Research Areas

Researchers in the Division of General Internal Medicine and Primary Care at Brigham and Women's Hospital conduct research in a wide variety of areas, from improving the quality, safety, and equity of health care delivery to ground-breaking research in health information technology.

Research Areas of Focus

Health Care Delivery Quality and Safety

The Division has decades of experience conducting research to better understand and reduce threats to patient safety among medical patients in inpatient and outpatient settings and during care transitions. Areas of focus include medication safety, diagnostic errors, and hospital-acquired conditions.

The Division also conducts research to improve the quality of health care delivery more broadly, making it more effective, patient-centered, equitable, timely, and efficient. Interventions to achieve these goals are often multi-faceted, involving high-tech and high-touch components, process redesign, systems engineering, and implementation science methods. Many of these interventions have made an impact locally, nationally, and internationally. The Division also explores the effects of different payment and organizational structures on healthcare cost and quality.

Faculty

  • David Bates
  • Evan Benjamin
  • Asaf Bitton
  • Bonnie Blanchfield
  • Issac Chua
  • Anuj Dalal
  • Patricia Dykes
  • Shira Fischer
  • Dinah Foer
  • Ishani Ganguli
  • David Levine
  • Stephanie Mueller
  • Larissa Nekhlyudov
  • Ronen Rozenblum
  • Alejandra Salazar
  • Hojjat Salmasian
  • Gordon Schiff
  • Jeffrey Schnipper
  • Shela Sridhar
  • Emani Srinivas

References:

  1. Basu S, Berkowitz SA, Phillips RL, Bitton A, Landon BE, Phillips RS. Association of Primary Care Physician Supply With Population Mortality in the United States, 2005-2015. JAMA Intern Med. 2019;179(4):506-514. 1001/jamainternmed.2018.7624
  2. Basu S, Phillips RS, Berkowitz SA, Landon BE, Bitton A, Phillips RL. Estimated Effect on Life Expectancy of Alleviating Primary Care Shortages in the United States. Ann Intern Med. 2021 07; 174(7):920-926. https://doi.org/10.7326/M20-7381
  3. Bates DW, Cullen DJ, Laird N, Petersen LA, Small SD, Servi D, Laffel G, Sweitzer BJ, Shea BF, Hallisey R, Vander Vliet M, Nemeskal R, Leape Incidence of adverse drug events and potential adverse drug events: implications for prevention. ADE Prevention Study Group. JAMA 1995;274(1):29-34. PMID: 771255
  4. Bates DW, Kuperman GJ, Wang S, Gandhi T, Kittler A, Volk L, Spurr C, Khorasani R, Tanasijevic M, Middleton Ten commandments for effective clinical decision support: making the practice of evidence-based medicine a reality. J Am Med Inform Assoc 2003;10(6):523-530. DOI: 10.1197/jamia.M1370
  5. Blanchfield BB, Demehin AA, Cummings CT, Ferris TG, Meyer GS. The Cost of Quality: An Academic Health Center's Annual Costs for its Quality and Patient Safety Infrastructure. Joint Comm J Qual Patient Safety. Jt Comm J Qual Patient Safety. 2018; 44(10):583–9. https://doi.org/10.1016/j.jcjq.2018.03.012
  6. Collins SA, Rozenblum R, Leung WY, Morrison CR, Stade DL, McNally K, Bourie PQ, Massaro A, Bokser S, Dwyer C, Greysen RS, Agarwal P, Thornton K, Dalal AK. Acute care patient portals: a qualitative study of stakeholder perspectives on current practices. J Am Med Inform Assoc. 2017 Apr 1;24(e1):e9-e17. PubMed PMID: 27357830.
  7. Dykes PC, Carroll DL, Hurley A, Lipsitz S, Benoit A, Chang F, Meltzer S, Tsurikova R, Zuyov L, Middleton B. Fall prevention in acute care hospitals: a randomized trial. Journal of the American Medical Association 2010;304:1912-8. DOI: 1093/jamia/ocw081
  8. Dykes PC, Rozenblum R, Dalal AK, Massaro A, Chang F, Clements M, Collins S, Donze J, Fagan M, Gazarian P, Hanna J, Lehmann L, Leone K, Lipsitz S, McNally K, Morrison C, Samal L, Mlaver E, Schnock K, Stade D, Williams D, Yoon C, Bates DW. Prospective Evaluation of a Multifaceted Intervention to Improve Outcomes in Intensive Care: The Promoting Respect and Ongoing Safety Through Patient Engagement Communication and Technology Study. Crit Care Med. 2017 Aug;45(8):e806-e813. PubMed PMID: 28471886. DOI: 1097/ccm.0000000000002449
  9. Dykes PC, Burns Z, Adelman J, Benneyan J, Bogaisky M, Carter E, Ergai A, Lindros ME, Lipsitz SR, Scanlan M, Shaykevich S, Bates DW. Evaluation of a Patient-Centered Fall-Prevention Tool Kit to Reduce Falls and Injuries: A Nonrandomized Controlled Trial. JAMA Netw Open. 2020 11 02; 3(11):e2025889. PMID: 33201236. DOI: 10.1001/jamanetworkopen.2020.25889
  10. Edwards ST, Neri PM, Volk LA, Schiff GD, Bates DW. Association of note quality and quality of care: a cross-sectional BMJ Qual Saf. 2014 May;23(5):406-13. Doi: 10.1136/bmjqs-20
  11. Emani S, Sequist TD, Lacson R, Khorasani R, Jajoo K, Holtz L, Desai S. Ambulatory Safety Nets to Reduce Missed and Delayed Diagnoses of Cancer. The Joint Commission Journal on Quality and Patient Safety. 2019;45(8):552-7. DOI: 1016/j.jcjq.2019.05.010
  12. Engelman D, Benjamin E. Physician Engagement: The “Secret Sauce” to Success in Bundled Healthcare. Am J Med Qual. 2018;33(1):100-102. DOI: 2147/JHL.S214765
  13. Fischer SH, Tjia J, Reed G, Peterson D, Gurwitz JH, Field TS. (2014) Factors associated with ordering laboratory monitoring of high-risk medications. Journal of General Internal Medicine. 29(12),1589-98. PMCID: PMC4242891. doi: 1007/s11606-014-2907-9
  14. Foer D, Ornstein K, Soriano TA, Kathuria N, Dunn A. Nonmedical factors associated with prolonged hospital length of stay in an urban homebound population. J Hosp Med. 2012 Feb;7(2):73-8. PMID: 21391944 DOI: 1002/jhm.992
  15. Ganguli I, Wasfy JH, Ferris TG. What is the Right Number of Clinical Appointments? Visit Frequency and the Accountable Care JAMA. 2015;313(19):1905-6 DOI:10.1001/jama.2015.3356
  16. Ganguli I, Thompson RW, Ferris What can five high-cost patients teach us about healthcare spending? Healthcare. 2016;5(4):204-13. DOI: 10.1016/j.hjdsi.2016.12.004
  17. Gandhi TK, Weingart SN, Borus J, Seger AC, Peterson J, Burdick E, Seger DL, Shu K, Federico F, Leape LL, Bates DW. Patient safety - adverse drug events in ambulatory N Engl J Med 2003;348:1556-1564. DOI: 10.1056/NEJMsa020703
  18. Ganguli I, Souza J, McWilliams, JM, Mehrotra A. Association of Medicare’s Annual Wellness Visit with Cancer Screening, Referrals, Utilization, and 2019, Nov Health Aff. (Millwood). DOI: 10.1377/hlthaff.2019.00304
  19. Ganguli I, Lupo C, Mainor AJ, Raymond S, Wang Q, Orav EJ, Chang CH, Morden NE, Rosenthal MB, Colla CH, Sequist TD. Cascades Following Low-value Care: Pre-operative Electrocardiogram for Cataract JAMA Internal Medicine. 2019 Jun 3;179(9):1211-1219.
  20. Ganguli I, Shi Z, Orav EJ, Rao A, Ray KN, Mehrotra A. Declining Use of Primary Care among Commercially Insured Adults in the US, 2008-2016. Ann Intern 2020 Feb 18;172(4):240-7 doi: 10.1001/jamanetworkopen.2019.1514
