I am a health services researcher and primary care physician. My research centers around understanding and addressing the inefficient delivery of health care in the United States in settings from doctors' offices to nursing homes. The COVID-19 pandemic has only highlighted the major challenges faced by the US health care delivery system. In this vein, my work has centered on three key ares:
1. HIgh risk prescribing and its consequences
Physicians commonly prescribe high risk medications with major public health consequences like antibiotic resistance and addiction. I have done work to examining the patterns and consequences of prescribing of antibiotics, opioids, antipsychotics and stimulant medications. My current research on opioids centers on understanding the factors that influence opioid prescribing by physicians, and evaluate policies that can promote responsible prescribing and reduce the burden of opioid use disorder. I am also studying the role of buprenorphine and other medication therapy for opioid use disorder in combatting the epidemic of overdose deaths from opioids. For antibiotics, I study prescription patterns of antibiotics and how they may relate to antibiotic resistance. Future work will examine how new technologies like vaccines influence antibiotic use.
2. Understanding and improving specialty care delivery and the primary-specialty care interface
I am deeply interested in patterns of how specialty care is delivered at a population level, which is underexplored in health services research. For example, how often do physicians refer to other specialists, and how are patterns of specialty care changing nationally over the past two decades? Second, how can information technology improve the delivery of specialty care in a variety of settings? One focus of this research has been on “eConsult” models of electronic specialty consultation. I am evaluating the impact of implementing these systems and also how we can harness machine learning to extract actionable clinical data from eConsult requests. Another exploding technology since the beginning of the Covid-19 pandemic is telemedicine. Telemedicine has long had potential as a revolution for specialty access, especially mental health care. But prior to 2020 it was still a niche corner in health care. Now that telemedicine has entered mainstream awareness, a number of questions will be important to answer, such as understanding the quality of care delivered by telemedicine, how telemedicine changes the patient-provider relationship and the impact of telemedicine availability on population health.
3. Post-acute care and long-term care delivery in nursing homes
Another important topic in my work has been understanding the quality of care delivered in nursing homes and other post-acute care settings. With the Covid-19 pandemic, the safety of nursing homes has become an urgent public health priority. Nursing homes contain 1% of the US population and approximately 40% of deaths due to Covid-19. My research focused on understanding care gaps in nursing homes for Covid-19 and factors that can reduce the burden of the pandemic in this vulnerable population. Another topic that fascinates me is the decision during a hospitalization on whether a patient should receive post-acute care and the subsequent delivery of rehabiliation in nursing homes. Nursing home use for post-acute care has received increased scrutiny as it drives much of the variation across regions in the US in Medicare spending but there is very little research examining the clinical consequences of post-acute use. My research examines this question through the lens of payment reform in Medicare, especially in bundled payment models.
Teaching and mentoring are also integral to my professional life. I am teach a course (HPM 505) on health care delivery reform in the United States for master’s students at HSPH. In addition, I serve as advisor for MPH students at HSPH and I provide research mentorship to graduate students, residents, and fellows. I am also active in clinical and research teaching for BWH medical trainees and formal teaching of peers through CME activities.