CHA 2019 Academic Overview

Cambridge Health Alliance: 2019 Academic Overview

Cambridge Health Alliance: 2019 Academic Overview Preface We dedicate this annual report to Patrick Wardell, our CEO who recently announced his retirement. Academics at CHA has thrived under Pat’s leadership over the past seven years.

The teaching and training programs for students and residents have continued to innovate and we have been able to recruit excellent future health professionals and leaders. New programs have been launched and the research endeavor has matured. Our national reputation has never been stronger!

Patrick Wardell

During this seven-year time period, CHA recruited to our medical staff over seventy-seven new primary care, psychiatry and psychology practitioners who graduated from our own training programs. Amber Frank was our first Harvard Medical School-Cambridge Integrated Clerkship graduate to return to CHA as faculty; she is now the co-director of our Adult Psychiatry Residency program Nearly all graduates of the CHA-Gold Innovation Fellowship, under Maren Batalden’s direction (and inspiration), have assumed roles of greater administrative responsibility at CHA! This time period is also marked by the increased integration of the multiple health professions in teaching, career development and practice.

Of particular note, Pat has invested in the Center for Professional and Academic Development (CPAD) and its staffing and created the Chief Academic Officer position. Many new programs sprouted during this time. They include: the Center for Mindfulness and Compassion, the CHA-Gold Innovation (co-production) Fellowship, the Clinical Learning Environment Review Innovation Awards program (CEO-CLER), the Gold Foundation Research Institute (which, sadly, closed its doors after 6 ½ years), the Pharmacy Residency program, the Art Museum-based Health Professions Education Fellowship and most recently, a new Center for Health Equity Education and Advocacy (CHEEA). The Health Equity Research Lab and the Institute for Community Health have flourished with continued financial support for their administrative infrastructures.

CHA’s faculty has published over 600 peer-reviewed articles during Pat’s tenure, 225 in just the past two years a remarkable achievement for an institution of our size. These papers cover the gamut of areas of interest to our community - health policy, medical education, quality improvement, population health, case studies and more.

Through publication, we advocate for our patients and values, share our lessons and enhance CHA’s national reputation.

Pat Wardell leaves CHA in July with pride of accomplishment and a legacy that should endure for years to come.

Spring 2019

David Bor, MD

Elizabeth Gaufberg, MD, MPH

Chief Academic Officer, Cambridge Health Alliance Charles S. Davidson Professor of Medicine, Harvard Medical School

Director, Center for Professional and Academic Development Associate Professor of Medicine and Psychiatry, Harvard Medical School; Lecturer, Tufts Medical School

Table of Contents Academic Overview

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CHA: A Socially Accountable Health System

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A Brief History of CHA’s Academic Vision

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Academic Vision Statement and Academic Scorecard

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Current and Future Academic Programming

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Profiles: Selected Academic Programs

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Center for Health Equity Education and Advocacy Center for Mindfulness and Compassion CEO Clinical Learning Environment Review (CLER) Innovation Awards CHA - Gold Innovation Fellowship CHA - Pharmacy Residency Program Division on Addiction Harvard Medical School - Cambridge Integrated Clerkship Health Equity Research Lab Institute for Community Health

Appendix I. CHA Faculty A. B. C. D. E.

Academic Appointments and Promotions Faculty Recognition - Local (HMS, Tufts, CHA) Faculty Recognition - Regional and National Faculty Participation in Competitive Fellowship CHA-Gold Innovation Fellowship

II. CHA Educational Programs A. B. C. D. E.

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Adult Psychiatry Training Program - New Initiatives Family Medicine Residency Program - New Initiatives Harvard Medical School Clinical Capstone Clerkship in Emergency Medicine Internal Medicine Residency Program - New Initiatives Oral Health at CHA

III. Publications

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ACADEMIC OVERVIEW CHA’s academic vision statement declares that ​“Academics is Fundamental to Cambridge Health Alliance”​. Just over fifty years ago, Harvard University and the City of Cambridge affiliated in order to radically improve the poor quality of medical care at its public hospital. That decision spawned a new era. Academic programming attracted an excellent medical staff and fostered an increasingly empathetic, curious, socially committed and well-trained medical community. It served to improve the health of our local communities, but moreover, to shape medical practice, education and policy for the nation. Our reputation is increasingly well-known and well-earned in our communities, the Massachusetts State House, Washington D.C, and in academic centers around the nation. It would not be an overstatement to say that CHA would not exist today if it were not for its academic affiliations and pursuits.

We track academic progress in two ways: through this bi-annual narrative report and through a “scorecard”.

This report details our efforts to advance academics and to demonstrate how these synergize with CHA’s strategic priorities. The scorecard highlights several easily tracked and important areas of emphasis and accomplishment.

These are some highlights of accomplishments of the past two years: ● ● ● ● ● ● ●

32 CHA graduates of our residency programs joined the medical staff (77 since 2013); 6 Harvard faculty members were promoted, including 2 to full Professor, and 2 Tufts faculty members to Associate Professor; CHA staff published 225 peer-reviewed articles in journals accessible through the National Library of Medicine’s Medline; 27 new research protocols were approved this past year. The Office of Sponsored Research is managing 30 active grants and contracts; All residency programs have received full accreditation including our fledgling Pharmacy Residency Program; Dozens of faculty members from many disciplines participated in continuing education fellowships; The graduating students rated CHA’s “clinical learning environment” extremely highly.

In this report, we contextualize CHA as a socially accountable health care system, describing the linkage between CHA’s academics and its strategic direction. We include our “Academic Scorecard”. Next, we describe the major recent activities designed to achieve our academic vision, noting the obstacles we face and future plans. Brief descriptions of major initiatives and programs selected by the Department Chiefs follow. The report concludes with an appendix that includes our recent publication citations, award recipients and other useful data.

This report is undoubtedly incomplete. First, the purview of the Academic Council and the Center for Professional and Academic Development is limited to the credentialed medical staff. Second, despite collecting data through multiple means and surveying the Department Chiefs and Academic Council members repeatedly, we anticipate that individuals, programs or plans may have been misstated or left out altogether. We regret any errors and hope our readers will give us feedback to improve the next report.

2019 CHA Academic Report

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CHA: A Socially Accountable Health System Cambridge Health Alliance is a socially accountable health system, dedicated to addressing the priority health needs of its communities through its service, education, research and advocacy. CHA’s mission statement – “to improve the health of our communities” – speaks of this social accountability. We aspire to reduce suffering caused by disease. Yet, in addition to treating illness, we seek to prevent disease and to improve health and wellbeing. We seek to attend to social determinants of health by engaging with community partners, not just with individuals. In proclaiming our motto, “we care for all,” we embrace patients and communities that are especially vulnerable – those who suffer from economic and social deprivation, mental illness and addiction, racism and traumatic experiences. Immigrants, including those seeking asylum, comprise nearly a majority of our patients.

As a highly integrated community-oriented health system, we meld primary care practice with public health. The organization’s CEO serves as the Commissioner of Health for the City of Cambridge. We work closely with governmental agencies and community organizations in a half-dozen cities north of Boston.

Behavioral health care is a “center of excellence” at CHA, extensively programmed in community settings, health centers and hospital units for children, adults and elders.

We provide secondary hospital care at our Cambridge and Everett Hospital campuses and specialty care at many convenient settings. Finally, we engage our patients in tertiary and quaternary care at our affiliates – Beth Israel Deaconess Medical Center for adults and Massachusetts General Hospital for pediatric care.

CHA seeks to serve as an international model. We advocate for policies that support equitable care for all and test organizational structures that facilitate community care and collaborative person-centered caring. CHA embraces the WHO’s Global Strategy on Human Resources for Health, which aspires toward “universal health coverage with safe, effective, person-centered health services by 2030.”

CHA serves as a portal to the best of health care in the world. We offer primary care at a dozen health centers spread throughout the region as well as in high schools, nursing homes, shelters and homes. Primary care clinicians with training in Family Medicine, Internal Medicine and Pediatrics work and teach side-by-side with behavioral health and allied health practitioners at many of these settings.

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A Brief History of CHA’s Academic Vision

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City Council Act 1911: “to authorize the City of Cambridge to incur indebtedness for the erection of a City Hospital ... to serve the medically indigent in the community.”

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April 16, 1961: NBC “White Paper #5: Anatomy of a Hospital.” Presaging Medicare and Medicaid, this nationally televised white paper describes Cambridge City Hospital as chronically underfunded, understaffed and under-equipped.

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1966: Harvard affiliation. The architects of the 1966 affiliation agreement hypothesized that a clear and well-resourced academic vision would attract capable clinicians who would provide robust clinical care. ● A new culture: At the dedication of The Cambridge Hospital’s new building in 1968, Mayor Walter Sullivan proclaimed, “This is a symbol of the unanimity of Cambridge, for here is a building that will house the sick, treat the injured ... without regard to color, religion, economic status or political persuasion.” ● An activist faculty: Within two decades, in addition to establishing academic medicine departments, CHA faculty members co-founded Harvard Community Health Plan, Physicians for Human Rights, the Society for General Internal Medicine, the US Preventive Services Task Force, the Harvard Center for Health and the Environment, and Physicians for a National Health program.

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1996: CHA re-chartered as a Massachusetts Public Authority, to enable expansion of clinical services and academics beyond the municipal boundaries of Cambridge. Somerville Hospital and its affiliated health centers were purchased. Whidden Hospital (Everett) was acquired in 2001 and new health centers were subsequently constructed in Somerville, Everett, Malden and Revere.

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2001 to present: ● Affiliation agreements renewed with Harvard Medical School, Tufts University School of Medicine, Harvard School of Dental Medicine and Harvard School of Public Health; ● Academic Council established to ensure that CHA pursues its academics with the highest integrity and creativity and in concert with the institution’s strategic plan. The council includes representation from the major academic departments and administrative leaders, and it reports to CHA’s CEO and its Board of Trustees; ● CHA Board of Trustees affirms the Academic Vision Statement; ● Tufts Family Medicine Residency program acquired; ● Cambridge Integrated Clerkship founded; ● New academic centers inaugurated: the Institute for Community Health, the Center for Health Equity Research, the Center for Mindfulness and Compassion and the Center for Health Equity Education & Advocacy;

Over the past half century, CHA has attracted a talented faculty. In addition to its clinical excellence, the faculty has contributed to high-profile academic and service innovations. Today, CHA is perhaps best known for its public mission, its community-based and highly integrated primary care model, and its most celebrated educational innovation – the HMS-Cambridge Integrated Clerkship.

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Academic Vision Statement Academics is fundamental to Cambridge Health Alliance. Our scholarly environment sustains clinical excellence, fosters discovery and nurtures the next generation of clinicians and leaders to serve our communities.

CHA’s success in improving the health of our communities and modeling innovations for the nation depends on the robustness of our academics. CHA’s scholarly environment: ● ● ●

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Attracts and sustains excellent clinicians from the multiple health professions by fostering curiosity, continuous learning and professional growth; Promotes efforts to continuously improve health outcomes for our patients and their communities through the most equitable, efficient, effective, safe, timely and patient-centered care; Fosters discovery of new knowledge about the treatment and prevention of illness, promotion of population health, design of innovative educational models, implementation of new systems of care and deployment of new health policies; Nurtures the education of health professionals to provide skilled compassionate care and innovative leadership for CHA’s communities.

Academic Scorecard Academics is Fundamental to CHA. Our Scholarly Environment: Attracts and Sustains Excellent Clinicians: 1. Recruit and train excellent residents who matriculate to join the CHA medical staff a. 2017-18: 32 CHA residency graduates joined the medical staff (7 Family Medicine, 14 Internal Medicine, 10 Psychiatry, 1 Podiatry); b. Since 2013, 77 graduates joined the medical staff; c. Of the 21 who joined in 2015-16, 15 remain at CHA. 2. Advance medical staff academic promotions a. HMS (July 2017- Oct 2018): 3 Assistant Professor promotions, 1 Associate Professor promotion, 2 Professorial promotions; b. Tufts: 2 Associate Professor promotions.

3. Recognize individuals’ and CHA’s excellence through Academic Awards a. CHA Academic Council awards: 7 b. HMS and Tufts recognition: 12 c. National/International awards: 6

2019 CHA Academic Report

Fosters Discovery of New Knowledge 1. Disseminate peer reviewed publications in concert with CHA’s mission - for example, in education, policy, clinical practice, professional development, etc. a. 225 peer reviewed publications in 2017-8 b. 203 peer reviewed publications in 2015-6 c. 139 peer reviewed publications in 2013-4 2. Increase the number of CHA faculty or staff submitting IRB applications and/or receiving grant funding as principal or co-principal investigators. a. 30 active grants/contracts; b. $4.012,000 in Total Expenditure (direct and indirect); c. 27 new research protocol applications from 20 unique PIs.

Nurtures the Education of Health Professionals 1.

Engage medical staff in competitive fellowships or scholarships – for example, Harvard Macy Institute, HMS Academy, Mount Auburn Health Professions Education, CHA-Gold Innovation Fellowship, Rabkin or Diversity Fellowships. a. 10 Macy, 13 CEO-CLER; b. 13 CHA Innovation Fellowships; c. 1 Shore Fellowship.

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Current and Future Academic Programming Most CHA medical and advanced practice clinicians’ departments pursue educational and research programming.

CHA’s Academic Council promotes these activities, seeks adequate resourcing and fruitful collaborations, and ensures adherence to accreditation standards and requirements. The Center for Professional and Academic Development (CPAD), under Elizabeth Gaufberg’s direction, leads institution-wide programming to augment these departmental efforts in alignment with CHA’s strategic direction. CPAD’s three principal leaders - Drs. Elizabeth Gaufberg, Maren Batalden and David Bor - foster collaboration and serve as mentors, intellectual and practical resources to our medical community. While the purview of the Academic Council and CPAD is limited to the credentialed medical staff, many activities extend to the wider CHA community. Ellen Hedstrom and Ellen Pridham provide superb administrative support for CPAD’s efforts.

In this section, we summarize the obstacles, current and future strategies to achieve that vision for each of the four aspects of CHA’s Academic Vision.

1. CHA’s Scholarly Environment: Attracts and sustains excellent clinicians from the multiple health professions by fostering curiosity, continuous learning and professional growth Strategies: ● Attract applicants to the residency programs and faculty by expanding CHA’s national presence.

We are known primarily for our mission-orientation, out-sized presence as innovators in medical education, policy research, improvement science and political advocacy. Continually nourish and expand these activities; ● Position the training programs to serve as escalators to our medical staff for well-trained, acculturated and loyal future faculty members; ● Increase formalized post-graduate training for allied health professions; ● Invest in creative means to increase the attractiveness of CHA faculty careers for under-represented minorities; ● Continue to innovate in primary care delivery, med-psych integration, population health etc. in order to improve not just patient care but also the staff’s experience in caring. Evaluate innovations carefully and publish successes and failures.

Obstacles: ● Existential threats to the medical professions: The increasingly transactional nature of today’s medical care (including pay for performance), coupled with an intense focus on externally generated clinical goals, many of which are not evidence-based, undermine many of the values that brought clinicians to the profession: altruism, clinical autonomy and the spirit of scientific inquiry; ● Time pressure: The plethora of administrative tasks attendant to clinical practice and intensifying productivity demands distract clinicians from academic pursuits not to mention from attending to their patients’ problems. Furthermore, these tasks crowd out opportunities to develop and sustain mastery of their professional roles; ● Burnout has afflicted health professionals across the country and CHA is no exception. Only a small minority of primary care clinicians are able to manage full-time employment, owing to the job stress and inefficiencies; ● CHA is an academic cultural outlier: The dominant academic reward system values the basic sciences and clinical specialization more highly than CHA’s faculty’s strengths: c​ommitments to practice innovation, improvement science, social ​and policy research and clinical practice in primary care and interprofessional education;

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Sustaining a diverse workforce: CHA attracts many under-represented minorities to our residency programs, however we have been less successful in retaining a diverse workforce or leadership.

The high cost of living in metropolitan Boston coupled with its history of racism are major barriers. Nonetheless, we should do better.

Accomplishments: ● These past two years, we have recruited and retained a record number of graduates; ● The Department of Pharmacy Residency Program was founded last year and received full accreditation; ● A new Chair of Psychiatry was appointed. Philip Sung-En Wang, MD, DrPh, is an extraordinarily energetic leader and humanist, and an accomplished researcher in areas of particular relevance to CHA; ● Under the appellation, Reach for the Stars, Pat Wardell sponsored a competition to choose “a high-profile, paradigm-changing educational innovation that will bring joy and discovery to CHA’s clinical community and value to our communities and the nation.” The winning proposal was designed by Danny McCormick and Gaurab Basu - The CHA Center for Health Equity Education and Advocacy (CHEEA); ● David Hirsh was chosen as Director of HMS Academy and was awarded the “George E. Thibault Academy Professorship”, an HMS endowed chair; ● All but one of CHA-Gold Innovation Fellowship graduates found administrative positions with greater responsibility and influence at CHA. Current Activities: ● Sponsor workshops on the academic promotion processes; ● Participate on the Provider Engagement Steering Committee; ● Offer quarterly RFP’s for members of the medical staff to apply for modest support (consultation, educational, funding) for professional development activities; ● Offer staff recognition competitions and programs: Academic Council Awards, Macy Fellowships, Innovation (Co-production) fellowship.

Future Activities: ● Reformat the co-production fellowship to focus on developing mid-career clinician-administrators; ● Subsidize residents from low SES to promote diversity at CHA; ● Offer residency programs for advanced practice nurses and newly hired RN’s through the Department of Nursing; ● Establish formal affiliations with advanced practice nursing schools; ● Work with CHA’s press office to increase dissemination of academic pursuits in the lay press; ● Work with Department Chiefs and schools to guide academic advancement; ● Create a new endowed HMS teaching award for CHA faculty: The Sandra and Arnold Gold Award for Humanism in Education; ● CPAD to consider leadership in: Clinician Health Committee, Office for Diversity and Inclusion; Communication and Resolution program (apology and disclosure coaching, peer support, early resolution); an Academy at CHA; ● Evaluate the Center for Professional and Academic Development (CPAD) effectiveness.

2. CHA’s Scholarly Environment: Promotes efforts to continuously improve health outcomes Strategies: ● Continue to work with administration to carefully evaluate and disseminate our lessons learned; ● Employ the front-line, uninured, critical eyes and creative minds of our students and trainees to identify opportunities and propose methods to improve the quality of our practice, training and research environments.

Obstacles: ●

The public sector: CHA is highly dependent upon public funding and, thus, the political system that allocates funds;

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Our political lobbyists and financial managers understandably fear that public disclosure of unsuccessful innovations or critique of current policies could undermine our funding. This sensitivity is compounded when financial reimbursement is tied to accomplishing pre-specified outcome measures; Our advocacy community sometimes feels similarly restrained; Fiscal uncertainty discourages long term investments.

Current Activities: ● Sponsor a small ​grants program for trainee-faculty partnerships: CEO Clinical Learning Environment Review (CLER); ● Residency programs require quality improvement projects: TUSM FM Residency Community Health Projects; ● Internal Medicine Research-based Advocacy Curriculum and MGH Pediatrics Residents’ (at CHA) Community Resource Surveys; ● CHA-Gold Innovation Fellowship (for faculty) mentors QI projects that are chartered by the sponsoring administrator; ● Annual “Academic Poster Session” features educational innovations, quality improvement initiatives, policy investigations and case studies; ● Continued participation in the HMS Primary Care Division quality improvement initiative; ● Increase contracting to ICH to evaluate innovations that have the potential to improve the quality and manner of care. Recent examples include: the use of scribes in primary care; evaluation of our ACO; complex care initiative; ● Improve the “clinical learning environment” (culture of safety, SERS reporting, resident workload), integrate learners into QI teams, improve overall well-being; ● Celebrate and facilitate scholarly approaches to driving practice assessment and change, for example: ○ studies of immigrant experiences ○ med-psych integration ○ use of scribes ○ social justice coalition ○ health & law immigrant solidarity network Future Activities: ● Shepherd the fledgling Center for Health Equity Education and Advocacy; ● Track the effectiveness of the various student, residency program curriculum and faculty projects (co- production Fellowship) focused on quality.

3. CHA’s Scholarly Environment: Fosters discovery of new knowledge Strategies: ● Foster collaboration between established researchers and eager clinicians who have academic proclivities but neither time nor experience to pursue research independently; ● Offer web-based and in-person coaching, trainings and consultations for interested faculty; ● Encourage continued formal evaluation of several of our institutional priorities, for example, the ACO, med-psych integrative care, addiction care, patient centered medical home, etc.; ● Seek research or programmatic funding from local philanthropists including Kendall Square entrepreneurs, potentially in concert with HMS; ● Build CHA’s capacity to seek such research funding​.

Obstacles: ● Limited funding: while most academics complain of scant grant funding, the research agenda our faculty pursues is not prioritized by external foundations or the federal government. Philanthropists resist donating to public sector institutions (“that’s why we pay taxes!”) and our grateful patients are rarely wealthy enough to contribute. Patient revenues do not generate an ample surplus that could be invested in research infrastructure, for example, a fully functioning grants management office;

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As above, the administrative time demands on most CHA practitioners crowds out time for academic pursuits; Many faculty members have important observations to test or share but lack the skills to study and publish.

Current Activities: ● Fund ICH to consult to CHA researchers in assisting with study design, statistical analysis and grant writing; ● Embed scholarship into CHA’s strategic activities, including the ACO, waiver agreements, community networking and quality improvements; ● Provide consultation on research methods/grant writing faculty development in teaching; ● Current investigations cluster under the following rubrics: ○ I​nnovations in medical education: Drs. David Hirsh, Barbara Ogur and Elizabeth Gaufberg in Internal Medicine; Dr. Allen Shaughnessy in Family Medicine; Drs. Marshall Forstein and Todd Griswold in Psychiatry, and others; ○ N​ational and regional health policy, with special emphasis on disparities, inequities and the care: Drs. Danny McCormick, David Himmelstein, Steffie Woolhandler in Medicine and Dr. Benjamin Cook in Psychiatry and Leah Zallman in Medicine and ICH, and others; ○ C​ommunity/population health improvement with a special emphasis on community-based participatory research – Institute for Community Health; ○ H​ealth services improvement and implementation science – Dr. Benjamin Cook and the Health Equity Research Lab and the Institute for Community Health are leaders in this realm. In addition, Dr. Brian Swann, Chief of Dentistry, and Dr. Greg Sawin, Family Medicine Residency Program Director, have collaborated to develop a new discipline, the Oral Health Professional. They are co-training a dually boarded MD-DMD for a future leadership role in that fledgling field; ○ M​edical Humanism and the clinician-patient relationship - Drs. Elizabeth Gaufberg and Maren Batalden leaders in this area; ○ M​indfulness and Compassion Research, including ground-breaking work in Mindfulness-Based Interventions in Primary Care Settings (Zev Schuman Olivier and Center for Mindfulness and Compassion team); ○ A​ddictions studies: Drs. Howard Shaffer and Debi LaPlante lead CHA’s Division on Addiction which dedicates itself to ameliorating the medical, social and economic burdens of addiction through research, education, outreach and policy development. Dr. Zev Schuman Olivier including app-based peer coaching for addictions; Ellie Grossman and David Roll in Medicine and others; ○ E​nvironmental and occupational health: Dr. Stefanos Kales in workers’ health, and Dr. Pieter Cohen for his investigations of the adverse consequences and inadequate regulation of dietary supplements.

Future Activities: ● Design, implement and promote the external and internal academic websites including links to academic resources and a directory of faculty interests, etc.; ● Seek additional evaluative/research roles at CHA for the Health Equity Research Lab, ICH and Division of Social Medicine, and encourage collaboration between the various research groups; ● Design evaluation methods for the new CHA programming: The Center for Health Equity Education and Advocacy, the Art Museum-based Health Professions Education Fellowship; ● Improve research support including outreach to the philanthropic community; ● Promote the scientific basis of our profession as an evidence-based means to eliminate overuse of Dx & Rx interventions (possibly in concert with the Lown Institute); ● Support new Chief of Psychiatry and CHA’s research centers to raise philanthropic funds.

