Research
I am a pediatric translational researcher and was named the Robert P. Kelch, MD, Research Professor of Pediatrics in 2016. As one of the few individuals across the country who has completed dual training in Pediatric Endocrinology and Pediatric Health Services Research and a Master in Public Health, my research agenda focuses on the overarching themes of obesity and type 1 and type 2 diabetes. Because of my specialized training, I have been able to approach these problems from a unique vantage point, using a variety of methodologies including applied clinical research, epidemiologic analyses of nationally representative data, state transition modeling, cost-effectiveness analysis, as well as design and emerging technologies (design ethnography, participatory design, human-centered design, quality improvement science).
At the 2016 Pediatric Academic Societies meeting, I was the first recipient of the Paul Kaplowitz, MD, Endowed Lectureship for my contributions to quality and cost-effective care in Pediatric Endocrinology, an award sponsored by the American Academy of Pediatrics and the Pediatric Endocrine Society. My major research contributions have included studies evaluating recommended screening guidelines for type 2 diabetes for overweight and obese children, studies evaluating the link between overweight and obesity and timing of puberty and chronic disease risk factors, studies focused on quality measurement and quality of care for overweight and obese children, and research in health outcomes for type 1 diabetes. To date, I have over 130 peer-reviewed publications. You can link to my CV here and learn more about my current work and publications below:
My current work:
I am now pursuing my research under the broader framework of “Learning Health Systems”, which are systems in which “research, improvement, management and patient care, are intentionally integrated. In such a health system ”learning while doing” is the default, thus ensuring that the right care is provided to the right child at the right time, every time.” Forrest et al. Health Affairs 2014
The Learning Health System model has resulted in dramatic improvements in health outcomes for a variety of children with chronic illnesses. There is greater opportunity for achieving this vision given the increasing focus on improving the quality of care for children in delivery systems, the near-universal adoption of electronic health records, and the rising interest in patient-centered care and design thinking. To support this shift in focus to a broader systems design approach to healthcare, I completed training in Advanced Methods in Quality Improvement at Cincinnati Children’s, became an Epic Physician Builder to redesign the clinical workflow to support an LHS model, and achieved proficiency with sql and the development of Tableau dashboards to liberate health system data for clinical care, quality improvement, and research. As of July 2019, I have taken on the roles of Associate Chief Medical Information Officer for Pediatric Research and Associate Chair for Health Metrics and Learning Health Systems for the Department of Pediatrics which allows me to further support this vision for pediatric health. In 2020 I was name Ambulatory Care Clinical Chief for Pediatric Medical Subspecialties, an operational role which is guiding ambulatory health system redesign and that leverages my Health IT/Pediatrics leadership roles. I also hold the role of Associate Director for Informatics and Clinical Research Innovation for the Caswell Diabetes Institute, which has the objective of leveraging EHR tools and data for diabetes/metabolism researchers on campus. In 2024, I became board certified in Clinical Informatics.
My learning health system work focuses on three main areas:
1) Type 1 Diabetes: We collaborate with the T1D Exchange Quality Improvement Collaborative to improve the quality of care and health outcomes of individuals with Type 1 Diabetes. Particular areas of interest include adoption of telemedicine, Epic tool development and Tableau dashboard development for support operations and QI, measurement of patient reported outcomes (i.e. psychosocial outcomes) using Health IT tools, and interventions to support data literacy and data engagement among parents of children with T1D.
2) Type 2 Diabetes in Adults: I work with the leadership team for the Michigan Collaborative for Type 2 Diabetes, which is a Blue Cross-funded Statewide Quality Collaborative of over 26 practices in Michigan which has the goal of improving the delivery of evidence-based care for all adults with type 2 diabetes in the state. In particular, I work with the data team on the development of an all-payer database which is integrating claims data, electronic health record data, and health information exchange data to support the activities of the network, and business analytic dashboards to support the quality improvement activities of participating organizations and to track the pay for performance metrics.
3) Prevention and treatment of childhood overweight/obesity: We are focused on development of statewide collaboration in the state of Michigan to address childhood overweight/obesity, and I serve as Director of the newly established Childhood Obesity Research Core (CORC), an NIH-funded core of the Michigan Nutrition Obesity Research Center which supports basic, clinical, and translational researchers focused on childhood nutrition and obesity and enhances integration of research into the clinical delivery system.
