Patient Outcomes

Brennan Spiegel

Type of Faculty: 
Part Time
Appointment Title: 
Associate Professor-in-Residence
Address: 
UCLA/VA Center for Outcomes Research and Education (CORE) 11301 Wilshire Blvd Building 115, Room 215 Los Angeles, California 90073
310.268.3256
310.268.4510
Areas of Interest: 
  • Decision analysis / healthcare decision making
  • Cost-effectiveness analysis
  • Patient reported outcomes (PROs)
  • Clinical trial design
  • Patient-provider portals / electronic health records (EHRs)
  • Social media in healthcare 
  • Wireless healthcare technologies
  • Colon cancer screening
  • Managing chronic diseases
  • Gastrointestinal disorders      
  • Developing quality indicators (QIs)
  • Threat detection
Biographical Information: 

Dr. Spiegel is Associate Professor of Medicine in the Division of Digestive Diseases, UCLA School of Medicine, and in the Division of Gastroenterology, VA Greater Los Angeles Health Care System. Dr. Spiegel is the Section Chief for Outcomes Research at the UCLA Division of Digestive Diseases, adjunct faculty in the Department of Health Policy and Management, UCLA Fielding School of Public Health, and a member of the CURE Digestive Diseases Research Center. Dr. Spiegel attended Tufts University where he majored in Philosophy and Community Health, and received his M.D. with Alpha Omega Alpha honors from New York Medical College. He received training in internal medicine at Cedars-Sinai Medical Center in Los Angeles, completed a fellowship in Gastroenterology at UCLA, and completed advanced studies in Health Services Research at the UCLA Fielding School of Public Health, where he received a Master’s Degree in Health Services. He received a Research Career Development Award through the Veteran Administration during which time he was trained in health services methodology.

Dr. Spiegel's research focuses on acid-peptic disorders, colon cancer screening, gastrointestinal hemorrhage, diverticular diseases, and functional bowel disorders such as irritable bowel syndrome (IBS). His overall research is defining strategies that improve the quality and cost-effectiveness of care for patients with digestive diseases. To achieve this goal, Dr. Spiegel conducts cost-effectiveness analyses, patient reported outcome (PRO) research, health related quality of life studies, meta-analyses, epidemiological studies, provider surveys, quality indicator developmental studies, and other "outcomes" research.

Dr. Spiegel’s group at the UCLA/VA Center for Outcomes Reserach and Education (CORE) is also developing new technological innovations to expand care outside of the provider visit, including use of patient-provider electronic portals to support clinical decision making in electronic health records (example here), use of social media as a clinical tool, and a range of wireless biosensors to track physiology remotely and in real time. In addition, as Chair of the Rome Foundation Outcomes and Endpoints Committee and a member of the U.S. Food and Drug Administration Gastroenterology Field Advisory Committee, Dr. Spiegel is focused on developing valid and reliable endpoints for clinical trials. Dr. Spiegel is a peer-reviewer for numerous medical journals, and is on the editorial boards for the Alimentary Pharmacology and Therapeutics and Clinical Gastroenterology and Hepatology. He is currently an Associate Editor of the American Journal of Gastroenterology. He receives active funding from the NIH, VA, and industry sources.

Education: 
MSHS, UCLA
MD, New York Medical College
BS, Philosophy and Community Health, Tufts University
Selected Courses: 
HS 239A: Decision Analysis and Cost-Effectiveness Analysis
HS 239B: Advanced Topics in Decision Analysis and Cost-Effectiveness Analysis
HS 441: Health Analytics: Identifying, Collecting, and Analyzing Big Data in Healthcare
Selected Publications: 

Spiegel BMR, Vakil NB, Ofman JJ.  Endoscopy for acute non-variceal upper gastrointestinal tract hemorrhage: is sooner better?  A systematic review.  Archives of Internal Medicine 2001; 161:1393-1404.

Spiegel BMR, Vakil NB, Ofman JJ.  Dyspepsia management in primary care: a decision analysis of competing strategies.  Gastroenterology 2002;122:1270-1285 [with editorial]  

 Spiegel BMR, Ofman JJ, Vakil NB.  Minimizing recurrent peptic ulcer hemorrhage after endoscopic hemostasis: the cost-effectiveness of competing strategies.  American Journal of Gastroenterology 2003; 98:86-97.            

Spiegel BMR, Targownik LE, Karsan HA, Dulai GS, Gralnek IM.  Endoscopic screening for esophageal varices in cirrhosis: is it ever cost-effective?  Hepatology 2003:37:366-77. [with editorial] [113 citations]

 Spiegel BMR, Targownik LE, Dulai GS, Gralnek IM.  The cost-effectiveness of cyclooxygenase-2 selective inhibitors in the management of chronic arthritis.  Annals of Internal Medicine 2003;138:795-806.

Spiegel BMR, DeRosa VP, Gralnek IM, Wang V, Dulai GS.  Testing for celiac sprue in diarrhea-predominant irritable bowel syndrome: a cost-effectiveness analysis.  Gastroenterology 2004;126:1721-32.

Spiegel BMR, Targownik LE, DeRosa V, Dulai GS, Gralnek IM, Chiou CF. The quality of published health economic analyses in digestive diseases: a systematic review and quantitative appraisal.  Gastroenterology 2004; 127:403-411.

Spiegel BMR, Gralnek IM, Mayer EB, Bolus R, Dulai GS, Chang L, Naliboff B.  Clinical determinants of health-related quality of life in patients with irritable bowel syndrome.  Archives of Internal Medicine 2004; 164:1773-1780.

Spiegel BMR, Younossi ZM, Hays RD, Revicki D, Robbins S, Kanwal F.  The impact of hepatitis C on health related quality of life: a systematic review of the literature.  Hepatology 2005; 41:790-800.

Spiegel BMR, Chiou CF, Ofman JJ.  Minimizing complications from nonsteroidal anti-inflammatory drugs: the cost-effectiveness of competing strategies in varying risk groups.  Arthritis Care and Research 2005;15:185-97.

Kanwal F, Gralnek IM, Martin P, Dulai GS, Martin P, Spiegel BMR.  The cost-effectiveness of competing therapies in the management of chronic infection with hepatitis B virus.  Annals of Internal Medicine 2005; 142:821-31. 

Spiegel BMR, Kanwal F, Naliboff B, Mayer E.  The impact of somatization on gastrointestinal health resource use in irritable bowel syndrome.  American Journal of Gastroenterology 2005; 100:2262-73.

