more issues where thoughtful public input is essential, especially in these polarizing times.”
CHCD will be housed within CHPR, near the University of California, Davis, medical center:
Address: 2103 Stockton Blvd, Sacramento, CA 95817
Founded in 1994, CHCD is a non-partisan, non-profit organization based in Sacramento, CA. CHCD promotes civic engagement in health policy, capturing the public voice on contemporary, often controversial, local, state, or national health issues.
CHPR Members Contribute to AcademyHealth and AHRQ--NRSA Research Trainee Conferences
CHPR members and fellows contributed their health services and policy research to two national conferences in June 2017.
Seven of our members reported sharing their research findings at the 2017 Annual Research Meeting in New Orleans, where researchers excelling in health services research share methodological research advances and peer-reviewed research findings aimed improving health outcomes.
Dr. Patrick Romano chaired the workshop entitled “Publish or Perish: Meet the Editors.” As editor of Health Services Research journal, Dr. Romano led a panel of journal editors in a discussion of the peer-review process and helpful tips on writing solid research and policy papers.
Drs. Susan Perez, Melissa Gosdin, Jesse Pintor, and Patrick Romano presented a poster entitled “Ensuring Timely Access and Finding a Trusted Provider Is Key to Supporting Consumer Decision-Making.”
Dr. Pintor also moderated a session entitled "Caring for Our Future Generation: Innovative, Promising Approaches in Pediatric and Young Adult Care."
Dr. Katherine Kim was a discussant for a panel entitled “Patients First: Patient-Facing Technologies to Enhance Health Care Engagement” and presented a poster entitled “A Novel Stakeholder Engagement Approach for Patient-Centered Outcomes Research.”
Drs. Marc Schenker and Jesse Pintor presented a poster entitled “Assessing the Long-Term Impact of Expanding a Workplace Diabetes Intervention among Latino Immigrant Farmworkers: A Simulation Study.”
Dr. Michelle Ko presented a poster entitled “Educational Outcomes of School-Based Health Interventions for Children of Color.”
Five of our QSCERT Fellows were invited to present at the 23rd Annual AHRQ National Research Services Award (NRSA) Research Trainees Conference in New Orleans, where awardees of the National Research Service Award formally present research results from their fellowship training.
As part of the “Topics in Health Policy” panel, Ethan Evans, PhD, presented “The Challenge of Choice in the Individual Market: Learning from California’s Enrollment Assistance Infrastructure” and Brock Daniels, MD, MPH, presented “Physician in Triage Does Not Improve Patient-Centered Metrics in an Overcrowded, Academic Emergency Department.”
Jesse Pintor, PhD, MPH, took a public health perspective with her presentation on “Assessing the Long-Term Impact of Expanding a Workplace Diabetes Intervention among Latino Immigrant Farmworkers: A Simulation Study.”
Robert Doiron, MD, presented his poster “Successful Implementation and Improvements Identified with In-Situ Simulated Adult Trauma Resuscitation Scenarios.”
Aimee Moulin, MD presented on “County Variation in Mental Health Emergency Department and Hospitalization Use in California.”
CHPR Members serve on ICER’s California Technology Assessment Forum
Ms. Pat Powers and Professor Jeffrey Hoch will join Dr. Melnikow on the Institute for Clinical and Economic Review's (ICER) California Technology Assessment Forum (CTAF). Powers and Hoch were appointed as voting panelists this Spring and will have their first meeting this June. At that meeting CTAF will consider the clinical and economic evidence for two anabolic agents for treatment of osteoporosis in postmenopausal women who are at high risk for fracture.
ICER recently released a draft Evidence Report assessing the comparative clinical effectiveness and value of the two anabolic agents, and the team from CHPR will participate in reviewing the Evidence Report, the public comments responding to the draft report, and ICER’s written response to comments. The report will be the subject of a public meeting of CTAF this summer, during which voting members will vote on key questions raised in the report, and a policy roundtable of experts will discuss recommendations to apply the evidence to policy and practice.
For more information, see:
Dr. Hoch teaches about health technology assessment of cancer drugs
As part of the Annual Meeting of the American Society of Clinical Oncology (ASCO), Professor Jeffrey Hoch participated in a pre-conference, 2-day seminar dedicated to the Economics of Cancer Care. Professor Hoch's talk entitled, "Canadian Oncology Drug Health Technology Assessment: Lessons for the US eh" was featured in the session, "What Can We Learn from the International Experience?" Hoch's presentation drew on his experiences as Director of a Pharmacoeconomics Research Unit at a Provincial Cancer Agency in Canada. During this time, he supported Canada's efforts to set up the world's first and only health technology assessment (HTA) process solely for cancer drugs. The experiences have been published as a trio of freely available articles at http://tinyurl.com/hg7yekx and http://tinyurl.com/hv8gwzh and http://tinyurl.com/gm2bvfa . A copy of the presentation is available here.
CHPR welcomes Sun Y. Jeon, PhD
Sun joined the center as a statistician in 2017. Prior to joining the CHPR, she worked as a Presidential Doctoral Research Fellow at Utah State University from 2012 to 2017, and conducted research on socio-demographic contributors to health outcomes, particularly suicide, mental health, and obesity, using national health surveys such as National Health Interview Survey (NHIS), National Health and Nutrition Examination Survey (NHANES), and National Longitudinal Survey of Youth (NLSY) datasets. She also has experiences of studying the application of multivariate models, statistical machine learning techniques, and age-period-cohort (APC) models to health research.
