Andrew J. Epstein, Ph.D., M.P.P.
Research Associate Professor in the Perelman School of Medicine
Co-Director of Research at the Leonard Davis Institute of Health Economics
Dr. Epstein is a Research Associate Professor in the Perelman School of Medicine and a Co-Director of Research at the Leonard Davis Institute of Health Economics at the University of Pennsylvania. His additional affiliations include the Abramson Cancer Center and the University of Pennsylvania and the Center for Health Equity Research and Promotion (CHERP) at the Philadelphia VA Medical Center. Previously, he was an Assistant Professor in the Yale University School of Public Health.
Dr. Epstein has 20 years of experience (10 post-doctoral) conducting empirical health services and health economics research studies. His research program combines novel data, careful application of analytic methods and an appreciation for the institutional context, and focuses on better understanding the sources of variation in medical care and their implications for the performance of the delivery system. His research has been published in leading medical, health services research, and economics journals, including JAMA, BMJ, Health Services Research, Medical Care, the Journal of Health Economics, and the Rand Journal of Economics.
Dr. Epstein received a bachelor’s degree in Computer Science from Amherst College, a master’s degree in Health Policy from Georgetown University, and a Ph.D. in Applied Economics and Managerial Science from the Wharton School of the University of Pennsylvania.
Epstein AJ, Ketcham JD. Information technology and agency in physicians’ prescribing decisions. RAND Journal of Economics, 45(2):422-448, 2014.
Epstein AJ, Srinivas SK, Nicholson S, Herrin J, Asch DA. Association between physician experience after training and maternal obstetrical outcomes: cohort study. British Medical Journal, 346:f1596, 2013.
Epstein AJ, Groeneveld PG, Harhay MO, Yang F, Polsky D. The impact of minimally invasive surgery on medical spending and employee absenteeism. JAMA Surgery, 148(7):641-647, 2013.
Epstein AJ, Busch SH, Busch AB, Asch DA, Barry CL. Does exposure to conflict of interest policies in psychiatry residency affect antidepressant prescribing? Medical Care, 51(2):199-203, 2013.
Epstein AJ, Johnson SJ. Physician response to financial incentives when choosing drugs to treat breast cancer. International Journal of Health Care Finance and Economics, 12(4):285-302, 2012.
Epstein AJ, Ketcham JD, Rathore SS, Groeneveld PW. Variations in the use of an innovative technology by payer: the case of drug-eluting stents. Medical Care, 50(1):1-9, 2012.
Description of Program
The mission of the Center for Healthcare Improvement and Patient Safety at the University of Pennsylvania is to advance the field of quality improvement and patient safety in healthcare. Trainees in this Center will receive a degree in the Masters of Science in Health Policy Research (MSHP) program at Penn with a research focus in quality improvement and patient safety, while also gaining leadership experience in healthcare quality and safety administration.
This fellowship will specifically prepare graduates for careers in health services and health policy research related to healthcare improvement in academic, government, community, and industry settings. It will also prepare graduates for careers in healthcare administration in which knowledge and leadership in quality improvement and patient safety are increasingly needed.
Applicants will be physicians completing residency or fellowship training and interested in applying the methods of quality improvement and patient safety research to improve processes and reduce variability in healthcare settings. The program can also be completed as part of a two-year research component of a fellowship or residency.
Interested residents, fellows, or faculty should send curriculum vitae, three letters of recommendation, and a personal statement stating your clinical background, research and quality interests, and reasons for pursuing this fellowship to Jennifer Myers MD, Director of Training Programs for the Center for Healthcare Improvement and Patient Safety. Applications will be accepted up until November 30, 2013. Additional information about the MSHP: http://www.med.upenn.edu/mshp/. For application materials email: email@example.com. Additional information about the CHIPS fellowship can be found at: http://www.med.upenn.edu/chips. Questions about the fellowship program or the Center should be directed to Dr. Myers at: firstname.lastname@example.org.