Spiegel BMR, Chen K, Broder M, Chiou Chiun-Fang.  Erythropoietic Growth Factors for the management of treatment-related anemia in hepatitis C: clinical and economic consequences.  Clinical Gastroenterology and Hepatology 2005; 3:1034-42.

Spiegel BMR, Gralnek IM, Bolus R, Mayer E, Chang L, Dulai GS, Naliboff B.  Is a negative colonoscopy associated with improved health-related quality of life or reassurance in irritable bowel syndrome?  Gastrointestinal Endoscopy 2005; 62:892-899.

Spiegel BMR, Farid M, Gralnek IM, Dulai GS, Kanwal F.  Comparing rates of dyspepsia with coxib versus NSAID+PPI combination therapy: a systematic review and meta-analysis.  American Journal of Medicine 2006; 119(5):448.e27-36.

Spiegel BMR, Lim B, Mann N, Dulai GS, Gralnek IM.  The cost-effectiveness of intravenous versus oral proton pump inhibitor therapy in the management of peptic ulcer hemorrhage: a cost-effectiveness analysis.  Clinical Gastroenterology and Hepatology 2006; 4:988-997.  

Kanwal F, Farid M, Gralnek IM, Dulai G, Martin P, Chen G, Spiegel BMR.  Treatment alternatives for hepatitis B cirrhosis: a cost-effectiveness analysis.  American Journal of Gastroenterology 2006;101:2076-89

Gralnek IM, Fennerty B, Spiegel BMR.  The effectiveness of esomeprazole in erosive esophagitis: a meta-analysis.  Clin Gastroenterol Hepatol. 2006; 4:1452-8.

Spiegel BMR, Bolus R, Han S, Tong M, Esrailian E, Talley J, Tran T, Smith J, Karsan H, Durazo F, Bacon B, Martin P, Younossi Z, Hwa-Ong S, Kanwal F. Development and validation of a disease-targeted health-related quality of life instrument in chronic hepatitis B infection: the HBQOL v1.0. Hepatology 2007;46:113-21

Spiegel BMR, Schoenfeld P, Naliboff B.  Prevalence of suicidal behavior in patients with chronic abdominal pain and irritable bowel syndrome: a systematic review.  Aliment Pharmacol Ther. 2007; 26:183-193.

Esrailian E, Spiegel BMR, Targownik L, Dulai GS, Gralnek IM. Differences in the management of Crohn's disease among experts and community providers, based on a national survey of sample case vignettes.  Aliment Pharmacol Ther. 2007; 26:1005-18.  

Spiegel BMR, Esrailian E, Laine L, Chamberlain M.  Clinical relevance of adjuvant chemotherapy in glioblastoma multiforme: a meta-analysis of competing agents.  CNS Drugs 2007;21:775-87.

Spiegel BMR, Esrailian E, Eisen G.  The budget impact of screening for esophageal varices in cirrhosis Gastrointestinal Endoscopy2007;66:679-92 [

Huang E, Esrailian E, Spiegel BMR.  The cost-effectiveness of competing therapies for hepatic encephalopathy: a decision analysis. Alimentary Pharmacology and Therapeutics. 2007;26:1147-61.

World Gastroenterology Organization Advisory Board on Irritable Bowel Syndrome.  Systematic review on the management of irritable bowel syndrome in the European Union.  Eur J Gastro Hep 2007;19:S11-37 

Desai A, Bolus R, Nissenson A, Bolus S, Solomon M, Khawar O, Gitlin M, Talley J, Spiegel BMR. Identifying “best practices” in dialysis care: results of a national survey and cognitive interviews of dialysis stakeholders.  Clinical Journal of the American Society of Nephrology (CJASN) 2008; Apr 16.

Spiegel BMR, Strickland A, Naliboff B, Mayer E, Chang L.  Predictors of patient-assessed illness severity in irritable bowel syndrome.  American Journal of Gastroenterology 2008 [Jun 30 – Epub ahead of print]

Spiegel BMR, Melmed G, Robbins S, Esrailian E.  The relationship between biomarkers and health related quality of life in end-stage renal disease: a systematic review. Clinical Journal of the American Society of Nephrology (CJASN) 2008; Oct 1 [Epub ahead of print]

Esrailian E, Gralnek IM, Jensen D, Laine L, Dulai GS, Eisen G, Spiegel BMR.  Evaluating the process of care in non-variceal upper gastrointestinal hemorrhage: a national vignette survey of experts vs. community gastroenterologists.  Alimentary Pharmacology & Therapeutics 2008;28:1199.

Spiegel BMR, Ho W, Esrailian E, Targan S, Higgins P, Siegel C, Dubinsky M, Melmed G.  Controversies in Ulcerative Colitis: A National Survey Comparing Decision-Making of Experts versus Community Gastroenterologists.  Clinical Gastroenterology and Hepatology. 2008.

Ford AC, Talley NJ, Spiegel BMR, Foxx-Orenstein A, Schiller L, Quigley EMM, Moayyedi P. Efficacy of fibre, antispasmodics, and peppermint oil in irritable bowel syndrome: systematic review and meta-analysis.  British Medical Journal. 2008 13;337. [157 citations]

Greengold B, Nyamathi A, Kominski G, Hodge F, Singer M, Spiegel BMR. Cost-Effectiveness Analysis of Behavioral Intervention to Improve Vaccination Compliance in Homeless Adults.  Vaccine. 2008; 27:718-25.  

Spiegel BMR, Farid M, van Oijen MGH, Laine L, Howden CW, Esrailian E.  Adherence to best practice guidelines in dyspepsia: a survey comparing dyspepsia experts, community gastroenterologists, and primary care providers.  Alimentary Pharmacology and Therapeutics 2009;29:871-81

Desai A, Bolus R, Nissenson A, Chertow GM, Bolus S, Solomon M, Khawar O, Talley J, Spiegel BMR. Is there “cherry picking” in the ESRD program? Perceptions from a dialysis provider survey.  Clinical Journal of the American Society of Nephrology (CJASN) 2009;4:772-7  

Kanwal F, Gralnek IM, Bolus R, Kim SJ, Spiegel BMR.  Health Related Quality of Life Predicts Mortality in Patients awaiting Liver Transplantation.  Clinical Gastroenterology and Hepatology 2009 [Epub ahead of print]

