Announcing the first UMMS-Chang Gung joint research projects

A new institutional partnership with Taiwan’s Chang Gung Memorial Hospital has produced its first joint research projects.

Colleagues from UMMS and Chang Gung Memorial Hospital celebrate the new partnership during a Symposium in Taiwan last summer.

With co-investigators from both UMMS and Chang Gung Memorial, the projects tackle an array of subjects, from better understanding individual diseases like respiratory distress syndrome, to leveraging Taiwan’s comprehensive national health insurance database to study factors involved in surgical outcome variation and preventable hospitalizations.

“I am pleased that the first round was able to generate substantial interest,” said UMMS Professor of Surgery Kevin Chung, MD, who helped forge the new partnership, UMMS’ first institutional collaboration in Taiwan. “These grants were selected because there was already a mature working relationship between the teams, providing a high likelihood of project success, including publications leading to external grant funding.”

Each of the seven projects will be awarded $100,000 from funding secured after leaders at Chang Gung and UMMS signed a Memorandum of Understanding (MOU) agreement during a Symposium and delegation visit to Taipei last summer. The proposals stem from Surgery, Internal Medicine and Otolaryngology. A new call for proposals for the next round of funding is expected soon.

With seven individual hospitals comprising some 10,000 beds, Chang Gung Memorial is Taiwan’s biggest healthcare institution, and also the largest hospital system ever to be accredited by the Joint Commission International.

“Chang Gung hospital is among the most sophisticated hospitals in Asia, with huge clinical volumes and a research infrastructure that is similar to ours,” said Dr. Chung. “This collaboration can be highly successful almost immediately because of our mutual commitment to discovery benefitting our patients as well as proficiencies in scientific conduct between their researchers and ours.” 

Congratulations to the first-ever recipients of Chang Gung Memorial Hospital-UMMS project awards. Below, find an overview of each proposal.


Frequency and cost of preventable hospitalization among patients with multiple chronic conditions

UMMS PI: Elham Mohmoudi, PhD, MS, MBA, Assistant Research Professor of Surgery

Chang Gung PI: Chang-Fu Kuo, MD, PhD, Associate Professor of Rheumatology

The number of people with multiple chronic conditions (MCC) is growing worldwide, with a large portion of healthcare costs attributed to treating and managing them, particularly among the elderly population. Understanding the prevalence and health challenges of MCC is an important health policy initiative. Using nationally representative claims data from Taiwan’s National Health Insurance Research database as well as Medicare Claims Data from the United States, we will conduct a comparative study of potentially preventable use of health services and their corresponding costs associated with MCC among older populations. This work will not only determine factors that are associated with preventable hospitalization, but also will provide a strong foundation for future interventions to streamline care for patients with MCC.


The effect of fecal metabolites and racial factors in the development of recurrent C. difficile infection

UMMS PI: John Kao, MD, Associate Professor of Internal Medicine

Chang Gung PI: Sen-Yung Hsieh, MD, PhD, Professor of Gastroenterology

Clostridium difficile infection (CDI) is a healthcare problem with significant morbidity and mortality in the US and most of the Western world. Although CDI is responsive to treatment with metronidazole, vancomycin, or fidaxomicin, approximately 25 percent of the patients will develop recurrent C. difficile diarrhea. While C. difficile is common in the US, it is relatively uncommon in Asian-Pacific regions including Taiwan. There are growing concerns in Taiwan that CDI may be an emerging healthcare issue given a rising incidence of inflammatory bowel disease, since these individuals are more susceptible to CDI. Our study will investigate microbiota and racial factors that may account for the polarized incidences of CDI between Taiwan and the US. We hypothesize that the composition of gut microbiota and the concentration of bile acids are different between the two countries, contributing to the different CDI incidence rates observed.


Effectiveness of VLNT Surgery on Fat and Muscle Tissue Components Per Analytic Morphomics

UMMS Co-PI: Stewart Wang, MD, PhD, Professor of Surgery

UMMS Co-PI: Paul Caderna, MD, Professor of Surgery

Chang Gung Co-PI: Ming Huei Cheng, MD, Senior Professor of Plastic & Reconstructive Surgery

Chang Gung Co-PI: Sung-Yu Chu, MD, Lecturer, Department of Medical Imaging and Intervention

Lymphedema, a swelling in the arms or legs often caused by the removal of lymph nodes as part of cancer treatment, is widely understood to impact the layer of subcutaneous fat just beneath the skin. However, changes and impact to the deeper muscles have not been studied. Pilot studies between UMMS and CGMH showed substantial changes to intra-compartmental muscle volumes as well subcutaneous fat in lymphedematous limbs. If confirmed, these findings would lead to new and greater understandings of the pathophysiologic processes underlying extremity lymphedema, as well as vascularized lymph node transfer (VLNT) treatment measures.


