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. I have four main areas of work at the moment:
1. The role of physicians in the US opioid crisis
The opioid crisis is arguably the largest, most poorly controlled public health emergency in the US today. Physician prescribing of opioids has played an important role in this crisis, though the current role of prescribing and the effects of limiting opioid use are not clear. I have sought to understand 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.
2. Understanding and improving specialty care delivery
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? The focus of this research so far has been on “eConsult” models of electronic specialty consultation. This work has been in collaboration with public health system partners in Boston, Los Angeles County and New York City.
3. Understanding the scope and consequences of medical overuse
I study the patterns and consequences of medical overuse in the United States, particularly overprescribing of unnecessary or dangerous medications. I have recently focused my attention in this topic on the prescribing of antibiotics and opioid medications. My current work in antibiotics focuses on the relationship between antibiotic overuse, antibiotic resistance and patient outcomes.
4. Understanding the factors that influence quality of care in hospitals and post-acute care settings
Another important topic in my work has been understanding the quality of care delivered in hospitals, recently moving into post-acute care settings as a new research focus. This research has focused on using robust quasi-experimental approaches or new data sources to answer pressing policy questions in hospital quality. For example, I used the Health and Retirement Study to explore the consequences of risk adjustment for dozens of socioeconomic and health indicators on hospital quality measurement.
Teaching and mentoring are also integral to my professional life. I am teaching a course beginning in 2018 (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.