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4. CHA’s Scholarly Environment: Nurtures the education of health professionals Strategies: ● Design additional curriculum at CHA that prepares learners at all levels to work at CHA, e.g., with emphasis on topics like population health, team-care, primary care, med-psych integration, improvement science, advocacy, the care of disadvantaged, disenfranchised populations including immigrants, and . . .with methods like relationship-centered and inter-professional education; ● Assist the department chiefs to manage academic promotions for their staff; ● Nurture affiliation relationships with targeted area health professional schools; ● Advocate for changes in/exceptions to some HMS appointment rules; ● Promote the concept that the “learning environment” and the “clinical environment” are one and the same, requiring the same nurturance.

Obstacles: ● HMS appointments: HMS requires 50 hour/year annual teaching for an academic appointment.

While CHA’s faculty greatly values its academic appointments and our learners regard CHA faculty highly, not all faculty members can satisfy this requirement (and other detailed rules) annually. Our primary care-oriented faculty engages in teaching activities that are not rewarded by current ​HMS ​rules: ​inter-professional teaching, training learners from schools other than Harvard, and educating our communities.

Current Activities: ● Reach for the Stars proposal selected: the “Center for Equity Education and Advocacy” ● Leadership changes: ○ Yamini Saravanan and Tara Singh chosen as CIC Associate Directors; ○ David Hirsh chosen as Director of HMS Academy and was awarded the George E. Thibault Academy Professorship, established by the Josiah Macy Jr. Foundation; ● Consulting on CV preparation for those seeking promotion by longer service criteria; ● Addressing student criticism of the “learning environment”. The areas for improvement include “providing constructive feedback” and occasional “abusive behavior by attendings”. Of note, CHA is generally held in very high regard and these issues are relatively infrequent. ● Current Teaching Activities: ○ Medical students ■ Cambridge Integrated Clerkship ■ New courses: subinternship in Medicine; ■ Plethora of electives mentoring and precepting students and residents at affiliated schools and programs. Clinical Management of Addictions, Occupational-Environmental Health, ​Community ​Dentistry, Emergency Medicine – Care Continuity, Community Participatory Research Projects; ■ Family Medicine Intro to the Profession; Practice of Medicine and Electives; ■ Medicine intro to the Profession, Practice of Medicine, HMS-Cambridge Integrated Clerkship (CIC) and Electives; ■ Core Clerkship, Tufts Affiliated OB/GYN Residency; ■ Pediatrics CIC, Psychiatry CIC, Core Psychiatry Clerkship; ■ Surgery CIC and Electives; ■ Interprofessional education involving HMS CIC students and PA students. ○ Residents ■ Family Medicine; ■ Graduate Dentistry, Oral Health and General Dentistry Residency; ■ Emergency Medicine BIDMC Affiliated Emergency Medicine Residency; HSPH Occupational Medicine Residency Obstetrics & Gynecology;

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Primary Care Residency; Transitional Internship; MGH Affiliated Pediatrics Residency; Affiliated Surgery Residency; Podiatric Medicine Residency; Adult, Child and Adolescent, Geriatrics and Psychosomatic Psychiatry Residencies; Psychology Training Healthcare Advocacy Elective, Financing Public Sector Mental Health Services, GLBT Community Outreach, Linguistic Mental Health and Community Health Education; ■ Accreditation of the pharmacy residency program. Plans underway for an advanced practice nursing residency program. ○ Fellowships ■ Tufts Family Medicine Residency; Master Teacher Fellowship; Reproductive Health and Advocacy; ■ HMS General Internal Medicine Fellowship; ■ Art Museum-based Health Professions Education Fellowship - in collaboration with the Harvard Macy Institute and the Museum of Fine Arts, Boston. ○ Continuing Education ■ Innovation/Co-production Fellowship ■ Psychiatry Department CME Program ■ Harvard Macy Scholarships ● Initiatives that were sunsetted: ○ Gold Foundation Research Institute - The Foundation’s Board changed its strategic direction; ○ Family Medicine grant at HMS - HMS administration decided not to invest in family medicine at this time.

Future Activities: ● Assist CHEEA to implement its strategic and sustainable plan; ● Develop advanced HMS electives in areas of interest; ● Develop and evaluate the new HMS Subinternship in Medicine; ● Foster mentoring programming; ● Consider CHA Academy; ● Facilitate Allied Health Professions’ training aspirations; ● Convene fourth Cohort of CHA-Gold Innovation Fellows.

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Profiles: Selected Academic Programs

1) Center for Health Equity Education and Advocacy Introduction: In 2018, CEO Pat Wardell offered to “invest in a high-profile, paradigm-changing educational innovation that would bring joy and discovery to CHA’s clinical community and value to our patients and the nation”. He regarded the Cambridge Integrated Clerkship as a model of such an innovation and sought CHA’s next game-changer?

Chief Academic Officer David Bor assembled a steering committee and conducted listening tours across CHA. They identified two areas for focus “health, beyond healthcare” and “team care” - that were ripe for innovation, aligned with CHA’s strategic direction and critically important for workforce development. They solicited letters of intent to address one or both of these themes and to satisfy a number of funding requirements and priorities (e.g., game changer, practicable, sustainable, etc.). Two review committees (selected to avoid conflicts of interest) - one external to CHA and one internal including board members - reviewed the proposals and selected “The Center for Health Equity Education and Advocacy” for three years funding to begin in July 2019.

The following is a brief description: The Center for Health Equity Education & Advocacy (CHEEA) will be established in July 2019. CHEEA’s founding co-directors are Danny McCormick, MD,

MPH and Gaurab Basu, MD, MPH. The motivation for the center is to respond to the structural causes that result in healthcare inequities throughout the healthcare system.

CHEEA will provide the curriculum Danny McCormick MD MPH and community needed to support and train an interprofessional audience of clinicians as they develop as agents of social change for health equity. CHEEA also spotlights the social accountability of institutions to invest in the development of trainees such that they can engage with and address the social factors that underlie health inequities. The objectives of CHEEA are: 1) to

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create curricula for multiple types of health professions at different career stages; 2) to improve the health of CHA’s communities; 3) to be a center of excellence on health equity education scholarship; and 4) to train the next generation of health equity educators.

CHEEA currently plans to develop the following programs: 1) a CHA wide interprofessional health equity curriculum; 2) a Boston-wide pre-internship health equity daylong workshop; 3) a health equity medical education fellowship; 4) a Gaurab Basu, MD, MPH health professions scholars curriculum for faculty level educators; and 5) CME course.

CHEEA seeks to create a healthcare workforce that is better prepared to improve health equity in the US and develop innovative models of curriculum development that reimagines the role medical education can play in promoting health equity.

Selected Bibliography Basu G​, ​Pels RJ​, ​Stark RL​, ​Jain P​, ​Bor DH​, ​McCormick​. Training Internal Medicine Residents in Social Medicine and Research-Based Health Advocacy: A Novel, In-Depth Curriculum. ​Acad Med​.​ 2017 92(4):515-520. doi: 10.1097/ACM.0000000000001580.

2) Center for Mindfulness and Compassion The Center for Mindfulness and Compassion (CMC) (​chacmc.org​) is a vibrant multidisciplinary center integrated into CHA’s Department of Psychiatry. CMC’s offices and research lab are located at 1035 Cambridge St, Cambridge, MA Zev Schuman-Olivier, MD 02141, and CMC’s clinical and research mindfulness groups are held throughout CHA primary care and outpatient psychiatry sites.

CMC is dedicated to enhancing the health and well-being of CHA’s diverse community by integrating evidence-based mindfulness and compassion into

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health care. CMC’s mission is realized across five main arms: patient care, employee well-being, scientific research, professional education and community service. CMC was founded in 2014 with broad support from the CHA executive team, faculty and staff. Funding for CMC came from an Arthur Vining Davis Foundation healthcare system transformation grant, the Gold Foundation, CHA Executive Leadership fund and the CHA Department of Psychiatry. CMC has been supported by a team of nine core faculty members, including accomplished mindfulness and compassion teachers, thought leaders, educators and clinical researchers with expertise in compassionate care and the integration of mind-body medicine into behavioral health and primary care. In the past five years, CMC has grown to support nine full-time and six part-time staff members, as well as 8-12 volunteers and interns per season. CMC also continues to welcome a number of fellows and faculty from universities around the world. CMC serves CHA staff, the local community and healthcare professionals by offering regular high-quality evidence-based mindfulness and compassion programming.

CMC investigates mechanisms of mindfulness and compassion-based interventions in clinical populations as well as methods for implementation of these evidence-based programs in the healthcare system. CMC is a core partner of the NIH Science of Behavior Change Project focusing on the mechanisms through which mindfulness influences self-regulation.

CMC investigators have ongoing collaborative research with federally-funded investigators at institutions including Dartmouth College, Massachusetts General Hospital, Brigham and Women’s Hospital, University of Massachusetts Medical School, Brown University, Vanderbilt University, Georgetown University, University of South Florida, Universit​é ​Laval in Quebec, University of Zaragoza, ​Universidade Federal de São Paulo,​ and the University of Southern California.

A core clinical research program of CMC’s is MINDFUL-PC: Integrating Mindfulness into the Patient Centered Medical Home. MINDFUL-PC is a clinical implementation program, which supports a research study that offers an eight-week mindfulness-based intervention (MBI), called Mindfulness Training for Primary Care (MTPC), to CHA primary care patients as an insurance-reimbursable, referral-based program, delivered by CHA mental health and primary care providers. Over 2000 primary care patients have been referred to MINDFUL-PC since October of 2015.

Within the MINDFUL-PC implementation project is embedded a randomized comparative effectiveness 2019 CHA Academic Report

trial that investigates the impact of the high-dose eight-week, trauma-informed, MTPC program on self-regulation and initiation of health behavior change as well as patient-driven outcomes of anxiety, depression and stress, as compared to a low-dose comparator group receiving a one-hour introduction to mindfulness and referral to community resources.

CMC’s research findings, recently published in the Journal of General Internal Medicine (JGIM)​ and the journal ​Mindfulness​ describe the process of integrating mindfulness training into primary care, and demonstrate that CMC’s eight-week MTPC helps primary care patients with chronic illness initiate health behavior change. ​CMC’s research team was also awarded first place for their poster “Impacts of mindfulness training in primary care on patient self-regulation and accessibility,” at ​Osher Center for Integrative Medicine Network Forum​. CMC has offered two MTPC groups for Portuguese speakers and plans to offer Spanish groups in 2019-2020. ​CMC is collaborating with the Martinos Center for Biomedical Imaging on an fMRI pilot study to investigate the neural mechanisms of self-regulation as a result of mindfulness training. Posters have been accepted demonstrating neural correlates associated with the effects of mindfulness on interoceptive attention. Additional research on the neural correlates associated with the impact of mindfulness training on self-appraisal and pain regulation mechanisms are ongoing. CMC has received additional funding from NCCIH and NIH Science of Behavior Change Initiative to support two more years for research understanding the mechanisms of action of mindfulness training in MINDFUL-PC. In addition, through funding from the Osher Foundation, Harvard Mind/Brain/Behavior Initiative and the Mind and Life Institute, CMC and the MGH/Martinos Center have collaborated on the first fMRI neuroimaging study of a brief mindful self-compassion intervention for chronic pain. Several poster presentations and manuscripts have been submitted reporting findings from this pilot study, showing neural correlates associated with brief self-compassion interventions.

This past year, CMC received funding for several innovative projects: 1. The MINDFUL-OBOT study was funded by NCCIH and aims to explore the effects of mindfulness on opioid use and anxiety during primary care buprenorphine treatment. This study builds on prior research about group-based opioid treatment conducted in collaboration with the CHA office-based addiction treatment network across several 12

CHA primary care sites and outpatient addiction services.

2. CMC was funded to participate in an NCCIH center grant in collaboration with the MGH/Martinos Center for Biomedical Imaging. The study will examine top-down and bottom-up mechanisms for addressing chronic pain. This study will investigate the potential synergistic effects of transcutaneous vagal nerve stimulation and stress reduction for migraines, using MRI, autonomic testing, quantitative sensory testing, and PET to examine various mechanisms.

3. CMC is funded by grants from the CDC and NIDA with additional support from RIZEMA and Russell Berrie Foundation to conduct the MySafeRx​ project. ​MySafeRx​ is an integrated behavioral intervention based on a compassion-based medication adherence technology program, integrating daily empathic motivational coaching via video conference and electronic pill dispensers to prevent opioid overdose and relapse post-detox in Tampa, FL (​www.mysaferx.org​).

In collaboration with the CHA Outpatient Psychiatry Department, CMC started a Mindful Mental Health Clinic (MMHS) for CHA patients using the Mindfulness-Based Cognitive Therapy approach. This service aims to make mindfulness training and adaptations accessible to a wide range of patients seeking more holistically-oriented mental health care at CHA, including those who speak Spanish and Portuguese, those with trauma history, psychosis, and substance use disorder.

CMC also offers an extensive range of programs and professional trainings for CHA employees and the community. Programs range from one-hour free introductions to mindfulness, weekend workshops, CE/CME, professional trainings, an eight-week intensive training courses, group leader trainings, and a first of its kind Advanced Fellowship in Mindfulness and Psychotherapy offered at CHA in partnership with The Institute for Meditation and Psychotherapy (IMP), the CHA Department of Psychology, and CHA Primary Care Behavioral Health Integration. In September 2018, CMC partnered with Harvard University’s ​Center for Wellness and Health Promotion and IMP ​to bring together mindfulness thought leaders, innovators, ethicists, and exhibitors for a sold-out Symposium on Technology-Assisted Meditation at the Harvard University Science Center.

2019 CHA Academic Report

Since 2014, CMC has served hundreds of CHA staff through the Mindful Lunch, Community Speaker Series and Mindfulness at Work programs, staff retreats, eight-week programs with generous subsidies through CHA Human Resources’ Wellness Initiative, and professional group leader and mindfulness teacher trainings.

Selected Bibliography Gawande R, To MN, Pine E, Griswold T, Creedon TB, Brunel A, Lozada A, Loucks EB, Schuman-Olivier Z. ​Mindfulness Training Enhances Self-Regulation and Facilitates Health Behavior Change for Primary Care Patients: A Randomized Controlled Trial​. J ​Gen Intern Med. ​2019;34(2):293-302. PMID: 30511291.

Gawande R, Pine E, Griswold T, Creedon T, Vallejo Z, Rosenbaum E, Lozada A, Schuman-Olivier Z. Insurance-Reimbursable Mindfulness for Safety-Net Primary Care Patients: a Pilot Randomized Controlled Trial​.

Mindfulness. 2019; https://doi.org/10.1007/s12671-019-01116-8.

Lovas DA, Lutz J, Schuman-Olivier Z. Meditation and Medication-What About a Middle Path? JAMA Psychiatry.

2016 Dec 1;73(12):1294-1295.

Loucks EB, Schuman-Olivier Z, Britton WB, Fresco DM, Desbordes G, Brewer JA, Fulwiler C. Mindfulness and Cardiovascular Disease Risk: State of the Evidence, Plausible Mechanisms, and Theoretical Framework. Curr Cardiol Rep. 2015 Dec;17(12):112.

Barnes N, Hattan P, Black D, Schuman-Olivier Z. An Examination of Mindfulness-Based Programs in US Medical Schools. Mindfulness.​ Springer​ 2016. DOI 10.1007/s12671016-0623-8.

Schuman-Olivier Z​. Why use group visits for opioid use disorder treatment in primary care? A patient-centered qualitative study.​ ​Substance Abuse.​ 2017; 19:1-7. ​PMID: 28723302.

Schuman-Olivier Z, Borodovsky JT, Steinkamp J, Munir Q, Butler K, Greene MA, Goldblatt J, Xie HY, Marsch LA. The effect of MySafeRx mobile platform on buprenorphine adherence among young adults: A pilot study.​ Addiction Science & Clinical Practice​. 2018.

Khoury NM, Lutz, J, Schuman-Olivier Z.​ ​Interoception in Psychiatric Disorders: A Review of Randomized, Controlled Trials with Interoception-Based Interventions. Harvard Review of Psychiatry. ​2018; ​26(50):​ 250-263. PMID: 30188337.

Sokol R, LaVertu AE, Morrill D, Albanese C, Schuman-Olivier Z. Group-based treatment of opioid use disorder with buprenorphine: A systematic review. Journal of Substance Abuse Treatment. 2018; 84:78-87. PMID: 29195596.

Lovas DA, Schuman-Olivier Z. Mindfulness-based cognitive therapy for bipolar disorder: A systematic review. J Affect Disord. 2018; 240:247-261. PMID: 30086469.

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3) CEO Clinical Learning Environment Review (CLER) Innovation Awards Empowering our trainees to make meaningful change at CHA Now in its fifth year, the annual Clinical Learning Environment Innovation Awards Program is a small grants initiative that provides financial awards of up to $2,000 to graduate-level trainees

Maren Batalden, MD, MPH

for projects intended to improve the clinical learning environment in which they work and learn and in which patients receive care. The Clinical Learning Environment Review is a framework developed by the ACGME and encourages special attention to healthcare quality and equity, patient safety, transitions of care, faculty supervision, professionalism and resident well-being. In the interest of inviting trainees to be co-creators of their own clinical learning environment, the program invites trainees to identify opportunities for improvement within the clinical learning environment and engage actively as change agents and problem solvers.

prioritized and initiated by residents and “top down” institution-mandated agendas.​, ​The small grants program provides a pragmatic mechanism for accomplishing this bidirectionality. Though residents identify and shape proposals in their own areas of concern, the formal request for proposals permits us to name specific areas of strategic import to the institution. Feedback on first iterations of proposals encourages applicants to revise drafts in partnership with key institutional leaders and stakeholders.

Selection criteria weigh alignment with institutional priorities heavily.

The program was supported for the first three years with an unrestricted educational grant from the Arnold P. Gold Foundation Research Institute. Since the end of the grant period, however, the institution’s senior leadership team has elected to continue program funding annually.

​Selected Bibliography Batalden M​, ​Fisher C​, ​Pels R​, ​Gaufberg E​. CEO-CLER Innovation Grants Program: Empowering Residents as Clinical Learning Environment Change Agents. ​J Grad Med Educ.​ 2019 Feb;11(1):72-78. doi: 10.4300/JGME-D-18-00278.1.

4) CHA-Gold Innovation Fellowship

The program includes an annual request for proposals that is issued at the beginning of the academic year. Funding decisions are made by the CLER Faculty Program Committee, comprised of representatives from each of the core GME training programs and the Center for Professional and Academic Development. Successful proposals have a clearly described problem, a pragmatic and feasible change idea, identified support from appropriate institutional leaders, and a strategy for measuring impact. Grantees are encouraged to avail themselves of technical assistance in Performance Improvement and program development and evaluation from the Quality Department and the Institute for Community Health. They are expected to submit a poster to the annual CHA Academic Poster session.

Problem

Over the last four years, the Committee has made 41 awards to 44 different trainees, engaging 23% of trainees in our five core programs. Seventy percent of projects produced change that continued beyond the funded grant year; forty six percent produced academic publication or presentation.

The CHA-Gold Innovation Fellowship offers an institutional response that meets a need for clinician leader personal and professional development and an institutional need to accelerate successful institutional transformation.

Many have noted the challenge of creating bidirectionality in resident engagement in systems improvement – linking “bottom up” change projects 2019 CHA Academic Report

Healthcare systems are changing rapidly and clinicians struggle to keep pace with their changing roles – team- based care, population health, outcomes measurement, value-based purchasing, widespread digitization, increasing expectations for transparency and partnership with patients and families. These changes have created more and different work for physicians and have led to a crisis of physician burnout. The pace of change has created the need for a new generation of clinician-leader.

Leaders with the skills to design, implement, evaluate and manage institutional change and transformation are in short supply.

Solution

Fellows are recruited through a competitive selection process with a change project aligned with key institutional priorities. Fellowship learning objectives include tools and frameworks from improvement

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science, organizational development, and leadership.

The curriculum is organized into monthly half-day learning sessions in which fellows’ own change leadership work becomes a focus for inquiry. In preparation for sessions, fellows complete required reading, project-related assignments and other exercises intended to catalyze reflection on experience. Between sessions, each fellow is expected to engage in two meetings with other fellows – one in which he or she is a designated coach and another in which he or she is designated to receive coaching support.

Results In year 1, 5 fellows were chosen from an initial pool of 12 applicants. In year 2, 6 fellows were chosen from a pool of 15 applicants. In year 3, 7 fellows were chosen from a pool of 17 applicants and are currently engaged in their fellowship experience. Of the 18 fellows across three cohorts, 13 (72%) are physicians, four are nurses, and one a clinical psychologist. Reflecting the service mix at the Cambridge Health Alliance, 9 (50%) of the 18 fellows are based in a primary care setting, four in mental health services, two in the emergency department, two in the acute care hospital setting, and one in medical specialties.

All eleven fellows who have completed the fellowship remain employed at the Cambridge Health Alliance.

Of the eleven, ten have acquired new positions with expanded leadership scope within the institution.

Five have presented their work external to the institution in the form of academic presentation or publication; three have received academic rank promotions. Fellow self assessment of their own knowledge, skills, and attitudes before and after the fellowship demonstrates improvement in most of the 30 domains linked to fellowship learning objectives.

In a follow up survey of alumni, all fellows endorsed the durability of key fellowship learning related to core concepts in improvement science, change leadership, and patient engagement. All reported using fellowship learning in current work and subsequent projects. Qualitative data from mid-fellowship and end-of-fellowship interviews with fellows suggests that the fellowship facilitated a transformational experience which has forged meaningful connections between fellows and deepened fellow engagement with the institution.

All but one of the eleven fellowship projects in the first two cohorts was successful in accomplishing stated aims. Fellows brought about measurable reductions in ED visits and hospitalizations for patients with COPD and patients with dementia; reductions in hospital admission for low risk chest 2019 CHA Academic Report

pain; improvements in blood pressure control; increases in the use of patient-centered care plans for patients with diabetes and patients with severe and persistent mental illness; increases in measured engagement among CHA providers; increases in the use of peer support in group-based primary care for patients with depression and substance use disorder; new care models for integrated behavioral health services in pediatrics and improved access for patients with opiate use disorder.

The insight that patients and families are co-producers of health outcomes is a central theme in the curriculum; each project explores in its own manner opportunities for greater partnership with patients and families.

Next Steps With each cohort, the program has evolved and strengthened. The program has become more interdisciplinary; the curriculum has incorporated more tools related to human centered design and has developed a more explicit focus on leadership; senior leaders have been more engaged as faculty; fellows have cultivated deeper partnerships with our growing performance improvement team. Plans for cohort #4 are in development now. Recognizing the critical role of relationships and teamwork in institutional change making, we propose for 2020 to recruit dyadic partners -- a clinical provider and an operational manager -- who will learn as “co-fellows.”

Selected Bibliography Batalden M, Batalden P, Margolis P, et al. Coproduction of healthcare service. ​ BMJ Qual Saf​ Published Online First: 16 September 2015. ​Tepper MC, Taneja E, King KM. Planning together: Patient-centered care planning to improve health outcomes. Healthc (Amst). 2019 Feb 11.

5) CHA - Pharmacy Residency Program In July 2017, the Cambridge Health Alliance (CHA) Pharmacy Enterprise initiated a one-year PGY1 pharmacy residency program. In October 2018, the program received a full eight-year accreditation by the American Society of Health-System Pharmacists. Now in its 3​rd​ academic year, the residency program attracts highly qualified candidates from all Gail Sanchez, PharmD, BCPS over the country.

With 17 pharmacist preceptors embedded in the inpatient and ambulatory settings who provide direct pharmaceutical patient care to a diverse population,

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residents gain clinical experience through a wide variety of rotation offerings during this intensive one-year program. They also gain leadership and management experience via block and unique longitudinal rotations with members of the Pharmacy Leadership Team. In addition to rotations in internal medicine, family medicine, infectious diseases, inpatient adult and geriatric psychiatry, ambulatory care and practice management, residents engage in an independent research project, formulary management and decision making, formally accredited continuing education lectures, medication safety seminars, and a number of additional teaching and service opportunities. At the end of their one-year experience, CHA’s pharmacy residents are well prepared to provide direct patient care in a broad range of clinical settings.

training. Founded at Harvard Medical School during 1992, the Division currently is part of the Department of Psychiatry at CHA. The Division derives its funding entirely from gifts, grants, and contracts; Division staff develop proposals for investors from the National Institutes of Health and private industry to the Commonwealth of Massachusetts and Harvard Catalyst. As of March 1, 2019, the Division is led by Debi LaPlante, PhD, Director and Assistant Professor of Psychiatry at HMS, Sarah Nelson, PhD, Associate Director of Research and Assistant Professor of Psychiatry at HMS, and Heather Gray, PhD, Associate Director of Academic Affairs and Instructor of Psychiatry at HMS. The Division's work is aligned closely with CHA's mission to "improve the health of our communities." It does

Residency research areas over the past two years:

Debi LaPlante, PhD

Infectious Diseases:

this with (1) research that addresses health disparities and challenges stigma and misinformation; (2) education and training for medical students, public officials, professionals, faculty, and allied providers; and (3) outreach to the public with numerous initiatives, tools, and resources.

