Joshua M Thorpe, Ph.D., MPH
Associate Professor
PHONE(919) 225-2747
joshua.thorpe@unc.edu
ADDRESS
Kerr Hall, 301 Pharmacy Lane, , Chapel Hill, NC, 27599, , Kerr Hall, , , Chapel Hill, NC, 27599
Joshua Thorpe, PhD, MPH, is a tenured Associate Professor in the Division of Pharmaceutical Outcomes and Policy, healthcare scientist in the Department of Veterans Affairs (VA), and Director of Analytics and Research in the VA’s National Center for End-of-Life Care. Substantively, Dr. Thorpe’s research, teaching, and service activities are shaped by three overlapping themes in geriatric care and pharmaceutical policy and outcomes research: (1) assessing the impact of pharmaceutical policy on medication safety and quality in vulnerable populations, (2) conducting pharmacoepidemiologic research on the safety and effectiveness of medications in people who are excluded from clinical trials such as dementia patients and patients nearing end-of-life; (3) understanding the critical roles played by family caregivers in facilitating high-quality medication use and medical care in dependent older adults, and (4) understanding racial/ethnic and urban/rural disparities in access and appropriate use of medications and outpatient services. Methodologically, Dr. Thorpe uses machine-learning, latent variable models, and secondary data analysis methods to improve our understanding of prescribing and medication use behaviors and health outcomes. Dr. Thorpe also serves as lead psychometrician for the VA’s National Center for End-of-Life Care where he leads the development and evaluation of measures to evaluate quality of end-of-life care. Dr. Thorpe has been continuously funded for over 15 years by the VA, NIH, and Foundation grants. His laboratory uses a wide range of “big data” databases including: Medicare outpatient, inpatient, and prescription claims, the Medical Expenditure Panel Survey, CDC’s National Ambulatory & Hospital healthcare data, AHRQ’s Healthcare Cost and Utilization Project inpatient and emergency room data, and Veteran Affairs healthcare utilization and outcomes data. Dr. Thorpe has published over 100 peer-reviewed articles and government reports. He was the recipient of the national VA’s 2018 Best Research Paper of the Year Award for his article published in the Annals of Internal Medicine, “Dual Health Care System Use and High-Risk Prescribing in Patients with Dementia.” He also received the 2018 Excellence in Government Award for Outstanding Contribution to Science (Medical), and the 2018 Rho Chi Society (Honor society for pharmacy students).
Dr. Thorpe’s teaching and mentoring interests are in three main areas: (1) mentoring graduate students and post-doctoral fellows on their journey to expert; (2) enhancing the scientific skills of pharmacists, graduate students, and postdoctoral fellows by providing high-quality methodological training in the areas in “big data” analytics, comparative effectiveness, pharmacoepidemiology, and health services research; (3) raising awareness of pharmacists about the needs of the communities in which they practice, and challenging future pharmacists to play a greater role in efforts to reduce disparities and improve public health. Dr. Thorpe co-teaches the advanced methods course in DPOP PhD program and co-teaches the evidence-based medicine course in the professional program. Dr. Thorpe is a highly active research mentor, having mentored of trainees from a range of disciplines including medicine, surgery, nursing, pharmacy, and dentistry. Dr. Thorpe’s mentees have gone on to successful careers in academia, industry, and the government; with several mentees receiving recognition at local and national meetings. He has served as mentor or co-mentor to 15 PhD students, 5 pharmacy residents, 6 post-doctoral fellows, and 5 pharmacy honors students.
Dr. Thorpe’s service to the discipline of pharmaceutical outcomes and policy includes permanent membership on the Agency for Healthcare Research and Quality’s Healthcare Safety and Quality Improvement Research study section, a former Associate Editor for the journal, “Research and Social & Administrative Pharmacy (RSAP), current Editorial Board member for the American Journal of Geriatric Psychiatry, and as a member of the VA’s national advisory board on “big data” use.
