Research
The University of Rochester Department of Family Medicine ranks in the top 10 family medicine departments in the USA in federally funded research. Research in the Department focuses on improving communication between patients and health professionals, behavior change and reducing disparities in health and health care. Specific areas of research include:
- Patient navigation to reduce disparities in cancer care
- Patient activation to improve recognition and treatment of depression in primary care
- Promoting physical exercise in minority populations
- Improving patient-physician communication about risk and uncertainty
- Web-based approaches to suicide prevention for gay and lesbian adolescents
- Improving patient-clinician communication and healthcare for deaf patients and families who communicate with American Sign Language (ASL)
- Promoting mindfulness and self-monitoring in clinical practice
- Peer review to improve quality of care and professionalism
- Healthcare needs of refugees
Our research programs, directed by Dr. Ronald Epstein, are housed in a 5,000 square foot building at 1381 South Avenue in Rochester. We emphasize a collaborative approach to research, including a variety of disciplines and areas of expertise, including psychology, family systems, epidemiology, qualitative methods, psychometrics, and analysis of large claims databases.
Ronald M. Epstein, MD
Dr Epstein directs the Rochester Center to Improve Communication in Health Care, founded in 2003 to promote research relating to communication among health professionals, patients and their families, and to address the needs of vulnerable and marginalized populations.
Dr. Ronald Epstein is Professor of Family Medicine, Psychiatry and Oncology at the University of Rochester Medical Center. His research focuses on communication in health care settings and patient-physician relationships, and their impact on health, quality of life, process of care, and patient attitudes. He also studies professional competence, mindfulness, and well-being of physicians. Dr. Epstein is a practicing family physician, palliative care physician, educator, and researcher. He directs the Rochester Center to Improve Communication in Health Care at the University of Rochester and the Deans Teaching Fellows Program.
Dr Epstein’s AHRQ, NCI and NIMH-funded studies have used unannounced covert standardized patients to study physicians' practice behaviors. These mixed qualitative/quantitative studies have assessed: the impact of patient-physician relationships on health and health care costs, physician empathy and patient trust, physicians’ assessment of medically unexplained symptoms, effects of patient race on opioid prescribing in advanced cancer, effects of direct-to-consumer advertising on antidepressant prescribing and effects of patients’ requests on quality of clinical care. Medical education studies include studies of peer assessment of professional competence and a recent study of effects of a program in physician self-awareness and self-monitoring on physician burnout, empathy and practice orientation. An experienced qualitative researcher; he has studied barriers to care-seeking for depression, characteristics of successful patient navigation, physicians' responses to patient expressions of worry, and counseling those with and at high risk for HIV disease -- using semi-structured interviews, focus groups, ethnography, and coding of recorded patient-physician conversations. A current NIMH RCT is testing targeted public service announcements and tailored computer programs to prompt care-seeking for depression. Dr Epstein has authored over 120 peer-reviewed publications plus a 2007 monograph with Richard Street PhD (Patient-Centered Communication in Cancer Care: Promoting Healing and Reducing Suffering. National Cancer Institute, 2007) to outline future research initiatives in clinical communication and cancer.
Dr. Epstein was named the first George Engel and John Romano Dean’s Teaching Scholar at the University of Rochester, and is the recipient of the Lynn Payer Award from the American Academy on Communication in Healthcare for lifetime contributions to the theory, practice and teaching of effective communication. Dr Epstein has received awards from the National Institute of Mental Health, National Cancer Institute, Agency for Healthcare Research and Quality, Department of Health and Human Services, and numerous foundations: American Cancer Society, Arnold P Gold, Arthur Vining Davis, Avon, Fulbright, Greenwall, Koppaka, Mannix, Pfizer-AAFP, Robert Wood Johnson and the Physicians Foundation for Healthcare Excellence.
