Population Science and Health Systems (PISCES) Initiative
Population- and health systems-based research are major focuses in the Division of General Internal Medicine, where faculty lead and collaborate on a range of population- and health systems-based projects investigating the financing, organization, and delivery of health care services.
Our work involves the use of electronic health records across multiple health care delivery organizations, large insurance claims and other administrative data, and tumor registries. Projects may require integration between different types of datasets.
Although these data are powerful tools, working with them can require considerable clinical, care delivery, and methodological experience. Expertise is needed to aggregate datasets; map, summarize, and manage each; create cohorts, analytic files and other resources; to conduct analyses that answer important care delivery and population health questions; and design and implement pragmatic interventions in clinical practice. In the Division of General Internal Medicine, we seek to do this work while combining clinical, care delivery, and health systems expertise into collaborative science.
The PISCES Initiative reflects this commitment to advance population- and health systems-based scholarship. Through the Initiative, we are enthusiastic about collaborating with trainees, staff, and faculty across backgrounds on population- and health systems-based projects.
Engaging with PISCES
PISCES seeks to promote strong but flexible engagement. Initiative members collaborate in a number of ways, including the following:
- Project Collaboration. See a description of projects below and fill out our intake form to learn more about collaborating on proposals, projects, abstracts, and manuscripts.
- Educational & Training Experiences. PISCES members are active educators and mentors in the UTSW, teaching courses, advising trainees, and developing educational curricula for learners. Fill out our intake form to learn about ways to participate in educational or training experiences in PISCES.
- Career Opportunities. Review our open postings or inquire to learn about future opportunities
Projects from PISCES Members
- Characterizing the Ambulatory Safety-Net System in the US
Description forthcoming
- Comparing Care Delivery Patterns and Outcomes in Cancer Patients by Insurance Choices
This study aims to address the critical knowledge gap in understanding the impact of insurance choice on cancer care quality and outcomes. By leveraging real-world evidence datasets, including the Flatiron dataset, we conduct retrospective, population-based cohort analyses to compare care delivery patterns and survival outcomes among cancer patients, assessing the impact of their insurance coverage. The study may provide patient-centered insights on insurance choices and inform policy-making to enhance care access and quality for all cancer patients. The findings will also contribute to patient education, empowering them to make informed decisions about their insurance plan such as Medicare advantage plan selection. The study's design, grounded in real-world clinical settings, ensures the relevance and applicability of findings to patient care and policy formulation.
- Effect of Behaviorally Designed Population-Based Interventions on Outcomes and Equity in Preventive Care
Description forthcoming
- Impact of Bundled Payments on Health Equity
Description forthcoming
- Impact of Non-Medical Drivers of Health on Healthcare Utilization among Patients with Cancer
This study aims to address the critical knowledge gap in understanding the impact of insurance choice on cancer care quality and outcomes. By leveraging real-world evidence datasets, including the Flatiron dataset, we conduct retrospective, population-based cohort analyses to compare care delivery patterns and survival outcomes among cancer patients, assessing the impact of their insurance coverage. The study may provide patient-centered insights on insurance choices and inform policy-making to enhance care access and quality for all cancer patients. The findings will also contribute to patient education, empowering them to make informed decisions about their insurance plan such as Medicare advantage plan selection. The study's design, grounded in real-world clinical settings, ensures the relevance and applicability of findings to patient care and policy formulation.
- Impact of Culinary medicine vs. Nutrition Education on Diabetes
In partnership with culinary medicine experts and food is medicine researchers, we work on a number of projects, including a randomized trial that evaluated the effectiveness of hands-on, cooking classes + nutrition with standard of care nutrition therapy to improve glycemic control in patients with uncontrolled diabetes.
- Implementation of Guideline-Driven Prescribing for GLP-1 Agonists and SGLT2 Inhibitors in Patients with Type 2 Diabetes and Cardiorenal Disease
This project seeks to quantify and characterize prescribing gaps in GLP-1 Agonist and SGLT2 inhibitor medications, and to design and implement clinical decision support in the electronic health record to increase guideline-indicated prescribing.
- Improving care after a cancer diagnosis
Patients undergoing cancer treatment often end up going to the emergency department for symptoms stemming from their disease and treatment. We have used geospatial analysis to map the distances patients travel, identified potentially actionable predictors of frequent emergency department use, documented how challenging it is for patients to decide what is a true medical emergency, and evaluated whether urgent care clinics for cancer patients can reduce emergency department visits. This research links many types of datasets to generate insights into sometimes invisible dimensions of clinical care. This work has led to the creation of the Cancer Care Delivery Research Collaborative, which builds clinical-research partnerships with a diverse array of provider and community groups to steer research so that it is grounded in the reality of clinical care.
- Insurance, law, and clinical care
Clinical care is delivered within the strictures of laws governing programs that pay for care, particularly for the uninsured, which also determines who is eligible for these programs. Even the administrative process of determining eligibility of these programs may impact clinical outcomes. At the end of this lever, clinicians, who are sometimes frustrated by these strictures, curiously find that they are too busy to participate in the electoral process that ultimately influences these laws. We work on a variety of projects that illuminate inefficiencies in this system, as well as ways to complete this circle of interaction.
- Patterns of diagnostic imaging use
We have used insurance billing claims datasets to study clinician responses to campaigns and guideline changes to reduce non-recommended imaging, clinician-level drivers of non-recommended use, and including whether higher patient costs changes use of non-recommended imaging. We have also compared national-level imaging use across Medicare and commercial insurances. We are expanding this work into other types of non-recommended diagnostic testing.
- Population Health Strategies to Close Screening Gaps in Primary Care
We have worked on designing and implementing health systems strategies to improve population health and outcomes. This work includes projects focused on conditions such as diabetes. For instance, in one project, we have worked to utilize electronic health record data to identify patients at high risk for diabetes using a customized, automated diabetes risk score integrated into the Epic electronic health record to facilitate system-level risk assessment, bulk ordering of screening tests, and patient outreach to close screening gaps. Run by a centralized population health nurse, the intervention integrates into existing infrastructure and was designed in partnership with diverse stakeholders at Parkland Health. Study evaluation will assess the effectiveness of screening invitations co-designed with patients and diabetes stakeholders to close screening gaps in minoritized populations using a large scale pragmatic clinical trial. Key outcomes of interest include screening rates, case finding rates, and the cost effectiveness of the intervention from the health system perspective.
Interested in learning more or collaborating? Fill out our intake form