R. Adams Dudley, MD, MBA

Professor of Medicine and Health Policy

Director, UCSF Center for Healthcare Value
Associate Director for Research, 
Philip R. Lee Institute for Health Policy Studies

Twitter: @RAdamsDudleyMD

Dr. Dudley is Professor of Medicine and Health Policy and Director of UCSF’s Center for Healthcare Value (CHV) at the Philip R. Lee Institute for Health Policy Studies. The overarching aim of the CHV is to improve the quality and value of care while reducing harm and waste. His research reflects these aims.  His group’s activities include: 1) developing and validating novel measures of quality and safety, 2) studying the clinical and policy determinants of clinical performance, and 3) implementing programs to measure quality and report providers’ performance to the providers themselves, the public, and other policymakers.  The first two activities have led to numerous publications (see below).

Creating change in the health care system

His initiatives to implement change in the health care system include the California Intensive Care Outcomes (CALICO) network, which provided hospitals with reports of hospital-specific ICU quality of care and efficiency for ICUs in California and which produced National Quality Forum-endorsed measures of ICU mortality rates and length of stay. He also co-founded the California Hospital Assessment and Reporting Task Force (CHART), which convened representatives of consumers, purchasers, health plans, and hospitals in California to establish a consensus, universal, robust hospital performance reporting system. (CHART was named the best hospital performance public reporting program in the country by the Center for Studying Health System Change and the CHART web site, www.CalHospitalCompare.org, received over 1.5 million page views annually. It has now moved to http://www.calqualitycare.org. He led a national study of AHRQ-supported web sites reporting on quality of care, so the sites could understand who was using their data and how. He currently leads California’s initiatives to establish price transparency and an all payer claims database.

Research

His group addresses these topics with a variety of techniques, including using large databases to measure performance, develop new measures, or assess how policies are associated with level of performance.  As electronic health records (EHRs) have become more widespread, efforts to measure and improve care have become more dependent on using natural language processing and machine learning applied to big clinical data from electronic sources (both structured and unstructured). As Director of UCSF’s Health Services Informatics Lab, Dr. Dudley has led UCSF’s efforts to use EHRs to measure performance.

Dr. Dudley’s mentees have an outstanding track record, including winning Young Investigator and Article of the Year Awards from such organizations as AcademyHealth, the American College of Cardiology, and the Society of General Internal Medicine. Eight different mentees have had first author papers in JAMA and the New England Journal of Medicine. Dr. Dudley’s mentees have also published in health services research journals such as Medical Care and Health Affairs, and in specialty journals such as the Journal of the American College of Surgeons, Kidney International, Diabetes Care, and CHEST. In addition, they have obtained K awards or equivalent career development awards from NIH, AHRQ, the Robert Wood Johnson Foundation, and specialty organizations such as the American Heart Association. Current or former mentees are on the faculties at the University of Witten/Herdecke (Germany), Harvard, Penn, RAND/Pitt, Vanderbilt, UCSF, Stanford, and the University of Hawaii.

In 2005, Dr. Dudley became the first physician at UCSF to receive the prestigious Robert Wood Johnson Foundation Investigator Award in Health Policy. He has been elected to the American Society for Clinical Investigation.

 

Publications: 

Chen, LC, Lin, GA, Bardach, NS, Boscardin, WJ, Gelb, AW, Maze, M, Gropper, MA, Dudley, RA. Preoperative Medical Testing Prior to Cataract Surgery in Medicare Patients. New England Journal of Medicine, 2015, in press.

Bardach, NS, Hibbard, JH, Greaves, F, Dudley, RA. Sources of Traffic and Visitors’ Preferences Regarding Online Public Reports of Quality. Journal of Medical Internet Research, 2015, in press.

Duseja, R, Bardach, NS, Lin, GA, Yazdany, J, Dean, ML, Clay, T, Dudley, RA. Revisit Rates and Associated Costs after an Emergency Department Encounter: A Multi-State Analysis. Annals of Internal Medicine, 2015, in press.

Marafino, BJ, Boscardin, WJ, Dudley, RA. Efficient and Sparse Feature Selection for Biomedical Text Classification via the Elastic Net: Application to ICU Risk Stratification from Nursing Notes. Journal of Biomedical Informatics, 2015, in press.

Chen, LC, Lin, GA, Bardach, NS, Boscardin, WJ, Gelb, AW, Maze, M, Gropper, MA, Dudley, RA. Preoperative Medical Testing Prior to Cataract Surgery in Medicare Patients. New England Journal of Medicine, 2015, in press.

DeJong, C, Santa, J, Dudley, RA. Websites That Offer Care over the Internet: Is There an Access Quality Tradeoff? JAMA, 2014 Apr 2;311(13):1287-8.

