Jennifer Elston Lafata
Professor and Executive Vice Chair, Division of Pharmaceutical Outcomes and Policy
Adjunct Professor, Health Policy and Management
Kerr Hall, , CB# 7573, Chapel Hill, NC, 27599, , Kerr Hall, , , Chapel Hill, NC, 27599
Dr. Lafata’s research seeks to improve cancer care quality via improved decision-making and patient-clinician communication. Her current research focuses on understanding the care quality and communication implications of virtual visits in oncology care, developing measures of shared decision making for use in cancer screening and treatment, and enhancing decision support for oncology navigation programs. She has extensive experience conducting practice-integrated research and working with delivery organizations to develop, implement and evaluate interventions designed to improve cancer and other care delivery. Her research has been supported by NIH, AHRQ, PCORI, RWJ and industry.
Before coming to UNC, Dr. Lafata was on faculty in the School of Medicine at Virginia Commonwealth University where she served as co-leader for the Cancer Prevention and Control Program at the NCI Designated Massey Cancer Center. Prior to that she was with Henry Ford Health in Detroit Michigan where she was a practice-embedded health services researcher. While there she served in leadership roles for 10 years, including serving as director of the Center for Health Services Research and chairperson for the HMO Research Network Governing Board (now Health Care System Research Network).
She enjoys mentoring students and trainees and has served as co-leader for the NCI-sponsored Cancer Research Network’s Scholar Program, a 26-month intensive training program designed to facilitate practice-integrated research among early-stage scientists.
In addition to her faculty roles, she currently serves as an Associate Director in the UNC Institute for Healthcare Quality Improvement, and co-lead of the UNC Cancer Care Quality Initiative. In these roles, she works closely with members of UNC Health to coach and support quality improvement initiatives and the development of infrastructure for an Oncology Care Population Management System. The latter includes developing EHR-integrated risk stratification and monitoring systems for patients receiving chemotherapy.
Dr. Lafata is a graduate of the University of North Carolina at Chapel Hill and the University of Michigan in Ann Arbor. She received her doctorate in health services management and policy from the School of Public Health at the University of Michigan in Ann Arbor.
Much of my current research is directed at understanding how the engagement of patients during office visits can facilitate patient adherence and outcomes. For example, my research has been instrumental in documenting shortcomings in primary care office-based colorectal cancer screening conversations and to our understanding of the relationship between the content of these conversations and patients’ use of recommended screening services. Using data from office visit audio-recordings joined with data from patient surveys and the electronic health record, I have shown how these office-based conversations fall short of what is recommended for shared decision making, how patients rarely ask questions of physicians to fill their informational needs, and how the effectiveness of physician recommendations for colorectal cancer screening can be enhanced with the use of the “5As” approach to preventive health service counseling. Papers stemming from this research have highlighted specific opportunities to improve office-based counseling, identify patients at risk for not receiving evidence-based care recommendations, and offer clinicians practical steps for improving adherence to recommended cancer screening and other services.
- Shay LA*, Lafata JE. Understanding patient perceptions of shared decision making. Patient Education and Counseling, 2014 Sep; 96(3):295-301. [PMID: 25097150]
- Lafata JE, Cooper G, Divine G, Flocke S, Oja-Tebbe N. Patient-Physician Colorectal Cancer Screening Discussions and Patient’s Use of Colorectal Cancer Screening, Patient Education and Counseling, 2014 Jan; 94(7):76-82. [PMID: 24094919]
- Lafata JE, Morris HL*, Dobie E, Heisler M, Werner RM, Dumenci L. Patient-Reported Collaborative Goal Setting and Change in Glycemic Control among Patients with Diabetes, Patient Education and Counseling 2013 Feb 19. [PMID: 23433777]
- Flocke SA, Stange KC, Cooper GS, Wunderlich T*, Oja-Tebbe N, Divine G, Lafata JE. Patient-rated importance and receipt of information for colorectal cancer screening. Cancer Epidem Biomar, 2011 Aug 3; 20(10): 2168-73. [PMID 21813727]
My research has also used health system data to identify gaps in cancer care quality. My 2001 publication in Medical Care was among the first to describe shortfalls in the quality of surveillance care received by colorectal cancer survivors. That paper identified socio-demographic disparities in surveillance care receipt. Other early research in this area has described the use of imaging among prostate cancer patients, illustrated the utility and challenges of using medical care claims data to document the use and effectiveness of routine surveillance care among cancer survivors. Since then, my research has continually identified both under- and over-use of surveillance care among cancer survivors as well as the multi-level factors associated with observed use patterns.