A National Comparative Study of Replantation and Revision Amputation Treatment for Digit Amputations

UMMS PI: Kevin Chung, MD, MS, Professor of Surgery

Chang Gung PI: Chung-Chen Hsu, MD, Assistant Professor of Surgery

Traumatic digit amputations account for up to 90% of all amputations in the United States. Though not fatal, these injuries occur commonly in the young and working age people and have substantial social and economic consequences. Replantation of the amputated digit or revision of the amputation stump is the treatment for such injuries. However, variations exist in the frequency with which the two treatment options are performed. The researchers propose a study using National Health Insurance Research Database from Taiwan to: (a) compare the characteristics of high- and low-volume providers (hospitals and surgeons) that perform replantation and revision amputation procedures for digit amputations; (b) examine the characteristics of patients who underwent digit replantation or revision amputation treatment; and (c) investigate the cost variations for replantation and revision amputation procedures for a digit amputation between high-volume and low-volume hospitals. The findings could be applied to facilitate effective patient triage between hospitals for efficient and economical care delivery in amputation cases.


Application of analytics morphomics in acute respiratory distress syndrome (ARDS)

UMMS PI: Stewart Wang, MD, PhD, Professor of Surgery

Chang Gung PI: Kuo-Chin Kao, MD, Associate Professor of Pulmonary & Critical Care

Mortality rates for patients with acute respiratory distress syndrome (ARDS) have remained stubbornly consistent since the disease was first described in the 1960s. Researchers plan to use powerful analytic morphomic research techniques developed at U-M to assess risk factors in thoracic surgery patients to examine CT scans in a large registry of Chang Gung ARDS patients. Their precise approach, using a number of extracted biomarkers, will help identify lung and non-lung factors that predict progressive pulmonary failure. Results could help inform future ARDS treatment regimens and significantly improve patient outcomes.


Overall medical standards of care and institution-wide surgical outcomes

UMMS PI: Kevin Chung, MD, MS, Professor of Surgery

Chang Gung PI: Fu-Kuo Chang, MD, PhD, Associate Professor of Rheumatology

Over one million surgical procedures are performed in Taiwan each year, but the variation in surgical outcomes hints at economic or administrative inefficiencies. The magnitude of and potential contributors to such variation has been infrequently investigated. Past research has focused on surgical volumes by institutions or surgeons as a pivotal factor for surgical outcome variation. Other factors, such as the quality of care of chronic illness may also have an impact on surgical outcome variation. We plan to use the Taiwan National Health Insurance Database to estimate the variation of surgical outcomes of joint replacement, coronary bypass, appendectomy, obstetric procedures and solid organ transplantation to evaluate the contribution of patient-, institution-, and region-level factors. We will develop chronic illness quality of care indicators, such as complication rates for diabetes patients, to measure institutional performance on the care of patients with chronic illnesses. We hypothesize that quality of chronic illness care directly relates to surgical outcomes in the same institution. We plan to develop a multi-level prediction model by incorporating layers of factors to explain the surgical outcome variation. Our unique approach considers the complex data structure of real-world data and will shed light on the causes of surgical outcome variation. We plan to further implement our methodology to the US and other countries by applying suitable data sources.


Human Papillomavirus and oropharyngeal squamous cell carcinoma in Taiwan: Association of viral mechanisms and risk factors with outcome

UMMS Co-PI: Thomas Carey, PhD, Professor of Otolaryngology

UMMS Co-PI: Heather Walline, PhD, Research Assistant Professor

Collaborator: Kai-Ping Chang, PhD, Professor of Otolaryngology

Researchers aim to characterize oropharyngeal cancers in Taiwan. While clinicopathologic features of human papillomavirus (HPV) related oropharyngeal squamous cell carcinoma (OPSCC) have been examined in the United States, this is lacking in head and neck cancer patients in Taiwan, where smoking is known to be an important factor. It is yet unknown whether HPV is a significant causal factor in development and progression of OPSCC in Taiwanese head and neck cancer patients. We plan to investigate the frequency of HPV in OPSCC in this unstudied population, focusing on prevalence of HPV positive tumors, identification of the HPV types involved, evidence of HPV-driven disease by examining p16ink4a expression, clinical and behavioral factors contributing to outcome, and viral mechanisms associated with survival. If we are able to determine that HPV is implicated in OPSCC in this population, detection and identification of HPV can help guide the most appropriate patient treatment, which could decrease morbidity of treatment and possibly reduce mortality.