Current Projects by Staff Member
PI: Michael Rothberg, MD, MPH
Mobility Technicians to Increase Ambulation for Hospitalized Medical Patients
Older patients who are hospitalized often suffer a devastating loss of function as a result of too much bedrest. Although patients are encouraged to ambulate in the hospital, they may feel unsafe and nurses have limited time to help them. In this randomized trial, we will test the impact of dedicated mobility technicians who will work with patients every day to ensure that they ambulate three times daily. We will find out whether this intervention improves mobility in the hospital, whether it helps patients to go home instead of a skilled nursing facility, and whether the mobility is preserved 30 days after discharge.
Sponsor: National Institute on Aging
Patient-Centered Approach to Reducing Harm from VTE
Venous thromboembolism (VTE) is a serious source of hospital morbidity and mortality. It can be prevented with heparin prophylaxis, but treatment should be reserved for high risk patients because prophylaxis increases the risk for bleeding and is costly and uncomfortable. Identifying low risk patients is difficult, because there are no validated risk prediction tools for use in US hospitals. Thus many hospitals offer near-universal prophylaxis, putting patients at unnecessary risk. In this project, we used data from the Cleveland Clinic to create a tool to assess risk of VTE and embedded it in the electronic health record. We studied the impact of the risk assessment tool in a randomized trial and are now trying to understand the use of the tool after the trial ended. We are currently conducting additional analyses on this dataset which contains over 160,000 patients. Findings from this study should improve the use of VTE prophylaxis across the US. We hope to conduct another randomized trial to test the use of our tool in a large sample of US hospitals.
Reducing Antimicrobial Overuse in Community-Acquired Pneumonia (CAP) through Personalized Antimicrobial Recommendations
Pneumonia is a leading cause of hospitalization and death. Antibiotics are the mainstay of treatment, but increasing antibiotic resistance among the bacteria that cause pneumonia threatens our ability to treat this disease. One of the key decisions in treating pneumonia is which antibiotic regimen to prescribe. For this project, we used data from a large national sample of patients to create tools that physicians can use to assess an individual patient’s risk of having a resistant infection and to choose the appropriate antibiotic. Risk models were developed and incorporated the electronic health record (EHR) in the form of a smart order set that makes personalized antibiotic recommendation. In the future, we hope to assess the effects of the order set on physician behavior and patient outcomes in a randomized trial. As a by-product of creating these models, we were able to derive numerous insights into the diagnosis and treatment of pneumonia, including the value of various diagnostic tests, the causes of pneumonia, and the most appropriate means of treating it.
Reducing Antimicrobial Overuse through Targeted Therapy for Patients with Community-Acquired Pneumonia (CAP)
This project builds on our previous studies in CAP. Our overall goal is to improve antimicrobial prescribing for patients with CAP by emphasizing pathogen-directed therapy. An accurate pathogenic diagnosis could contribute to antimicrobial stewardship in 2 ways: 1) by allowing for initial narrow-spectrum therapy and 2) by providing confidence when de-escalating therapy following negative cultures. Rapid diagnostic assays have the potential to provide accurate results within hours and thereby reduce the duration of exposure to extended spectrum empiric therapy. Rapid viral testing for respiratory pathogens is recommended as a means to reduce the use of inappropriate antibiotics, but these recommendations are based on low-quality evidence and it is unknown whether more widespread testing could reduce the use of broad-spectrum antibiotics and/or prompt initiation of antiviral therapy. De-escalation following negative bacterial cultures is another antimicrobial stewardship target that is based on low-quality evidence. We will conduct a large, multicenter 2 X 2 factorial cluster randomized controlled trial to test both approaches to reducing the use of broad-spectrum antibiotics in patients with CAP: a) routine use of rapid diagnostic testing at the time of admission and b) pharmacist-led de-escalation after 48 hours for clinically stable patients with negative cultures. Our study will be the largest randomized trial to determine the impact of rapid diagnostic testing on antimicrobial stewardship and patient outcomes. Our randomized trial design will allow us to establish causality and determine whether broad spectrum antibiotics can be safely de-escalated in stable patients. Findings from our proposed trials will generate important new knowledge about pathogen targeted therapy and antimicrobial de-escalation in patients with CAP.
Modeling the Disease Burden and Cost-Effectiveness of Screening and Treatment for Non-Alcoholic Fatty Liver Disease in Type 2 Diabetes Patients
Type 2 diabetes (T2D) is a major cause of morbidity and mortality due to microvascular and macrovascular complications. Nonalcoholic fatty liver disease (NAFLD) is another common co-morbidity but its burden in patients with T2D is poorly studied. Although NAFLD affects 50-70% of T2D patients, there is neither a screening guideline nor established treatment for NAFLD. However, at least 5 drugs are undergoing phase 3 trials and up to 50 drugs are in phase 2 trials. As new drugs become available in the near future, physicians and patients will face difficult tradeoffs among long-term benefits, risks, and costs. Given the widespread nature of NAFLD in patients with T2D, screening to identify those with NASH, who are at high-risk of advance liver disease, for early intervention may help patients live longer with a better quality life. Choosing the best screening and treatment strategy for NAFLD is complicated and can be aided by the use of computer-based models. The objective of this study is to develop a computer microsimulation model of NAFLD in T2D to estimate its burden, and evaluate screening and treatment options for NASH. Our model will provide a better understanding of a prevalent, important, yet underappreciated diabetes complication, using an innovative approach to diabetes and liver disease modeling. The study also establishes the groundwork for future evaluation of new treatment regimens and screening modalities for patients with T2D and NAFLD, which will advance the prevention and treatment of both diseases for millions of patients each year.
Dr. Rothberg's publications can be found here.
PI: Jordan Alpert, PhD
S.E.N.D.: Developing a web-based, interactive guide to enhance patient-clinician electronic communication by focusing on specificity, expressing concerns, need, and directness
The use of secure messaging (SM) is increasingly being relied upon for cancer communication. SM can improve care and provide an outlet for patient-clinician communication. However, patients are uncertain about how to use SM effectively to communicate with clinicians, and clinicians have cited difficulties understanding the goals of patients’ messages. This project aims to develop an evidence-based, online, interactive tool to facilitate quality healthcare communication between patients and clinicians. This project will provide tips to patients as well as providing valuable insights into how clinicians perceive quality SM communication, enabling future interventions focusing on clinicians’ techniques for responding to messages.
Informal caregivers’ communication and informational needs when caring for patients with Dementia
As the number of Americans who suffer from Dementia increases, informal caregivers, individuals caring for a relative or friend facing a condition requiring particular attention, are often overwhelmed and are underprepared to navigate the requirements of daily care. As the disease progresses, measures can be taken to limit avoidable hospitalizations and plan for end-of-life. This project aims to understand the communication and informational needs of informal caregivers so that more productive discussions can occur between informal caregivers and clinicians throughout a patient’s treatment for Dementia.
Dr. Alpert's publications can be found here.
PI: Abhishek Deshpande, MD, PhD
Using Large Observational Datasets to Improve Antibiotic Prescribing for Community-Acquired Pneumonia
Community-acquired pneumonia (CAP) is a leading cause of hospitalizations and death in the United States. Identification of the causative organism’s antibiotic susceptibility is the key to appropriate antibiotic prescribing. Current treatment guidelines encourage physicians to consider local antimicrobial resistance, but actionable information, such as the resistance patterns for CAP, is rarely available. This study will utilize data from three large observational datasets to describe the microbial etiology and antimicrobial resistance patterns of CAP in a US and describe the relationship between local antibiotic resistance patterns, physician prescribing and patient outcomes. The study will also compare the effectiveness of an early switch from intravenous to oral antibiotics with the standard course of intravenous antibiotics. Knowledge to be gained will inform best practices for CAP antimicrobial therapy and lead to similar interventions for other pneumonias.
Derivation of Clinical Prediction Rule for Recurrent Clostridioides difficile Infection
Clostridioides difficile infection (CDI) is the most common cause of hospital acquired diarrhea in the developed world. CDI therapy is initially effective for most patients, but an estimated 20-30% of patients develop symptomatic recurrence within 2 weeks of successful completion of therapy. Many observational studies have demonstrated that CDI recurrence rates are higher in transplant recipients and patients receiving chemotherapy for malignancies when compared with the general population. However, it is not clear as to why some CDI patients develop recurrence while others do not. Using a Cleveland Clinic system wide cohort, this project will evaluate the risk factors for recurrent CDI (rCDI) among patients with an initial episode of CDI. The data will be used to develop a clinical prediction rule for identifying patients who may be predisposed to rCDI.
Prevention of Healthcare-Associated Infections
Contaminated healthcare workers hands and environmental surfaces have been identified as the most important sources for transmission of healthcare-associated infections (HAIs) including multiple multi-drug resistant organisms (MDRO). In this study we examine the environmental burden of HAIs/MDROs and the role of contaminated surfaces in the transmission of HAIs in an acute-care setting. The study will also assess the role of novel disinfection strategies including newer technologies such as UV disinfection to help reduce the incidence of HAIs.
Dr. Deshpande's publications can be found here.
PI: Hamlet Gasoyan, PhD
Modifiable Determinants of Disparities in Multiple Myeloma Treatment Patterns
Multiple myeloma is the second most common hematologic cancer in the US with an estimated 34,470 new cases and 12,640 deaths in 2022. Black individuals have a dramatically higher incidence of multiple myeloma, as well as a higher rate of mortality from multiple myeloma, compared with White individuals, likely due to several, complex risk factors, such as genetics and differences in exposure to established multiple myeloma risk factors, such as obesity. The project’s goal is to inform the clinicians and policymakers whether undertreatment, in addition to biology, is responsible for the poorer outcomes observed among Black patients with multiple myeloma. This goal will be achieved by examining whether patients’ insurance coverage related factors and social determinants of health can explain the racial disparities in multiple myeloma treatment patterns, as well as studying the effects of the COVID-19 pandemic on multiple myeloma care patterns.
Funding: National Cancer Institute
Access to and Outcomes of Pharmacotherapy for Chronic Weight Management
The past decade has witnessed significant progress in the development of new antiobesity pharmacological agents. Several appear to have greater efficacy than medications previously approved by the Food and Drug Administration (FDA). Despite the potential of these new medications to combat America's obesity crisis, access to FDA-approved antiobesity medications is severely limited. This project will examine the association between socio-demographic factors, health insurance characteristics, social determinants of health, and the use of medications for chronic weight management, as well as study the long-term weight loss outcomes in patients with obesity who receive medications for chronic weight management.
Dr. Gasoyan's publications can be found here.
PI: Phuc Le, PhD, MPH
Screening and treatments of nonalcoholic fatty liver disease (NAFLD)
Using the literature and a number of publicly available datasets, we are constructing a disease model of the natural history of nonalcoholic fatty liver disease. The model can be used to compare the effectiveness and cost-effectiveness of different screening and treatment options for NAFLD in the general population, as well as in patients with type 2 diabetes and/or obesity.
Use of prescription medications based on population-based survey
Using the National Health and Nutrition Examination Survey data, we will assess the use of prescription medications in the elderly and other specific populations (e.g. patients with type 2 diabetes).
Dr. Le's publications can be found here.
PI: Kathryn Martinez, PhD
Improving outcomes in atrial fibrillation through patient-centered decision making
Atrial fibrillation is a leading cause of stroke. Treatment with oral anticoagulation reduces stroke risk by up to 60%, yet is widely underutilized. Anticoagulation poses a risk of bleeding, which must be weighed against the predicted benefit of stroke reduction. Patient and physician priorities regarding anticoagulation are often misaligned: patients prioritize avoiding strokes, while physicians are wary of causing bleeds. Lack of patient-centered decision making, therefore, likely contributes to underuse of anticoagulation among eligible patients. The goal of Dr. Martinez’s work in this area is to identify strategies to improve outcomes in atrial fibrillation through patient-centered decision making for oral anticoagulation.
Increasing statin initiation through use of an EHR-embedded decision aid
Suboptimal statin adherence is associated with excess death and disability, but improved patient-centered decision making for statins could improve adherence. Decision aids can facilitate patient-centered decision making, but are not routinely used by physicians. Dr. Martinez’s current work in this domain is two-fold. First, Dr. Martinez is examining variation in use of an EHR-embedded decision aid for statins by patient and physician factors. Second, she is assessing the association between use of an EHR-embedded decision aid for statin therapy and patient uptake and adherence with statins.
BRCA testing in primary care and follow-up subsequent to a positive test
The U.S. Preventive Services Task Force recommends primary care physicians refer women at high risk of breast cancer for BRCA mutation genetic counseling, yet very little is known about whether primary care physicians are doing this. Dr. Martinez recently examined patterns of BRCA testing referrals from primary care physicians over 10 years, finding only a quarter of physicians ever referred a patient. Even among patients with a documented family history, the majority were not referred for testing. Increasing primary care physician referral of appropriate patients for BRCA testing has the potential to save lives. Dr. Martinez is building on these findings by exploring physician-focused interventions to increase appropriate referral practices.
