Jennifer Elston Lafata

Professor Vice Department Chair Adjunct Professor

Jennifer Elston Lafata, Ph.D., is a professor in the Division of Pharmaceutical Outcomes and Policy at the UNC Eshelman School of Pharmacy at the University of North Carolina at Chapel Hill.

Lafata’s research centers on how the engagement of patients can facilitate the delivery and receipt of evidence-based preventive care, particularly in the context of cancer prevention and control. This research has been instrumental to our understanding of how to improve office-based colorectal cancer screening discussions and to the relationship between the content of these discussions and patients’ use of recommended screening services. She has participated in a number of NCI-funded practice-based trials evaluating interventions to improve colorectal cancer screening in primary care as well as those evaluating the appropriateness of using claims data to study the care delivered to cancer survivors. Through these and other efforts, she has extensive experience working with delivery organizations to develop, implement and evaluate interventions designed to improve cancer control and routine chronic care management.

Before coming to UNC, Lafata was a professor in the Department of Social and Behavioral Health in the School of Medicine at Virginia Commonwealth University and a co-leader of the Cancer Prevention and Control Program at the Massey Cancer Center. She served as co-leader of the National Cancer Institute–sponsored Cancer Research Network’s Scholar Program and held an appointment with the Center for Health Services Research and Health Policy at the Henry Ford Health System in Detroit, Michigan.

Prior to joining VCU, Lafata held a full-time appointment at the Henry Ford Health System where she served as acting director of the Center for Clinical Effectiveness (1997–1999), director of the Center for Health Services Research (1999–2005) and chairperson for the HMO Research Network Governing Board (2005–2006). While at the Henry Ford Health System she was responsible for leading the implementation of one of the first electronic-health-record-based diabetes care registries and other population management strategies.

Lafata’s research has always been motivated by the desire to improve the experience and outcomes of health care for patients. It was the desire to have her research make a difference in the delivery of care that led her to the Henry Ford Health System upon completion of her doctoral training. There, as a health system embedded researcher for 17 years, she participated in and published results from extramural research as well as internally supported quality improvement projects.

Lafata’s research has 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 design, implement and understand the impact of one of the first automated Diabetes Care Registries in the country. With the registry in place, she used its infrastructure to highlight further areas for diabetes quality improvement, and for the design and implementation of population-based interventions. The latter included electronic health 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.

Lafata’s research has also illustrated the persistence of racial disparities in outcomes among patients with diabetes, despite a context of generally increasing care quality. The quality of pharmaceutical care has been a particular area of interest within care quality. Her 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. Most recently this 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. She has used findings from these results to design and test care innovations within integrated delivery systems.

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 with a concentration in economics from the School of Public Health at the University of Michigan in Ann Arbor.

Much of Lafata’s current research is directed at understanding how the engagement of patients can facilitate the delivery and receipt of evidence-based preventive care, particularly in the context of cancer prevention and control. To this end, her research has centered on understanding how patient-physician communication and decision-making contribute to patients’ receipt of routine screening services. This research has highlighted opportunities for improvement in the delivery of colorectal cancer prevention, particularly in terms of the delivery of screening services among average risk primary care patient populations. Lafata’s 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 health care claims, she has 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 (over six of which included a trainee as either a co-author or first author) have highlighted specific opportunities to improve the colorectal cancer screening decision-making process, identify patients at risk for not receiving evidence-based preventive health services, and offer clinicians practical steps for improving adherence to recommended colorectal cancer screening among their patient population.

