About

Li Min is an Associate Professor in the UCLA Department of Anthropology. His major field of research is the archaeology of prehistoric and Bronze Age China, with a focus on state formation, social memory, storytelling, place-making, and religious and social responses to climatic change. He also studies the maritime archaeology of the Asiatic Trade in the Early Modern Era (13th to 17th centuries), using research on ceramic production and trade in coastal China and Southeast Asia to document the transformations in material culture brought by the inauguration of early global trade. He teaches graduate seminars in archaeology theories and several undergraduate courses on anthropological archaeology and ancient civilizations of China. These classes are offered through Anthropology, Asian Languages and Cultures, and the Interdepartmental Program of Archaeology. Li Min is also co-director of the Wen-Si River Basin archaeological survey project, a collaboration between UCLA and archaeologists in China. His most recent book is 'Social Memory and State Formation in Early China,' published by Cambridge University Press in 2018. His research interests include social archaeology and cultural history of continental East Asia focusing on the emergence of early civilizations in Neolithic and Bronze Age China, historical anthropology, material culture, and conceptions of the past in early modern China, as well as landscape archaeology integrating systematic survey, analysis of archaeological ceramics, remote sensing imagery, traditional studies of stone inscriptions, and numismatics.

Research topics

• Medicine
• Internal medicine
• Radiology
• Psychiatry
• Nursing
• Emergency medicine
• Cardiology
• Family medicine
• Medical emergency
• Physical therapy
• Gerontology
• Pathology
• Physical medicine and rehabilitation
• Multimedia
• Intensive care medicine

Selected publications

• Prompted Text-Based Vital Sign Recording Versus Unprompted Electronic Medical Record Entries in Patients With Advanced Heart Failure: Observational Study (Preprint)

  JMIR Formative Research · 2025-01-22

  articleOpen access
  PublisherDOI

• Medicare Advantage Plan Disenrollment: Beneficiaries Cite Access, Cost, And Quality Among Reasons For Leaving

  Health Affairs · 2025-06-01 · 3 citations

  article

  Medicare Advantage (MA) is growing in popularity, but it is seeing substantial plan disenrollments among high-risk Medicare beneficiaries. Understanding and addressing factors associated with disenrollment are crucial for improving MA access and quality but are complicated by data issues, including the inability to adequately assess beneficiaries' perceptions of access and quality in MA. Using data from the 2015-20 restricted Medicare Current Beneficiary Survey with information on beneficiaries' perceptions of access, cost, and quality, plus MA contract star ratings and plan generosity data, we assessed factors associated with disenrolling from an MA plan. Enrollees' self-reported inability to access and receive high-quality care, more than perceived burdens of out-of-pocket costs, was associated with MA plan disenrollment, as was an objective measure of plan generosity. Difficulty accessing needed medical care was more strongly associated with MA-to-traditional Medicare exits than MA-to-MA plan switching. Dissatisfaction with access, cost, and quality was much more common for enrollees in poor health. These findings renew concerns about access to high-quality care for high-risk and other MA enrollees.

  PublisherDOI

• Epidemiology and transmission dynamics of multidrug-resistant organisms in nursing homes within the United States

  Nature Communications · 2025-03-13 · 6 citations

  articleOpen access

  Nursing home (NH) residents in the United States routinely attend interactive visits for services such as therapy or dialysis, creating opportunities for pathogen transmission. A paucity of studies exist which delineate spread of pathogens beyond residents' in-room environment. In this prospective cohort study, we recruited 197 newly-admitted residents across three Veterans Affairs NHs to characterize multidrug-resistant organism (MDRO) prevalence, acquisition, and transmission. Participant hands, nares, groin, and seven environmental surfaces were swabbed during 758 regularly scheduled in-room visits; participant hands, healthcare personnel hands, and equipment were swabbed during 345 unscheduled interactive visits. We demonstrate that baseline MDRO colonization and new acquisition is common, and one in six interactive visits result in MDRO transmission. Whole genome sequencing on a subset of participants enabled us to identify sources of transmission where it was unknown using microbiologic methods alone. Our results illustrate MDRO transmission pathways and highlight the need for innovative, multidisciplinary interventions.