Spiegel BM, Harris L, Lucak S, Mayer E, Naliboff B, Bolus R, Esrailian E, Chey WD, Lembo A, Karsan H, Tillisch K, Dulai G, Talley J, Chang L.  Developing valid and reliable health utilities in irritable bowel syndrome: results from the IBS PROOF cohort.  American Journal of Gastroenterology 2009

Desai A, Farid M, Singh I, van Oijen MGH, Esrailian E, Solomon MD, Spiegel BM.  The relationship between laboratory-based outcomes and mortality in end-stage renal disease: a systematic review.  Hemodialysis International 2009[Epub ahead of print]

Spiegel BM, Bolus R, Harris LA, Lucak S, Naliboff B, Esrailian E, Chey WD, Lembo A, Karsan H, Tillisch K, Talleyl J, Mayer E, Chang L.  Measuring IBS patient reported outcomes with an abdominal pain numeric rating scale: results from the PROOF cohort. Alimentary Pharmacology and Therapeutics. 2009 Dec [Epub ahead of print]

Spiegel BM, Camilleri M, Bolus R, Andresen V, Chey WD, Fehnel S, Mangel A, Talley NJ, Whitehead WE.  Psychometric evaluation of endpoints in IBS randomized controlled trials: a Rome Foundation Working Group report.  Gastroenterology [Epub ahead of print]

Weinberg B, Spiegel BM, Tomlinson J, Farrel J.  Asymptomatic Pancreatic cysts: maximizing survival and quality of life using Markov-based clinical nomograms.  Gastroenterology. 2010

Spiegel BM, Farid M, Esrailian E, Talley J, Chang L.  Is irritable bowel syndrome a diagnosis of exclusion? A survey of primary care providers, gastroenterologists, and IBS experts.  Am J Gastroenterol. 2010 Apr;105(4):848-58. Epub 2010 Mar 2.

Spiegel BM, Bolus R, Desai AA, Zagar P, Parker T, Moran J, Bolus S, Solomon MD, Khawar O, Gitlin M, Talley J, Nissenson A. Dialysis practices that distinguish top vs. bottom performing facilities by hemoglobin outcomes. Am J Kidney Dis. 2010 May 19. [Epub ahead of print]

Kanwal F, Barkun A, Gralnek IM, Asch SM, Kuipers EJ, Bardou M, Sung J, Enns R, Agreus L, Armstrong D, Spiegel BM.  Measuring quality of care in patients with nonvariceal upper gastrointestinal hemorrhage: development of an explicit quality indicator set.  Am J Gastroenterol 2010;105:1710-8  

Spiegel BM, Roberts L, Mody R, Harding G, Kothari-Talwar S, Kahrilas PJ, Camilleri ML, Dabbous O, Revicki DA.  The Development and validation of a Nocturnal Gastro-oesophageal Reflux Disease Symptom Severity and Impact Questioninaire for adults.  Aliment Pharmacol The 2010;32:591-602  

Spiegel BM, Bolus R, Desai AA, Zagar P, Parker T, Moran J, Bolus S, Solomon MD, Khawar O, Gitlin M, Talley J, Nissenson A. Dialysis practices that distinguish facilities with below versus above-average mortality.  Am J Kidney Dis. 2010; 56:86-94.

Spiegel BM, Bolus R, Harris L, Lucak S, Mayer E, Naliboff B, Esrailian E, Chey WD, Lembo A, Karsan H, Tillisch K, Dulai G, Talley J, Chang L.  Characterizing abdominal pain attributes in IBS: guidance for study inclusion and outcome assessment.  Aliment Pharmcol Ther 2010 Nov; 32(9):1192-202

Spiegel BM, Bolus R, Agarwal N, Harris L, Lucak S, Sayuk G, Esrailian E, Chey WD, Lembo A, Karsan H, Tillisch K, Dulai G, Talley J, Chang L.  Measuring symptoms in irritable bowel syndrome: development of a framework for clinical trials.  Aliment Pharmacol Ther 2010 Nov;32(10):1275-91.

Kaneshiro M, Ho A, Chan M, Cohen H, Spiegel BM.  Colonoscopy yields fewer polyps as the day progresses despite using social influence theory to reverse the trend.  Gastrointest Endosc 2010;72:1233-40.

Chan M; Cohen H; Spiegel BM. Colonoscopy yields fewer polyps as the day progresses: Experience in a Veteran Administration teaching hospital. Clinical Gastroenterology and Hepatology [Epub ahead of print] 2010 Dec 

Spiegel BMR, Talley J, Shekelle P, Bolus R, Kurzbard N, Chan M, Ho A, Kaneshiro M, Cordasco K, Cohen H.  Development and validation of a novel patient educational booklet to enhance colonoscopy preparation.  Am J Gastroenterol. 2011 May; 106(5):875-83.

Solomon M, Bonafede M, Pan K, Wilson K, Beam C, Chakravarti P, Spiegel B.  Direct medical care costs among pegylated infereron plus ribavirin-treated and untreated chronic hepatitis C patients.  Dig Dis Sci 2011 Jun 30 [Epub ahead of print].

Huang ES, Karsan S, Kanwal F, Singh I, Makhani M, Spiegel BM. Impact ofnasogastric lavage on outcomes in acute GI bleeding. Gastrointest Endosc. 2011Jul 6.

Foster T, Hon H, Kanwal F, Han S, Spiegel B.  Screening for high risk individuals for hepatitis B: physician knowledge, attitudes, and beliefs. Dig Dis Sci 2011; 56:3471-87.

Wang HS, Pisegna J, Modi R, Liang LJ, Atia M, Nguyen M, Cohen H, Ohning G, van Oijen M, Spiegel BM. Adenoma detection rate is necessary but insufficient for distinguishing high versus low endoscopist performance. Gastrointest Endosc. 2013 Jan;77(1):71-78.

Whitman CB, Shreay S, Gitlin M, van Oijen MG, Spiegel BM. Clinical Factors and the Decision to Transfuse Chronic Dialysis Patients. Clin J Am Soc Nephrol. 2013 Aug 8.

Shahedi K, Fuller G, Bolus R, Cohen E, Vu M, Shah R, Agarwal N, Kaneshiro M, Atia M, Sheen V, Kurzbard N, van Oijen MG, Yen L, Hodgkins P, Erder MH, Spiegel B. Long-term Risk of Acute Diverticulitis Among Patients With Incidental Diverticulosis Found During Colonoscopy. Clin Gastroenterol Hepatol. 2013 Jul 12.