- UNC Eshelman School of Pharmacy, Ph.D. in Pharmaceutical Sciences (Outcomes & Policy Research), 2005
- George Washington University, Master of Public Health, School of Public Health (Epidemiology), 2001
- Hamilton College, Bachelor of Arts (Neuroscience), 1995
Current Research Areas & Recent Publications (selected from over 100 total)
Potentially unsafe and unnecessary medications in older adults.
The primary focus of Dr. Thorpe’s research program focuses on reducing the overuse of unnecessary or inappropriate medications in medically-complex older adults. He has conducted extensive research on how on a range of topics including unsafe use in older Veterans with dementia, chronic high-dose opioid use, non-adherence and oversupply of chronic disease medications, the role of over-the-counter medications in unsafe medication use, and the dyadic nature of unsafe use of dementia patients and their family caregivers.
- Thorpe JM, Thorpe CT, Carico R, Cashy JP, Gellad WF, Van Houtven CH. Association between dual use of Department of Veterans Affairs and Medicare drug benefits and potentially unsafe prescribing. JAMA-Internal Medicine. 2019 Jul 22.
- Gellad WF, Thorpe JM, Zhao X, Thorpe CT, Sileanu F, Cashy J, Hale J, Mor M, Radomski TR, Hausmann LRM, Donohue JM, Gordon AJ, Suda K, Stroupe K, Hanlon JT, Good CB, Fine MJ. Impact of dual use of VA and Medicare Part D drug benefits on potentially unsafe opioid use. American Journal of Public Health. 2018;108(2):248-55. PMC5846585
- Thorpe JM, Thorpe CT, Gellad WF, Good CB, Hanlon JT, Mor MK, Pleis JR, Schleiden LJ, Van Houtven CH. Dual health care system use and high-risk prescribing in patients with dementia: a national cohort study. Annals of Internal Medicine. 2017;166(3):157-63. PMC5846585
- Chui MA, Stone JA, Martin BA, Croes KD, Thorpe JM. Safeguarding older adults from inappropriate over- the-counter medications: the role of community pharmacists. Gerontologist. 2014;54(6):989-1000.
- Thorpe JM, Thorpe CT, Kennelty KA, Gellad W, Schulz S. The impact of family caregivers on potentially inappropriate medication use in non-institutionalized older adults with dementia. American Journal of Geriatric Pharmacotherapy. 2012;10(4):230-41. PMC3413778
Palliative and End-of-Life (EOL) quality of care.
Dr. Thorpe leads a team who has published numerous articles on access and quality of palliative and EOL-care in older adults with life-limiting conditions such as cancer, dementia, and heart disease. His research in this stream has sought to optimize the timing of palliative care, identify and understand racial/ethnic disparities in access to EOL services, and the psychometric evaluation of quality of care measures at EOL.
- Smith D, Thorpe JM, Ersek M, Kutney-Lee A. Identifying optimal factor scores on the Bereaved Family Survey: Implications for practice and policy. J Pain Symptom Manage. 2019 Jul;58(1):108-114
- Carpenter JG, McDarby M, Smith D, Johnson M, Thorpe JM, Ersek M. Associations between the timing of palliative care consults and family evaluation of care for Veterans who die in a hospice/palliative care unit. Journal of Palliative Medicine. 2017;20(7):745-75. PMC5510033
- Kutney-Lee A, Smith D, Thorpe JM, Del Rosario C, Ibrahim S, Ersek M. Race/ethnicity and end-of-life care among Veterans. Medical Care. 2017;55(4):342-51.
- Thorpe JM, Smith D, Kuzla N, Ersek M. Does mode of survey administration matter? Using measurement invariance to validate the mail and phone versions of the Bereaved Family Survey (BFS). Journal of Pain and Symptom Management. 2016;51(3):546-56.
The role of caregivers in the quality of care received by vulnerable older adults.
