I, Joseph A. Ladapo, MD, PhD, am a physician and health policy researcher who is passionately committed to pursuing a meaningful career in clinical research by translating research findings into better care for patients. The NHLBI K23 Mentored Patient-Oriented Research Career Development Award will provide me with the additional training I need to achieve this goal, thus maximizing my contribution to patients'lives I completed a PhD in Health Policy during medical school and my primary research interest relates to the use of clinical decision-analysis to improve the care of patients evaluated and treated for coronary heart disease (CHD) and other chronic diseases. My interest in this area has grown out of my own personal experience with diagnostic uncertainty and also from my experience caring for patients evaluated for new, life-changing diseases. I have published prior studies in this area, some of which has been cited in clinical guidelines issued by the American College of Cardiology and the American Heart Association.
The specific aims of this proposal involve developing patient-centered approaches to diagnosing CHD that improve diagnostic accuracy, reduce unnecessary testing and radiation exposure, and incorporate the impact of false-positive stress test results on patients'anxiety, perception of illness, and quality of life These aims significantly extend prior work in this area and involve (1) primary analyses of electronic health records from Geisinger Health System that inform clinical and demographic characteristics of this patient population;(2) development of epidemiological models of follow-up management and Bayesian models of diagnostic test performance that adjust for verification bias (this has not previously been done in this type of work);(3) qualitative interviews of patiens in focus groups to better understand the impact of false-positive test results on quality of life, followed by survey research informed by these interviews;and (4) development of a clinical decision-analysis model that combines all of the above elements and informs optimal approaches to evaluation and treatment. [The overall hypothesis that drives my work is the belief that patient-centered approaches to diagnosing CHD can improve diagnostic accuracy while reducing patient harms. The clinical decision-analysis model I propose to build in Aim 3 will permit formal evaluation of this hypothesis.] With the supervision and mentorship of Scott Braithwaite, MD, MSc (primary mentor), Judith Hochman, MD (co-mentor), Donna Shelley, MD (co-mentor), David Carey, PhD (co-mentor), Gbenga Ogedegbe, MD, MS, MPH, FACP (co-mentor), and Pamela Douglas, MD (advisor);participation in seminars and workshops at New York University (NYU);and formal coursework, I will receive the training I need to develop into an independent investigator. The specific methodological skills that will enable me to complete my training and research objectives constitute a combination of quantitative and qualitative training, including epidemiological training in survival analysis, clinical informatics training to leverage the powerful tool of EHR for research, qualitative methods in the performance and analysis of patient focus groups, and survey research. I will also benefit from additional training in advanced clinical decision-analysis, computer modeling techniques, model calibration, and validation. My coursework will be completed at NYU's Graduate School of Arts and Science;Steinhardt School of Culture, Education, and Human Development;Stern School of Business;and the School of Medicine. My career goals are consistent with NHLBI's mission to promote the prevention and treatment of heart disease and enhance the health of all individuals, and I have a highly supportive team of mentors to supervise and direct my training. I believe the K23 will provide me with the training and mentorship I need to develop into an independent investigator.

Public Health Relevance

The proposed research is relevant to public health because the findings will support the dissemination of approaches to improve screening, diagnosis, and clinical management of patients evaluated for coronary heart disease, while reducing risks from excessive radiation and unnecessary testing. The proposed research is relevant to the part of NHLBI's mission that seeks to promote treatment of heart disease to improve individuals'quality of life and longevity.

National Institute of Health (NIH)
National Heart, Lung, and Blood Institute (NHLBI)
Mentored Patient-Oriented Research Career Development Award (K23)
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Special Emphasis Panel (ZHL1-CSR-X (M1))
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Wei, Gina
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New York University
Internal Medicine/Medicine
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New York
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Hochheiser, Louis I; Juusola, Jessie L; Monane, Mark et al. (2014) Economic utility of a blood-based genomic test for the assessment of patients with symptoms suggestive of obstructive coronary artery disease. Popul Health Manag 17:287-96
Ladapo, Joseph A; Blecker, Saul; Douglas, Pamela S (2014) Physician decision making and trends in the use of cardiac stress testing in the United States: an analysis of repeated cross-sectional data. Ann Intern Med 161:482-90
Ladapo, Joseph A; Ogedegbe, Gbenga (2014) Do black patients with chronic kidney disease benefit equally from all blood pressure lowering agents? BMJ 348:g142
Ladapo, Joseph A; Elliott, Marc N; Kanouse, David E et al. (2014) Tobacco use and smoking intentions among U.S. fifth-grade students. J Adolesc Health 55:445-51
Ladapo, Joseph A; Blecker, Saul; Elashoff, Michael R et al. (2013) Clinical implications of referral bias in the diagnostic performance of exercise testing for coronary artery disease. J Am Heart Assoc 2:e000505