  21. Ganguli I, Simpkin AL, Colla CH, Weissman A, Mainor AJ, Rosenthal MB, Sequist TD. Why Do Physicians Pursue Cascades of Care After Incidental Findings? A National J Gen Intern Med. 2020;35(4):1352‐1354. DOI: 10.1007/s11606-019-05213-1
  22. Garabedian, P. M., Wright, A., Newbury, I., Volk, L. A., Salazar, A., Amato, M. G., Nathan, A. W., Forsythe, K. J., Galanter, W. L., Kron, K., Myers, S., Abraham, J., McCord, S. K., Eguale, T., Bates, D. W., & Schiff, G. D. (2019). Comparison of a Prototype for Indications-Based Prescribing With 2 Commercial Prescribing Systems. JAMA network open, 2(3), e191514. https://doi.org/10.1001/jamanetworkopen.2019.1514
  23. Kachalia A, Sands K, Niel MV, Dodson S, Roche S, Novack V, Yitshak-Sade M, Folcarelli P, Benjamin EM, Woodward AC, Mello MM. Effects of a communication-and-resolution program on hospitals’ malpractice claims and costs. Health Affairs. 2018 Nov 1;37(11):1836-44. DOI: 1377/hlthaff.2018.0720
  24. Levine DM, Linder JA, Landon BE. The Quality of Outpatient Care Delivered to Adults in the United States, 2002 – 2013. JAMA Intern Med. 2016;176(12):1778-1790. DOI: 1001/jamainternmed.2016.6217
  25. Levine DM, Healey MJ, Wright A, Bates DW, Linder JA, Samal L. Changes in the quality of care during progress from stage 1 to stage 2 of Meaningful Use. J Am Med Inform Assoc. 2016 Aug 26. DOI: 1093/jamia/ocw127
  26. Levine DM, Landon BE, Linder JA. Quality and Experience of Outpatient Care in the United States for Adults With or Without Primary Care. JAMA Intern Med. 2019;179(3):363-372. DOI: 1001/jamainternmed.2018.6716
  27. Mueller SK, Cunningham Sponsler K, Kripalani S, Schnipper JL. Hospital-based medication reconciliation practices: a systematic review. Arch Intern Med. 2012;172 (14):1057-1069. DOI: 1001/archinternmed.2012.2246
  28. Mueller SK, Yoon C, Schnipper JL. Association of a Web-Based Handoff Tool With Rates of Medical Errors. JAMA Intern Med. Aug 1 2016. DOI: 1001/jamainternmed.2016.4258
  29. Hickman, T. T., Quist, A., Salazar, A., Amato, M. G., Wright, A., Volk, L. A., Bates, D. W., & Schiff, G. (2018). Outpatient CPOE orders discontinued due to 'erroneous entry': prospective survey of prescribers' explanations for errors. BMJ quality & safety, 27(4), 293–298. https://doi.org/10.1136/bmjqs-2017-006597
  30. Paladino J, Koritsanszky L, Neal BJ, Lakin JR, Kavanagh J, Lipsitz S, Fromme EK, Sanders J, Benjamin E, Block S, Bernacki R. Effect of the Serious Illness Care Program on Health Care Utilization at the End of Life for Patients with Cancer. J Palliat Med. 2020 Jan 3. DOI: 10.1089/jpm.2019.0437
  31. Panda N, Benjamin E, et al. Global Survey of Perceptions of the Surgical Safety Checklist Among Medical Students, Trainees, and Early Career Providers. World Journal of Surgery. 2020 April 19. https://doi.org/10.1007/s00268-020-05518-x
  32. Pippins JR, Gandhi TK, Hamann C, Ndumele CD, Labonville SA, Diedrichsen EK, Carty MG, Karson AS, Bhan I, Coley CM, Liang CL, Turchin A, McCarthy PC, Schnipper JL. Classifying and predicting errors of inpatient medication reconciliation. J Gen Intern Med. 2008;23(9):1414-1422. DOI: 1007/s11606-008-0687-9
  33. Ratcliffe HL, Schwarz D, Hirschhorn LR, Cejas C, Diallo A, Elorrio EG, Fifield J, Gashumba D, Hartshorn L, Leydon N, Mohamed M, Nakamura Y, Ndiaye Y, Novignon J, Ofosu A, Roder-DeWan S, Rwiyereka A, Secci F, Veillard JH, Bitton A. PHC Progression Model: a novel mixed-methods tool for measuring primary health care system capacity. BMJ Global Health 2019;4(5):e001822. DOI: 1136/bmjgh-2019-001822
  34. Salmasian H, Blanchfield B, Joyce K, Centeio K, Schiff G, Wright A, Baugh CW, Schuur J, Bates DW, Adelman JS, Landman AB. Association of Display of Patient Photographs in the Electronic Health Record with Wrong-Patient Order Entry Errors. JAMA Netw Open.2020;3(11):e2019652. DOI: 10.1001/jamanetworkopen.2020.19652
  35. Samal L, Wright A, Healey MJ, Linder JA, Bates DW. Meaningful Use and Quality of Care. JAMA Intern Med. 2014 Jun;174(6):997-8. DOI: 1001/jamainternmed.2014.662
  36. Schnipper JL, Kirwin JL, Cotugno MC, Wahlstrom SA, Brown BA, Tarvin E, Kachalia A, Horng M, Roy CL, McKean SC, Bates DW. Role of pharmacist counseling in preventing adverse drug events after hospitalization. Arch Intern Med. 2006;166(5):565-71. DOI: 1001/archinte.166.5.565
  37. Schnipper JL, Hamann C, Ndumele CD, Liang CL, Carty MG, Karson AS, Bhan I, Coley CM, Poon E, Turchin A, Labonville SA, Diedrichsen EK, Lipsitz S, Broverman C, McCarthy P, Gandhi TK. Effects of a medication reconciliation application and process redesign on potential adverse drug events: a cluster-randomized trial. Arch Intern Med 2009; 169(8):771-780. DOI: 1001/archinternmed.2009.51
  38. Schnipper JL, Mixon AS, Stein J, Wetterneck TB, Kaboli P, Mueller S, Labonville S, Minahan JA, Burdick E, Orav EJ, Goldstein J, Nolido NV, Kripalani S. The effects of a multi-faceted medication reconciliation quality improvement intervention on patient safety: final results of the MARQUIS study. BMJ Qual Saf DOI: 10.1136/bmjqs-2018-008233
  39. Schnipper JL, Nolido N, Dalal AK, et al. The Effects of a Multifaceted Intervention to Improve Care Transitions Within an Accountable Care Organization: Results of a Stepped-Wedge Cluster-Randomized Trial. J Hosp Med. 2021 Jan;16(1):15-22. doi: 10.12788/jhm.3513. PMID: 33357325
  40. Schnipper JL, Reyes Nieva H, Mallouk M, et al. Effects of a refined evidence-based toolkit and mentored implementation on medication reconciliation at 18 hospitals: results of the MARQUIS2 study. BMJ Qual Saf. 2021. Epub ahead of print: DOI: 10.1136/bmjqs-2020-012709.
  41. Schiff, G. D., Klinger, E., Salazar, A., Medoff, J., Amato, M. G., John Orav, E., Shaykevich, S., Seoane, E. V., Walsh, L., Fuller, T. E., Dykes, P. C., Bates, D. W., & Haas, J. S. (2019). Screening for Adverse Drug Events: a Randomized Trial of Automated Calls Coupled with Phone-Based Pharmacist Counseling. Journal of general internal medicine, 34(2), 285–292. https://doi.org/10.1007/s11606-018-4672-7
  42. Sridhar S, Schmid A, Biziyaremye F, Hodge S, Patient N, Wilson K. “Implementation of a Pediatric Early Warning Score as a Tool for Improving Communication and Nursing Empowerment in Rural District Hospital in Rwanda” Global Health: Science & Practice. Oct 2020 DOI: 9745/GHSP-D-20-00075
  43. Chua I, Petrides AK, Schiff GD, Ransohoff JR, Kantartjis M, Streid J, Demetriou CA, Melanson SEF. Provider Misinterpretation, Documentation, and Follow-Up of Definitive Urine Drug Testing Results. J Gen Intern Med. 2020 Jan;35(1):283-290. DOI: 10.1007/s11606-019-05514-5
  44. Chua IS, Ransohoff JR, Ehrlich O, Katznelson E, Virk ZM, Demetriou CA, Petrides AK, Orav EJ, Schiff GD, Melanson SEF. Laboratory-Generated Urine Toxicology Interpretations: A Mixed Methods Study. Pain Physician. 2021 Mar;24(2):E191-E201
Health Information Technology and Informatics

