History

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Established in 1969 as the Health Services Research and Development Center, the Center is one of the oldest in the United States devoted to research on health care. The founding Director was Malcolm Peterson. Sam Shapiro was recruited as Director in 1973. Donald Steinwachs was Director from 1982 until 2011, when Albert Wu assumed that role. Important work conducted at the Center has included:

• Studies of the use, outcomes and cost of health and mental health services for people with severe mental illnesses such as schizophrenia and major depression. One was the Epidemiological Catchment Area (ECA) survey, the first to examine the prevalence of mental disorders and use of mental health services. Another was the Center for Research on Services for Severe Mental Illness (SMI Center), led jointly with the University of Maryland. One of the projects undertaken by the SMI Center was the Schizophrenia Patient Outcomes Research Team (PORT). Later projects have tested a web-based program to empower patients with schizophrenia to discuss their care with their mental health providers, assessed cancer risk and injury risk and severity in Maryland residents with severe mental illness, and examined the impact of Medicare Part D for medication use and cost among dually eligible Maryland residents.

• The creation of the ACG System for case-mix categorization by Barbara Starfield, Jonathan Weiner and Donald Steinwachs. ACGs are now used worldwide for over 100 million patients in 17 countries for a wide range of purposes including population health research, care management, performance analysis and finance and budgeting.

• The Lipitz Center for Integrated Health Care, founded and directed by Chad Boult, which developed and evaluated the Guided Care program, a prime example of the Patient-Centered Medical Home. Karen Davis returned to Johns Hopkins and was named Director in 2013. The Lipitz Center strives to discover and disseminate practical, cost-effective approaches to providing comprehensive, coordinated, compassionate health care to chronically ill people and their families.

• Studies in gerontology, including the Hospital at Home Program, led by Bruce Leff, John Burton and Donald Steinwachs, which developed methods for managing some patients at home with clinical and social supports rather than in the hospital. The National Health and Aging Trends Study (NHATS), led by Judy Kasper, is an ongoing longitudinal population-based study of late-life functioning among Medicare beneficiaries aged 65 and over. An earlier study examined the likely effects of Medicare coverage for preventive health services on use of those services and cost, a benefit that has since been added to the Medicare program.

• Patient-reported outcomes assessment tools, including the Sickness Impact Profile developed by Marilyn Bergner, the MOS-HIV Health Survey, developed by Albert Wu, and the Child Health and Illness Profile (CHIP) developed by Barbara Starfield, Marilyn Bergner, Chris Forrest and Anne Riley.

• Asthma management and outcomes for adults and children. These were addressed in a series of studies conducted by Albert Wu, Donald Steinwachs, Greg Diette and Elizabeth Skinner, including quality of care and outcomes for adult asthmatics treatment by specialists and generalists in managed care organizations, and the development and testing of the Asthma Therapy Assessment Questionnaire for use with children.

• The Developing Evidence to Inform Decisions about Effectiveness (DEcIDE) Center for comparative effectiveness research, funded by the Agency for Healthcare Research and Quality in 2005, was led by Albert Wu, Jodi Segal and Eric Bass. DEcIDE investigators conducted more than a dozen funded studies that demonstrated the effectiveness of diabetes treatments including bariatric surgery, developed research methods for competing risks and heterogeneity of treatment effects, studied the timing of kidney dialysis, and evaluated the effectiveness of alternative employment services for persons with severe mental illness.

• The Johns Hopkins Evidence-Based Practice Center, Eric B. Bass MD, MPH, and Karen Robinson PhD, Directors. The Evidence-based Practice Center, established in 1997, is supported by the Effective Healthcare Program of the Agency for Healthcare Research and Quality (AHRQ). The mission of the Center is to conduct systematic reviews and meta-analyses on important topics in clinical medicine and public health. The Center also identifies future research needs in topic areas, and helps to develop enhanced systematic review methodologies. To date, the Center has published 76 reports, including systematic comparative effectiveness reviews, as well as reports on future research needs and methodologic issues. The Center’s projects have led to over 120 peer-reviewed journal articles, of which 8 have been cited more than 100 times in the medical literature.

• Patient safety. Albert Wu has conducted studies on the handling of adverse events and improving patient safety since 1990. Some of these projects have focused on disclosing adverse events to patients and their families, and supporting health care workers who are “second victims” of stressful patient related incidents. Additional projects conducted by Jill Marsteller, Sydney Dy and others have focused on developing and implementing safety reporting systems, developing indicators of quality and safety, and evaluating initiatives to reduce health care acquired infections.

Today CHSOR has 25 primary and 28 affiliated faculty from all JHU divisions who continue research in these areas, with an increasing focus on studies of the quality of care, shared decision making and patient-centered outcomes research. There are also 27 research staff and 6 administrative staff members.