Investigator Dominick L. Frosch, Ph.D.

Dominick L. Frosch, Ph.D., is Director and Senior Scientist at the Palo Alto Medical Foundation Research Institute as well as Chief Care Delivery Evaluation Officer at the Palo Alto Medical Foundation. He received his Ph.D. in clinical psychology with an emphasis on behavioral medicine from the San Diego State University/University of California San Diego Joint Doctoral Program and completed a fellowship as Robert Wood Johnson Foundation Health & Society Scholar at the University of Pennsylvania.

Dr. Frosch’s research has focused on advancing patient engagement and patient-centered care for almost 20 years. His methodological expertise includes intervention development, randomized efficacy and effectiveness trials, implementation science, measurement and qualitative methods.

Dr. Frosch’s work has been funded by the National Institutes of Health, Department of Health and Human Services, Patient-Centered Outcomes Research Institute, Robert Wood Johnson Foundation and Informed Medical Decisions Foundation. He has published over 100 articles, editorials and chapters in the scholarly literature and serves as Deputy Editor for the Journal of General Internal Medicine.

Profile: http://scholar.google.com/citations?user=_yYVbv8AAAAJ&hl=en

Sutter Health Research Enterprise
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froschd@sutterhealth.org

Primary Research Interests

Research Studies

Enhancing Physician, Clinician, and Staff Joy of Work Through Well-being Research

Goal is to improve clinician and staff well-being by understanding predictors of well-being and impact of system changes on burnout.

Investigators: Ellis C. Dillon Ph.D., Assistant Scientist, Dominick L. Frosch Ph.D., Director, PAMFRI

Open and Ask Study

Study is a head-to-head comparison of three different interventions that empower patients to speak up and enable MDs to respond effectively when they do.

Investigators: Albert S. Chan M.D., M.S., FAAFP, Dominick L. Frosch Ph.D., Director, PAMFRI, Cheryl Stults Ph.D., Assistant Scientist

Publications

Physicians’ well-being linked to in-basket messages generated by algorithms In EHRs.

Meaningful redesign of EHR in-basket workflow and a wellness-enhancing work environment are necessary to effectively improve physicians’ well-being.

Physicians’ well-being linked to in-basket messages generated by algorithms In electronic health records.

Meaningful redesign of EHR in-basket workflow and a wellness-enhancing work environment are necessary to effectively improve physicians’ well-being.

Actions and processes that patients, family members, and physicians associate with patient- and family-centered care.

We identified 47 actions that patients, family members, and physicians associate with pt- and family-centered care.

Racial/ethnic differences in reporting versus rating of healthcare experiences.

Observed poorer experiences by Asians vs NHWs are in part explained by their worse rating of similar objectively measurable experiences.

Predicting prostate cancer treatment choices: The role of numeracy, time discounting, and risk attitudes.

Results showed that active surveillance was the most chosen option and its preference was predicted by numeracy and time discounting.

Isolated greater trochanteric fracture and the direct anterior approach using a fracture table.

Worse preop ambulatory status, dx of slipped capital femoral epiphysis or rheumatoid arthritis, greater DORR ratio, lower FNCR were assoc with increased fx risk

Development of a patient decision aid for syncope in the emergency department: the SynDA tool.

We iteratively developed an evidence-based decision aid to facilitate shared decision-making for alert syncope patients after an unremarkable ED evaluation.

Engaging patients in decisions about cancer screening: exploring the decision journey through the use of a patient portal.

Most patients wanted help in finalizing their decision. Many wanted to weigh the pros and cons and expressed fears of potential harms from screening.

Will use of patient portals help to educate and communicate with patients with diabetes?

Pts with diabetes (than without) were significantly more likely to believe that reading their visit notes would help them take their medication better.

A three-talk model for shared decision making: multistage consultation process.

Revised 3-talk model of shared dec making: provide support when introducing options, compare & discuss tradeoffs, decide based on informed preferences.

Shared decision making as part of value based care: new U.S. policies challenge our readiness.

During the last 10 yrs, state and fed initiatives have linked shared decision making with reimbursement and increased protection from litigation.

An evaluation of two interventions to enhance patient-physician communication using the observer OPTION5 measure of shared decision making.