The Division, under the leadership of David Bates, is internationally known for its research in HIT and informatics, including some of the earliest and best-known studies of the impact of computerized provider order entry (CPOE) and computer decision-support systems (CDSS) on patient care. Current work is wide-ranging and includes the design and implementation of HIT tools built within and around vendor electronic health-record systems, natural language processing, machine learning, the integration of genomic, clinical, and administrative data, and artificial intelligence (in conjunction with IBM Watson Health). The Division also has deep and broad expertise in usability evaluation of HIT tools.

Faculty:

  • Heather Baer
  • David Bates
  • Isaac Chua
  • Anuj Dalal
  • Patricia Dykes
  • Shira Fischer
  • Will Gordon
  • David Levine
  • Jorge Rodriguez
  • Ronen Rozenblum
  • Lipika Samal
  • Hojjat Salmasian
  • Gordon Schiff
  • Jeffrey Schnipper
  • Wenyu Song
  • Emani Srinivas
  • Li Zhou

References:

  1. Bates DW, Gawande Improving safety with information technology. N Engl J Med 2003;348:2526-34. PMID: 12815139 DOI: 10.1056/NEJMsa020847
  2. Bates DW, Bitton A. The future of health information technology in the patient centered medical home. Health Aff (Millwood). 2010 Apr; 29(4):614-21. DOI: 1377/hlthaff.2010.0007
  3. Dykes PC, Samal L, Donahue M, Greenberg JO, Hurley AC, Hasan O, O'Malley TA, Venkatesh AK, Volk LA, Bates DW. A patient-centered longitudinal care plan: vision versus reality J Am Med Inform Assoc. 2014 Nov-Dec;21(6):1082-90. doi: 1136/amiajnl-2013-002454
  4. Adelman JS, Applebaum JR, Southern WN, Schechter CB, Aschner JL, Berger MA, Racine AD, Chacko B, Dadlez NM, Goffman D, Babineau J, Green RA, Vawdrey DK, Manzano W, Barchi D, Albanese C, Bates DW, Salmasian H. Risk of Wrong-Patient Orders Among Multiple vs Singleton Births in the Neonatal Intensive Care Units of 2 Integrated Health Care Systems. JAMA Pediatr. 2019 Aug 26;173(10):979-985. PMCID: PMC6714004 DOI:1001/jamapediatrics.2019.2733
  5. Blackley SV, MacPhaul E, Martin B, Song W, Suzuki J, Zhou L. Using Natural Language Processing and Machine Learning to Identify Hospitalized Patients with Opioid Use Disorder. AMIA Annu Symp Proc. 2020.
  6. Chua IS, Gaziel-Yablowitz M, Korach ZT, et al. Artificial intelligence in oncology: Path to implementation. Cancer Med. 2021;10(12):4138-4149. DOI: 1002/cam4.3935
  7. Dalal AK, Roy CL, Poon EG, Williams DH, Nolido N, Yoon C, Budris J, Gandhi T, Bates DW, Schnipper JL. Impact of an automated email notification system for results of tests pending at discharge: a cluster-randomized controlled trial. J Am Med Inform Assoc. May-Jun 2014;21(3):473-480. DOI: 1136/amiajnl-2013-002030
  8. Dalal AK, Dykes PC, Collins S, Lehmann LS, Ohashi K, et al. A web-based, patient-centered toolkit to engage patients and caregivers in the acute care setting: a preliminary evaluation. Journal of the American Medical Informatics Association: J Am Med Inform Assoc. 2015; PubMed PMID: 26239859 DOI: 1093/jamia/ocv093
  9. Dalal AK, Dykes P, Samal L, McNally K, Mlaver E, Yoon CS, Lipsitz SR, Bates DW. Potential of an Electronic Health Record-Integrated Patient Portal for Improving Care Plan Concordance during Acute Care. Appl Clin Inform. 2019;10(3):358‐ DOI: 10.1055/s-0039-1688831
  10. Dalal AK, Fuller T, Garabedian P, Ergai A, Balint C, Bates DW, Benneyan J. Systems engineering and human factors support of a system of novel EHR-integrated tools to prevent harm in the hospital. J Am Med Inform Assoc. 2019 Mar 22. pii:ocz002. DOI: 10.1093/jamia/ocz002. [Epub ahead of print] PubMed PMID: 30903660. DOI: 1093/jamia/ocz002
  11. Dykes PC, Rozenblum R, Dalal A, Massaro A, Chang F, Clements M, Collins S, Donze J, Fagan M, Gazarian P, Hanna J, Lehmann L, Leone K, Lipsitz S, McNally K, Morrison C, Samal L, Mlaver E, Schnock K, Stade D, Williams D, Yoon C, Bates DW. Prospective Evaluation of a Multifaceted Intervention to Improve Outcomes in Intensive Care: The Promoting Respect and Ongoing Safety Through Patient Engagement Communication and Technology Study. Crit Care Med. 2017;45(8):e806‐e813 DOI: 1097/CCM.0000000000002449
  12. Emani S, Yamin CK, Peters E, Karson AS, Lipsitz SR, Wald JS, Williams DH, Bates DW. Patient perceptions of a personal health record: A test of the diffusion of innovation model. J Med Internet Res 2012;14(6):e150. DOI: 2196/jmir.2278
  13. Emani S, Peters E, Desai S, Karson AS, Lipsitz SR, LaRocca R, Stone J, Suric V, Wald J, Wheeler A, Williams DH, Bates DW. Perceptions of adopters versus non-adopters of a patient portal: An application of diffusion of innovation theory. J Innov Health Inform 2018;25(3):149-157. DOI:10.14236/jhi.v25i3.991
  14. Faherty LJ, Rose AJ, Chappel A, Taplin C, Martineau M, Fischer SH. (2020). Assessing and Expanding the Evidence Base for Project ECHO and ECHO-Like Models: Findings of a Technical Expert Panel. J Gen Intern Med. 35:899–902. PMCID: PMC7080945. DOI: 1007/s11606-019-05599-y
  15. Fischer SH, Rose AJ, McBain RK, Faherty LJ, Sousa J, Martineau M. (2019) Evaluation of Technology-Enabled Collaborative Learning and Capacity Building Models: Materials for Report to Congress. Santa Monica, CA: RAND Corporation. Available at: https://www.rand.org/pubs/research_reports/RR2934.html
  16. Fischer SH, Uscher-Pines L, Roth E, Breslau J. (2021). The Transition to Telehealth during the First Months of the COVID-19 Pandemic: Evidence from a National Sample of Patients. JGIM. 36:849-851 PMCID: PMC7787420. DOI: 1007/s11606-020-06358-0
  17. Gordon WJ, Fairhall A, Landman A. Threats to Information Security - Public Health Implications. N Engl J Med. 2017 Aug 24; 377(8):707-709.DOI: 1056/NEJMp1707212
  18. Gordon WJ, Bates DW, Fuchs D, Pappas J, Silacci S, Landman A. Comparing Characteristics of Patients Who Connect Their iPhones to an Electronic Health Records System Versus Patients Who Connect Without Personal Devices: Cohort Study. J Med Internet Res. 2019 Aug 22; 21(8):e14871. DOI: 2196/14871
  19. Gordon WJ, Wright A, Aiyagari R, Corbo L, Glynn RJ, Kadakia J, Kufahl J, Mazzone C, Noga J, Parkulo M, Sanford B, Scheib P, Landman AB. Assessment of Employee Susceptibility to Phishing Attacks at US Health Care Institutions. JAMA Netw Open. 2019 Mar 01; 2(3):e190393. DOI: 1001/jamanetworkopen.2019.0393
  20. Gordon WJ, Mandl KD. The 21st Century Cures Act: A Competitive Apps Market and the Risk of Innovation Blocking. J Med Internet Res. 2020 12 11; 22(12):e2482DOI: 2196/24824
  21. Levine DM, Lipsitz SR, Linder JA. Trends in Seniors’ Use of Digital Health Technology in the United States, 2011 – 2014. JAMA. 2016;316(5):538-40. DOI: 1001/jama.2016.9124
  22. Levine DM, Mehrotra, A. Assessment of Diagnosis and Triage in Validated Case Vignettes Among Non-physicians Before and After Internet Search. JAMA Netw Open. 2021 Mar 1;4(3).
  23. Navathe AS, Zhong F, Lei V, Chang F, Sordo Sanchez M, Navathe S, Topaz M, Rocha RA, Zhou L Hospital Readmission and Social Risk Factors Identified from Physician Notes. Health Serv Res. 2017 Mar 13. DOI: 10.1111/1475-6773.12670. PubMed PMID: 28295260
  24. Rodriguez JA, Davis RB, Percac-Lima S. Non-English Language Availability of Community Health Center Websites. Med Care. 2019 Jun;57 Suppl 6 Suppl 2:S121-S126. PubMed PMID: 31095050. DOI: 1097/MLR.0000000000001027
  25. Rodriguez JA, Clark CR, Bates DW. Digital Health Equity as a Necessity in the 21st Century Cures Act Era. JAMA. 2020 Jun 16;323(23):2381-2382. PubMed PMID: 32463421. DOI: 1001/jama.2020.7858
  26. Rodriguez JA, Fossa A, Mishuris R, Herrick B. Bridging the Language Gap in Patient Portals: An Evaluation of Google Translate. J Gen Intern Med. 2021 Feb;36(2):567-569. PubMed Central PMCID: PMC7878638. DOI: 1007/s11606-020-05719-z
  27. Rodriguez JA, Saadi A, Schwamm LH, Bates DW, Samal L. Disparities In Telehealth Use Among California Patients With Limited English Proficiency. Health Aff (Millwood). 2021 Mar;40(3):487-495. PubMed PMID: 33646862. DOI: 1377/hlthaff.2020.00823
  28. Salmasian H, Tran TH, Chase H, Friedman C. Medication-indication knowledge-bases: a review and critical appraisal. J Am Med Inform Assoc. 2015 Nov;22(6):1261-70. . PMCID: PMC5009909 DOI: 1093/jamia/ocv129
  29. Samal L, D'Amore JD, Bates DW, Wright A. Implementation of a Scalable, Web-based, Automated Clinical Decision Support Risk Prediction Tool for Chronic Kidney Disease Using C-CDA and Application Programming Interfaces. J Am Med Inform Assoc, 2017. 24(6): p. 1111-1115. DOI: 1093/jamia/ocx065
  30. Schnipper JL, Linder JA, Palchuk MB, Einbinder JS, Li Q, Postilnik A, Middleton B. “Smart Forms” in an Electronic Medical Record: Documentation-Based Clinical Decision Support to Improve Disease Management. J Am Med Inform Assoc. 2008;15(4):513-523. DOI: 1197/jamia.M2501
  31. Schnipper JL, Gandhi TK, Wald JS, Grant RW, Poon EG, Volk LA, Businger A, Williams DH, Siteman E, Buckel L, Middleton B. Effects of an online personal health record on medication accuracy and safety: a cluster-randomized trial. J Am Med Inform Assoc. 2012; 19(5):728-734. DOI: 1136/amiajnl-2011-000723
  32. Song W, Kossowsky J, Torous J, Chen CY, Huang H, Mukamal KJ, Berde CB, Bates DW, Wright A. Genome-wide association analysis of opioid use disorder: A novel approach using clinical data. Drug Alcohol Depend 2020, 217:108276. DOI: 1016/j.drugalcdep.2020.108276
  33. Song, W., Kang, M. J., Zhang, L., Jung, W., Song, J., Bates, D. W., & Dykes, P. C. (2021). Predicting pressure injury using nursing assessment phenotypes and machine learning methods. J Am Med Inform Assoc. DOI: 10.1093/jamia/ocaa336
  34. Syrowatka A, Pullman A, Kim W, Lipsitz SR, Sainlaire M, Song W, Thai T, Bates DW, Dykes PC (2020) Re-tooling an Existing Clinical Quality Measure for Chronic Opioid Use to an Electronic Clinical Quality Measure (eCQM) for Post-Operative Opioid Prescribing: Development and Testing of Draft Specifications. AMIA Annu Symp Proc 2020:1200-1209.
  35. Topaz M, Seger DL, Slight SP, Goss F, Lai K, Wickner PG, Blumenthal K, Dhopeshwarkar N, Chang F, Bates DW, Zhou L. Rising drug allergy alert overrides in electronic health records: an observational retrospective study of a decade of experience. J Am Med Inform Assoc. 2016 May;23(3):601-8. doi: 10.1093/jamia/ocv143. PMID: 26578227.
  36. Wang L, Sha L, Lakin JR, Bynum J, Bates DW, Hong P, Zhou L. Development and Validation of a Deep Learning Algorithm for Mortality Prediction in Selecting Patients with Dementia for Earlier Palliative Care Interventions. JAMA Netw Open. 2019;2(7):e196972. PMID: 31298717. DOI: 1001/jamanetworkopen.2019.6972
  37. Yamin, CK, Emani S, Wlliams DH, Lipsitz SR, Karson AS, Wald JS, Bates DW. The digital divide in adoption and use of a personal health record. Arch Intern Med 2011;171(6):568-74. DOI: 1001/archinternmed.2011.34
  38. Yang J, Wang L, Phaske NA, Wickner PG, Mancini CM, Blumenthal KG*, Zhou L*. Development and validation of a deep learning model for detection of allergic reactions using safety event reports across hospitals: 2004-2019. JAMA Netw Open. 2020;3(11):e2022836. PMID: 33196805. DOI: 1001/jamanetworkopen.2020.22836
  39. Zhou L, Maviglia SM, Mahoney LM, Chang F, Orav, EJ, Plasek J, Boulware LJ, Lou H, Bates DW, Rocha RA. Supratherapeutic Dosing of Acetaminophen among Hospitalized Patients. Arch Intern Med (now JAMA Intern Med). 2012;172(22):1721-8. PMID: 23401887. DOI: 1001/2013.jamainternmed.438
  40. Zhou L, Plasek JM, Mahoney LM, Karipineni N, Chang F, Yan X, Chang F, Dimaggio D, Goldman DS, Rocha RA. Using Medical Text Extraction, Reasoning and Mapping System (MTERMS) to Process Medication Information in Outpatient Clinical Notes. AMIA Annu Symp Proc 2011:1639-48.
  41. Chua IS, Ritchie CS, Bates DW. Enhancing serious illness communication using artificial intelligence. NPJ Digit Med.2022 Jan 27;5(1):14. DOI: 10.1038/s41746-022-00556-2
Health Care Disparities and Equity

