Daren Anderson, MD

Research Interests

Health Services Administration; Health Care Quality, Access, and Evaluation

Public Health Interests

Health Disparities; Telemedicine

Research Organizations

General Internal Medicine

School of Public Health

Research Summary

My research career has been broadly focused on health services interventions aimed at improving primary care access and quality for medically underserved patients. All of my work has been informed by my clinical experience as a general internist caring for patients in Federally Qualified Health Centers and has centered on three main, inter-related areas: Exploring the impact of different technologies to enhance the interface between primary care and specialty care, studying new tools and approaches to improving outcomes for chronic and complex illness in primary care, and improving the identification and management of chronic pain in primary care.

Extensive Research Description

Telehealth Interventions for Primary Care: Our research in telehealth has contributed to the understanding of the impact of telehealth and telementoring strategies on primary care delivery and specialty access in safety net settings. Project ECHO is a telehealth intervention that uses videoconferencing to join specialists and PCPs to enhance competence in the care of specific conditions. Our publication on Pain ECHO demonstrated that primary care providers taking part in a chronic pain telementoring intervention increased knowledge and self efficacy and that this translated into increased adoption of guideline recommended care for patients with chronic pain. 

Our related work in eConsults has expanded our understanding of the important role of asynchronous telehealth for improving access to specialty care and reducing overall cost of care. We conducted a randomized controlled trial in Connecticut, with primary care providers as the unit of randomization. Those in the intervention group had access to cardiology "eConsults" while those in the control group referred only for face to face care. Results demonstrated that providers in the eConsult arm were able to resolve a substantial number of consults without need for face to face care, and that overall, using an intention to treat analysis, their patients received care more rapidly, and were less likely to have an emergency room visit. A subsequent analysis published in the American Journal of Managed Care used claims data from Medicaid to demonstrated the impact of this intervention on the total cost of care. Patients with Medicaid in the intervention arm of the RCT had nearly a $500 reduction in the total cost of care at six months compared to patients cared for by providers in the control arm. These studies contributed to changes at the policy level, with Connecticut Department of Social Services becoming the first in the nation to authorize reimbursement for eConsults.   

Chronic Pain Care: Chronic pain is among the most complex conditions managed in primary care. PCPs manage a substantial number of patients with chronic pain but receive little or no training in this area. Patient outcomes are poor, and the use of prescription opioids to manage pain has markedly increased despite growing evidence for the harms to patients and society. I have worked to develop approaches to improve the quality of pain care in primary care. My work describing provider attitudes and beliefs about pain care contributed to the development of Project Step, an implementation science project introducing the Stepped Care Model for Pain (SCM-PM) at VA Connecticut Healthcare. Following this I served as PI for a three-year study, Project Stepping Out, which focused on developing a new framework based on the VA’s SCM-PM, to improve the management of pain in the community health center setting. This project was largely focused on creating and supporting PCP behavioral changes necessary in providing best-practice care. Our principal findings demonstrated the significant lack of knowledge and confidence in the PCP workforce for managing pain, and the lack of adherence to guidelines for pain and prescription opioid analgesic use. First published in 2012, these findings led to funding for several additional projects including Project Next Steps, a telehealth initiative to provide video consultations between PCPs and pain specialists as well as PainNET, a project developing a web-based collaborative learning tool to support pain management best practice implementation in primary care. In our most recent publication we describe the development and implementation of an “Opioid Dashboard” that resulted in improvements in adherence to safe opioid prescribing practices and a decrease in overall opioid prescribing rates.

 



Selected Publications

  • Advanced Access Works, but Only When Implemented Effectively. Annals of Internal Medicine Anderson, D. Advanced Access Works, but Only When Implemented Effectively. Ann Intern Med (letter), Dec 2008; 149: 909 – 910
  • Diabetes Self Management in a Community Health Center. Improving Health Behaviors and Clinical Outcomes for Underserved Patients Anderson D, Christison-Lagay J. Diabetes Self Management in a Community Health Center. Improving Health Behaviors and Clinical Outcomes for Underserved Patients. Clinical Diabetes. 2008;26:22-27.
  • Integrating Depression Care With Diabetes Care in Real-World Settings: Lessons From the Robert Wood Johnson Foundation Diabetes Initiative Anderson D, Horton C, O'Toole ML, Brownson CA, Fazzone P, Fisher EB. Integrating Depression Care With Diabetes Care in Real-World Settings: Lessons From the Robert Wood Johnson Foundation Diabetes Initiative. Diabetes Spectr. 2007;20:10-16.
  • Synthesizing Lessons Learned from the Robert Wood Johnson Diabetes Initiative Burton J, Anderson D, McCormack L, Fisher E, Sawyer D. Synthesizing Lessons Learned from the Robert Wood Johnson Diabetes Initiative. Academy Health Annual Research Meeting, June 2007.
  • A Cost Effectiveness Analysis of Cardiology eConsults for Medicaid Patients Anderson D, Villagra V, Coman E, Zlateva I, Hutchinson A, Villagra J, Olayiwola, N. A Cost Effectiveness Analysis of Cardiology eConsults for Medicaid Patients. Am J Managed Care 2018; 24(1): e9-e16.
  • Access to Care and Skin Cancer Screening in Underserved Populations: A Model for Teledermatology Services in Community Health Center Naka F, Lu J, Porto A, Villagra J, Wu Z, Anderson D. Impact of Dermatology eConsults on Access to Care and Skin Cancer Screening in Underserved Populations: A Model for Teledermatology Services in Community Health Centers. J Am Acad Dermatol 2018; 78(2):293-320
  • Improving Pain Care with Project ECHO in Community Health Centers Anderson D, Zlateva I, Coman E, Davis B, Giannotti T, Coman E, Spegman D. Improving Pain Care with Project ECHO in Community Health Centers. Pain Med 2017; 18(10):1882-1889
  • Evaluation of a mobile phone app to support patient self-management of diabetes and hypertension in a FQHC Thies T, Anderson D, Cramer B. Evaluation of a mobile phone app to support patient self-management of diabetes and hypertension in a FQHC. JMIR Hum Factors. 2017:4(4) e24
  • Improving pain care through implementation of the Stepped Care Model at a multisite community health center Anderson D, Zlateva I, Coman E, Khatri K, Tian T, Kerns R. Improving pain care through implementation of the Stepped Care Model at a multisite community health center. Journal of Pain Research 2016: (9):1021-1029
  • Electronic Consultations to Improve the Primary Care-Specialty Care Interface for Cardiology in the Medically Underserved: A Cluster Randomized Controlled Tria Olayiwola JN, Anderson D (co-first author), Jepeal N, Aseltine R, Pickett C, Yan J, Zlateva I. Electronic Consultations to Improve the Primary Care-Specialty Care Interface for Cardiology in the Medically Underserved: A Cluster Randomized Controlled Trial. Ann Fam Med 2016; 14(2):133-140
  • Evaluating management of long term opioid therapy with a pain care quality extraction tool Moore, B.A., Anderson, D., Dorflinger, L., Zlateva, I., Lee, A. , Gilliam, W., Tian, T., Khatri, K., Kerns, R.D. (2016). Evaluating management of long term opioid therapy with a pain care quality extraction tool. Journal of Rehabilitation Research & Development 2016; 53(1):137-146
  • Improving the management of chronic non-cancer pain in primary care: Results of a multifaceted quality improvement initiative Anderson D, Zlateva I, Moore B. Improving the management of chronic non-cancer pain in primary care: Results of a multifaceted quality improvement initiative 2015: Implementation Science10(Suppl 1):A45
  • Using Clinical Microsystems to Implement Care Coordination in Primary Care. J Nurs Care Anderson D, Khatri K, Blankson M. Using Clinical Microsystems to Implement Care Coordination in Primary Care. J Nurs Care. 2015, 4 (5)
  • Development and validation of the Medical Home Care Coordination Survey for assessing care coordination in the primary care setting from the patient and provider perspectives Zlateva I, Anderson D, Coman E, Khatri K, Tian T & Fifield J. Development and validation of the Medical Home Care Coordination Survey for assessing care coordination in the primary care setting from the patient and provider perspectives. BMC Health Services Research 2015
