I am a health services researcher with an abiding interest in the health and well-being of vulnerable populations. I am especially concerned with improving preventive medicine practice and the quality of health care for older adults.
I have devoted my career to mentoring the work of young scholars in their efforts to improve U.S. health outcomes by developing, evaluating and disseminating evidence-based information to patients, clinicians, and policymakers. Integral to my work is the generation of methods for responding to health care stakeholders’ expressed needs about which clinical and health system interventions prove most effective for which patients under which specific circumstances. Among my methodological expertise is program evaluation and survey research.
Throughout my career, I have been actively engaged in teaching and mentoring physicians and surgeons, conducting research, writing and reviewing scholarly papers and books, and serving as an advisor to academic and community institutions and agencies at home and abroad. The following briefly explains my activities and expertise.
Teaching and Mentoring Physicians and Surgeons
I have been on the Research Advisory Committee for UCLA’s Robert Wood Johnson Clinical Scholars Program for over two decades. This fellowship program is designed to train leaders in medicine and provide them with the necessary skills to be research and policy experts. UCLA’s program is one of the best of its kind in the country. I have been on the program’s faculty since its inception in 1975.
In my role on the Clinical Scholars’ faculty, I have been the principal or co-principal mentor of seven fellows. I have worked intensively, often daily, with the fellows for whom I had principal responsibility, and in all cases, supervised their education and research. Five of the seven fellows have already graduated from the program. Dr. Kavita Patel, an internist, is a Fellow at the Brookings Institute and was formerly Director of Policy for the Office of Governmental Affairs and Public Engagement for President Obama. I supervised Dr. Patel’s national survey of the American College of Physicians to uncover how they spend their time when not in the office. Similarly, I supervised Dr. Sierra Matula’s survey of surgeons to identity their pro bono activities. Dr. Matua is now at UC San Francisco. Dr. John Gore, a Urologist, who is currently on the faculty at the University of Washington (Seattle) and I worked on a study to determine the mental health of low-income prostate cancer patients. Dr. Rhonda Mattox, a psychiatrist who is currently in a rural practice in Little Rock, Arkansas and I developed methods for her study of the effects of religious beliefs on health care preferences. Dr. Joan Ryoo, now a radiation oncologist at Kaiser, and I worked on a community-based survey of the incidence of helicobacter pylori among Koreans in LA. I am currently working with Dr. Charles Scales to develop and evaluate the effectiveness of a mobile-phone-based educational intervention for postgraduates to improve the quality and safety of their care for urological disease. We are working with the Dean’s Office and others to produce the education and its evaluation.
Over the past five years, I have also served as a faculty mentor to urological fellows, residents and medical students as part of my responsibilities as evaluation director for UCLA’s IMPACT program. This program treats indigent men with prostate cancer, and we collect quality of life and other data on all patients. As with the Clinical Scholars, I meet regularly with fellows and students to supervise their research and collaborate in teaching them research skills and writing papers with them. Among the fellows with whom I have worked are Drs. Jennifer Anger, Jonathan Bergman, and David Miller. I have worked with medical students and urological residents including Dr. Jennifer Heckman, Dr. Christopher Delbert, Mary Zavala, Dr. Karim Chamie, and Dr. John Augustus.
I have continued to work with postdoctoral fellows such as Marsha McGory, M.D., Ph.D.13. I was her co-mentor when she was a Clinical Scholar. I also continue to collaborate with Dr. Carol Eisen whom I mentored when she was an NIMH Faculty Scholar at UCLA. Dr. Eisen Is now the Regional Medical Director for the Los Angeles County Department of Mental Health (DMH). Dr. Kim Gregory, who received an M.P.H. at UCLA and took my course in program evaluation and comparative effectiveness research, and I continue to collaborate. Dr, Gregory is is Vice Chair of Women's Healthcare Quality and Performance Improvement at Cedars-Sinai. Dr. Gregory and I submitted a joint proposal in December, 2010 to the Patient Centered Outcomes Research Institute (PCORI) to develop methods for actively involving pregnant women in their health care decision-making.
In July 2010, I joined the UCLA Gambling Studies Program. One of my responsibilities is to co-mentor the work of Dr. Iman Parham, a psychiatrist. We recently completed a review of the quality of the gambling literature (submitted to Addiction and currently being revised for resubmission). Previous versions of our study were presented to the Western Association of Physicians and also to the National Council of Responsible Gambling (NCRG). The NCRG selected the presentation as the best in the conference (September 2011).
A major focus of my career has been on improving care for vulnerable populations including people with chronic health (indigent men with prostate cancer) and mental health (pathological gamblers) problems. I have collaborated with Dr. Mark Litwin, Chair of the Department of Urology) to build the UCLA Prostate Caner Treatment Program into one of national prominence. The purpose of the program is to provide treatment to men who do not have health insurance and who are not eligible for MediCal. I assisted Dr. Litwin with the proposal that won the grant and have been the evaluation coordinator for the study since its inception 10 years ago. In specific, I developed and continue to oversee the evaluation of the project and all research connected with it. We have published over 50 papers over a 10-year period. I have also been working with the UCLA Gambling Program to make it into a national center of excellence, using the UCLA Prostate Treatment Program as a model.
