AHA FIT Newsletter

Describe your journey in becoming interested and involved with quality and outcomes research.

I first became interested in quality and outcomes research when I worked as a research assistant in the Providence Veterans Affairs Medical Center after graduating from college. I was involved in a project evaluating the impact of a multidisciplinary treatment team led by pharmacists on outcomes for veterans with diabetes. That led to other projects including one where we evaluated hospital and treatment team factors on lipid level. In residency I participated in a leadership and management track and after residency I joined the Center for Medicare and Medicaid Innovation which was a group at CMS creating innovative policies to improve the quality of care received by Medicare and Medicaid beneficiaries and help lower costs. I was specifically in a project to allow Medicare to pay for life-style interventions to prevent diabetes. This was eventually approved by the Secretary of Health and Human Services and became one of the largest expansions of preventive services for Medicare beneficiaries.

Since becoming a cardiology fellow at the University of Pennsylvania I have been involved in different research projects related to quality measurement and cardiovascular outcomes. However, over the past year I have started studying the impact of recent health care reform, particularly Medicaid expansion, on cardiovascular outcomes. This is of particular interest to me given it's potential for significant changes in the health outcomes of vulnerable populations.

What advice would you share with those fellows who are interested in designing their first QCOR investigation?

My advice would be to think about a topic that is meaningful to you as well as other important stakeholders such as patients, policy makers, administrators, etc. With the wider availability of data of various types including registries, electronic medical record data, and administrative claims, it is important to think carefully about both the potential impact of a project as well as the statistical methods that would be best suited to the question. A lot of the projects I have worked on in the recent past have involved using publicly available national and state datasets which anyone can access.

Who was your first influential mentor in this space and how did they impact you?

I have had many great mentors in my career so far. One of my first mentors in medicine in general and in outcomes research in particular was Dr. Hank Wu of Brown University/Providence Veterans Affairs Medical Center. Dr. Wu provided a great example of a clinician scientist whose clinical work inspired his research and whose research informed his clinical work. He was the first person who helped guide me through the process of designing a study, analyzing data, writing a manuscript and presenting the results at a national conference.

Does being your involvement with quality and outcomes research change how you practice medicine and/or how you view today's medical landscape?

When I see individual patients in my clinic, I am very much focused on that person rather than thinking of the health system overall. However, I do try to keep in mind that the person I am seeing is part of a community and there are many factors beyond the medications I may be prescribing that will be influencing their health. On the flip side, my clinical work is a very strong influence on my research work and many times questions that have come up about the care of my patients has directly led to research questions that I have then decided to pursue.

How will QCOR research play a role in your next steps/future goals?

I am in my last year of cardiology training currently and I am hoping in a year's time to transition to the role of a health services and policy researcher as well as a general cardiologist. I will continue to pursue health outcomes and policy research after fellowship and hope to be able to mentor students and trainees who are interested in this area as well.

How can the American Heart Association continue to meet the needs of fellows in training interested in QCOR?

By having a distinct council dedicated to outcomes research, the AHA has shown a strong commitment to this important line of work which can have very direct and immediate impact on our patients. I am hopeful that given the extremely complex healthcare system in the US with an evolving policy landscape, the AHA will continue to support trainees and early career investigators as they pursue this area of research.

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