Investigator Harold (Hal) Luft, Ph.D.

Harold S. Luft, Ph.D., received his A.B., M.A. and Ph.D. in economics, specializing in health sector economics and public finance, from Harvard University. He is Senior Scientist at the Palo Alto Medical Foundation Research Institute. In addition, he is the Caldwell B. Esselstyn Professor Emeritus of Health Policy and Health Economics and former director of the Institute for Health Policy Studies (IHPS) at the University of California, San Francisco (UCSF).

Dr. Luft's experience in research and teaching has covered a wide range of areas, including medical care utilization; health maintenance organizations; hospital market competition; volume, quality and outcomes of hospital care; risk assessment and risk adjustment; and health care market reform. He has been involved continuously in postdoctoral training since 1973, having served as director of the IHPS postdoctoral program and associate director of the Health and Society Scholars program sponsored jointly by UCSF and the University of California, Berkeley as well as other programs. He led a K12 post doctoral training program funded by the agency of Healthcare Research and Quality called "PARTNERS" (Patients centered outcomes research: Applied Research TraNsforming Engaged Real World Systems) in collaboration with UCSF and San Francisco General Hospital.

He is a member of the Institute of Medicine (IOM) and served six years on the IOM Council. He was a member of and chaired the National Advisory Council of the Agency for Health Care Policy and Research (now the Agency for Healthcare Research and Quality). He also served on the board of AcademyHealth for 10 years and was co-editor in chief of the journal Health Services Research.

His current research focuses on several areas: (1) how information on best practices can be used to improve clinical care, (2) how economic incentives for providers can be restructured to enhance value to patients, (3) what methods can be used to derive valuable learnings from routinely collected information, such as in the electronic health record.

Sutter Health Research Enterprise
795 El Camino Real
Ames Building
Palo Alto, CA, 94301-2303
6508534804
lufth@sutterhealth.org

Primary Research Interests

Research Studies

A Study of Trends in Obesity Progression Among Complex Patients

We propose an innovative exploratory research project focusing on patients with a constellation of three chronic conditions: (1) obesity, (2) hypertension, and (3) depression.

Investigator: Harold (Hal) Luft Ph.D., Senior Scientist

Exploring Potential Gains and Losses for Providers in a System of Episode-Based Payment in Ambulatory Care

This project will characterize the cost components within ambulatory care episodes—physician-specific services, labs, imaging, and drugs.

Investigator: Harold (Hal) Luft Ph.D., Senior Scientist

Improving Cancer Care

Project will provide information about referrals to palliative care and way to enhance goals of care discussions for patients diagnosed with stage IV cancer.

Investigators: Ellis C. Dillon Ph.D., Assistant Scientist, Su-Ying Liang Ph.D., Research Economist, Harold (Hal) Luft Ph.D., Senior Scientist

Improving Outcomes for Breast Cancer Patients: A PAMF-Stanford Research Collaboration

This study examines the "trajectories" of breast cancer patients from diagnosis through treatment within and across these two delivery systems.

Investigators: Su-Ying Liang Ph.D., Research Economist, Harold (Hal) Luft Ph.D., Senior Scientist

Lung Cancer in Never Smokers: Incidence, Risk Factors and Molecular Characteristics in Asian American, Native Hawaiian, and Pacific Islander (AANHPI) Women

The goal of this project is to document incidence and risk factors for lung cancer by smoking status, among AANHPIs, focusing especially on female never smokers.

Investigators: Su-Ying Liang Ph.D., Research Economist, Harold (Hal) Luft Ph.D., Senior Scientist, External PI Principal Investigator

NAMCS Coding Project

This study uses ethnographic observation of physician interviews and electronic data extraction to explore alternative approaches to the NAMCS survey method.

Investigator: Harold (Hal) Luft Ph.D., Senior Scientist

PCOR -- Applied Research TraNsforming Engaged Real-world Settings (PARTNERS)

This training grant is for doctoral-level clinicians to develop the research skills to undertake patient-centered outcomes research.

Investigator: Harold (Hal) Luft Ph.D., Senior Scientist

Primary and Secondary Prevention of Osteoporosis-Related Fracture: The Use of DEXA and FRAX Results in a Community–based Practice

This study explores whether physicians recommend guideline-based interventions reflecting results of DEXA & FRAX risk scores provided w/ DEXA results.

Investigator: Harold (Hal) Luft Ph.D., Senior Scientist

Reconfiguring the US Health Care System: Function, Form, and Feasibility

Develop a proposal for fundamental reform of health care delivery using reconfigured incentives and information, then a supplement for adapting and disseminating policy recommendations.

