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Introduction
Skills and Expertise
Publications
Publications (245)
Objective
To estimate changes in life expectancy in 2010-18 and during the covid-19 pandemic in 2020 across population groups in the United States and to compare outcomes with peer nations.
Design
Simulations of provisional mortality data.
Setting
US and 16 other high income countries in 2010-18 and 2020, by sex, including an analysis of US outco...
Background:
Many patients with poorly controlled multiple chronic conditions (MCC) also have unhealthy behaviors, mental health challenges, and unmet social needs. Medical management of MCC may have limited benefit if patients are struggling to address their basic life needs. Health systems and communities increasingly recognize the need to addres...
Background:
Adult opioid use and neonatal abstinence syndrome (NAS) are growing public health problems in the United States (U.S.). Our objective was to determine how opioid use disorder treatment access impacts the relationship between adult opioid use and NAS.
Methods:
We conducted a cross-sectional state-level ecologic study using 36 states w...
Introduction:
Engaging patients to make informed choices is paramount but difficult in busy practices. This study sought to engage patients outside the clinical setting to better understand how they approach cancer screening decisions, including their primary concerns and their preferences for finalizing their decision.
Methods:
Twelve primary c...
Purpose:
Technology could transform routine decision making by anticipating patients' information needs, assessing where patients are with decisions and preferences, personalizing educational experiences, facilitating patient-clinician information exchange, and supporting follow-up. This study evaluated whether patients and clinicians will use suc...
Background:
Electronic surveys are convenient, cost effective, and increasingly popular tools for collecting information. While the online platform allows researchers to recruit and enroll more participants, there is an increased risk of participant dropout in Web-based research. Often, these dropout trends are simply reported, adjusted for, or ig...
In 2013, the US Preventive Services Task Force (USPSTF) recommended low-dose computed tomographic (CT) screening for high-risk current and former smokers with a B recommendation (indicating a level of certainty that it offered moderate to substantial net benefit). Under the Affordable Care Act, the USPSTF recommendation requires commercial insurers...
Patient decision aids facilitate informed decision making for medical tests and procedures that have uncertain benefits.
Purpose:
Health care leaders encourage clinicians to offer portals that enable patients to access personal health records, but implementation has been a challenge. Although large integrated health systems have promoted use through costly advertising campaigns, other implementation methods are needed for small to medium-sized practices where most p...
There is growing interest in offering patients better information to guide their health care decisions, from choosing a clinician or hospital to deciding which surgical procedure to consider.1 The availability and use of such information may be a powerful vehicle to help consumers understand their options and make informed decisions about their car...
Although clinical preventive services (CPS)-screening tests, immunizations, health behavior counseling, and preventive medications-can save lives, Americans receive only half of recommended services. This "prevention gap," if closed, could substantially reduce morbidity and mortality. Opportunities to improve delivery of CPS exist in both clinical...
Importance
The conflicting recommendations for prostate cancer (PCa) screening and the mixed messages communicated to the public about screening effectiveness make it critical to assist men in making informed decisions. Objective
To assess the effectiveness of 2 decision aids in helping men make informed PCa screening decisions.Design, Setting, a...
To assess factors related to use and non-use of a sophisticated interactive preventive health record (IPHR) designed to promote uptake of 18 recommended clinical preventive services; little is known about how patients want to use or be engaged by such advanced information tools.
Descriptive and interpretive qualitative analysis of transcripts and f...
Concern is growing over a potential flaw in the Affordable Care Act (ACA): the mandate to offer first-dollar coverage for all preventive services that receive A and B recommendations from the US Preventive Services Task Force (USPSTF). The USPSTF, an independent panel established during the Reagan administration in 1984, is composed of clinicians w...
The growing influence of practice guidelines has increased concern for potential sources of bias. Two recent guidelines for primary immune thrombocytopenia (ITP) provided a unique opportunity for a systematic comparison of different methods of practice guideline development. One guideline (International Consensus Report [ICR]) was supported by phar...
The United States spends more on health care than does any other country, but its health outcomes are generally worse than those of other wealthy nations. People in the United States experience higher rates of disease and injury and die earlier than people in other high-income countries. Although this health disadvantage has been increasing for dec...
The alarming rise in health care costs haunts our society. The United States now spends $2.6 trillion per year on health care,1 and the spiraling costs are placing unsustainable burdens on employers and workers, Medicare and Medicaid, state and local governments, and American families. A growing proportion of Americans are now foregoing health care...
Clinical practice guidelines are one of the foundations of efforts to improve healthcare. In 1999, we authored a paper about methods to develop guidelines. Since it was published, the methods of guideline development have progressed both in terms of methods and necessary procedures and the context for guideline development has changed with the emer...
