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<TD BGCOLOR="#CCCCFF" ALIGN="LEFT"><a name="skipnav"></A><DIV CLASS="main"><font face="arial,sans-serif" size="3" color="#000000"><B>Areas of Research</B>
<P>
<B>A. The Program on Health, Work and Productivity</B>
<P>
The Program on Health, Work and Productivity focuses on the rising tide of chronic health problems in the working-age population. From the employee�s perspective, chronic health problems (such as arthritis, for example) frequently interfere with the ability to participate fully in the labor market. And for employers, chronic health problems translate into diminished productivity and increased employee turnover - concerns that ultimately affect the bottom line. This program conducts interdisciplinary research on both the impact of chronic conditions as well as on intervention strategies. The program�s Work Limitations Questionnaire (WLQ) is used worldwide by employers, pharmaceutical firms, researchers and insurers to assess the impact of health and treatment on work productivity. The Program is collaborating with both individual employers and employer coalitions to improve data on employee health and to develop strategies for employee health improvement and productivity-loss prevention. Studies such as the NIH-sponsored Depression in the Workplace project are examining the employment experience of working individuals with depression and identifying work conditions that influence outcome.
<P>
Key contributors to this program include Drs. Debra Lerner (Director), David Adler, and William Rogers.
<P> </P>
<B>B. Primary Care Quality, Access, and Policy</B>
<P>
The Program on Primary Care Quality, Access and Policy began its work in the early 1990s and is currently working with key stakeholders nationwide to advance the metrics and methods for measuring and improving primary care quality. Under this program, Drs. Safran, Rogers and colleagues pioneered a measurement system that characterizes the primary care performance of individual clinicians, practices and organizations. The measurement tools, which have been widely adopted nationally and internationally for research and quality improvement, examine essential features of primary care including continuity, access, integration, health promotion, and detailed indicators of the quality of clinician-patient interactions. In its early years, the program�s grant-supported studies contributed important new knowledge for policymakers, purchasers and providers concerning primary care quality differences achieved under different models of health insurance, and demonstrating the importance of the clinical relationship to achieving desired outcomes of care. Currently, the program is working with numerous state and federal initiatives to test the feasibility and value of adapting these performance measures for widespread and ongoing use in monitoring and improving the quality of primary care.
<P>
Key contributors to this program include Dr. Dana Gelb Safran (Director), Dr. Hong Chang, Dr. Julie Irish, and Dr. William Rogers; Mr. Jamie Belli, and Ms. Angela Li.
<P> </P>
<B>C. Mental Health Services Research Group</B>
<P>
The Mental Health Services Research Group (MHSRG) is a collaborative effort of a multidisciplinary group of health services researchers dedicated to improving the delivery of mental health services in health-care delivery systems, particularly in primary care. Led by Drs. David Adler (Director), Kathy Bungay, PharmD (Associate Director) and Richard Hermann, MD (Associate Director), the MHSRG strives for the practical application of empirical research to improve patient care and inform decision-makers.
<P>
The MHSRG focuses on studies of patient-based outcomes assessment. Under a grant from the National Institute of Mental Health, the MHSRG is studying methods of improving both the detection and treatment of depression and other psychiatric disorders in the primary care setting. The group has developed patient-based health status screening assessments and interventions (including clinical, physician-extender, educational and evaluative assessments) that are practical for use in primary care settings. Though numerous psychiatric treatments (say, various antidepressant drugs) are available to primary care patients, treatment effectiveness ultimately depends on patient compliance. Participation in care by clinical pharmacists has been proposed as a way both to improve compliance and toinsure the safe and effective use of drugs.
<P>
In conjunction with the THI Program on Health, Work and Productivity, the MHSRG is also studying both the impact of depression on work functioning and interventions that can improve the work performance of employees with psychiatric disorders. Furthermore, in conjunction with the THI Center for Quality Assessment and Improvement in Mental Health (CQAIMH), the MHSRG is examining methods to improve the effectiveness of measurement-based quality improvement within health-care organizations.
<P>
Key contributors to this program include Drs. David Adler (Director), Kathleen Bungay, Richard Hermann, and William Rogers.
<P> </P>
<B>D. Program on Measuring and Improving the Quality of HIV Care</B>
<P>
The overriding goal of this program, led by Dr. Wilson, is to engage in multidisciplinary research efforts aimed at understanding and improving the quality of care provided to persons with HIV disease. To this end, the Program investigates the relationships among the following variables: 1) the structural characteristics of the health-care delivery system in which persons with HIV receive care, 2) the characteristics and quality of the relationships between physicians and patients with HIV, 3) adherence to anti-retroviral medication therapy, and 4) technical health-care quality measures and self-reported functional health outcomes.