●

●

Impact of tiered interventions to decrease routine urine cultures in asymptomatic patients undergoing arthroplasty (published in Infection Control & Hospital Epidemiology 2019;40(1):109-110); Evaluation of time to organism identification and pharmacist impact on antibiotic prescribing through utilization of MALDI-TOF.

Medication Safety / Efficacy: ●

● ●

●

●

Comparison of various basal insulin regimens and their associated incidence of hypoglycemia-related emergency department visits; Improving utilization of pharmacotherapy services for management of hypertension; De-prescribing medications in elderly homebound patients at increased risk for falls; Medication reconciliation and optimization by clinical pharmacists in the primary care setting; Impact of a pharmacist-led inhaler education on patients with COPD in a pulmonary rehabilitation clinic.

Institutional Cost Savings / Access Enhancement: ●

Cost-savings of long-acting antipsychotic injections in a transitional clinic upon hospital discharge.

6) Division on Addiction The mission of the Division on Addiction is to alleviate addiction-related social, medical, and economic burdens through research, education, outreach, and 2019 CHA Academic Report

Research During the past five years, the Division has published book chapters, state reports, reports to tribal nations, self-help guides, and original research articles (www.divisiononaddiction.org). These publications include Overcoming Addiction: Finding an effect path toward recovery and Understanding Opioids: From addiction to recovery from Harvard Health Publications. Division articles can be found in a variety of topline journals including Harvard Review of Psychiatry, Psychology of Addictive Behaviors, Psychiatric Annals, Journal of Consulting and Clinical Psychology, Psychology of Addictive Behaviors, Annual Review of Clinical Psychology, Psychological Assessment, American Journal of Public Health, and European Journal of Public Health. Books include Change Your Gambling, Change your Life: Strategies for Managing your Gambling and Improving your Finances, Relationships and Health, Responsible Drinking for Women, and the American Psychological Association’s Addiction Syndrome Handbook.

The Division's research represents worldwide collaborations, including research with colleagues across the United States and seven Native American nations, as well as colleagues from South Korea, Denmark, Switzerland, Hong Kong, Iceland, Canada, and Australia. The Division's current primary areas of interest include psychiatric comorbidity of DUI offenders; epidemiology and determinants of 16

gambling- and gaming-related problems, substance use disorders, addiction treatment and treatment outcomes; and relapse and addiction among vulnerable populations, including tribal youth, people with criminal justice involvement, and people experiencing homelessness. The Division supports open science through its innovative Transparency Project data sharing repository (www.thetransparencyproiect.org).

across 47 US states have registered to download CARS. Finally, the Division recently developed guidelines for evidence-based treatment of gambling-related problems for the Massachusetts Department of Public Health. (https://www.mass.gov/practice-guidelines-for-treati ng-gambling-related-problems).

Education & Training

Selected Bibliography (past 5 years)

The Division uses its research to build innovative teaching and training programs for a diverse set of learners. It has provided education to professionals seeking continuing medical education, visiting scholars, undergraduate interns, residents and fellows, postdoctoral researchers, and graduate student trainees. During the past five years, it has offered many educational opportunities, including our Addiction Medicine live CME course; three online CME courses; CHA seminars (CHARGE, the Addiction Syndrome model, and a Research Methods for Healthcare Professionals); didactic research experiences with HMS residents; guest lecturing; invited conference presentations; and webinars and workshops for national and international audiences.

Outreach & Clinical Services The Division has developed evidence-based public health screens and self-help guides (i.e., Brief Biosocial Gambling Screen; Your First Step to Change) for gambling, alcohol, marijuana, shopping, and smoking. For 23 years, the Division has published The BASIS (Brief Addiction Science Information Source; www.basisonline.org), a free weekly addiction science review that many thousands of people access each year. This year, the Division participated as a registered program in NIDA’s National Drug and Alcohol Facts Week by disseminating BASIS bites, which are brief, impactful addiction science facts delivered via social media. The Division created and leads Gambling Disorder Screening Day, an international initiative designed to promote screening for Gambling Disorder. The Division recently completed a five-year project that created a freely available software system for mental health screening and assessment (CARS; www.carstrainingcenter.org) that includes a guided diagnostic interview and a report generator permitting lay interviewers to identify psychiatric disorders, complete an assessment report, and refer patients to treatment providers. Currently, the Division is adapting CARS for DSM-5 and developing a Spanish edition. Since the Division publicly launched this program during June 2017, more than 640 sites 2019 CHA Academic Report

LaPlante, D.A., Gray, H.M., Williams, P.M., & Nelson, S.E. (2018). An empirical review of gambling expansion and gambling-related harm. SUCHT, 64, 295-306.

Nelson, S.E., Shoov, E., LaBrie, R.A., & Shaffer, H.J. (In Press).

Externalizing and self-medicating: Heterogeneity among repeat DUI offenders. Drug and Alcohol Dependence.

Gray, H. M., Nelson, S. E., Shaffer, H. J., Stebbins, P., & Farina, A. R. (2017). ​How do homeless adults change their lives after completing an intensive job-skills program?​ Journal of Community Psychology, 45, 888-905.

Gray, H. M., Shaffer, P. M., Nelson, S. E., & Shaffer, H. J. (2016).

Changing social networks among homeless individuals: A prospective evaluation of a job- and life-skills training program​. Community Mental Health Journal, 52(7), 799-808.

Nelson, S. E., Belkin, K., LaPlante, D. A, Bosworth, L., & Shaffer, H. J. (2015). A prospective study of psychiatric comorbidity and recidivism among repeat DUI offenders. Archives of Scientific Psychology, 3(1), 8-17.

LaPlante, D. A., Nelson, S. E., & Gray, H. M. (2014). Breadth and depth involvement: Understanding Internet gambling involvement and its relationship to gambling problems.

Psychology of Addictive Behaviors, 28(2), 396-403.

7) Harvard Medical School-Cambridge Integrated Clerkship

David Hirsh, MD

In 2004, HMS and CHA sparked the most reaching and impactful transformation of clinical education since Flexner when they created the first academic longitudinal integrated clerkship (LIC). This program, the

complete redesign of the core clinical year is the HMS-Cambridge Integrated Clerkship (HMS-CIC). In the HMS-CIC model, students follow their “own” cohorts of patients’ year-long in primary care and specialty clinics, with direct faculty supervision in all core disciplines simultaneously, in lieu of traditional block rotations. HMS-CIC students achieve all the goals of HMS’s core clinical year, to train outstanding

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and distinguished physician-scientist-leaders for all specialties.

The LIC literature is robust and powerfully affirms the HMS-CIC programmatic success. CHA and UCSF also collaborated to create the first LIC book. Through scholarship, dissemination and widespread media attention, medical schools nationwide and worldwide have reproduced the HMS-CIC model: • Multiple institutions (UCSF, Duke, Columbia) follow HMS’s example and created LICs in the HMS- CIC structure.

• More than 40 percent of U.S. medical schools are building, running and growing their LICs. • Approximately half the medical schools in Canada and Australia and medical schools in the UK, Netherlands, Taiwan, Singapore and South Africa have developed LICs. • ​Institutions around the nation and world contact and visit Cambridge Health Alliance to learn about the HMS-CIC. Leaders of the HMS-CIC are invited to speak nationwide and worldwide to help institutions start and grow their LICs. • The educational science and principles animated and described by the HMS-CIC underpin the foundational 14-month restructuring of the HMS’s Pathways curriculum. The 2003 HMS-CIC educational pillars ground the Pathways structure: longitudinal design, curricular integration, meaningful roles for students, a core faculty model and fostering an active, supportive and effective learning environment.

The HMS-CIC also defined and disseminated a core educational principle, “Educational Continuity” (Hirsh et al. ​NEJM​, 2007), that is guiding the leading publications (e.g., ​Carnegie Report: Educating Physicians and The Future of Medical Education in Canada​) and is the leading discourse in medical education design nationally and internationally: Continuity of Care​ (The student matters to the patient and the patient matters to the student) • With their faculty preceptors, students build their “own” panel of patients whom they see regularly in each core specialty throughout the year.

• Students can follow their cohort of patients longitudinally across all venues of care (including home and out-of-hospital care) to engage in their patients’ care and their lives meaningfully.

• Students’ experiences are structured and tracked to ensure full breadth of experience.

2019 CHA Academic Report

• Students know their patients and deeply learn their patients’ experience of illness and their context of care.

Continuity of Supervision ​ (The student matters to the faculty and the faculty matter to the student) • Carefully selected attending physicians are the principal educators throughout the year. Students receive one-to-one precepting by experienced faculty in each core discipline who serve as educators and role models for the year-long course.

• Students have the opportunity to closely connect to faculty members who come to know the students well—to support, advise and mentor them, maximizing professional and personal development and residency opportunities.

• Team learning and team care are central tenets of the experience. Accordingly, role models and teachers come from in and out of medicine, nursing and others on the interprofessional team.

Continuity of Curriculum​ (The student matters to the curriculum and the curriculum matters to the student) • The curriculum progresses developmentally, is student- focused, flexible and carefully constructed.

The program supports individual interests and growth needs. The curriculum seeks that the students flourish.

• The patients are the loci of integration for the curriculum. Serving patients authentically is the currency of learning and professional growth.

Activities to foster clinical reasoning rather than clinical “tasks” are the core.

• The curriculum seeks to foster human flourishing and is designed to support each student’s growth.

Alongside experienced clinician-educators and scientists, patients and staff, social scientists and administrators, community groups and policy makers, clergy and the students’ own families may all serve as “core faculty” in this profound and transformative experience.

Continuity of Idealism ​(Humanity matters to the student and the student matters to humanity) • The CIC manifests a return to the transcendent values and the educational method which trained generations of physicians until current delivery system models made it increasingly difficult (if not impossible) for students to care for their patients over substantial time.

• The program is designed to reassert the centrality of the student-patient and student-faculty relationships – the bases for the idealized 18

development of highly trained and highly fulfilled learners. Humanism and professionalism emanate from its core.

• The CIC seeks deliberately to foster students’ energy and inspiration by creating authentic, richly meaningful educational and care engagements with patients and faculty whom the students come to know well.

Selected Bibliography CIC Research Cheng E, Hirsh D, Gaufberg E, Griswold T, Wesley Boyd J. Findings from the Harvard Medical School Cambridge Integrated Clerkship, a Year-Long Longitudinal Psychiatry Experience. ​Acad Psychiatry​. 2017 Jun 23.

Gaufberg E, Dinardo P, Krupat E, Pine E, Ogur B, Bor D, Hirsh DA. In Pursuit of Educational Integrity: Professional identity formation in the Harvard Medical School Cambridge Integrated Clerkship. ​Perspect Biol Med​. 2017;60(2):258-274.

Other LIC Research Gheihman G, Jun T, Young GJ, Liebman D, Sharma K, Brandes E, Ogur B, Hirsh DA. A review of longitudinal clinical programs in US medical schools. ​Med Educ Online​. 2018 Dec; 23(1):1444900.

Mazotti L, Adams J, Peyser B, Chretien K, Duffy B, Hirsh DA. Diffusion of Innovation and Longitudinal Integrated Clerkships: Results of the Clerkship Directors in Internal Medicine Annual Survey. ​Med Teach​. 2018.

Other LIC Related Bernstein J, Wood S, Latessa R, Hirsh DA. Teaching in Longitudinal Integrated Clerkships: The Seven “C”s. ​Clin Teach​.

2018

LIC Book Chapters Hirsh,D.Longitudinal integrated clerkships: Embracing the hidden curriculum, stemming ethical erosion, transforming medical education. In Hafferty FW and ODonnell J, eds. The Hidden Curriculum in Health Professions Education.

Dartmouth College Press​. Hanover, NH. 2014.

Hirsh DA, Walters L. Longitudinal Integrated Clerkships. In Dent JA, Harden RM, Hunt D, eds. A Practical Guide for Medical Teachers. 5th edition. ​Elsevier​; 2017.

Forward for Medical Education. ​Academic Medicine​.

2012;87(5):1-8.

Gaufberg E, Hirsh D, Krupat E, Ogur B, Reiff DB, Pelletier S, Bor D. Into the Future: Patient-Centeredness Endures in Longitudinal Integrated Clerkship Graduates. ​Med Educ​.

2014;48: 572–582.

Ogur B, Hirsh D, Krupat E, Bor D. The Harvard Medical SchoolCambridge Integrated Clerkship: An Innovative Model of Clinical Education. ​Academic Medicine.​ 2007;82(4): 397-404.

Gaufberg E, Shtasel D, Hirsh D, Ogur B, Bor D. The Harvard Medical School Cambridge Integrated Clerkship: Challenges of Longitudinal Integrated Training. The Clinical Teacher 2008; 5:78-82 Ogur B, Hirsh D. Learning through longitudinal care— narratives from the Harvard Medical School-Cambridge Integrated Clerkship. ​Academic Medicine.​ 2009;84: 844-50.

Sample of Other Research Investigations O’Brien BC, Poncelet A, Hansen L, Hirsh D, Ogur B, Alexander E, Krupat E, Hauer KE. Students’ workplace learning in two clerkship models: A multi-site observational study. ​Med Educ.​ 2012: 46: 613–624.

Hauer KE, Hirsh D, Ma I, Hansen L, Ogur B, Poncelet AN, Alexander EK, O’Brien BC. The role of role: learning in longitudinal integrated and traditional block clerkships. ​Med Educ​. 2012: 46: 698–710.

Hauer KE, O’Brien BC, Hansen LA, Hirsh D, Ma IH, Ogur B, Poncelet AN, Alexander EK, Teherani A. More is better: Students describe successful and unsuccessful experiences with teachers differently in brief and longitudinal relationships. ​Acad Med​. 2012; 87(10):1389-1396.

O’Brien BC, Hirsh D, Krupat E, Batt J, Hansen LA, Poncelet AN, Ogur B, Hauer KE. Learners, performers, caregivers and team players: Descriptions of the ideal medical student in longitudinal integrated and block clerkships. ​Med Teach​.

2016;38(3):297-305.

Ghosh A, Hirsh D, Schwaitzberg S, Ogur B. Bearing Witness: Cancer Curriculum for Students. Clin Teach. 2016 Feb 4. doi: 10.1111/tct.12498.

Worley P, Couper I, Strasser R, Graves L, Cummings BA, Woodman R, Stagg P, Hirsh D; Consortium of Longitudinal Integrated Clerkships (CLIC) Research Collaborative. A typology of longitudinal integrated clerkships. ​Med Educ​. 2016 Sep;50(9):922-32.

Latessa RA, Swendiman RA, Parlier AB, Galvin SL, Hirsh DA. Graduates’ Perceptions of Learning Affordances in Longitudinal Integrated Clerkships: A Dual-Institution, MixedMethods Study. ​Acad Med.​ 2017

Core CIC publications

Sample of Other CIC Publications

Hirsh DA, Ogur B, Thibault GE, Cox M. “Continuity” as an organizing principle for clinical education reform. ​N Engl J Med​. 2007;356(8):858-66.

Hirsh D, Walters L, Poncelet AN. Better learning, better doctors, better delivery system: Possibilities from a case study of longitudinal integrated clerkships. ​Med Teach​.

2012;34(7):548-54.

Hirsh D, Gaufberg E, Ogur B, Cohen P, Krupat E, Cox M, Pelletier S, Bor D. Educational Outcomes of the Harvard Medical School-Cambridge Integrated Clerkship: A Way

2019 CHA Academic Report

Tara Singh, MD

Osman NY, Atalay A, Ghosh A, Saravanan Y, Shagrin B, Singh T, Hirsh DA. Designing medical education structure for workforce transformation: Continuity, Symbiosis, 19

and Longitudinal Integrated Clerkships. ​Education Sciences​.

2017. In Press.

Strasser R, Hirsh D. Longitudinal integrated clerkships: transforming medical education worldwide? ​Med Educ 2011;45:436–437.

2.

Hirsh D, Worley P. Better Learning, Better Doctors, Better Community: How transforming clinical education can help repair society. ​Med Educ​. 2013;47(9):942-9.

Hirsh DA, Holmboe ES, Ten Cate O. Time to Trust: Longitudinal Integrated Clerkships and Entrustable Professional Activities.

Acad Med​. 2014;89:201–204.

Books Poncelet A and Hirsh D, eds. Longitudinal Integrated Clerkships: Principles, outcomes, practical tools and future directions. Syracuse, NY​: Gegensatz Press; 2016.

3.

8) Health Equity Research Lab Overview

Ben Cook, MD, MPH

The Health Equity Research Lab at CHA is an interdisciplinary group led by Dr. Benjamin Cook and comprised of health services researchers and clinicians. It is dedicated to conducting research on behavioral health and health

service delivery issues relevant to multicultural, underserved and vulnerable populations. The four major center activities include: identifying the mechanisms and factors of resiliency underlying pathways towards health in the face of social and economic adversity; using data analytics to prevent negative social, health and mental health outcomes among racial/ethnic minority populations; intervening to reduce disparities in negative social, health, and mental health outcomes; and mentoring disparities researchers. All of these activities are informed by engagement with patients, families, providers and community stakeholders to generate research that is meaningful and resonates with the community.

Current Projects 1. PCORI Grant to Improve Methods of Incorporating Minority Patients' Treatment Preferences into Clinical Care. Using community-based participatory research methods, we developed and implemented a nationally representative survey of patient preferences for treatment and experiences of discrimination in the healthcare system for individuals with depression and type 2

2019 CHA Academic Report

4.

5.

diabetes. We are working with community and provider partners to use our findings to improve patients’ encounters with the healthcare system.

National Cancer Institute grant on the Impact of State Policies on Smoking among Individuals with Substance Use Disorder. We assess the impact of expanded coverage of tobacco dependence treatment in Medicaid as well as tobacco excise taxes on the use of tobacco dependence treatment services, smoking intensity, and quit rates for smokers with substance use disorders; we further propose to assess the combined effect of Medicaid coverage of tobacco dependence treatment alongside excise taxes on these outcomes.

Predictive Analytics to Prevent Suicide and Adverse Health Outcomes: Using natural language processing and machine learning algorithms, we hope to use unstructured text in electronic health records (EHR) to predict negative outcomes, re-hospitalizations and adverse health events of patients. Two current projects that utilize this method are the Suicide Prediction in Adolescent Psychiatric Patients and Prediction of Negative Outcomes in Gender Minority Patients.

Assessing Disparities by Race/Ethnicity, Gender and Gender Identity Status in Medicare Accountable Care Organizations: We study differences in ACO participation by race/ ethnicity, gender (minorities) and mental health status of beneficiaries; disparities within ACOs by Medicare/Medicaid dual eligibility status, race/ethnicity and gender/ gender identity in access. utilization and quality of mental health services; and racial/ethnic and gender disparities in access, utilization and quality for beneficiaries treated within ACOs. The Effect of Provider Payment Reform on Mental Health Care Disparities: The Affordable Care Act (ACA) temporarily increased the payments for PCPs caring for Full Subsidy dual-eligible Medicare beneficiaries. Meanwhile, the Medicare Improvements for Patients and Providers Act (MIPPA) gradually increased payments to mental health specialists for Full Subsidy beneficiaries and reduced beneficiary coinsurance for specialist visits for Partial beneficiaries. We assess the effects of these policies on racial/ethnic disparities in mental health care outcomes including: medical care 20

and quality process measures (e.g., diagnosis and medication use); clinical events (e.g., emergency department visits and hospitalizations); and medical spending.

6. Juvenile and Adult Criminal Justice Reform for Individuals with Mental Illness: We evaluate two ongoing programs at the Cambridge Police Department (CPD) targeting the reduction of arrest and incarceration of individuals with mental illness. The Cambridge Safety Net Collaborative fosters positive youth development, promote mental health, support a safe community and schools, and limit youth involvement in the juvenile justice system through coordinated services for Cambridge youth and their families. For adults at risk of criminal justice system involvement, CPD has developed a coordinated coalition of officers and community stakeholders to treat individuals living with mental illness and substance use disorders. We identify predictors of improved outcomes for these populations and evaluate the success of CPD’s diversion and prevention activities.

7. Opioid Mortality: The current opioid epidemic is a public health emergency and requires immediate action. It is critical to expand research to include neighborhood-level determinants of opioid-related mortality and to better understand prescribing patterns and opioid use disorder treatment. We assess patterns of care and predictors of service use prior to opioid-related mortality that can help clinicians identify high-risk patients in need of multi-system treatment and inform the development of timely interventions. We use electronic health records, nationally representative surveys, and administrative claims data to understand opioid use/misuse and access to opioid-related treatment and to estimate and understand the impact of federal payment policy reforms on racial/ethnic disparities in opioid misuse, access, use, and completion of opioid-related treatment.

Completed Projects 1. Comparative Effectiveness Research and Racial/ Ethnic Health Care Equity: Using linked MAX and MEPS data, we examined whether specific information in FDA warnings influenced disparity trends in 2019 CHA Academic Report

psychotropic drug use and mental health care and identified how provider characteristics and HMO enrollment act as mechanisms that underlie the differential diffusion of health risk warnings. We identified that the communication of these risks and benefits of medications are inequitably disseminated and discuss the ramifications of these inequities on disparities.

2. RISE for Boys and Men of Color Field Scan: We completed a systematic review of the literature at the intersection of mental health services, education and juvenile justice and consolidated findings into actionable recommendations for the RISE initiative.

3. Behavioral Health Home Evaluation at CHA: The Behavioral Health Home Program (BHHP) at CHA integrates primary care services within the outpatient specialty behavioral health clinic at the CHA Central Street Care Center. Using a mixed-methods approach, the Lab evaluated the implementation of the program on its goal of enhancing training and care coordination, increasing screening and monitoring of co-morbid medical conditions and expanding health promotion activities.

Selected Bibliography Creedon T., Cook B. Access to mental health care increased but not for substance use, while disparities remain.​ Health Affairs​. 2016; 35(6): 1017-1021.

Cook B., Trinh NH, Li Z, Hou S, Progovac A. Trends in racial-ethnic disparities in access to mental health care, 2004-2012​. Psychiatric Services​. 2017; 68(1): 9-16.

Cook B, Carson NJ, Kafali EN, Valentine A, Rueda JD, Coe-Odess S, Busch S. Examining psychotropic medication use among youth in the U.S. by race/ethnicity and psychological impairment. ​General Hospital Psychiatry​. 2017; 45: 32-39.

Tepper M, Cohen A, Progovac A, Ault-Brutus A, Leff H, Mullin B, Cunningham C, Cook B. Mind The Gap: Developing an integrated behavioral health home to address health disparities in serious mental illness. ​Psychiatric Services.​ 2017; 68(12): 1217-1224.

Carson N, Progovac A, Wang Y, Cook B. A decline in depression treatment following FDA antidepressant warnings largely explains racial/ethnic disparities in prescription fills.

Depression and Anxiety​. 2017; 34(12): 1147-1156.

Progovac A, Mullin B, McDowell A, Cook B. Identifying gender minority patients’ health and healthcare needs in

21

administrative claims data from a national sample of Medicare beneficiaries. ​Health Affairs​. 2018; 37(3): 413-420.

Cook B, Creedon T, Wang Y, Lu C, Carson N, Jules P, Lee E, Alegría M. Examining racial/ethnic differences in patterns of benzodiazepine prescription and misuse.​ Drug and Alcohol Dependence​. 2018; 187: 29-34.

Cook B, Sonik R, Wang Y, Progovac A, Carson N, Busch S, Zaslavsky A. Assessing provider and racial/ethnic variation in response to the FDA antidepressant box warning. ​Health Services Research.​ 2019; 54:255-262.

Carson NJ, Mullin B, Sanchez MJ, Lu F, Yang K, Menezes M, Cook BL. Identification of suicidal behavior among psychiatrically hospitalized adolescents using natural language processing and machine learning of electronic health records.

PLOS ONE​. 2019. 14(2): e0211116.

electronic medical records, claims, and public health surveillance data - as well as extensive experience with survey methods, qualitative interviews, focus groups, time-motion studies, mixed methods, and more.