  PublisherOA PDFDOI

• Delirium screening and alerting systems for older hospital inpatients

  BMC Health Services Research · 2025-05-07 · 4 citations

  articleOpen access

  BACKGROUND: Delirium often goes unrecognized in the hospital, leading to missed opportunities for management. The objective of this study was to test a multicomponent program for delirium screening and reporting for older, hospitalized adults. METHODS: We implemented a multicomponent delirium screening and alerting program within two university hospital units for all patients ≥ 70 years of age. The initiative compared performance of the 4 'A's Test, Nursing Delirium Screening Scale, and Confusion Assessment Method. Additionally, the study team provided recurrent educational sessions with nurses and implemented pager and electronic health record alerts for patients who screened positive for delirium. Nurses were then surveyed about their perspectives, and clinical outcomes were abstracted from the medical record. RESULTS: Compared to the Confusion Assessment Method, the proportion of positive screens was significantly higher (positive screens/admissions) with the 4 'A's Test (49/448, 11% vs. 12/399, 3%, p < 0.001) and the Nursing Delirium Screening Scale (83/539, 15% vs. 12/399, 3%, p < 0.001). Among surveyed nurses, 32/41 (78%) expressed that the alerting system provided at least "moderate" motivation to screen for delirium, and 35/41 (85%) voiced that it provided at least "moderate" motivation to record positive screens. Most respondents (23/42, 55%) reported recurrent educational sessions as "very helpful." Positive screens were associated with higher mortality (6.6% vs. 1.9%, p = 0.003), longer hospitalizations (13 [± 11] days vs. 7 [± 11], p < 0.001), and higher likelihood of discharge to care facilities (45% vs. 23%, p < 0.001). CONCLUSIONS: Positive delirium screening rates were higher with the 4AT and NuDesc compared to the CAM. Additionally, alerting systems and educational initiatives served as motivating factors for delirium screening and charting.

  PublisherOA PDFDOI

• Evaluating Prompted Text-Based Vital Sign Recording Versus Unprompted Electronic Medical Record Entries in Patients With Advanced Heart Failure (Preprint)

  2025-01-22

  preprintOpen access

  <sec> <title>BACKGROUND</title> Long-term remote patient monitoring, particularly of weight, pulse, and blood pressure, has been shown to significantly reduce mortality and hospitalization rates due to cardiovascular issues in heart failure patients. Despite its proven effectiveness, maintaining patient engagement in remote monitoring programs remains a challenge. </sec> <sec> <title>OBJECTIVE</title> This study aims to evaluate the impact of two-way mobile text-based communication in prompting patients to record key vital signs, and how it compares to traditional, unprompted patient reporting through electronic medical records in terms of engagement and clinical outcomes. </sec> <sec> <title>METHODS</title> We analyzed data from patients participating in the University of Michigan Advanced Heart Failure Program. Participants were required to submit daily reports of their weight, blood pressure, and pulse via one of two methods: the MiChart Patient Outreach Texting Application (MPOTA) or the Patient Enrolled Flowsheets (PEF). The study's primary metric was the consistency of patient-reported vital signs, with secondary metrics including variations in hospitalization and emergency room visits pre- and post-enrollment in the programs. </sec> <sec> <title>RESULTS</title> The study included 890 patients, with 301 in the MPOTA group and 589 in the PEF group, after applying exclusion criteria. The engagement rate for the PEF group had a median of 2.29%, with a range from 0 to 99.76%. In contrast, the MPOTA group showed a significantly higher median engagement rate of 66.67%, with rates spanning from 0% to 100%. Analysis of hospitalization and emergency room visit trends revealed no significant changes following the initiation of MPOTA. </sec> <sec> <title>CONCLUSIONS</title> The findings from this study suggest that while the adoption of the MPOTA system did not result in a noticeable reduction in hospitalizations or emergency room visits, it significantly improved patient engagement levels. This underscores the potential of mobile text-based communication in enhancing patient involvement in remote monitoring programs, particularly for those with advanced heart failure. </sec>