 Spiegel BM. Patient-reported outcomes in gastroenterology: clinical and research applications. J Neurogastroenterol Motil. 2013 Apr;19(2):137-48.

Cohen E, Fuller G, Bolus R, Modi R, Vu M, Shahedi K, Shah R, Atia M, Kurzbard  N, Sheen V, Agarwal N, Kaneshiro M, Yen L, Hodgkins P, Erder MH, Spiegel B. Increased Risk for Irritable Bowel Syndrome After Acute Diverticulitis. Clin Gastroenterol Hepatol. 2013 Mar 21

 Spiegel B. Polarizing or paralyzing? Moving forward with patient reported outcome measurement in irritable bowel syndrome. Rev Gastroenterol Mex. 2013;78(1):1-4.

Arlene Fink

Type of Faculty: 
Part Time
Appointment Title: 
Adjunct Professor
Address: 
911 Broxton Plz
310.454.4296
310.454.1944
Biographical Information: 

I am a health services researcher with an abiding interest in the health and well-being of vulnerable populations.  I am especially concerned with improving preventive medicine practice and the quality of health care for older adults.

 I have devoted my career to mentoring the work of young scholars in their efforts to improve U.S. health outcomes by developing, evaluating and disseminating evidence-based information to patients, clinicians, and policymakers.  Integral to my work is the generation of methods for responding to health care stakeholders’ expressed needs about which clinical and health system interventions prove most effective for which patients under which specific circumstances.   Among my methodological expertise is program evaluation and survey research.

Throughout my career, I have been actively engaged in teaching and mentoring physicians and surgeons, conducting research, writing and reviewing scholarly papers and books, and serving as an advisor to academic and community institutions and agencies at home and abroad.  The following briefly explains my activities and expertise.

  

Teaching and Mentoring Physicians and Surgeons

I have been on the Research Advisory Committee for UCLA’s Robert Wood Johnson Clinical Scholars Program for over two decades.  This fellowship program is designed to train leaders in medicine and provide them with the necessary skills to be research and policy experts.  UCLA’s program is one of the best of its kind in the country.  I have been on the program’s faculty since its inception in 1975.

In my role on the Clinical Scholars’ faculty, I have been the principal or co-principal mentor of seven fellows.  I have worked intensively, often daily, with the fellows for whom I had principal responsibility, and in all cases, supervised their education and research.   Five of the seven fellows have already graduated from the program.  Dr. Kavita Patel, an internist, is a Fellow at the Brookings Institute and was formerly Director of Policy for the Office of Governmental Affairs and Public Engagement for President Obama.  I supervised Dr. Patel’s national survey of the American College of Physicians to uncover how they spend their time when not in the office.  Similarly, I supervised Dr. Sierra Matula’s survey of surgeons to identity their pro bono activities.  Dr. Matua is now at UC San Francisco.  Dr. John Gore, a Urologist, who is currently on the faculty at the University of Washington (Seattle) and I worked on a study to determine the mental health of low-income prostate cancer patients.  Dr. Rhonda Mattox, a psychiatrist who is currently in a rural practice in Little Rock, Arkansas and I developed methods for her study of the effects of religious beliefs on health care preferences.  Dr. Joan Ryoo, now a radiation oncologist at Kaiser, and I worked on a community-based survey of the incidence of helicobacter pylori among Koreans in LA.. I am currently working with Dr. Charles Scales to develop and evaluate the effectiveness of a mobile-phone-based educational intervention for postgraduates to improve the quality and safety of their care for urological disease   We are working with the Dean’s Office and others to produce the education and its evaluation.

Over the past five years, I have also served as a faculty mentor to urological fellows, residents and medical students as part of my responsibilities as evaluation director for UCLA’s IMPACT program.  This program treats indigent men with prostate cancer, and we collect quality of life and other data on all patients.  As with the Clinical Scholars, I meet regularly with fellows and students to supervise their research and collaborate in teaching them research skills and writing papers with them.  Among the fellows with whom I have worked are Drs. Jennifer Anger,1 Jonathan Bergman, 2-5and David Miller6.  I have worked with medical students and urological residents including  Dr. Jenniifer Heckman,7 Dr. Christopher Delbert,8 Mary Zavala,9,10 Dr. Karim Chamie11 and Dr. John Augustus.12

I have continued to work with postdoctoral fellows such as Marsha McGory, M.D., Ph.D.13.  I was her co-mentor when she was a Clinical Scholar.  I also continue to collaborate with Dr. Carol Eisen14 whom I mentored when she was an NIMH Faculty Scholar at UCLA.  Dr. Eisen Is now the Regional Medical Director for the Los Angeles County Department of Mental Health (DMH).  Dr. Kim Gregory, who received an M.P.H. at UCLA and took my course in program evaluation and comparative effectiveness research, and 15I continue to collaborate.  Dr, Gregory is is Vice Chair of Women's Healthcare Quality and Performance Improvement at Cedars-Sinai.  Dr. Gregory and I submitted a joint proposal in December, 2010 to the Patient Centered Outcomes Research Institute (PCORI) to develop methods for actively involving pregnant women in their health care decision-making.

 In July 2010, I joined the UCLA Gambling Studies Program.  One of my responsibilities is to co-mentor the work of Dr. Iman Parham, a psychiatrist.  We recently completed a review of the quality of the gambling literature (submitted to Addiction and currently being revised for resubmission).  Previous versions of our study were presented to the Western Association of Physicians and also to the National Council of Responsible Gambling (NCRG)  The NCRG selected  the presentation as the best in the conference (September 2011). 

 

Research

 A major focus of my career has been on improving care for vulnerable populations including people with chronic health (indigent men with prostate cancer) and mental health (pathological gamblers) problems.   I have collaborated with Dr. Mark Litwin, Chair of the Department of Urology) to build the UCLA Prostate Caner Treatment Program into one of national prominence.   The purpose of the program is to provide treatment to men who do not have health insurance and who are not eligible for MediCal.  I assisted Dr. Litwin with the proposal that won the grant and have been the evaluation coordinator for the study since its inception 10 years ago.  In specific, I developed and continue to oversee the evaluation of the project and all research connected with it.  We have published over 50 papers over a 10-year period.  I have also been working with the UCLA Gambling Program to make it into a national center of excellence, using the UCLA Prostate Treatment Program as a model.