ICH works on over 70 projects a year, including investigator-initiated research as well as client-driven work. Projects span a diverse array of content areas including behavioral health and substance use disorders, infectious diseases, healthy parenting and child development, sexual and reproductive health, immigrant health, advocacy and policy, health systems transformation, and many others. Our projects range in scale from providing technical assistance and consultation to small community organizations serving as the cross-site evaluator for large multi-year grant initiatives.

9) Institute for Community Health The Institute for Community Health (ICH) is a nonprofit research and consulting organization that provides participatory evaluation, applied research, assessment, planning, and data services to health systems, community-based organizations, and government agencies. ICH’s goal is to use data-driven approaches to help communities develop create sustainable solutions to complex public health challenges. ICH was founded in 2000 by three healthcare systems: Cambridge Health Alliance (CHA), Mount Auburn Hospital, and Partners HealthCare.

Currently, all three institutions have representatives on the ICH Board of Directors, and ICH's current benefactors are CHA and Beth Israel Deaconess Medical Center (BIDMC). Since its founding, ICH has had a close partnership with CHA and the two organizations continue to collaborate on many projects.

ICH is led by Lise E. Fried, DSc, MS, an epidemiologist and an executive with demonstrated success leading organizations and guiding them through all phases of development with skill and inspiration. ICH’s Associate Director, Emily Chiasson, MPH, MSW, has over 15 years of Lise Fried, DSc, MS experience in program planning, implementation, and evaluation, as well as project and organizational management.

ICH has a talented and interdisciplinary staff with training in many fields including program evaluation, epidemiology, anthropology, public health, and medicine. ICH staff have methodological expertise in quantitative methods - including analysis of 2019 CHA Academic Report

Across all projects, ICH has a strong and consistent commitment to sound methodological practices, tailored to client needs and program goals. ICH’s work is characterized by a strengths-based, collaborative approach that builds organizational capacity and emphasizes utilization of data for program improvement and sustainability. ICH works closely with its clients to gather and use data that can inform priorities and decisions, build stronger programs and services, demonstrate outcomes and impacts and ultimately improve community health.

The results of this work have been disseminated in a wide range of formats and venues, including conference presentations​, ​white papers and web publication​s,​ ​and​ peer-reviewed journal articles​.

Below are examples of ICH's recent work: ICH recently conducted a research study that aimed to understand immigrants’ and US-born individuals’ contributions to private health insurance compared to health care expenditures. This work built on ICH Director of Research Leah Zallman’s previous work studying immigrants’ Medicare contributions and expenditures. Using two nationally representative databases, we determined private health insurance expenditures and individual premiums and extracted information about employer contributions to private insurance premiums. We tabulated private health insurance contributions, insurers’ expenditures, and net contributions for immigrants and US-born individuals. Results showed that immigrants paid $88.7 billion in private insurance premiums but only used $63 billion in insurer-paid health care, resulting in a $24.7 billion surplus in 2014. This dispels the common myth that immigrants drive up health care

22

costs. The study was ​published​ in​ Health Affairs ​in October 2018.

Since 2011, ICH has collaborated with CHA on a range of assessment and evaluation projects related to CHA’s delivery system transformations and transition to value-based payment models. This work has included: ●

●

●

●

an annual survey of primary care providers and staff to assess workforce experience, practices, and perceptions, which led to a peer-reviewed publication patient interviews across a range of disease areas to inform medical management program design (peer-reviewed article published) evaluation of the primary care behavioral health integration program (academic publication currently under review) evaluation of the complex care management program (peer-reviewed article published).

Currently, ICH is conducting a quasi-experimental study to determine the impact of participation in the Tufts Health Together with CHA Accountable Care Organization (ACO) on health care utilization and costs. CHA ACO patients will be compared to a comparison group of non-CHA patients insured by a Medicaid Managed Care Organization (MCO) - Tufts Health Public Plan. The comparison group will be selected from Tufts MCO patients using a propensity score matching technique. Claims data will be analyzed to compare utilization outcomes (ED, inpatient, primary care and behavioral health visits) and medical costs for CHA’s ACO patients and the comparison group. As a secondary analysis, ICH will examine outcomes among specific subgroups of patients who are enrolled in specialty programs such as complex care management and long-term support services.

Toni McGuire. NEJM Catalyst. January 2019.

Immigrants Pay More In Private Insurance Premiums Than They Receive In Benefits. Leah Zallman, Steffie Woolhandler, Sharon Touw, David U. Himmelstein, and Karen E. Finnegan.

Health Affairs​ 2018 37:10, 1663-1668.

Lila Flavin, Leah Zallman, Danny McCormick, and J. Wesley Boyd. (2018). Medical Expenditures on and by Immigrant Populations in the United States: A Systematic Review.

International Journal of Health Services, https://doi.org/10.1177/0020731418791963​.

Zallman L, Finnegan K, Roll D, Todaro M, Oneiz R, Sayah A. “Impact of Medical Scribes in Primary Care on Productivity, Face-to-Face Time, and Patient Comfort”, J ​Am Board Fam Med ​2018; 31 (4): 612-619. doi:10.3122/jabfm.2018.04.170325.

Public Charge Rule Could Prompt Up to 455,000 California Kids Who Need Care to Leave Medi-Cal. Leah Zallman, Karen Finnegan. California Health Care Foundation. November 2018.

Leah Zallman, Karen Finnegan, David Himmelstein, Steffie Woolhandler.

Changing Public Charge Immigration Rules: The Potential Impact on Children Who Need Care. Issue Brief, California Health Care Foundation 2018.

Leah Zallman, MD, MPH

Selected Bibliography: Planning together: Patient-centered care planning to improve health outcomes. Miriam Tepper, Ekta Taneja, Kristin King.

Healthcare: ​The Journal of Delivery Science and Innovation, 2019.

CEO-CLER Innovation Grants Program: Empowering Residents as Clinical Learning Environment Change Agents. Maren Batalden, Carolyn Fisher, Richard Pels, Elizabeth Gaufberg.

Journal of Graduate Medical Education​, 2019.

A Teledermatology Initiative to Increase Access for Community Health Center Patients. Ranjani K. Paradise, Carla Bettano,

2019 CHA Academic Report

23

Appendix I. CHA Faculty A. Academic Appointments and Promotions

Department

Academic Appointments

Emergency Medicine

17

Family Medicine (Department of Population Medicine)

Medicine

51

139

Current Academic Appointments by Rank

Rank

HMS 4 HMS 11 HMS 2

Lecturer Instructor Assistant Professor

HMS 1 Tufts 17 Tufts 23 Tufts 4 Tufts 2 HMS 10 HMS 98 HMS 23 HMS 6 HMS 2

Tufts 4

Lecturer Instructor Assistant Professor Associate Professor Professor Lecturer Instructor Assistant Professor Associate Professor Professor

Obstetrics & Gynecology

7

HMS 6 HMS 1

Instructor Assistant Professor

Orthopedics

1

HMS 1

Assistant Professor

Pathology

3

HMS 3

Instructor

Pediatrics

10

HMS 6 HMS 3 HMS 1

Instructor Assistant Professor Associate Professor

HMS 64 HMS 70 HMS 52 HMS 14 HMS 8 HMS 4 HMS 1 HMS 1 HMS 3 HMS 4 HMS 1

Lecturer Instructor Assistant Professor Associate Professor Professor Instructor Associate Professor Lecturer Instructor Assistant Professor Associate Professor

Psychiatry

208

Radiology

5

Surgery

9

450

2019 CHA Academic Report

Promotions July 2017-December 2018

Tufts 2

HMS 2

HMS 3 HMS 1

8

24

HMS Faculty at Cambridge Health Alliance CHA HMS Appointments as of 10/2018 Professors

10

Associate Professors

23

Assistant Professors

87

Instructors

208

Lecturers

82

Total

410

HMS Overall Faculty

2019 CHA Academic Report

25

B. Faculty Recognition: Local (HMS, Tufts, CHA) Award Date

Name

Department

Award

Awarding Org

2019

Pieter Cohen, MD

Medicine

A. Clifford Barger Excellence in Mentoring Award

HMS

2019

Rachel Stark, MD

Medicine

Young Mentor Award

HMS

2019

Silvia Halperin, MD

Psychiatry

Harold Amos Diversity Award

HMS

2019

Soledad Vera, MD

Psychiatry

Harold Amos Diversity Award

HMS

2018

Gaurab Basu, MD, MPH

Primary Care

Charles McCabe Faculty Prize for Excellence in Teaching

HMS

2018

Deborah Erlich, MD, MMedEd, FAAFP

Medicine

Innovations in Education Intramural Grant Award

Tufts

2018

Clinton Pong, MD

Medicine

Innovations in Education Intramural Grant Award

Tufts

2018

Allen Shaughnessy, PharmD, MMedEd

Medicine

Innovations in Education Intramural Grant Award

Tufts

2018

Nicholas Carson, MD

Psychiatry

Al Margulies Award for Excellence in Teaching

CHA

2018

Treniece Lewis Harris, PhD

Psychiatry

Leston Havens Award for Excellence in Teaching

CHA

2018

Benjamin Cook, PhD, MPH

Psychiatry/Research

Academic Council Award

CHA

2018

Abigail Love, MD, MPH

Medicine

Academic Council Award

CHA

2018

Randi Sokol, MD, MPH, MMedEd

Medicine

Academic Council Award

CHA

2018

Leah Zallman, MD, MPH

Medicine

Academic Council Award

CHA

2018

Marla Eby, PhD

Psychiatry

Excellence in Teaching Award

HMS

2018

Aaronson Chew, PhD

Psychiatry

Harold Amos Diversity Award

HMS

2018

David Hirsh, MD

Medicine

George E. Thibault Academy Professorship

HMS

2018

David Hirsh, MD

Medicine

A. Clifford Barger Excellence in Mentoring Award

HMS

2017

Benjamin Le Cook, PhD

Psychiatry

Young Mentor Award

HMS

2017

J. Wesley Boyd, MD, PhD

Psychiatry

Academic Council Award

CHA

2017

Priyank Jain, MD

Medicine

Academic Council Award

CHA

2017

Honor MacNaughton, MD

Family Medicine

Academic Council Award

CHA

C. Faculty Recognition: Regional and National Year

Name

Title

Award Faculty Innovation in Education Award from the American Board of Psychiatry and Neurology

2018 Elizabeth Gaufberg, MD, MPH

Assistant Professor, Psychiatry Associate Professor, Medicine and Psychiatry

2018 Katherine Grimes, MD, MPH

Associate Professor, Psychiatry

Outstanding Mentor Award from the American Academy of Child and Adolescent Psychiatry

2018 Tyrone Williams, MD

Instructor, Psychiatry

Carl B. Cutchins Award for Children's Behavioral Health

2018 Sandra DeJong, MD, MSc

Anne L. Brodie Medical Education Scholar Award (University of Virginia)

Young Investigator Award from the American Medical Society of Sports Medicine

2017 Jessica Knapp, DO 2017 Ana Nava, PhD

Teaching Associate, Psychiatry

MAPS Mary and Manual Rogers Lifetime Community Service Award

2017 Richard Pels, MD

Assistant Professor, Medicine

Parker J. Palmer Courage to Teach Award from the Accreditation Council for Graduate Medical Education (ACGME)

2017 Nancy Rappaport, MD

Associate Professor, Psychiatry

American Medical Women's Association 2017 Exceptional Mentor Award

2019 CHA Academic Report

26

D. Faculty Participation in Competitive Fellowships Year Recipient

Fellowship

Discipline

Title

Aileen Lorenzo, MD Benjamin Adler, MD & Rachel Schoenburg, MD

CEO CLER Innovation

Child Psychiatry

Understanding Trainee Preferences for Screening, Triaging, and Managing Wellbeing Concerns Using a Focus Group Model

CEO CLER Innovation

Family Medicine

Medical Assistant/Resident Pairing Project

CEO CLER Innovation

Family Medicine

Fluoride Varnish in Primary Care

2019

Brittanie Dillon, DO, DMD Christina Lee, MD & Clara Kim, MD

CEO CLER Innovation

Adult Psychiatry

2019

Janine Petito, MD

CEO CLER Innovation

2019

Jennifer Ren-Si Cheung, MD

CEO CLER Innovation

Internal Medicine Family Medicine/ Master Teacher Fellowship

2019

John Gaudet, MD

CEO CLER Innovation

Internal Medicine

2019

Kira Mengistu, MD

CEO CLER Innovation

Internal Medicine

2019

Maria Roccisano, MD

CEO CLER Innovation

Child Psychiatry

Increasing Utilization of SERS in the Department of Psychiatry Professional Development Coaching Program for Internal Medicine Residents Developing a Process to Improve Hypertension Diagnosis and Management Through the Use of Home Blood Pressure Monitors Building a Stronger Community for Underrepresented Minority Residents Investigating Resident Perception and Utilization of EConsults at CHA Improving the Psychiatric Inpatient Adolescent and Child Unit Experience through the Use of Music

2019

Megan Rose Carr LaPorte, MD

CEO CLER Innovation

Internal Medicine

2019

Nakul Singh, MD

CEO CLER Innovation

2019

Rami Al-Sumairi, MBBCh

CEO CLER Innovation

2019

Steven Krueger, MD

CEO CLER Innovation

2019

Aaronson Chew, PhD & Brittany Pierce, PA-C Harvard Macy

2019

Lenna Finger, MD

Harvard Macy

2019

Liza Hoffman, MSW, LICSW

Harvard Macy

2019

Miriam Tepper, MD

Harvard Macy

2019

Nicholas Carson, MD, FRCPC

Harvard Macy

2019

Lynne Crawford, APRN

Harvard Macy

Procalcitonin testing at CHA: Is our Algorithm Working?

Low Cost Interventions to Improve Sleep Quality in the Inpatient Transitional Year Internship Setting Using a Co-Production Model to Partner with Non-English Speaking Families to Improve the Care of Children with Child Psychiatry Neurodevelopmental Disorders Identifying Models for Meeting Inpatient Dermatology Needs at Transitional Year Internship Community Hospitals Program for Educators in Health Professions project: Physician Integrative Psychiatry & Family Assistant Interdisciplinary Training Curriculum: Primary Care and Medicine Behavioral Health Program for Educators in Health Professions project: TeamInternal Medicine/Pediatrics Based Care Medical Student Elective Program for Educators in Health Professions project: Resident Primary Care - Behavioral Training in Behavioral Health Intervention and Interdisciplinary Health Integration Collaboration Leading Innovations in Health Care & Education project: Population Health in Psychiatry Co-funded with the Department Psychiatry of Psychiatry Leading Innovations in Health Care & Education project: Experience-Based Co-Design in Child Psychiatry Co-funded with Child Psychiatry the Department of Psychiatry.

Leading Innovations in Health Care & Education project: Development of a Nurse Practitioner Residency in Primary Care Medicine & Nursing at CHA. Co-funded with Nursing and Primary Care

2018

Bree Dallinga, PA-C

Harvard Macy

Surgery

2018

Pauline Mathewson, PA-C

Harvard Macy

Primary care

2018

Lee Robinson, MD

Harvard Macy

Psychiatry

Peer Mentoring as a Tool to Improve Provider Engagement Improving the Onboarding Process of Physician Assistants at a Primary Care Clinic through PA Mentorship Social Determinants of Child & Family Mental Health: Curricular and Experiential Learning for Child & Adolescent Psychiatry Fellows at Cambridge Health Alliance

2018

Hugo Torres, MD

Harvard Macy

Internal Medicine

Clinical Reasoning in Graduate Medical Education

2017

Peter Brown, PhD

Harvard Macy

Psychiatry

2017

Rachel Hathaway, MD

Harvard Macy

Internal Medicine

Cognitive Behavior Therapy for Chronic Pain in Primary Care Medical Detective Rounds: Adopting case-based, collaborative learning in the clinical year for Cambridge Integrated Clerkship students

2019 2019 2019

2019 CHA Academic Report

27

E. CHA-Gold Innovation Fellowship Program Year

Recipient

Project Title

2018 Margaret Buckley, RN, MSN

Bedside Change of Shift for ED Nurses

2018 Christina Phillips, MD

Avoiding Avoidable ED Visits

2018 Lee Robinson, MD

Integrated Care for Patients with Neurodevelopmental Disorders

2018 Amy Smith, MD, MPH

Primary Care Redesign: Empowering Teams, Liberating Access Initiating Medication Assisted Treatment for Opiate Use Disorder in the Acute Setting

2018 Randi Sokol, MD, MPH, MMedEd 2018 Rebecca Sweeney, RN, MSN, MBA

Peer Recovery Coaches for Substance Use Disorders

2018 Cecilia Buckley, RN, MSN, MBA 2017 Nicholas Carson, MD

Leader Rounding to Improve Patient Experience at Everett Hospital Co-Producing Health Decisions for Families at the Interface of Behavioral Health and Primary Care

2017 Serena Chao, MD

Improving Dementia Care in the CHA House Calls Program

2017 Ellie Grossman, MD

Improving Entry into Treatment for Opioid Use Disorder at CHA Developing a Patient-Care Team Co-management Model for Diabetes Management Planning Together - Use of the care plan the support the health goals of adults with serious mental illness

2017 Fiona McCaughan, RN, MS 2017 Miriam Tepper, MD 2017 Leah Zallman, MD, MPH 2015 Richard Balaban, MD

Co-producing provider engagement: a novel paradigm Engaging Patients and PCPs to Ensure Timely and Appropriate Post-Discharge Care

2015 Chris Fischer, MD

Implementation of a Chest Pain Clinical Pathway in the Emergency Department

2015 Lorky Libaridian, MD

Heart Healthy Hypertension Program The Firehouse Model: Creating Community Health Worker Teams to Engage Vulnerable Patients in the CHA Catchment Area Co-producing Primary Care Behavioral Health Using Wellness Recovery Action Planning (WRAP)

2015 Rob Marlin, MD 2015 Colleen O'Brien, PsyD

2019 CHA Academic Report

28

II. CHA Educational Programs In depth descriptions of CHA's educational programs can be found on our external website www.challiance.org/academic/cha-academics. The following updates highlight recent innovations within these selected programs.

A. Adult Psychiatry Training Program - New Initiatives The Adult Psychiatry Training Program has been working on curriculum initiatives in psychopharmacology, neuroscience, psychotherapy and quality improvement curricula. Each of these areas is a core area of clinical and didactic learning that is repeated and built upon in each training year for general psychiatry residents. For our psychopharmacology and quality improvement curricula, we have focused on matching didactic curricula to the specific learning Amber Frank, MD needs of each training year and building progressive sophistication with each training year. As an example, psychopharmacology coursework progresses from practical, on-call oriented content at the end of the PGY1 year, through a detailed review of medications organized by medication family in the PGY2 year, and culminates with a “junior attending” model in the PGY4 year, in which residents attend a faculty seminar and serve as peer consultants (with faculty supervision) on complex psychopharmacology cases.

In QI and patient safety, PGY1 residents receive a basic education in terms and applicability to the psychiatric context through a case-based curriculum.

They then build upon their skills with progressive independence ​through case presentations that simulate an RCA experience ​and a group QI project in the PGY2-4 years.

For psychotherapy and neuroscience, our focus has been on integrating more national cutting-edge and best-practice approaches into our own residency’s curriculum. These initiatives have included increasing faculty development and engagement for our psychotherapy faculty supervisors and augmenting our existing Cognitive Behavioral Therapy (CBT) curricula by exploring increased faculty supervision and integration of CBT content into all training years.

For our neuroscience curriculum, we have progressively increased our utilization of curricula from the National Neuroscience Curriculum Initiative (NNCI), with training directors participating in annual 2019 CHA Academic Report

NNCI training opportunities. We are revising our PGY3 and PGY4 neuroscience didactic curricula to include more NNCI modules, grouped into a PGY3 course focusing on normal anatomy and physiology followed by a PGY4 course focusing on the neuroscience underlying psychiatric disorders and symptoms, including how to integrate neuroscience into patient care and education.

B. Family Medicine Residency Program - New Initiatives A Focus on Leadership and Excellence The Family Medicine Department at CHA is the home to the family medicine residency program. The residency, affiliated with Tufts University School of Medicine and now in its 27th year, is one of the premier family medicine programs in the U.S. Its nationally recognized faculty attracts graduates from top medical schools as well as students from Tufts and Harvard who seek mentoring and clinical experiences.

Greg Sawin, MD

The residency program seeks to impact family medicine training and practice nationally with focus on primary care transformation and health equity. The program was one of just 14 (2.3%) family medicine residencies in the nation selected to participate in “Preparing the Personal Physician for Practice”national demonstration project exploring residency redesign to support concepts of patient centered medical home.​1​ The residency has been recognized as a program of excellence in an AAMC report highlighting characteristics of the highest functioning primary care residency clinics in the nation.​2​ The program has a focus on health equity and successfully recruits residents to match the diverse population we serve. 58% of its current residents are people of color. Uncharacteristic of most family medicine training programs, approximately one third of each year’s graduates seek further fellowship training. A significant proportion of CHA’s Family Medicine Residency Program graduates joined the faculty at medical schools such as Tufts, HMS, Boston University, Universities of California - San Francisco and Davis, and Pennsylvania State, Hershey.

29

Skill Development in Team-Based Care and Population Management By practicing in our NCQA Level 3 Patient-Centered Medical Home practice in Malden, residents develop leadership skills in team-based care. Our longitudinal curricula in Leadership and Improvement Science and in Community Medicine and Equity provide a solid knowledge base to support learners’ development in these areas. We are creating practices where patients and their communities can support and grow with each other. We deliver the clinical and didactic training needed to provide excellent care across the spectrum of primary care, population health, mental health and substance abuse. Our clinic has group visits for prenatal care, weight loss and wellness and opioid addiction. Medical students observe residents in leadership roles in the practice, such as leading clinical teams, group visits and quality improvement activities. The milieu cultivates a passion both for continued learning and health equity.

Primary care based hepatitis C treatment and outpatient based addiction care including establishment of group based opioid treatment models are other areas of clinical and research interest.​9​, ​10​,​11​ ,​12​ ​The Family Medicine Department is developing collaborative investigations with CHA’s major research groups on topics of mutual interest and with extensive ties to the surrounding communities.

Competency-Based Education The residency has been a leader nationally in the competency-based education movement. Faculty members have been involved in the formation of ACGME’s “Next Accreditation System” for residency training and have developed competency definitions, curricula and assessment tools that have been published and used nationally​.3​ Residents also have the option of developing additional proficiency by selecting an area of concentration. Faculty have drawn the attention of a serial entrepreneur and are part of a start-up company designing next-generation assessment systems to capture high frequency/low stakes feedback to accelerate adult learning.

Quick Stats ●

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Evidence-Informed Decision Making

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The residency is a national leader in teaching the basic science of evidence-based medicine, the applied science of information mastery and the application of cognitive science to improve decision making.​3​ Our curriculum, which has been evaluated and published, is used nationally by residency programs.​ ​4​, ​5​, ​6​, ​7​ Residents develop the knowledge and metacognitive skills necessary to monitor their decision making to improve patient care.

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Education and Population Research

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The faculty comprises several clinician-researchers who have published extensively. Education research focuses on the development of competency-based education, assessment techniques and curriculum innovations such as group visits and the role of reflective writing in resident self-development.​8​ ,​ 2019 CHA Academic Report

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Eight-eight-eight (total = 24 residents) three-year categorical family medicine residency program; Eight core faculty physicians, with 30 additional part-time teaching faculty; 58% of our residents are people of color 31% are underrepresented minorities in medicine.

Fellowships: ○ Master Teacher Fellowship (includes Masters of Medical Education); ○ Reproductive Health and Advocacy; Medical students trained each year from Tufts, HMS and other schools.

Research areas: Education innovations, outpatient based opioid treatment and addictions care, value based care, primary care transformation, primary care-based Hepatitis C treatment, clinical practice guideline development, the role of conflicts of interest in medical research.

Each resident conducts over 2,000 primary care patient visits over his/her three years.

Second and third year residents have patient panels of ~400 patients each.

Selected Bibliography Carney PA, Eiff MP, Green LA, et al. Site-Specific Innovations, Hypotheses, and Measures at Baseline. ​Fam Med​.:8.

30

High-Functioning Primary Care Residency Clinics. https://store.aamc.org/high-functioning-primary-care-reside ncy-clinics.html. Accessed February 28, 2019.