  • Shay LA*, Lafata JE. Understanding patient perceptions of shared decision making. Patient Education and Counseling, 2014 Sep;96(3):295-301. PMID:25097150.
  • El-Shahway O*, Shires DA, Elston Lafata J. Assessment of the Efficiency of Tobacco Cessation counseling in Primary Care, Evaluation and The Health Professions, 2015 Aug 18; :1-10. doi:1177/0163278715599204.
  • 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
  • Mosen DM, Feldstein AC, Perrin NA, Rosales AG, Smith DH, Liles EG, Schneider JL, Meyers RE, Elston-Lafata More comprehensive discussion of CRC screening associated with higher screening. Am J Manag Care. 2013 Apr;19(4):265-71.PMID:23725359

My research has always been motivated by the desire to improve the experience and outcomes of health care for patients. It was the desire to have my research make a difference in the delivery of care that led me to the Henry Ford Health System upon completion of my doctoral training. There, as a health system embedded researcher for 17 years, I participated in and published results from extramural research as well as internally supported quality improvement projects. My research has 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 design, implement and 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 further areas for diabetes quality improvement, and for the design and implementation of population-based interventions. The latter included electronic health 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.

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. Most recently this research has highlighted the inability of differences in medication adherence to explain observed differences between African American and White patients in the attainment of cariodmetabolic risk factor control and improvement. I have used findings from these results to design and test care innovations within integrated delivery systems.

  • 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
  • Saffar D, Williams LK, Elston Lafata J, Divine G, Pladevall M. Racial Disparities in Lipid Control in Patients with Diabetes, Am J Manag Care. Am J Manag Care. 2012 Jun;18(6):41-49.
  • Lafata JE, Dobie EA, Divine GW, Ulcickas Yood ME, McCarthy BD. Sustained hyperglycemia among patients with diabetes: what matters when action is needed? Diabetes Care. 2009 Aug; 32(8):1447-52. Cited in: PubMed; PMID 19638524.
  • 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.

In addition to a specific focus on diabetes care quality, Lafata has also conducted research to identify opportunities to improve the quality of care delivered in primary care more generally as well as to understand the multi-level factors associated with care quality. To this end, her 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. Lafata has also participated on NIH-funded projects to develop and evaluate patient- and provider-targeted interventions to improve primary care quality. These efforts have documented the benefits and costs of patient-targeted telephone reminders and 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.
  • Shires, DA*, Stange KC, Divine G, Ratliff S, Vashi R*, Tai-Seale M, Lafata JE. Prioritization of evidence-based preventive health services during periodic health examinations. Am J Prev Med, 2012 Feb;42(2):164-173. Cited in: PubMed; PMID 22261213.
  • 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. Cited in: PubMed; 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. Cited in: PubMed; PMID 17356966.

The quality of pharmaceutical care has been a particular area of interest of Lafata’s within care quality. Her 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. Most recently this research has highlighted the inability of differences in medication adherence to explain observed differences between African American and White patients in the attainment of cariodmetabolic risk factor control and improvement.

  • Lafata JE, Tunceli O, Cerghet M, Sharma KP*, Lipton RB. The use of migraine preventive medications among patients with and without migraine headaches.  Cephalalgia. 2010 Jan;30(1):97-104. Cited in: PubMed; PMID 19489877.
  • 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. Cited in: PubMed; 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. Cited in: PubMed; 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. Cited in: PubMed; PMID 16470693.

A final area of interest of Lafata’s has been the quality of care delivered to cancer survivors. Her 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 of Lafata’s in this area 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, her 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.

  • Lafata JE, Salloum RG, Fishman PA, Pearson Ritzwoller D, O’Keeffe-Rosetti MC, Hornbrook MC, Preventive Care Receipt and Office Visit Use among Breast and Colorectal Cancer Survivors Relative to Age- and Gender-matched Cancer Free Controls, Journal of Cancer Survivorship, 2014 Sept 25. PMID: 25252623.
  • 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. Cited in: PubMed; PMID 22434568.
  • Salz T*, Weinberger M, Ayanian JZ, Brewer NT, Earle CC, Elston Lafata J, Fisher DA, Weiner BJ, Sandler RS. Variation in the use of surveillance colonoscopy among colorectal cancer survivors in the United States. BMC Health Services Research. 2010 Sep 1; 10:256. Cited in: PubMed; PMID 20809966.
  • Cooper GS, Schultz L, Simpkins J, Lafata JE. The utility of administrative data for measuring adherence to cancer surveillance care guidelines. Med Care. 2007 Jan;45(1):66-72. Cited in: PubMed; PMID 17279022.

