Candidate: Dr. Candace Feldman is an Instructor in Medicine in the Division of Rheumatology, Immunology and Allergy and the Section of Clinical Sciences (SCS) at Brigham and Women?s Hospital (BWH). Dr. Feldman has a longstanding passion to understand and reduce disparities in rheumatic diseases. Her research focuses on racial/ethnic and socioeconomic disparities in prevalence, access and outcomes among patients with systemic lupus erythematosus (SLE). Her 14 peer-reviewed original publications, 8 first author, and 2 early career development grants exemplify her track record and her commitment to this field. She holds a MPH degree and is pursuing a doctorate in social epidemiology from the Harvard T.H. Chan School of Public Health (HSPH). Her immediate goals are to learn and apply advanced health services research and qualitative methods to understand SLE-related avoidable acute care use to inform a future intervention. She will be guided by Dr. Costenbader, an established SLE epidemiologist, and an expert mentoring team. Dr. Feldman strives to apply rigorous methods to redesign healthcare delivery for vulnerable rheumatology patients. Environment: Dr. Feldman?s Division Chief ensures that >75% of her time will be protected for research and career development for the 5-year duration of this K23 award. She has financial support to supplement her salary and project-related expenses from the Division, the SCS, and her primary mentor?s funding. The BWH Lupus Center, co-directed by Dr. Costenbader, is the largest in New England. The research infrastructure established as part of the Center will enable Dr. Feldman to recruit patients. In addition, the SCS has extensive research infrastructure, which will continue to support her work. Dr. Feldman has access to Medicaid data under Dr. Costenbader?s Data Use Agreement with the Centers for Medicare & Medicaid Services, and to Partners HealthCare electronic health records linked to claims data through the explicit support of Population Health Management. For her training, she will have access to courses and mentorship at HSPH, where she is a doctoral student, and through Harvard Medical School and the Harvard Catalyst Program. Research: Dr. Feldman will rigorously define SLE-related conditions that may result in avoidable acute care use (e.g. emergency department visits and hospitalizations). She will then examine rates and predictors of potentially avoidable use, and associated mortality and costs in two large, diverse datasets. She will learn and apply qualitative methods, including Photovoice, which will empower SLE patients to photograph their homes and communities, to explore the contribution of social determinants to avoidable care use. Dr. Feldman will hold focus groups of SLE patients, providers and administrators to design a rheumatology-based intervention to improve healthcare delivery for these high-utilizing, vulnerable SLE patients. Dr. Feldman will develop skills in rigorous mixed methods research. This project, and the training Dr. Feldman will gain, will position her for a R01 and for a career as an independent social epidemiology and patient-oriented investigator in rheumatology.

Public Health Relevance

Lupus is a complex autoimmune disease, disproportionately affecting vulnerable populations and resulting in high acute care use, much of which could be prevented if patients had consistent access to high-quality outpatient care. There is a need to define and understand lupus-specific avoidable acute care use (emergency department visits and hospitalizations) and to identify those patients at highest risk. This study will inform the design of interventions aimed at optimizing outpatient care, preventing adverse outcomes, and reducing disparities among patients with complex, subspecialty-managed diseases.

National Institute of Health (NIH)
National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS)
Mentored Patient-Oriented Research Career Development Award (K23)
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Special Emphasis Panel (ZAR1)
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Wang, Yan Z
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Brigham and Women's Hospital
United States
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Feldman, Candace H; Costenbader, Karen H; Solomon, Daniel H et al. (2018) Area-level Predictors of Medication Nonadherence among U.S. Medicaid Beneficiaries with Lupus: A Multilevel Study. Arthritis Care Res (Hoboken) :
Barbhaiya, Medha; Feldman, Candace H; Guan, Hongshu et al. (2018) Racial/ethnic variation in stroke rates and risks among patients with systemic lupus erythematosus. Semin Arthritis Rheum :
Feldman, Candace H; Collins, Jamie; Zhang, Zhi et al. (2018) Dynamic patterns and predictors of hydroxychloroquine nonadherence among Medicaid beneficiaries with systemic lupus erythematosus. Semin Arthritis Rheum 48:205-213
Feldman, Candace H; Broder, Anna; Guan, Hongshu et al. (2018) Sex Differences in Health Care Utilization, End-Stage Renal Disease, and Mortality Among Medicaid Beneficiaries With Incident Lupus Nephritis. Arthritis Rheumatol 70:417-426
Lin, Tzu-Chieh; Marmor, Michael F; Barbhaiya, Medha et al. (2018) Baseline Retinal Examinations in Patients With Systemic Lupus Erythematosus Newly Initiating Hydroxychloroquine Treatment in a US Medicaid Systemic Lupus Erythematosus Population, 2000-2010. Arthritis Care Res (Hoboken) 70:1700-1706
Feldman, Candace H; Collins, Jamie; Zhang, Zhi et al. (2018) Azathioprine and Mycophenolate Mofetil Adherence Patterns and Predictors among Medicaid Beneficiaries with Systemic Lupus Erythematosus. Arthritis Care Res (Hoboken) :