Grad R, Pluye P, Tang D, Shulha M, Slawson DC, Shaughnessy AF. Patient-Oriented Evidence that Matters (POEMs)​TM Suggest Potential Clinical Topics for the Choosing Wisely​TM Campaign. ​J Am Board Fam Med​. 2015;28(2):184-189. doi:10.3122/jabfm.2015.02.140226​.

Shaughnessy AF, Gupta PS, Erlich DR, Slawson DC. Ability of an information mastery curriculum to improve residents’ skills and attitudes. ​Fam Med​. 2012;44(4):259-264.

Slawson DC, Shaughnessy AF. Teaching Evidence-Based Medicine: Should We Be Teaching Information Management Instead? ​Acad Med​. 2005;80(7):685.

clerkships emphasize further preparing fourth year medical students for assumption of core duties and responsibilities in a few short months as junior clinicians beginning internship and residency. Unlike their previous rotations, the Clinical Capstone clerkship is purely formative. Students receive coaching and feedback from seasoned clinicians while they continue to develop their individual professional skills and care for patients in an active clinical setting.

The CHA Emergency Medicine Clinical Capstone clerkship takes place in the Cambridge Hospital Emergency Department providing front-line exposure to our diverse community.

Slawson DC, Shaughnessy AF. Teaching information mastery: creating informed consumers of medical information. ​Journal of the American​ Board of Family Practice​ 1999 Nov-Dec;12:444-9.

D. Internal Medicine Residency Program - New Initiatives

Shaughnessy AF, Slawson DC, Bennett JH. Teaching Family Practice Residents to be Information Masters: A Curriculum for the Evaluation of Pharmaceutical Representatives. ​Family Medicine​ 1995 (Oct);27:581-5.

Social Medicine & Research-Based Health Advocacy Curriculum

Shaughnessy AF, Sparks J, Cohen-Osher M, Goodell KH, Sawin GL, Gravel J. Entrustable Professional Activities in Family Medicine. ​J Grad Med Educ​. 2013;5(1):112-118. doi:10.4300/JGME-D-12-00034.1​.

Sokol R, Albanese C, Chaponis D, et al. Why use group visits for opioid use disorder treatment in primary care? A patient-centered qualitative study. ​Subst Abuse​.

2018;39(1):52-58. doi:10.1080/08897077.2017.1356792​.

Sokol R, LaVertu AE, Morrill D, Albanese C, Schuman-Olivier Z. Group-based treatment of opioid use disorder with buprenorphine: A systematic review. ​J Subst Abuse Treat​.

2018;84:78-87. doi:10.1016/j.jsat.2017.11.003​.

Implementation of a multidisciplinary, team-based model to treat chronic hepatitis C in the primary care setting: Lessons learned - ScienceDirect. https://www-sciencedirect-com.ezproxy.library.tufts.edu/sci ence/article/pii/S2213076417301045. Accessed February 26, 2019.

Sokol R. Sofosbuvir/Velpatasvir (Epclusa) for Hepatitis C. ​Am Fam Physician​. 2017;95(10):664-666.

C. Harvard Medical School Clinical Capstone Clerkship in Emergency Medicine at Cambridge Hospital In 2019, CHA and the other Harvard Medical School-affiliated teaching sites implemented the Clinical Capstone program, a required clinical clerkship that supplements the HMS principal clinical experience (PCE). These HMS Clinical Capstone 2019 CHA Academic Report

The Social Medicine and Research- Based Health Advocacy curriculum was initially established in 2005

by Danny McCormick, MD, MPH, as an elective course. Recognizing the popularity of the course, and its importance in medical professionalism, the course was transformed into a required curriculum in 2012.

All internal medicine residents now receive over 100 hours of curricular programming taught by Dr. McCormick and Gaurab Basu, MD, MPH. They learn about health disparities, social justice, U.S. healthcare reform, global health and human rights. They are introduced to quantitative and qualitative research methodology and participate in skills workshops on public narrative and community organizing/power mapping.

A central component of the course is the research-based health advocacy project, which enables experiential learning. Residents work as a group to identify a socioeconomic factor that has unjustly influenced their patients’ care and then develop a research study to investigate it. They then use their findings to bring awareness to the issue and to try to influence policy. Last year, the residents’ project on the impact of the Affordable Care Act on Americans with chronic disease was published in Annals of Internal Medicine​ (Torres et al.) and featured in popular media such as CNN, ABC News and ​Kaiser Health News​. Residents also wrote an op-ed on the topic that was published by NPR/WBUR’s ​CommonHealth ​blog. Other recent project topics include: a survey of access to buprenorphine providers in Massachusetts and of curriculum for addiction treatment among U.S. internal medicine residency programs, and the effect 31

of healthcare reform on safety net hospitals: view from the CEO’s office.

In the last year, the course has developed increasing national attention. A descriptive paper was published in ​Academic Medicine​ (Basu et al.) in 2017, and it was highlighted in STAT News, the Harvard Macy Institute’s blog and the Harvard Medical School Academy’s Insights newsletter.

Recent qualitative studies have explored how the course has impacted knowledge and skill development, and the course’s role in increasing inspiration and sense of self-efficacy. The qualitative study suggests that the course helps many prepare for roles as health advocates and may support residents in finding purpose, aligning personal values with their professional roles and mitigating burnout during training and beyond.

Selected Bibliography Basu G, Pels RJ, Stark RL, Jain P, Bor DH, McCormick D. Training Internal Medicine Residents in Social Medicine and Research-Based Health Advocacy: A Novel, In-Depth Curriculum. ​Acad Med​. 2017 Apr;92(4):515-520.

Torres H, Poorman E, Tadepalli U, Schoettler C, Fung CH, Mushero N, et al. Coverage and Access for Americans With Chronic Disease Under the Affordable Care Act: A QuasiExperimental Study. ​Ann Intern Med​. 2017;166:472-479. doi: 10.7326/M16-1256.

Basu,G, Dryden EM, Pels RJ, Stark RL, Jain P, Bor DH, Sullivan AM, McCormick D. Taking the spark…and teaching them how to light a fire. Lessons from A Social Medicine & Advocacy Curriculum ​(submitted for publication).

E. Oral Health at CHA In 1994, the Windsor Street Care Center of Cambridge Health Alliance (CHA) became part of the Harvard School of Dental Medicine’s affiliated dental services. A formal affiliation agreement was signed on May 7, 2003.

The original idea stemmed from a collaboration between Dr. Chester Douglass and Dr. David Bor. CHA has a unique place in the community it serves – it provides health care to Cambridge as it has both a public health facility and a local hospital. The Windsor Street Care Center has received recognition from the City of Cambridge for its important work.

Providing oral health services, an important aspect of general health, required attention. A dental service was implemented with Dr. Douglass as the head. As the needs became more apparent, a general practice 2019 CHA Academic Report

dental residency, under the direction of Dr. John Zdanowicz, was started. Dr. Brian Swann then joined the service as both the chief of the oral health department and the clinical residency program.

Based on current reviews, additional faculty may be added to assist with the many ongoing projects.

The existence of the general practice residency offers a unique opportunity to address the longstanding problem of the separation of medicine and Brian Swann, DDS, MPH dentistry. With the guidance of Dr. Donald Giddon, the concept of a medical-dental integration was established within the residency, having joint programs with other medical specialties, especially with primary care/family medicine. The program also utilizes the facilities at the dental school to enrich the experience of its residents. The “oral physician” rotation has developed innovative delivery systems like group visits, incorporating the medical interview into the scope of practice, cross training pharmacy students, and developing oral health interventions for diabetic patients. Several scholarly articles have also been published about the important work of the program. It is also notable that the program attracts high caliber applicants, most who are interested in caring for patients from a diverse socio-economic population.

In February of 2016, discussions began with the CHA Executive Committee regarding the potential of developing a dual degree program between the medical and dental school. These graduates would then complete a combined general dental and family medicine residency; there is currently one person in the family medicine portion of such a program. Drs. Donoff and Hundert have met with CHA senior staff who have approved this concept and further planning and development between HMS and HSDM are underway. This would be an innovative example of interprofessional education and practice. In addition, first and second year dental students are rotating through the dental clinic in order to observe primary care dentistry within a safety net organization on patients with complex medical histories, and to conduct medical interviews in the oral health setting.

Our residents have become ambassadors thought out various primary care settings including special rotations in the hospital emergency departments.

We also send residents to screen children and educate parents about oral disease prevention at two 32

Women’s, Infants and Children (WIC) nutritional programs. We screen and treat homeless patients from the Salvation Army’s homeless shelter monthly.

We are assisting in the development of school based dental programs at Somerville and Everett High Schools. We have also integrated into the mass School of Pharmacy by bringing more power into their oral health lecture. We have our residents participate in the Harvard School of Medicine’s Oral Health Day workshop and lecture. Our presidents are giving lectures to second year dental students at Harvard about inter profession training, applicable pharmacology and multidisciplinary approaches to specialty dental care within the dental school. The oral physician concept is a work in progress and it is important to provide as many multifaceted opportunities to help the next generation of oral health providers better appreciate their capacity.

2019 CHA Academic Report

33

III. Publications This listing is necessarily incomplete. It covers the 2017 and 2018 calendar years and includes peer reviewed articles only. We created the list by searching the National Library of Medicine database for articles where Cambridge Health Alliance was included among the author's affiliation. In addition, we contacted all Department Chiefs and our major researchers to augment the list. Thus, this listing does not include our colleagues' many book chapters, non-peer reviewed articles or op eds, blog posts and other contributions found in the lay press. It only includes journals that are listed by Medline. We apologize if your work was not referenced.

Publication 30-Day Readmission Rates in Patients Admitted for Heart Failure Exacerbation with and without Palliative Care Consultation: A Retrospective Cohort Study.

"It's like a mirror image of my illness": Exploring Patient Perceptions About Illness Using Health Mind Mapping-a Qualitative Study.

A 53 year old Haitian male presenting with a liver abscess A Case-Control Study of Sonographic Maximum Ovarian Diameter as a Predictor of Ovarian Torsion in Emergency Department Females With Pelvic Pain.

A comprehensive meta-analysis on evidence of Mediterranean diet and cardiovascular disease: Are individual components equal?

A decline in depression treatment following FDA antidepressant warnings largely explains racial/ethnic disparities in prescription fills.

A Multi-Stakeholder Consensus-Driven Research Agenda for Better Understanding and Supporting the Emotional Impact of Harmful Events on Patients and Families.

A National Imperative: Multimodal Pain Education Reform in US Medical Schools.

A retrospective analysis of cardiometabolic health in a large cohort of truck drivers compared to the American working population.

A review of longitudinal clinical programs in US medical schools.

A Review of Mental Health and Mental Health Care Disparities Research: 2011-2014.

Authors Chuang E, Kim G, Blank AE, Southern W, Fausto J. Buitron de la Vega P1,2, Coe C3, Paasche-Orlow MK4,3, Clark JA5, Waite K4, Sanchez MJ6, Armstrong E4, Bokhour BG5,7.

Publication Information

Department

J Palliat Med. 2017 Feb;20(2):163-169. doi: 10.1089/jpm.

2016.0305. Epub 2016 Nov 8.

Medicine

J Gen Intern Med. 2018 Oct;33(10):1692-1699. doi: 10.1007 /s11606-018-4557-9. Epub 2018 Jul 10.

Psychiatry

Ue F, Bruno-Murtha LA, Kuhn D, Shipton L Budhram G1, Elia T1, Dan J1, Schroeder M1, Safain G1,2, Schlech W1,3, Friderici J1, Knee A1, Anthouard M1,4, Schoenfeld E1.

Accepted for publication (08/02/2018) in Clin Infect Dis

Medicine

Acad Emerg Med. 2018 Jul 25. doi: 10.1111/acem.13523. [Epub ahead of print]

Emergency Medicine

Grosso G, Marventano S, Yang J, Micek A, Pajak A, Scalfi L, Galvano F, Kales SN.

Crit Rev Food Sci Nutr. 2017 Oct 13;57(15):3218-3232. doi: 10.1080/10408398.2015.1107021.

Medicine

Carson NJ, Progovac AM, Wang Y, Cook BL. Bell SK, Etchegaray JM, Gaufberg E, Lowe E, Ottosen MJ, Sands KE, Lee BS, Thomas EJ, Van Niel M, Kenney L; Healing After Harm Conference Group.

Depress Anxiety. 2017 Dec;34(12):1147-1156. doi: 10.1002/da.

22681. Epub 2017 Sep 29.

Psychiatry

Jt Comm J Qual Patient Saf. 2018 Jul;44(7):424-435. doi: 10.1016 /j.jcjq.2018.03.007. Epub 2018 May 30.

Medicine

Barreveld AM1, Griswold T2.

Pain Med. 2018 Mar 1;19(3):415-416. doi: 10.1093/pm/pnx337

Psychiatry

Thiese MS1, Hanowski RJ2, Moffitt G3, Kales SN4, Porter RJ5, Ronna B1, Hartenbaum N6, Hegmann KT1.

Gheihman G1, Jun T1,2, Young GJ1, Liebman D1, Sharma K1, Brandes E1, Ogur B1,3, Hirsh DA1,3.

Cook BL1,2, Hou SS1, Lee-Tauler SY3, Progovac AM1,2, Samson F1, Sanchez MJ1

Am J Ind Med. 2018 Feb;61(2):103-110. doi: 10.1002/ajim.22795.

Epub 2017 Nov 8.

Med Educ Online. 2018 Dec;23(1):1444900. doi: 10.1080 /10872981.2018.1444900.

Med Care Res Rev. 2018 Jun 1:1077558718780592. doi: 10.1177 /1077558718780592.

Ann Intern Med. 2018 Oct 2;169(7):504-505. doi: 10.7326/M181730. No abstract available.

Infect Control Hosp Epidemiol. 2018 Feb;39(2):234-236. doi: 10.1017/ice.2017.289. Epub 2018 Jan 5 Breastfeed Med. 2018 Nov;13(9):559-574. doi: 10.1089/bfm.

2018.29110.mha.

Medicine Medicine Psychiatry Medicine

A Strawberry Milkshake.

A Successful Strategy to Decrease Hospital-Onset Clostridium difficile.

ABM Clinical Protocol #7: Model Maternity Policy Supportive of Breastfeeding.

Access to health insurance and utilization of substance use disorder treatment: Evidence from the Affordable Care Act dependent coverage provision.

Addictions Training in Child and Adolescent Psychiatry Fellowships.

Addictions Training in General Psychiatry Training Programs: Current Gaps and Barriers.

Affordability of and Access to Information About Health Insurance Among Immigrant and Non-immigrant Residents After Massachusetts Health Reform.

Dohlman JC1.

Allograft Cartilage Replacements.

Already at the Table: Patterns of Play and Gambling Involvement Prior to Gambling Expansion.

American College of Foot and Ankle Surgeons Clinical Consensus Statement: Diagnosis and Treatment of Adult Acquired Infracalcaneal Heel Pain.

An Evaluation of a Multidisciplinary Pediatric Behavioral Health Medication Initiative Workgroup's Interventions on Medication Prescribing in a Population of Medicaid Patients.

Theodoulou MH1, Bohman L2.

Nelson SE1,2, LaPlante DA3,4, Gray HM3,4, Tom MA3,4, Kleschinsky JH3, Shaffer HJ3,4.

J Immigr Minor Health. 2017 Aug;19(4):929-938. doi: 10.1007 /s10903-016-0479-y.

Clin Podiatr Med Surg. 2018 Jul;35(3):281-293. doi: 10.1016/j. cpm.2018.02.003. Epub 2018 May 8.

J Gambl Stud. 2018 Mar;34(1):275-295. doi: 10.1007/s10899017-9711-5.

Schneider HP1, Baca JM2, Carpenter BB3, Dayton PD4, Fleischer AE5, Sachs BD6.

J Foot Ankle Surg. 2018 Mar - Apr;57(2):370-381. doi: 10.1053/j. jfas.2017.10.018. Epub 2017 Dec 25.

Podiatry

J Manag Care Spec Pharm. 2018 Aug;24(8):746-751. doi: 10.18553/jmcp.2018.24.8.746.

Psychiatry

Bruno-Murtha LA1, Osgood RA2, Alexandre CE3.

Hernández-Aguilar MT1,2, Bartick M3,4, Schreck P5, Harrel C6; Academy of Breastfeeding Medicine.

Saloner B, Maclean C, Akosa Antwi YO, Cook B. Welsh JW1, Schwartz AC2, DeJong SM3.

Schwartz AC1, Frank A2, Welsh JW3, Blankenship K4, DeJong SM2.

Kang YJ, McCormick D, Zallman L.

Chiara AN1, Kashalikar N1, Pomfret TC1, Lenz K2, Faber DM3, Goldstein J4, Clements KM5, Angelini MC6, Leto P1, Jeffrey PL2 Stuebe AM, Jegier BJ, Schwarz EB, Green BD, Reinhold AG, An Online Calculator to Estimate the Impact of Changes Colaizy TT, Bogen DL, Schaefer AJ, Jegier JT, Green NS, in Breastfeeding Rates on Population Health and Costs.

Bartick MC. Analysis of Work Requirement Exemptions and Medicaid Goldman AL1,2, Woolhandler S3,4, Himmelstein DU3,4, Bor Spending.

DH1,3, McCormick D1,3.

A National Imperative: Multimodal Pain Education Barreveld AM1, Griswold T2 Reform in US Medical Schools.

Antipsychotic augmentation for major depressive Simons P, Cosgrove L, Shaughnessy AF, Bursztajn H. disorder: A review of clinical practice guidelines.

Antipsychotic prescribing patterns in a Medicare Advantage population of older individuals with Kester R1, Unützer J2, Hogan D3, Huang H1. dementia.

Progovac AM, Chang YF, Chang CH, Matthews KA, Donohue JM, Scheier MF, Habermann EB, Kuller LH, Goveas JS, Chapman BP, Duberstein PR, Messina CR, Weaver KE, Are Optimism and Cynical Hostility Associated with Saquib N, Wallace RB, Kaplan RC, Calhoun D, Smith JC, Smoking Cessation in Older Women?

Tindle HA. Aspirin-Exacerbated Respiratory Disease Assessing the Individual, Neighborhood, and Policy Predictors of Disparities in Mental Health Care.

Assessing provider and racial/ethnic variation in response to the FDA antidepressant box warning.

2019 CHA Academic Report

Kuhn DM1.

Cook BL, Zuvekas SH, Chen J, Progovac A, Lincoln AK. Cook BL1, Wang Y2, Sonik R3, Busch S4, Carson N1, Progovac AM1, Zaslavsky AM5.

Health Economics. 2018; 27(1): 50-75.

Acad Psychiatry. 2018 Jul 31. doi: 10.1007/s40596-018-0959-6.

[Epub ahead of print] Acad Psychiatry. 2018 Oct;42(5):642-647. doi: 10.1007/s40596018-0950-2. Epub 2018 Aug 2.

Breastfeed Med. 2017 Dec;12(10):645-658. doi: 10.1089/bfm.

2017.0083. Epub 2017 Sep 14.

JAMA Intern Med. 2018 Nov 1;178(11):1549-1552. doi: 10.1001 /jamainternmed.2018.4194.

Medicine Medicine

Psychiatry Psychiatry Psychiatry

Medicine Podiatry Psychiatry

Medicine Medicine *

Pain Med. 2018 Mar 1;19(3):415-416. doi: 10.1093/pm/pnx337.

Int J Law Psychiatry. 2017 Nov - Dec;55:64-71. doi: 10.1016/j.ijlp.

2017.10.003. Epub 2017 Nov 8. Review.

Family Medicine

J Ment Health. 2017 Apr;26(2):167-171. doi: 10.1080/09638237.

2016.1244720. Epub 2016 Nov 12.

Psychiatry

Ann Behav Med. 2017 Aug;51(4):500-510. doi: 10.1007/s12160016-9873-x.

N Engl J Med. 2018 Dec 6;379(23):2281. doi: 10.1056 /NEJMc1813469 Med Care Res Rev. 2017 Aug;74(4):404-430. doi: 10.1177 /1077558716646898. Epub 2016 May 4.

Health Serv Res. 2019 Feb;54 Suppl 1:255-262. doi: 10.1111 /1475-6773.13104.

Psychiatry

Psychiatry Medicine Psychiatry Psychiatry

34

Assessment of Digital Media Use in the Adolescent Psychiatric Evaluation.

Assessment of inpatient psychiatric readmission risk among patients discharged on an antipsychotic polypharmacy regimen: A retrospective cohort study.

Association Between Substance Use Diagnoses and Psychiatric Disorders in an Adolescent and Young Adult Clinic-Based Population.

Augmenting Mental Health in Primary Care: A 1-Year Study of Deploying Smartphone Apps in a Multi-site Primary Care/Behavioral Health Integration Program.

Authors' Reply to Letter to the Editor.

Availability of Outpatient Mental Health Care by Pediatricians and Child Psychiatrists in Five U.S. Cities.

Babies in boxes and the missing links on safe sleep: Human evolution and cultural revolution.

Barriers to and Correlates of Retention in Behavioral Health Treatment Among Latinos in 2 Different Host Countries: The United States and Spain.

Bearing witness: a longitudinal integrated cancer care curriculum.

Burden of Mental Illness and Non-communicable Diseases and Risk Factors for Mental Illness Among Refugees in Buffalo, NY, 2004-2014.

Capsule Commentary on Kalkhoran et al., Patterns of and Reasons for Electronic Cigarette Use in Primary Care Patients.

CEO-CLER Innovation Grants Program: Empowering Residents as Clinical Learning Environment Change Agents.

Characteristics of International Assaultive Psychiatric Patients: Review of Published Findings, 2013-2017.

Chief Resident Immersion Training in the Care of Older Adults: A Successful National Replication of an Interspecialty Educational Intervention.

Chronic fatigue syndrome and the somatic expression of emotional distress: Applying the concept of illusory mental health to address the controversy.

Clinical characteristics and outcomes in polyarticular septic arthritis.

Clinical characteristics and outcomes of septic bursitis.

Clinicians' Obligations to Use Qualified Medical Interpreters When Caring for Patients with Limited English Proficiency.

Collaborative Care for Women With Depression: A Systematic Review.

Commercial Health Plan Coverage of Selected Treatments for Opioid Use Disorders from 2003 to 2014.

Communitisation of healthcare: peer support groups for chronic disease care in rural India.

Comparison of Mental Health Treatment Adequacy and Costs in Public Hospitals in Boston and Madrid.

Components Analyses of a School-Based Cognitive Behavioral Treatment for Youth Depression.

Conflict of Interest Policies and Industry Relationships of Guideline Development Group Members: A CrossSectional Study of Clinical Practice Guidelines for Depression.

Co-Occurrence of Posttraumatic Stress Disorder and Cardiovascular Disease Among Ethnic/Racial Groups in the United States.

Coroners and PTSD: Treatment Implications.

Critique of Cheatle et al.'s Study of Risk of Opioid Use Disorder Due to Prescribing Opioids for Chronic Noncancer Pain.

Current Perspective on the Use of Opioids in Perioperative Medicine: An Evidence-Based Literature Review, National Survey of 70,000 Physicians, and Multidisciplinary Clinical Appraisal.

Demographic and clinical characteristics associated with a history of bizarre delusions in a cross-diagnostic sample of individuals with psychotic disorders.

Designing Medical Education Structure for Workforce Transformation: Continuity, Symbiosis and Longitudinal Integrated Clerkships Developing a Collaborative Care Training Program in a Psychiatry Residency.

Developing High-Functioning Teams: Factors Associated With Operating as a "Real Team" and Implications for Patient-Centered Medical Home Development.

Diagnosis of Hand Infections in Intravenous Drug Users

by Ultrasound and Water Bath: A Case Series.

Differences in BMI between Mexican and Colombian patients receiving antipsychotics: results from the International Study of Latinos on Antipsychotics (ISLA).

Diffusion of innovation and longitudinal integrated clerkships: Results of the clerkship directors in internal medicine annual survey

2019 CHA Academic Report

Carson NJ1, Gansner M2, Khang J3.

Child Adolesc Psychiatr Clin N Am. 2018 Apr;27(2):133-143. doi: 10.1016/j.chc.2017.11.003. Epub 2018 Jan 2.

Boskailo E, Malkoc A, McCurry DB, Venter J, Drachman D, Ramos GM.

Acta Med Acad. 2017 Nov;46(2):133-144. doi: 10.5644/ama2006124.198.

Psychiatry

Welsh JW, Knight JR, Hou SS, Malowney M, Schram P, Sherritt L, Boyd JW.