  PublisherDOI

• Endpoint assessment via routinely collected data generates estimates comparable to randomized controlled trial data: analysis of a cluster-randomized trial on fall injury prevention

  Journal of Clinical Epidemiology · 2025-02-10

  articleOpen access

  BACKGROUND AND OBJECTIVES: Routinely collected data (RCD) from healthcare claims and encounters are increasingly used for outcomes in randomized trials; however, methods for estimating the validity and relative precision of RCD-derived outcomes compared to those from conventional outcome ascertainment are limited. We developed an approach to measuring validity and relative precision of RCD and quantifying uncertainty. METHODS: We reanalyzed data from the Strategies to Reduce Injuries and Develop Confidence in Elders (STRIDE) cluster-randomized, controlled trial. Eighty-six primary care practices in 10 US healthcare systems were randomized to either a multifactorial intervention delivered by nurse falls care managers, or enhanced usual care, with 5451 persons age ≥ 70 at increased fall injury risk enrolled in the study. We estimated the hazard ratio (HR) and confidence interval (CI) for STRIDE's primary outcome (time to first serious fall injury) using original study data and RCD. The ratio of the RCD HR to original HR ("ratio of HRs") measured validity. The confidence limit ratio (CLR; upper divided by lower confidence limits of CI) measured precision, with the ratio of the CLR with RCD to the CLR from the original study data ("ratio of CLRs"), measuring relative precision. We estimated uncertainty around the ratio of HRs and ratio of CLRs using bootstrapped 95% CIs and performed sensitivity analyses to assess the effects of adaptations needed to use RCD. RESULTS: Among the original sample of 5451 study participants, 5036 (92%) were linked to RCD. The intervention to control HR was 0.91 (95% CI: 0.78-1.07) in RCD, compared to 0.92 (95% CI: 0.80-1.06) in the original data. Using all RCD through STRIDE's administrative end date, the ratio of HRs was 1.00 (95% CI: 0.89-1.11) and ratio of CLRs was 1.03 (95% CI: 0.96-1.06). The CI around ratio of HRs was about three-fold wider for RCD than for the original STRIDE data in individuals who linked to RCD. Relative precision of RCD improved with increased length of follow-up. CONCLUSION: Relying solely on RCD to ascertain the primary outcome in STRIDE would have resulted in similar point estimates and confidence limits for the treatment effect as in the original data. However, there was meaningful uncertainty around the estimate of validity. Efforts to validate RCD-derived outcomes for use as clinical trial endpoints should include measurement of uncertainty around validity estimates.

  PublisherOA PDFDOI

• Validation of a Rule-Based ICD-10-CM Algorithm to Detect Fall Injuries in Medicare Data

  The Journals of Gerontology Series A · 2024-04-03 · 9 citations

  articleOpen access

  BACKGROUND: Diagnosis-code-based algorithms to identify fall injuries in Medicare data are useful for ascertaining outcomes in interventional and observational studies. However, these algorithms have not been validated against a fully external reference standard, in ICD-10-CM, or in Medicare Advantage (MA) data. METHODS: We linked self-reported fall injuries leading to medical attention (FIMA) from the Strategies to Reduce Injuries and Develop Confidence in Elders (STRIDE) trial (reference standard) to Medicare fee-for-service (FFS) and MA data from 2015-19. We measured the area under the receiver operating characteristic curve (AUC) based on sensitivity and specificity of a diagnosis-code-based algorithm against the reference standard for presence or absence of ≥1 FIMA within a specified window of dates, varying the window size to obtain points on the curve. We stratified results by source (FFS vs MA), trial arm (intervention vs control), and STRIDE's 10 participating health care systems. RESULTS: Both reference standard data and Medicare data were available for 4 941 (of 5 451) participants. The reference standard and algorithm identified 2 054 and 2 067 FIMA, respectively. The algorithm had 45% sensitivity (95% confidence interval [CI]: 43%-47%) and 99% specificity (95% CI: 99%-99%) to identify reference standard FIMA within the same calendar month. The AUC was 0.79 (95% CI: 0.78-0.81) and was similar by FFS or MA data source and by trial arm but showed variation among STRIDE health care systems (AUC range by health care system, 0.71 to 0.84). CONCLUSIONS: An ICD-10-CM algorithm to identify fall injuries demonstrated acceptable performance against an external reference standard, in both MA and FFS data.