Marafino, BJ, Davies, JM, Bardach, NS, Dean, ML, Dudley, RA. N-gram Support Vector Machines for Scalable Procedure and Diagnosis Classification, with Applications to Clinical Free Text Data from the Intensive Care Unit. Journal of the American Medical Informatics Association, 2014 Sep-Oct;21(5):871-5.

Begum, R, Smith Ryan, M, Winther, CH, Wang, JJ, Bardach, NS, Parsons, AH, Shih, SC, Dudley, RA. Small Practices’ Experience with EHR, Quality Measurement, and Incentives. American Journal of Managed Care, 2013;19(10 Spec No):eSP12-8.

Bardach, NS, Wang, JJ, De Leon, SF, Shih, SC, Boscarin, WJ, Goldman, LE, Dudley, RA. Effect of Pay-for-Performance Incentives on Quality of Care in Small Practices with Electronic Health Records: A Randomized Trial. JAMA, 2013;310(10):1051-9.

Petersen, LA, Simpson, K, Pietz, K, Urech, TH, Hysong, SJ, Profit, J, Conrad, DA, Dudley, RA, Woodard, LD. Effects of Individual Physician-Level and Practice-Level Financial Incentives on Hypertension Care: A Cluster Randomized Trial. JAMA, 2013;310(10):1042-50.

Bardach, NS, Vittinghoff, E, Asteria-Peñaloza, R, Edwards, JD, Yazdany, J, Lee, HC, Boscardin, WJ, Cabana, MD, Dudley, RA. Measuring Hospital Quality Using Pediatric Readmission and Revisit Rates. Pediatrics, 2013 Sep;132(3):429-36.

Rhoads, KF, Ngo, JV, Ma, Y, Huang, L, Welton, ML, Dudley, RA. Do Hospitals that Serve a High Percentage of Medicaid Patients Perform Well on Evidence-based Guidelines for Colon Cancer Care? Journal of Health Care for the Poor and Underserved, 2013;24(3):1180-93.

Bardach NS, Asteria-Peñaloza R, Boscardin WJ, Dudley RA. The relationship between commercial website ratings and traditional hospital performance measures in the USA. BMJ Qual Saf. 2013 Mar;22(3):194-202.

Werner, RM, Dudley, RA. Medicare’s New Hospital Value-Based Purchasing Program Is Likely to Have Only a Small Impact on Hospital Payment. Health Affairs, 2012 Sep;31(9):1932-40.

Finlayson, E, Zhao, S, Boscardin, WJ, Fries, BE, Landefeld, CS, Dudley, RA. Functional Status after Colon Cancer Surgery in Elder Nursing Home Residents:  A National Study. Journal of the American Geriatrics Society, 2012; 60(5):967-73.

Finlayson, E, Wang, L, Dudley, RA. Major Abdominal Surgery in Nursing Home Residents:  A National Study. Annals of Surgery, 2011; 254(6):921-6.

Lin GA, Redberg RF, Anderson HV, Shaw RE, Milford-Beland S, Peterson ED, Rao SV, Werner, RM, Dudley, RA. Effect of Changes in Clinical Practice Guidelines on Assessment of Quality of Care. Medical Care, 2010; 48(8):733-8.

Tseng, CW, Waitzfelder, BE, Tierney, E, Gerzoff, RB, Marrero, DG, Piette, JD, Karter, AJ, Curb, JD, Chung, R, Mangione, CM, Crosson, J, Dudley, RA. Patients’ Willingness to Discuss Trade-offs to Lower Their Out-of-Pocket Drug Costs. Archives of Internal Medicine, 2010; 170(16):1502-1504.

Gregg, EW, Karter, AJ, Gerzoff, RB, Safford, MM, Brown, A, Tseng, CW, Waitzfielder, B, Herman, W, Mangione, CM, Selby, J, Thompson, J, Dudley, RA. Characteristics of Insured Patients with Persistent Lapses in Diabetes Care Services: The Translating Research into Action for Diabetes (TRIAD) study. Medical Care, 2010; 48(1):31-37.

Yoo, EJ, Dudley, RA. Evaluating Telemedicine in the ICU. JAMA, 2009; 302(24):2705-2706.

Kernisan, LP, Lee, SJ, Boscardin, WJ, Landefeld, CS, Dudley, RA. Association between Hospital-reported Leapfrog Safe Practices Scores and Inpatient Mortality. JAMA, 2009; 301(13):1341-1348.

Werner, RM, Dudley, RA. Making the “Pay” Matter in Pay-for-Performance: Implications for Payment Strategies. Health Affairs, 2009; 28(5):1498-508.

Vasilevskis, EE, Kuzniewicz, MW, Cason, B, Lane, R, Dean, ML, Clay, T, Rennie, DJ, Vittinghoff, E, Dudley, RA. Mortality Probability Model III and Simplified Acute Physiology Score II: Assessing their Value in Predicting Length of Stay and Comparison to APACHE IV. CHEST, 2009; 136(1):89-101.