Several researchers in the Division have spent their careers studying and trying to reduce disparities in health care delivery and outcomes by race, ethnicity, sex, gender, primary language, nationality, and socioeconomic status. Investigations range from large epidemiologic studies to community-based research.

Faculty:

  • Alev Atalay
  • Asaf Bitton
  • Ann Celi
  • Cheryl Clark
  • Ishani Ganguli
  • Nancy Keating
  • David Levine
  • Jorge Rodriguez
  • Valerie Stone
  • Bram Wispelwey

References:

  1. Bitton A, Ratcliffe HL, Veillard JH, Kress DH, Barkley S, Kimball M, Secci F, Wong E, Basu L, Taylor C, Bayona J, Wang H, Lagomarsino G, Hirschhorn LR. Primary Health Care as a Foundation for Strengthening Health Systems in Low- and Middle-Income Countries. J Gen Intern Med. 2017; 32(5):566-571. DOI: 1007/s11606-016-3898-5
  2. Celi AC, Rich-Edwards JW, Richardson MK, Kleinman KP, Gillman MW. Immigration, race/ethnicity, and social and economic factors as predictors of breastfeeding initiation. Arch Pediatr Adolesc Med. 2005;159(3):255-260. DOI: 1001/archpedi.159.3.255
  3. Clark CR, Baril N, Kunicki M, Johnson N, Soukup J, Ferguson K, Lipsitz S, Bigby J. Addressing social determinants of health to improve access to early breast cancer detection: results of the Boston REACH 2010 Breast and Cervical Cancer Coalition Women's Health Demonstration Project. J Women's Health (Larchmt). 2009 May;18(5):677-90. PubMed PMID: 19445616. DOI:1089/jwh.2008.0972
  4. Clark CR, Soukup J, Govindarajulu U, Riden HE, Tovar DA, Johnson PA. Lack of access due to costs remains a problem for some in Massachusetts despite the state's health reforms. Health Aff (Millwood). 2011 Feb;30(2):247-55. PubMed PMID: 21289346.
  5. Clark CR, Ridker PM, Ommerborn MJ, Huisingh CE, Coull B, Buring JE, Berkman LF. Cardiovascular inflammation in healthy women: multilevel associations with state-level prosperity, productivity and income inequality. BMC Public Health. 2012 Mar 20;12:211. PubMed PMID: 22433166; PubMed Central PMCID: PMC3323890.
  6. Clark CR, Ommerborn MJ, A Coull B, Pham DQ, Haas JS. Income inequities and Medicaid expansion are related to racial and ethnic disparities in delayed or forgone care due to cost. Med Care 2016 Mar 11 [Epub ahead of print]. DOI: 1097/MLR.0000000000000525
  7. Clark CR, Ommerborn MJ, Moran K, Brooks K, Haas J, Bates DW, Wright A. Predicting Self-Rated Health Across the Life Course: Health Equity Insights from Machine Learning Models. J Gen Intern Med. 2021 May;36(5):1181-1188. doi: 10.1007/s11606-020-06438-1. Epub 2021 Feb 23. PMID: 33620624; PMCID: PMC8131482.
  8. Cleveland Manchanda EC, Marsh RH, Osuagwu C, Decopain Michel J, Dugas JN, Wilson M, Morse M, Lewis E, Wispelwey BP. Heart Failure Admission Service Triage (H-FAST) Study: Racialized Differences in Perceived Patient Self-Advocacy as a Driver of Admission Inequities. Cureus 2021;13(2):e13381. DOI: 7759/cureus.13381
  9. Eberly LA, Richterman A, Beckett AG, Wispelwey B, Marsh RH, Cleveland Manchanda EC, Chang CY, Glynn RJ, Brooks KC, Boxer R, Kakoza R, Goldsmith J, Loscalzo J, Morse M, Lewis EF. Identification of Racial Inequities in Access to Specialized Inpatient Heart Failure Care at an Academic Medical Center. Circ Heart Fail 2019 Nov;12(11):e006214. DOI: 1161/circheartfailure.119.006214
  10. Ganguli I, Sheridan B, Gray J, Chernew M, Rosenthal M, Neprash Physician Work Hours and the Gender Pay Gap: Evidence from Primary Care. N Engl J Med. 2020;383(14):1349-1357. DOI: 10.1056/NEJMsa2013804
  11. Keating NL, Kouri EM, He Y, Freedman RA, Volya R, Zaslavsky AM. Location isn't everything: proximity, hospital characteristics, choice of hospital and disparities for breast cancer surgery patients. Health Serv Res. 2016; 51(4):1561-83. PMCID: PMC4946041. DOI: 1111/1475-6773.12443
  12. Keating NL, Huskamp HA, Kouri EM, Schrag D, Hornbrook MC, Haggstrom DA, Landrum MB. Understanding factors contributing to geographic variation in end-of-life expenditures. Health Aff 2018. 37(7):1136-1143. PMCID: PMC6059805
  13. Landon BE, Onnela JP, Meneades, L, O’Malley JA, Keating NL. Assessment of racial disparities in primary care physician subspecialty referrals. JAMA Netw Open. 2021;4(1):e2029238. DOI: 1001/jamanetworkopen.2020.29238
  14. Levine DM, Linder JA, Landon BE. Characteristics and Disparities among Primary Care Practices in the United States. J Gen Intern Med. 2018;33(4):481-486. DOI: 1007/s11606-017-4239-z
  15. Moran KE, Ommerborn MJ, Blackshear CT, Sims M, Clark CR. Financial Stress and Risk of Coronary Heart Disease in the Jackson Heart Study. American journal of preventive medicine. 2019 Feb 1;56(2):224-31. DOI: 1016/j.amepre.2018.09.022
  16. Okaka Y, AbdelHameid D, Olson RM, Kwarteng-Siaw M, Spanos N, Stone VE. Rallying Against Racism: Hospitals Join the Fight for Racial Justice. J Gen Intern Med 2020; Oct 20. PMID: 33083920.
  17. Park ER, Betancourt JR, Miller E, Nathan M, MacDonald E, Ananeh-Firempong O, Stone VE. Internal Medicine Residents’ Reports of their Cross-Cultural Training Needs. J Gen Intern Med 2006; 21(5): 476-480. doi: 1111/j.1525-1497.2006.00430.x
  18. Pham do Q, Ommerborn MJ, Hickson DA, Taylor HA, Clark CR. Neighborhood safety and adipose tissue distribution in African Americans: the Jackson Heart Study. PLoS One. 2014;9(8):e105251. PubMed PMID: 25166297; PubMed Central PMCID: PMC4148311.
  19. Riley WJ, Stone VE. Quest for Diversity and Inclusion for our Members and the Patients We Serve. In: Tooker J, Dale DC, (Eds.) To Serve our Patients and Profession: A Centennial History of the American College of Physicians (1915-2015). Philadelphia; ACP Press, 2015.
  20. Samal L, Lipsitz SR, Hicks LS. Impact of electronic health records on racial and ethnic disparities in blood pressure control at US primary care visits. Arch Int Med. 2012 Jan 9: 172(1):75-6 DOI: 1001/archinternmed.2011.604
  21. Solomon SR, Atalay AJ, Osman NY. Diversity Is Not Enough: Advancing a Framework for Antiracism in Medical Education. Acad Med. 2021;96(11):1513-1517. DOI: 1097/ACM.0000000000004251
  22. Stone VE. White Coats for Black Lives. The Time has Come for Action. Ann Intern Med 2020 Jun 18. PMID: 3255181 DOI: 7326/M20-4280
  23. Wispelwey BP. Rethinking responsibility in global health: a case from Ethiopia. Social Medicine 2016 May; 9(3):129-31.
Preventive Medicine and Chronic Disease Management