Kira Ryskina, MD is a 2nd year MSHP student, funded by a two-year Ruth L. Kirschstein National Research Service Award (NRSA) T32 research fellowship in general internal medicine, and is a practicing internist at the PennCare Internal Medicine Associates practice at 3701 Market Street, where she also supervises residents. Dr. Ryskina plans to pursue an academic career as clinician investigator, working to maximize healthcare efficiencies from both physician and patient perspectives, including identifying and reducing low value care, improving diagnostic efficiency, and developing innovative processes to maximize physician output as measured by population health. Recently, Dr. Ryskina completed four studies evaluating the role of training hospitals' care intensity environment in shaping physicians' attitudes toward cost-consciousness and the practice of high value care. Two papers from this work are in press - one in the Journal of Graduate Medical Education and one in the Annals of Internal Medicine. Dr. Ryskina has received local and national recognition for her research, including selection as a 2014 finalist in the Mack Lipkin Sr. Associate Member Award competition by the Society of General Internal Medicine. Dr. Ryskina is the recipient of the Sam Martin Education Pilot Award to conduct a survey study of physicians' views on overtreatment guidelines. In her second year of MSHP, she aims to lay the groundwork for a career defining, assessing, and increasing value in healthcare.
The following is a selected list of Dr. Ryskina's most recent work:
Ryskina KL, Smith D, Weissman A, Post J, Dine J, Gwisdalla K, Korenstein D. US physicians' exposure to, knowledge and practice of high value care during training: a national survey of internal medicine residents. 37th Annual Meeting of the Society of General Internal Medicine. April 25, San Diego, CA (Oral)
Ryskina KL, Korenstein D, Weissman A, Masters P, Alguire P, Smith CD. High value care by US internal medicine residents: using exam vignettes to assess practice. 37th Annual Meeting of the Society of General Internal Medicine. April 25, 2014; San Diego, CA (Oral)
Ryskina KL, Bishop TF. Physicians' lack of awareness of how they are paid: implications for new models of reimbursement. JAMA Internal Medicine. 2013; 173(18):1745-6.
Ryskina KL, Meah YS, Thomas DC. Quality of diabetes care at a student-run free clinic. J Health Care Poor Underserved. 2009;20(4):969-81. Also published in Free Clinics: Local Responses to Health Care Needs. Ed. Virginia M. Brennan. Baltimore: The Johns Hopkins University Press, 2013. p189-201. Print.
Raina Merchant, MD MSHP
Assistant Professor, Department of Emergency Medicine
University of Pennsylvania Perelman School of Medicine
Dr. Merchant is an Assistant Professor (tenure track) of Emergency Medicine at the University of Pennsylvania and has a secondary appointment in the Department of Internal Medicine. She is also the Director of the inaugural University of Pennsylvania Social Media and Health Innovation Lab within the Penn Medicine Center for Innovation.
She attended Yale University for her undergraduate degree, University of Chicago for Medical School, and the University of Pennsylvania for an MSHP and the Robert Wood Johnson Clinical Scholars Program. She serves on several leadership committees within the American Heart Association.
Her research interest is in diffusion of innovation, social media, and resuscitation science. Her work involves development and testing of health related mobile apps and she has conducted several projects evaluating health communication on social/mobile media sites like Facebook, Yelp, Foursquare, Gigwalk, and others. She additionally runs a Twitter lab which analyzes tweets related to resuscitation, critical care, and public health/policy. Much of her work bridges new technologies in the field of cardiovascular health. In this context, she is the Director of the MyHeartMap Challenge- a social media and crowdsourcing project aimed at improving AED access and awareness by engaging the public to serve as citizen scientist.
She has received numerous awards for her work in social media and crowdsourcing. Fall 2012, she was recognized by the Robert Wood Johnson Foundation as one of 10 young investigators likely to have a significant impact on the future of health and healthcare in the US.
The MSHP program is happy to announce the appointment of Marilyn Schapira, MD, MPH as the new HPR-track Director and MSHP Executive Committee member. Dr. Schapira is a clinician-investigator in the area of risk communication and medical decision-making.She has conducted original research in the development and evaluation of decision-aids for prostate cancer treatment and postmenopausal hormone therapy. Dr. Schapira has focused her area of investigation on how patients understand and use quantitative information in the context of clinical decision-making and doctor-patient communication.She has expertise in the measurement of risk perceptions, patient preferences, and quality of life. Dr. Schapira’s research in judgment and decision making also addresses how to effectively communicate risk and uncertainty regarding medical outcomes to patients, physicians, the public, and policy makers. Her current work involves the development of a construct of health numeracy and the evaluation of numeracy as a potential link between formal education and improved health.Dr. Schapira is the immediate past president of the Society for Medical Decision Making, serves on the editorial board of the Journal of Medical Decision Making and currently reviews for the Journal of General Internal Medicine and the Journal of Health Communication. She is a Fellow of the American College of Physicians and a graduate of the Executive Leadership in Academic Medicine (ELAM) class of 2011.