  PublisherOA PDFDOI

• Experiences of older surgical patients and care partners during <scp>COVID</scp> ‐19: Lessons for future care

  Journal of the American Geriatrics Society · 2024-10-16

  articleOpen access

  The COVID-19 pandemic introduced unique challenges for patients undergoing elective major surgery, including scheduling delays, a transition to virtual care, and frequent policy changes (e.g., visitor restrictions, discharge processes).1, 2 These challenges disproportionally affected older adults (aged ≥65 years), who are more medically complex, less apt to use technology, and often involve friends and family members (i.e., care partners) in their surgical care.3, 4 The dismantling of routine care processes and support systems provided an opportunity to evaluate perceptions and values of older surgical patients and their care partners both separately and as a patient–caregiver dyad.5 Using preoperative and postoperative patient and care partner interviews, we sought to understand dyad experiences during major surgery to inform potential strategies to improve surgical care. We used convenience sampling to identify dyads undergoing elective colorectal surgery (n = 10) from July 2020 to July 2021.6 Participants were diverse across race, patient-care–partner relationship, and cognitive status as assessed using the Telephone Montreal Cognitive Assessment with scores <18 indicating possible impairment (Table 1).7 Verbal informed consent was obtained. Using Zoom, we interviewed dyad members separately before and after surgery. Interview domains centered on preparations, knowledge, and challenges. Interviews were audio recorded and transcribed. Using an inductive thematic analysis approach, two researchers independently coded transcripts without a preexisting coding schema. Following each interview, the full team met to review the codes and refine the codebook. Interviews continued until reaching data saturation. A final coding schema was then applied, and the full team analyzed the codes in segments for overarching themes. The University of Michigan Medicine Institutional Review Board approved this study. Interviews revealed four dominant themes impacting surgical experiences (Table 2). (1) Surgery was perceived as non-elective: Due to discomfort or a perceived lack of alternative options, dyads viewed the surgery as urgently needed to maintain or improve their quality of life. Uncertainty around scheduling and delays led to distress among dyads. (2) In-person meetings were valued: Meetings in-person, especially with the surgeon, were critical for establishing trust. Additionally, virtual care was sometimes perceived as an indicator of lower surgical complexity and contributed to additional distress when recovery was prolonged. (3) Importance of care partner involvement: Patients felt the emotional, physical, and informational support of their care partner contributed to the success of their surgery. Care partner involvement also improved perceived patient recall and adherence to directions from the surgical team. Without care partners present in the hospital, many patients reported remaining in bed too long after surgery, patients with cognitive impairment often underreported symptoms, and dyads felt less able to elicit responses to their inquiries. (4) Inconsistent communication: Variation in how and when surgical team members communicated with dyads reduced confidence and preparedness for surgery. Due to the pandemic, visitation policies were frequently changed and inconsistently enforced, which introduced additional challenges for care partners seeking updates on the patient's care. This was especially distressing for dyads where the patient had cognitive impairment and depended on care partner involvement for managing their health. I'm more than a little worried right now with the university canceling surgeries, that this is gonna get canceled. And I won't do well with that. Because of, it's impacting everything else I'm doing right now…You know it's, yeah, it, you know sort of an elective surgery but it's not. It's sorta one step past elective. -Patient #7 It wasn't an easy decision. It'd been recommended for quite a while, and we finally made up our mind. So now we're confident this is the way to go… we were hopin’ to get it like the next week [after surgical consultation], which we know wouldn't happen, but… if anything, to have