 In keeping with my interests in vulnerable populations in general, and the elderly in particular, I have developed “The Alcohol-Related Screening Problems Survey, “often called the ARPS.  This screening and education system is designed to identify alcohol-related problems in older adults.   Older people may incur alcohol-related risks at relatively low consumption levels because of alcohol’s potential adverse interaction with an elderly person’s declining health and functional status and increased medication-use.  The ARPS system consists of a survey to identify risks and problems, personalized reports of each patient’s risks, physician reports, and an educational program for patients (A Toast to Health in Later Life!).  I have been PI of three NIH grants to develop the system, which I created in conjunction with UCLA faculty (e.g., Ron Hays, Ph.D., medicine and public health; Merle Wittrock, Ph.D., education; John Beck, MD, medicine.)   In the past five years, I have overseen the transition of the ARPS from a paper-and-pencil survey to one that is available online at http://www.wisedrinking.org.  (A password is required, which I can provide.)  The ARPS and its scoring system, which involves complex algorithms has been translated into French and has been used in France (touch screen) under my supervision for over five years.16 For the past two years, I have consulted with the government of Victoria, Australia to “translate” the US version into one that is suitable to Australian drinking standards.  We have presented the results in Canberra Australia and are writing up the results for publication17.   I am also working with researchers at the Palo alto Medical Research Foundation as part of an ongoing effort to try out the ARPS system in a facility with an electronic health record.18  Finally, I am in the process of writing up the results of a study that was done in conjunction with Wise and Healthy Aging, a community-based full-service center for seniors in Santa Monica.  In that study, we found that older adults (average age 77 years) were able to use the online version of the ARPS as easily as they could use the paper and pencil version.

 For many years, I have been interested in improving health literacy.  This has led to an AHRQ grant in 2011 to develop an online education program to teach older adults to evaluate health information.  Many older (55 year plus) people have at least one health condition (e.g., hypertension), and according to the Pew Internet and American Life Project, nearly 70% of them have gone online to collect health information for themselves or others.  Most people start with a search engine and are offered millions of sites, many of which are unreliable and possibly harmful.  The online program, which is in the evaluation phase, is designed to improve older adults’ abilities to identify and evaluate the information they find regardless of the source.  A preliminary version is available at:  http://www.ehealthsearch.info (A user name and password are required, which I can provide).  The published report of the study will be available in 2013 in the Journal of Applied Gerontology (http://jag.sagepub.com/).

 Although information technology to aid in improving health literacy for vulnerable populations is a major interest 19,20, I have continued to maintain a concern for the RAND/UCLA Appropriateness method, which I helped to originate.  This method was originally designed to help understand under and over use of medical and surgical procedures and also study variations in care.  It relies on the literature (‘best available evidence”) and clinical expertise to identify appropriate indications for medical and surgical procedures and has been used hundreds of times nationally and internationally to study appropriate use.  Recently the method has also been adapted  as a means of developing indicators for evaluating quality improvement.13  I was recently the principal investigator of a study of the appropriate indications for transfusion, which is the most commonly procedure in the US21.

  

Peer-Reviewed Papers and Books

 I have published 135 papers in peer-reviewed journals and 15 textbooks. The papers represent my combined interests in vulnerable populations and research methodology, particularly effectiveness evaluation, survey research, and clinical literature review methods.  For example, I wrote a textbook, “Practicing Research.”  This book aims to teach health care practitioners how to translate research into practice.  I also completed the third edition of a textbook that has been in print since the 1990’s, “Conducting Research Literature Reviews.”  Finally, I have spent a great deal of 2012 writing a textbook called “Evidence-Based Public Health Practice.”  This book, which bases its main premises on the principles of evidence-based medicine, aims to teach health care professionals how to identify and evaluate the best available evidence and ingrate it with clinical expertise and patient preferences to make informed public health care and policy decisions.  I am developing an interactive website to accompany the textbook.  It is the first book of its kind that actually describes what to do to practice evidence-based public health, which public health models are appropriate, and how to evaluate the process, outcomes, impact, and costs.

 

Advisory Roles and Journal Reviews

 I have served as a reviewer for the NIH’s Internet Assisted Review process   I was among the first to try out a review method in which all reviews and discussions take  place over the internet.  I have just agreed to chair a study section for the Patient Centered Research Institute (PCORI), a new federal program associated.  PCORI was established by Congress through the 2010 Patient Protection and Affordable Care Act.  It is an independent organization created to help people make informed health care decisions and improve health care delivery.   

 I have served as a reviewer the Journal of the American Medical Association, Annals of Internal Medicine (top 30% of reviewers), BioMed Central, and Drug and Alcohol Review, I have also reviewed proposals in the Netherlands (ZonMw ) and for the Israel Bi-National Committee.

I have worked with colleagues from other academic institutions including the Mt. Sinai School of Medicine,21 the University of Wisconsin,22 and the University of Washington (Puget Sound).23   I am currently working in France, Australia, and New Zealand as an advisor to doctoral students.17

 I am an advisor to the UCLA Gambling Studies Program.  In that capacity, I help select research topics and priories and oversee the development of new research ideas.  I am also on the Research Advisory committee of the Robert Wood Johnson Clinical Scholar Program and assist in overseeing the quality and characteristics of the Program’s research activities.

 

References

 

 ADDIN EN.REFLIST 1.         Anger JT, Maliski SL, Krupski TL, et al. Outcomes in men denied access to a California public assistance program for prostate cancer. Public Health Rep. Mar-Apr 2007;122(2):217-223.

 

2.         Bergman J, Kwan L, Fink A, Connor SE, Litwin MS. Hospice and emergency room use by disadvantaged men dying of prostate cancer. J Urol. May 2009;181(5):2084-2089.

 

3.         Bergman J, Logan S, Fink A, Ganz DA, Peterson MA, Litwin MS. Caring for the Uninsured with Prostate Cancer: A Comparison of Four Policy Alternatives in California. J Community Health. Nov 13 2009.

 

4.         Bergman J, Logan S, Fink A, Ganz D, Peterson M, Litwin M. Caring for the Uninsured with Prostate Cancer: A Comparison of Four Policy Alternatives in California. Journal of Community Health. 2010;35(1):18-26.

 

5.         Bergman J, Fink A, Kwan L, Maliski S, Litwin MS. Spirituality and end-of-life care in disadvantaged men dying of prostate cancer. World J Urol. Feb 2011;29(1):43-49.

 

6.         Miller D, Gelberg L, Kwan L, et al. Racial Disparities in Access to Care for Men in a Public Assistance Program for Prostate Cancer. Journal of Community Health. 2008/10/01/ 2008;33(5):318-335.

