Health policy

Encina Commons, Room 220
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Stanford, CA 94305-6006

(650) 721-2486 (650) 723-1919
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Professor, Health Policy
jeremy-fisch_profile_compressed.jpg PhD

Jeremy Goldhaber-Fiebert, PhD, is a Professor of Health Policy, a Core Faculty Member at the Center for Health Policy and the Department of Health Policy, and a Faculty Affiliate of the Stanford Center on Longevity and Stanford Center for International Development. His research focuses on complex policy decisions surrounding the prevention and management of increasingly common, chronic diseases and the life course impact of exposure to their risk factors. In the context of both developing and developed countries including the US, India, China, and South Africa, he has examined chronic conditions including type 2 diabetes and cardiovascular diseases, human papillomavirus and cervical cancer, tuberculosis, and hepatitis C and on risk factors including smoking, physical activity, obesity, malnutrition, and other diseases themselves. He combines simulation modeling methods and cost-effectiveness analyses with econometric approaches and behavioral economic studies to address these issues. Dr. Goldhaber-Fiebert graduated magna cum laude from Harvard College in 1997, with an A.B. in the History and Literature of America. After working as a software engineer and consultant, he conducted a year-long public health research program in Costa Rica with his wife in 2001. Winner of the Lee B. Lusted Prize for Outstanding Student Research from the Society for Medical Decision Making in 2006 and in 2008, he completed his PhD in Health Policy concentrating in Decision Science at Harvard University in 2008. He was elected as a Trustee of the Society for Medical Decision Making in 2011.

Past and current research topics:

  1. Type 2 diabetes and cardiovascular risk factors: Randomized and observational studies in Costa Rica examining the impact of community-based lifestyle interventions and the relationship of gender, risk factors, and care utilization.
  2. Cervical cancer: Model-based cost-effectiveness analyses and costing methods studies that examine policy issues relating to cervical cancer screening and human papillomavirus vaccination in countries including the United States, Brazil, India, Kenya, Peru, South Africa, Tanzania, and Thailand.
  3. Measles, haemophilus influenzae type b, and other childhood infectious diseases: Longitudinal regression analyses of country-level data from middle and upper income countries that examine the link between vaccination, sustained reductions in mortality, and evidence of herd immunity.
  4. Patient adherence: Studies in both developing and developed countries of the costs and effectiveness of measures to increase successful adherence. Adherence to cervical cancer screening as well as to disease management programs targeting depression and obesity is examined from both a decision-analytic and a behavioral economics perspective.
  5. Simulation modeling methods: Research examining model calibration and validation, the appropriate representation of uncertainty in projected outcomes, the use of models to examine plausible counterfactuals at the biological and epidemiological level, and the reflection of population and spatial heterogeneity.
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Division of Nephrology
Stanford University School of Medicine
780 Welch Road, Suite 106
Palo Alto, CA 94034

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Norman S. Coplon/Satellite Healthcare Professor of Medicine and Professor, by courtesy, of Epidemiology and Population Health and of Health Policy
Associate Chair, Department of Medicine
glenn_chertow_.jpg MD, MPH

Glenn M. Chertow, MD, MPH, is Professor of Medicine and Chief, Division of Nephrology at Stanford University School of Medicine.  Prior to joining the faculty at Stanford, Dr. Chertow served with distinction on the faculties at Brigham and Women’s Hospital and Harvard Medical School (1995-98) and the University of California San Francisco (UCSF) (1998-2007).  Dr. Chertow has established a successful career as a clinical investigator and continues to maintain a productive research program focused on improving care for persons with acute and chronic kidney disease (CKD).  Recent projects include several NIDDK-sponsored initiatives: Acute Renal Failure Trials Network (ATN) Study, the United States Renal Data System (USRDS) Special Studies Center in Nutrition, the Chronic Renal Insufficiency Cohort (CRIC) study and the Frequent Hemodialysis Network (FHN) study. 