Researchers in the Division study and design interventions to improve preventive care and chronic disease management, using a variety of approaches such as patient-facing digital tools, intensive care management, and improving primary care-specialty care interactions. Content areas include obesity, chronic kidney disease, diabetes, heart failure, asthma, cancer survivors, and chronic fatigue syndrome.

Faculty:

  • Heather Baer
  • Ebrahim Barkoudah
  • Ann Celi
  • Srinivas Emani
  • Dinah Foer
  • Ishani Ganguli
  • Nancy Keating
  • Anthony Komaroff
  • Larissa Nekhlyudov
  • Lipika Samal

References:

  1. Baer HJ, Brawarsky P, Murray MF, Haas JS. Familial risk of cancer and knowledge and use of genetic testing. J Gen Intern Med 2010; 25: 717-24. PMCID: PMC2881969 DOI: 1007/s11606-010-1334-9
  2. Baer HJ, Tworoger SS, Hankinson SE, Willett Body fatness at young ages and risk of breast cancer throughout life. Am J Epidemiol 2010; 171:1183-94. PMCID: PMC2888954 doi: 10.1093/aje/kwq045
  3. Baer HJ, Karson AS, Soukup JR, Williams DH, Bates DW. Documentation and diagnosis of overweight and obesity in electronic health records of adult primary care patients. JAMA Intern Med 2013;173(17):1648-52. DOI: 1001/jamainternmed.2013.7815
  4. Baer HJ, Schneider LI, Colditz GA, Dart H, Andry A, Williams DH, Orav EJ, Haas JS, Getty G, Whittemore E, Bates DW. Use of a web-based risk appraisal tool for assessing family history and lifestyle factors in primary care. J Gen Intern Med 2013;28(6):817-24 DOI: 1007/s11606-013-2338-z
  5. Baer HJ, Rozenblum R, De La Cruz BA, Orav EJ, Wien M, Nolido NV, Metzler K, McManus KD, Halperin F., Aronne LJ, Minero G, Block JP, Bates DW. Effect of an online weight management program integrated with population health management on weight change: a randomized clinical JAMA 2020; 324: 1737-1746. DOI: 10.1001/jama.2020.18977
  6. Barkoudah E,Piazza G, Hecht TEH, Grant P, Deitelzweig S, Fang MC, Fanikos J, Kao CK, Barnes GD, Chen T, Ramishvili T, Schnipper JL, Goldstein JN, Ruff CT, Kaatz S, Schwartz A, Connors JM, Goldhaber SZ. Extended Venous Thromboembolism Prophylaxis in Medically Ill Patients: An NATF Anticoagulation Action Initiative. Am J Med. 2020;133 Suppl 1:1-27 DOI: 1016/j.amjmed.2019.12.001
  7. Bates DW, Schmitt W, Buchwald D, Ware NC, Lee J, Thoyer E, Kornish RJ, Komaroff AL. Prevalence of fatigue and chronic fatigue syndrome in a primary care practice. Arch Intern Med 1993;153:2759-65. doi:10.1001/archinte.1993.00410240067007
  8. Celi AC, Rich-Edwards JW, Seely EW, Frolkis J, Johnson PA, Wilkins-Haug L. Preeclampsia and Cardiovascular Disease, A Call to Action. J Clin Outcomes Management. 2013 March; 20(3): 123-126. doi: 2147/IBPC.S138383
  9. Chan RJ, Oluwaseyifunmi AA, Yates PM, Emery J, Jefford M, Koczwara B, Hart NH, Crichton M, Nekhlyudov L. Outcomes of cancer survivorship education and training for primary care providers: a systematic review. J Cancer Surv 2021 Mar 24:1–24. doi: 10.1007/s11764-021-01018-6. Epub ahead of print. PMID: 33763806; PMCID: PMC7990618.
  10. Desai AS, Vaduganathan M, Cleland JG, Claggett BL, Barkoudah E, Finn P, McCausland FR, Yilmaz MB, Lefkowitz M, Shi V, Pfeffer MA, McMurray JJV, Solomon SD. Mode of Death in Patients With Heart Failure and Preserved Ejection Fraction: Insights From PARAGON-HF Trial. Circ Heart Fail. 2021 DOI: 1161/CIRCHEARTFAILURE.121.008597
  11. Duffy FH, McAnulty GB, McCreary MC, Cuchural GJ, Komaroff AL. EEG spectral coherence data distinguish chronic fatigue syndrome patients from healthy controls and depressed patients—A case control study. BMC Neurology 2011;11:82. doi: 1186/1471-2377-11-82
  12. Foer D*, Beeler PE*, Cui J, Karlson EW, Bates DW, Cahill KN. Asthma exacerbations in type 2 diabetics with asthma on glucagon-like peptide-1 receptor agonists. Am J Respir Crit Care Med. 2021 Apr; 203(7):831-40. PMID: 33052715. *equal contribution (co-first authors) DOI: 1164/rccm.202004-0993OC
  13. Fukuda K, Straus SE, Hickie I, Sharpe MC, Dobbins JG, Komaroff AL, International Chronic Fatigue Syndrome Study Group. The chronic fatigue syndrome: a comprehensive approach to its definition and study. Ann Intern Med 1994;121:953-959. DOI: 7326/0003-4819-121-12-199412150-00009
  14. Ganguli I and Thakore N. Cost Conversations About Atrial Fibrillation Care—Who Is Talking the Talk? JAMA Net. Open. 2021;4(7):e2116670 DOI: 1001/jamanetworkopen.2021.16670
  15. Keating NL, Huskamp HA, Schrag D, McWilliams JM, McNeil BJ, Landon BE, Chernew ME, Normand SLT. Diffusion of bevacizumab across oncology practices: an observational study. Med Care. 2018; 56(1):69-77. PMCID: PMC5726588. DOI: 1097/MLR.0000000000000840
  16. Komaroff AL. Myalgic Encephalomyelitis/Chronic Fatigue Syndrome: A real illness. Ann Intern Med 2015;162:871-872. DOI: 7326/M15-0647
  17. Nekhlyudov L, O’Malley D, Hudson SV. Integrating primary care providers in the care of cancer survivors: gaps in evidence and future opportunities. Lancet Oncol. 2017 Jan;18(1):e30-8. PMID: 28049575. DOI: 1016/S1470-2045(16)30570-8.
  18. Nekhlyudov L, Walker R, Ziebell R, Nutt S, Chubak J. Cancer survivors’ experiences with insurance, finances and employment: results from a multiple study. J Cancer Surviv. 2016 Dec; 10(6):1104-11. PMID: 27277896. DOI: 1007/s11764-016-0554-3
  19. Nekhlyudov L, Ganz PA, Arora NK, Rowland JH. Going Beyond Being Lost in Transition: A Decade of Progress in Cancer Survivorship. J Clin Oncol. 2017 Jun 20;35(18):1978-1981. doi: 10.1200/JCO.2016.72.1373. Epub 2017 Apr 24. PubMed PMID: 28437163; PubMed Central PMCID: PMC5676953.
  20. Nekhlyudov L, Mollica MA, Jacobsen PB, Mayer DK, Shulman LN, Geiger AM. Developing a Quality of Cancer Survivorship Care Framework: Implications for Clinical Care, Research and Policy. J Natl Cancer Inst. 2019 Nov 1;111(11):1120-1130. doi: 1093/jnci/djz089
  21. Rozenblum R, De La Cruz BA, Nolido NV, Adighibe I, Secinaro K, McManus KD, Halperin F, Block JP, Bates DW, Baer HJ. Primary care patients’ and providers’ perspectives about an online weight management program: a qualitative J Gen Intern Med 2019; 34: 1503-1521. DOI: 10.1007/s11606-019-05022-6
  22. Samal L, Linder JA, Bates DW, Wright A. Electronic Problem List Documentation of Chronic Kidney Disease and Quality of Care. BMC Nephrol. 2014 May 4; 15:70. DOI: 1186/1471-2369-15-70
  23. Samal L, Wright A, Waikar SS, Linder JA. Nephrology Co-Management Versus Primary Care Solo Management for Early Chronic Kidney Disease: A Retrospective Cross-sectional Analysis. BMC Nephrol 2015. BMC Nephrol. 2015; 16:162. DOI: 1186/s12882-015-0154-x
  24. Vaduganathan M, Cunningham JW, Claggett BL, Causland FM, Barkoudah E, Finn P, Zannad F, Pfeffer MA, Rizkala AR, Sabarwal S, McMurray JJV, Solomon S, Desai AS. Worsening Heart Failure Episodes Outside a Hospital Setting in Heart Failure with Preserved Ejection Fraction: The PARAGON-HF Trial. JACC Heart Fail. 2021:S2213-1779(21)00063-9. DOI: 1016/j.jchf.2021.01.014
Systems Engineering and Implementation Science

