Research

My research intersects public health and informatics. Public health informatics is defined as the systematic application of information and computer science and technology to public health practice research and learning. Public health informatics involves more than simply automating existing activity. It enables the redesign of systems using approaches that were previously impractical or not even contemplated (Yasnoff et al). The field is relatively unexplored, and the potetial is great for new applications. Looking at the Ten Essential Services of public health is a good way to start thinking about ways technology can be applied to achive core public health functions.

Current Projects

MI-HEART - The MI Heart Study (Myocardial Infarct: Health Education and Awareness for Rapid Treatment) is designed to determine the role of clinical information systems in improving the outcome of patients experiencing myocardial infarction. We propose a model which attempts to represent patients' decision making processes (grounded in the Health Belief Model and Social Learning Theory). Using this model, we tailor the web-based intervention to each patient by using specific health data and by delivering a complex mix of educational services including information, decision support, and skills training tools. The primary outcome measure will be reduced prehospital delay (the time between onset of symptoms and decision to seek help).

AETC National Evaluation Center- A year long feasibility study is proposed to extend AETC training activities to incorporate advances in information technology to enable the dissemination of patient specific guidelines at the point of care. The trend in AETC training in recent years has been to complement classroom based education with training methods that focus directly on improving skills for clinical management of HIV. Various forms of clinical training programs and clinical consultation services exemplify the type of AETC training activities that are intended to improve clinical care of people living with HIV. Electronic-based information technology as described above is a potential but undeveloped channel by which the AETC may more effectively support improved clinical care.

A major focus of this study is adapting information technology that generally relies on integration of clinical information systems available in large tertiary care medical centers to AETC priority providers who often work in poor and minority communities, and in settings which lack access to sophisticated information systems. Consequently this study examines the feasibility of developing a web-based interactive system that in principle can be accessed by an AETC training with access to the internet. We further propose to assess the feasibility of this approach in comparison to clinical consultation as two alternative methods that provide information tailored to the needs of a provider's client.

We propose to use the knowledge base contained in the Pocket Guide to Adult HIV/AIDS treatment (May 2001) produced by the AETC National Resource Center. Enabled by technology, we also propose to produce web based patient tailored educational materials to incorporate generation of computer mediated patient tailored educational materials designed to enhance patient adherence to antiretroviral therapy.
Several studies have demonstrated that tailored print interventions are more effective than generic health education materials, particularly for some important high risk populations.8-10 In several studies, patient tailored education materials have been found to overcome some of the most important guideline implementation barriers related to counseling. Barriers reported by providers often include lack of time during a visit to sufficiently elicit the breadth of individual information necessary to tailor counseling and then to actually engage in the counseling.

While Web based dissemination addresses the problem of accessibility, our proposal actively coordinates dissemination and implementation to facilitate the practitioner's ability to apply the recommendations. Studies evaluating single interventions to promote guideline dissemination and implementation often fall short of achieving improvements in provider behavior and patient outcomes. The most critical point arising from systematic reviews is that a multifaceted dissemination and implementation strategy is much more likely to increase the probably of uptake in practice than reliance upon a single intervention. Our approach is multifaceted addressing not only dissemination but also implementation through patient specific recommendations produced by the interactive guideline, and generation of patient tailored education materials to assist providers in counseling patients at the point of care. Specific project aims are to:

1. develop the system;
2. assess the performance of the system;
3. test whether providing healthcare providers with computerized interactive guidelines and patient tailored education represents a feasible and successful approach;
4. compare this technology-mediated approach to the alternative AETC expert consultative approach.