gotten the surgery a little sooner in the month, would have been better. -Care Partner #8 When I talked to [surgeon], and we, we've only met video, so I said I would like to meet her in person before the surgery. They said she would see me in the preop area, which is fine. -Patient #7 But his follow-up surgical appointment was video. Now I found that odd—I found that odd! I mean how do you look at the surgical site and, you know? I guess just by the questions they asked they could surmise they didn't need to… I just kinda figured that was one we'd probably have to go back in person. But, you know like I say, he did, he did fine. -Care Partner #9a He's been to every one of the doctor's appointments, the only time he couldn't was when I went to the sugar doctor last week. But he got to go online, in another room. You know, he didn't want anybody in with the virus. He Is the only one that ever said no, he can't come, he can't come in. Well, then you better find; because I want him to hear everything that's being said. Cause you know four ears are better than two. -Patient #4 What things could you not provide the patient now, given the (pandemic)? The role of patient advocate. I missed all of [the plan from the medical team]. So all I had was her report, which, when you're on pain meds and you're in pain, you don't always remember exactly what was said or what the plan is. So, information was sketchy. And it was frustrating. -Care Partner #7 That's one that we do, we'll check at that time also. The way I read the… the things online is, that I can have one visitor per day. I think that, I think that means one total, not one at a time, but we need to check, ‘cause those things seem to be very… fluid and changing at the, at the moment with the COVID thing of how many… how many visitors. Other than that, uh…we'll, we just, uh… go with the flow as we go through this thing. -Patient #6a Did you have to look into the visitor policy or anything like that? “Dad was gonna check on it, um, and let me know. (Yeah) ‘Cause I mean around here… I don't even, I know some people who work at hospitals around here, and I think it's… one visitor and it's like basically for a short time… I mean without me really knowin’ what's goin’ on, I've, (Yeah) prepared the best I can” -Care Partner #1a Perspectives of patients undergoing surgery and their care partners during the COVID-19 pandemic revealed important opportunities to optimize surgical care for older adults. Participants viewed the surgery as non-elective; cited inconsistencies in communication; and placed high value on in-person meetings with their medical team and the inclusion of care partners. Other studies of older surgical patients during the pandemic have also highlighted a desire for better communication with the surgical team, the inclusion of caregivers, and a preference to meet their surgeon face-to-face before surgery as a mechanism to build trust.1, 8, 9 A strength of our study is the inclusion of care partners who are often viewed as a vital component to a successful surgery. We have four recommendations for this growing population of patients undergoing surgery: (1) Teams should consider designating “elective surgery” as “scheduled surgery” to patients and their care partners to acknowledge the importance of the surgery to dyads. (2) Virtual care practices should offer opportunities for dyads to meet the surgeon in-person and specify that virtual meetings do not signify lower surgical complexity. (3) Surgical teams should advocate for care partner involvement from initial consultation to recovery at home to better support the patient and reinforce recommendations. (4) Health systems should develop reliable methods for care partners to communicate with the surgical team (e.g., a secure portal for asynchronous two-way communication regarding patients' daily progress) during hospitalization. Such recommendations may better support dyads undergoing major surgery. All authors contributed to the study concept and design, drafting of the manuscript, and reviewing the manuscript for critical feedback and approval of the final version for publication. Blue Cross Blue Shield of Michigan Foundation (002816), VA Ann Arbor | Geriatric Research Education and Clinical Center (GRECC). No conflicts of interest declared. The sponsor had no role in the study design, data analysis, or preparation of the manuscript.