Results suggest targeting patient and physician behaviors promotes SDM better than patient activation only. Improving SDM for less educated patients is crucial.

Redefining risk and benefit: understanding the decision to undergo contralateral prophylactic mastectomy.

Findings show the importance of psychosocial factors in patients' assessments of risk and benefit, and support the need for additional pt-provider communication

"Many miles to go …": a systematic review of the implementation of patient decision support interventions into routine clinical practice.

Need to understand more the professional and organizational resistance to decision aids, e.g., lack of incentives to use these interventions.

Communicating with physicians about medical decisions: a reluctance to disagree.

We sought to describe patients’ intentions to engage in shared decision making communication behaviors in response to a hypothetical preference-sensitive clinical scenario and to examine the effects of underlying patient beliefs on these behaviors.

Authoritarian physicians and patients' fear of being labeled 'difficult' among key obstacles to shared decision making.

MDs may not be aware of a need to create a safe env. for open communication to facilitate shared decision making. Rigorous measures of pt engagemt are needed.

Conducting implementation research in community-based primary care: a qualitative study on integrating patient decision support interventions for cancer screening into routine practice.

Use DESIs immediately before a consultation if the practice can provide basic accommodation and value pt care goals.

Internet patient decision support: a randomized controlled trial comparing alternative approaches for men considering prostate cancer screening.

Public Web sites about prostate cancer provide less effective decision support than a specially designed Internet decision aid.

Shared decision making in clinical medicine: past research and future directions.

This paper reviews the literature on shared medical decision making. Several questions are considered. Although several studies suggest that patients do not want to be involved in decision making, these studies typically fail to separate decisions about technical aspects of treatment from preferences for outcomes.

Implementation of patient decision support interventions in primary care: the role of relational coordination.

A high level of relational coordination within clinical settings may be a key component and facilitator of successful patient decision support implementations.

Shared medical appointments: a promising innovation to improve patient engagement and ease the primary care provider shortage.

Although SMAs improve access, engagement with physicians and other patients, and knowledge of patients' health, they also help to ease the workload for physicians.

A clinician's guide to privacy and communication in the ICU.

ICUs should develop policies for handling info sharing and methods for pts to voice objections to info sharing with caregivers.

Exploring provider reactions to decision aid distribution and shared decision making: lessons from two specialties.

Implementing decision aids in clinical practice to promote shared dec making requires addressing individual provider attitudes, beliefs, and knowledge of SDM.

Physicians' perceptions of shared decision-making behaviours: a qualitative study demonstrating the continued chasm between aspirations and clinical practice.

Study sample showed that many supported shared decision making but held inconsistent beliefs. More training is needed.

Perceived appropriateness of shared decision-making in the emergency department: a survey study.

Acceptance of shared decision making among emergency physicians appears to be strong across management categories and in various clinical scenarios.

An exploratory mixed-methods crossover study comparing DVD- vs. Web-based patient decision support in three conditions: The importance of patient perspectives.

DVD- and Web-based pt decision spt both increase knowledge. No single format may be best for all pts.

Implementing shared decision-making: consider all the consequences.

A broader conceptualization and measurement of shared decision-making would provide a more substantive evidence base to guide implementation.

What will it take to reduce the app gap?

Editorial: There is an urgent need to shape the future of mobile health for safety, value and optimal benefit.

Collaborative deliberation: a model for patient care.

Collaborative deliberation proposes interpersonal engagement, recognition of alternative actions, comparative learning, preference construction and integration.

Patient-reported outcomes as a measure of healthcare quality.

Patient-reported outcome measures are a key tool for ensuring that the care patients receive actually meets their goals for improving their health.

Promoting patient and family partnerships in ambulatory care improvement: a narrative review and focus group findings.

This paper describes emergent mechanisms and processes that ambulatory care practices use to partner with patients and families in QI including outcomes, facilitators, and challenges.

In absentia: an exploratory study of how patients are considered in multidisciplinary cancer team meetings.

Tumor board meetings we observed did not exhibit shared decision-making. Patient perspectives were absent.

Who and when should we screen for prostate cancer? Interviews with key opinion leaders.

BMC Medicine invited some of the world's key opinion leaders to discuss who, and when, to screen for prostate cancer.

