Although the research that Anita Arora and Carolyn Presley are conducting as Robert Wood Johnson Foundation Clinical Scholars focuses on different populations, the two physicians share a common goal. Both are working to improve health care delivery so it is more equitable, more patient-centered, less wasteful, and more likely to create well-being for patients and communities.
Anita Arora, who holds an MBA from Dartmouth’s Tuck School (TU'11) in addition to an MD from Geisel, is applying her dual skill sets to three research projects, all focused on different aspects of “well-being,” which she explains is a comprehensive measure of physical, mental, and social health. Arora is using data from a national survey to examine whether variation in population well-being helps to explain geographic disparities in life expectancy. She hopes this work will highlight well-being as an important metric of a population’s health and as a focus for intervention.
In a second project, Arora is examining variation in well-being among underserved, low-income communities and has already discovered higher-than-average well-being in areas of high poverty. What enables the economically disadvantaged to be happy, healthy, and resilient? She’s working to answer that question.
In a third project, Arora is collaborating with a team of community leaders to study whether community and capacity building activities can improve social cohesion and reduce exposure to gun violence in two New Haven, Conn., neighborhoods. This study also explores whether geographic variation in social cohesion tracks with variation in emergency department utilization related to gun violence across neighborhoods in New Haven.
Tackling Treatment Burden
Carolyn Presley, who is completing a combined fellowship in geriatric oncology and hematology at Yale, is researching treatment burden, functional status, and integrated oncology and palliative care delivery models for older adults undergoing cancer treatment. She is seeking effective ways to improve appropriate treatment and quality of life for these patients and their families. In one project, Presley is analyzing Medicare data to measure the treatment burden older Medicare beneficiaries carry after a diagnosis of early-stage lung cancer, enumerating inpatient and outpatient medical visits, physicians seen, and medicines prescribed during the first 12 months following diagnosis. The second phase involves interviewing patients and families about their experience within the health care system.
In a second project, Presley is investigating the events that contribute to functional decline in elderly people undergoing cancer treatment. The project, which draws on data from an ongoing 15-year study, ultimately aims to design interventions that will allow older patients to maintain independence even after a cancer diagnosis. “It’s a different way of taking care of patients, within a social construct that is less fragmented and with less risk of both undertreatment and overtreatment,” she says.
At her clinical practice at the West Haven, Conn., VA hospital, Presley is working to compare outcomes of patients who receive cancer treatment concurrent with hospice and palliative care against outcomes of patients who receive cancer treatment alone. Currently, Medicare covers hospice care only after cancer treatment fails; her experience as a geriatric oncologist indicates that incorporating aspects of palliative care earlier would benefit patients, their families, and physicians.
Presley plans to continue her work on improving patient-centered outcomes in geriatric oncology as a clinician-researcher at an academic medical center.
AUTHOR: Deborah Lee Luskin