Patients with life-limiting conditions often rely on informal caregivers to assist with a range of day-to-day healthcare decisions. Dr. Thorpe’s research has sought to understand better how caregiver factors influence the quality of care received by patients with life-limiting conditions (LLCs). This work has revealed several intriguing discoveries. For example, when informal caregivers are depressed, LLC patients receive fewer visits to primary care and mental health providers, are at greater risk for preventable hospitalizations and are less likely to receive recommended clinical preventive services. We have also found that caregiver psychological distress and disability are barriers to preventive health care. His work has demonstrated that caregiver interventions that improve caregiver well-being are cost-neutral. In other NIA-supported work, Dr. Thorpe discovered that caregiver factors were generally significant predictors of unsafe medication use in dementia patients, including the caregiver’s unsafe use. These results were featured as a “Priority Paper Evaluation” in the journal Aging Health (Lavretsy, 2012). Together, this body of work has raised awareness about the importance of “caring for the caregiver” in order to ensure high-quality medical care and medications are received by vulnerable older adults and their caregivers
- Thorpe JM, Thorpe CT, Schulz R, Van Houtven CH, Schleiden L. Caregiver disability and access to preventive care in care recipients. American Journal of Preventive Medicine. 2015;49(3):370-9.
- Van Houtven CH, Thorpe JM, Chestnutt D, Molloy M, Boling J, Davis LL. Do nurse-led skill training interventions affect caregivers’ out-of-pocket expenditures? Gerontologist. 2013;53(1):60-70. PMC3551205
- Thorpe JM, Thorpe CT, Kennelty KA, Gellad WF, Schulz R. The impact of family caregivers on potentially inappropriate medication use in non-institutionalized older adults with dementia. American Journal of Geriatric Pharmacotherapy. 2012;10(4):230-41. PMC3413778
- Thorpe JM, Sleath BL, Thorpe CT, Van Houtven CH, Blalock SJ, Landerman LR, Campbell WH, Clipp EC. Caregiver psychological distress as a barrier to influenza vaccination among community-dwelling Veterans with dementia. Medical Care. 2006;44(8):713-21.
Secondary data analytic methods, analytics, and psychometrics.
For ethical or logistical reasons, many important research questions in geriatric health services research cannot be addressed using randomized study designs or smaller convenience samples. Over the past 20 years, Dr. Thorpe has developed considerable expertise in the application of observational comparative effectiveness research (CER) methods to a range of complex surveys and large administrative databases to generate valid answers to these otherwise-intractable questions. In addition to using entropy balancing, coarsened exact matching, and propensity score methods for addressing selection bias, I have particular expertise in the application of latent variable modeling techniques and advanced classification methods to improve our understanding of medication prescribing and use behaviors. This expertise has generated numerous interdisciplinary collaborations with colleagues in pharmacy as well as nursing, psychology, medicine, and public health.
- Batten A, Thorpe JM, Piegari R, Rosland AM. A resampling based grid search method to improve reliability and robustness of mixture-item response theory models of multimorbid high-risk patients. IEEE J Biomed Health Inform. 2019 Nov 4.
- Kutney-Lee A, Carpenter J, Smith D, Thorpe JM, Rudose A, Ersek M. Case-mix adjustment of the Bereaved Family Survey. American Journal of Hospice and Palliative Care. 2018;35(7):1015-22.
- Lo-Ciganic W, Donohue JM, Thorpe JM, Perera S, Thorpe CT, Marcum ZA, Gellad WF. Using machine learning to examine medication adherence thresholds and risk of hospitalization. Medical Care. 2015;53(8):720-8. PMC4503478
- Thorpe JM, Smith D, Kuzla N, Scott L, Ersek M. Does mode of survey administration matter? Using measurement invariance to validate the mail and phone versions of the Bereaved Family Survey (BFS). Journal of Pain and Symptom Management. 2016;51(3):546-56.
