RESEARCH

I use mixed methods to investigate how healthcare practitioners and patients can better use information to improve chronic disease outcomes for at-risk patients – while reducing cost of care – through financially sustainable care delivery models.  I develop and enhance innovative, scalable approaches to care delivery, with a particular emphasis on community-based participatory (CBPR) research strategies. My dissertation describes the psychosocial factors that practitioners consider in providing outpatient diabetes care. Among my findings are the perceived facilitators and barriers of EHR tools in documenting and using pertinent psychosocial information.

My research covers the following 3 themes:

  1. Evaluation of current capabilities, such as how current health system capabilities support chronic disease patients

  2. Identification of areas of improvement, such as describing disparities in prenatal antiretroviral (ARV) treatment among HIV-infected Medicaid enrollees

  3. Development of new capabilities and measurement of their impact, such as documenting improvement to community engagement in health informatics research and practice

My dissertation study resulted in four major findings:

  1. Psychosocial information is not considered when patients are stable and well controlled, but it is considered under 3 circumstances: a) patient has persistent, poor glycemic control, b) worsening of glycemic control, and c) new patient to the provider, or a new diagnosis.

  2. Access to psychosocial information is granted through dialogue in the context of an ongoing, trusting relationship.

  3. Awareness of psychosocial information may trigger decisions to personalize HbA1c targets, pursue less aggressive treatment plans, or augment guideline-concordant treatment with actions to address barriers to care.

  4. Current electronic health record (EHR) designs are not optimized for capturing and retrieving qualitative and situationally dependent psychosocial information, which tends to come in a narrative form.

My research work trajectory includes developing capabilities, for both patients and providers, in the primary care setting to collect and use psychosocial information to support a more personalized consultation. There is notable support for the relevance of this work. For example, in November, 2014 the Institute of Medicine released the report, Capturing Social and Behavioral Domains and Measures in Electronic Health Records: Phase 2 which details specific recommendations for capturing social and behavioral data in the EHR. My dissertation study findings, which describe how and under which circumstances providers use psychosocial information, are critical to understanding what information is needed, and when. My research agenda includes piloting capabilities to capture and use this psychosocial information in clinical settings in order to measure the impact of its use. I am seeking to use this insight to develop sustainable models of care delivery, which result in more efficient care—as measured by health outcomes, patient satisfaction, patient activation, and cost of care.

I intend to collect and use psychosocial information in order to extend personalized medicine capabilities—which are currently tailored to the genetics of the patient—to the lived experience of the person.