Lin, GA, Dudley RA, Lucas, FL, Malenka, DJ, Vittinghoff, E, Redberg, RF. Frequency of Stress Testing to Document Ischemia Prior to Elective Percutaneous Coronary Intervention. JAMA, 2008; 300(15):1765-1773.

Werner, RM, Goldman, LE, Dudley, RA. Comparison of change in quality of care between safety-net and non-safety-net hospitals. JAMA, 2008; 299(18):2180-2187.

Kuzniewicz, MW, Vasilevskis, EE, Lane, R, Dean, ML, Trivedi, NG, Rennie, DJ, Clay, T, Kotler, PK, Dudley, RA. Variation in ICU Risk-adjusted Mortality: Impact of Methods of Assessment and Potential Confounders. CHEST, 2008; 133(6):1319-27.

Anderson Rothman, A, Park, H, Hays, RD, Edwards, C, Dudley, RA. Can Additional Patient Experience Items Improve the Reliability of and Add New Domains to the CAHPS® Hospital Survey? Health Services Research, 2008; 43(6):2201-22.

Lin, GA, Dudley, RA, Redberg, RF. Why Physicians Favor Use of Percutaneous Coronary Intervention to Medical Therapy: A Focus Group Study. Journal of General Internal Medicine, 2008; 23(9):1458-63.

Rhoads, KF, Ackerson, LK, Jha, AK, Dudley, RA. Quality of Surgical Outcomes in Hospitals with High Percent Medicaid Patients. Journal of the American College of Surgeons, 2008; 207(2):197-204.

Tseng, CW, Mangione, CM, Brook, RH, Keeler, EM, Dudley, RA. Identifying Widely Covered Drugs and Drug Coverage Variation Among Medicare Part D Formularies. JAMA, 2007; 297(23):2596-2602.

Rosenthal MB, Dudley RA. Pay-for-Performance: Will the Latest Payment Trend Improve Care? JAMA, 2007; 297(7):740-744.

Lin, GA, Dudley, RA, Redberg, RF. Cardiologists’ Use of Percutaneous Coronary Interventions for Stable Coronary Artery Disease. Archives of Internal Medicine, 2007; 167(15):1604-9.

Frolich, A, Talavera, JA, Broadhead, P, Dudley, RA. A Behavioral Model of Clinician Responses to Incentives to Improve Quality. Health Policy, 2007; 80(1):179-93.

Mehrotra, A, Grier, SA, Dudley, RA. The Relationship Between Health Plan Advertising and Market Incentives: Evidence of Risk Selective Behavior. Health Affairs, 2006; 25(3):759-65.

Robinowitz, DL, Dudley, RA. Public Reporting of Provider Performance: Can it Improve Quality? Can Its Impact Be Made Greater? Annual Review of Public Health, 2006; 27:517-536.

Dudley RA. Pay-for-performance research: how to learn what clinicians and policy makers need to know. JAMA. 2005; 294(14):1821-3.

Lipton, HL, Agnew, JD, Stebbins, M, Kuo, A, Dudley, RA. Managing the Unmanageable: The Nature and Impact of Drug Risk in Physician Groups. J of Health Politics, Policy and Law, 2005; 30(4):719-50.

Jha, AK, Perlin, JB, Kizer, KW, Dudley, RA. Effect of the Transformation of the VA Health Care System on the Quality of Care. New England Journal of Medicine, 2003; 348(22):2218-27.

Mehrotra, A, Bodenheimer, T, Dudley, RA. Employers’ Efforts To Measure And Improve Hospital Quality: Determinants of Success. Health Affairs, 2003; 22(2):60-71.

Dudley, RA, Medlin, CA, Hammann, LB, Cisternas, MG, Brand, R, Rennie, DJ, Luft, HS. The Best of Both Worlds? The Potential of Hybrid Prospective/Concurrent Risk Adjustment. Medical Care, 2003; 41(1):56-69.

Dudley, RA, Luft, HS. Managed Care in Transition. New England Journal of Medicine, 2001; 344(14):1087-1092.

Dudley, RA, Johansen, KL, Brand, R, Rennie, DJ, Milstein, A. Selective Referral to High Volume Hospitals: Estimating Potentially Avoidable Deaths. JAMA, 2000; 283(9):1159-1166.

Dudley, RA, Luft, HS. Goals, Targets, and Tactics: Making Health Care Policy Decisions Explicit. J Health Politics, Policy and Law, 1999; 24(4):705-713.

Dudley, RA, Miller, RH, Korenbrot, TY, Luft, HS. The Impact of Financial Incentives on Quality of Health Care. Milbank Quarterly, 1998; 76(4):649-686.

Selected Projects: