Improving Health Outcomes Through Enhanced Patient-Provider Relationships

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Project Summary / Abstract This K23 career development award will support the training and career development of the Candidate to develop expertise in measuring and evaluating patient-provider relationships – the core of the healing arts – and their effects on health outcomes. While this relationship influences symptoms in many different conditions, we know little about the mechanisms underlying its effect or how to augment it. The rapid growth of complementary and integrative medicine (IM) may, in part, be due to a qualitative difference in patient-provider relationships compared to conventional medicine. Training in three critical areas will facilitate the Candidate’s transition to independence: 1) measurement and analysis of physiologic biomarkers of autonomic nervous system activity including galvanic skin response (GSR) and heart rate variability (HRV); 2) design, execution, and analysis of qualitative research with a focus on analysis of videos of patient-provider interactions; and 3) design and management of clinical trials and relevant biostatistical analyses. These training goals will be supported by 1) a stellar team of mentors and consultants – Maurizio Fava, MD (primary mentor), John Denninger, MD, PhD (co-mentor), and consultants Chin Hur, MD, MPH, Prof.Ted Kaptchuk, Eric Macklin, PhD, Vitaly Napadow, PhD, Elyse Park, PhD, MPH, and Cheng-Kang Peng, PhD; 2) a resource-rich institutional environment; 3) targeted advanced coursework, mentored laboratory experiences, and research seminars; and 4) the proposed research studies. Using gastroesophageal reflux disease (GERD) as a model system, the proposed studies will seek to 1) identify physiologic responses associated with GERD symptom improvement in enhanced patient-provider interactions, 2) use qualitative approaches to determine the visit characteristics associated with the identified physiologic responses, and 3) determine whether enhanced patient-provider interactions (similar to an IM provider visit) vs. empathic, conventional medical visits can augment the effect of omeprazole on GERD symptom improvement in a pilot randomized controlled trial. Results of the proposed studies will provide insights into the mechanisms underlying effective patient-provider relations, preliminary data for an R01 application, and will effectively lay the foundation for a career focused on studying patient- provider relations and their effects on health outcomes. While initial studies will focus on GERD, it is anticipated that the mechanisms identified will be broadly applicable to range of different health conditions and have implications for improving quality of care in the conventional medical setting and training of healthcare providers.