J Adolesc Health. 2017 Jun;60(6):648-652. doi: 10.1016/j. jadohealth.2016.12.018. Epub 2017 Feb 12.

Hoffman L1,2, Benedetto E1, Huang H3, Grossman E1, Kaluma D1, Mann Z3, Torous J2.

Schneider HP1, Baca J2, Carpenter B3, Dayton P4, Fleischer AE5, Sachs BD6.

Cama S, Malowney M, Smith AJB, Spottswood M, Cheng E, Ostrowsky L, Rengifo J, Boyd JW.

Front Psychiatry. 2019 Feb 28;10:94. doi: 10.3389/fpsyt.

2019.00094. eCollection 2019.

J Foot Ankle Surg. 2018 Sep - Oct;57(5):1052-1053. doi: 10.1053 /j.jfas.2018.02.015. Epub 2018 May 18.

Int J Health Serv. 2017 Oct;47(4):621-635. doi: 10.1177 /0020731417707492. Epub 2017 May 5.

Matern Child Nutr. 2018 Apr;14(2):e12544. doi: 10.1111/mcn.

12544. Epub 2017 Oct 18. Review.

Bartick M1, Tomori C2, Ball HL3.

Falgas I1, Ramos Z, Herrera L, Qureshi A, Chavez L, Bonal C, McPeck S, Wang Y, Cook B, Alegría M.

Psychiatry

Psychiatry

Psychiatry Podiatry Psychiatry Medicine

Ghosh AC, Hirsh D, Schwaitzberg S, Ogur B.

J Public Health Manag Pract. 2017 Jan/Feb;23(1):e20-e27.

Clin Teach. 2017 Apr;14(2):95-99. doi: 10.1111/tct.12498. Epub 2016 Feb 4.

Medicine

Mulugeta W1, Xue H2, Glick M3, Min J2, Noe MF4, Wang Y2,5.

J Racial Ethn Health Disparities. 2018 May 21. doi: 10.1007 /s40615-018-0498-6. [Epub ahead of print]

Psychiatry*

Grossman E.

J Gen Intern Med. 2017 Oct;32(10):1135. doi: 10.1007/s11606017-4131-x. No abstract available.

Medicine

Flannery RB Jr1,2, Wyshak G3, Flannery GJ4.

Journal of Graduate Medical Education. Feb 2019, Vol 11, No 1, pp 72-78. https://doi.org/10.4300/JGME-D-18-00278.1 Psychiatr Q. 2018 Jun;89(2):349-357. doi: 10.1007/s11126-0179539-2.

Levine SA1, Chao SH, Caruso LB, Jackson AH, Russell ML, Young ME, Brett B.

Acad Med. 2018 Sep;93(9):1341-1347. doi: 10.1097/ACM. 0000000000002311.

Bram AD1,2,3, Gottschalk KA4, Leeds WM3,5.

Lieber SB1, Fowler ML2, Zhu C2, Moore A3, Shmerling RH4, Paz Z4.

J Clin Psychol. 2018 Aug 28. doi: 10.1002/jclp.22692.

Joint Bone Spine. 2018 Jul;85(4):469-473. doi: 10.1016/j.jbspin.

2017.09.001. Epub 2017 Sep 14.

Infection. 2017 Dec;45(6):781-786. doi: 10.1007/s15010-0171030-3. Epub 2017 May 29.

Batalden M, Fisher C, Pels R, Gaufberg E.

Lieber SB, Fowler ML, Zhu C, Moore A, Shmerling RH, Paz Z.

AMA J Ethics. 2017 Mar 1;19(3):245-252. doi: 10.1001 /journalofethics.2017.19.3.ecas2-1703.

Psychosomatics. 2017 Jan - Feb;58(1):11-18. doi: 10.1016/j.psym.

2016.09.002. Epub 2016 Sep 6.

J Psychoactive Drugs. 2017 Apr-Jun;49(2):102-110. doi: 10.1080 Reif S, Creedon TB, Horgan CM, Stewart MT, Garnick DW. /02791072.2017.1300360. Epub 2017 Mar 28.

BMJ. 2018 Jan 10;360:k85. doi: 10.1136/bmj.k85. No abstract Jain Y1, Jain P1,2. available.

Carmona R1, Cook BL2,3, Baca-García E1,4,5,6,7,8,9, Chavez J Behav Health Serv Res. 2018 Mar 7. doi: 10.1007/s11414-018L10, Alvarez K11, Iza M1, Alegría M12,13.

9596-9.

J Clin Child Adolesc Psychol. 2017 Feb 16:1-14. doi: 10.1080 Arora PG, Baker CN, Marchette LK4, Stark KD. /15374416.2017.1280800.

Basu G1, Costa VP2, Jain P3.

Huang H, Tabb KM, Cerimele JM, Ahmed N, Bhat A, Kester R.

Cosgrove L, Krimsky S, Wheeler EE, Peters SM, Brodt M, Shaughnessy AF. Vidal C1, Polo R, Alvarez K, Falgas-Bague I, Wang Y, Lê Cook B, Alegría M.

Account Res. 2017;24(2):99-115. Epub 2016 Oct 24.

Psychiatry

Medicine Psychiatry

Medicine

Psychiatry Medicine Medicine

Medicine Psychiatry Psychiatry Medicine* Psychiatry Psychiatry

Family Medicine

Flannery RB Jr1,2, Greenhalgh T3.

Psychosom Med. 2018 Sep;80(7):680-688. doi: 10.1097/PSY. 0000000000000601.

Psychiatr Q. 2018 Dec;89(4):765-770. doi: 10.1007/s11126-0189580-9. Review.

McAuliffe WE1.

Pain Med. 2018 May 1;19(5):1100-1101. doi: 10.1093 /pm/pnx313.

Psychiatry

Jahr JS1, Bergese SD2, Sheth KR3,4, Bernthal NM5, Ho HS6, Stoicea N2, Apfel CC7,8.

Pain Med. 2018 Sep 1;19(9):1710-1719. doi: 10.1093 /pm/pnx191.

Surgery

Yuksel C1, Yilmaz S2, Nesbit A3, Carkaxhiu G2, Ravichandran Asian J Psychiatr. 2018 Jan;31:82-85. doi: 10.1016/j.ajp.

C4, Salvatore P5, Pingali S6, Cohen B4, Ongur D4.

2018.02.011. Epub 2018 Feb 9.

Osman NY, Atalay A, Ghosh A, Saravanan Y, Shagrin B, Singh T, Hirsh DA Educ. Sci. 2017:7(2);58 Psychosomatics. 2017 May - Jun;58(3):245-249. doi: 10.1016/j.

Huang H, Forstein M, Joseph R. psym.2016.12.006. Epub 2016 Dec 20. Review.

Stout S, Zallman L, Arsenault L, Sayah A, Hacker K. DeAngelis J1,2, St James E1, Lema PC1.

Ng B1,2, Camacho A1,3, Parra K4, de la Espriella R4, Rico V5, Lozano S5, Troncoso M6, Castilla-Puentes RC7, Cook BL8, Jimenez DE9.

Mazotti L1,2, Adams J3, Peyser B4, Chretien K5, Duffy B6, Hirsh DA7.

Inquiry. 2017 Jan 1;54:46958017707296. doi: 10.1177 /0046958017707296.

Clin Pract Cases Emerg Med. 2018 Mar 14;2(2):132-135. doi: 10.5811/cpcem.2018.1.36283. eCollection 2018 May.

Psychiatry Psychiatry

Psychiatry

Medicine Psychiatry*

Medicine Emergency Medicine

Ethn Health. 2018 Mar 7:1-8. doi: 10.1080/13557858.

2018.1439894.

Psychiatry

Med Teach. 2018 May 25:1-7. doi: 10.1080/0142159X. 2018.1472369

Medicine*

35

Disfiguring facial lesions and loss of sensation.

Disparities in Breastfeeding: Impact on Maternal and Child Health Outcomes and Costs.

Disparities in hospital smoking cessation treatment by immigrant status.

Disparities in pulmonary fibrosis care in the United States: an analysis from the Nationwide Inpatient Sample.

Does behavioral health integration improve primary care providers' perceptions of health-care system functioning and their own knowledge?

Do Gold Humanism Honor Society Inductees Differ From Their Peers in Empathy, Patient-Centeredness, Tolerance of Ambiguity, Coping Style, and Perception of the Learning Environment?

Do Medical Students' Narrative Representations of "The Good Doctor" Change Over Time? Comparing Humanism Essays From a National Contest in 1999 and 2013.

Do state physician health programs encourage referrals that violate the Americans with Disabilities Act? Do Work Condition Interventions Affect Quality and Errors in Primary Care? Results from the Healthy Work Place Study.

Does breastfeeding duration decrease child obesity? An instrumental variables analysis.

Does foreign aid crowd out government investments?

Evidence from rural health centres in Rwanda.

Dual Use and Hospital Admissions among Veterans Enrolled in the VA's Homeless Patient Aligned Care Team.

Effect of Having a Usual Source of Care on Health Care Outcomes Among Children With Serious Emotional Disturbance.

Effectiveness of the DECIDE Interventions on Shared Decision Making and Perceived Quality of Care in Behavioral Health With Multicultural Patients: A Randomized Clinical Trial.

Effects Of The ACA's Health Insurance Marketplaces On The Previously Uninsured: A Quasi-Experimental Analysis.

Enhanced Child Psychiatry Access and Engagement via Integrated Care: A Collaborative Practice Model With Pediatrics.

Entrustable Professional Activities as a Novel Framework for Pharmacy Education.

Ethical conflict and moral distress in veterinary practice: A survey of North American veterinarians.

Ethical Considerations for Mental Health Clinicians Working with Adolescents in the Digital Age. Evidence for the Baby-Friendly Hospital Initiative to Support Breastfeeding.

Examining psychotropic medication use among youth in the U.S. by race/ethnicity and psychological impairment.

Examining racial/ethnic differences in patterns of benzodiazepine prescription and misuse.

Experiences of Intimate Partner Violence: Findings From Interviews With South Asian Women in the United States.

Exploring Asian American attitudes regarding mental health treatment in primary care: A qualitative study.

Exploring exposure to Agent Orange and increased mortality due to bladder cancer.

Externalizing and self-medicating: Heterogeneity among repeat DUI offenders.

Factor structure of the Cannabis Experiences Questionnaire in a first-episode psychosis sample.

Findings from the Harvard Medical School Cambridge Integrated Clerkship, a Year-Long Longitudinal Psychiatry Experience.

Firefighting and the Heart: Implications for Prevention.

Flaws in the methods and reporting of physician health program outcome studies.

Fostering Psychotropic Medication Oversight for Children in Foster Care: A National Examination of States' Monitoring Mechanisms.

Four experimental stimulants found in sports and weight loss supplements: 2-amino-6-methylheptane (octodrine), 1,4-dimethylamylamine (1,4-DMAA), 1,3dimethylamylamine (1,3-DMAA) and 1,3dimethylbutylamine (1,3-DMBA).

FUSE certification enhances performance on a virtual computer based simulator for dispersive electrode placement.

Geographic variation in mental health care disparities among racially/ethnically diverse adults with psychiatric disorders.

Glecaprevir/Pibrentasvir (Mavyret) for the Treatment of Chronic Hepatitis C.

2019 CHA Academic Report

Chen J1, Grossman E2, Link A1, Wang B1, Sherman S1.

Hundemer M, Wan CR.JAAPA. 2018 Jan;31(1):27-29. doi: 10.1097 Family Medicine /01.JAA.0000526775.98315.5a.

J Pediatr. 2017 Feb;181:49-55.e6. doi: 10.1016/j.jpeds.

Medicine 2016.10.028. Epub 2016 Nov 10.

J Ethn Subst Abuse. 2018 May 4:1-14. doi: 10.1080/15332640.

Medicine* 2018.1446377

Gaffney AW1,2, Woolhander S3, Himmelstein D3, McCormick D4,5.

BMC Health Serv Res. 2018 Aug 8;18(1):618. doi: 10.1186 /s12913-018-3407-0.

Hundemer M1, Wan CR. Bartick MC, Jegier BJ, Green BD, Schwarz EB, Reinhold AG, Stuebe AM.

Medicine*

Zallman L1, Joseph R2, O'Brien C2, Benedetto E3, Grossman Gen Hosp Psychiatry. 2017 May;46:88-93. doi: 10.1016/j.

E2, Arsenault L4, Sayah A2. genhosppsych.2017.03.005. Epub 2017 Mar 14.

Medicine

Gaufberg E1,2, Dunham L3, Krupat E4, Stansfield B5, Christianson C6, Skochelak S3.

Teach Learn Med. 2018 Jul-Sep;30(3):284-293. doi: 10.1080 /10401334.2017.1419873. Epub 2018 Jan 24.

Medicine*

Rutberg PC, King B, Gaufberg E, Brett-MacLean P, Dinardo P, Frankel RM.

Acad Med. 2017 Apr;92(4):537-543. doi: 10.1097/ACM. 0000000000001531.

Int J Law Psychiatry. 2018 Jan - Feb;56:65-70. doi: 10.1016/j.ijlp.

2017.12.004. Epub 2018 Jan 5.

Lawson ND, Boyd JW1.

Linzer M, Poplau S, Brown R, Grossman E, Varkey A, Yale S, Williams ES, Hicks L, Wallock J, Kohnhorst D, Barbouche M. Modrek S, Basu S, Harding M, White JS, Bartick MC, Rodriguez E, Rosenberg KD. Lu C, Cook B, Desmond C.

J Gen Intern Med. 2017 Jan;32(1):56-61. doi: 10.1007/s11606016-3856-2. Epub 2016 Sep 9.

Pediatr Obes. 2017 Aug;12(4):304-311. doi: 10.1111/ijpo.12143.

Epub 2016 May 10.

BMJ Glob Health. 2017 Aug 10;2(3):e000364. doi: 10.1136 /bmjgh-2017-000364. eCollection 2017.

Trivedi AN1,2, Jiang L1, Johnson EE1, Lima JC1,2, Flores M3, Health Serv Res. 2018 Dec;53 Suppl 3:5219-5237. doi: 10.1111 O'Toole TP1. /1475-6773.13034. Epub 2018 Aug 27.

Medicine Psychiatry

Medicine Medicine Psychiatry

Psychiatry

Witt WP, Fullerton CA, Chow C, Gokhale M, Naeger S, Walsh C, Karnell L. Alegria M1,2,3, Nakash O1,4, Johnson K5, Ault-Brutus A6, Carson N3,7, Fillbrunn M1,2, Wang Y1, Cheng A8, Harris T3, 9, Polo A10, Lincoln A11, Freeman E12,13, Bostdorf B14, Rosenbaum M15, Epelbaum C16, LaRoche M3,17, Okpokwasili-Johnson E18, Carrasco M19, Shrout PE20.

Acad Pediatr. 2017 Jan - Feb;17(1):45-52. doi: 10.1016/j.acap.

2016.06.001. Epub 2016 Jun 8.

Psychiatry

JAMA Psychiatry. 2018 Apr 1;75(4):325-335. doi: 10.1001 /jamapsychiatry.2017.4585.

Psychiatry

Goldman AL1, McCormick D2, Haas JS3, Sommers BD4.

Health Aff (Millwood). 2018 Apr;37(4):591-599. doi: 10.1377 /hlthaff.2017.1390.

Medicine*

Grimes KE1, Creedon TB1, Webster CR1, Coffey SM1, Hagan Psychiatr Serv. 2018 Sep 1;69(9):986-992. doi: 10.1176/appi.ps.

GN1, Chow CM1.

201600228. Epub 2018 Jul 25.

Jarrett JB1, Berenbrok LA2, Goliak KL1, Meyer Am J Pharm Educ. 2018 Jun;82(5):6256. doi: 10.5688/ajpe6256 SM2, Shaughnessy AF J Vet Intern Med. 2018 Oct 15. doi: 10.1111/jvim.15315. [Epub Moses L1,2,3, Malowney MJ4, Wesley Boyd J2,5. ahead of print] Curr Psychiatry Rep. 2018 Oct 13;20(12):113. doi: 10.1007 Sussman N1, DeJong SM2. /s11920-018-0974-z. Review.

JAMA. 2017 Feb 21;317(7):770-771. doi: 10.1001/jama.

Bartick MC, Nickel NC, Hanley LE. 2016.20832. No abstract available.

Cook BL, Carson NJ, Kafali EN, Valentine A, Rueda JD, CoeGen Hosp Psychiatry. 2017 Mar - Apr;45:32-39. doi: 10.1016/j.

Odess S, Busch S. genhosppsych.2016.12.004. Epub 2016 Dec 15.

Cook B1, Creedon T2, Wang Y3, Lu C4, Carson N2, Jules P2, Drug Alcohol Depend. 2018 Jun 1;187:29-34. doi: 10.1016/j.

Lee E2, Alegría M3 drugalcdep.2018.02.011. Epub 2018 Mar 26.

Ahmad-Stout F1,2, Nath SR3, Khoury NM4, Huang H5,6.

Hails, K., Madu, A., Kim, D., Hahm, H., Cook B, Chen, J., Chang, T., Yeung, A., Trinh, N. Mossanen M, Kibel AS, Goldman RH 3 Nelson SE1, Shoov E2, LaBrie RA3, Shaffer HJ3.

Birnbaum ML1,2,3,4, Cleary SD5, Ramsay Wan C6, Pauselli L7, Compton MT7

Psychiatry & Pediatrics* Family Medicine* Psychiatry Psychiatry Medicine Psychiatry Psychiatry

J Interpers Violence. 2018 Feb 1:886260517753850. doi: 10.1177 /0886260517753850. [Epub ahead of print] Psychiatry Annals of Clinical Psychiatry. 2018; 30(2): 133-139.

Urol Oncol. 2017 Nov;35(11):627-632. doi: 10.1016/j.urolonc.

2017.07.030. Epub 2017 Aug 18. Review.

Drug Alcohol Depend. 2018 Oct 26;194:88-96. doi: 10.1016/j. drugalcdep.2018.09.017.

Psychiatry

Early Interv Psychiatry. 2017 Oct 20. doi: 10.1111/eip.12509.

Psychiatry

Cheng E1, Hirsh D1, Gaufberg E1, Griswold T1, Wesley Boyd Acad Psychiatry. 2018 Jun;42(3):357-361. doi: 10.1007/s40596J2.

017-0742-0. Epub 2017 Jun 23.

Circulation. 2017 Apr 4;135(14):1296-1299. doi: 10.1161 Kales SN, Smith DL. /CIRCULATIONAHA.117.027018. No abstract available.

Gen Hosp Psychiatry. 2018 Sep - Oct;54:65-66. doi: 10.1016/j.

Lawson ND, Boyd JW1. genhosppsych.2018.06.002. Epub 2018 Jun

Medicine Psychiatry

Medicine & Psychiatry Medicine Psychiatry

Mackie TI, Hyde J, Palinkas LA, Niemi E, Leslie LK.

Adm Policy Ment Health. 2017 Mar;44(2):243-257. doi: 10.1007 /s10488-016-0721-x.

Institute for Community Health

Cohen PA1, Travis JC2, Keizers PHJ3, Deuster P4, Venhuis BJ5.

Clin Toxicol (Phila). 2018 Jun;56(6):421-426. doi: 10.1080 /15563650.2017.1398328. Epub 2017 Nov 8.

Medicine*

Dombek M1,2, Lopez CA3, Han Z3, Lungarini A4, Santos N4, Schwaitzberg S5, Cao C6, Jones DB7, De S3, Olasky J8.

Surg Endosc. 2018 Aug;32(8):3640-3645. doi: 10.1007/s00464018-6095-2. Epub 2018 Feb 13.

Surgery

Kim G, Dautovich N, Ford KL, Jimenez DE, Cook B, Allman RM, Parmelee P.

Soc Psychiatry Psychiatr Epidemiol. 2017 Aug;52(8):939-948. doi: 10.1007/s00127-017-1401-1. Epub 2017 Jun 6.

Am Fam Physician. 2018 Nov 15;98(10):601-602. No abstract available.

Grover A1, Erlich DR2.

Psychiatry Family Medicine*

36

Glycopyrrolate (Seebri Neohaler) for Maintenance Therapy in Patients with COPD. Graduates' Perceptions of Learning Affordances in Longitudinal Integrated Clerkships: A Dual-Institution, Mixed-Methods Study.

Group-based treatment of opioid use disorder with buprenorphine: A systematic review.

Gun Marksmanship and Youth Lead Exposure: A Practice-Oriented Approach to Prevention.

Head CT for Minor Head Injury Presenting to the Emergency Department in the Era of Choosing Wisely.

Heads Up: The Presentation of Schizoaffective Disorder in an Elite College Soccer Player with Prior Concussion.

Healing an ailing pharmaceutical system: prescription for reform for United States and Canada.

Health Insurance Reform in the United States - What, How and Why? Hospital Payer and Racial/Ethnic Mix at Private Academic Medical Centers in Boston and New York City.

How broad are state physician health program descriptions of physician impairment?

How do homeless adults change their lives after completing an intensive job-skills program? A prospective study.

How good is the evidence to support primary care practice?

I Just Felt Like I Was Stuck in the Middle": Physician Assistants' Experiences Communicating With Terminally Ill Patients and Their Families in the Acute Care Setting.

Identification of suicidal behavior among psychiatrically hospitalized adolescents using natural language processing and machine learning of electronic health records.

Identifying Gender Minority Patients' Health And Health Care Needs In Administrative Claims Data.

Immigrants Pay More In Private Insurance Premiums Than They Receive In Benefits.

Impact of a Patient Navigator Program on HospitalBased and Outpatient Utilization Over 180Â Days in a Safety-Net Health System.

Impact of a Usual Source of Care on Health Care Use, Spending, and Quality Among Adults With Mental Health Conditions.

Impact of comorbid mental health needs on racial/ethnic disparities in general medical care utilization among older adults.

Impact of Massachusetts Health Reform on Inpatient Care Use: Was the Safety-Net Experience Different Than in the Non-Safety-Net? Impact of Medical Scribes in Primary Care on Productivity, Face-to-Face Time, and Patient Comfort.

Impact of tiered interventions to decrease routine urine cultures in asymptomatic patients undergoing arthroplasty.

Implementation of a multidisciplinary, team-based model to treat chronic hepatitis C in the primary care setting: Lessons learned.

In Pursuit of Educational Integrity: Professional Identity Formation in the Harvard Medical School Cambridge Integrated Clerkship.

Infectious Diseases Physicians' Perspectives Regarding Injection Drug Use and Related Infections, United States, 2017.

Inpatient Medicaid Usage and Expenditure Patterns After Changes in Supplemental Nutrition Assistance Program Benefit Levels.

Interest in Collaborative, Practice-Based Research Networks in Pediatric Refugee Health Care.

Integration of Neuropsychology in Primary Care International Review of Precipitants to Patient Assaults on Staff, 2013-2017.

Interoception in Psychiatric Disorders: A Review of Randomized, Controlled Trials with Interoception-Based Interventions.

Pong CK.

Acad Med. 2017 Sep;92(9):1313-1319. doi: 10.1097/ACM. 0000000000001621.

J Subst Abuse Treat. 2018 Jan;84:78-87. doi: 10.1016/j.jsat.

2017.11.003. Epub 2017 Nov 9. Review.

Clin Pediatr (Phila). 2017 Oct;56(11):1068-1071. doi: 10.1177 Goldman RH, Woolf AD, Karwowski MP. /0009922817701177. Epub 2017 Apr 26.

DeAngelis J, Lou V, Li T, Tran H, Bremjit P, McCann M, Crane West J Emerg Med. 2017 Aug;18(5):821-829. doi: 10.5811 P, Jones CMC. /westjem.2017.6.33685. Epub 2017 Jul 12.

Harv Rev Psychiatry. 2017 Nov/Dec;25(6):302-310. doi: 10.1097 Adelsky SJ, Ducharme S, Wilner EK, Yudkoff B, Lejeune S. /HRP.0000000000000147. No abstract available.

Gaffney A1, Lexchin J2; US; Canadian Pharmaceutical Policy The British Medical Journal 2018:361.

Reform Working Group.

Latessa RA, Swendiman RA, Parlier AB, Galvin SL, Hirsh DA. Sokol R1, LaVertu AE2, Morrill D3, Albanese C4, SchumanOlivier Z5.

Gaffney A Tikkanen RS, Woolhandler S, Himmelstein DU, Kressin NR, Hanchate A, Lin MY, McCormick D, Lasser KE. Lawson ND1, Boyd JW2.