 

7.         Heckman JE, Chamie K, Maliski SL, et al. The Role of Self-Efficacy in Quality of Life for Disadvantaged Men With Prostate Cancer. The Journal of Urology. 2011;186(5):1855-1861.

 

8.         Deibert CM, Maliski S, Kwan L, Fink A, Connor SE, Litwin MS. Prostate Cancer Knowledge Among Low Income Minority Men. The Journal of Urology. 2007/5 2007;177(5):1851-1855.

 

9.         Mary Wassel Zavala SLM, Lorna Kwan, Arlene Fink, Mark S. Litwin,. Spirituality and quality of life in low-income men with metastatic prostate cancer. Psycho-Oncology. 2008;9999(9999):n/a.

 

10.       Zavala MW, Maliski SL, Kwan L, Fink A, Litwin MS. Spirituality and quality of life in low-income men with metastatic prostate cancer. Psychooncology. Jul 2009;18(7):753-761.

 

11.       Chamie K, Connor SE, Maliski SL, Fink A, Kwan L, Litwin MS. Prostate cancer survivorship: Lessons from caring for the uninsured. Urologic Oncology: Seminars and Original Investigations. 2012(0).

 

12.       Augustus JS, Kwan L, Fink A, Connor SE, Maliski SL, Litwin MS. Education as a predictor of quality of life outcomes among disadvantaged men. Prostate Cancer Prostatic Dis. 2009;12(3):253-258.

 

13.       McGory ML, Kao KK, Shekelle PG, et al. Developing quality indicators for elderly surgical patients. Ann Surg. Aug 2009;250(2):338-347.

 

14.       Eisen C, Shaner R, Unutzer J, Fink A, Wells KB. Datapoints: second-generation antipsychotic medication combinations for schizophrenia. Psychiatr Serv. Mar 2008;59(3):235.

 

15.       Gregory KD, Korst LM, Fridman M, et al. Vaginal birth after cesarean: clinical risk factors associated with adverse outcome. American Journal of Obstetrics and Gynecology. 2008/4 2008;198(4):452.e451-452.e412.

 

16.       Lecallier D, Fink A. Un questionniare de reperage du risque alcool adapte au senior. Alcoologie et Addictologie. 2009;31:225-234.

 

17.       Bright S, Singh D, Fink A. International use of screening tools that measure 'standard drinks': whose standard? Addiction. May 2011;106(5):1022-1023.

 

18.       Wilson SR, Fink A, Verghese S, Beck JC, Nguyen K, Lavori P. Adding an Alcohol-Related Risk Score to an Existing Categorical Risk Classification for Older Adults: Sensitivity to Group Differences. Journal of the American Geriatrics Society. 2007;55(3):445-450.

 

19.       Korst LM, Signer JMK, Aydin CE, Fink A. Identifying Organizational Capacities and Incentives for Clinical Data-sharing: The Case of a Regional Perinatal Information System

 

10.1197/jamia.M2475. J Am Med Inform Assoc. March 1, 2008 2008;15(2):195-197.

 

20.       Korst LM, Aydin CE, Signer JM, Fink A. Hospital readiness for health information exchange: Development of metrics associated with successful collaboration for quality improvement. Int J Med Inform. Feb 15 2011.

 

21.       Shander A, Fink A, Javidroozi M, et al. Appropriateness of Allogeneic Red Blood Cell Transfusion: The International Consensus Conference on Transfusion Outcomes. Transfus Med Rev. Apr 15 2011.

 

22.       Young S, Fink A, Geiger S, Marbella A, Mast AE, Schellhase KG. Community blood donors' knowledge of anemia and design of a literacy-appropriate educational intervention. Transfusion. Jan 2010;50(1):75-79.

 

23.       Delaney M, Schellhase KG, Young S, Geiger S, Fink A, Mast AE. Blood center practice and education for blood donors with anemia. Transfusion. 2010:no-no.

Education: 
PhD, University of California, Los Angeles
MA, Columbia University
Selected Publications: 

1.            Wilson SR, Knowles SB, Huang Q, Fink A. The prevalence of harmful and hazardous alcohol consumption in U.S. older adults: Data from the 2005-2008 National Health and Nutrition Examination Survey (NHANES)

Journal of General Internal Medicine. 2013;In press.

2.            Fink A, Beck JC. Developing and Evaluating a Website to Guide Older Adults in Their Health Information Searches: A Mixed-Methods Approach Journal of Applied Gerontology. 2013.

3.            Fink A, Parhami I, Rosenthal RJ, Campos MD, Siani A, Fong TW. How transparent is behavioral intervention research on pathological gambling and other gambling-related disorders? A systematic literature review. Addiction. 2012;107(11):1915-1928.

4.            Fink A. Your Health Online:  Guiding eSearches. 2012; How to evaluate the quality of online health information. Available at: http://www.ehealthsearch.info. Accessed May, 2012, 2012.

5.            Fink A. Evidence-Based Public Health Practice. Thousand Oaks, CA, London, UK New Delhi, India: Sage; 2012.

6.            Fink A. How to Conduct Surveys. 5th ed. Thousand Oaks, London, New Delhi: Sage; 2012.

7.            Chamie K, Connor SE, Maliski SL, Fink A, Kwan L, Litwin MS. Prostate cancer survivorship: lessons from caring for the uninsured. Urol Oncol. Jan 2012;30(1):102-108.

8.            Shander A, Fink A, Javidroozi M, et al. Appropriateness of Allogeneic Red Blood Cell Transfusion: The International Consensus Conference on Transfusion Outcomes. Transfus Med Rev. Apr 15 2011.

9.            Parhami I, Campos MD, Fink A, Fong T. TRANSPARENT REPORTING OF GAMBLING EFFECTIVENESS STUDIES. J. Invest. Med. Jan 2011;59(1):114-114.

10.         Korst LM, Aydin CE, Signer JMK, Fink A. Hospital readiness for health information exchange: Development of metrics associated with successful collaboration for quality improvement. International Journal of Medical Informatics. 2011;80(8):e178-e188.

11.         Heckman JE, Chamie K, Maliski SL, et al. The Role of Self-Efficacy in Quality of Life for Disadvantaged Men With Prostate Cancer. The Journal of Urology. 2011;186(5):1855-1861.

12.         Fink A. Wise and Healthy Drinking:  The Aclohol-Related Problems Survey. 2011; An alcohol screening survey and education for older adults. Available at: http://wisedrinking.org. Accessed May, 2012, 2011.

