Harvard Catalyst Profiles

Cornell University Medical School		1979
Harvard School of Public Health	M.Sc.	1987

The theme of my research, teaching, and clinical work has been the development and evaluation of management strategies that improve the quality and efficiency of care. This theme is the common thread of my research and administrative careers, and has been the focus of my work with trainees including undergraduate and medical students, house staff, fellows, and junior faculty.

In the early years of my career, the focus of this work was on risk stratification of patients with cardiovascular conditions such as acute chest pain. Through collaborations with trainees in other specialties, I extended these approaches to non-cardiovascular issues such as suspected sepsis and postoperative delirium. While I continue to be engaged in such clinical epidemiological investigations, my work broadened in the late 1980s to include health services research dimensions including economic and cost-effectiveness analyses.

In the early 1990s, I became interested in quality improvement from research and administrative perspectives. This shift led to my assumption of roles including Director of the Quality Improvement Program at Brigham and Women’s Hospital, and, most recently, Medical Director of Partners Community HealthCare, Inc. Although these roles appear to be chiefly administrative, they represent continuing interests in “research and development” for me.

Currently, my major focuses are (1) development and evaluation of disease management programs in our community-based network, and (2) the development of a community-based network for clinical trials. My colleagues and I have performed the first controlled trials of disease management programs, and will shortly be submitting manuscripts for publication. Concurrently, I have continued clinical epidemiological research, and have published the largest study of predictors of major cardiac complications after noncardiac surgery, as well as an ancillary study examining the impact on outcome of right heart catheterization in the noncardiac surgical population.

Finally, I have assumed the role of Associate Editor of The New England Journal of Medicine, and led the development of a new series of reviews aimed at practicing physicians, Clinical Practice. These reviews seek to integrate my interests in evidence-based medicine, guideline development, and quality improvement.