2019 CHA Academic Report

Journal of Policy Analysis and Management 2018;37:188-95 Int J Health Serv. 2017 Jul;47(3):460-476. doi: 10.1177 /0020731416689549. Epub 2017 Feb 2.

Subst Abuse Treat Prev Policy. 2018 Aug 23;13(1):30. doi: 10.1186/s13011-018-0168-z.

Ebell MH, Sokol R, Lee A, Simons C, Early J.

J Community Psychol. 2017 Sep;45(7):888-905. doi: 10.1002 /jcop.21900. Epub 2017 Aug 10.

Evid Based Med. 2017 Jun;22(3):88-92. doi: 10.1136/ebmed2017-110704. Epub 2017 May 29.

Chuang E, Lamkin R, Hope AA, Kim G, Burg J, Gong MN.

J Pain Symptom Manage. 2017 Jul;54(1):27-34. doi: 10.1016/j. jpainsymman.2017.03.011. Epub 2017 May 4.

Carson NJ1,2, Mullin B1, Sanchez MJ1,3, Lu F1, Yang K1,4, Menezes M1,5, Cook BL1,2.

Progovac AM1, Cook BL2, Mullin BO3, McDowell A4, Sanchez R MJ5, Wang Y6, Creedon TB7, Schuster MA8.

Zallman L1, Woolhandler S2, Touw S3, Himmelstein DU4, Finnegan KE5.

PLoS One. 2019 Feb 19;14(2):e0211116. doi: 10.1371/journal. pone.0211116. eCollection 2019.

Health Aff (Millwood). 2018 Mar;37(3):413-420. doi: 10.1377 /hlthaff.2017.1295.

Health Aff (Millwood). 2018 Oct;37(10):1663-1668. doi: 10.1377 /hlthaff.2018.0309.

Gray HM, Nelson SE, Shaffer HJ, Stebbins P, Farina AR.

Family Medicine

Medicine* Psychiatry* Medicine Emergency Medicine Psychiatry Medicine* Medicine* Medicine* Psychiatry

Psychiatry Family Medicine

Medicine

Psychiatry Psychiatry* Medicine*

Balaban RB, Zhang F, Vialle-Valentin CE, Galbraith AA, Burns J Gen Intern Med. 2017 Sep;32(9):981-989. doi: 10.1007/s11606ME, Larochelle MR, Ross-Degnan D. 017-4074-2. Epub 2017 May 18.

Medicine Fullerton CA1, Witt WP2, Chow CM1,3, Gokhale M1, Walsh CE4, Crable EL1,5, Naeger S6

Adm Policy Ment Health. 2018 May;45(3):462-471. doi: 10.1007 /s10488-017-0838-6.

Psychiatry

Jimenez DE, Schmidt AC, Kim G, Cook BL.

Int J Geriatr Psychiatry. 2017 Aug;32(8):909-921. doi: 10.1002 /gps.4546. Epub 2016 Jul 1.

Psychiatry

Hanchate AD, McCormick D, Lasser KE, Feng C, Manze MG, Kressin NR. Zallman L1, Finnegan K2, Roll D2, Todaro M2, Oneiz R2, Sayah A2.

Health Serv Res. 2017 Oct;52(5):1647-1666. doi: 10.1111/14756773.12542. Epub 2016 Aug 8.

J Am Board Fam Med. 2018 Jul-Aug;31(4):612-619. doi: 10.3122 /jabfm.2018.04.170325.

Jackson EC1, Thai XC1, Bruno-Murtha LA2, Barner AE1.

Infect Control Hosp Epidemiol. 2018 Nov 5:1-2. doi: 10.1017/ice.

2018.278.

Medicine

Sokol R1, Early J2, Barner A3, Gottfried S4, Gumpert R5, Libaridian L4, Morrison V5, Santamaria A2, Shipton L6

Healthc (Amst). 2018 Sep;6(3):205-209. doi: 10.1016/j.hjdsi.

2017.09.005. Epub 2017 Oct 18.

Family Medicine*

Medicine* Medicine*

Gaufberg E, Bor D, Dinardo P, Krupat E, Pine E, Ogur B, Hirsh Propspectives in Biology & Medicine, Volume 60, nuber 2, pp.

DA. 258-274.

Medicine*

Rapoport AB1,2, Fischer LS3, Santibanez S3, Beekmann SE4, Open Forum Infect Dis. 2018 Jun 8;5(7):ofy132. doi: 10.1093 5, Polgreen PM4,5, Rowley CF6,7,2. /ofid/ofy132. eCollection 2018 Jul.

Medicine*

Sonik RA1,2, Parish SL3, Mitra M4.

Shah S1,2,3, Yun K4.

Lanca M1 Flannery RB1,2, Flannery GJ3.

Prev Chronic Dis. 2018 Oct 4;15:E120. doi: 10.5888/pcd15.

180185.

J Immigr Minor Health. 2018 Feb;20(1):245-249. doi: 10.1007 /s10903-016-0500-5.

Arch Clin Neuropsychol. 2018 May 1;33(3):269-279. doi: 10.1093 /arclin/acx135.

Psychiatr Q. 2018 Jun;89(2):497-503. doi: 10.1007/s11126-0179552-5. Review.Roll

Harv Rev Psychiatry. 2018 Sep/Oct;26(5):250-263. doi: 10.1097 Khoury NM1, Lutz J, Schuman-Olivier Z. /HRP.0000000000000170.

Tabb KM1,2, Huang H2,3,4, Valdovinos M5, Toor R6, Ostler T1, Vanderwater E1,2, Wang Y1,2, Menezes PR7, Faisal-Cury J Womens Health (Larchmt). 2018 Feb;27(2):171-178. doi: 10.1089/jwh.2016.6077. Epub 2017 May 24.

A2,7.

J Gen Intern Med. 2018 Jul;33(7):980-982. doi: 10.1007/s11606Wolfe SM1, Woolhandler S2,3, Himmelstein DU4,5.

018-4448-0. No abstract available.

Intimate Partner Violence Is Associated with Suicidality Among Low-Income Postpartum Women.

It Is Time to Liberate Hospitals from Profit-Centered Care.

Leadership development in a professional medical society using 360-degree survey feedback to assess Gregory PJ, Robbins B, Schwaitzberg SD, Harmon L. emotional intelligence.

Learning colorectal endoscopic submucosal dissection: a Gromski MA, Cohen J, Saito K, Gonzalez JM, Sawhney M, prospective learning curve study using a novel ex vivo Kang C, Moore A, Matthes K. simulator.

Legionnaire's Disease: Cardiac Manifestations.

Leprosy Diagnosed Via Teledermatology in a U. S. Urban Academic Health Center Highlights Potential Benefits and a Pitfall of Existing Telemedicine Services.

Am Fam Physician. 2017 Sep 15;96(6):395-398. No abstract available.

Surg Endosc. 2017 Sep;31(9):3565-3573. doi: 10.1007/s00464016-5386-8. Epub 2016 Dec 30.

Brusch JL.

Surg Endosc. 2017 Oct;31(10):4231-4237. doi: 10.1007/s00464017-5484-2. Epub 2017 Mar 9.

Infect Dis Clin North Am. 2017 Mar;31(1):69-80. doi: 10.1016/j. idc.2016.10.006. Review.

Watchmaker L1, Watchmaker J2, DeLeon D3, Stavert R3.

Telemed J E Health. 2018 Sep 12. doi: 10.1089/tmj.2018.0142.

[Epub ahead of print]

Psychiatry Pediatrics Psychiatry Psychiatry

Psychiatry

Psychiatry Medicine

Surgery

Medicine Medicine

Medicine*

37

Lessons From ACEs: Pay Now or Pay (More) Later.

Lessons from the Launch: Program Directors Reflect on Implementing the Child and Adolescent Psychiatry Milestones.

LGBT-Specific Education in General Psychiatry Residency Programs: a Survey of Program Directors.

Longitudinal Changes and High-Risk Subgroups for Obesity and Overweight/Obesity Among Refugees in Buffalo, NY, 2004-2014.

Long-Run Trends in Antidepressant Use Among Youths After the FDA Black Box Warning.

Long-term abstinence and predictors of tobacco treatment uptake among hospitalized smokers with serious mental illness enrolled in a smoking cessation trial.

Long-Term Impact of a Postdischarge Community Health Worker Intervention on Health Care Costs in a SafetyNet System.

Lower education among low-income Brazilian adolescent females is associated with planned pregnancies.

Making the Most of Continuing Medical Education: Evidence of Transformative Learning During a Course in Evidence-Based Medicine and Decision Making.

Mapping the Landscape, Journeying Together: The Gold Foundation's Model for Research-Based Advocacy in Humanism in Medicine.

Massachusetts Health Reform's Effect on Hospitalizations with Substance Use Disorder-Related Diagnoses.

Media Engagement and Identity Formation Among Minority Youth.

Medical education research should extend further into clinical practice.

Medical Expenditures on and by Immigrant Populations in the United States: A Systematic Review.

Medication Reconciliation in the Hospital: An Interactive Case-Based Session for Internal Medicine Residents.

Mesenchymal Stem Cell Applications for Joints in the Foot and Ankle.

Mind the Gap: Developing an Integrated Behavioral Health Home to Address Health Disparities in Serious Mental Illness.

Mindfulness-based cognitive therapy for bipolar disorder: A systematic review.

Moonlighting by Psychiatry Residents: a Survey of Residents and Training Directors.

Multiple Conditions Increase Preventable Crash Risks Among Truck Drivers in a Cohort Study.

MySafeRx: a mobile technology platform integrating motivational coaching, adherence monitoring, and electronic pill dispensing for enhancing buprenorphine/naloxone adherence during opioid use disorder treatment: a pilot study.

Near-Infrared Spectroscopy Imaging for Assessing Skin and Wound Oxygen Perfusion.

Nearly Half Of Small Employers Using Tobacco Surcharges Do Not Provide Tobacco Cessation Wellness Programs.

Near-Normal Shoulder Function 10 Years After Complete Acromionectomy: A Case Report.

Neglected encounters: addiction and the meaning of pain Nicotinamide Inhibits Ethanol-Induced Caspase-3 and PARP-1 Over-activation and Subsequent Neurodegeneration in the Developing Mouse Cerebellum.

No Magic Bullet: A Theory-Based Meta-Analysis of Markov Transition Probabilities in Studies of Service Systems for Persons With Mental Disabilities.

Obesity and health in the North American Fire Service: research points the way to positive culture change.

Older adult fall prevention practices among primary care providers at accountable care organizations: A pilot study.

On the Inner Life of Physicians: Analysis of Family Medicine Residents' Written Reflections.

Acad Pediatr. 2017 Sep - Oct;17(7S):S18-S19. doi: 10.1016/j.acap.

Psychiatry Grimes KE. 2016.12.013. No abstract available.

Sadhu JM1, Lee PC2, Stewart C3, Carson NJ4, Usher C5, Maneta E6, Kitts R7, Sharma N8, Adams A9, Hazen EP7, Myint MT10, Lee ES11, Vasa RA11, Randall TL12, Leong SL2, Acad Psychiatry. 2018 Aug;42(4):510-516. doi: 10.1007/s40596Jacobson SL13 017-0852-8. Epub 2017 Dec 1.

Psychiatry Acad Psychiatry. 2018 Nov 14. doi: 10.1007/s40596-018-1008-1.

Hirschtritt ME1, Noy G2, Haller E3, Forstein M4.

Psychiatry [Epub ahead of print] Mulugeta W1,2, Glick M3, Min J4, Xue H4, Noe MF4, Wang Y4,5,6.

Kafali N1, Progovac A1, Hou SS1, Cook BL1.

Rogers ES, Friedes R, Jakes A, Grossman E, Link A, Sherman SE. Galbraith AA1,2,3, Meyers DJ4,5, Ross-Degnan D2, Burns ME6, Vialle-Valentin CE2, Larochelle MR7, Touw S8, Zhang F2, Rosenthal M4, Balaban RB9.

Faisal-Cury A, Tabb KM, Niciunovas G, Cunningham C, Menezes PR, Huang H.

J Behav Med. 2017 Oct;40(5):750-759. doi: 10.1007/s10865-0179844-0. Epub 2017 Mar 27.

Health Serv Res. 2017 Dec;52(6):2061-2078. doi: 10.1111/14756773.12790.

Int J Womens Health. 2017 Jan 21;9:43-48. doi: 10.2147/IJWH. S118911. eCollection 2017.

Medicine Psychiatry

Medicine*

Medicine Psychiatry

Sokol RG1, Shaughnessy AF

J Contin Educ Health Prof. 2018 Spring;38(2):102-109. doi: 10.1097/CEH.0000000000000199.

Family Medicine*

Gaufberg E.

Acad Med. 2017 Dec;92(12):1671-1673. doi: 10.1097/ACM. 0000000000001987. Review.

Medicine

Lasser KE1,2, Hanchate AD1,3, McCormick D4, Walley AY1, Saitz R1,2, Lin MY1,5, Kressin NR1,3.

Mayhew A1, Weigle P2.

Teodorczuk A1, Yardley S2, Patel R3, Rogers GD1, Billett S4, Worley P5, Hirsh D6, Illing J7.

Flavin L1, Zallman L2,3, McCormick D3,4, Wesley Boyd J5,6.

McShane M1,2, Stark R3,4.

Melick G1, Hayman N1, Landsman AS2.

Tepper MC, Cohen AM, Progovac AM, Ault-Brutus A, Leff HS, Mullin B, Cunningham CM, Cook BL. Lovas DA1, Schuman-Olivier Z2 Robinson LA1, Osborne LM2, Hsu AJ3, Park H4, Arbuckle MR4.

Thiese MS, Hanowski RJ, Kales SN, Porter RJ, Moffitt G, Hu N, Hegmann KT.

Health Serv Res. 2018 Jun;53(3):1727-1744. doi: 10.1111/14756773.12710. Epub 2017 May 19.

Child Adolesc Psychiatr Clin N Am. 2018 Apr;27(2):269-285. doi: 10.1016/j.chc.2017.11.012.

Med Educ. 2017 Nov;51(11):1098-1100. doi: 10.1111/medu.

13459.

Int J Health Serv. 2018 Oct;48(4):601-621. doi: 10.1177 /0020731418791963. Epub 2018 Aug 8.

MedEdPORTAL. 2018 Nov 9;14:10770. doi: 10.15766/mep_23748265.10770.

Clin Podiatr Med Surg. 2018 Jul;35(3):323-330. doi: 10.1016/j. cpm.2018.02.007.

Psychiatr Serv. 2017 Dec 1;68(12):1217-1224. doi: 10.1176/appi. ps.201700063. Epub 2017 Aug 1.

J Affect Disord. 2018 Nov;240:247-261. doi: 10.1016/j.jad.

2018.06.017. Epub 2018 Jul 6.

Acad Psychiatry. 2018 Nov 19. doi: 10.1007/s40596-018-1004-5.

[Epub ahead of print] J Occup Environ Med. 2017 Feb;59(2):205-211. doi: 10.1097 /JOM.0000000000000937.

Schuman-Olivier Z1,2,3, Borodovsky JT4, Steinkamp J5,6, Munir Q4,5, Butler K4, Greene MA4, Goldblatt J5,7, Xie HY4, Addict Sci Clin Pract. 2018 Sep 24;13(1):21. doi: 10.1186/s13722Marsch LA4.

018-0122-4.

Clin Podiatr Med Surg. 2018 Jul;35(3):343-355. doi: 10.1016/j.

Landsman AS1, Barnhart D2, Sowa M2. cpm.2018.02.005. Epub 2018 May 3.

Gardner C1

Health Aff (Millwood). 2018 Mar;37(3):473-481. doi: 10.1377 /hlthaff.2017.1062.

Orthop J Sports Med. 2017 Sep 7;5(9):2325967117726072. doi: 10.1177/2325967117726072. eCollection 2017 Sep Lancet. 2018 May 26;391(10135):2100-2101. doi: 10.1016 /S0140-6736(18)31087-0. Epub 2018 May 24

Ieraci A1,2, Herrera DG3,4.

Cerebellum. 2018 Jun;17(3):326-335. doi: 10.1007/s12311-0170916-z.

Pesko MF1, Bains J2, Maclean JC3, Cook BL4.

Rasmussen JF, Wing DW, Steiner ME.

Leff HS, Chow CM, Graves SC. Korre M1,2, Smith D3, Kales SN1,2.

Howland J1,2, Hackman H1,2, Taylor A1,2, O'Hara K1,2, Liu J1,2, Brusch J3.

Vicini A, Shaughnessy AF, Duggan A. Progovac AM, Donohue JM, Matthews KA, Chang CH, Optimism predicts sustained vigorous physical activity in Habermann EB, Kuller LH, Saquib J, LaMonte MJ, postmenopausal women.

Salmoirago-Blotcher E, Zaslavsky O, Tindle HA. Out-of-Pocket Spending and Premium Contributions Goldman AL1,2, Woolhandler S2,3, Himmelstein DU2,3, Bor After Implementation of the Affordable Care Act. DH1,2, McCormick D1,2.

P3 amplitude attenuation secondary to increases in target-to-target interval (TTI) during spatial serial order recall: implications for EEG models of working memory Hochberger WC1,2, Axelrod JL3, Sarapas C4,5, Shankman function.

SA6, Kristian Hill S3.

Pancreaticoduodenectomy and metastasectomy for Chawla A1, Williams RT2, Sich N3, Clancy T1, Wang J1, metastatic pancreatic neuroendocrine tumors.

Ashley S1, Pezzi C4, Swanson R5.

Parental Depressive Symptoms as a Predictor of Eckshtain D1, Marchette LK2, Schleider J3, Weisz JR4.

Outcome in the Treatment of Child Depression.

2019 CHA Academic Report

J Racial Ethn Health Disparities. 2018 Feb;5(1):187-194. doi: 10.1007/s40615-017-0356-y. Epub 2017 Mar 31.

Psychiatr Serv. 2018 Apr 1;69(4):389-395. doi: 10.1176/appi.ps.

201700089. Epub 2017 Dec 15.

Psychiatr Serv. 2017 Mar 1;68(3):278-287. doi: 10.1176/appi.ps.

201500523. Epub 2016 Oct 17.

Occup Med (Lond). 2018 May 17;68(3):160-162. doi: 10.1093 /occmed/kqy019. No abstract available.

PLoS One. 2018 Oct 11;13(10):e0205279. doi: 10.1371/journal. pone.0205279. eCollection 2018.

J Relig Health. 2017 Aug;56(4):1191-1200. doi: 10.1007/s10943017-0394-0.

Prev Med Rep. 2017 Oct 16;8:286-293. doi: 10.1016/j.pmedr.

2017.10.008. eCollection 2017 Dec. JAMA Intern Med. 2018 Mar 1;178(3):347-355. doi: 10.1001 /jamainternmed.2017.8060.

Int J Neurosci. 2018 Aug 20:1-8. doi: 10.1080/00207454.

2018.1486834. [Epub ahead of print] J Surg Oncol. 2018 Nov;118(6):983-990. doi: 10.1002/jso.25219.

Epub 2018 Sep 13.

J Abnorm Child Psychol. 2018 May;46(4):825-837. doi: 10.1007 /s10802-017-0323-4.

Medicine* Medicine* Medicine* Medicine* Medicine Podiatry

Psychiatry Psychiatry Psychiatry Medicine

Psychiatry Podiatry

Psychiatry Orthopedics Psychiatry

Psychiatry

Psychiatry Medicine*

Medicine Family Medicine

Psychiatry Medicine*

Psychiatry Surgery Psychiatry

38

Pathoanatomic Findings Associated With Duty-Related Cardiac Death in US Firefighters: A Case-Control Study.

Pathogen or contaminant? Distinguishing true infection from synovial fluid culture contamination in patients with suspected septic arthritis.

Patient preferences and access to text messaging for health care reminders in a safety-net setting.

Patient-Provider Therapeutic Alliance Contributes to Patient Activation in Community Mental Health Clinics.

Pharmaceutical doses of the banned stimulant oxilofrine found in dietary supplements sold in the USA. Post-discharge Medication Reconciliation: Reduction in Readmissions in a Geriatric Primary Care Clinic.

Practitioner Review: Empirical evolution of youth psychotherapy toward transdiagnostic approaches.

Smith DL1, Haller JM1, Korre M2,3, Fehling PC1, Sampani K2,4, Grossi Porto LG2,5, Christophi CA2,6, Kales SN2,3.

J Am Heart Assoc. 2018 Sep 18;7(18):e009446. doi: 10.1161 /JAHA.118.009446.

Medicine*

Fowler ML, Zhu C, Byrne K, Lieber SB, Moore A, Shmerling RH, Paz Z.

Infection. 2017 Dec;45(6):825-830. doi: 10.1007/s15010-0171051-y. Epub 2017 Aug 1.

Medicine

Zallman L, Bearse A, West C, Bor D, McCormick D. Allen ML1, Cook BL2,3, Carson N2,3, Interian A4, La Roche M3,5, Alegría M2,3.

Inform Health Soc Care. 2017 Jan;42(1):32-42. Epub 2016 Feb 11.

Adm Policy Ment Health. 2017 Jul;44(4):431-440. doi: 10.1007 /s10488-015-0655-8.

Drug Test Anal. 2017 Jan;9(1):135-142. doi: 10.1002/dta.1976.

Epub 2016 Apr 7.

J Aging Health. 2018 Aug 30:898264318795571. doi: 10.1177 /0898264318795571.

J Child Psychol Psychiatry. 2017 Sep;58(9):970-984. doi: 10.1111 /jcpp.12747. Epub 2017 May 26. Review.

Cohen PA, Avula B, Venhuis B, Travis JC, Wang YH, Khan IA. Liu VC1,2, Mohammad I2,3, Deol BB2,3, Balarezo A2, Deng L4, Garwood CL2,3.

Marchette LK, Weisz JR. Weaver KE1, Snively BM1, Hogan P1, Josephs K2, Johnson Predictors of Continued Smoking and Interest in KC3, Coday M3, Progovac AM4,5, Cirillo DJ6,7, Ockene JK8, Cessation Among Older Female Smokers.

Tindle HA9.

Preference for Human Papillomavirus Self-Collection and Kilfoyle KA1, Des Marais AC2, Ngo MA3, Romocki L4, Papanicolaou: Survey of Underscreened Women in Richman AR5, Barclay L6, Brewer NT7,8, Rahangdale L8,9, North Carolina.

Smith JS2,8.

Primary care and survival among American Indian patients with diabetes in the Southwest United States: King C1, Atwood S2, Brown C3, Nelson AK3, Lozada M4, Wei Evaluation of a cohort study at Gallup Indian Medical J4, Merino M4, Curley C3, Muskett O3, Sabo S5, Gampa V6, Center, 2009-2016.

Orav J7, Shin S8.

Medicine Psychiatry Family Medicine Psychiatry Psychiatry

J Aging Health. 2018 Apr;30(4):624-640. doi: 10.1177 /0898264316687622. Epub 2017 Jan 30.

Psychiatry

J Low Genit Tract Dis. 2018 Oct;22(4):302-310. doi: 10.1097/LGT. 0000000000000430.

Ob-Gyn

Probiotic Safety-No Guarantees.

Cohen PA1,2.

Probiotic Safety-Reasonable Certainty of No Harm-Reply.

Professionalism and Technology: Competencies Across the Tele-Behavioral Health and E-Behavioral Health Spectrum.

Prohibited Stimulants in Dietary Supplements After Enforcement Action by the US Food and Drug Administration.

Provider and Health System Factors Associated with Usage of Long-Acting Reversible Contraception in Adolescents.

Cohen PA1.

Prim Care Diabetes. 2018 Jun;12(3):212-217. doi: 10.1016/j.pcd.

2017.11.003. Epub 2017 Dec 8.

JAMA Intern Med. 2018 Sep 17. doi: 10.1001/jamainternmed.

2018.5403.

JAMA Intern Med. 2019 Feb 1;179(2):276-277. doi: 10.1001 /jamainternmed.2018.7492.

DeJong SM1.

Acad Psychiatry. 2018 Dec;42(6):800-807. doi: 10.1007/s40596018-0947-x. Epub 2018 Jun 14.

Psychiatry

Cohen PA1,2, Wen A3, Gerona R4.

JAMA Intern Med. 2018 Oct 22. doi: 10.1001/jamainternmed.

2018.4846.