13.         Bright S, Singh D, Fink A. International use of screening tools that measure 'standard drinks': whose standard? Addiction. May 2011;106(5):1022-1023.

14.         Bergman J, Fink A, Kwan L, Maliski S, Litwin MS. Spirituality and end-of-life care in disadvantaged men dying of prostate cancer. World J Urol. Feb 2011;29(1):43-49.

15.         Young S, Fink A, Geiger S, Marbella A, Mast AE, Schellhase KG. Community blood donors' knowledge of anemia and design of a literacy-appropriate educational intervention. Transfusion. Jan 2010;50(1):75-79.

16.         Fink A. Conducting Research Literature Reviews:  From the Internet to Paper. 3rd ed. Thousand Oaks, New Delhi, London: Sage; 2010.

17.         Delaney M, Schellhase KG, Young S, Geiger S, Fink A, Mast AE. Blood center practice and education for blood donors with anemia. Transfusion. 2010:no-no.

18.         Bergman J, Logan S, Fink A, Ganz D, Peterson M, Litwin M. Caring for the Uninsured with Prostate Cancer: A Comparison of Four Policy Alternatives in California. Journal of Community Health. 2010;35(1):18-26.

19.         Zavala MW, Maliski SL, Kwan L, Fink A, Litwin MS. Spirituality and quality of life in low-income men with metastatic prostate cancer. Psychooncology. Jul 2009;18(7):753-761.

20.         McGory ML, Kao KK, Shekelle PG, et al. Developing quality indicators for elderly surgical patients. Ann Surg. Aug 2009;250(2):338-347.

21.         Lecallier D, Fink A. Un questionniare de reperage du risque alcool adapte au senior. Alcoologie et Addictologie. 2009;31:225-234.

22.         Bergman J, Logan S, Fink A, Ganz DA, Peterson MA, Litwin MS. Caring for the Uninsured with Prostate Cancer: A Comparison of Four Policy Alternatives in California. J Community Health. Nov 13 2009.

23.         Bergman J, Kwan L, Fink A, Connor SE, Litwin MS. Hospice and emergency room use by disadvantaged men dying of prostate cancer. J Urol. May 2009;181(5):2084-2089.

24.         Augustus JS, Kwan L, Fink A, Connor SE, Maliski SL, Litwin MS. Education as a predictor of quality of life outcomes among disadvantaged men. Prostate Cancer Prostatic Dis. 2009;12(3):253-258.

25.         Miller D, Gelberg L, Kwan L, et al. Racial Disparities in Access to Care for Men in a Public Assistance Program for Prostate Cancer. Journal of Community Health. 2008/10/01/ 2008;33(5):318-335.

26.         Mary Wassel Zavala SLM, Lorna Kwan, Arlene Fink, Mark S. Litwin,. Spirituality and quality of life in low-income men with metastatic prostate cancer. Psycho-Oncology. 2008;9999(9999):n/a.

27.         Korst LM, Signer JMK, Aydin CE, Fink A. Identifying Organizational Capacities and Incentives for Clinical Data-sharing: The Case of a Regional Perinatal Information System

10.1197/jamia.M2475. J Am Med Inform Assoc. March 1, 2008 2008;15(2):195-197.

28.         Gregory KD, Korst LM, Fridman M, et al. Vaginal birth after cesarean: clinical risk factors associated with adverse outcome. American Journal of Obstetrics and Gynecology. 2008/4 2008;198(4):452.e451-452.e412.

29.         Eisen C, Shaner R, Unutzer J, Fink A, Wells KB. Datapoints: second-generation antipsychotic medication combinations for schizophrenia. Psychiatr Serv. Mar 2008;59(3):235.

30.         Wilson SR, Fink A, Verghese S, Beck JC, Nguyen K, Lavori P. Adding an Alcohol-Related Risk Score to an Existing Categorical Risk Classification for Older Adults: Sensitivity to Group Differences. Journal of the American Geriatrics Society. 2007;55(3):445-450.

31.         Fink A. Practicing Research:  Discovering Evidence that Matters. Thousand Oaks, New Delhi, London: Sage Publications; 2007.

32.         Deibert CM, Maliski S, Kwan L, Fink A, Connor SE, Litwin MS. Prostate Cancer Knowledge Among Low Income Minority Men. The Journal of Urology. 2007/5 2007;177(5):1851-1855.

33.         Anger JT, Maliski SL, Krupski TL, et al. Outcomes in men denied access to a California public assistance program for prostate cancer. Public Health Rep. Mar-Apr 2007;122(2):217-223.

34.         Maliski SL, Connor S, Fink A, Litwin MS. Information desired and acquired by men with prostate cancer: data from ethnic focus groups. Health Educ Behav. Jun 2006;33(3):393-409.

35.         Tang L, Song J, Belin TR, Unützer J. A comparison of imputation methods in a longitudinal randomized clinical trial. Statistics in Medicine. 2005;24(14):2111-2128.

36.         McGory ML, Shekelle PG, Rubenstein LZ, Fink A, Ko CY. Developing quality indicators for elderly patients undergoing abdominal operations. J Am Coll Surg. Dec 2005;201(6):870-883.

37.         Krupski TL, Sonn G, Kwan L, Maliski S, Fink A, Litwin MS. Ethnic variation in health-related quality of life among low-income men with prostate cancer. Ethn Dis. Summer 2005;15(3):461-468.

38.         Krupski TL, Kwan L, Fink A, Sonn GA, Maliski S, Litwin MS. Spirituality influences health related quality of life in men with prostate cancer. Psychooncology. May 3 2005.

39.         Krupski TL, Fink A, Kwan L, et al. Health-related quality-of-life in low-income, uninsured men with prostate cancer. J Health Care Poor Underserved. May 2005;16(2):375-390.

40.         Gore JL, Krupski T, Kwan L, Fink A, Litwin MS. Mental health of low income uninsured men with prostate cancer. J Urol. Apr 2005;173(4):1323-1326.

41.         Fink A, Elliott MN, Tsai M, Beck JC. An evaluation of an intervention to assist primary care physicians in screening and educating older patients who use alcohol. J Am Geriatr Soc. Nov 2005;53(11):1937-1943.

42.         Fink A, Beck JC. The problem drinking pain paradox. Addiction. Jun 2005;100(6):731-732.

43.         Fink A. Epidemiological Field Work in Population-Based Studies

Handbook of Epidemiology. In: Ahrens W, Pigeot I, eds: Springer Berlin Heidelberg; 2005:399-436.

