Current Research and Scholarly Interests
My research aims to advance scientific understanding of the forces that influence physician and patient behavior, with a focus on evaluating and modifying physician and patient practices to improve health outcomes through prevention. The process by which new medical practices and knowledge are disseminated often fails to serve the best interests of patients. Frequently, new practices are readily adopted without adequate assessment. Paradoxically, other practices with strong evidence-based support are adopted only slowly and then inconsistently. By understanding the determinants of health behaviors, specific factors that facilitate or impede the adoption of appropriate new practices can be identified. These issues are critical to the future of medicine. Rising health care costs and the changing organization of health care have increased societal demands for high quality, yet cost-effective, clinical care. A preventive model that focuses on reducing the risk of future adverse outcomes, rather than symptom management, has become a dominant goal of health care delivery. By evaluating current practices and designing interventions to improve health care, my work responds to these demands. In addition, this nations investment in biomedical science is jeopardized if we fail to recognize that the adoption of new medical practices and health behaviors is a complex, yet potentially modifiable, process. My objective is to further develop the science of health care innovation as a mean for understanding current patterns of health care and as a vehicle for designing interventions to facilitate the adoption of evidence-based practices by patients, their care providers, and health care systems. This research agenda is reinforced and stimulated by an array of clinical and teaching activities. My clinical work in general internal medicine and preventive cardiology provide a rich observational experience that guides my research, as well as a context for applying clinical insights derived from my research. My educational activities involving undergraduates through post-doctoral fellows provide numerous opportunities to excite future clinicians and researchers about a population-based perspective.
My focus on the adoption of innovation encompasses four several closely related themes. First, a focal point of my research is the investigation of health care disparities by gender, race, socioeconomic status, and advanced age. Second, my work emphasizes epidemiological methods for the analysis of large, administrative data sources. Third, the measurement and improvement of health care quality is an increasingly important component of my work. Finally, my work involves use of clinical trial methods to investigate whether strategies for improvement in prevention are both effective and cost-effective. In pursuit of these four themes, my research spans a broad clinical range including cesarean section use, recommended cardiac medications, prevention practices, antibiotic use, screening tests, and patterns of disease management. While much of my research has focused on physician practices, newly initiated and planned future work emphasizes interventions that engage patients, physicians and health care systems to improve health outcomes through adherence to evidence-based recommendations. A main focus of this new line of research is optimizing the use of cardiovascular disease prevention guidelines within specific health care systems. The overarching aim of my research agenda is add to knowledge about the process of behavior change in individuals and institutional change in health care systems with the ultimate goal of improving health outcomes. A diverse portfolio of grant funding by the NIH, AHRQ, and private foundations currently supports this research agenda. The pursuit of this research agenda has been facilitated by a growing number of collaborators, trainees and staff members affiliated with my Program on Prevention Outcomes and Practices.