  PublisherOA PDFDOI

• Improved accuracy and efficiency of primary care fall risk screening of older adults using a machine learning approach

  Journal of the American Geriatrics Society · 2024-01-13 · 13 citations

  articleOpen access

  BACKGROUND: While many falls are preventable, they remain a leading cause of injury and death in older adults. Primary care clinics largely rely on screening questionnaires to identify people at risk of falls. Limitations of standard fall risk screening questionnaires include suboptimal accuracy, missing data, and non-standard formats, which hinder early identification of risk and prevention of fall injury. We used machine learning methods to develop and evaluate electronic health record (EHR)-based tools to identify older adults at risk of fall-related injuries in a primary care population and compared this approach to standard fall screening questionnaires. METHODS: Using patient-level clinical data from an integrated healthcare system consisting of 16-member institutions, we conducted a case-control study to develop and evaluate prediction models for fall-related injuries in older adults. Questionnaire-derived prediction with three questions from a commonly used fall risk screening tool was evaluated. We then developed four temporal machine learning models using routinely available longitudinal EHR data to predict the future risk of fall injury. We also developed a fall injury-prevention clinical decision support (CDS) implementation prototype to link preventative interventions to patient-specific fall injury risk factors. RESULTS: Questionnaire-based risk screening achieved area under the receiver operating characteristic curve (AUC) up to 0.59 with 23% to 33% similarity for each pair of three fall injury screening questions. EHR-based machine learning risk screening showed significantly improved performance (best AUROC = 0.76), with similar prediction performance between 6-month and one-year prediction models. CONCLUSIONS: The current method of questionnaire-based fall risk screening of older adults is suboptimal with redundant items, inadequate precision, and no linkage to prevention. A machine learning fall injury prediction method can accurately predict risk with superior sensitivity while freeing up clinical time for initiating personalized fall prevention interventions. The developed algorithm and data science pipeline can impact routine primary care fall prevention practice.

  PublisherOA PDFDOI

• Hypertension Severity as Quantified by Hypertension Daily Dose and Blood Pressure With Risk of Stroke in REGARDS

  Journal of the American Heart Association · 2024-08-19 · 4 citations

  articleOpen access

  Background It is unknown how blood pressure (BP) relates to stroke risk across levels of hypertension daily dose (HDD)‐quantified antihypertensive medication intensity. Methods and Results The REGARDS (Reasons for Geographic and Racial Differences in Stroke) study enrolled 30 239 participants from the 48 contiguous US states in 2003 to 2007 with in‐person follow‐up in 2013 to 2016 (Visit 2). We included those without prior stroke at Visit 2, treating this visit as T 0 . Biannual phone calls and medical record review ascertained incident stroke events. Cox proportional hazard models estimated the hazard ratio (HR) of incident stroke by treatment intensity defined by systolic BP stages and HDD groupings. There were 344 stroke events over a median 5.5 years. Relative to systolic BP &lt;120 mm Hg and no antihypertensive medications, the stroke HR was 2.86 (95% CI, 1.68–4.85) for systolic BP 140 to 159 mm Hg and HDD tertile 2, 2.33 (1.37–3.97) for systolic BP 140 to 159 mm Hg and HDD tertile 3, 3.08 (1.20–7.88) for systolic BP ≥160 mm Hg and HDD tertile 2, and 3.66 (1.61–8.30) for systolic BP ≥160 mm Hg and HDD tertile 3. Stroke risk was similar across HDD levels for people with systolic BP &lt;140 mm Hg. Conclusions Among adults without prior stroke, systolic BP ≥140 mm Hg and HDD tertile ≥2 was associated with greater stroke risk. For adults with BP &lt;140 mm Hg, stroke risk was similar despite cumulative dose of antihypertensive medications used. These findings support the practice of BP‐lowering medications to mitigate stroke risk.

  PublisherDOI

Recent grants

• Optimizing Treatment of Older Adults with Hypertension: A Net Benefit Analysis of Falls Injury vs Cardiovascular Outcomes

  NIH · $1.7M · 2015–2020

• NIH Grant R21HS017621

  NIH · $263k · 2012

• Assessing Hypertension Care for Aged Veterans: Balancing Risks and Benefits

  NIH · 2015–2019

Frequent coauthors

• Lona Mody

  VA Ann Arbor Healthcare System

  80 shared

• Neil S. Wenger

  74 shared

• David A. Ganz

  58 shared

• David B. Reuben

  University of California, Los Angeles

  51 shared

• Eve A. Kerr

  49 shared

• Kenneth M. Langa

  Health Services Research & Development

  47 shared

• Timothy P. Hofer

  46 shared

• Carole E. Aubert

  University of Bern

  42 shared