In conjunction with Northeastern University's Healthcare Systems Engineering Institute (HSyE), the Division is conducting a number of studies that integrate systems engineering approaches to understand and improve the safety of healthcare delivery. These efforts include two Patient Safety Learning Lab (PSLL) grants from the Agency for Healthcare Research and Quality (AHRQ) regarding Quality and Safety Dashboards and Diagnostic Errors in the inpatient setting. The Division also has expertise in applying implementation science principles, such as the Consolidated Framework for Implementation Research, to plan, understand, and optimize dissemination, implementation, and sustainability of programs to improve healthcare quality and safety.

Faculty:

  • David Bates
  • Evan Benjamin
  • Anuj Dalal
  • Shira Fischer
  • David Levine
  • Jeffrey Schnipper

References:

  1. Bersani, K., Fuller, T. E., Garabedian, P., Espares, J., Mlaver, E., Businger, A., Chang, F., Boxer, R. B., Schnock, K. O., Rozenblum, R., Dykes, P. C., Dalal, A. K., Benneyan, J. C., Lehmann, L. S., Gershanik, E. F., Bates, D. W., & Schnipper, J. L. (2020). Use, Perceived Usability, and Barriers to Implementation of a Patient Safety Dashboard Integrated within a Vendor EHR. Applied clinical informatics, 11(1), 34–45. https://doi.org/10.1055/s-0039-3402756
  2. Businger, A. C., Fuller, T. E., Schnipper, J. L., Rossetti, S. C., Schnock, K. O., Rozenblum, R., Dalal, A. K., Benneyan, J., Bates, D. W., & Dykes, P. C. (2020). Lessons learned implementing a complex and innovative patient safety learning laboratory project in a large academic medical center. Journal of the American Medical Informatics Association : JAMIA, 27(2), 301–307. https://doi.org/10.1093/jamia/ocz193
  3. Dalal AK, Fuller T, Garabedian P, et al. Systems engineering and human factors support of a system of novel EHR-integrated tools to prevent harm in the hospital. J Am Med Inform Assoc. 2019;26(6):553-560. DOI: 1093/jamia/ocz002
  4. Engelman DT, Boyle EM Jr., Benjamin EM. Addressing the imperative to evolve the hospital new product value analysis process. J Thorac Cardiovasc Surg. 2018;155(2):682-685. DOI: 1016/j.jtcvs.2017.10.057
  5. Fischer SH, Armstrong CK, Duffy EL, Hussey PS. (2017) A mixed-methods evaluation of an Integrated Medication Management program and implications for implementation. Research in Social and Administrative Pharmacy 13(5), 959-968. DOI: 1016/j.sapharm.2017.06.003
  6. Fuller, T. E., Garabedian, P. M., Lemonias, D. P., Joyce, E., Schnipper, J. L., Harry, E. M., Bates, D. W., Dalal, A. K., & Benneyan, J. C. (2020). Assessing the cognitive and work load of an inpatient safety dashboard in the context of opioid management. Applied ergonomics, 85, 103047. https://doi.org/10.1016/j.apergo.2020.103047
  7. Gallagher TH, Boothman RC, Schweitzer L, Benjamin EM. Making communication and resolution programmes mission critical in healthcare organisations. BMJ Quality & Safety. Published Online First: 2020 May 5. doi: 10.1136/bmjqs-2020-010855
  8. Gesell, S. B., Prvu Bettger, J., Lawrence, R. H., Li, J., Hoffman, J., Lutz, B. J., Grudzen, C., Johnson, A. M., Krishnan, J. A., Hsu, L. L., Zwart, D., Williams, M. V., & Schnipper, J. L. (2021). Implementation of Complex Interventions: Lessons Learned From the Patient-Centered Outcomes Research Institute Transitional Care Portfolio. Medical care, 59(Suppl 4), S344–S354. https://doi.org/10.1097/MLR.0000000000001591
  9. Zwart DLM, Schnipper JL, Vermond D, Bates DW. How Do Care Transitions Work?: Unraveling the Working Mechanisms of Care Transition Interventions. Med Care. 2021;59(Suppl 4):S387-S397. DOI: 1097/MLR.0000000000001581
Care Transitions and Alternative Sites of Care

The Division has been studying care transitions for years, including transitions out of the hospital (e.g., discharge, inter-hospital transfers), transitions within the hospital (e.g., handoffs in care among residents), and outpatient transitions (e.g., obstetrics to primary care, oncology to primary care). Interventions designed to improve transitions have included multifaceted efforts involving health information technology, more effective use of pharmacists, patient-caregiver education, improved communication among providers, and other care redesign efforts. More recently, the Division has become an international leader in implementing and rigorously studying home hospital programs in order to provide the right care to the right patient at the right time.

Faculty:

  • Bonnie Blanchfield
  • Ann Celi
  • Dinah Foer
  • David Levine
  • Stephanie Mueller
  • Larissa Nekhlyudov
  • Jeffrey Schnipper

References:

  1. Auerbach AD, Kripalani S, Vasilevskis EE, Sehgal N, Lindenauer PK, Metlay JP, Fletcher G, Ruhnke GW, Flanders SA, Kim C, Williams MV, Thomas L, Giang V, Herzig SJ, Patel K, Boscardin WJ, Robinson EJ, Schnipper JL. Preventability and causes of readmissions in a national cohort of general medicine patients. JAMA Intern Med. 2016; 176(4): 484-493. PMID: 26954564. DOI: 1001/jamainternmed.2015.7863
  2. Bell SP, Schnipper JL, Goggins K, et al. Effect of Pharmacist Counseling Intervention on Health Care Utilization Following Hospital Discharge: A Randomized Control Trial. J Gen Intern Med. 2016;31(5):470-477. DOI: 1007/s11606-016-3596-3
  3. Blanchfield BB, Meyer GS,Thakkar AB, Howell M, Meyer CJ. Lessons Learned from Pioneer ACOs: The CFO Perspective For Successful Volume to Value Transition. HFMA, December 2020.
  4. Blanchfield BB, Jubelt L, Meyer GS. Home-based care is ripe for innovation and implementation post COVID-19. HFMA October 2021.
  5. Celi AC, Seely, EW, Wang, P, Thomas AM, Wilkins-Haug, LE Caring for Women After Hypertensive Pregnancies and Beyond: Implementation and Integration of a Postpartum Transition Clinic. Maternal Child Health Journal 2019 July 23: 1459-1466.
  6. Donze J, Aujesky D, Williams D, Schnipper JL. Potentially avoidable 30-day hospital readmissions in medical patients: derivation and validation of a prediction model. JAMA Intern Med. Apr 22 2013;173(8):632-638. DOI: 1001/jamainternmed.2013.3023
  7. Donze J, Aujesky D, Williams M, Fletcher G, Robinson E, Metlay J, Wallington T, Zimlichman E, Auerbach A, Schnipper JL. International validation of the “HOSPITAL” score to predict 30-day avoidable readmissions. JAMA Int Med. 2016;176(4):496-502. DOI: 1001/jamainternmed.2015.8462
  8. Kripalani S, Roumie CL, Dalal AK, Cawthon C, Businger A, Eden S, Shintani A, Cunningham Sponsler K, Harris J, Theobald C, Huang RL, Scheurer D, Hunt S, Jacobson TA, Rask KJ, Vaccarino V, Gandhi TK, Bates DW, Williams MV, Schnipper JL. Effect of a pharmacist intervention on clinically important medication errors after hospital discharge: a randomized controlled trial. Ann Intern Med. 2012;157:1-10. DOI: 7326/0003-4819-157-1-201207030-00003
  9. Levine DM, Ouchi K, Blanchfield B, Saenz A, Burke K, Paz M, Diamond K, Pu CT, Schnipper JL. Hospital-Level Care at Home for Acutely Ill Adults: A Randomized Controlled Trial. Ann Intern Med. 2020. 21;172(2):77-85. https://doi.org/10.7326/M19-0600
  10. Levine DM, Paz M, Burke K, Schnipper JL. Predictors and Reasons Why Patients Decline to Participate in Home Hospital: a Mixed Methods Analysis of a Randomized Controlled Trial. J Gen Intern Med. 2021 May 5. [Epub ahead of print]. DOI: 1007/s11606-021-06833-2
  11. Mueller SK, Donze J, Schnipper JL. Intern workload and discontinuity of care on 30-day readmission. Am J Med. Jan 2013;126(1):81-88. DOI:1016/j.amjmed.2012.09.003
  12. Mueller SK, Zheng J, Orav EJ, Schnipper JL. Rates, Predictors and Variability of Interhospital Transfers: A National Evaluation. J Hosp Med. 2017;12(6):435-442. DOI: 12788/jhm.2747
  13. Mueller SK, Shannon E, Dalal A, Schnipper JL, Dykes P. Patient and Physician Experience with Interhospital Transfer: A Qualitative Study. J Patient Saf. 2018. DOI: 1097/PTS.0000000000000501
  14. Mueller SK, Zheng J, Orav EJ, Schnipper JL. Inter-Hospital Transfer and Patient Outcomes: A Retrospective Cohort Study. BMJ Qual Saf. 2018.
  15. Mueller SK, Fiskio J, Schnipper JL. Interhospital Transfer: Transfer Processes and Patient Outcomes. J Hosp Med. 2019;14:E1-E6. DOI: 12788/jhm.3192
  16. Nekhlyudov L, Ganz PA, Arora NK, Rowland JH. Going Beyond Being Lost in Transition: A Decade of Progress in Cancer Survivorship. J Clin Oncol. 2017 Jun 20;35(18):1978-1981. doi: 10.1200/JCO.2016.72.1373. Epub 2017 Apr 24. PubMed PMID: 28437163; PubMed Central PMCID: PMC5676953.
  17. Ornstein K, Smith KL, Foer DH, Lopez-Cantor MT, Soriano T. To the hospital and back home again: a nurse practitioner-based transitional care program for hospitalized homebound people. J Am Geriatr Soc. 2011 Mar;59(3):544-51. PMID: 21391944. DOI: 1111/j.1532-5415.2010.03308.x
  18. Pevnick JM, Anderson LJ, Chirumamilla S, Luong DD, Noh LE, Palmer KA, Amer K, Shane R, Nuckols TK, Lesser R, Schnipper JL and the PHARM-DC group. Tools and Tactics for Post-Discharge Medication Management Interventions. Am J Health-System Pharm. 2021;78(7):619-632. DOI: 1093/ajhp/zxab010
  19. Pian J, Cannon B, Schnipper JL, Levine DM. Burnout among staff in a home hospital pilot. J Clin Med Res. 2019; 11(7): 484-488. PMID: 31236166. DOI: 14740/jocmr3842
  20. Schnipper JL, Kirwin JL, Cotugno MC, Wahlstrom SA, Brown BA, Tarvin E, Kachalia A, Horng M, Roy CL, McKean SC, Bates DW. Role of pharmacist counseling in preventing adverse drug events after hospitalization. Arch Intern Med. 2006;166(5):565-71. DOI: 10.1001/archinte.166.5.565
Medical Education Research