Enhancing shared decision making through carefully designed interventions that target patient and provider behavior.

Designed novel, multidimensional intervention to nudge patients and primary care providers to communicate more openly.

Mapping the decision-making process for adjuvant endocrine therapy for breast cancer: the role of decisional resolve.

Adjuvant endocrine therapy has a long decision-making process and implementation pd. Clinical approaches should explore decisional resolve and med adherence.

Balancing digital information-sharing and patient privacy when engaging families in the intensive care unit.

Proxy decision makers should typically have access to health info from the current episode of care when the patient is decisionally impaired.

The language of engagement: "aha!" moments from engaging patients and community partners in two pilot projects of the Patient-Centered Outcomes Research Institute.

Fruitful collaborative wk with pts and community partners must attend to creation of a common language of engagemt. Be mindful of social power pt-MD dynamics.

Patient and family engagement: a survey of US hospital practices.

There is large variation in hospital implementation of pt & family engagemt practices, with competing organisational priorities being the most common barrier.

The patient is the most important member of the team.

Twenty-five years after this author had type 1 diabetes diagnosed, he found health professionals still fail to treat him as an equal in managing his disease.

Shared decision making and motivational interviewing: achieving patient-centered care across the spectrum of health care problems.

Motivational interviewing and/or shared decision making can be used to achieve pt-centered care in many health care problems.

Patient-centric scheduling with the implementation of health information technology to improve the patient experience and access to care: retrospective case-control analysis.

Automated rescheduling system can improve pt. access and reduce no-shows.

Perioperative complications stratified by body mass index for the direct anterior approach to total hip arthroplasty.

A greater rate of surgical complications, in number and severity, occurs with the morbidly obese undergoing direct anterior approach total hip arthroplasty.

Development of a patient decision aid for the management of superficial basal cell carcinoma (BCC) in adults with a limited life expectancy.

Pt decision aid has been adapted and designed to support pts with limited life expectancy in making decisions about their low-risk basal cell carcinoma.

The relationship between primary care physician burnout and patient-reported care experiences: a cross-sectional study.

Physician burnout adversely affects patient-provider communication in primary care visits. Improving MD work environments could have an impact on pt experience.

Shared decision-making for syncope in the emergency department: a randomized controlled feasibility trial.

Among ED patients with unexplained syncope, a randomized controlled trial of a shared decision-making tool is feasible.

Assessment of accuracy and usability of a fee estimator for ambulatory care in an integrated health care delivery network.

QI study: Fee estimator was easy to use and provided accurate results.

Frontline perspectives on physician burnout and strategies to improve well-being: interviews with physicians and health system leaders.

Changes to improve physician well-being: increasing support staff, reducing EHR workload, changing revenue generation, compensation approaches, and org culture.

Function of the medical team quarterback: patient, family, and physician perspectives on team care coordination in patient- and family-centered primary care.

Medical team quarterbacks were perceived as enhancing team-based care by facilitating the coordination/communication critical to pt- and family-centered care.

Diabetes Prevention Program attendance is associated with improved patient activation: results from the Prediabetes Informed Decisions and Education (PRIDE) study.

Finding of increased patient activation with DPP attendance suggests a mechanism for the improved health outcomes seen in DPP real-world translational studies.

Effectiveness of shared decision-making for diabetes prevention: 12-month results from the Prediabetes Informed Decision and Education (PRIDE) Trial.

A prediabetes shared decision-making intervention led by pharmacists increased patient engagement in evidence-based options for diabetes prevention.

Pragmatic study of clinician use of a personalized patient decision aid integrated into the electronic health record: an 8-year experience.

Integration of PDAs into the EHR results in sustained use. Further research is needed to assess the impact of integrated PDAs on decisional quality.

A randomized controlled effectiveness trial for PSA screening decision support interventions in two primary care settings.

Mailing PSA decision support interventions or inviting men to shared medical appointments unrelated to a primary care office visit do not appear to promote informed decision making, or change PSA testing behavior.

An effort to spread decision aids in five California primary care practices yielded low distribution, highlighting hurdles.

This paper highlights that major structural and cultural changes in health care practice and policy are necessary to increase patient shared decision making.

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Investigator Dominick L. Frosch, Ph.D.

Primary Research Interests

Research Studies

Publications

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