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Dr. Goldstein is Professor of Medicine in the Center for Health Policy/Center for Primary Care and Outcomes Research (CHP/PCOR) at Stanford University; and National Director of Data Analytics, Quality Improvement, and Research in the Office of Geriatrics and Extended Care (GEC), Veterans Health Administration (VHA), effective May 24, 2020. Prior to the role in GEC, Dr. Goldstein was Chief, Medical Service, at the VA Palo Alto Health Care System. Her primary area of research expertise is health services research (HSR) involving health information technology to improve quality of health care. She leads a project team that has developed and implemented Clinical Decision Support (CDS) for primary care providers to improve care for common chronic conditions. She also collaborates with other investigators exploring factors that provide data for and/or influence medical decision making. Dr. Goldstein is particularly interested in clinical care for patients with multiple comorbidities (mulitmorbidity) and services for frail older adults.
The primary program goal is to optimize medication management in the VA in general and in Patient Aligned Care Teams (PACTs) in particular, using pharmacy networks and clinical decision support (CDS). Dr. Goldstein is one of two "multiple PI's" for this project. Dr. Goldstein leads the project incorporating CDS into an existing clinical dashboard for PACTs to manage common chronic conditions in primary care.
Palo Alto, CA
The overall objective of this project is to develop new informatics methods to automate quality improvement measures for patients with complex clinical scenarios and to develop systems to provide clinical decision support (CDS) across multiple chronic conditions to health professionals in the VA Patient-Aligned Care Teams (PACTs) to improve performance.
3801 Miranda Avenue, Palo Alto, CA 94304
Implement an automated clinical decision support system for hypertension (ATHENA-HTN), upgraded to newer guidelines and with improved functionality, in primary care clinics in 5 VA medical centers in VISN 1 New England Healthcare Network. Evaluate the impact in a clinical trial with random allocation of more than 20 clinic sites with approximately 100 primary care providers.
The goal of this project is to develop prototype tools that will link a free-standing heart failure CDS system, ATHENA-Heart Failure (HF) directly with the VA electronic health record, CPRS, making it easier and more efficient for VA health professionals to see the recommendations from the CDS system in their regular clinical workflow and to translate the recommendations into action.
3801 Miranda Avenue, Palo Alto, CA 94304
This project aims to develop methods for applying clinical guideline recommendations with complex clinical criteria to large numbers of electronic health records for purpose of quality assessment.
3801 miranda avenue, palo alto, ca 94304
CADMA promotes the study of decision making processes and the determinants of choices that affect health and well-being in the later years of life. CADMA researchers conduct basic and applied research on decision making processes with a goal of developing and implementing practical methods for improving fundamental decisions affecting the well-being of the elderly.
Stanford University, Stanford, CA
Health services research in primary care and geriatrics applying health informatics for quality improvement in health care. The ATHENA-Clinical Decision Support (CDS) project develops knowledge-based systems for application to patient data in electronic health records (EHR) and presentation of findings and recommendations to health professionals within the EHR. Current work in this project includes knowledge engineering of knowledge bases to expand the library of encoded clinical guidelines; evaluation of existing systems based on stakeholder input; integrating CDS into the clinician dashboard to support Patient-Aligned Care Teams (PACTS; akin to PCMH) for Department of Veterans Affairs; and using encoded knowledge to automate clinically-relevant performance metrics using EHR data.<br/><br/>Multiple comorbidities: I am especially interested in addressing information needs of health professionals related to the growing numbers of patients with multiple co-existing conditions (known as multiple chronic conditions, multimorbidity, or multiple comorbidities.) I am collaborating with other investigators to explore how often clinical practice guidelines address commonly co-occurring conditions; decision complexity for health care decision-making with patients with multimorbidity; and effects of comorbidity on benefits and harms of treatment for chronic disease.<br/><br/>Other work includes: <br/><br/>-extracting information from free-text of the EHR using natural language processing, for use in clinical decision support, quality measurement, and predictive analytics; <br/><br/>-developing methods to incorporate patient goals, patient-generated data, and quality of life information into electronic health records and cost-effectiveness analyses for health care of older adults.
VISN Collaborative for Improving Hypertension Management With ATHENA-HTN
This project is a VA HSR&D-funded Quality Enhancement Research Initiative (QUERI) project to
translate into practice evidence about clinical management of primary hypertension. The
project aims to contribute to quality improvement of care for patients with primary
hypertension. The project implemented a clinical decision support (CDS) system for primary
care clinicians and evaluated the implementation by studying the following: impact on the
clinicians' prescribing and their patients' blood pressures; the clinician satisfaction with
the CDS; and organizational factors in the implementation.
Stanford is currently not accepting patients for this trial.
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Group Visits to Improve Hypertension Management
This study investigates group medical visits as a quality improvement strategy for
hypertension. It studies group visits in which patients see their own primary care provider
together with other patients who have hypertension. The group visits are intended to enhance
the patient's self-efficacy for self-management of their chronic disease (hypertension).
Guidelines for Drug Therapy of Hypertension: Multi-Site Implementation
Clinical trial of implementation of clinical practice guidelines for managing hypertension in
primary care clinics.
Guidelines for Drug Therapy of Hypertension: Closing the Loop
Hypertension is a major risk factor for heart disease and stroke. Evidence-based guidelines
support the use of specific drugs for patients with specific comorbidities to maximize the
decrease in cardiovascular risk; yet, many physicians do not follow these guidelines in
choosing drug therapy.