In conjunction with the Department of Medicine's Clinical Education Research Scholar (CERS) program, the Division conducts research to improve education of trainees and faculty in a variety of disciplines and content areas, including procedural competence (e.g., colonoscopy), geriatrics, cancer survivorship, virtual teaching, growth mindset, and others.

Faculty:

  • Alev Atalay
  • Nora Osman
  • Subha Ramani
  • Valerie Stone

References:

  1. Atalay AJ, Ard K, Bethea E, Christopher KB, Yialamas MA. Residents Take the Lead: A Modern Collaborative Approach to Research During Residency. Adv Med Educ Pract. 2020;11:121-129. DOI: 2147/AMEP.S238221
  2. Atalay AJ, Osman NY, Krupat E, Alexander EK. Building Longitudinal Relationships Into a Traditional Block Clerkship Model: A Mixed-Methods Study. Acad Med. DOI: 10.1097/ACM.0000000000003810
  3. Blumenthal DM, Bernard K, Fraser TN, Bohen J, Zeidman, Stone VE. Implementing a pilot leadership course for internal medicine residents: design considerations, participant impressions and lessons learned. BMC Medical Education 2014; 14:1-11. https://doi.org/10.1186/s12909-014-0257-2
  4. Nemeth A, Chisty A, Spagnoletti CL, Stankiewicz CA, Burant C, Ramani S. Exploring Mentoring Experiences, Perceptions, and Needs of General Internal Medicine Clinician Educators Navigating Academia: a Mixed-Methods Study. J Gen Intern Med. 2020 Nov 2. doi: 10.1007/s11606-020-06310-2. Epub ahead of print. PMID: 33140271. DOI: 1007/s11606-020-06310-2
  5. Ramani S. Twelve tips to excellent physical exam teaching. Medical Teacher 2008; 30: 851-6. DOI:1080/01421590802206747
  6. Ramani S, Orlander JD. Human Dimensions in Bedside Teaching: Focus group discussions of Teachers and Learners. Teaching and Learning in Medicine 2013, 25(4), 312–18. DOI: 1080/10401334.2013.827979
  7. Ramani S, Mann K, Taylor D, Thampy H. Residents as teachers: Near peer learning in clinical work settings. Teaching and learning series. Medical Teacher. 2016; 38 (7): 642-55. DOI: 3109/0142159X.2016.1147540
  8. Ramani S, Post SE, Könings K, Mann K, Katz JT, van der Vleuten CPM. “It’s just not the culture”: A qualitative study exploring residents’ perceptions of the impact of institutional culture on feedback. Teaching and Learning in Medicine 2017; 29 (2): 153-61. DOI: 1080/10401334.2016.1244014
  9. Ramani S, Könings K, Mann K, van der Vleuten CPM. About Politeness, Face and Feedback: Exploring perceptions of residents and faculty regarding institutional cultural factors that influence feedback. Acad Med 2018; 93:1348–1358. DOI: 1097/ACM.0000000000002193
  10. Ramani S, McKimm J, Thampy H, O’Sullivan PS, Roger GD, Turner TL, Chisolm MS, Kusurkar RA, Hays R, Fornari A, Kachur EK, Wilson KW, Filipe HP, Schumacher DJ. From clinical educators to educational scholars and leaders: Strategies for developing and advancing a career in health professions education. The Clinical Teacher 2020; 17 (5): 477-482. https://doi.org/10.1111/tct.13144
  11. Thampy H, Willert E, Ramani S. Assessing Clinical Reasoning: Targeting the Higher Levels of the Pyramid. J Gen Intern Med. 2019 Aug;34(8):1631-1636. DOI: 1007/s11606-019-04953-4
  12. Bright CM, Duefield CA, Stone VE. Perceived Barriers and Biases in the Medical Education Experience by Gender and Race. J. Nat Med Assoc 1998; 90: 681-88. PMID: 9828583
  13. Park ER, Betancourt JR, Miller E, Nathan M, MacDonald E, Ananeh-Firempong O, Stone VE. Internal Medicine Residents' Reports of their Cross-Cultural Training Needs. J Gen Intern Med 2006; 21(5): 476-480. DOI: 10.1111/j.1525-1497.2006.00430.x
  14. Smith WR, Betancourt JR, Wynia MK, Bussey-Jones J, Stone VE, et al. Recommendations for Teaching about Racial and Ethnic Disparities in Health and Health Care. Annals of Intern Med 2007; 147:654-665. DOI: 10.7326/0003-4819-147-9-200711060-00010
  15. Blumenthal DM, Bernard K, Fraser TN, Bohen J, Zeidman, Stone VE. Implementing a pilot leadership course for internal medicine residents: design considerations, participant impressions and lessons learned. BMC Medical Education 2014; 14:1-11. DOI: 10.1186/s12909-014-0257-2
  16. Rieselbach RE, Feldstein DA, Lee, PT, Nasca TJ, Rockey PH, Steinmann AF, Stone VE. Ambulatory Training for Primary Care General Internists: Innovation with the Affordable Care Act in Mind. Journal of Graduate Medical Education 2014; 6(2):395-8. DOI: 10.4300/JGME-D-14-00119.1
  17. Palamara K, Kauffman C, Stone VE, Bazari H, Donelan K. Promoting success: A professional development coaching program for interns in medicine. J of Graduate Med Ed 2015; 7(4): 630-637. DOI: 10.4300/JGME-D-14-00791.1
Palliative Care

The Division of General Internal Medicine works collaboratively with experts at Dana​-Farber Cancer Institute and the BWH Division of Aging on several projects related to palliative care ​that include promoti​ng Serious Illness Communication with patients and families earlier in the disease course, ​increasing access to ​subspecialty palliative care, ​establishing best practices for managing substance use disorder in the setting of serious illness, and ​improving symptom​ management for patients near the end of life.