Clinical practice guidelines are one of the foundations of efforts to improve health care. In 1999, we authored a paper about methods to develop guidelines. Since it was published, the methods of guideline development have progressed both in terms of methods and necessary procedures and the context for guideline development has changed with the eme...
Clinical practice guidelines are one of the foundations of efforts to improve health care. In 1999, we authored a paper about methods to develop guidelines. Since it was published, the methods of guideline development have progressed both in terms of methods and necessary procedures and the context for guideline development has changed with the eme...
Americans receive only one-half of recommended preventive services. Information technologies have been advocated to engage patients. We tested the effectiveness of an interactive preventive health record (IPHR) that links patients to their clinician's record, explains information in lay language, displays tailored recommendations and educational re...
Americans are enthusiastic about screening, especially cancer screening.1 What could be wrong with screening, especially if it can detect a life-threatening condition at an earlier stage? Trials show that early detection of breast, colorectal, and other cancers can reduce cause-specific mortality rates, and the same could apply to other conditions....
Evidence-based preventive services offer profound health benefits, yet Americans receive only half of indicated care. A variety of government and specialty society policy initiatives are promoting the adoption of information technologies to engage patients in their care, such as personal health records, but current systems may not utilize the techn...
Health disparities by racial or ethnic group or by income or education are only partly explained by disparities in medical care. Inadequate education and living conditions-ranging from low income to the unhealthy characteristics of neighborhoods and communities-can harm health through complex pathways. Meaningful progress in narrowing health dispar...
Unhealthy behaviors, notably tobacco use; unhealthy diets; and inadequate physical activity are major contributors to chronic disease in the U.S. and are more prevalent among socioeconomically disadvantaged groups. Differences in the prevalence of unhealthy behaviors among communities with different physical, social, and economic resources suggest...
The Robert Wood Johnson Foundation Commission to Build a Healthier America was charged to identify strategies beyond medical care to address health disparities in the U.S. related to social and economic disadvantage. Based on insights gained while providing scientific support for the commission's efforts, this paper presents an overview of major is...
The health information technology movement focuses much of its energy on the use of electronic medical records by clinicians, but the use of information technology by patients carries equal promise. Outside of health care, the public routinely uses computers and smart phones to access information and perform tasks with a click of a button. Patients...
Clinical guidelines recommend offering patients options for colorectal cancer (CRC) screening, but the modalities vary by frequency, accuracy, preparations, discomfort, and cost, which may cause confusion and reduce screening rates. We examined whether patients reported confusion about the options and whether confusion was associated with socio-dem...
Barriers experienced by patients influence the uptake of colorectal cancer (CRC) screening. Prior research has quantified how often patients encounter these challenges but has generally not revealed their complex perspective and experience with barriers.
This mixed-methods study was conducted to understand current perspectives on CRC screening.
A t...
Counseling by clinicians promotes smoking cessation, but in most U.S. primary care practices, it is difficult to provide more than brief advice to quit in the course of routine work. Telephone quitlines can deliver effective intensive counseling, but few collaborate closely with clinicians.
This study aimed to determine whether cessation support in...
Appendix A. Outcomes of Randomized Controlled Trials of Prostate Cancer Screening Decision Aids
Supp File 3. Pilot Screening and Internet Usage Questionnaire-Feasibility Study 2 - June 2006
Supp File 2. Pilot Screening and Internet Usage Questionnaire-Feasibility Study 1 - January 2005
Supp File 5. Website Usability Testing Questionnaire
Supp File 4. Booklet Usability Testing Questionnaire
Although intensive health behavior counseling has been demonstrated to help patients lose weight and quit smoking, many payers offer limited coverage for such counseling.
This mixed-methods case study examined how coverage affected utilization of an electronic linkage system (eLinkS) to help adult patients obtain intensive health behavior counselin...
Whether early detection and treatment of prostate cancer (PCa) will reduce disease-related mortality remains uncertain. As a result, tools are needed to facilitate informed decision making. While there have been several decision aids (DAs) developed and tested, very few have included an exercise to help men clarify their values and preferences abou...
Obesity has become a public health epidemic in adults and children. Clinician practices need new models to effectively address overweight in patients, yet, practices lack time and resources. We tested a clinician-delivered intervention that utilized community resources for in-depth counseling for unhealthy behaviors including overweight.
Eligible p...
Colorectal cancer (CRC) screening rates are suboptimal. The most important barriers identified by patients are poorly understood. A comprehensive assessment of barriers to all recommended modalities is needed.
In 2007, a questionnaire was mailed to 6100 patients, aged 50-75 years, from 12 family medicine practices in the Virginia Ambulatory Care Ou...
We estimated how many deaths would be averted if the entire population of Virginia experienced the mortality rates of the 5 most affluent counties or cities.