Ongoing Research Support

UM1 CA221939-01 Ritzwoller and Doubeni (Co-PIs)2/01/17-11/30/22 Center for Research to Optimize Precision Lung Cancer Screening (CPLS) 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.
Role: Co-Investigator

FP00005212_SA0010 Hagiwara (PI) 7/2017-06/2021
Unveiling the role of physician implicit bias and communication behaviors in dissatisfaction, mistrust, and non-adherence in Black patients with Type 2 diabetes
This study uses a mixed-methods design that integrates the strengths of inductive and deductive reasoning to identify physicians’ communication behaviors that are associated with physicians’ implicit racial bias and Black patients’ immediate (satisfaction, trust) as well as clinically important longer-term outcomes (adherence, healthcare utilization).
Role: Co-Investigator

1R01CA197205-01 Elston Lafata (PI) 08/01/15-07/31/20
e-Assist: A Post-Visit Patient Portal Tool to Promote Colorectal Cancer Screening
The goal of this project is to work in partnership with a learning health system to develop and evaluate a post physician office visit colorectal cancer screening decision support and assistance tool, e-Assist. The evaluation is designed to provide cross-cutting information on how and in what contexts e-Assist impacts patient’s colorectal cancer screening perceptions, screening intentions, and screening use as well as how to ensure that, if effective, the tool can be implemented in diverse clinic settings.
Role: PI

5U24CA171524-03 Kushi (PI) 03/01/15-08/31/18 
Cancer Research Resources & Collaboration in Integrated Health Care Systems
The CRN and Scholars Program aims to help investigators develop research projects using CRN resources to conduct population-based multi-site and multi-disciplinary studies that leverage the network’s strengths.
Role: Site PI and Co-Lead, CRN Scholars Program

RCA166375A Jones (PI) 03/01/15-02/28/18 
An Interactive Preventive Health Record to Increase Colorectal Cancer Screening
This study is developing and evaluate the effectiveness of the theory-based MyCRCS+ intervention, which will be integrated into an existing interactive preventive health record.
Role: Co-Investigator

Selected Completed Research Support

5P30CA016059 Ginder (PI) 08/30/12-04/30/17
Massey Cancer Center Core Support (Cancer Prevention and Control Research Program)
The goal of this program is to provide support for the development, administration, and maintenance of a center that consolidates and focuses cancer-related activities in a single administrative and programmatic structure. Role: Co-Investigator and Co-Lead, Cancer Prevention and Control

 

Positions and Employment

  • 1993–1999  Research Scientist. Center for Clinical Effectiveness, Henry Ford Health System. Detroit, MI
  • 1997–1999  Acting Director, Center for Clinical Effectiveness, Henry Ford Health System. Detroit, MI
  • 1997–2009  Research Scientist, Josephine Ford Cancer Center. Henry Ford Health System, Detroit, MI
  • 2000–2005  Director, Center for Health Services Research. Henry Ford Health System, Detroit, MI
  • 2005–2009  Research Scientist, Center for Health Services Research, Henry Ford Health System
  • 2009–2015  Adjunct Research Scientist, Center for Health Services Research, Henry Ford Health System
  • 2009–present  Professor, Department of Health Behavior and Policy, Virginia Commonwealth University
  • 2010–present  Co-Lead, Cancer Prevention and Control Program, Massey Cancer Center, Virginia Commonwealth University, Richmond, VA.

Honors

  • 1985  Delta Omega, National Public Health Honor Society, The University of North Carolina.
  • 1986  Foster McGaw Scholarship Award.
  • 1989-1992  National Institute of Aging (NIA) Predoctoral Traineeship, The University of Michigan.
  • 2014  Outstanding Departmental Teacher Award in Health Sciences Education, Virginia Commonwealth University