Health Care

Encina Commons, Room 190
615 Crothers Way,
Stanford, CA 94305-6006

(650) 723-0570
0
Professor, Health Policy
Professor, Medicine
Professor, Stanford Graduate School of Business (by courtesy)
Senior Fellow, by courtesy, Freeman Spogli Institute for International Studies
sarah_singer_head-2023.jpg PhD, MBA

Sara Singer, PhD, MBA, is a professor of health policy at the Stanford University School of Medicine and Professor by courtesy at the Stanford Graduate School of Business. She is the faculty director of the Health Leadership, Innovation, and Organizations (HELIO) Labs, which fosters interdisciplinary collaboration among colleagues from across the University, including Stanford Health Care and the Schools of Medicine, Business, Engineering, Design, Sustainability, Law, and Humanities and Sciences — and across the globe.

Singer's research in the field of health care management and policy is informed by her interdisciplinary training in health policy, organizational behavior, and general management. Using innovative mixed methods and organizational theories, she studies health-care teams and organizations to understand how leaders and policymakers can improve the safety and quality of health-care delivery through changes in institutional culture, leadership, organizational design, and team dynamics. Her research program is built around central challenges in health-care delivery (ensuring patient safety despite enormous complexity and uncertainty in diagnosis, treatment, and disease progression; integrating increasingly fragmented services across multiple service providers and organizations; and implementing, adapting, and sustaining innovations that enhance the value of health care), where my research suggests that learning- and systems-oriented leaders and teams and supportive organizational cultures are critical factors for creating a high performing health care delivery system.

Sara Singer on Communication in Health Care

CV
Date Label

VA Palo Alto Health Care System Medical Service (111) 3801 Miranda Avenue Palo Alto, CA 94304;

Encina Commons, 615 Crothers Way Room 210, Stanford, CA 94305-6006

(650) 493-5000,,1,,1,62105
0
Professor, Health Policy
Professor, Medicine (by courtesy)
mary_goldstein_profile.jpg MD, MS

 

Mary K. Goldstein is a Professor of Health Policy and a core faculty member at the Department of Health Policy and the Center for Health Policy, and the Director of the Geriatrics Research Education and Clinical Center (GRECC) at the VA Palo Alto Health Care System. She directs the Primary Care Policy and Practice Advancement program at PCOR, the Stanford/VA Palo Alto Geriatric Medicine Fellowship Program, and the Special Fellowship Program in Advanced Geriatrics at VA Palo Alto. She also serves as associate director for the Physician Post-Residency Fellowship Program in Health Services Research and Development, and for the Postdoctoral Fellowship in Medical Informatics, both at VA Palo Alto Health Care System.

Goldstein studies innovative methods of implementing evidence-based clinical practice guidelines for quality improvement. She leads the ATHENA Decision Support System project that has developed and implemented an automated clinical decision support system for primary care clinicians, using hypertension as a model, and now extended into several other clinical domains.  Goldstein's research also explores older adults' health preferences (health utility) for application to cost-effectiveness analysis.

Goldstein is a fellow of the American Geriatrics Society, and an emerita of the Society's board of directors. Goldstein has received a number of honors and awards including an Advanced Career Development award from the Department of Veterans Affairs Health Services Research and Development (HSR&D) program.  She received a BA in philosophy and an MD, both from Columbia University, and completed her residency in family medicine at Duke University Medical Center. At the Stanford School of Medicine she completed an AHRQ-funded fellowship and an MS in health services research.

CV

Health Research and Policy
Sequoia 132
Stanford, California 94305-4065

(650) 723-2206 (650) 725-8977
0
Max H. Stein Professor and Professor of Statistics and of Health Research and Policy
efron_new.jpeg PhD

Professor Efron is a member of the National Academy of Sciences, president of the American Statistical Association, recipient of the MacArthur Prize, and winner of the Wilks Medal of the American Statistical Association. Professor Efron is renowned internationally for his pioneering work in computationally intensive statistical methods that substitute computer power for mathematical formulas, particularly the bootstrap method. The goal of this research is to extend statistical methodology in ways that make analysis more realistic and applicable for complicated problems. He consults actively in the application of statistical analyses to a wide array of health care evaluations.