Using census data and vital statistics for the years 1990 through 2006, we applied the mortality rates of the 5 counties/cities with the highest median household income to the populations of a...
Like Neugut and Lebwohl,1 we welcome the recent successes in promoting colorectal cancer screening. We also agree that offering too many testing options can dampen enthusiasm for screening, but we disagree with their solution: to promote a “preferred” test. Setting aside the question of whether colonoscopy is the “best” test—Neugut and Lebwohl them...
The prostate-specific antigen (PSA) test was introduced in the late 1980s. Twenty years later there remains inadequate evidence about its benefits and harms when used for screening. The seriousness of the disease is unquestioned—prostate cancer claimed an estimated 28 660 lives in 20081—and the human toll impels the public, clinicians, and the publ...
Idiopathic thrombocytopenic purpura (ITP, also known as immune thrombocytopenic purpura) affects both children and adults. In childhood, the peak age is 2–4 years, girls and boys are equally affected, and in most children, the disease is self-limited with spontaneous recovery occurring in several weeks to several months. In adults, ITP is most comm...
What health professionals might call social issues—eg, the economy, jobs, education—now dominate the national agenda. Families, businesses, and government are confronting a recession, unstable financial markets, unemployment, a housing crisis, environmental challenges, and other global threats. Sweeping corrective measures are under way to restore...
Disease prevention has always been the preferred option for promoting health and reducing disease rates. For many, this health argument is reason enough to invest in prevention, economics aside. Others, citing scarce resources, advocate a careful assessment of the costs and savings associated with prevention. It initially costs more to deliver prev...
A variety of factors limit the ability of clinicians to offer intensive counseling to patients with unhealthy behaviors, and few patients (2%-5%) are referred to the community counseling resources that do offer such assistance. A system that could increase referrals through an efficient collaborative partnership between community programs and clini...
Primary care practices able to create linkages with community resources may be more successful at helping patients to make and sustain health behavior changes.
Health behavior-change interventions in eight practice-based research networks were examined. Data were collected July 2005-October 2007. A comparative analysis of the data was conducted to...
Policy makers, researchers, clinicians, and the public are frustrated that research in the health sciences has not resulted in a greater improvement in patient outcomes. Our experience as clinicians and researchers suggests that this frustration could be reduced if health sciences research were directed by 5 broad principles: (1) the needs of patie...
Residents are required to demonstrate competency in communication skills. Prostate cancer screening discussions are examples of complex physician-patient communication processes, requiring an objective presentation of the known risks, potential benefits, and scientific uncertainties surrounding screening. National organizations recommend shared dec...
Translational research means different things to different people, but it seems important to almost everyone. The National Institutes of Health (NIH) has made translational research a priority, forming centers of translational research at its institutes and launching the Clinical and Translational Science Award (CTSA) program in 2006. With 24 CTSA-...
Guidelines encourage primary care clinicians to document smoking status when obtaining patients' blood pressure, temperature, and pulse rate (vital signs), but whether this practice promotes cessation counseling is unclear. We examined whether the vital sign intervention influences patient-reported frequency and intensity of tobacco cessation couns...
Colonoscopy possesses the highest sensitivity of available screening tests for colorectal cancer and polyps, but it also carries risks. Appropriate intervals for repeating colonoscopy are important to ensure that the benefits of screening and surveillance are not offset by harms. The study objective was to examine whether endoscopists' recommendati...
We estimated the costs associated with reducing class sizes in kindergarten through grade 3 as well as the effects of small class sizes on selected outcomes such as quality-adjusted life-years and future earnings.
We used multiple data sets to predict changes in the outcomes assessed according to level of educational attainment. We then used a Mark...
Today's clinicians and health care leaders are perhaps unaware of the decline in household income and the widening of income disparities that are occurring in the United States. The effects of these trends may not become apparent in hospitals or examination rooms until late in the careers of today's physicians or in their children's generation, but...
This chapter highlights the recent call by the Institute of Medicine for the use of a cancer survivorship plan to be provided This chapter highlights the recent call by the Institute of Medicine for the use of a cancer survivorship plan to be provided
to patients and their primary care providers at the end of cancer treatment. The need for evidence...
Social determinants of health, such as inadequate education, contribute greatly to mortality rates. We examined whether correcting the social conditions that account for excess deaths among individuals with inadequate education might save more lives than medical advances (e.g., new drugs and devices).
Using US vital statistics data for 1996 through...
Many clinicians lack resources to engage patients in shared decision making for prostate cancer screening. We sought to evaluate whether previsit educational decision aids facilitate shared decision making.
This randomized controlled study compared a Web-based and a paper-based decision aid with no previsit education. Men aged 50 to 70 years underg...