PENDING/CURRENTLY ACTIVE
Project Number: Status on Grant: Project Period:
IIR: 003059 PI 10/1/2020-9/30/2024
Title: Outpatient palliative care and prescribing safety and quality at end-of-life Source: Department of Veteran Affairs, Health Services Research & Development
Role (Percent effort): PI (40%)
Total Direct Costs: $1,200,000
Project Number: Status on Grant: Project Period:
IIR 12-379 (Kutney-Lee, A) Co-I 03/01/18-01/31/21
Title: Investigating Multi-Level Determinants of Racial/Ethnic Disparities in Quality of End-of-Life Source: Department of Veteran Affairs, Health Services Research & Development
Role (Percent effort): Co-I (15%)
Total Direct Costs: $1,010,000
Project Number: Status on Project: Project Period:
IIR 14-306 (C Thorpe) Co-I 3/1/16 – 2/28/19
Title of Project: De-intensifying Unnecessary Medications in VA CLC Residents Nearing End of Life Source: Department of Veteran Affairs, Health Services Research & Development
Role (Percent effort): Co-I (15%)
Total Direct Costs: $979,986
Project Number: Status on Project: Project Period:
N/A(Shreve/Gilbert) Director, Analytics & Research 10/01/14-09/30/21
Title of Project: Comprehensive End-of-Life Care’s Veteran Experience Center
Source: Veterans Health Administration
Role (Percent effort): Director, Analytics & Research (25%)
Project Number: Status on Project: Project Period:
XVA 41-061 (Rosland) Co-I 10/01/17-09/30/21
Title of Project: PACT Implementation and Outcomes for High-Risk Patients
Source: Veterans Health Administration, Office of Primary Care
Role (Percent effort): Co-I (10%)
COMPLETED
Project Number Status on Grant Project Period:
IIR 12-379-2, VA R01 PI 6/1/14 – 9/30/18
Title of Project: Dual Use of VA/Medicare Part D and Unsafe Prescribing in Veterans with Dementia Source: Department of Veteran Affairs, Health Services Research & Development
Role (Percent effort): PI (40%)
Total Direct Costs: $920,000
Project Number Status on Grant Project Period:
IIR 14-297, VA R01 (Gellad) Co-I 1/1/15 – 5/31/18
Title of Project: Safety of Opioid Use among Veterans Receiving Care in Multiple Health Systems Source: Department of Veteran Affairs, Health Services Research & Development
Role (Percent effort): Co-I (15%)
Total Direct Costs: $1,047,615
Project Number Status on Grant Project Period:
N/A PI 10/1/13 – 9/30/14
Title of Project: Developing a Typology Veterans’ Healthcare Experiences Source: VA HSR&D CHERP Competitive Pilot Research Program
Role (Percent effort): PI (15%)
Total Direct Costs: $33,000
Project Number Status on Grant Project Period:
N/A Co-I (PI: C. Thorpe) 12/1/13 – 11/30/15
Title of Project: Impact of Healthcare Utilization and Informal Caregiving for Primary Systemic Vasculitis Source: Vasculitis Foundation Pilot Grant Program
Role (Percent effort): Co-I (12%)
Total Direct Costs: $100,000
Project Number Status on Grant Project Period:
N/A Co-I (PI: N. Fowler) 7/1/13 – 6/30/14
Title of Project: Use and Discontinuation of Antidementia Drugs and Perspectives from Regional Stakeholders Source: RAND-University of Pittsburgh Health Institute
Role (Percent effort): Co-I (3%)
Total Direct Costs: $30,000
Project Number Status on Grant Project Period:
N/A Co-I (PI: C. Thorpe) 10/1/13 – 9/30/14
Title of Project: Supporting Medication Adherence in Veterans with Dementia and Their Caregivers Source: VA HSR&D CHERP Competitive Pilot Research Program
Role (Percent effort): Co-I (5%)
Total Direct Costs: $35,000
Project Number: Status on Grant: Project Period:
R03 AG039644-01 Co-I 4/1/11 – 3/31/14
Title of Project: Developing MIDUS Medication Data Via Linkage to the Multum Lexicon Source: NIH-NIA
