Bio

Bio


Rachel Schwartz received her BA in Linguistics from UCLA followed by a PhD in Communication Sciences and Disorders from McGill University. She completed postdoctoral fellowships in Delivery System Science (AcademyHealth, Palo Alto Medical Foundation Research Institute), and Health Services Research & Development (VA Palo Alto Health Care System and Stanford Center for Heath Policy / Primary Care & Outcomes Research). She has experience leading research in pediatrics (Lucile Packard Children?s Hospital), neurology (Palo Alto Medical Foundation), emergency medicine (Stanford) and primary care (Stanford and Palo Alto VA).

Her research interests center around systems-level interventions for improving provider wellness and medical education initiatives that provide physicians with tools for navigating psychosocial aspects of the clinical encounter.

Service, Volunteer and Community Work


  • Families At The Border

    Families At The Border is a group of medical professionals working to bring supplies and medical care to immigrants at the California border. More information here: https://www.gofundme.com/f/supplies-for-family-amp-children-at-the-border

    Location

    Stanford, CA

Publications

All Publications


  • Can Patient-Provider Interpersonal Interventions Achieve the Quadruple Aim of Healthcare? A Systematic Review. Journal of general internal medicine Haverfield, M. C., Tierney, A., Schwartz, R., Bass, M. B., Brown-Johnson, C., Zionts, D. L., Safaeinili, N., Fischer, M., Shaw, J. G., Thadaney, S., Piccininni, G., Lorenz, K. A., Asch, S. M., Verghese, A., Zulman, D. M. 2020

    Abstract

    Human connection is at the heart of medical care, but questions remain as to the effectiveness of interpersonal interventions. The purpose of this review was to characterize the associations between patient-provider interpersonal interventions and the quadruple aim outcomes (population health, patient experience, cost, and provider experience).We sourced data from PubMed, EMBASE, and PsycInfo (January 1997-August 2017). Selected studies included randomized controlled trials and controlled observational studies that examined the association between patient-provider interpersonal interventions and at least one outcome measure of the quadruple aim. Two abstractors independently extracted information about study design, methods, and quality. We characterized evidence related to the objective of the intervention, type and duration of intervention training, target recipient (provider-only vs. provider-patient dyad), and quadruple aim outcomes.Seventy-three out of 21,835 studies met the design and outcome inclusion criteria. The methodological quality of research was moderate to high for most included studies; 67% of interventions targeted the provider. Most studies measured impact on patient experience; improvements in experience (e.g., satisfaction, patient-centeredness, reduced unmet needs) often corresponded with a positive impact on other patient health outcomes (e.g., quality of life, depression, adherence). Enhanced interpersonal interactions improved provider well-being, burnout, stress, and confidence in communicating with difficult patients. Roughly a quarter of studies evaluated cost, but the majority reported no significant differences between intervention and control groups. Among studies that measured time in the clinical encounter, intervention effects varied. Interventions with lower demands on provider time and effort were often as effective as those with higher demands.Simple, low-demand patient-provider interpersonal interventions may have the potential to improve patient health and patient and provider experience, but there is limited evidence that these interventions influence cost-related outcomes.

    View details for DOI 10.1007/s11606-019-05525-2

    View details for PubMedID 31919725

  • Practices to Foster Physician Presence and Connection With Patients in the Clinical Encounter JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION Zulman, D. M., Haverfield, M. C., Shaw, J. G., Brown-Johnson, C., Schwartz, R., Tierney, A. A., Zionts, D. L., Safaeinili, N., Fischer, M., Israni, S. T., Asch, S. M., Verghese, A. 2020; 323 (1): 70-81

    View details for DOI 10.1001/jama.2019.19003

  • Developing institutional infrastructure for physician wellness: qualitative Insights from VA physicians BMC Health Services Research Schwartz, R., Shanafelt, T. D., Gimmler, C., Osterberg, L. 2020; 20 (7)
  • Neurologist Strategies for Optimizing the Parkinson's Disease Clinical Encounter. Journal of geriatric psychiatry and neurology Schwartz, R., Trivedi, R., Gray, C., Lorenz, K. A., Zulman, D. 2019: 891988719845509

    Abstract

    For patients with Parkinson's disease (PD), effective communication during neurology encounters is critical to ensuring the treatment plan maximizes quality of life. However, few research studies have engaged neurologists as key experts in identifying opportunities to optimize the clinical encounter. In this study, 16 neurologists from 4 clinic sites participated in hour-long semistructured interviews targeting opportunities to better address patients' quality of life needs.Neurologists identified opportunities to meet needs across 4 domains: (1) PD patient education materials and self-management tools to facilitate clinical communication; (2) techniques for improving clinical communication, including strategies for eliciting nonmotor symptoms and contextualizing symptoms to better meet patient quality of life needs; (3) addressing system-level barriers, including time constraints and the lack of an identified specialist referral network; and (4) training in how to lead difficult conversations.Neurologists identified specific barriers, and proposed solutions, to improving care delivery for patients with PD. Integrating practice tools to address quality of life needs, training neurologists in communication around end-of-life care, and strengthening referral networks for rehabilitation and psychosocial support hold promise for improving quality of life for patients with PD.