Because of my focus on the EHR as a tools for operations, QI, and research, I also hold the role of Associate Director for Informatics and Clinical Research Innovation for the Caswell Diabetes Institute, which has the objective of leveraging EHR tools and data for diabetes/metabolism researchers on campus. Other areas of interest include biomarker discovery for prediabetes and type 2 diabetes in children and the use of real-time CGM in prediabetes. For a full list of my publications, please see my CV.
My Research Contributions:
1. My work focuses on the development of learning health systems, leveraging data from the EHR, and collaboration with human computing interaction and machine learning/artificial intelligence experts from the Schools of Information/Engineering in the areas of obesity and diabetes.
Lee JM, Rusnak A, Garrity A, Hirschfeld E, Thomas IH, Wichorek M, Lee JE, Rioles NA, Ebekozien O, Corathers SD. Characterizing Health Disparities in Type 1 Diabetes with the “Six Habits”: Quality Metrics to Support 2 an Equitable Future for Glycemic Outcomes. JAMA Netw Open. 2021;4(10):e2131278. doi:10.1001/jamanetworkopen.2021.31278
Lee JM, Carlson E, Albanese-O’Neill A, Demeterco-Berggren C, Corathers S, Vendrame F, Weinstock RS, Prahalad P, Alonso T, Kamboj M, DeSalvo DJ, Malik FS, Izquierdo FS, Ebekozien O. Adoption of Telemedicine for Type 1 Diabetes Care During the COVID-19 Pandemic. Diabetes Technology and Therapeutics. 2021, September 23. DOI: 10.1089/dia.2021.0080. PMID: 33851873
Alonso GT, Corathers S, Shah A, Clements M, Kamboj M, Sonabend R, DeSalvo D, Mehta S, Cabrera A, Rioles N, Ohmer A, Mehta R, Lee J. Establishment of the Type 1 Diabetes Exchange Quality Improvement Collaborative (T1DX-QI). Clinical Diabetes. 2020; 38(2):141-151. doi:10.2337/cd19-0032.
2. I have conducted a series of studies that have important policy implications for the screening and diagnosis of diabetes in children and adolescents, assessing the test performance, efficacy, and cost-effectiveness of Hemoglobin A1c and a variety of other screening methods for prediabetes and diabetes.
Lee JM, Gebremariam A, Wu E, LaRose J, Gurney JG. Evaluation of nonfasting tests to screen for childhood and adolescent dysglycemia. Diabetes Care 2011;34(12):2597-602. PMCID: PMC3220868
Lee JM, Wu E, Herman WH, Tarini BA, Yoon EY. Diagnosis of diabetes using Hemoglobin a1c: should recommendations in adults be extrapolated to adolescents? J Pediatr 2011;158(6):947-952.e3. PMCID: PMC3210198
Wu E, Kazzi N, Lee JM. Cost-effectiveness of screening strategies for identifying pediatric diabetes and dysglycemia. JAMA Pediatr. 2013 Jan 1;167(1):32-9. PMCID: PMC3837695
Lee JM, Eason A, Nelson C, Kazzi NG,* Cowan AE, Tarini BA. Screening practices for identifying type 2 diabetes in adolescents. J Adolesc Health. 2013 Feb;54(2):139-43. doi: 10.1016/j.jadohealth.2013.07.003. Epub 2013 Aug 20.
Vajravelu ME, Lee JM. Identifying Prediabetes and Type 2 Diabetes in Asymptomatic Youth: Should HbA1c Be Used As a Diagnostic Approach? Curr Diab Rep. 2018 Jun 4;18(7):43.
3. I have studied the impact of emerging technologies (mobile technology and social media) and the maker movement on health outcomes through a research collaboration with the Nightscout community, a global online community of 30,000 patients and caregivers with diabetes who have created their own do it yourself technology innovations for diabetes. I am also collaborating with the community to create opportunities for patient-driven open science research using the Open Humans platform. Please learn more about studies using the Nightscout data commons here.
