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Dr. Shalini Navale is a research development scientist at OCHIN. She is a health behavioralist and epidemiologist with a background in public health. She has a PhD in health behavior from Indiana University and an MPH in epidemiology from Eastern Virginia Medical School. Shalini’s research focuses on understanding health disparities and behaviors among underserved and high-risk populations across the world. Her area of specialty focuses more specifically on maternal and child health, reproductive and sexual health, infectious disease, youth substance use, and global health. At OCHIN, Shalini collaborates with investigators to craft scientifically rigorous and meticulously designed research proposals aimed at enhancing health equity, expanding health care access, and ameliorating health outcomes among underserved populations. She has taught at several universities, at the undergraduate and graduate level, with a focus on human sexuality, multicultural health, infectious disease, global public health and grant writing.
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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