- Salloum RG, M O’Keeffe-Rosetti, DP Ritzwoller, MC Hornbrook, J Elston Lafata, ME Nielsen. Use of Evidence-based Prostate Cancer Imaging in a Non-Governmental Integrated Healthcare System, J Oncol Pract. 2017 May; 13 (5):e441-e450. [PMID 28221895]
- Dyer K*, L Dumenci, LA Siminoff, M Thomson, J Elston Lafata. The Contribution of body mas index to delay in diagnosis of colorectal cancer. British Journal of Cancer, May 2017; 1-5. 2017 Jun 6; 116(12):1638-1642. [PMID 28463963]
- Salloum RG*, Hornbrook MC, Fishman PA, Ritzwoller DP, O’Keefe Rossetti MC, Elston Lafata J. Adherence to Surveillance Care Guidelines after Breast and Colorectal Cancer Treatment with Curative Intent. Cancer 2012 Mar 20. [PMID: 22434568]
- Elston Lafata J, Johnson CC, Ben-Menachem T, Morlock RJ*. Sociodemographic differences in the receipt of colorectal cancer surveillance care following treatment with curative intent. Med Care. 2001 Apr; 39(4):361-72. [PMID 11329523]
The quality of pharmaceutical care has been a particular area of interest of mine within care quality. My research in this area has shown the validity of pharmacy claims-based measures of medication adherence, ongoing challenges in medication adherence and routine monitoring among chronically ill patient populations as well as highlighted potential medication safety challenges specific to the use of contra-indicated medications among the elderly, potentially harmful co-prescribing of medications, and safety practices to monitor biological responses to medication use. My research has highlighted the inability of differences in medication adherence to explain observed differences between African American and White patients in the attainment of cardiometabolic risk factor control and improvement.
- Chou Y*, Farley JF, Stinchcombe TE, Proctor AE, Elston Lafata J, Dusetzina S. Delays in Orally-administered Anticancer Treatment Initiation for Medicare Beneficiaries. J Natl Cancer Inst 2019 Sept 10 [Epub ahead of print]
- Elston Lafata J, Cerghet M*, Dobie E, Schultz L, Tunceli K, Reuther J, Elias S. Measuring adherence and persistence to disease modifying agents among patients with relapsing remitting multiple sclerosis. Journal Am Pharm Assoc. 2008 Nov-Dec;48(6):752-7. [PMID: 19019804]
- Elston Lafata J, Gunter MJ, Hsu J, Kaatz S, Krajenta R, Platt R, Schultz L, Selby JV, Simon SR, Simpkins J, Soumerai SB, Uratsu C. Academic detailing to improve laboratory testing among outpatient medication users. Med Care. 2007 Oct;45(10):966-972. [PMID: 17890994]
- Raebel MA, McClure DL, Simon SR, Chan KA, Feldstein A, Andrade SE, Lafata JE, Roblin D, Davis RL. Gunter MJ, Platt R. Laboratory monitoring of potassium and creatinine in ambulatory patients receiving angiotensin converting enzyme inhibitors and angiotensin receptor blockers. Pharmacoepidemiol Drug Saf. 2007 Jan;16(1):55-64. [PMID: 16470693]
My research has always been motivated by the desire to improve the experience and outcomes of health care for all patients. The desire to have my research make a difference in the delivery of care led me to the Henry Ford Health System upon completion of my doctoral training. There, I participated in and published results from both extramural research as well as internally supported quality improvement efforts. My early research spanned the spectrum from documenting gaps in the translation of evidence-based care, to understanding the root causes of these gaps, to developing and evaluating programs to overcome them. Much of this research was in the area of diabetes care management. That research helped to understand the impact of one of the first automated Diabetes Care Registries in the country. With the registry in place, I then used its infrastructure to highlight areas for diabetes quality improvement, and for the design and implementation of population-based interventions. The latter included electronic medical record prompts for clinician teams and mailed reminders to patients—both of which were designed with extensive input from clinical teams. Subsequent research focused on identifying patients at risk of poor medication adherence as well as the factors associated with delays in indicated medication intensifications, and the impact both of these had on the achievement of clinical control among patients with diabetes. My research has also illustrated the persistence of racial disparities in outcomes among patients with diabetes, despite a context of generally increasing care quality.