Kevin Fiscella, MD, MPH
Dr. Fiscella’s research focuses on factors that promote and eliminate disparities in health care, including access to care, prejudice and bias, health insurance status, trust, and communication. His major grants have been funded by the Agency For Healthcare Research And Quality; Centers for Disease Control and Prevention; National Heart, Lung and Blood Institute; National Cancer Institute (NCI); and the Robert Wood Johnson Foundation. Dr. Fiscella's grant from the NCI, entitled "Randomized Control Trial of Primary Care-based Patient Navigation-Activation," is designed to evaluate the impact of patient navigation on both cancer related quality of care and on disparities in cancer-related care. He is further exploring the area of Patient Navigation with Jennifer Carroll, Site Principal Investigator, on a subcontract with Boston Medical Center funded by the Avon Foundation that is intended to develop a measure to directly observe and quantify the tasks of patient navigators and the networks they employ to conduct their work. In 2007, Dr Fiscella received a large grant from the American Cancer Society to assess the impact of reminders, recall, and outreach on disparities in cancer screening, and a grant from the National Heart, Lung and Blood Institute to access the added benefit of the incorporation of social risk into coronary heart disease risk assessment. He is also exploring the impact of interactive media on informed decision making in colorectal screening of underserved patients through a subcontract with the University of California at Davis on Dr. Anthony Jerant's grant from the NCI.
Steven Barnett, MD
Dr. Barnett has devoted his career to health promotion and healthcare with deaf people and their families, with a focus on working with people and families who primarily communicate with American Sign Language (ASL). He is Associate Director of the Center for Disease Control (CDC) funded Rochester Prevention Research Center: National Center for Deaf Health (NCDHR). NCDHR 's mission is health promotion and disease prevention with deaf and hard-of-hearing people and their families through community-based participatory research (CBPR). NCDHR's initial five-years (2004-2009) focused on collecting baseline health data by adapting a CDC telephone survey for use in ASL on a touchscreen computer-kiosk. During the second cycle (2009-2014), NCDHR will focus on developing and evaluating linguistically accessible and culturally appropriate healthy weight interventions. Dr Barnett also received an AHRQ K08 Mentored Research Career Development Award (2006-2011). That research studies the healthcare experiences of deaf adult ASL-users by first adapting AHRQ's CAHPS®(Consumer Assessment of Healthcare providers and Systems) ambulatory surveys for use in ASL.
Jennifer K. Carroll, MD, MPH
Dr. Carroll's work focuses on the role of exercise in the prevention of cancer, and, as a trainee on the UR Cancer Center's Cancer Control grant funded by the National Cancer Institute, was the Principal Investigator on three studies designed to explore various issues related to physical education counseling, including underserved communities. She is now exploring the same areas of interest as a K Award recipient from the National Cancer Institute.
Dr. Carroll has also focused on refugee health, including issues of political asylum, torture, and the role and status of women in refugee communities, and was the recipient of a grant from the Agency for Healthcare Research and Quality to continue her research on refugee health issues. Major refugee populations in Rochester include those from Sub-Saharan Africa and Southeast Asia. She was the recipient of an NIH Loan Repayment Award, and completed the highly competitive Grant Generating Project sponsored by the American Academy of Family Practice.
Vincent M. B. Silenzio, MD, MPH
Dr. Silenzio focuses on suicide prevention research among gay, lesbian, and bisexual, adolescents using Internet-based approaches. He has a 3-year T32 NRSA Research Fellowship in Suicide Prevention Research from the National Institute of Mental Health, and works closely with the Psychiatry Department's Center for Study and Prevention of Suicide. Dr. Silenzio has focused on health care for the lesbian, gay, bisexual and transgendered (LGBT) population with emphasis on HIV risk behaviors and the effects of violence directed at LGBT individuals upon mental health, particularly with regard to suicide. He has received a New Investigator Award from the National Institute of Mental Health, and has expertise in qualitative and quantitative methodology.
Robert E. Gramling, MD, DSc
Dr. Gramling holds two NIH independent research awards investigating the 1) impact of cardiovascular disease (CVD) risk perception on long-term CVD outcomes and 2) whether raising awareness of heritable CVD risk improves long-term outcomes among individuals with a strong family history. Dr. Gramling is also conducting pilot research on palliative care consultations and clinical outcomes.
