Dr. Sox-Harris has three major health services research areas, all with high relevance to VA healthcare. 1) Developing, validating, and implementing predictive models for surgical treatments and their alternatives. Dr. Sox-Harris is leading a HSR&D-funded project (IIR 13-051-3) to develop and validate predictive models of short-term complications and long-term outcomes of patients receiving total hip or knee arthroplasty. This project has produced the most accurate predictive models of surgical complications following total joint arthroplasty and the team is in the process of producing models to predict which patients will experience the most and least improvements from this common treatment for osteoarthritis. The next step in this program of research is to test methods to integrate these predictions into informed consent, shared decision making, and risk stratification, as well as the identification and management of modifiable risk factors to improve the outcomes of patients. He is also submitting two new grants in the fall of 2018 to develop and validate prediction models for (a) candidate treatments for non-specific low back pain and (b) persistent postoperative pain. 2) Developing, validating, and evaluating the effects of health care quality measures for diverse medical conditions. Dr. Sox-Harris has led several projects (e.g., 07-092-1, IIR10-370-2) focused on the validity and effects of existing addiction treatment quality measures. Results from this research has generated wide interest and debate in the addiction field and contributed to the methodological literature by increasing awareness of the ecological fallacy (i.e., misleading conclusions about individuals from analyses of aggregated data) as it pertains to quality measure validation and interpretation. Overall, his work changed the landscape of addiction treatment quality measurement within VA and beyond, and has been recognized with several national awards. He has expanded the impact of this line of research in a mentoring role (e.g., IIR 15-436-2, IIR 16-239), and his program of quality measurement research continues with a shift in clinical focus to conditions for which surgery is a major treatment option (e.g., carpal tunnel syndrome, total joint arthroplasty); 3) Implementation and de-implementation research. Dr. Sox- Harris has two VA-funded projects (SDP 11-411 recently completed, IIR 16-216) focused on implementation of evidence-supported treatments (e.g., medication treatment of alcohol use disorder) and de-implementation of unsafe, ineffective, or low value treatments and practices (e.g., low value preoperative testing for low risk procedures). His current and planned work in this area is primarily focused on targets relevant to surgical procedures (e.g., low value testing after surgery, routine use of general anesthesia when less risky/costly options exist) and conditions for which surgery is a major treatment option (e.g., chronic low back pain). The unifying theme behind these research areas is that they represent significant unsolved problems in the VA health care system and beyond. Dr. Sox-Harris' driving motivation is to identify high-impact and persistent problems in the VA healthcare system for which health services research might provide essential insights and innovations. He has a record of successful grant applications (15 grants as PI, 18 as co-investigator), publishing in scientific journals (185 manuscripts, H-Index of 40), and mentoring early career and other researchers. In recognition of his commitment to conducting research that directly informs healthcare delivery and outcomes, Dr. Sox-Harris received the inaugural VA HSR&D System Impact Award in 2015, for a program of research that has had ?a direct and important impact on clinical practice or clinical policy in the VA Healthcare System.?
My research is focused on predictive modeling, quality measurement and management, and implementation and de-implementation science. I will use the research career scientist (RCS) award to extend my programs of research in three high-impact areas. First, many health conditions have several competing treatment options but clinicians and patients do not have accurate information about which patients are most likely to benefit from which treatments. To realize the promise of ?precision medicine?, accurate patient-specific prediction models need to be developed, validated, and methods to integrate the predictions into informed consent and shared decision-making need to be tested. Second, research on the effects of healthcare quality measurement is essential to ensure that our systems of accountability are having the intended effects. Finally, designing and testing strategies to get healthcare systems to provide higher quality care and to stop providing care that is unsafe, ineffective, or low value represents an enduring scientific and organizational priority.