Investigator: Harold (Hal) Luft Ph.D., Senior Scientist

Risk-Benefit Trade-Offs for Whole Genome Sequencing

Describe the clinical pathway of genetic testing at PAMF, and assess and obtain preliminary data on the use of genetic tests at PAMF.

Investigators: Su-Ying Liang Ph.D., Research Economist, Harold (Hal) Luft Ph.D., Senior Scientist, External PI Principal Investigator

Spreading Lean—Taking Efficiency Interventions in Health Services Delivery to Scale

Examine contextual factors that facilitate the implementation, spread and sustainability of Lean as a system-wide value improvement initiative.

Investigators: Dorothy Hung Ph.D., M.A., MPH, Associate Scientist, Harold (Hal) Luft Ph.D., Senior Scientist

The Impact of Lean Management on Primary Care Efficiency, Affordability, and the Patient Experience

The goal of this study is to investigate the impact of Lean on provider work efficiency, system affordability, and patient experiences in primary care.

Investigators: Dorothy Hung Ph.D., M.A., MPH, Associate Scientist, Su-Ying Liang Ph.D., Research Economist, Harold (Hal) Luft Ph.D., Senior Scientist

Time, Referrals, and Doctoring-Efficient Options for the Future (TRADEOFF)

This project explores whether increased time spent by PCPs substitutes for services they directly order and/or services patients may access from other PCPs.

Investigators: Su-Ying Liang Ph.D., Research Economist, Harold (Hal) Luft Ph.D., Senior Scientist

Towards Aligned Incentives

This project focuses on the variability in the components of total cost of care across patients with specific conditions to examine whether different types of risk can be borne by the appropriate parties.

Investigator: Harold (Hal) Luft Ph.D., Senior Scientist

Towards an Understanding of the Influence of Significant Others on Breast Cancer Patients’ Treatment Decision Making

The goal of this ethnographic study is to describe the influence and impact that others may have on breast cancer patients’ clinical decision making.

Investigator: Harold (Hal) Luft Ph.D., Senior Scientist

Publications

Validation of prediction models for critical care outcomes using natural language processing of electronic health record data.

ICU mortality prediction models using measures of clinical trajectory and NLP-derived terms yielded excellent predictive performance in this hospitals sample.

Preventive visit among older adults with Medicare's introduction of Annual Wellness Visit: closing gaps in underutilization.

Evaluated changes in preventive visit utilization with Medicare's Annual Wellness Visits, begun in 2011, how coverage expansion differentially affected seniors.

New recommendation and coverage of low-dose computed tomography for lung cancer screening: uptake has increased but is still low.

Lung CA screening may be more effective if they focus on accurate documentation of smoking hx and target former smokers who don't see their own PCP.

Beyond consent: building trusting relationships with diverse populations in precision medicine research.

Based on focus group findings, we make suggestions for research institutions seeking to cultivate long-term, trusting relationships with patients.

Collecting practice-level data in a changing physician office-based ambulatory care environment: a pilot study examining the physician induction interview component of the National Ambulatory Medical Care Survey.

Some MD induction interview questions were challenging in a multispecialty practice setting. Improving design/adm of NAMCS data collection is part of NCHS QI.

Is good enough for our peers good enough for policy makers?

Pubs should be research contributions & also impact practice & policy. How do this for policy-makers, who don't have methods training or time for lit review?

Comment on: Measuring the volume-outcome relation for complex hospital surgery.

Letter to the editor regarding article, "Measuring the volume-outcome relation for complex hospital surgery."

Fifty years of the journal HSR: informing policy and practice.

Impact on policy and practice of 50 years of Health Services Research journal.

Five decades of HSR-by words and figures.

Review of 50 years of Health Services Research journal, examining predominant words and figures.

Scaling Lean in primary care: impacts on system performance.

Lean redesigns can benefit primary care patients, physicians, and staff without negatively impacting the quality of clinical care.

Electronic health record logs indicate that physicians split time evenly between seeing patients and desktop medicine.

MDs logged avg. of 3.08 hrs on office visits & 3.17 hrs on desktop medicine daily. Desktop med includes pt and staff emails, Rx refills, test orders and review.

Association between monetary deposits and weight loss in online commitment contracts.

Voluntary use of commitment contracts may be an effective tool to assist weight loss. Those who choose to use monetary incentives report more weight loss. It is not clear whether this is due to the incentives or higher motivation.