In keeping with my interests in vulnerable populations in general, and the elderly in particular, I have developed “The Alcohol-Related Screening Problems Survey, “often called the ARPS. This screening and education system is designed to identify alcohol-related problems in older adults. Older people may incur alcohol-related risks at relatively low consumption levels because of alcohol’s potential adverse interaction with an elderly person’s declining health and functional status and increased medication-use. The ARPS system consists of a survey to identify risks and problems, personalized reports of each patient’s risks, physician reports, and an educational program for patients (A Toast to Health in Later Life!). I have been PI of three NIH grants to develop the system, which I created in conjunction with UCLA faculty (e.g., Ron Hays, Ph.D., medicine and public health; Merle Wittrock, Ph.D., education; John Beck, MD, medicine.) In the past five years, I have overseen the transition of the ARPS from a paper-and-pencil survey to one that is available online at https://www.responsibility.org/. (A password is required, which I can provide.) The ARPS and its scoring system, which involves complex algorithms has been translated into French and has been used in France (touch screen) under my supervision for over five years. For the past two years, I have consulted with the government of Victoria, Australia to “translate” the US version into one that is suitable to Australian drinking standards. We have presented the results in Canberra Australia and are writing up the results for publication. I am also working with researchers at the Palo alto Medical Research Foundation as part of an ongoing effort to try out the ARPS system in a facility with an electronic health record. Finally, I am in the process of writing up the results of a study that was done in conjunction with Wise and Healthy Aging, a community-based full-service center for seniors in Santa Monica. In that study, we found that older adults (average age 77 years) were able to use the online version of the ARPS as easily as they could use the paper and pencil version.
For many years, I have been interested in improving health literacy. This has led to an AHRQ grant in 2011 to develop an online education program to teach older adults to evaluate health information. Many older (55 year plus) people have at least one health condition (e.g., hypertension), and according to the Pew Internet and American Life Project, nearly 70% of them have gone online to collect health information for themselves or others. Most people start with a search engine and are offered millions of sites, many of which are unreliable and possibly harmful. The online program, which is in the evaluation phase, is designed to improve older adults’ abilities to identify and evaluate the information they find regardless of the source. A preliminary version is available at: http://www.ehealthsearch.info (A user name and password are required, which I can provide). The published report of the study will be available in 2013 in the Journal of Applied Gerontology (http://jag.sagepub.com/).
Although information technology to aid in improving health literacy for vulnerable populations is a major interest, I have continued to maintain a concern for the RAND/UCLA Appropriateness method, which I helped to originate. This method was originally designed to help understand under and over use of medical and surgical procedures and also study variations in care. It relies on the literature (‘best available evidence”) and clinical expertise to identify appropriate indications for medical and surgical procedures and has been used hundreds of times nationally and internationally to study appropriate use. Recently the method has also been adapted as a means of developing indicators for evaluating quality improvement. I was recently the principal investigator of a study of the appropriate indications for transfusion, which is the most commonly procedure in the US.
Peer-Reviewed Papers and Books
I have published 135 papers in peer-reviewed journals and 15 textbooks. The papers represent my combined interests in vulnerable populations and research methodology, particularly effectiveness evaluation, survey research, and clinical literature review methods. For example, I wrote a textbook, “Practicing Research.” This book aims to teach health care practitioners how to translate research into practice. I also completed the third edition of a textbook that has been in print since the 1990’s, “Conducting Research Literature Reviews.” Finally, I have spent a great deal of 2012 writing a textbook called “Evidence-Based Public Health Practice.” This book, which bases its main premises on the principles of evidence-based medicine, aims to teach health care professionals how to identify and evaluate the best available evidence and ingrate it with clinical expertise and patient preferences to make informed public health care and policy decisions. I am developing an interactive website to accompany the textbook. It is the first book of its kind that actually describes what to do to practice evidence-based public health, which public health models are appropriate, and how to evaluate the process, outcomes, impact, and costs.
Advisory Roles and Journal Reviews
I have served as a reviewer for the NIH’s Internet Assisted Review process. I was among the first to try out a review method in which all reviews and discussions take place over the internet. I have just agreed to chair a study section for the Patient Centered Research Institute (PCORI), a new federal program associated. PCORI was established by Congress through the 2010 Patient Protection and Affordable Care Act. It is an independent organization created to help people make informed health care decisions and improve health care delivery.
I have served as a reviewer the Journal of the American Medical Association, Annals of Internal Medicine (top 30% of reviewers), BioMed Central, and Drug and Alcohol Review, I have also reviewed proposals in the Netherlands (ZonMw ) and for the Israel Bi-National Committee.
I have worked with colleagues from other academic institutions including the Mt. Sinai School of Medicine, the University of Wisconsin, and the University of Washington (Puget Sound). I am currently working in France, Australia, and New Zealand as an advisor to doctoral students.
I am an advisor to the UCLA Gambling Studies Program. In that capacity, I help select research topics and priories and oversee the development of new research ideas. I am also on the Research Advisory committee of the Robert Wood Johnson Clinical Scholar Program and assist in overseeing the quality and characteristics of the Program’s research activities.