Paul Winters, MS
Mr. Winters’ focus is on statistical methods in research. He does statistical analysis of cross-sectional and longitudinal data including complex sample surveys, epidemiologic studies, clinical trials, experiments, and observational studies. He calculates sample sizes and power for t-tests, confidence intervals, linear models, tests of proportions, and rank tests for survival analysis for use in study planning.
His methods include analysis of variance for balanced and unbalanced designs, repeated measurements, and linear and nonlinear mixed models; least squares regression and diagnostic measures; multivariate analysis such as factor analysis and principal components; survival analysis including Cox proportional hazards; nonparametric (Kruskal-Wallis, Wilcoxon-Mann-Whitney and Friedman) tests; and categorical data analysis such as contingency tables and measures of association, logistic regression, and generalized estimating equations.
While SAS® is used for most analyses, SUDAAN® is used to provide estimates that correctly account for complex study design features such as unequal weighting, stratification, clustering, and with or without replacement sampling designs.
Pascal Jean-Pierre, PhD, MPH
Dr. Jean-Pierre is a Research Assistant Professor of Radiation Oncology and Family Medicine. His research focuses on developing strategies and interventions for assessing and controlling cancer-related cognitive dysfunction for cancer patients and survivors. Dr. Jean-Pierre's current studies are examining the effects of cancer and its treatment on neurocognitive function (e.g., attention, working memory, processing, speed, and executive functioning), serum biomarkers (e.g., TNF, Interleukin), psychological distress (e.g., depression and anxiety), social functioning, cancer treatment outcome and quality of life. Dr. Jean-Pierre has been the recipient of numerous accolades and awards from his research peers and colleagues, as well as the National Institutes of Health, the National Cancer Institute, the American Association for Cancer Research, the American Society of Clinical Oncology, the American Cancer Society, the Society for Behavioral Medicine, and the Multinational Association for Supportive Care in Cancer.
Dr. Jean-Pierre is also interested in Healthcare disparities research. He has lead the psychometric development and validation of two measures of Patient Satisfaction with Cancer Care and Patient Satisfaction with Navigator measure for the NCI funded multi-site Patient Navigation Reserch Program (PNRP). Dr. Jean-Pierre has also received funding from the NCI's Center to Reduce Cancer Health Disparities to conduct a mixed-model investigation of key domains and processes of patient navigation. He is committed to developing cancer control studies that are applicable across diverse populations.
Stephen Lurie, MD
Dr. Lurie serves as Director of Assessment in the Office of Curriculum and Assessment at the University of Rochester School of Medicine. He also serves as an evaluator for the Medical Center's NIH-funded Clinical Translational Science Institute. Steve previously served as Senior Editor at JAMA from 2000-2004. Since arriving in Rochester in 2004, has has published 15 research articles on a number of topics relating to assessment in medical education. He maintains a clinical practice within the Department of Familuy Medicine. Steve recently organized the 35-piece Medical Center Chamber Orchestra, comprising of pyhsicians, scientists, students, and medical-center staff.
Sally Rousseau, MSW, LMFT
Sally Rousseau, MSW, LMFT is a behavioral health faculty member and trainer in the departments of Family Medicine & Phychiatry as well as a doctoral student at the University of Rochester, Warner School. Her dissertation topic centers on ciritical self-relection of the graduate level psychotherapist practitioner trainee. The goal of her reserach in this area is to develop and evaluate transformational learning applications in the on-going practice of critical self-reflection for the next generation(s) of family medicine resident physicians and master's level marriage and family therapy trainees.In the face over decreasing resources of mentorship and traditional supervision; self-reflection can offer the, as yet, unrealized capacity to ignite/deepen clinical curiosity, nurture patient-centeredness, and inspire creativity for the practitioner that will benefit the patients, families, and the health care systems they serve.