Dr. Chertow was elected to the American Society of Clinical Investigation in 2004 and appointed to the Scientific Advisory Board of the National Kidney Foundation in 2007.  He was Vice Chair and member of two workgroups for the Kidney Disease Quality Outcomes Initiative (K/DOQI) and Associate Editor of the Journal of the American Society of Nephrology

He will be among the five Co-Editors of the 9th edition of Brenner & Rector’s The Kidney.  Dr. Chertow also received the 2007 National Torchbearer Award from the American Kidney Fund for his career-long contributions toward improving the lives of persons with kidney disease.

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High-quality medical care requires implementing evidence-based best practices, with continued monitoring to improve performance. Implementation science is beginning to identify approaches to developing, implementing, and evaluating quality improvement strategies across health care systems that lead to good outcomes for patients. Health information technology has much to contribute to quality improvement for hypertension, particularly as part of multidimensional strategies for improved care. Clinical reminders closely aligned with organizational commitment to quality improvement may be one component of a successful strategy for improving blood pressure control. The ATHENA-Hypertension (Assessment and Treatment of Hypertension: Evidence-based Automation) system is an example of more complex clinical decision support. It is feasible to implement and deploy innovative health information technologies for clinical decision support with features such as clinical data visualizations and evidence to support specific recommendations. Further study is needed to determine the optimal contexts for such systems and their impact on patient outcomes.

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Publication Type
Journal Articles
Publication Date
Journal Publisher
Current hypertensions report
Authors
Mary K. Goldstein
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Objective
Inadequate adherence to highly active antiretroviral therapy (HAART) may lead to poor health outcomes and the development of HIV strains that are resistant to HAART. The authors developed a model to evaluate the cost-effectiveness of counseling interventions to improve adherence to HAART among men who have sex with men (MSM).

Methods
The authors developed a dynamic compartmental model that incorporates HIV treatment, adherence to treatment, and infection transmission and progression. All data estimates were obtained from secondary sources. The authors evaluated a counseling intervention given prior to initiation of HAART and before all changes in drug regimens, combined with phone-in support while on HAART. They considered a moderate-prevalence and a high-prevalence population of MSM.

Results
If the impact of HIV transmission is ignored, the counseling intervention has a cost-effectiveness ratio of $25,500 per quality-adjusted life year (QALY) gained. When HIV transmission is included, the cost-effectiveness ratio is much lower: $7400 and $8700 per QALY gained in the moderate- and high-prevalence populations, respectively. When the intervention is twice as costly per counseling session and half as effective as estimated in the base case (in terms of the number of individuals who become highly adherent, and who remain highly adherent), then the intervention costs $17,100 and $19,600 per QALY gained in the 2 populations, respectively.

Conclusions
Counseling to improve adherence to HAART increased length of life, modestly reduced HIV transmission, and cost substantially less than $50,000 per QALY gained over a wide range of assumptions but did not reduce the proportion of drug-resistant strains. Such counseling provides only modest benefit as a tool for HIV prevention but can provide significant benefit for individual patients at an affordable cost.

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Publication Type
Journal Articles
Publication Date
Journal Publisher
Medical Decision Making
Authors
Margaret L. Brandeau
Douglas K. Owens
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Many quality improvement strategies have focused on improving blood pressure control, and these strategies can target the patient, the provider, and/or the system. Strategies that seem to have the biggest effect on blood pressure outcomes are team change, patient education, facilitated relay of clinical information, and promotion of self-management. Barriers to effective blood pressure control can affect the patient, the physician, the system, and/or "cues to action."We review the barriers to achieving blood pressure control and describe current and potential creative strategies for optimizing blood pressure control. These include home-based disease management, combined patient and provider education, and automatic decision support systems. Future research must address which components of quality improvement interventions are most successful in achieving blood pressure control.

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Publication Type
Journal Articles
Publication Date
Journal Publisher
Journal of Clinical Hypertension
Authors
Douglas K. Owens
Mary K. Goldstein
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