  • Patient-provider social concordance and health outcomes in patients with type 2 diabetes: A retrospective study from a large Federally Qualified Health Center in Connecticut Kurek K, Teevan B, Zlateva I, Anderson D. Patient-provider social concordance and health outcomes in patients with type 2 diabetes: A retrospective study from a large Federally Qualified Health Center in Connecticut. Journal of Racial and Ethnic Health Disparities. 2015
  • Using Health Information Technology to Improve Adherence to Opioid Prescribing Guidelines in Primary Care Anderson D, Zlateva I, Khatri, K & Ciaburri N. Using Health Information Technology to Improve Adherence to Opioid Prescribing Guidelines in Primary Care. Clin J Pain. 2015 Jun;31(6):573-9
  • Using electronic health records data to identify patients with chronic pain in a primary care setting Tian TY, Zlateva I, Anderson DR. Using electronic health records data to identify patients with chronic pain in a primary care setting. Journal of the American Medical Informatics Association : JAMIA. 2013; 20(e2):e275-80
  • Barriers and Facilitators to Chronic Non-cancer Pain Management in Primary Care: A Qualitative Analys is of Primary Care Providers’ Experiences and Attitudes Lincoln LE, Pellico L, Kerns R, Anderson D (2013) Barriers and Facilitators to Chronic Non-cancer Pain Management in Primary Care: A Qualitative Analys is of Primary Care Providers’ Experiences and Attitudes. J Palliative Care Med S3:001
  • Replicating a Novel Model to Enhance Access to Hepatitis C Care in a Community Health Center Khatri K, Haddad M, Anderson D. Project ECHO: Replicating a Novel Model to Enhance Access to Hepatitis C Care in a Community Health Center. Journal of Healthcare for the Poor and Underserved 2013; 24 (2), 850-858
  • Comprehensive Assessment of Chronic Pain Management in Primary Care- a First Phase of a Quality Improvement Initiative at a Multi-Site Community Health Center Anderson D, Wang S, Zlateva I. Comprehensive Assessment of Chronic Pain Management in Primary Care- a First Phase of a Quality Improvement Initiative at a Multi-Site Community Health Center. Journal of Quality in Primary Care. , 2012, 20(6):421-433.
  • Primary Care Nursing and Care Coordination An Observational Study of Nursing Work in a Community Health Center Anderson D, St. Hilaire D, Flinter M. Primary Care Nursing and Care Coordination An Observational Study of Nursing Work in a Community Health Center. The Online Journal of Nursing Research, 2012, 12
  • Community Health Centers and the Patient-Centered Medical Home: Challenges and Opportunities to Reduce Health Care Disparities in America Anderson D. Community Health Centers and the Patient-Centered Medical Home: Challenges and Opportunities to Reduce Health Care Disparities in America. Journal of Healthcare for the Poor and Underserved, 2012, 23: 949-957
  • Varicella hepatitis: a fatal case in a previously healthy, immunocompetent adult Anderson DR, Schwartz J, Hunter NJ, Cottrill C, Bisaccia E, Klainer AS. Varicella hepatitis: a fatal case in a previously healthy, immunocompetent adult. Arch Int Med 1994;154:2101-2105
  • Validation of a Staging System for Evaluating Prognosis in Prostate Cancer Anderson DR, Patil S, Kamina A, Penson DF, Peduzzi P, Concato J. Validation of a Staging System for Evaluating Prognosis in Prostate Cancer. Connecticut Medicine 2000;64:459-464
  • The implementation of a translational study involving a primary care based behavioral program to improve blood pressure control: The HTN-IMPROVE study protocol Bosworth HB, Almirall D, Weiner BJ, Maciejewski M, Kaufman MA, Powers BJ, Oddone EZ, Lee SY, Damush TM, Smith V, Olsen MK, Anderson D, Roumie CL, Rakley C, Del Monte PS, Bowen ME, Kravetz JD, and Jackson GL. The implementation of a translational study involving a primary care based behavioral program to improve blood pressure control: The HTN-IMPROVE study protocol. Implementation Science 2010, 5:54

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Contact Info

Daren Anderson, MD
Mailing Address
Internal MedicinePO Box 208056
333 Cedar Street

New Haven, CT 06520-8056