Stanford Health Policy Associate
Paragraphs

Previous research suggests that "direct" reforms to the liability system - reforms designed to reduce the level of compensation to potential claimants - reduce medical expenditures without important consequences for patient health outcomes. We extend this research by identifying the mechanisms through which reforms affect the behavior of health care providers. Although we find that direct reforms improve medical productivity primarily by reducing malpractice claims rates and compensation conditional on a claim, our results suggest that other policies that reduce the time spent and the amount of conflict involved in defending against a claim can also reduce defensive practices substantially. In addition, we find that "malpractice pressure" has a larger impact on diagnostic rather than therapeutic treatment decisions. Our results provide an empirical foundation for simulating the effects of untried malpractice reforms on health care costs and outcomes, based on their predicted effects on the malpractice pressure facing medical providers.

All Publications button
1
Publication Type
Working Papers
Publication Date
Journal Publisher
NBER
Authors

The Global Health Productivity project is a Stanford-led network of collaborators from 20 developed nations organized to assess the impact of healthcare regulation, financing and organization on healthcare delivery and health system performance. The project studies diverse issues of global interest, including pharmaceutical regulation, policies regarding financing the care of elderly individuals with dementia, and approaches to managing common clinical problems such as congestive heart failure.

Paragraphs

Health care report cards - public disclosure of patient health outcomes at the level of the individual physician and/or hospital - may address important informational asymmetries in markets for health care, but they may also give doctors and hospitals incentives to decline to treat more difficult, severely ill patients. Whether report cards are good for patients and for society depends on whether their financial and health benefits outweigh their costs in terms of the quantity, quality, and appropriateness of medical treatment that they induce. Using national data on Medicare patients at risk for cardiac surgery, we find that cardiac surgery report cards in New York and Pennsylvania led both to selection behavior by providers and to improved matching of patients with hospitals. On net, this led to higher levels of resource use and to worse health outcomes, particularly for sicker patients. We conclude that, at least in the short run, these report cards decreased patient and social welfare.

All Publications button
1
Publication Type
Working Papers
Publication Date
Journal Publisher
NBER
Authors
Paragraphs

We present a methodology and database mediator tool for integrating modern knowledge-based systems, such as the Stanford EON architecture for automated guideline-based decision-support, with legacy databases, such as the Veterans Health Information Systems & Technology Architecture (VISTA) systems, which are used nation-wide. Specifically, we discuss designs for database integration in ATHENA, a system for hypertension care based on EON, at the VA Palo Alto Health Care System. We describe a new database mediator that affords the EON system both physical and logical data independence from the legacy VA database. We found that to achieve our design goals, the mediator requires two separate mapping levels and must itself involve a knowledge-based component.

All Publications button
1
Publication Type
Working Papers
Publication Date
Journal Publisher
Proceedings of the 1999 Annual Meeting of the American Medical Informatics Association
Authors
Mary K. Goldstein
Mark A. Musen
Paragraphs

What should be government's role in a market-oriented health care system?

What's the appropriate amount of regulation?

Who should regulate-states, federal government, or market forces?

What role do the courts play in this regulation?

Are there existing models that might guide leaders in designing an effective regulatory structure?

Welcome to the great managed care debate. In Regulating Managed Care, twenty-six of the nation's leading health policy experts give health care administrators, clinicians, and policy makers insight into the issues behind this critical exchange and provide leaders with a road map to assess the policy options available to protect the quality of our health care delivery system.

All Publications button
1
Publication Type
Books
Publication Date
Journal Publisher
Jossey-Bass (Menlo Park, CA) in "Regulating Managed Care: Theory, Practice, and Future Options", Altman, Reinhardt, and Schactman, editors.
Authors
Sara J. Singer
Number
0787947830
Subscribe to Health Care