Dr. Martinez's publications can be found here.
PI: Matt Pappas, MD, MPH
Understanding and Improving Preoperative Testing
Nearly 190,000 Americans die in the 30 days after a major noncardiac surgery each year, and cardiac complications account for many of those premature deaths. For over 40 years, attempts to minimize the cardiac risk of surgery has focused on stress testing before surgery. Dr. Pappas has assembled a dataset of patients considering surgery at the Cleveland Clinic (perhaps the largest such database using electronic medical record data to date), to understand what interventions might prevent morbidity and death and guide future decision-making regarding testing before noncardiac surgery. His work uses a variety of advanced machine learning techniques and advanced methods to disentangle causal relationships from other associations.
Issues crucial to the future of Hospital Medicine
Hospital Medicine is a relatively young field, and only the third medical specialty organized around a site of care. Dr. Pappas has multiple related projects intended to help the field grow in ways that are both sustainable and sustaining. His work investigates whether and how hospitalists improve at delivering outcomes important to hospitals (such as cost and length-of-stay) as they gain experience, whether the costs of turnover differ meaningfully from earlier estimates, and how hospital medicine has grown as a research specialty.
Personalizing Anticoagulation Decision-making
Patients with atrial fibrillation are commonly managed using anticoagulants, such as warfarin or apixaban, to reduce the likelihood of stroke. But patient risks of bleeding and stroke vary widely, and change over time. Dr. Pappas developed a microsimulation model of anticoagulation in atrial fibrillation, and has used that model to inform common clinical scenarios where anticoagulants must be changed, including in what scenarios short-term anticoagulants (“bridging” anticoagulation) might offer patients benefit, and how long anticoagulants should be withheld after being hospitalized for bleeding.
Dr. Pappas' publications can be found here.
PI: Elizabeth Pfoh, PhD, MPH
The Impact of Depression Screening on Receipt of Depression Treatment and Remission
Depression is a prevalent disease, affecting between 7-27% of the population. Unfortunately, depression is often under-diagnosed and under-treated. Routine depression screening as part of quality reporting programs, despite the fact that depression screening alone has not been found to improve patient outcomes. However, the harms associated with depression screening are low, and providing appropriate treatment along with depression screening can save lives. This study will provide timely, policy-relevant information related to whether depression screening increases depression treatment.
Assessing the Effect of a Population-wide Program to Reduce Hypertension on Cardiovascular Health
Hypertension, or high blood pressure, affects one in three Americans. Hypertension is a major contributor to cardiovascular disease. Blood pressure can be effectively lowered, and lowering blood pressure results in improved cardiovascular health. Nevertheless, fifty-percent of individuals with high blood pressure do not have it controlled. This study evaluates the effectiveness of a system-wide intervention to increase hypertension control through medication intensification.
Dr. Pfoh's publications can be found here.
PI: Glen Taksler, PhD
Testing the Effectiveness of Individualized Disease Prevention in Middle-Aged Adults
The goal of this project is to help middle-aged adults make an informed decision about the primary preventive services that are most likely to promote a longer, healthier life. We will adapt an analytic model developed by the investigative team to incorporate quality of life and integrate a decision aid into electronic health records. Then, in a randomized trial at diverse primary care clinics, we will test of effectiveness of the decision aid on preventive care utilization for middle-aged patients.
Individualizing Disease Prevention for Middle-Aged Adults
This study employs an analytic model and mixed-methods (qualitative focus groups and a national survey) to learn how to best communicate the net benefits of all major preventive care services to patients, individualized for their age and risk factors. We also develop proof-of-concept for delivering individualized recommendations via electronic health records and pilot test the framework with middle-aged adults.
Achieving Individualized Precision Prevention (IPP) Through Scalable Infrastructure Employing the USPSTF Recommendations in Computable Form
This project explores potential to make the US Preventive Services Task Force’s evidence-based recommendations computable in a scalable form using electronic health records.
Dr. Taksler's publications can be found here.