Medicine *

Psychiatric Resident Participation in an Asylum Clinic: a Single-Institutional Experience.

Psychiatry residents' confidence in integrated care skills on a collaborative care rotation at a safety net health care system.

Psychological Assessment Training in Clinical Psychology Doctoral Programs.

Race in Supervision: Let's Talk About It. Racial Differences in Breastfeeding Initiation Among Participants in a Midwestern Public Health District.

Racial/ethnic differences in perceived need for mental health care and disparities in use of care among those with perceived need in 1990-1992 and 2001-2003.

Randomized controlled trial of an internet cognitive behavioral skills-based program for auditory hallucinations in persons with psychosis.

Reconciling technology and humanistic care: Lessons from the next generation of physicians.

Recruit Fitness as a Predictor of Police Academy Graduation.

Reducing Preventable Hospitalization and Disparity: Association With Local Health Department Mental Health Promotion Activities.

Reply to: Comment on "Serious infections among a large cohort of subjects with systemically treated psoriasis".

Responsible Gambling Research and Industry Funding Biases.

Reviving and Refining Psychodynamic Interpretation of the Wechsler Intelligence Tests: The Verbal Comprehension Subtests.

Reward and aversion processing in patients with posttraumatic stress disorder: functional neuroimaging with visual and thermal stimuli.

Risk of weight gain for specific antipsychotic drugs: a meta-analysis.

Scientific Trials-In the Laboratories, Not the Courts.

Screening and Brief Advice to Reduce Adolescents' Risk of Riding With Substance-Using Drivers.

Self-Compassion and Responses to Trauma: The Role of Emotion Regulation.

Self-rated health among multiracial young adults in the United States: findings from the add health study.

Self-regulated learning in professional students.

Severe Aggression After Perampanel Overdose: Case Report.

Shared Understanding With Patients.

2019 CHA Academic Report

Smith AJB, Harney KF, Singh T, Hurwitz AG.

Patel NA1, Sreshta N1, Frank A1, Marlin RP1, Boyd JW2.

J Pediatr Adolesc Gynecol. 2017 Dec;30(6):609-614. doi: 10.1016 /j.jpag.2017.05.001. Epub 2017 May 11.

Acad Psychiatry. 20https://www.ncbi.nlm.nih. gov/pubmed/2968730618 Apr 23. doi: 10.1007/s40596-0180925-3.

Schen CR1, Greenlee A2.

Pineros-Leano M1,2, Tabb KM2,3, Simonovich SD2,4, Wang Y2,3, Meline B2,5, Huang H2,6.

Gen Hosp Psychiatry. 2018 Mar - Apr;51:130-131. doi: 10.1016/j. genhosppsych.2017.10.008. Epub 2017 Oct 31.

J Pers Assess. 2017 Mar-Apr;99(2):153-164. doi: 10.1080 /00223891.2016.1201978. Epub 2016 Jul 26.

Psychodyn Psychiatry. 2018 Spring;46(1):1-21. doi: 10.1521/pdps.

2018.46.1.1.

Health Equity. 2018 Oct 19;2(1):296-303. doi: 10.1089/heq.

2018.0016. eCollection 2018.

Ault-Brutus A1, Alegria M2.

Ethn Health. 2018 Feb;23(2):142-157. doi: 10.1080/13557858.

2016.1252834. Epub 2016 Nov 3.

Noy G 1, Greenlee A 2, Huang H. 3 Mihura JL, Roy M, Graceffo RA.

Gottlieb JD, Gidugu V, Maru M, Tepper MC, Davis MJ, Greenwold J, Barron RA, Chiko BP, Mueser KT. Simpkin AL, Dinardo PB 3, Pine E 3, Gaufberg E. 2,3 Shusko M, Benedetti L, Korre M, Eshleman EJ, Farioli A, Christophi CA, Kales SN. Chen J1, Bloodworth R2, Novak P2, Cook BL3, Goldman HH4, Rendall MS5, Thomas SB6, Reynolds CF 3rd7.

Psychiatr Rehabil J. 2017 Sep;40(3):283-292. doi: 10.1037 /prj0000258. Epub 2017 May 18.

Med Teach. 2017 Apr;39(4):430-435. doi: 10.1080/0142159X. 2017.1270434. Epub 2016 Dec 25.

Occup Med (Lond). 2017 Oct 1;67(7):555-561. doi: 10.1093 /occmed/kqx127.

Ladouceur R1, Shaffer P2, Blaszczynski A3, Shaffer HJ4.

Am J Prev Med. 2018 Jan;54(1):103-112. doi: 10.1016/j.amepre.

2017.10.011.

J Am Acad Dermatol. 2018 May;78(5):e115. doi: 10.1016/j.jaad.

2017.12.017. Epub 2017 Dec 14.

J Gambl Stud. 2018 Jul 21. doi: 10.1007/s10899-018-9792-9.

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Bram AD.

J Pers Assess. 2017 May-Jun;99(3):324-333. doi: 10.1080 /00223891.2016.1236342. Epub 2016 Nov 3.

Dobry AS1, Quesenberry CP2, Asgari MM3.

Medicine Medicine * Medicine

Ob-Gyn

Psychiatry

Psychiatry* Psychiatry Psychiatry Psychiatry

Psychiatry

Psychiatry Medicine Medicine

Psychiatry Medicine Psychiatry

Psychiatry

Elman I1, Upadhyay J2, Langleben DD3, Albanese M4, Becerra L2, Borsook D2.

Transl Psychiatry. 2018 Nov 2;8(1):240. doi: 10.1038/s41398-0180292-6.

Psychiatry NPJ Schizophr. 2018 Jun 27;4(1):12. doi: 10.1038/s41537-018Spertus J1, Horvitz-Lennon M2,3, Abing H1, Normand SL4,5. 0053-9.

Psychiatry JAMA Intern Med. 2018 Jan 1;178(1):7-8. doi: 10.1001 Bagley N1, Carroll AE2, Cohen PA3.

Medicine * /jamainternmed.2017.5730.

Knight JR1,2,3, Csemy L4,5, Sherritt L1,2,3, Starostova O4, 5,6, Van Hook S1,2, Bacic J7, Finlay C2, Tauber J2, Brooks T8,9,10, Kossack R11, Kulig JW12, Shaw J13,14,15, Harris SK1,2,3.

J Stud Alcohol Drugs. 2018 Jul;79(4):611-616.

Medicine Scoglio AAJ1, Rudat DA2, Garvert D3, Jarmolowski M1, J Interpers Violence. 2018 Jul;33(13):2016-2036. doi: 10.1177 Psychiatry Jackson C4,5, Herman JL1. /0886260515622296. Epub 2015 Dec 16.

Ethn Health. 2017 Jun 28:1-17. doi: 10.1080/13557858.

Tabb KM, Gavin AR, Smith DC, Huang H. Psychiatry 2017.1346175 Clin Teach. 2018 Dec;15(6):513-514. doi: 10.1111/tct.12965. No Singh TA1.

Ob-Gyn abstract available.

Psychosomatics. 2018 Jul 11. pii: S0033-3182(18)30323-2. doi: Wu CC1, McShane M2, Huttlin EA3, Novoa KC3.

Psychiatry 10.1016/j.psym.2018.07.002.

JAMA Intern Med. 2017 Sep 1;177(9):1247-1248. doi: 10.1001 Maskrey N, Gordon A. Family Medicine /jamainternmed.2017.1932. Review.

39

Should US doctors mourn for Obamacare?

Skin-to-skin care cannot be blamed for increase in suffocation deaths.

Sleep disturbance as a predictor of time to drug and alcohol use treatment in primary care.

Social Work's Role in Medicaid Reform: A Qualitative Study.

Gaffney A, Berger ZD, Jha S.

Bartick M1, Feldman-Winter L2.

Fortuna LR1, Cook B2, Porche MV3, Wang Y4, Amaris AM5, Alegria M6.

Bachman SS, Wachman M, Manning L, Cohen AM, Seifert RW, Jones DK, Fitzgerald T, Nuzum R, Riley P. Petranto RD1, Lubin M2, Floros RC2, Pfeiffer DA2, Spiess K2, Soft Tissue Reconstruction with Artelon for Multiple Foot Lenz R2, Crowell A2, Ahmad H3, Chandrani S3, Landsman and Ankle Applications.

AS4.

Klompas M, Cocoros NM, Menchaca JT, Erani D, Hafer E, State and Local Chronic Disease Surveillance Using Herrick B, Josephson M, Lee M, Payne Weiss MD, Electronic Health Record Systems.

Zambarano B, Eberhardt KR, Malenfant J, Nasuti L, Land T. Store and forward teledermatology improves dermatology knowledge among referring primary care Mohan GC1, Molina GE2, Stavert R3. providers: A survey-based cohort study.

Stories from Patients and Families: An Invitation to a CoBatalden M productive Partnership in Healthcare Service Strengthening the Case for the Role of Thrombophilia in Dobry AS1, Kroshinsky D2.

Calciphylaxis.

Stretching the Scope - Becoming Frontline AddictionRapoport AB1, Rowley CF1.

Medicine Providers Bartick MC1,2, Schwarz EB3, Green BD4, Jegier BJ5, Suboptimal breastfeeding in the United States: Maternal Reinhold AG6, Colaizy TT7, Bogen DL8, Schaefer AJ9, Stuebe and pediatric health outcomes and costs.

AM10,11.

Successful Treatment of Acute Liver Failure due to Bassem W Ghali, Timothy S Laux, Gajanan B Phutke, Yellow Phosphorus Ingestion in a Rural, Low Resource Reshma D Souza and Priyank Jain Setting Sudden infant death and social justice: A syndemics Bartick M1, Tomori C2. approach.

SUDEP and Grief: Overview and Current Issues.

Sunlight and ultraviolet radiation-pertinent retinal implications and current management.

Surgery Clerkship Evaluations Are Insufficient for Clinical Skills Appraisal: The Value of a Medical Student Surgical Objective Structured Clinical Examination.

Surgical Correction of Metopic Craniosynostosis: A 3-D Photogrammetric Analysis of Cranial Vault Outcomes.

Survival Mediterranean Style: Lifestyle Changes to Improve the Health of the US Fire Service.

TEACH Cards: Teaching Evidence-Based Medicine and Clinical Topics in the Hospital Teaching in longitudinal integrated clerkships: the seven 'C's.

Teaching Physician Assistant Students Real-World Evidence-Based Medicine Technology-enabled examinations of cardiac rhythm, optic nerve, oral health, tympanic membrane, gait and coordination evaluated jointly with routine health screenings: an observational study at the 2015 Kumbh Mela in India.

Temporal Patterns in Chlamydia Repeat Testing in Massachusetts The "Virtual Preceptor": A Teaching Tool Developed to Increase Resident Access to Supervision.

The Affordable Care Act: implications for health-care equity.

The burden of suicidal ideation among persons with type II diabetes: A scoping review.

The Effects of Household Medical Expenditures on Income Inequality in the United States.

The Evolving Practice of Psychiatry in the Era of Integrated Care.

Flannery RB Jr1,2,3, Lomke E4,5.

Begaj T1, Schaal S2.

Butler KL1, Hirsh DA2, Petrusa ER3, Yeh DD3, Stearns D4, Sloane DE5, Linder JA5, Basu G6, Thompson LA7, de Moya MA3.

Linden OE1, Baratta VM2, Gonzalez JA3, Byrne ME4, Klinge PM5, Sullivan SR6, Taylor HO6.

Korre M, Sotos-Prieto M, Kales SN. Hahn T, D'Agata C, Edgoose J, Mastrocola J, Zakletskaia L, White M Bernstein J1, Wood S2, Latessa R3, Hirsh DA4.

Banning AS1, White DM, Shaughnessy AF.

Shah P#1, Yauney G#1, Gupta O1, Patalano Ii V2,3, Mohit M1, Merchant R4, Subramanian SV5.

Dee EC1, Hsu KK2, Kruskal BA3, Menchaca JT4, Zambarano B5, Cocoros N4, Herrick B6, Weiss MDP6, Hafer E7, Erani D7, Josephson M7, Young J4, Torrone EA8, Flagg EW8, Klompas M9.

BMJ. 2017 Mar 24;356:j1441. doi: 10.1136/bmj.j1441.

J Pediatr. 2018 Sep;200:296-297. doi: 10.1016/j.jpeds.

2018.06.010. Epub 2018 Jun 28.

Sleep Med. 2018 Feb;42:31-37. doi: 10.1016/j.sleep.2017.12.009.

Epub 2018 Jan 9.

Am J Public Health. 2017 Dec;107(S3):S250-S255. doi: 10.2105 /AJPH.2017.304002.

Medicine Medicine Psychiatry Psychiatry

Clin Podiatr Med Surg. 2018 Jul;35(3):331-342. doi: 10.1016/j. cpm.2018.02.008. Epub 2018 May 4. Review.

Podiatry

Am J Public Health. 2017 Sep;107(9):1406-1412. doi: 10.2105 /AJPH.2017.303874. Epub 2017 Jul 20.

Medicine

J Am Acad Dermatol. 2018 Nov;79(5):960-961. doi: 10.1016/j. jaad.2018.05.006. Epub 2018 May 10. No abstract available.

Medicine*

Future Hospital Journal 2016 Vol 3, No 3: 197-8 JAMA Dermatol. 2018 Aug 1;154(8):970-971. doi: 10.1001 /jamadermatol.2018.1534. No abstract available.

N Engl J Med. 2017 Aug 24;377(8):705-707. doi: 10.1056 /NEJMp1706492.

Matern Child Nutr. 2017 Jan;13(1). doi: 10.1111/mcn.12366.

Epub 2016 Sep 19. Erratum in: Matern Child Nutr. 2017 Apr;13 (2):null.

Medicine

Biomed J Sci & Tech Res DOI: 10.26717/BJSTR.2018.04.001072 Matern Child Nutr. 2018 Aug 23:e12652. doi: 10.1111/mcn.

12652.

Psychiatr Q. 2018 Oct 18. doi: 10.1007/s11126-018-9608-1.

[Epub ahead of print] Review.

Surv Ophthalmol. 2018 Mar - Apr;63(2):174-192. doi: 10.1016/j. survophthal.2017.09.002. Epub 2017 Sep 18. Review.

Medicine

J Surg Educ. 2017 Mar - Apr;74(2):286-294. doi: 10.1016/j.jsurg.

2016.08.018. Epub 2016 Sep 28.

Cleft Palate Craniofac J. 2018 Jan 1:1055665618775729. doi: 10.1177/1055665618775729.

Front Public Health. 2017 Dec 18;5:331. doi: 10.3389/fpubh.

2017.00331. eCollection 2017.

Medicine Medicine*

Medicine

Medicine Psychiatry Medicine

Medicine Medicine Medicine

PRiMER. 2018;2:25

Family Medicine

Clin Teach. 2018 Sep 7. doi: 10.1111/tct.12947 J Physician Assist Educ. 2018 Mar;29(1):52-57. doi: 10.1097/JPA. 0000000000000181.

Medicine*

BMJ Open. 2018 Apr 20;8(4):e018774. doi: 10.1136/bmjopen2017-018774.

Family Medicine

Surgery

The Opioid Crisis and Schools-A Commentary.

The Prevalence of Posttraumatic Stress Disorder in Primary Care: A Systematic Review.

The Role of Health Plans in Supporting Behavioral Health Integration.

The Role of Placental Membrane Allografts in the Surgical Treatment of Tendinopathies.

The stimulant higenamine in weight loss and sports supplements.

Welsh JW1, Tretyak V2, Rappaport N3.

Therapeutic Assessment With Child Inpatients.

The Temporal Relationship Between Medicaid Payment Acceptance and the Implementation of MedicationAssisted Drug Treatment.

To Dodge or Disclose: a Faculty Development Workshop to Promote Discussion of Racial/Ethnic Minority Trainee Cultural Identity.

Top 20 POEMs of the Past 20 Years: A Survey of PracticeChanging Research for Family Physicians.

Pagano CJ1, Blattner MCC2, Kaplan-Levy S3.

Am J Prev Med. 2019 Mar;56(3):458-463. doi: 10.1016/j.amepre.

2018.10.006 Acad Psychiatry. 2017 Aug;41(4):569-570. doi: 10.1007/s40596017-0736-y. Epub 2017 Jun 6.

Lancet. 2017 Apr 8;389(10077):1442-1452. doi: 10.1016/S01406736(17)30786-9. Review.

J Psychosom Res. 2017 Dec;103:113-118. doi: 10.1016/j. jpsychores.2017.10.009. Epub 2017 Oct 19. Review.

Am J Public Health. 2018 Mar;108(3):351-354. doi: 10.2105 /AJPH.2017.304213. Epub 2018 Jan 18.

Psychosomatics. 2017 Sep - Oct;58(5):466-473. doi: 10.1016/j. psym.2017.04.003. Epub 2017 Apr 13. Review.

JAMA Netw Open. 2018 Oct 5;1(6):e183329. doi: 10.1001 /jamanetworkopen.2018.3329.

Acad Med. 2010 Nov;85(11):1709-16. doi: 10.1097/ACM. 0b013e3181f57899 J Sch Health. 2018 May;88(5):337-340. doi: 10.1111/josh.12617.

No abstract available.

Harv Rev Psychiatry. 2017 Jul/Aug;25(4):159-169. doi: 10.1097 /HRP.0000000000000136. Review.

Adm Policy Ment Health. 2017 Nov;44(6):967-977. doi: 10.1007 /s10488-017-0812-3.

Clin Podiatr Med Surg. 2018 Jul;35(3):311-321. doi: 10.1016/j. cpm.2018.02.004. Epub 2018 May 4.

Clin Toxicol (Phila). 2019 Feb;57(2):125-130. doi: 10.1080 /15563650.2018.1497171. Epub 2018 Sep 6.

J Pers Assess. 2018 Apr 3:1-11. doi: 10.1080/00223891.

2018.1447945.

Guerrero EG1, Garner BR2, Cook B3, Kong Y4, Vega WA1.

Subst Abuse. 2018 Nov 12;12:1178221818811314. doi: 10.1177 /1178221818811314. eCollection 2018

Taneja E1, Sehgal P1, Greenlee A1, Frank AA2.

Ebell MH1, Barry HC2, Shaughnessy AF3, Slawson DC4, Kulkarni N5, Speer L6.

Acad Psychiatry. 2018 Nov 16. doi: 10.1007/s40596-018-1000-9.

[Epub ahead of print] No abstract available.

Psychiatry Annals of Family Medicine 2018; 16(5):436-439. PMID: 30201640 Family Medicine* DOI: 10.1370/afm.2288

Frank AA, Banik DR, Bass D. Gaffney A, McCormick D. Tabb KM, Perez-Flores N, Wang Y, Huang H. Christopher AS1, Himmelstein DU1, Woolhandler S1, McCormick D1 Joseph R1, Kester R2, O'Brien C2, Huang H2.

The FDA and Adulterated Supplements-Dereliction of Duty.Cohen PA. The hidden curriculum: what can we learn from thirdGaufberg EH1, Batalden M, Sands R, Bell SK. year medical student narrative reflections?

2019 CHA Academic Report

Spottswood M, Davydow DS, Huang H. Stewart MT1, Horgan CM2, Quinn AE3, Garnick DW2, Reif S2, Creedon TB2,4, Merrick EL2.

Ang J1, Liou CD2, Schneider HP2.

Cohen PA1, Travis JC2, Keizers PHJ3, Boyer FE2, Venhuis BJ3.

Family Medicine

Psychiatry Medicine Psychiatry Medicine* Psychiatry Medicine Medicine Psychiatry Psychiatry Psychiatry Podiatry Medicine Psychiatry

Psychiatry

40

Training emotion regulation through real-time fMRI neurofeedback of amygdala activity.

Training in office-based opioid treatment with buprenorphine in US residency programs: A national survey of residency program directors.

Training Internal Medicine Residents in Social Medicine and Research-Based Health Advocacy: A Novel, In-Depth Curriculum.

Trends in Racial-Ethnic Disparities in Access to Mental Health Care, 2004-2012.

Herwig U1, Lutz J2, Scherpiet S3, Scheerer H3, Kohlberg J4, Opialla S3, Preuss A3, Steiger VR5, Sulzer J6, Weidt S3, Stämpfli P3, Rufer M3, Seifritz E3, Jäncke L7, Brühl AB3.

Neuroimage. 2019 Jan 1;184:687-696. doi: 10.1016/j. neuroimage.2018.09.068. Epub 2018 Oct 1.

Psychiatry

Tesema L1, Marshall J2, Hathaway R3, Pham C4, Clarke C5, Bergeron G3, Yeh J6, Soliman M7, McCormick D3.

Subst Abus. 2018 Mar 7:1-7. doi: 10.1080/08897077.

2018.1449047. [Epub ahead of print]

Medicine*

Acad Med. 2017 Apr;92(4):515-520. doi: 10.1097/ACM. 0000000000001580.

Psychiatr Serv. 2017 Jan 1;68(1):9-16. doi: 10.1176/appi.ps.

Cook BL1, Trinh NH1, Li Z1, Hou SS1, Progovac AM1.

201500453. Epub 2016 Aug 1.

Indian J Med Ethics. 2018 May 18;-(-):1-7. doi: 10.20529/IJME. Ultrasound in rural India: a failure of the best intentions. Phutke G1, Laux T2, Jain P3, Jain Y4.

2018.041.

Variability in strength of red yeast rice supplements Eur J Prev Cardiol. 2017 Sep;24(13):1431-1434. doi: 10.1177 Cohen PA, Avula B, Khan IA. purchased from mainstream retailers. /2047487317715714. Epub 2017 Jun 23.

Variation in analytic transparency in recent efficacy BMJ Evid Based Med. 2018 Oct;23(5):177-182. doi: 10.1136 Vannoy S1, Brodt M1, Cosgrove L1, Shaughnessy AF2. studies of antidepressant medication. /bmjebm-2018-110947. Epub 2018 Jun 27 Video-Based Grocery Shopping Intervention Effect on Am J Public Health. 2017 May;107(5):800-806. doi: 10.2105 Amaro H, Cortes DE, Garcia S, Duan L, Black DS. Purchasing Behaviors Among Latina Shoppers. /AJPH.2017.303725. Epub 2017 Mar 21.

Okwerekwu JA1, McKenzie JB2, Yates KA2, Sorrentino RM2, J Am Acad Psychiatry Law. 2018 Oct 31. pii: JAAPL.003780-18.

Voting by People with Mental Illness.

Friedman SH2. doi: 10.29158/JAAPL.003780-18.

When is a guideline not a guideline? The devil is in the BMJ Evid Based Med. 2018 Feb;23(1):33-36. doi: 10.1136 Cosgrove L1, Shaughnessy AF2, Shaneyfelt T3. details. /ebmed-2017-110845 When Criticizing Others It is Helpful to Focus on Actual J Gambl Stud. 2017 Dec;33(4):1035-1037. doi: 10.1007/s10899Shaffer HJ, Tom MA, Braverman J. Behavior: A Comment About Auer and Griffiths (2016).

016-9667-x. Review.

Weisz JR1, Ugueto AM2, Herren J3, Marchette LK4, When the torch is passed, does the flame still burn?

Bearman SK5, Lee EH6, Thomassin K7, Alleyne A8, Cheron Testing a "train the supervisor" model for the Child DM8, Tweed JL9, Hersh J10, Raftery-Helmer JN11, J Consult Clin Psychol. 2018 Sep;86(9):726-737. doi: 10.1037 STEPs treatment program.

Weissman AS12, Jensen-Doss A13 /ccp0000331.

Why Are We So Slow to Adopt Some Evidence-Based Ebell MH1, Shaughnessy AF2, Slawson DC3.

Am Fam Physician. 2018 Dec 15;98(12):709-710 Practices?

Why use group visits for opioid use disorder treatment Sokol R 1, Albanese C, Chaponis D, Early J 1, Maxted G 1, Subst Abus. 2018 Jan 2;39(1):52-58. doi: 10.1080/08897077. in primary care? A patient-centered qualitative study.

Morrill D, Poirier G 1, Puopolo F 4, Schuman-Olivier Z.5 2017.1356792. Epub 2017 Sep 8.

Basu G, Pels RJ, Stark RL, Jain P, Bor DH, McCormick D.

Medicine Psychiatry Medicine* Medicine* Family Medicine* Psychiatry Psychiatry Family Medicine* Psychiatry

Psychiatry Family Medicine* Family Medicine*

* Colleagues have selected these publication to be of special interest

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