The predominant focus of my work is methodological: decision analysis, cost-effectiveness analysis and related topics. I am currently applying that methodology to three main clinical areas, antiplatelet therapy, nursing home policy, and breast cancer.
Antiplatelet therapy: An ongoing line of my research included evaluation of the cost-effectiveness of antiplatelet medications designed to reduce the risk of thrombotic events, which may include stroke or myocardial infarction. This work has centered on one medication, clopidogrel, either alone or in combination with aspirin, and has also considered different populations: those with a prior stroke, a prior myocardial infarction, peripheral arterial disease, or with recent acute cardiac events, including stroke implantation.
Nursing home policy: Hospitalization is typically viewed as an adverse event for long-term nursing home residents, as it represents a potential failing of preventative care, and may be associated with adverse events for frail elders. It is also costly. In collaboration with researchers from the Brown Center for Gerontology and the Department of Community Health, I have been involved in a line of work evaluating the effect of State policies and nursing home organizational practices on hospitalization related outcomes. We have identified a number of such interventions that are significantly associated with the hospitalization rate. We are currently completing a cost-benefit analysis to evaluate the financial impact of these interventions. This is particularly warranted as there is potential misalignment of financial incentives between the States, which typically pay for nursing home care via Medicaid, and the Federal government, which pays for hospitalizations via Medicare. We are finding that interventions that reduce hospitalization increase costs to the States, but result in savings for Medicare.
Breast cancer: Ongoing work in breast cancer has focused on two topics: cost-effectiveness of emerging breast cancer screening modalities, and using decision-analysis to evaluate breast cancer treatment disparities. I am eliciting quality of life outcomes and conducting cost-effectiveness analyses in synchrony with protocol 6666 of the American College of Radiology Imaging Network. This prospective, multi-institution, multi-year project is designed to assess the efficacy of annual whole breast ultrasound in addition to mammography in women at high-risk of breast cancer. A recently approved supplement will add MRI to the assessed screening technologies.
I have recently completed a project in which I assessed utilities, a subjective measure of quality of life, for breast cancer health states from a socio-demographically diverse sample of women. In accordance with the principles of utility theory outlined by von Neumann and Morgenstern, I used these utilities to model a breast cancer treatment decision, and found that Black, older, less affluent and unmarried women expressed utilities suggesting they would be less likely to accept chemotherapy should they be diagnosed with breast cancer at a stage for which chemotherapy would typically be recommended. This suggests that utilities may reflect sources of disparity, such as access to care, perceived discrimination and financial barriers. I am currently seeking funding to pursue the degree to which causes of healthcare disparities affect utilities.