In addition to her work with the MSHP program, Dr. Schapira is a member of the Center for Health Equity Research and Promotion at the Philadelphia VA medical center and Co-Director of the Cancer Prevention and Control Research Program at the Abramson Cancer Center of the University of Pennsylvania. A few of her most recent selected publications include:
Schapira MM, Walker CM, Cappaert KJ, Ganschow PS, Fletcher KE, McGinley EL, Del Pozo S, Schauer C, Tarima S, Jacobs EA: The Numeracy Understanding in Medicine Instrument(NUMi): A Measure of Health Numeracy Developed Using Item Response Theory. Medical Decision Making 2012 Notes: In Press.
Lamba AR, Schapira MM, Singh S, Fletcher KE.: Defining and measuring the effort needed for inpatient medicine work. Journal of Hospital Medicine 2012 Notes: In Press.
Schapira MM, Fletcher KE, Eastwood D, Hayes A, Patterson L, Ertl K, Whittle J: The Development and Validation of the Hypertension Evaluation of Lifestyle and Management (HELM) Knowledge Scale. The Journal of Clinical Hypertension 2012 Notes: In Press.
Schapira MM: How Individual Genetic Test Disclosure May Affect Population Health. Medical Decision Making 2012 Notes: In Press.
Kristin Rising, MD is a 2nd-Year Masters of Science in Health Policy Research student who plans to practice medicine in an academic setting where she can devote time to research issues involving exploration of the overall structure of acute care delivery in the US and how the emergency department (ED) fits into this healthcare delivery system.
Kristin is an attending physician in the emergency department at the Hospital of the University of Pennsylvania (HUP) and is currently funded by a 2-year NIH T32 research fellowship for critical care health services research. She was recently awarded a one-year grant starting July 2013 from the Emergency Medicine Foundation / Emergency Nurses Association to study factors associated with ED bounce-back patients. This grant includes projects to determine which patients are at greatest risk of returning to the ED after ED discharge, when after discharge they are at greatest risk of returning, and top reasons for why they are returning. The end goal of this work is to develop an ED-based intervention to assist patients in a more successful transition home from the ED at the time of their initial ED discharge. (see http://bcove.me/ofe58g5z for a short video of Dr. Rising discussing this grant)
The following is a selected list of Dr. Rising's most recent publications and presentations:
Rising KL, White LF, Fernandez WG, Boutwell AE. Emergency Department Visits After Hospital Discharge: A Missing Part of the Equation. Ann Emerg Med. 2013. 62(2): 145-150.
Rising, KL. Home Is Where the Heart Is (editorial). Ann Emerg Med. In press.
Rising KL, Hollander JE. Observation units: Cost savings through cost shifting (letter). Health Affairs. 2012;31(12):2829.
Rising KL, Hilton JA, Polsky D, Roy, JA, Metlay JP, Carr BG. Hospital- and County-Level Determinants of Emergency Department Admission for Deep Vein Thrombosis. Poster Presentation. 2013 Society of Academic Emergency Medicine Annual Meeting. Atlanta GA, May 2013.
Rising, KL, Wiebe DJ, Victor TW, Hollander JE, Carr BG. Seeking a second opinion: Use of the same versus a different hospital for patients requiring recurrent emergency department visits. Poster Presentation. To be presented at the 2013 American College of Emergency Physicians Research Forum, October 2013.
Rising, KL, Wiebe DJ, Victor TW, Hollander JE, Carr BG. Patient Returns to the Emergency Department: The Time-to-Return Curve. Poster Presentation. To be presented at the 2013 American College of Emergency Physicians Research Forum, October 2013.