- Hagiwara N, Lafata JE, Mezuk B, Vrana S, Fetters M. Detecting implicit racial bias in provider communication behaviors to reduce disparities: Challenges, solutions and future directions for novel coding systems, Patient Education and Counciling, in press.
- Schmittdiel JA, Raebel MA, Dyer W, Xu S, Goodrich GK, Schroeder EB, Segal JB, O’Connor PJ, Nichols GA, Lawrence JM, Kirchner HL, Karter AJ, Lafata JE, Butler MG, Steiner JF. Prescription medication burden in patients with newly diagnosed diabetes: A SUrveillance, PREvention, and ManagEment of Diabetes Mellitus (SUPREME-DM) study. J Am Pharm Assoc. 2014 Jul-Aug;54(4):374-82. [PMID: 24860866]
- Lafata, JE. Karter A, O’Connor P, Morris H*, Schmittdiel JA, Ratliff S, Newton KM, Raebel MA, Pathak RD, Thomas A, Butler MG, Reynolds K, Waitzfelder B, Steiner JF. Medication Adherence Does Not Explain Black-White Differences in Cardiometabolic Risk Factor Control among Insured patients with Diabetes, Journal of General Internal Medicine, J Gen Intern Med. 2015 Aug 18. [PMID: 26282954]
- Baker A, Elston Lafata J, Ward RE, Whitehouse F, Divine G. A web-based diabetes care management support system. Jt Comm J Qual Improv. 2001 Apr;27(4):179-90. [PMID: 11293835]
I have also conducted research to identify opportunities to improve the quality of care delivered in both primary care and oncology care, and to understand the multi-level factors associated with care quality. To this end, my research has identified patients at risk of not receiving a physician recommendation for evidence-based screening services as well as documented both the intended and unintended consequences of commonly used primary care office based tools, such as electronic health records and patient initiated question lists on patient-physician communication, the delivery of routine preventive health services, and office visit length. I have also participated on NIH-funded projects to develop and evaluate patient- and provider-targeted interventions to improve care quality, including medication adherence. These efforts have documented the benefits and costs of patient-targeted telephone reminders, tailored print newsletters, and other reminders as well as physician targeted electronic health record prompts and other interventions.
- Lafata JE, Shay LA, Brown R, Street R. Primary Care Office-based Tools and Patient-Physician Communication Behaviors, Visit Length, and the Delivery of Preventive Health Services, Health Services Research, 2016 Apr;51(2):728-45. doi: 10.1111/1475-6773.12348. Epub 2015 Aug 7.
- Mosen DM, Feldstein AC, Perrin N, Rosales AG, Smith DH, Liles EG, Schneider JL, Lafata JE, Myers RE, Kositch M, Hickey T, Glasgow RE. Automated telephone calls improved completion of fecal occult blood testing. Med Care. 2010. Jul; 48(7):604-610. [PMID: 20508529]
- Lafata JE, Kolk D, Peterson EL, McCarthy BD, Weiss TW, Chen YT, Muma BK. Improving osteoporosis screening: results from a randomized cluster trial. J Gen Intern Med. 2007 Mar;22(3):346-51. [PMID: 17356966]
- Lafata JE, Baker A, Divine G, McCarthy B, Xi H. The use of computerized birthday greeting reminders in the management of diabetes. J Gen Intern Med. 2002 Jul;17(7):521-30. Cited in: PubMed; [PMID 12133142]
Ongoing Research Support
Development of a Shared Decision-making Support (SDM-S) Measure for Use with Team-based Care
R01HS028455-01[ELJ1] 2020 – 2023
Identifying Opportunities to Pursue Equity When Implementing Virtual Visits in Oncology Care
2021 – 2023
PI ($750 K).
