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Dr. Rachel Gold is the program director of the implementation science program at OCHIN. She is an epidemiologist and health services researcher. Her research asks how health information technology can reduce health disparities, and what implementation methods best support safety net clinics’ adoption of such technologies. Rachel has worked with OCHIN since 2005; she has a joint appointment at the Kaiser Permanente Center for Health Research.
Rachel’s past research includes studying the impact of an initiative targeting cardiovascular disease (CVD) and diabetes care in Kaiser Permanente for community clinics, and the comparative effectiveness of implementation strategies at supporting its adoption. She then studied the impact of an innovative point-of-care risk assessment tool on CVD outcomes in community clinics.
Rachel also developed and pilot-tested informatics tools for documenting and addressing patient-reported social drivers of health (social risks), then studied how to help community clinics adopt social risk screening and referral-making. She now studies how to use informatics tools to help minimize social risks’ impact on patients’ ability to follow care plans. She leads the laboratory of the Building Research in Implementation and Dissemination to close Gaps and achieve Equity in Cancer Control Center (BRIDGE-C2), which studies how to improve cancer preventive services in community clinics. She co-leads the Network for Community-Engaged Primary Care Research site involving OCHIN, which studies how to better engage safety net patients in studies of chronic disease management.
Rachel led the nation’s first pilot study of the feasibility of developing EHR-based approaches to collecting, reviewing, and acting on patient-reported social drivers of health data; her team’s EHR tools were activated in >400 community health centers (CHCs) around the nation in June 2016. She now leads the first study of how best to support implementation of SDH data collection and action in CHCs, and co-leads the first study on clinical decision support related to SDH needs. Her earlier research contributed understanding of how neighborhood environment affects various measures of health status and health disparities. Much of Rachel’s research focuses on disseminating HIT-based interventions in the safety net setting. For example, her work demonstrated that quality improvement strategies that involve clinical decision support, and are effective in private, integrated care settings, could feasibly be translated into safety net clinics. They also assessed methods for supporting uptake of such resources in the safety net. This has important implications for how safety net clinics can stay up-to-date on care guidelines, and on effective practices for implementing practice changes related to such guidelines. Another current study is assessing the impact of a personalized, prioritized point-of-care shared decision-making tool at addressing CVD risk factors in CHC patients. Rachel is an expert in D&I science; she attended the 2012 NIH/VA Training Institute for Dissemination and Implementation Research in Health (TIDIRH), and served on its core faculty in 2014-2017. Rachel serves/has served as principal investigator (PI) or co-investigator (co-I) on multiple studies testing the health impacts of clinical decision support (CDS) and shared decision-making (SDM) strategies in CHCs’ EHRs, targeting outcomes in diabetes and cardiovascular health in safety net patients. She serve(d) as co-I on studies testing CDS approaches to improve care management in perinatal depression and to improve CHCs’ ability to help keep eligible patients enrolled in public insurance, and on a study of CHC care teams’ information needs when serving socially/medically complex patients. As noted above, Rachel is the PI of a current study on the impact of a personalized, prioritized point-of-care shared decision-making tool on CVD risk factor management in CHC patients. These studies have contributed to the scientific knowledge of optimal approaches to using CDS and SDM tools to improve care quality and outcomes in primary care settings serving socioeconomically vulnerable patients. Rachel has led and co-led multiple studies that analyzed complex EHR data from safety net clinics, and this has been her work’s primary focus since 2006. Her work demonstrated how safety net clinics’ EHR data can be used in research, which has important implications because most past clinical and health services research used insurance claims data, which by definition excludes the uninsured. This research demonstrates how such data can be used in diverse research that includes uninsured and underinsured patients. Rachel has examined how health policy changes impact health outcomes for members of vulnerable populations. For example, her work demonstrated how two major health policy initiatives—the Affordable Care Act and the 2008 ‘Oregon Experiment’ in randomized Medicaid expansion—affected demand for services at safety net clinics, and patient care quality in these settings. This has important implications for future health policy development, national health care expenditures, and the health of our most vulnerable patients.
Social drivers of health/health disparities
Dissemination and implementation (D&I) in safety net clinics
Decision support and shared decision-making tools in community health centers
Methods for using safety net EHRs and EHR data
Health policy changes and vulnerable populations
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