Caroline Reinke, MD, MSPH is a 2nd-Year Masters of Science in Health Policy Research student who plans to practice medicine in an academic setting where she can devote time to research issues involving patient safety and surgical education. Currently, Caroline is a PGY5 resident in general surgery at the Hospital of the University of Pennsylvania (HUP), with an interest in general abdominal surgery. She is also a fellow in the Center for Health Improvement and Patient Safety (CHIPS), where she participates in quality improvement and patient safety initiatives within the healthcare system.
During her time on the MSHP program, Dr. Reinke’s leadership positions have included Co-chair of the Housestaff Quality and Safety Council (2012-2013), Medical Student Clerkship Coordinator (2011-2012), Resident Education Task Force member (2011), Resident Executive Committee member (class representative, 2010-present), and Mortality Committee member (2010-present). She was also the recipient of the ASCRS General Surgery Resident Research Initiation Grant Award (2011-2012). The following is a selected list of Dr. Reinke’s most recent presentations:
Reinke CE, Showalter S, Mahmoud NN, Kelz RR. Anastomotic leak and databases: Improving Quality by Identifying Factors that Improve Predictive Value. Poster presentation. American Society of Colon and Rectal Surgeons Annual Meeting. June 2012, San Antonio, TX.
Reinke CE, Kelz RR, Pray L, Williams N, Bleier J, Murayama K, Morris JB. Trimming the Fat: Optimizing Overall Educational Value by Defining Factors Associated with Overall Educational Value and Service to Education Ratio. Oral presentation, Association of Program Directors in Surgery. March 2012, San Diego, CA.
Yang, R, Lin C, Newman A, Reinke CE, Karakousis G, Czerniecki B, Wu L, Kelz RR. State and Federal Health Policy and its Effects on Racial Disparities in Breast Cancer Reconstruction. Poster presentation, Society of Surgical Oncology’s Annual Cancer Symposium. March 2012
Reinke CE, Karakousis GC, Hadler RA, Drebin JA, Fraker DL, Kelz RR. Diagnosis of Venous Thromboembolism as an Outpatient in Patients Undergoing Surgical Treatment for Malignancy: An Analysis of ACS NSQIP Data 2005-2008. Oral presentation, Academic Surgical Congress.• Las Vegas, NV.• February 2012.
HPR 610: Achieving Evidence-Based Health Policy is offered in the spring semester and examines how research can influence health policy. Individual sessions are devoted to topics such as health insurance, obesity, immigrant health, early childhood mental health, and the Nurse-Family Partnership program. Sessions examine: how selection of research methods may influence results; the dialectical relationship between research and policy; and the role of various stakeholders (the media, foundations, government, advocates) in both research and policy debates. Didactic topical research presentations are followed by interactive discussions examining how research findings translate (or, as the case may be, do not translate) into policy. Guest speakers include research and policy experts from the public and private sectors.
HPR 504/NURS612: Principles and Practice of Quality Improvement and Patient Safety
Healthcare delivery is complex and constantly changing. A primary mission of leading healthcare organizations is to advance the quality of patient care by striving to deliver care that is safe, effective, efficient, timely, cost-effective, and patient-centered (Institute of Medicine). The goal of this interprofessional course is to provide students with a broad overview of the principles and tools of quality improvement and patient safety in healthcare, as well as address the knowledge, skills and attitudes as defined by the Institute of Medicine Report and the Quality and Safety Education for Nurses (QSEN) guidelines. It will provide a foundation for students and practicing clinicians who are interested in quality improvement process, research, administration, education, or clinical applications.
Content includes but is not limited to the history of the quality improvement process in healthcare, quality improvement processes and tools, patient safety science, evidence-based practice, and health information technology. Through the use of assigned readings, class lectures and discussion, and exercises students will be become familiar with the use of several quality improvement tools. Students will use the tools introduced in this course to design a quality improvement or patient safety project in their area of interest over the course of the semester.
HPR 504/NURS612: Principles and Practice of Quality Improvement and Patient Safety is offered in the fall semester and is taught by Dr. Jennifer Myers and Dr. Kathleen Burke. This course is affiliated with the Center for Healthcare Improvement and Patient Safety (CHIPS). Two MSHP students per year are awarded fellowships with CHIPS. Bios of current CHIPS fellows can be found here and information about former fellows can be found here.