Overview
My research relates to clinical practice improvement - from the development of clinical policies to their implementation in real world clinical settings. Most recently my major content focus has been cerebrovascular disease. Other major clinical areas in which I work include the range of disabling neurological conditions, cardiovascular disease, and cancer prevention.
Notable features of my work are: (1) reliance on analytic strategies such as meta-analysis, simulation, decision analysis and cost-effectiveness analysis; (2) a balancing of methodological rigor the needs of medical professionals; and (3) dependence on interdisciplinary groups of experts.
This approach is best illustrated by the Stroke Prevention Patient Outcome Research Team (PORT), for which I served as principal investigator. Funded by the AHCPR, the PORT involved 35 investigators at 13 institutions. The Stroke PORT has been highly productive and has led to a stroke prevention project funded as a public/private partnership by the AHCPR and DuPont Pharma, the Managing Anticoagulation Services Trial (MAST). MAST is a practice improvement trial in 6 managed care organizations, focussing on optimizing anticoagulation for individuals with atrial fibrillation.
I serve as consultant in the general area of analytic strategies for clinical policy development, as well as for specific projects related to stroke (e.g., acute stroke treatment, management of atrial fibrillation, and use of carotid endarterectomy.) I have worked with AHCPR (now AHRQ), ACP, AHA, AAN, Robert Wood Johnson Foundation, NSA, WHO, and several pharmaceutical companies.
Key Words: clinical policy, disease management, stroke, decision analysis, clinical guidelines
Notable features of my work are: (1) reliance on analytic strategies such as meta-analysis, simulation, decision analysis and cost-effectiveness analysis; (2) a balancing of methodological rigor the needs of medical professionals; and (3) dependence on interdisciplinary groups of experts.
This approach is best illustrated by the Stroke Prevention Patient Outcome Research Team (PORT), for which I served as principal investigator. Funded by the AHCPR, the PORT involved 35 investigators at 13 institutions. The Stroke PORT has been highly productive and has led to a stroke prevention project funded as a public/private partnership by the AHCPR and DuPont Pharma, the Managing Anticoagulation Services Trial (MAST). MAST is a practice improvement trial in 6 managed care organizations, focussing on optimizing anticoagulation for individuals with atrial fibrillation.
I serve as consultant in the general area of analytic strategies for clinical policy development, as well as for specific projects related to stroke (e.g., acute stroke treatment, management of atrial fibrillation, and use of carotid endarterectomy.) I have worked with AHCPR (now AHRQ), ACP, AHA, AAN, Robert Wood Johnson Foundation, NSA, WHO, and several pharmaceutical companies.
Key Words: clinical policy, disease management, stroke, decision analysis, clinical guidelines
Current Duke Appointments & Affiliations
Professor Emeritus of Medicine
·
2026 - Present
Medicine, General Internal Medicine,
Medicine
Director of the Center for Clinical Health Policy Research
·
1988 - Present
Institutes and Centers,
School of Medicine
Affiliate, Duke Global Health Institute
·
2009 - Present
Duke Global Health Institute,
University Institutes and Centers
Recent Scholarly Works
Translating genomic data into healthcare practice with the Singapore National Precision Medicine program.
Journal article Nat Genet · August 2026 The Singapore National Precision Medicine (NPM) program is a three-phase whole-of-nation effort designed to develop scalable, evidence-based solutions for precision health tailored to Asia's diverse populations. Here we present NPM phase II (2020-2025), hi ... Full text Link to item CiteCost-effectiveness of population screening for Lynch syndrome and hereditary breast and ovarian cancer syndrome in Singapore.
Conference Journal of Clinical Oncology · July 1, 2026 164Background: Hereditary breast and ovarian cancer syndrome (HBOC) and Lynch syndrom ... Full text CiteAssessing the Impact of Enhanced Primary Care on Population Health and Health Services Utilization in Singapore: A Modified Delphi Study
Journal article Journal of General and Family Medicine · May 1, 2026 Background: Rapid population aging and increasing chronic disease prevalence underscore the need to strengthen primary care systems globally. The Primary Care Assessment Tool (PCAT) provides a structured framework for evaluating how well primary care syste ... Full text CiteRecent Grants
Expanding Quality Care for Glaucoma through a Provider-Patient Partnership
ResearchCo Investigator · Awarded by National Institutes of Health · 2007 - 2013Thrombosis and Hemostasis Centers Research and Prevention Network
ResearchConsultant · Awarded by Centers for Disease Control and Prevention · 2002 - 2013EPC Project: Medical Test Guides - training modules
ResearchCo Investigator · Awarded by Agency for Healthcare Research and Quality · 2011 - 2012View All Grants
Education
University of Maryland, College Park ·
1980
M.D.