She has Master’s degrees in Statistics and Sociology, and a Ph.D. in sociology from the Utah State University.
Rob Doiron, MD and Brock Daniels, MD, MPH are middle author's on the paper that was just accepted:
Dr. Richard Kravitz offers insight into patient-doctor communication as it relates to cancer and its prognosis. Methods and perspectives to consider.
"The Effectiveness of Standardized Handoff Tool Interventions during Inter- and Intra-facility Care Transitions on Patient-Related Outcomes: A Systematic Review" for publication in a future issue of the American Journal of Medical Quality.
Jennifer L. Rosenthal, MDa , Robert Doiron, MDb, Sarah C. Haynes, MPHc,
Brock Daniels, MD, MPHd , Su-Ting T. Li, MD, MPHa
In debate over iPhone vs. health care costc, Gavin Newsom's claims are Most True
Two health care policy experts pointed to the $10,345 figure as the best available.
"That’s an accurate number," said Joy Melnikow, director of the UC Davis Center for Healthcare Policy and Research. "That number is as good as any."
While the government and private business pay for the bulk of the nation’s health care costs, Melnikow noted the government gets its money from taxpayers: "That’s all of our money. We’re paying for it." Full Article >>
Revised guidelines recommended later screening for breast cancer Full Article >>
Terminally ill cancer patients fare poorly after surgery Full Article >>
Hormonal Contraception and Risk of Thromboembolism in Women With Diabetes Full Article >>
Could Raising the Minimum Wage Improve the Public's Health? Full Article >>
David Chin's publication in Health Affairs: Rethinking Thirty-Day Hospital Readmissions: Shorter Intervals Might Be Better Indicators Of Quality Of Care. Full Article >>
The Center for Healthcare Policy and Research is excited to introduce the following employees to our team:
- Melissa Gosdin, Ph.D., Qualitative Reseach Analyst: Coming to UC Davis from Albany State University in Georgia where she was an Assistant Professor of Sociology, she brings 12 years of qualitative research experience and expertise in qualitative and mixed methods studies. Read more >>
- Dusan Hutak, Programmer, Information Technology
Dr. Richard Kravitz offers insight into patient-doctor communication as it relates to cancer and its prognosis. Methods and perspectives to consider.
When the Price Is Not Right: State Options on Prescription Drug Pricing—a new issue brief authored by CHPR researchers.
In collaboration with the Center for Healthcare Decisions, Professor Jeffrey Hoch and his CHPR team co-authored an issue brief about potential strategies for California to control escalating costs of prescription drugs. The brief, sponsored by the California Health Care Foundation, provides background information about the cost of prescription drugs, describes the role of the rebate system and legal barriers to managing cost, and describes strategies pursued at the state and national levels, including California-specific strategies.
Prestigious National Dissertation Awards
Eduard Poltavskiy, PHS
Jacqueline Stocking, BIMSON
It is official – two of our CHPR-affiliated PhD students –Eduard Poltavskiy from the Graduate Group in Epidemiology and Jacqueline Stocking from the Betty Irene Moore School of Nursing and the Graduate Group in Nursing Science and Health Care Leadership – have received very prestigious national awards for their dissertation research. Eduard has received a $41,791 Health Services Dissertation Research Grant - R36HS024657 – from the US Agency for Healthcare Research and Quality for his work on “Reliability of Diagnosis Coding with ICD-9-CM and ICD-10-CM.” Jacqueline received a $50,000 Impact Research Grant – #20297 – from the American Association of Critical Care Nurses for her work on “A Case-Control Study to identify Potentially Modifiable Risk Factors for the Agency for Healthcare Research and Quality Patient Safety Indicator 11-Postoperative Respiratory Failure.”
Dr. Patrick Romano of UC Davis’ Center for Health Care Policy and Research is the lead on a Robert Wood Johnson Foundation grant “Understanding Consumers Views of Cost Sharing, Quality and Network Choice” to identify the experiences and needs of individuals who are enrolled in Covered California in comparison with those who are enrolled through employer-based coverage. The Center for Healthcare Decisions is working in partnership with Dr. Romano and colleagues. Using focus groups and surveys, the team will identify and compare differences in the needs and perspectives of both groups in terms of the attributes of health care quality; how provider choice and treatments are influenced by cost-sharing; and the resources that plan members use and trust to help make purchasing and treatment decisions. The goal of the study is to improve on ways to provide consumers with the information and tools they need to choose health plans and make treatment decisions consistent with their values.
Anthony Jerant, MD, Professor, Department of Family and Community Medicine has received funding from CDC (National Center for Injury Prevention and Control), UCD Behavioral Health Center of Excellence, and UCD Department of Family and Community Medicine for his work on This study will refine a previously developed computerized depression program to create (MAPS) Multimedia Activation to Prevent Suicide for Men, designed to support suicide prevention in the primary care setting. The study will examine the effect of the MAPS for men on suicide preparatory behaviors in middle-aged men in a randomized controlled trial.