Current Research and Scholarly Interests
My goal is to translate research into real-world action and decision-making so that my work can impact patients and the institutions in which they receive care. With a research focus on healthcare cost and quality of care, I approach neurosurgery in a unique way—one that applies business operations, economics, and healthcare delivery principles to our field. I have pursued formal LEAN business training, and believe in the importance of working together with other departments and administrators, as well as physicians and surgeons on the hospital and national level, to effect change. During my residency, I developed and led a multi-departmental prospective study at UCSF called OR SCORE (OR Surgical Cost Reduction Project) that brought together surgeons from the neurosurgery, orthopedics and ENT departments with nurses and administrators. OR SCORE successfully reduced surgical supply costs by nearly one million dollars in its first year by providing >60 surgeons with price transparency scorecards. This work led to a first-author publication in JAMA Surgery, but more importantly, set the foundation for further quality improvement and cost reduction efforts across the UCSF hospital system.
A volunteer neurosurgical mission trip to Guadalajara, Mexico, where limited resources create an OR environment that is strikingly more frugal than the U.S., inspired me to lead another project aimed at quantifying and reducing operating room waste at UCSF. I have also conducted research looking at the safety and outcomes of overlapping surgery, as well as several projects to define the factors underlying variation in cost for neurosurgical care using UCSF’s hospital data and national databases like the National Inpatient Sample, Vizient (formerly known as University Health Consortium), and Medicare.
As a clinical fellow at Johns Hopkins, I continued and expanded these research efforts. I designed and implemented an Enhanced Recovery after Surgery (ERAS) protocol at the Johns Hopkins Bayview hospital. This protocol standardized care for our spine patients, emphasizing pre-operative rehabilitation, psychiatric and nutritional assessments, and smoking cessation, as well as intra- and post-operative multi-modal pain therapy, early mobilization, and standardized antibiotic and bowel regimens. I also collaborated with engineers in the Johns Hopkins Carnegie Center for Surgical Innovation to develop better algorithms for intra-operative CT imaging, and provided assistance with operations to a basic science study looking at the role of cerebrospinal fluid drainage and duraplasty in a porcine model of spinal cord injury.
At Stanford, I am building a research group focused on: (1) perfecting paradigms for delivery of high-end technology in spinal care, including robotics and navigation, (2) implementing cost and quality strategies in large healthcare systems, and (3) computational analysis of big-data to effect real-time risk stratification and decision making in spine surgery. I'm excited to collaborate with my peers across surgical and medical departments, as well as business and engineering colleagues.