<P>
Ongoing projects include an effort to assess the impact of managed care on technical and interpersonal measures of HIV-care quality in the greater Boston area, a national assessment of the relationship of structural characteristics of HIV-care sites to technical and interpersonal measures of HIV-care quality, an analysis of the relationship of different characteristics or dimensions of the physician-patient relationship to anti-retroviral medication adherence in HIV disease, the development and validation of a system to code audiotapes of physician-patient interactions for adherence-related content, an evaluation of the effectiveness of a �Breakthrough Series� quality improvement initiative conducted in clinics throughout the country, and the testing of a physician-focused intervention aimed at improving adherence with anti-retroviral medications in HIV disease. These efforts have been supported by grants from numerous sources including the Robert Wood Johnson Foundation, the National Institute on Drug Abuse, and the Agency for Health Research and Quality.
<P>
Key contributors to this program include Drs. Ira Wilson (Director),William Rogers, and Ylisabyth Bradshaw; Mr. William Coady, Ms. Janet Lee, Ms. Sarah Schalman-Bergen.
<P> </P>
<B>E. Center on Child and Family Outcomes</B>
<P>
The Center on Child and Family Outcomes, led by Dr. Parsons, is an interdisciplinary team of physicians, psychologists, mental health professionals, nurses, and health communications researchers. Its mission is to advance the development and application of knowledge regarding the quality of life of families coping with a chronic illness (such as cancer). The Center�s research focuses on: 1) the assessment of quality of life as well as both the functional and fiscal impact of chronic illness on individuals and families, 2) instrument and methodological design and interpretation, and 3) the design and evaluation of interventions to address quality-of-life, functional and fiscal issues.
<P>
Currently, the Center has a number of projects, including a five-year multicenter study of trajectories of health and adaptation after pediatric stem cell transplant; a study of maternal distress, cognitive processing and pediatric bone marrow transplant; a study validating the Quality of Life Assessment (QUOLA), a new brain-specific quality of life measure for children with brain tumors; a study of the quality of survival in patients with congenital diaphragmatic hernia; and a study of the effect of gender and family responsibilities on career advancement and satisfaction (which aims to identify obstacles to advancement and strategies for success).
<P>
Key contributors to this program include Dr. Susan Parsons (Director), Ms. Stefanie Jeruss, Ms. Deborah Mayer, Ms. Jennifer Morone, and Ms. Sara Ratichek.
<P> </P>
<B>F. Health Care and Outcomes in Older Adults</B>
<P>
The Program on Health Care and Outcomes in Older Adults, led by Drs. Safran and Wilson, is addressing critical policy issues related to health care quality, coverage and costs in the Medicare program. The program currently encompasses three national studies of Medicare beneficiaries, funded through a combination of federal and foundation grants. Through its research findings, the program continues to provide policymakers engaged in the debate over prescription drug coverage and Medicare reform with the most current and comprehensive data available on the coverage, costs and experiences of Medicare beneficiaries nationwide. The program�s study comparing the performance of the traditional Medicare program with Medicare HMOs offers the longest available panel of health outcome data under these two systems of care, and provides policymakers with richly detailed information on beneficiaries� enrollment choices, costs, access, quality, and health outcomes over a period of turbulent change in the program. The program continues to provide members of Congress, the Medicare Payment Advisory Commission and the Centers for Medicare and Medicaid Services (CMS) with empirical findings that directly address their needs for information as they work to define the nature and scope of Medicare reform and the role that competition will play in Medicare in the coming years.
<P>
Key contributors to this program include Drs. Dana Gelb Safran (Director), Hong Chang, Julie Irish, William Rogers, Ira Wilson; Ms. Jamie Belli, and Ms. Angela Li.
<P> </P>
<B>G. Center for Quality Assessment and Improvement in Mental Health</B>
<P>
The Center for Quality Assessment and Improvement in Mental Health, under the direction of Dr. Richard Hermann, conducts research into methods of assessing and improving the quality of both mental health and substance-abuse care. Areas of research include: 1) development and testing of evidence-based quality measures; 2) methods for risk adjustment and statistical benchmarking; and 3) organizational strategies and interventions to achieve successful quality improvement (QI) outcomes. Internet-based tools made available by the Center include a widely used inventory of mental health quality measures, a kit to help organizations select goals for QI, and a guide to help consumers identify and obtain quality mental health care.
<P>
Key contributors to this program include Drs. Richard Hermann (Director), David Adler, Kathleen Bungay, and William Rogers.
<P> </P>
<B>H. Pain</B>
<P> </P></font></DIV>
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