PI: Michelle Beidelschies, PhD
The Cleveland Clinic Center for Functional Medicine, of which Dr. Beidelschies is Research and Education Director, is currently developing or participating in numerous research studies that were either developed independently or in collaboration with other Cleveland Clinic institutes (eg. Rheumatology, Endocrinology, Respiratory, Plastic Surgery, or Digestive Disease). Dr. Beidelschies serves as a primary investigator on four of the studies and co-investigator on three of the studies.
Her research involves understanding the impact of the functional medicine model on value-based care. Specifically, she and her team are exploring if the functional medicine model of care can improve health-related quality of life (HRQoL) and biometrics while reducing cost. The Center utilizes PROMIS-10, an NIH validated questionnaire, to assess HRQoL.
Dr. Beidelschies and her team are currently exploring the impact of an innovative shared medical appointment program developed by the Center called Functioning for Life on HRQoL and biometrics. This research involves data collected in the Center’s IRB-approved registry that houses over 6,000 unique patients. In addition, the team is also exploring the impact of the functional medicine model on chronic conditions (eg. diabetes or irritable bowel disease) and surgical outcomes.
Dr. Beidelschies' publications can be found here.
PI: Nazleen Bharmal, MD, PhD, MPP
Pilot Study: Feasibility of a Functioning for Life Shared Medical Appointment in a Community Setting
Mixed method evaluation of a Center for Functional Medicine 10-week pilot program among participants at Cleveland Clinic’s Langston Hughes Health and Wellness Center. Work from this project is currently being reviewed for publication.
Dr. Bharmal's publications can be found here.
PI: Andrei Brateanu, MD, FACP
Multidisciplinary Rounding and Patient Satisfaction
The primary goal of the study is to measure the time hospitalists spend communicating individually with nurses, patients, other physicians, and families. In particular, we are interested in assessing how much time hospitalists communicate with others during Plan of Care Visits (POCVs), which are a new initiative at the Cleveland Clinic. Importantly, we plan to examine the correlation of the breadth (duration) of communication and depth (details) of communication based on the presence of POCVs, with several outcome measures including (a) patient satisfaction (b) the agreement of POC content among physicians and nurses, (c) patients’ knowledge and awareness of their POC each day, (d) length of hospital stay, (e) HCAHPS scores, and (f) efficiencies (such as numbers of pages hospitalists receive).
Assessment Tool Predicting Inappropriate Medical Admissions from the Emergency Department to the Intensive Care Unit or General Medical Ward Requiring Early Transfer to a Different Level of Service
The goal of the study is to create an assessment tool for unplanned transfers from the general medical ward to the intensive care unit within 24 hours of the admission from the Emergency Department and inappropriate admissions to the ICU that do not require invasive intervention within 24 hours of the admission. We will assess the impact of the initial triage on mortality and length of hospital stay.
Residents' Perceptions of Survey Participation and Feedback: Examining Factors that Influence Trainee Participation in Surveys and Survey Response Processes
In this quality improvement project, focus groups will be used to examine the perspectives of residents at Cleveland Clinic regarding survey participation and survey methodology. We plan to conduct a conventional content analysis which will generate themes and sub-themes.
Using the lenses of social and cognitive psychology, we will examine factors which appear to influence participants’ likelihood to participate in surveys, participants’ willingness to tell the truth, perceptions of threat from surveys, and participants’ perceptions of survey participation in relation to feedback processes.
We are interested in exploring possible reasons for non-participation in educational surveys, but also issues which can lead to measurement error, including satisficing (i.e., where answers do not represent true perspectives of participants), perceived problems with questions (e.g., lack of clarity, specificity, leading, double-barreled, etc), and lack of trust and/or feelings of threat when asked to provide feedback.
Dr. Brateanu's publications can be found here.
PI: Jarrod Dalton, PhD
Modeling and Forecasting Atherosclerotic Risk: A Complex Systems Approach
Inequality in health outcomes in relation to Americans’ socioeconomic position (SEP, defined as one’s relative position within a social hierarchy) is rising: a recent study by the Brookings Institution found that life expectancy for men and women in the top 10% of career earnings was over 10 years greater than those in the bottom 10%. Cardiovascular disease – still leading cause of death for Americans – merits study with respect to these findings. The goal of our project is to develop advanced forecasting algorithms for atherosclerotic cardiovascular disease (ASCVD)-related events – both at baseline and longitudinally – using systems-based modeling methodologies which incorporate probabilistic representations of patients’ socioeconomic and environmental characteristics. We believe that the prediction performance of ASCVD risk models can be significantly improved by incorporating socioeconomic and environmental risks, especially in an era where improved primary and secondary prevention and increased socioeconomic inequality have resulted in complex phenomena among elderly Americans with respect to ASCVD risk. Ultimately, this research is anticipated to yield new mechanistic insights and hypotheses, more accurate prediction models for cardiovascular outcomes, and a basis for informing decisions at multiple strategic and programmatic levels.