Role (Percent effort): Co-I (5%) *converted to consultant upon move from UW-Madison to Pittsburgh
Total Direct Costs: $100,000
Project Number: Status on Grant: Project Period:
N/A Methodologist (PI: Smithburger) 7/1/12 – 6/30/13
Title of Project: Multicenter Evaluation of Off-Label Medication use and Adverse Drug Event in ICU Patients Source: The American Society of Health-System Pharmacists
Role (Percent effort): Co-I (3%)
Total Direct Costs: $18,000
Project Number: Status on Grant: Project Period:
1R15DE021196-01 Methods Consultant (PI:Okunseri) 7/1/10 – 7/31/12
Title of Project: Medications Prescribed in Emergency Departments for Non-Traumatic Dental Conditions
Source: National Institute of Health, National Institute of Dental and Craniofacial Research (NIDCR)
Role (Percent effort): Consultant (3%)
Project Number: Status on Grant: Project Period:
NIH Loan Repayment Award for Health Disparities Research 7/1/10 – 6/30/12
Title of Project: Disparities in Healthy Behaviors and Preventive Care in Older Adult Caregivers
Source: National Center on Minority Health and Health Disparities (NCMHD)
Role (Percent effort): PI Total Awarded: $60,000 towards student loans
Project Number: Status on Grant: Project Period:
Pilot Grant Co-PI 8/1/10 – 7/31/12
Title of Project: Appropriate Over-The-Counter Medication Use in the Older Adult: Pharmacists’ Role
Source: School of Pharmacy Inter-Divisional Collaboration Grant
Role (Percent effort): Co-PI (5%)
Total Costs: $12,500
Project Number: Status on Grant: Project Period:
1R03AG029995-01A1 PI 4/1/08 – 3/31/11
Title of Project: Suboptimal Prescribing in Dementia Patients and Their Informal Caregivers
Source: NIH- NIA
Role (Percent effort): PI (20%)
Total Direct Costs: $100,000
Project Number: Status on Grant: Project Period:
Pilot Grant PI 1/1/09 – 12/31/10
Title of Project: Barriers to Medical Care and Medication Adherence in Persons with Alzheimer’s Disease and Dementing Disorders
Source: Wisconsin Comprehensive Memory Program
Role (Percent effort): PI (10%)
Total Direct Costs: $50,000
Project Number: Status on Grant: Project Period:
P19004 Methodologist Consultant (PI: Corazzini) 6/1/08 – 8/31/2010
Title of Project: Regulating Licensed Nursing Practice In Nursing Homes: RN Delegation, the Role of the LPN, and Outcomes of Nursing Home Care
Source: National Council of State Boards of Nursing’s Center for Regulatory Excellence
Role (Percent effort): Consultant (5%)
Total Costs: $300,000
Project Number: Status on Grant: Project Period:
5R01NR008285-02 Methodologist Consultant (PI: Davis) 9/30/02 – 6/30/07
Title of Project: Project ASSIST with Chronic Illness Caregivers
Source: National Institute for Nursing Research
Role (Percent effort): Consultant (10%) *Included on Aim 3 of grant
Total Direct Costs: $340,000
Project Number: Status on Grant: Project Period:
Pilot Grant PI 7/1/06 -6/30/07
Title of Project: Suboptimal Medication Use in Informal Caregivers
Source: Duke University TRAC Center
Role (Percent effort): PI (20%)
Total Direct Costs: $15,000
GRANT PROPOSALS UNDER REVIEW
Project Number: Status on Grant: Submitted:
1R21 000000-00 (Thorpe, J) PI February 2020
NIH-NIA
Outpatient Palliative Care and Prescribing Safety and Quality in Complex Older Adults
Role (Percent effort), PI (30%)
Total Direct Costs: $275,000
Project Number: Status on Grant: Submitted:
VA R01-equivalent (Raghunathan, K) Co-I May 2020
VA HSR&D
Improving Pain Management after Total Knee and Total Hip Arthroplasties.
Role (Percent effort), Co-I (15%)
Total Direct Costs: $1,200,000