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Geisinger
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Department of Epidemiology and Health Services Research

About

The Department of Epidemiology and Health Services Research offers unique opportunities for epidemiologic, outcomes, health services, social and behavioral health and population health, including community-based research. The department’s mission is to discover the means of understanding health and healthcare.  This department conducts research to address health and healthcare delivery across patients, providers, the health plan and the population.

Core areas of focus include:

  • The science of healthcare delivery, seeking solutions to simultaneously improve the quality and efficiency of healthcare;
  • Comparative effectiveness research (CER), emphasizing health economics and the application of novel methods that improve the validity of findings;
  • Epidemiology;
  • Social and behavioral health research, characterizing behavioral conditions and co-occurring illness influenced by social and behavioral issues and addressing the most challenging barrier to improving outcomes - patient’s health needs and care delivery models that improve access and outcomes;
  • Population and community health, including research on rural communities;
  • Environmental health, focusing on how the local environment influences health.

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Leadership

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Investigators

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Initiatives & Projects

The Built Environment & Obesity

We are evaluating the relation of the food, land use, physical activity and social environments, measured as features of communities, with body mass index by studying more than 160,000 children with a Geisinger primary care provider. We have funding from the National Institutes of Health as part of the Johns Hopkins Systems-oriented Childhood Obesity Center. This new center has three research projects, one of which is centered at Geisinger, and is applying mathematical modeling methods often used in engineering, such as complex dynamic systems and agent-based models, to the obesity epidemic in the region. In phase 2 of this work, we will complete more detailed measurements in both children and communities.

The General Environment & Chronic Rhinosinusitis

We have been studying the epidemiology of chronic rhinosinusitis (CRS) in Geisinger's patients. This is a chronic condition with a significant patient and population disease burden. It has many links to environmental exposures. Geisinger Health System, in collaboration with Northwestern University, The University of Chicago and the Johns Hopkins Bloomberg School of Public Health, has been awarded a program project grant (PO1) by the NIH to study the epidemiology, genetics and pathobiology of chronic rhinosinusitis. The collaborative group, collectively known as the Chronic Rhinosinusitis Integrative Studies Program (CRISP), is the only PO1 recipient in the United States studying this common but poorly understood disease. Program project grants are more complex in scope and budget than individual research grants, and are made available to a group of several investigators with differing areas of expertise who wish to collaborate in research by pooling their talents and resources. These resources will fund continued studies examining the genetic, environmental, molecular and immunologic underpinnings of CRS in order to discover new means of treating this disease. Project 1 of the CRISP is focused on the epidemiology of CRS, using both electronic health records and new primary data collection consisting of surveys, sinus CT scans and sinus endoscopy in patients with nasal and sinus symptoms. This will allow us to develop new approaches to understanding the diagnosis, treatment, natural history and risk factors for this common, disabling condition. For more information on the NIH grant, see the abstract.

Veterans Study

The Veterans' Cohort Study conducted a mental health assessment of veterans in Geisinger Health System. In phase I, we recruited a random sample of 700 veterans for a comprehensive telephone survey evaluation. This survey was completed in 2012. The main focus of the baseline survey was to assess the prevalence of and risk factors for mental health disorder among Geisinger's veteran population. This research is being used to develop the next generation of post-traumatic stress disorders (PTSD) prediction tools and to validate our PTSD prediction model among veterans.

In Phase 2, we plan to assess genetic risk factors for PTSD and related conditions among these veterans. We plan to collect DNA from those who completed the original baseline survey and who also agreed to participate in a future study. In the Phase 2 study, we also are planning to assess the association between genetic variants and the onset of cardiovascular diseases (and related conditions).