Forecasting Lung Transplant Benefit: A Dynamic Risk Modeling Approach
Donor lungs for transplantation are limited. The current Lung Allocation Score (LAS) system for rationing donor lungs poorly identifies who is likely to benefit from transplant and has resulted in overall poor survival and increasing use of healthcare resources. Our project focuses on improving the LAS system by: 1) designing better methodologies to more accurately identify the progression of illness in a patient who is awaiting transplant, 2) predicting ideal timing of transplant to maximize the number of years gained from a transplant, and 3) evaluating different allocation strategies and their impact on individual and population level survival. This research will contribute to the development of a more accurate way of determining which patients are most likely to benefit from a lung transplant, which will be of benefit to individual patients and society in general.
Dr. Dalton's publications can be found here.
PI: Aaron Hamilton, MD, MBA, FACP, SFHM
Dedicated Ambulator-Assisted Physical Activity to Improve Hospital Outcome Measures in Elderly Patients: A Randomized Controlled Trial
Patients who are hospitalized for acute medical problems often become deconditioned very quickly. Although nurses embrace the need to mobilize patients early in their hospital stay, they may not have time to get patients out of bed and walk them in the hallways. This pilot study will test whether a dedicated ambulator who is assigned to help elderly patients ambulate 3 times per day will impact patient outcomes in terms of length of stay, hospital complications, cost, and discharge disposition. Data from this study should inform a larger randomized trial.
Dr. Hamilton's publications can be found here.
PI: Jessica Hohman, MD, MSc
Evaluating the Impact of High Intensity Home-Based Rehabilitation
We have implemented this novel care model at four regional hospitals and are conducting both qualitative and quantitative assessments of the acceptability, appropriateness, costs, and patient outcomes for this ‘SNF at Home’ program. Additionally, we have expanded this model to include a higher intensity ‘Acute Rehab at Home’ program for stroke patients, which we are also evaluating.
Understanding Telemedicine Usage
We are examining both how direct-to-consumer telemedicine models can be leveraged for behavioral health, but also differences in use of telemedicine modalities by patient age during the COVID-19 pandemic.
Implementation of an Electronic Consultation Program
We are examining uptake among primary care providers of an electronic consultation system in our electronic medical records to better characterize who it is being used by and how it is being used in our health system. This will inform further refinements in this program.
Primary Care Practice Pattern Variation
We are examining variation in practice among our primary care providers. We have introduced a performance management tool and are examining its impact on performance.
Dr. Hohman's publications can be found here.
PI: Joshua Johnson, DPT, PhD
Understanding and Affecting Rehabilitation in the Acute Care Hospital
While physical and occupational therapists have played a prominent role in the efforts to drive early mobility in the hospital, there remains significant variability in terms of dosing mobilization interventions for hospitalized patients. There is no clear standard to help guide the most appropriate mobilization efforts for any patient population. In addition, evidence is sparse in describing the potential importance of considering a patient’s initial functional level as an indicator of necessary therapeutic mobility dosing and the effect of appropriately-dosed mobility interventions on clinically important outcomes remains unclear. A primary goal this project are to illuminate the associations between patient characteristics, rehabilitation practice patterns, and patients’ outcomes during and immediately following hospitalization. Our goal is to guide ongoing efforts aimed at improving our ability to match appropriate dosing of mobilization interventions with patients who have the greatest potential to benefit from those interventions by, for example, improving their function and discharging home.
Improving Transitions to Post-Acute Care
Patients transitioning out of the hospital often require ongoing physical rehabilitation. Our ability to match patients with the most appropriate level of post-acute care is limited by a host of factors. Among these factors is sparse evidence as to the characteristics of patients that predict successful outcomes in any particular post-acute care setting. Especially as health systems shift toward value-based care delivery across the continuum of care, it is imperative that patients discharged from the hospital to settings that will maximize their outcomes at appropriate costs.