Prioritizing Health Care Organization Characteristics to Inform Cancer Care Decision Making and Theory-based Research
2020 – 2021 (NCE)
NCI Contract/IPA Agreement
Unveiling the role of physician implicit bias and communication behaviors in dissatisfaction, mistrust, and non-adherence in Black patients with Type 2 diabetes
The purpose of this project is to determine how provider implicit racial bias presents during diabetes-related office visits, and how implicit racial bias affects care quality and patient outcomes.
NCI UM1CA221939-01 12/1/2017-11/30/2022
(PI: Ritzwoller/Doubeni); Role: Consortium PI
Center for Research to Optimize Precision Lung Cancer Screening in Diverse Populations
This study will determine the process-gaps, cost, and disparities in lung cancer screening at five health systems. In Years 3-5, an intervention will address at least one issue in the lung cancer screening continuum.
1UG3CA233251 9/30/2018 – 8/31/2023
(PI: Reuland); Role: Advisor
Scaling Colorectal Cancer Screening Through Outreach, Referral, and Engagement (SCORE): A State-Level Program to Reduce Colorectal Cancer Burden in Vulnerable Populations
The proposed project is relevant to public health because an effective strategy for improving colorectal cancer screening rates will lead to the prevention or earl detection of thousands of colorectal cancer cases annually among minority, low-income, and uninsured patients. Thus, the proposed research is relevant to the part of the NCI’s mission to conduct and fund research that improves early detection and diagnosis and reduces cancer disparities.
1R01CA222090 9/25/2018 – 8/31/2023
Memorial Sloan Kettering Cancer Center
(PI: Carter-Harris); Role: Consortium PI
Using a Mixed Methods Approach to Understand Shared Decision-Making in Lung Cancer Screening
The proposed grant aims to identify the multi-level factors associated with smokers having a lung cancer screening conversation with their primary care providers and the key components of those conversations that lead to optimal decision outcomes from the patients’ and health care organizations’ perspectives. Dr. Lafata will provide expertise and experience in patient-physician decision making and communication in the context of cancer screening to the team.
ACADEMIC APPOINTMENT HISTORY
Professor, 2016- present (with Tenure), Division of Pharmaceutical Outcomes and Policy, UNC Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, NC.
Professor, 2009 – 2016 (with Tenure), Department of Health Behavior and Policy (Formerly, Department of Social and Behavioral Health), School of Medicine, Virginia Commonwealth University, Richmond, Virginia.
Adjunct Associate Research Scientist, 2002 – 2009, Health Management and Policy, School of Public Health, The University of Michigan, Ann Arbor, MI.
LEADERSHIP AND EMPLOYMENT HISTORY
Executive Vice Chair, 2017 – present, Division of Pharmaceutical Outcomes and Policy, UNC Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, NC.
Co-Lead, 2016 – present, UNC Health Cancer Care Quality Initiative. UNC Health and UNC Lineberger Comprehensive Cancer Center, Chapel Hill, NC.
Associate Director, 2016 – present, UNC Institute for Healthcare Quality Improvement. School of Medicine and UNC Health, Chapel Hill, NC.
Interim Chair, 2015- 2016, Department of Health Behavior and Policy, School of Medicine, Virginia Commonwealth University, Richmond, VA.
Co-Lead, 2010 – 2016, Cancer Prevention and Control Program, Massey Cancer Center. Virginia Commonwealth University, Richmond, VA.
Adjunct Senior Research Scientist, 2009 – present, Center for Health Policy and Health Services Research, Henry Ford Health System, Detroit, MI.
Senior Research Scientist, 2007 – 2009, Center for Health Services Research. Henry Ford Health System, Detroit, MI.
Director, 1997 – 2006, Center for Health Services Research. Henry Ford Health System, Detroit, MI.
Assistant Research Scientist, 1993 – 1997, Center for Clinical Effectiveness. Henry Ford Health System, Detroit, MI.
Research Associate, 1989 – 1993, Health Services Management and Policy, School of Public Health, The University of Michigan, Ann Arbor MI.
Research Associate, 1987 – 1989, Program on Aging, School of Public Health, The University of North Carolina, Chapel Hill, NC.
e-Assist: A Post-Visit Patient Portal Tool to Promote Colorectal Cancer Screening