Chronic Hepatitis Cohort Study (CHeCS)

The Centers for Disease Control and Prevention (CDC) has provided funding to collect and analyze data on more than 12,500 people with chronic hepatitis B and C. The multi-center project is creating an anonymous electronic data base from medical and insurance records. In addition, for patients who give their consent, a survey developed by the CDC is being collected. Primary study aims include:

  • Determining the extent of health burden and mortality from chronic hepatitis B and C virus infection;
  • Describing the spectrum and natural history of disease associated with chronic hepatitis B and C virus infection;
  • Describing the characteristics of persons in care for chronic hepatitis B and C virus infection;
  • Monitoring modes of transmission and the extent of ongoing risk behaviors;
  • Monitoring the implementation and effectiveness of recommended chronic viral hepatitis screening and care practices;
  • Understanding access and potential barriers to care and treatment (who is in care and who is receiving therapy);
  • Understanding the types of therapy in use, the benefits and risks associated with therapy and factors influencing outcome of therapy for chronic hepatitis B and C virus infection;
  • Understand the costs and potential savings of appropriate care and treatment;
  • Evaluating ongoing behaviors (adherence to treatment, alcohol and smoking) and their impact on health outcomes; and
  • Providing data to evaluate primary and secondary prevention recommendations.

Long-term aims are to use the results of analyses of data from the cohort for public health planning, policy decisions and clinical management of chronic hepatitis B and C virus infections.

Evaluation of Behavioral Health Training for Pediatric Residents

This study compares changes in knowledge and attitude of pediatric residents who are exposed to two different behavioral health service delivery models: an integrated behavioral health/primary care model versus a usual care training program. A survey and knowledge test are administered prior to the intervention and yearly for four years. Focus groups are also conducted prior to the intervention and yearly for four years. Results from the survey, knowledge test and focus groups will be compared for each cohort each year over the duration of the study.

PREPARE NOW

Kidney failure affects more than 115,000 U.S. adults every year. Patients who develop this condition must choose from a variety of treatments, such as dialysis or a kidney transplant, each of which has advantages and disadvantages that may vary depending on the individual. Unfortunately, kidney failure often occurs before patients are aware of the extent of their illness, forcing them to quickly make decisions with lifelong consequences without being fully prepared or able to make informed decisions. Dr. Jamie Green is the co-principal investigator of a PCORI-sponsored project to measure the effectiveness of a new healthcare delivery process to improve the care of patients with advanced kidney disease. The PREPARE NOW study will employ a new care strategy to help patients understand their risks of kidney failure, understand their treatment options, obtain needed support and choose treatments that are aligned with their personal values. In a randomized controlled trial, researchers will measure the effectiveness on the new care strategy on patients’ outcomes. This study is in collaboration with Duke and Johns Hopkins.

 Bari-Kidney Study

The prevalence of obesity has risen dramatically in the last few decades, affecting more than one in three adults in the United States. Presence of class II and III obesity [body mass index (BMI) >=35 kg/m2] is associated with a greater than six-fold increased risk for end-stage renal disease. We and others have shown that reductions in weight are associated with decreased urine protein, which is a marker of kidney damage. However, there is little data on long-term effects of weight loss on kidney function. At Geisinger, one in five primary care patients has a BMI >= 35 kg/m2, and over 300 patients undergo bariatric surgery each year. We are conducting retrospective studies to examine the effect of bariatric surgery-induced weight loss and kidney function. Future study includes conducting a prospective study to investigate the effect of bariatric surgery on measured kidney function. Through funding from the National Institutes of Health, we are conducting studies to determine the long-term effects of bariatric surgery on kidney function. Future goals will be to test remote dietary counseling strategies in patients with kidney disease. 

PREVENT

The goal of this study is to determine if the pediatric care redesign with evidence-based screening, patient-centered education, negotiated decision-making and health information technology to reverse childhood obesity clinical improvement initiative is improving the quality of care by examining process and outcome measures associated with parent-child exposure to PREVENT.

This study aims to validate associations between parenting practices, child behavior and home environments on child growth with earlier studies and add new insights examining associations between FNPA constructs, longitudinal growth trajectories and health outcomes. The findings from this study will be used to continuously improve the quality of care for the primary prevention of pediatric obesity. 

Bladder Cancer Study

Decision-making in older cancer patients is becoming increasingly complex due to other health issues or multiple chronic conditions (MCC). Prior studies suggest that older, sicker patients place more importance on quality of life and functional status as compared to younger, healthier counterparts when making treatment decisions. Superficial bladder cancer has the highest median age at diagnosis (73 years) of all cancer sites, and 75 percent of incident bladder cancers are superficial. Limited understanding of what outcomes are most important to elders with MCC and superficial bladder cancer result in significant gaps in our ability to help physicians and patients make treatment decisions. The objective of this project is to apply mixed methods approaches to identify patient-centered outcomes most important to this population.

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Publications

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