In a series of studies, we are examining the relationship between hospital-measured patient characteristics and outcomes that patients achieve in various post-acute care settings including skilled nursing facilities, inpatient rehabilitation facilities, and home healthcare. We are also measuring implementation and effectiveness outcomes of a novel post-acute care model that modifies the current home healthcare model. With these studies, our goal is to generate findings that help patients and providers consider the optimal setting for post-acute care in order to maximize functional recovery.
Dr. Johnson's publications can be found here.
PI: Anita Misra-Hebert, MD
Evaluation of Team Based Primary Care Redesign Implementation
Primary care delivery is rapidly evolving to team-based models to improve the value of care provided to patient populations. We are studying outcomes of transitioning to team-based models in the Cleveland Clinic Health System. Our projects have included studying the effects of team-based care on physician-patient Interaction, evaluating the quality of progress notes written by physicians vs. medical assistant scribes, exploring views of providers and patients in redesign efforts, and understanding the role and outcomes related to embedding social work services in outpatient primary care. We have evaluated the outcomes of a care coordination program and also a post-discharge home visit program for patients at high risk for hospital admissions, and including patient and provider perspectives in our evaluation. As chair of a quarterly primary care stakeholder advisory panel, I work to ensure that patient perspectives guide the focus of our ongoing study of primary care redesign.
Funding: K08, Agency for Healthcare Research and Quality
Primary Care Physician Decision-Making Behavior
Variation in physician practice style, while necessary for personalizing care to the needs of individual patients, also affects implementation of evidenced-based guidelines. We are specifically examining the approach to prostate cancer screening as well as diabetes treatment decisions, for which shared-decision making with individual patients is recommended, through the use of tools embedded in the electronic medical record.
Predicting Severe Hypoglycemia Events (collaboration with Department of Quantitative Health Sciences, Lerner Research Institute)
We have identified and reported all severe hypoglycemia events defined as Emergency Department (ED) visits or hospitalizations for hypoglycemia in patients with type 2 diabetes(T2D) receiving care in the Cleveland Clinic Health System (CCHS) from 2005-2015. We described patient characteristics associated with severe hypoglycemia events and are creating predictive models to identify risk of developing a severe hypoglycemia event for patients with T2D. In another project we explored the use of natural language processing to identify mild-moderate severe hypoglycemia events through progress notes in the electronic medical record.
Dr. Misra-Hebert's publications can be found here.
PI: Susannah Rose, PhD, MS
Empathy and Artificial Intelligence - Improving Patient and Provider Experience
Funded: Caregiver Catalyst
Measuring the Impact of Care to Share on Patient and Caregiver
Experienced Funded: Caregiver Catalyst
Exploring the Relationship between Patients’ Emotional Experiences during Hospitalization and their HCAHPS Scores
Plan of Care Visits Retrospective Analysis to Assess Relationship with HCAHPS, Empathy and Teamwork
Predicting Patient Experience: Implications for Improving HCAHPS
Dr. Rose's publications can be found here.
PI: Robert Saper, MD, MPH
Yoga for chronic low back pain
Over the past 17 years, I have been PI on studies of the clinical effectiveness of hatha yoga for chronic pain. In 2009, I published results of a pilot study comparing weekly hatha yoga classes vs. waitlist control for patients with chronic low back pain. This was the first yoga for back pain study to enroll a community-based predominantly low-income minority population. This pilot study informed the design of my next project, a dosing trial comparing once- versus twice-weekly yoga classes for chronic low back pain in a similar population; this study found that once-weekly classes had similar effectiveness as twice-weekly classes. I then conducted a randomized non-inferiority trial comparing yoga to physical therapy for a diverse group of 320 adults with chronic low back pain. This study found that yoga was non-inferior to physical therapy for improving pain intensity and back-related function over 12 weeks. Currently we are investigating the use of yoga for chronic pain in patients with opioid use disorder who are on medication addiction treatment.
The effectiveness, safety, and implementation of integrative medicine, particularly in underserved populations
Historically integrative medicine services have been less utilized by low income racially diverse populations. In 2004, I founded the Program for Integrative Medicine and Health Disparities at Boston Medical Center, an urban safety-net hospital. We implemented and studied a variety of innovative interventions and have contributed to knowledge regarding integrative medicine users and the feasibility of providing these services to more diverse populations. We are continuing this work in Cleveland Clinic using observational and prospective clinical trial designs.
Dr. Saper's publications can be found here.