My research has had several foundational intellectual impacts on the fields of health services and disparities/equity research, within VA and the wider academic community. My studies have illustrated how veterans' individual characteristics affect their self-ratings of health and quality of life. Our work found that racial/ethnic disparities among veterans are a function of patient, provider, system, policy, and societal factors, and demonstrated that multi-faceted studies like ours are needed to distinguish the varying effects of each of these types of factors relative to each other. Our findings have shown that race itself recedes in significance when other characteristics that are associated with race (health beliefs, sociodemographics) are accounted for. We have demonstrated that VA healthcare provider communication does not change simply because of educational training and good intentions, but that workflows and systems must be altered to foster changes in practice. Our studies have documented that neither access to nor eligibility for VA care, policies that value equity, nor health insurance reform are sufficient to reduce disparities, though our findings about how policies and aspects of the societal environment affect VA utilization can guide VA policymakers as they estimate demand for VA care. Taken together, the results of my research to date now point me further upstream to the need to address social determinants of health (SDoH), and my future research will focus on how the VA healthcare system can identify and address these needs of veterans, so that their uptake of care and recommended therapies can ultimately improve health outcomes, optimize utilization, and reduce disparities. In the past 3 years, I have published 32 papers (senior author on 12, first author on 6). My H index in the Web of Science, which reflects the impact of my publications, is a 31, comparable to other VA HSR&D Research Career Scientists (exceeding about half of my RCS peers). In addition, the Almetrics scores of several of my highest profile publications place them within the top 5% of research outputs, demonstrating the strong impact of my work. According to Google Scholar, my work has been cited over 8,300 times (>3,000 since 2013). These scores indicate that my research products are being widely read and cited, shaping the state of knowledge in my fields, and informing future research. My very strong and consistent record of funding as a PI dates back to 1994, from VA, the NIH, and foundations including the American Heart Association. I have won $4,381,159 from VA HSR&D and QUERI, not including Research Career Scientist award funding, with NIH funding (as PI) totaling $13,786,483. In the future, I will leverage my seniority and strong track record to further serve VA, help others (locally and nationally) develop into independent investigators and to further develop disparities/equity research through a focus on how addressing SDoH within VA clinical care can reduce disparities and increase equity in veterans' health and healthcare utilization outcomes, optimizing VA resource use (a VA priority area).
I aim to: 1. Mentor and train at least 5 students/trainees/fellows/faculty per year, including at least 1 VA HSR&D CDA. 2. Publish at least 8 papers per year, including at least 3 in very high profile journals. 3. Obtain VA HSR&D Merit Review/QUERI funding as PI for at least 2 new projects in the next 2 years. 4. Continue strong VA service by chairing the VA CDA review panel, the Pittsburgh/Philadelphia COIN Steering Committee, and participating in local IRB, search committees, and other VA/non-VA workgroups.

Public Health Relevance

My research has had foundational intellectual impacts on the fields of health services and disparities/equity research, within VA and the wider academic community, through its contributions to understanding how individual veteran patients' characteristics, interactions between patients and providers, and health insurance and other policies affect disparities in care and outcomes. My strong publication history (>130 papers) and funding record (>$18 million, not including my SRCS award), noteworthy mentoring history, and extensive service to VA both locally and to the broader national health services, equity, and disparities research communities, have led to strong professional stature, recognition of my contributions as a mentor, and to numerous occasions of representing VA on national committees and workgroups determining the future of equity research within and beyond the VA. Renewal of this SRCS award will foster continued scientific, mentoring and service contributions to VA HSR&D.

National Institute of Health (NIH)
Veterans Affairs (VA)
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HSR-7 Service Directed Research (HSR7)
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VA Boston Health Care System
United States
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