Evaluating the healthiness of chain-restaurant menu items using crowdsourcing: a new method.

An algorithm incorporating crowdsourcing and a dietitian can quickly and efficiently analyze restaurant menus, allowing public health researchers to analyze the healthiness of menu items.

Use of gene expression profiling and chemotherapy in early-stage breast cancer: a study of linked electronic medical records, cancer registry data, and genomic data across two health care systems.

Although there was greater use of RS for patients who sought care in more than one health care setting, use of chemotherapy followed RS guidance in University and Community health care systems. These results suggest that precision medicine may help optimize cancer treatment across health care settings.

Effect of long-term antibiotic use on weight in adolescents with acne.

Contrary to original expectations, long-term antibiotic use in healthy adolescents with acne was not associated with weight gain. This finding, which was consistent across all analyses, does not support a weight-promoting effect of antibiotics in adolescents.

Clocks moving at different speeds: cultural variation in the satisfaction with wait time for outpatient care.

Given actual wait times, Asians perceive longer wait time and were less satisfied with wait times. Asians may have different expectations about wait time at the clinic.

Policy-oriented research on improved physician incentives for higher value health care.

Paper identifies areas where little is known about the effects of specific incentives (FFS, salary, etc.) on the two components of value: resource use, quality.

Enhancing Medicare's hospital-acquired conditions policy to encompass readmissions.

Non-payment for HAC-related readmissions would enhance incentives for prevention by increasing the frequency with which hospitals are held accountable for HACs.

Linking electronic health records to better understand breast cancer patient pathways within and between two health systems.

Linking EHR and cancer registry data from neighboring systems can enhance our information on breast cancer care trajectories.

Medicare annual preventive care visits: use increased among fee-for-service patients, but many do not participate.

Among Medicare fee-for-service pts, the use of preventive visits rose from 1.4 percent before implementation of the ACA to 27.5 percent after.

Becoming accountable—opportunities and obstacles for ACOs.

Public reporting of provider performance at a crossroads in the United States: summary of current barriers and recommendations on how to move forward.

Regarding public reports of hospital care quality, we present 10 recommendations to better engage and inform consumers.

Assignment, attribution, and accountability: new responsibilities and relationships in accountable care organizations.

Patients' body mass index and blood pressure over time: diagnoses, treatments, and the effects of comorbidities.

An observational study using multilevel models to analyze electronic health record data from a multispecialty practice from 2003 to 2010 to examine disease trajectories of patients with at least 2 of 3 common chronic conditions: overweight/obese, hypertension, and depression.

How, when, and why individuals with stage IV cancer seen in an outpatient setting are referred to palliative care: a mixed methods study.

We found high rates of referral for palliative care in stage 4 ovarian cancer. Referrals vary in timing, reason, usefulness to pts, families, & clinical teams.

Smoking-cessation interventions after lung cancer screening guideline change.

After implementation of new lung cancer screening guidelines, smoking-cessation interventions increased. This could have substantial public health benefits.

Primary care physician practice styles and quality, cost, and productivity.

Max-packing behavior yields desirable outcomes at lower overall cost but involves more conventionally uncompensated PCP time.

Population-based registry linkages to improve validity of electronic health record-based cancer research.

Leveraging linkages with cancer registries when using EHRs for research helps improve validity and generalizability.

Medicare's policy not to pay for treating hospital-acquired conditions: the impact.

Medicare stopped reimbursing hospitals for 8 avoidable hospital-acquired conditions. We modeled the financial impact of this policy on six such conditions.

Commentary: Protecting human subjects and their data in multi-site research

Comparative effectiveness research raises important issues regarding data usage authorizations, multiple IRBs with oversight authority & breach protection.

Advancing public reporting through a new ‘aggregator’ to standardize data collection on providers’ cost and quality

This paper proposes creating a public-private data aggregator that receives patient & provider data from payers for consumer-reporting and research purposes.

From small area variations to accountable care organizations: how health services research can inform policy

Health services research is characterized as policy-driven research. Research-driven policy, occures when studies alter perceived realtiy leading to new policy.

Data and methods to facilitate delivery system reform: harnessing collective intelligence to learn from positive deviance

By rewarding positive deviants, rather than trying to identify and "correct" those who are problematic, providers will voluntarily identify themselves and their methods for achieving superior outcomes.

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Investigator Harold (Hal) Luft, Ph.D.

Primary Research Interests

Research Studies

Publications

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