44.         Fink A. Evaluation Fundamentals:  Insights into the Outcomes, Effectiveness and Quality of Health Programs. 2nd ed. Thousand Oaks, New Delhi, London: Sage; 2005.

45.         Bolton LB, Shihady IR, Bennett C, et al. Engaging Nurse Leaders in Health Services Research. J Nurs Adm. May 2005;35(5):238-243.

46.         Weintraub D, Maliski SL, Fink A, Choe S, Litwin MS. Suitability of prostate cancer education materials: applying a standardized assessment tool to currently available materials. Patient Educ Couns. Nov 2004;55(2):275-280.

47.         Maliski SL, Kwan L, Krupski T, Fink A, Orecklin JR, Litwin MS. Confidence in the ability to communicate with physicians among low-income patients with prostate cancer. Urology. Aug 2004;64(2):329-334.

48.         Fink A. The Alcohol-related Problems Survey: Developing and Testing a Screening Measure for Older Adults

Comprehensive Handbook of Alcohol Related Pathology. In: Preedy VR, Watson RR, eds. Oxford: Academic Press; 2004:1403-1414.

49.         Fink A, ed The Survey Kit. 2nd ed. Thousand Oaks, London, New Delhi: Sage; 2004. Fink A, ed.

50.         Stein BD, Jaycox LH, Kataoka SH, et al. A mental health intervention for schoolchildren exposed to violence: a randomized controlled trial. Jama. Aug 6 2003;290(5):603-611.

51.         Roeloffs C, Sherbourne C, Unützer J, Fink A, Tang L, Wells KB. Stigma and depression among primary care patients. General hospital psychiatry. 2003;25(5):311-315.

52.         Roeloffs C, Sherbourne C, Unutzer J, Fink A, Tang L, Wells KB. Stigma and depression among primary care patients. Gen Hosp Psychiatry. Sep-Oct 2003;25(5):311-315.

53.         Moore AA, Endo JO, Carter MK. Is there a relationship between excessive drinking and functional impairment in older persons? J Am Geriatr Soc. Jan 2003;51(1):44-49.

54.         Lambe S, Washington DL, Fink A, et al. Waiting times in California's emergency departments. Ann Emerg Med. Jan 2003;41(1):35-44.

55.         Kataoka SH, Stein BD, Jaycox LH, et al. A school-based mental health program for traumatized Latino immigrant children. J Am Acad Child Adolesc Psychiatry. Mar 2003;42(3):311-318.

56.         Chaudhry S, Fink A, Gerlberg L, H.. BR. Utilization of Papanicolaou Smears by South Asian Women Living in the United States. J Gen Intern Med. 2003;18(5):377-384.

57.         Stein BD, Kataoka S, Jaycox LH, et al. Theoretical basis and program design of a school-based mental health intervention for traumatized immigrant children: a collaborative research partnership. J Behav Health Serv Res. Aug 2002;29(3):318-326.

58.         Moore AA, Beck JC, Babor TF, Hays RD, Reuben DB. Beyond alcoholism: identifying older, at-risk drinkers in primary care. J Stud Alcohol. May 2002;63(3):316-324.

59.         Lambe S, Washington DL, Fink A, et al. Trends in the use and capacity of California's emergency departments, 1990-1999. Ann Emerg Med. Apr 2002;39(4):389-396.

60.         Ko CY, Sack J, Chang JT, Fink A. Reporting randomized, controlled trials: where quality of reporting may be improved. Dis Colon Rectum. Apr 2002;45(4):443-447.

61.         Jaycox LH, Stein BD, Kataoka SH, et al. Violence Exposure, Posttraumatic Stress Disorder, and Depressive Symptoms Among Recent Immigrant Schoolchildren. Journal of the American Academy of Child & Adolescent Psychiatry. 2002;41(9):1104-1110.

62.         Jaycox LH, Stein BD, Kataoka SH, et al. Violence exposure, posttraumatic stress disorder, and depressive symptoms among recent immigrant schoolchildren. J Am Acad Child Adolesc Psychiatry. Sep 2002;41(9):1104-1110.

63.         Fink A, Tsai MC, Hays RD, et al. Comparing the alcohol-related problems survey (ARPS) to traditional alcohol screening measures in elderly outpatients. Archives of Gerontology and Geriatrics. 2002/2 2002;34(1):55-78.

64.         Fink A, Morton SC, Beck JC, et al. The alcohol-related problems survey: identifying hazardous and harmful drinking in older primary care patients. J Am Geriatr Soc. Oct 2002;50(10):1717-1722.

65.         Diamant AL, Brook RH, Fink A, Gelberg L. Use of preventive services in a population of very low-income women. J Health Care Poor U. May 2002;13(2):151-163.

66.         Roeloffs CA, Fink A, Unutzer J, Tang L, Wells KB. Problematic substance use, depressive symptoms, and gender in primary care. Psychiatr Serv. Sep 2001;52(9):1251-1253.

67.         Oishi SM, Morton SC, Moore AA, et al. Using data to enhance the expert panel process. Rating indications of alcohol-related problems in older adults. Int J Technol Assess Health Care. Winter 2001;17(1):125-136.

68.         Nguyen K, Fink A, Beck JC, Higa J. Feasibility of using an alcohol-screening and health education system with older primary care patients. J Am Board Fam Pract. Jan-Feb 2001;14(1):7-15.

69.         Molitor F, Kravitz RL, To YY, Fink A. Methods in survey research: Evidence for the reliability of group administration vs personal interviews. Am. J. Public Health. May 2001;91(5):826-827.

70.         Fink A, Beck JC, Wittrock MC. Informing older adults about non-hazardous, hazardous, and harmful alcohol use. Patient Educ Couns. Nov 2001;45(2):133-141.

71.         Diamant AL, Brook RH, Fink A, Gelberg L. Assessing use of primary health care services by very low-income adults in a managed care program. Arch Intern Med. May 14 2001;161(9):1222-1227.

72.         Washington DL, Stevens CD, Shekelle PG, Baker DW, Fink A, Brook RH. Safely directing patients to appropriate levels of care: guideline-driven triage in the emergency service. Ann Emerg Med. Jul 2000;36(1):15-22.

73.         Sugerman S, Halfon N, Fink A. Family planning clinic patients: Their usual health care providers, insurance status, and implications for managed care. J. Adolesc. Health. Jul 2000;27(1):25-33.

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