    View details for PubMedID 31046525

  • Transdisciplinary Strategies for Physician Wellness: Qualitative Insights from Diverse Fields Journal of General Internal Medicine Schwartz, R., Haverfield, M. C., Brown-Johnson, C., Maitra, A., Tierney, A., Bharadwaj, S., Shaw, J. G., Azimpour, F., Thadaney Israni, S., Verghese, A., Zulman, D. M. 2019

    Abstract

    While barriers to physician wellness have been well detailed, concrete solutions are lacking.We looked to professionals across diverse fields whose work requires engagement and interpersonal connection with clients. The goal was to identify effective strategies from non-medical fields that could be applied to preserve physician wellness.We conducted semi-structured interviews with 30 professionals outside the field of clinical medicine whose work involves fostering effective connections with individuals.Professionals from diverse professions, including the protective services (e.g., police officer, firefighter), business/finance (e.g., restaurateur, salesperson), management (e.g., CEO, school principal), education, art/design/entertainment (e.g., professional musician, documentary filmmaker), community/social services (e.g., social worker, chaplain), and personal care/services (e.g., massage therapist, yoga instructor).Interviews covered strategies that professionals use to initiate and maintain relationships, practices that cultivate professional fulfillment and preserve wellness, and techniques that facilitate emotional presence during interactions. Data were coded using an inductive thematic analysis approach.Professionals identified self-care strategies at both institutional and individual levels that support wellness. Institutional-level strategies include scheduling that allows for self-care, protected time to connect with colleagues, and leadership support for debriefing after traumatic events. Individual strategies include emotionally protective distancing techniques and engagement in a bidirectional exchange that is central to interpersonal connection and professional fulfillment.In this exploratory study, the purposive sampling technique and single representative per occupation could limit the generalizability of findings.Across diverse fields, professionals employ common institutional and personal wellness strategies that facilitate meaningful engagement, support collegiality, and encourage processing after intense events. The transdisciplinary nature of these wellness strategies highlights universal underpinnings that support wellbeing in those engaging in people-oriented professions.

    View details for DOI 10.1007/s11606-019-04913-y

  • "It's a disease of families": Neurologists' insights on how to improve communication and quality of life for families of Parkinson's disease patients. Chronic illness Schwartz, R., Zulman, D., Gray, C., Goldstein, M. K., Trivedi, R. 2018: 1742395318799852

    Abstract

    Objectives Parkinson's disease presents an evolving challenge for patients and families due to an unpredictable disease trajectory and symptoms that complicate social interactions. In this study, we explore neurologists' perspectives on the challenges Parkinson's disease presents for families and the strategies they use to improve communication and quality of life. Methods We conducted hour-long semi-structured interviews with 16 neurologists at 4 care delivery institutions in the San Francisco Bay Area, focusing on techniques neurologists use to support families through the Parkinson's disease journey. Results Neurologists identified strategies for addressing caregiver-patient disagreements around symptom accuracy and negotiating driving safety. Family education is needed to contextualize patient symptoms and to identify psychosocial support resources. Unmet caregiver needs remain, particularly in the form of psychosocial support, respite care and support for unequal gender dynamics in the Parkinson's disease caregiving experience. Discussion Family members of Parkinson's disease patients face unique caregiving and interpersonal challenges due to the nature of the disease. Targeted education and structural support are needed to alleviate current burdens and allow for improved patient- and family-centered care.

    View details for PubMedID 30208725

  • Changing the game for hand hygiene conversations Hospital Pediatrics Schwartz, R., Sharek, P. J. 2018; 8 (3): 168-169

    View details for DOI 10.1542/hpeds.2017-0205

  • Empathy present and future. The Journal of social psychology Hall, J. A., Schwartz, R. 2018: 1?19

    Abstract

    The empathy concept has central significance for social and personality psychology and in many other domains, including neuroscience, clinical/abnormal psychology, and the health professions. However, the current diversity in conceptual and operational definitions, and the promiscuous use of the term "empathy," threaten the ability of researchers to advance the field. The present article provides a quantitative review and conceptual analysis of empathy definitions and usages by examining 393 studies published between 2001 and 2013, and 96 studies published in 2017. We document the prevalence and diversity of definitions, as well as inconsistencies between conceptual definitions and measurements employed. We discuss ways to refine the conceptualization and operationalization of the empathy construct, including for many purposes, bypassing the term empathy in favor of lower-level construct labels that more precisely describe what is actually being measured. In many cases we see no added theoretical or empirical value in applying the term empathy.

    View details for DOI 10.1080/00224545.2018.1477442

    View details for PubMedID 29781776

  • When emotion and expression diverge: The social costs of Parkinson's disease JOURNAL OF CLINICAL AND EXPERIMENTAL NEUROPSYCHOLOGY Schwartz, R., Pell, M. D. 2017; 39 (3): 211-230
  • Unaltered emotional experience in Parkinson?s disease: Pupillometry and behavioral evidence Journal of Clinical and Experimental Neuropsychology Schwartz, R., Rothermich, K., Kotz, S. A., Pell, M. D. 2017: 1-14
  • Emotional Speech Processing at the Intersection of Prosody and Semantics PLOS ONE Schwartz, R., Pell, M. D. 2012; 7 (10)

    Abstract

    The ability to accurately perceive emotions is crucial for effective social interaction. Many questions remain regarding how different sources of emotional cues in speech (e.g., prosody, semantic information) are processed during emotional communication. Using a cross-modal emotional priming paradigm (Facial affect decision task), we compared the relative contributions of processing utterances with single-channel (prosody-only) versus multi-channel (prosody and semantic) cues on the perception of happy, sad, and angry emotional expressions. Our data show that emotional speech cues produce robust congruency effects on decisions about an emotionally related face target, although no processing advantage occurred when prime stimuli contained multi-channel as opposed to single-channel speech cues. Our data suggest that utterances with prosodic cues alone and utterances with combined prosody and semantic cues both activate knowledge that leads to emotional congruency (priming) effects, but that the convergence of these two information sources does not always heighten access to this knowledge during emotional speech processing.

    View details for DOI 10.1371/journal.pone.0047279

    View details for Web of Science ID 000310600500015

    View details for PubMedID 23118868

    View details for PubMedCentralID PMC3485297

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