In 2004, a commentary by Merenstein was published in JAMA describing how he was sued for engaging a patient in shared decision making for prostate cancer screening. The article sparked considerable debate on the impact of litigation on medical care. A natural experiment (a study assessing shared decision making under way at the practice that was su...
To maximize the health of its citizens, society should pursue interventions in proportion to the ability of those interventions to improve outcomes. All else being equal, a strategy that is more effective than its alternative should receive more, not less, attention. Doing otherwise can compromise the health of patients. For example, if interventio...
Editor's Note: This article is a reprint of a previously published article. For citation purposes, please use the original publication details: Harris RP, Helfand M, Woolf SH, et al. Current methods of the U.S. Preventive Services Task Force: a review of the process. Am J Prev Med. 2001;20(3S):21-35. The U.S. Preventive Services Task Force (USPSTF/...
The U.S. poverty rate has increased since 2000, but the depth of poverty experienced by Americans has been inadequately studied. Of particular concern is whether severe poverty is increasing, a trend that would carry important public health implications.
Income-to-poverty (I/P) ratios and income deficits/surpluses were examined for the 1990-2004 pe...
We reviewed published data describing use of beryllium lymphocyte proliferation testing (BeLPT) to determine the appropriateness of BeLPT for screening asymptomatic individuals.
Published studies were identified by computerized literature searches and hand searches of relevant bibliographies and cited references. Critical assessment of evidence foc...
Limited resources make it impossible to deliver all healthcare services to all people. Therefore, it is vital for the nation to adopt rational methods for setting priorities. The work of the National Commission on Prevention Priorities takes such an approach in ranking the relative importance of effective preventive services, and it carries importa...
estimate a 23.1% quit rate from repeatedannual screening and brief intervention for tobaccousers. Extended over the lifetimes of smokers, theintervention would save 2.47 million quality-adjustedlife years at a cost savings of $500 per smoker andbillions of dollars for the nation.The NCPP updates its previous 2001 effort to rankthe relative effectiv...
Dietary guidelines have broad implications for the health of individuals and populations. Increasingly, government agencies and medical organization that issue guidelines have pursued evidence-based approaches. These approaches emphasize a comprehensive, critical, and explicit examination of the scientific evidence that the proposed dietary practic...
We tested whether patients are more likely to pursue healthy behaviors (eg, physical activity, smoking cessation) if referred to a tailored Web site that provides valuable information for behavior change.
In a 9-month pre-post comparison with nonrandomized control practices, 6 family practices (4 intervention, 2 control) encouraged adults with unhe...
Society invests billions of dollars in the development of new drugs and technologies but comparatively little in the fidelity of health care, that is, improving systems to ensure the delivery of care to all patients in need. Using mathematical arguments and a nomogram, we demonstrate that technological advances must yield dramatic, often unrealisti...
Ours is an era in which patients seek greater engagement in health care choices, increasing the demand for high-quality information about clinical options. Providing support for informed choice is not straightforward, however, because of challenges faced by clinicians, health systems, and consumers. Greater use of written or electronic tools can he...
The purpose of this analysis and commentary was to explore the rationale for an integrated approach, within and outside the office, to help patients pursue healthy behaviors.
We examined the role of integration, building on (1) patterns observed in a limited qualitative evaluation of 17 Prescription for Health projects, (2) several national policy...
The United States has made progress in decreasing the black-white gap in civil rights, housing, education, and income since 1960, but health inequalities persist. We examined trends in black-white standardized mortality ratios (SMRs) for each age-sex group from 1960 to 2000. The black-white gap measured by SMR changed very little between 1960 and 2...
Americans receive only half of recommended clinical preventive services—screening tests, counseling about health behaviors, immunizations—due to deficiencies in the delivery system that extend to therapeutic services as well.1 Gaps in preventive care are a special concern, however, because of their importance in maintaining the health of the popula...
Whether Title VII funding enhances physician supply in underserved areas has not clearly been established.
To determine the relation between Title VII funding in medical school, residency, or both, and the number of family physicians practicing in rural or low-income communities.
A retrospective cross sectional analysis was carried out using the 20...
Current guidelines recommend shared decision-making to determine whether the prostate-specific antigen (PSA) test should be performed. At a large family medicine practice in suburban Washington, DC, we administered a sequence of patient and physician surveys to examine the desired and actual level of patient control over PSA screening decisions and...
Colorectal cancer, the second leading cause of death from cancer in the United States, will claim approximately 56,730 lives in 2004.1 Screening for colorectal cancer lowers both the mortality and the incidence of the disease and is widely recommended for persons 50 years of age or older. Interest in screening has increased in recent years but rema...
Projects
Projects (5)