Faculty:

  • Isaac Chua
  • Katalina Serna (Fellow)

References:

  1. Chua IS, Zachariah F, Dale W, et al. Early Integrated Telehealth versus In-Person Palliative Care for Patients with Advanced Lung Cancer: A Study Protocol. J Palliat Med. 2019;22(S1):7-19. DOI: 1089/jpm.2019.0210
  2. Chua IS, Leiter RE, Brizzi KT, Coey CA, Mazzola E, Tulsky JA, Lindvall C. US National Trends in Opioid-Related Hospitalizations Among Patients With Cancer. JAMA Oncol. 2019 May 1;5(5):734-735. PubMed Central PMCID: PMC6512252. DOI: 1001/jamaoncol.2021.0051
  3. Chua IS, Fratt E, Ho JJ, Roldan CS, Gundersen DA, Childers J. Primary Addiction Medicine Skills for Hospice and Palliative Medicine Physicians: A Modified Delphi Study. J Pain Symptom Manage. 2021;62(4):720-729. DOI: 1016/j.jpainsymman.2021.02.035
  4. Lally K, Chua IS, Lin NU, Siegel J, Bernacki R. Using Quality Improvement to Increase Access to Palliative Care. JCO Oncol Pract. 2021;17(2):107-110DOI: 1200/OP.20.00469
COVID-19

Several researchers in the Division have been engaged in better understanding and improving the delivery of health care for patients with COVID-19. Efforts have included multi-center collaboratives with hospitalists around the country (through the Hospital Medicine Reengineering Network – HOMERuN), determining optimal criteria for discharge patients hospitalized with COVID-19 pneumonia, diagnostic errors in patients under investigation for COVID-19, and scoring systems to determine risk for clinical deterioration.

Faculty:

  • Evan Benjamin
  • Bonnie Blanchfield
  • Isaac Chua
  • Ishani Ganguli
  • Will Gordon
  • Anthony Komaroff
  • David Levine
  • Jorge Rodriguez
  • Hojjat Salmasian
  • Jeffrey Schnipper

References:

  1. Bohmer R, Ives Erickson J, Meyer GS, Blanchfield BB, Mountford J, Vanderwagon WC, Boland G. 10 Leadership Lessons from Covid Field Hospitals. HBR Nov 16,2020.
    https://hbr.org/2020/11/10-leadership-lessons-from-covid-field-hospitals?ab=hero-main-text
  2. Chua IS, Jackson V, Kamdar M. Webside Manner during the COVID-19 Pandemic: Maintaining Human Connection during Virtual Visits. J Palliat Med. 2020 Nov;23(11):1507-1509. PubMed PMID: 32525744. DOI: 1089/jpm.2020.0298
  3. Chua IS, Shi SM, Levine DM. Place of Death and End-of-Life Care Utilization among COVID-19 Decedents in a Massachusetts Health Care System. J Palliat Med. 2021;24(3):322-323. DOI: 1089/jpm.2020.0674
  4. Gordon WJ, Henderson D, DeSharone A, et al. Remote Patient Monitoring Program for Hospital Discharged COVID-19 Patients. Appl Clin Inform. 2020;11(5):792-801. DOI: 1055/s-0040-1721039
  5. Greysen, S. R., Auerbach, A. D., Mitchell, M. D., Goldstein, J. N., Weiss, R., Esmaili, A., Kuye, I., Manjarrez, E., Bann, M., Schnipper, J. L., & HOMERuN collaborative working group (2021). Discharge Practices for COVID-19 Patients: Rapid Review of Published Guidance and Synthesis of Documents and Practices at 22 US Academic Medical Centers. Journal of general internal medicine, 36(6), 1715–1721. https://doi.org/10.1007/s11606-021-06711-x
  6. Harrison, J. D., Weiss, R., Radhakrishnan, N. S., Hanson, C., Carnie, M. B., Evans, P., Banta, J., Symczak, G., Ziegler, G., Holmes, D., Michel-Leconte, S. J., Rogers, B., Wurst, M., Alikhaani, J., Davis, C., Lee, T., Schnipper, J. L., Auerbach, A. D., & Romond, J. (2021). A Patient-Centered Environmental Scan of Inpatient Visitor Policies During the COVID-19 Pandemic. Journal of patient experience, 8, 23743735211049646. https://doi.org/10.1177/23743735211049646
  7. Ives Erikson J, Blanchfield B, Hutton S. Using Magnet Model Components at a COVID-19 Positive Field Hospital. Journal of Nursing Administration. September 22, 2020. DOI: 1097/NNA.0000000000000912
  8. Komaroff AL, Bateman L. Will COVID-19 lead to myalgic encephalomyelitis/chronic fatigue syndrome? Front Med (Lausanne) 2021;7:606824 https://doi.org/10.3389/fmed.2020.606824
  9. Levine DM, Lipsitz SR, Co Z, Song W, Dykes PC, Samal L. Derivation of a Clinical Risk Score to Predict 14-Day Occurrence of Hypoxia, ICU Admission, and Death Among Patients with Coronavirus Disease 2019. J Gen Intern Med 2020. DOI: 1007/s11606-020-06353-5
  10. Levine DM, Mitchell H, Rosario N, et al. Acute Care at Home During the COVID-19 Pandemic Surge in Boston. J Gen Intern Med. DOI: 10.1007/s11606-021-07052-5
  11. Meyer GS, Blanchfield BB, Bohmer RM, Mountford J, Vanderwagen WC. Alternative Care Sites for the Covid-19 Pandemic: The Early U.S. and U.K. Experience. NEJM Catalyst. May 22, 2020.
  12. Paladino J, Mitchell S, Mohta N, Lakin JR, Downey N, Fromme EK, Gullo S, Benjamin E, Sanders JJ. Communication Tools to Support Advance Care Planning and Hospital Care During the COVID-19 Pandemic: A Design Process. Jt Comm J Qual Patient Saf. 2021 Feb;47(2):127-136. doi: 10.1016/j.jcjq.2020.10.005. Epub 2020 Oct 24.
  13. Paul BD, Lemle MD, Komaroff AL, Snyder SH. Redox imbalance links COVID-19 and myalgic encephalomyelitis/chronic fatigue syndrome. Proc Nat Acad Sci USA 2021;118:e2024358118 https://doi.org/10.1073/pnas.2024358118
  14. Ortega G, Rodriguez JA, Maurer LR, Witt EE, Perez N, Reich A, Bates DW. Telemedicine, COVID-19, and disparities: Policy implications. Health Policy Technol. 2020 Sep;9(3):368-371. PubMed Central PMCID: PMC7428456. DOI: 1016/j.hlpt.2020.08.001
  15. Rodriguez JA, Betancourt JR, Sequist TD, Ganguli I. Differences in the use of telephone and video telemedicine visits during the COVID-19 pandemic. Am J Manag Care. 2021 Jan;27(1):21-26. PubMed PMID: 33471458. DOI: 37765/ajmc.2021.88573
  16. Kim, Ellen et al. “Coronavirus disease 2019 (COVID-19) screening system utilizing daily symptom attestation helps identify hospital employees who should be tested to protect patients and coworkers.” Infection control and hospital epidemiology, 1-5. 10 Nov. 2021, DOI: 10.1017/ice.2021.461
  17. Klompas, Michael et al. “A SARS-CoV-2 Cluster in an Acute Care Hospital.” Annals of internal medicine vol. 174,6 (2021): 794-802. DOI: 10.7326/M20-7567
Patient-Centered Care and Patient-Reported Outcomes

Several researchers in the Division conduct qualitative and quantitative research to collect data on Patient-Reported Outcomes (PROs), including the creation of new metrics, in new settings, or using novel technology, and to improve patient-centered care in inpatient, transitional, and ambulatory care settings.

Faculty:

  • Heather Baer
  • David Bates
  • Asaf Bitton
  • Anuj Dalal
  • Ishani Ganguli
  • David Levine
  • Jeffrey Schnipper

References:

  1. Figueroa JF, Schnipper JL, McNally K, Stade D, Lipsitz SR, Dalal AK. How often are hospitalized patients and providers on the same page with regard to the patient's primary recovery goal for hospitalization? J Hosp Med. 2016 Feb 29. doi: 10.1002/jhm.2569. [Epub ahead of print] Review. PubMed PMID: 26929079.
  2. Ganguli I, Orav EJ, Weil E, Ferris TG, Vogeli C. What do high-risk patients value? Patient perspectives on a care management J Gen Intern Med. 2018;33(1):26-33.
  3. Levine DM, Landon BE, Linder JA. Quality and Experience of Outpatient Care in the United States for Adults With or Without Primary Care. JAMA Intern Med. 2019;179(3):363-372.
  4. Rudin, R. S., Fanta, C. H., Qureshi, N., Duffy, E., Edelen, M. O., Dalal, A. K., & Bates, D. W. (2019). A Clinically Integrated mHealth App and Practice Model for Collecting Patient-Reported Outcomes between Visits for Asthma Patients: Implementation and Feasibility. Applied clinical informatics, 10(5), 783–793. https://doi.org/10.1055/s-0039-1697597
  5. Rudin, R. S., Perez, S., Rodriguez, J. A., Sousa, J., Plombon, S., Arcia, A., Foer, D., Bates, D. W., & Dalal, A. K. (2021). User-centered design of a scalable, electronic health record-integrated remote symptom monitoring intervention for patients with asthma and providers in primary care. Journal of the American Medical Informatics Association : JAMIA, 28(11), 2433–2444. https://doi.org/10.1093/jamia/ocab157
  6. Schnock, K. O., Snyder, J. E., Gershanik, E., Lipsitz, S., Dykes, P. C., Bates, D. W., & Rossetti, S. C. (2020). Unique Patient-Reported Hospital Safety Concerns With Online Tool: MySafeCare. Journal of patient safety, 10.1097/PTS.0000000000000697. Advance online publication. https://doi.org/10.1097/PTS.0000000000000697

General Internal Medicine and Primary Care Research

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