My prior research centered around decision-analysis and cost-effectiveness analysis applied to a number of clinical domains. These included anti-platelet therapy for the prevention of cardiovascular events, policies to reduce the rate of hospitalization for long-term nursing home residents, emerging breast cancer screening modalities, including ultrasound and MRI, and using utility theory as a tool for the evaluation of breast cancer treatment disparities.

The predominant focus of my work was methodological: decision analysis, cost-effectiveness analysis and related topics. I applied that methodology to three main clinical areas, antiplatelet therapy, nursing home policy, and breast cancer.

Antiplatelet therapy: This work evaluated the effectiveness and cost-effectiveness of antiplatelet medications designed to reduce the risk of thrombotic events, including stroke or myocardial infarction. 

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, our work evaluated the effect of State policies and nursing home organizational practices on hospitalization related outcomes. 

Breast cancer: My work in breast cancer focused on two topics: cost-effectiveness of emerging breast cancer screening modalities, and using decision-analysis and utility theory to evaluate breast cancer treatment disparities.
 

K12 HD43447 (Coustan) Jan 2003-Dec 2005.
NIH Office of Research on Women's Health
Building Interdisciplinary Research Careers in Women's Health Career Development Award.
Breast Cancer and Utilities for Health States Evaluation (BCAUSE)
Goals: To assess utilities for breast cancer health states from a socio-demographically diverse group of women, and to determine the association between socio-demographic characteristics and a treatment decision simulated from those utilities.
Role: BIRCWH Scholar, and project PI.

2 R01 HS013329-04A1 (Col) Sept 2005-Sept 2010
The Agency for Healthcare Research and Quality
Incorporating Temporary Health States into Decision Support
Goals: To develop a web-based tool for measuring women's quality of life during the menopause transition, assess its reliability and validity, embed it in a decision aid system previously developed, and evaluate its impact on women and clinicians.
Role: Co-PI

AHRQ-05-0013 (Hickam) Sept 2005-
The Agency for Healthcare Research and Quality
Eisenberg Center for Clinical Decisions and Communication Science
Goals: To make scientific information about comparative effectiveness accessible to patients, providers and policy makers in ways that promote evidence-based decision making and informed choice. The goal of the Rhode Island Hospital subcontract is to develop prototype decision aids derived from selected AHRQ evidence reports.
Role: Investigator, expert in utility assessment and simulation modeling


ACRIN 6666 (Berg) Jan 2004-Dec 2007.
American College of Radiology Imaging Network, NCI cooperative group and the Avon Foundation.
Screening Breast Ultrasound in High-Risk Women
Goals: To determine the effectiveness of adding annual whole breast ultrasound to routine screening with mammography in women at high risk for breast cancer with mammographically dense breasts.
Role: Co-Investigator, Quality of Life and Cost-Effectiveness Analysis

ACRIN 6666 Supplement (Berg) July 2006-March 2009
American College of Radiology Imaging Network, Avon Foundation
Yield of MRI after combined screening with US and mammography in high risk women
Goals: To determine the effectiveness of screening breast MRI in high-risk women with mammographically dense breasts previously screened with mammography and ultrasound.
Role: Co-Investigator, Quality of Life and Cost-Effectiveness Analysis

1. Lieschman Scholarship, Stanford University, Stanford, CA, 1991-1992.

2. Milton W. Hamolsky Junior Faculty Award, Most Outstanding Scientific Presentation, Society of General Internal Medicine, 26th Annual Meeting, Vancouver, British Columbia. May, 2003.

3. Symposium Chair, 27th Annual Meeting, Society for Medical Decision Making, San Francisco, CA. October 2005.

Society of General Internal Medicine

American College of Physicians

My current teaching centers around 3 key themes:  quality improvement, evidence-based medicine and physical examination.

I oversee a monthly quality improvement rotation for all of our second year Internal Medicine residents, and lead faculty development in quality improvement for our Division of General Internal Medicine.  Our topics of interest include patient experience, readmission rates, telemetry utilization, diabetes surveillance and cancer screening.

I also teach several evidence-based medicine sessions for our Internal Medicine residents, and also oversee our twice monthly journal club.  I also cover this topic as part of the Executive Master's in Healthcare Leadership: Data Driven Decision Making course.

Finally, I supervise weekly physical diagnosis rounds for our third year medical students.