Research Products: Publications

CoE investigators published 105 journal articles in the past year. These include articles by core and affiliate investigators. Additionally, our CoE staff made 73 conference presentations (either regional, national, or international).

Publications of National Importance

The publications and work described below represent scientific results that effect or improve patient care and influence health policy.

Does pay-for-performance improve the quality of health care?

Petersen LA, Woodard LD, Urech T, Daw C, Sookanan S. Does pay-for-performance improve the quality of health care? Ann Intern Med. 2006 Aug 15;145(4):265-72. Systematic Review.

This work was supported by HSR&D IIR 04-349. Dr. Laura Petersen and CoE colleagues' work on pay for performance was cited extensively by the Institute of Medicine's recent report "Provider Performance: Aligning Incentives in Medicine", and her systematic review on the topic was included verbatim as Appendix B in the report. The findings from this work will provide critical information needed to implement pay-for-performance methods and will be directly applicable to such programs for the 40.5 million Medicare beneficiaries and to staff-model health care delivery systems that collectively cover over 18 million individuals.

Facilitating the delivery of patient-centered communication between cancer patients/family.

Epstein RM, Street RL, Jr. Patient-Centered Communication in Cancer Care: Promoting Healing and Reducing Suffering Monograph. National Cancer Institute, NIH Publication No. 07-6225. Bethesda, MD, 2007.

To encourage and inform future research that would help the health care delivery team(s) across the cancer care continuum, the National Cancer Institute's Outcomes Research Branch (ORB), in collaboration with the Behavioral Research Programs Health Communication and Informatics Research Branch (HCIRB), commissioned the Patient-Centered Communication in Cancer Care: Promoting Healing and Reducing Suffering monograph. The monograph was written by Dr. Richard Street, CoE's Chief, Health Communication & Decision-Making, along with Dr. Ronald Epstein, University of Rochester School of Medicine & Dentistry. Effective patient-clinician communication is central to the delivery of high-quality care. It becomes even more crucial in the cancer setting where patients have to deal with stress, uncertainty, complex information, and life-altering medical decisions. Highlights of the monograph include conceptualization of patient-centered communication into six key functions; emphasis on research that examines the relationship between patient-centered communication and patient health outcomes; detailed discussion of potential mediating and moderating mechanisms of the association between communication and patient outcomes; and identification of specific research priorities that would guide the NCI in planning future research initiatives in this important area.

A practical screening tool for anxiety and depression in patients with chronic breathing disorders.

Kunik ME, Azzam PN, Souchek J, Cully JA, Wray NP, Krishnan LL, Nelson HA, Stanley MA. A practical screening tool for anxiety and depression in patients with chronic breathing disorders. Psychosomatics. 2007 Jan-Feb;48(1):16-21.

This work was supported by an HSR&D grant titled "Causes and Consequences of Aggressive Behavior in Demented Patients" (PI - Mark Kunik, M.D., M.P.H.; VA IIR). The goal of the study was to determine modifiable factors causing aggression in patients with dementia. Identification of such factors could potentially reduce institutionalization, injuries, restraint and use of anxiolytic and antipsychotic medications. Follow-up of 227 dementia patients and their caregivers was recently completed. Forty percent of patients became physically or verbally aggressive during the two-year follow-up. Findings are anxiously awaited by the field because new studies have demonstrated that the most commonly used medications for treatment of aggression have only modest efficacy, with serious morbidity and mortality.

The use of screening colonoscopy for patients cared for by the Department of Veterans Affairs.

El-Serag HB, Petersen LA, Hampel H, Richardson P, Cooper G. The use of screening colonoscopy for patients cared for by the Department of Veterans Affairs. Archives of Internal Medicine. 2006;166(20): 2202-8.

This work was supported by an HSR&D Advanced Career Development Award (CDA) titled "Clinical Outcomes and Resource Utilization in Gastrointestinal Disease" (Career Awardee - Hashem El-Serag, M.D., M.P.H.). The work will guide resource allocation for screening colonoscopy in the VA.

Medical Education

The role of the student-teacher relationship in the formation of physicians: The hidden curriculum as process.

Haidet P, Stein HF. The role of the student-teacher relationship in the formation of physicians. The hidden curriculum as process. J Gen Intern Med. 2006 Jan;21 Suppl 1:S16-20. Review.

This work was supported by an NIH CDA titled "Promoting Physicians' Cultural Competence Through Reflective Practice" (Career Awardee - Paul Haidet, M.D., M.P.H.; K07). The findings from this work will facilitate the implementation of an integrated curriculum in cultural competence at medical schools and help ensure that the institutional environment reinforces students' acquisition of knowledge, skills, and attitudes.

System Improvements

Identifying diagnostic errors in primary care using an electronic screening algorithm.

Singh H, Thomas EJ, Khan MM, Petersen LA. Identifying diagnostic errors in primary care using an electronic screening algorithm. Arch Intern Med. 2007 Feb 12;167(3):302-8.

The work presented in this manuscript was made possible through the South Central Veterans Health Care Network (VISN 16) Data Warehouse, which is a collection of administrative and clinical data from ten VAMCs in the south central United States. In addition, effort for the PI (Dr. Singh) was supported by the MEDVAMC. The work exemplifies an innovative approach to using a VA data warehouse to identify diagnostic breakdowns in primary care and hence to improve patient safety in the VA outpatient setting. To assess the feasibility of computerized screening to identify errors in diagnosis, Singh and colleagues applied a unique electronic "trigger" algorithm to data from primary care visits to identify records that may contain diagnostic errors. The performance of this algorithm is comparable to screening tools for other types of errors, such as medication errors.

National adherence to evidence-based guidelines for the prescription of nonsteroidal anti-inflammatory drugs.

Abraham NS, El-Serag HB, Johnson ML, Hartman C, Richardson P, Ray WA, Smalley W. National adherence to evidence-based guidelines for the prescription of nonsteroidal anti-inflammatory drugs. Gastroenterology. 2005 Oct;129(4):1171-8.

This work was supported by an HSR&D grant titled "Economic and Clinical Outcomes of Recommended NSAID Prescription Strategies" (PI - Neena Abraham, M.D., M.Sc.; VA IIR). The findings of this study will assist VA policy makers in deciding whether or not they should embrace current recommended guidelines for the safer prescription of NSAIDs. Preliminary results from this funded project have received national attention. The first abstract from this grant was awarded the American College of Gastroenterology Auxiliary Award for the best scientific abstract submitted by a member of the College to the Annual Scientific Meeting.