Lee JM, Hirschfeld E, Wedding J. A Patient-Designed Do-It-Yourself Mobile Technology System for Diabetes: Promise and Challenges for a New Era in Medicine. JAMA. 2016 Apr 12;315(14):1447-8. Link. Supplement Link.
Lee JM, Newman MW, Gebremariam A, Choi P, Lewis D, Nordgren W, Costik J, Wedding J, West B, Benovich Gilby N, Hannemann C, Pasek J, Garrity A, Hirschfeld E. Real-World Use and Self-Reported Health Outcomes of a Patient-Designed Do-it-Yourself Mobile Technology System for Diabetes: Lessons for Mobile Health. Diabetes Technol Ther 2017 Feb 28. Link.
Kaziunas E, Lindtner S, Ackerman MS and Lee JM. Lived data: Tinkering with bodies, code and care work. Human-Computer Interaction, Special Issue on The Examined Life: Personal Uses of Personal Data. (Forthcoming)
White K, Gebremariam A, Lewis D, Nordgren W, Wedding J, Pasek J, Garrity A, Hirschfeld E, Lee JM. Motivations for Participation in an Online Social Media Community for Diabetes J Diabetes Sci Technol. 2018 Jan 1:1932296817749611. doi: 10.1177/1932296817749611. Link.
Awori J, Lee JM, A Maker Movement for Health: A New Paradigm for Health Innovation. JAMA Pediatr. 2017;171(2):107-108. PMID: 27992620
4. I have conducted a number of studies focused on measuring health utilization, costs, cost-effectiveness, and health policy issues for children with diabetes.
Lee JM, Sundaram V, Sanders L, Chamberlain L, Wise P. Health care utilization and costs of publicly-insured children with diabetes in California. J Pediatr. 2015 May 28. doi: 10.1016/j.jpeds.2015.04.067. [Epub ahead of print]
Wolfgram PM, Sarrault J, Clark SJ, Lee JM. State-to-state variability in Title V coverage for children with diabetes. J Pediatr 2013 Apr;162(4):873-5. doi: 10.1016/j.jpeds.2012.12.009. Epub 2013 Jan 13.
Lee JM, Davis MM, Gebremariam A, Kim C. Age and sex differences in hospitalizations associated with diabetes. J Womens Health (Larchmt) 2010 Nov;19(11):2033-42. Epub 2010 Oct 12.
Lee JM, Okumura MJ, Freed GL, Menon RK, Davis MM. Trends in hospitalizations for diabetes among children and young adults: United States, 1993-2004. Diabetes Care 2007;30:3035-3039.
Lee JM, Rhee K, O'Grady MJ, Basu A, Winn A, John P, Meltzer DO, Kollman C, Laffel LM, Lawrence JM, Tamborlane WV, Wysocki T, Xing D, Huang ES. Health utilities for children and adults with type 1 diabetes. Med Care 2011 Oct;49(10):924-31.
5. I have completed a number of epidemiologic studies linking obesity with a variety of outcomes in childhood. I have shown that girls with excess weight have earlier onset of puberty compared with their normal weight girls, but that obese boys have a later onset of puberty compared with their normal weight boys. I have also conducted studies to evaluate associations of overweight and obesity with hyperinsulinemia, hyperlipidemia, and inflammation and I have conducted modeling studies to evaluate the long-term health policy implications of childhood obesity.
Lee JM, Appugliese D, Kaciroti N, Corwyn RF, Bradley RH, Lumeng JC. Weight status in young girls and the onset of puberty. Pediatrics 2007;119:624-630.
Lee JM, Kaciroti N, Appugliese D, Corwyn RF, Bradley RH, Lumeng JC. Body mass index and timing of pubertal initiation in boys. Arch Pediatr Adolesc Med 2010;164(2):139-44.
Lee, JM, Wasserman R, Kaciroti N, Gebremariam A, Steffes J, Dowshen S, Harris D, Serwint J, Abney D, Smitherman L, Reiter E, Herman-Giddens, ME. Timing of puberty in overweight versus obese boys. Pediatrics. 2016 Feb 137(2):e20150164. doi: 10.1542/peds.2015-0164. Epub 2016 Jan 27.
