Featured Publications

We conduct research on a diverse array of topics that have included implementation science theory and methods development, substance use, diabetes, incidental findings, and much more.

Please see our highlighted published studies below and contact us with questions, or to discuss your project. 

Critical Care Responses to the COVID-19 Pandemic

In partnership with the Society of Critical Care Medicine, we conducted a multistage investigation of new critical care practices in response to COVID-19 in order to inform clinical leaders on effective change management strategies to identify and integrate changes during sustained public health emergencies. The first stage of the project was a qualitative exploration of the facilitators and barriers to the implementation of new critical care practices, guided by the Consolidated Framework for Implementation Research (CFIR). Through interviews with critical care leaders across the U.S., we identified major implementation facilitators (e.g., staff commitment and resilience, promoted by collaborative feedback and decision-making mechanisms between leadership and frontline staff) and implementation barriers (e.g., lack of access to reliable and transferable information; limited resources; uncollaborative leadership and communication styles). The second stage of the project was a mixed-methods evaluation of the association between implementation climates across hospitals and clinical outcomes of critically ill COVID-19 patients. This study highlighted qualitative and statistically significant associations between implementation factors and COVID-19 mortality rates. Leadership engagement and engaging staff were strongly correlated with low mortality, while implementation climates governed by a trial-and-error approach strongly correlated with high mortality. Check out our publications in the Journal of Clinical and Translational Science and BMC Health Services Research.

Patient Perspectives of the Hospital Discharge Process: A Qualitative Study

Care transitions after hospitalization require communication across care teams, patients, and caregivers. As part of a quality improvement initiative, we conducted qualitative interviews with a diverse group of 53 patients who were recently discharged from a hospitalization within a safety net hospital to explore how patient preferences were included in the hospital discharge process and differences in the hospital discharge experience by race/ethnicity. Four themes emerged from participants regarding desired characteristics of interactions with the discharge team: (1) to feel heard, (2) inclusion in decision-making, (3) to be adequately prepared to care for themselves at home through bedside teaching, (4) and to have a clear and updated discharge timeline. Additionally, participants identified patient-level factors the discharge planning team should consider, including the social context, family involvement, health literacy, and linguistic barriers. Lastly, participants identified provider characteristics, such as a caring and empathetic bedside manner, that they found valuable in the discharge process. Our findings highlight the need for shared decision-making in the discharge planning process to improve both patient safety and satisfaction. Check out our publication in the Journal of Patient Experience. 

Corticosteroid Uptake For COVID-19 after Publication of RECOVERY: A Difference in Difference Model

Quantifying evidence adoption is a key component of implementation science; adoption patterns can also be leveraged to inform the effectiveness of treatments in the real-world. Using quasi-experimental econometric study designs that are resistant to many biases inherent to observational research, our team has expertise in dually evaluating the adoption and effectiveness of interventions into practice in the inpatient setting, especially in intensive care units (ICUs). Examples: (1) using interrupted time series, we found that patients with acute respiratory failure who were admitted to hospitals that adopted respiratory viral panel polymerase chain reaction tests into routine clinical care received fewer antibiotics and had lower risks of Clostridioides difficile infection compared to patients admitted to hospitals that did not adopt these tests (PMID 37748086); (2) we identified highly variable adoption of phenobarbital for the management of alcohol withdrawal across US hospitals; then – using difference-in-differences methods – we found that hospitals that adopted phenobarbital had lower rates of mechanical ventilation and shorter lengths of stay then hospitals that did not adopt phenobarbital (PMID 35833888); (3) using difference-in-differences methods during the COVID-19 pandemic, we found that hospitals that rapidly adopted dexamethasone evidence into practice had improvements in hospital mortality similar to those seen in the RECOVERY efficacy clinical trial. Check out our publication in the The Annals of the American Thoracic Society. 

Assessing Interventions to Increase Appointment Attendance in Safety Net Health Centers

Missed appointments (‘no shows’) are a common problem across healthcare settings, and persist in safety net settings. Missed appointments contribute to increased healthcare costs and delayed patient care. This systematic review and meta-analysis aims to systematically review published studies and identify the most effective strategies to increase appointment attendance in safety net settings. Check out our publication in the Journal of Evaluation in Clinical Practice.

Management Strategies to Promote Follow-Up Care for Incidental Findings

Incidental findings are frequently identified during diagnostic imagine studies, and may require timely follow-up care to determine if they are benign or malignant. However, many incidental findings do not receive post-identification diagnosis. We are partnering with surgical colleagues to conduct two studies to improve follow-up care. One study aims to identify management strategies and performance used to promote guideline-concordant follow-up care for incidental findings. Another study examines the effectiveness of a boilerplate radiology reporting template to improve patient outcomes. Check out our publication in the Journal of the American College of Radiology.

Evaluating a Continuous Glucose Monitoring and Endocrinology eConsult for Adults with Type 2 Diabetes in Primary Care

Type 2 diabetes is increasingly prevalence and carries significant economic and personal healthcare burden. Continuous glucose monitoring (CGM) has been shown to improve clinical outcomes, but it is unclear if CGM may help mitigate healthcare delivery challenges for safety-net patients. This pilot study examines the acceptability and clinical effectiveness of a CGM-enhanced eConsult healthcare delivery model as compared to routine in-person endocrinology consultation.

Barriers and Facilitators to Implementing Priority Initiatives in a Safety Net Hospital

Safety net hospitals, which serve vulnerable and underserved populations and often operate on smaller budgets than non-safety net hospitals, may experience unique implementation challenges. We sought to describe common barriers and facilitators that affect the implementation of improvement initiatives in a safety net hospital, and identify potentially transferable lessons to enhance implementation efforts in similar settings. We used the Consolidated Framework for Implementation Research to guide our qualitative analysis. Check out our publication in Implementation Science Communications.

Developing a New Tool to Standardize the Evaluation of Implementation Science Proposals

The fields of implementation and improvement sciences have experienced rapid growth in recent years. However, research that seeks to inform health care change may have difficulty translating core components of implementation and improvement sciences within the traditional paradigms used to evaluate efficacy and effectiveness research. We operationalized existing recommendations for writing implementation science proposals as the ImplemeNtation and Improvement Science Proposals Evaluation CriTeria (INSPECT) scoring system. We scored pilot grant proposals using INSPECT to evaluate its reliability and utility in measuring the quality of proposed research. Check out our publication in Implementation Science. 

Advancing Quality Improvement with Regression Discontinuity Designs

Robust implementation of process change is critically important to driving evidence uptake and quality, however routine methods to improve healthcare delivery often lack causal inference, and it can be difficult to know whether such efforts are improving patient care. Regression discontinuity  designs can be paired with traditional implementation science approaches, such as evaluation of implementation fidelity (the degree to which implementation is delivered as intended), to increase the value of both approaches. Check out our publication in Annals of the American Thoracic Society. 

Combined Difference-in-Difference/Regression Discontinuity Approach to Evaluate Effectiveness of a Re-admissions Reduction Initiative 

Current methods used to evaluate the effectiveness of healthcare improvement efforts are limited by design complexity or feasibility issues (e.g. randomized controlled trails) or the inability to infer causal relationships (e.g. pre/post designs). This study examined the utility of a novel design in implementation and improvement research – a hybrid regression discontinuity/difference-in-difference design – to evaluate the impact of a re-admissions reduction initiative. Check out our publication in BMJ Quality & Safety.