Lee JM, Okumura MJ, Davis MM, Herman WH, Gurney JG. Prevalence and determinants of insulin resistance among U.S. adolescents: A population based study. Diabetes Care 2006;29:2427-2432.
Lee JM, Gebremariam A, Card-Higginson P, Shaw JL, Thompson, JW, Davis MM. Poor performance of body mass index as a marker for hypercholesterolemia in children and adolescents. Arch Pediatr Adolesc Med 2009;163(8):716-23.
Singer K,* Eng D,* Lumeng CN, Gebremariam A., Lee JM. The relationship between body fat mass percentiles and inflammation in children. Obesity (Silver Spring). 2014 May;22(5):1332-6. doi: 10.1002/oby.20710. Epub 2014 Feb 18.
Lee JM, Pilli S, Gebremariam A, Keirns CC, Davis MM, Vijan S, Freed GL, Herman WH, Gurney JG. Getting heavier, younger: Birth cohort effects on obesity over the life course. Int J Obes (Lond). 2010 Apr;34(4):614-23. Epub 2009 Dec 1.
Lee JM, Lee H.* Obesity reduction within a generation: The dual roles of prevention and treatment. Obesity (Silver Spring) 2011 Oct;19(10):2107-10. doi: 10.1038/oby.2011.199. Epub 2011 Jun 30.
Lee JM, Gebremariam A, Vijan S, Gurney JG. Excess body mass index years, a measure of degree and duration of excess weight, and risk for incident diabetes. Arch Pediatr Adolesc Med 2012 Jan;166(1):42-8. doi: 10.1001/archpedi.166.1.42.
6. I have conducted work focused on the development of pediatric quality measures for childhood obesity. I was a funded co-investigator on a grant supported through the Children's Health Insurance Program Reauthorization Act (CHIPRA) of 2009 and lead the team that developed national quality measures focused on overweight and obesity in children, which included conducting a comprehensive literature review, convening a national expert panel, and drafting, prioritizing, refining, and testing the quality measures. These measures were submitted to the National Quality Measures Clearinghouse (NQMC) at the Agency for Healthcare Research and Quality (AHRQ).
Lee JM, Freed GL, Shevrin CA, McCormick JA, Gebremariam A, Madden BW, Dombkowski KJ for the Quality Measurement, Evaluation, Testing, Review, and Implementation Consortium. Documentation of BMI percentile and weight classification for children. National Quality Measures Clearinghouse (NQMC). Rockville (MD): Agency for Healthcare Research and Quality (AHRQ). Published November 23, 2015.
Lee JM, Freed GL, Shevrin CA, McCormick JA, Gebremariam A, Madden BW, Dombkowski KJ for the Quality Measurement, Evaluation, Testing, Review, and Implementation Consortium. Communication of weight classification for children who are overweight or obese. National Quality Measures Clearinghouse (NQMC). Rockville (MD): Agency for Healthcare Research and Quality (AHRQ). Published November 23, 2015.
Lee JM, Freed GL, Shevrin CA, McCormick JA, Gebremariam A, Madden BW, Dombkowski KJ for the Quality Measurement, Evaluation, Testing, Review, and Implementation Consortium. Hypertension screening for children who are overweight or obese. National Quality Measures Clearinghouse (NQMC). Rockville (MD): Agency for Healthcare Research and Quality (AHRQ). Published November 23, 2015.
Lee JM, Freed GL, Shevrin CA, McCormick JA, Gebremariam A, Madden BW, Dombkowski KJ for the Quality Measurement, Evaluation, Testing, Review, and Implementation Consortium. Follow-up visits for children who are obese or overweight with a weight-related comorbidity. National Quality Measures Clearinghouse (NQMC). Rockville (MD): Agency for Healthcare Research and Quality (AHRQ). Published November 23, 2015.
Lee JM, Freed GL, Shevrin CA, McCormick JA, Gebremariam A, Madden BW, Dombkowski KJ for the Quality Measurement, Evaluation, Testing, Review, and Implementation Consortium. Parent report of discussion of weight concerns for child. National Quality Measures Clearinghouse (NQMC). Rockville (MD): Agency for Healthcare Research and Quality (AHRQ). Published November 23, 2015.