Select Publications

Faculty and staff of the UCLA Healthcare Value Analytics and Solutions Consortium have published several articles on subjects related to healthcare value under the research themes below. Our research has appeared in several high-impact medical, health services research, and health policy journals that include the Journal of the American Medical Association (JAMA) , New England Journal of Medicine (NEJM), Health Affairs, American Journal of Managed Care, Journal of the American Heart Association, JAMA-Internal Medicine, JAMA Health Forum, JAMA Network Open, Journal of General Internal Medicine, Annals of Internal Medicine, Journal of the American Geriatrics Society, American Journal of Preventive Medicine, BMC Health Services Research, and the Proceedings of the National Academy of Sciences.

1. Low- and High-Value Healthcare

How can providers deliver high-quality patient care that optimizes available patient and provider resources? We explore issues of healthcare value through the development of empirical measures that quantify the incidence and cost of low-value diagnostics and therapeutic interventions, designing and evaluating interventions aimed at addressing issues of inappropriate use, and highlighting stakeholder perspectives on the care they receive.

Adams, M. A., Kerr, E. A., Dominitz, J. A., Gao, Y., Yankey, N., May, F. P., Mafi, J., & Saini, S. D. (2023). Development and validation of a new ICD-10-based screening colonoscopy overuse measure in a large integrated healthcare system: a retrospective observational study. BMJ Qual Saf, 32(7), 414-424.
Reynolds CA, Nair V, Villaflores C, Dominguez K, Arbanas JC, Treasure M, Skootsky S, Tseng CH, Sarkisian C, Patel A, Ghassemi K, Fendrick AM, May FP, Mafi JN. Developing an electronic health record measure of low-value esophagogastroduodenoscopy for GERD at a large academic health system. BMJ Open Qual. 2023 Dec 22;12(4):e002363. doi: 10.1136/bmjoq-2023-002363. PMID: 38135304; PMCID: PMC10749030.
Keller MS, Sarkisian CA. Beyond Titles: The Need to Reduce Prescribing Variation of Potentially Inappropriate Medications Among All Clinicians. Ann Intern Med. 2023 Nov;176(11):1548-1549. doi: 10.7326/M23-2556. Epub 2023 Oct 24. PMID: 37871319.
Ahmadi A, Duval VF, Bartlett JD, Hofer IS, Mafi J, Villaflores CWA, Sarkisian CA. Examining patient perspectives on low-value care: Findings from a survey on preoperative testing for cataract surgery. J Am Geriatr Soc. 2023 Nov;71(11):3641-3644. doi: 10.1111/jgs.18494. Epub 2023 Jul 12. PMID: 37436065; PMCID: PMC11006278.
Arbanas JC, Damberg CL, Leng M, Harawa N, Sarkisian CA, Landon BE, Mafi JN. Estimated Annual Spending on Lecanemab and Its Ancillary Costs in the US Medicare Program. JAMA Intern Med. 2023 Aug 1;183(8):885-889. doi: 10.1001/jamainternmed.2023.1749. PMID: 37167598; PMCID: PMC10176174.
Rockwell, M. S., Armbruster, S. D., Capucao, J. C., Russell, K. B., Rockwell, J. A., Perkins, K. E., Huffstetler, A. N., Mafi, J. N., & Fendrick, A. M. (2023). Reallocating Cervical Cancer Preventive Service Spending from Low- to High-Value Clinical Scenarios. Cancer Prev Res (Phila), 16(7), 385-391. https://doi.org/10.1158/1940-6207.Capr-22-0531
Rotenstein, L. S., Mafi, J. N., & Landon, B. E. (2023). Proportion Of Preventive Primary Care Visits Nearly Doubled, Especially Among Medicare Beneficiaries, 2001-19. Health Aff (Millwood), 42(11), 1498-1506. https://doi.org/10.1377/hlthaff.2023.00270
Mafi JN, Walling AM, Villaflores C, Vangala S, Sorensen A, Cheng E, Turner A, Trutner Z, Cheng G, Arbanas JC, Waterman B, Shu S, Goldstein N, Sarkisian C. A pragmatic parallel arm randomized-controlled trial of a multi-pronged electronic health record-based clinical decision support tool protocol to reduce low-value antipsychotic prescriptions among older adults with Alzheimer's and related dementias. PLoS One. 2022 Dec 20;17(12):e0277409. doi: 10.1371/journal.pone.0277409. PMID: 36538552; PMCID: PMC9767350.
Mafi JN, Leng M, Arbanas JC, Tseng CH, Damberg CL, Sarkisian C, Landon BE. Estimated Annual Spending on Aducanumab in the US Medicare Program. JAMA Health Forum. 2022 Jan 14;3(1):e214495. doi: 10.1001/jamahealthforum.2021.4495. Erratum in: JAMA Health Forum. 2022 Feb 18;3(2):e220053. doi: 10.1001/jamahealthforum.2022.0053. PMID: 35977233; PMCID: PMC8903103.
Oronce CIA, Arbanas JC, Leng M, Landon BE, Damberg CL, Sarkisian C, Mafi JN. Estimated wasteful spending on aducanumab dispensing in the U.S. Medicare population: A cross-sectional analysis. J Am Geriatr Soc. 2022 Sep;70(9):2714-2718. doi: 10.1111/jgs.17891. Epub 2022 Jun 27. PMID: 35758317; PMCID: PMC9489619.
Scott KW, Fendrick AM, Sarkisian CA. Ten Years of Choosing Wisely to Reduce Low-Value Care. N Engl J Med. 2022 Jun 23;386(25):2442. doi: 10.1056/NEJMc2206330. PMID: 35731660.
Soroudi C, Mafi J, Myint A, Gardner J, Kahlon S, Mongare M, Yang L, Tseng CH, Reynolds C, Nair V, Villaflores C, Cates R, Gupta R, Sarkisian C, May FP. Leveraging Electronic Health Records to Measure Low-Value Screening Colonoscopy. Am J Med. 2022 Jun;135(6):715-720.e2. doi: 10.1016/j.amjmed.2021.12.008. Epub 2022 Feb 25. PMID: 35219690; PMCID: PMC10176807.
Ahmadi A, Sorensen A, Villaflores CWA, Mafi JN, Vangala SS, Hofer IS, Bartlett JD, Cheng EM, Duval VF, Damberg C, Elashoff D, Goldstein NJ, Ladapo JA, Moore JM, Pessegueiro AM, Shu SB, Skootsky SA, Turner A, Sarkisian CA. Protocol for pragmatic randomised trial: integrating electronic health record-based behavioural economic 'nudges' into the electronic health record to reduce preoperative testing for patients undergoing cataract surgery. BMJ Open. 2021 Nov 3;11(11):e049568. doi: 10.1136/bmjopen-2021-049568. PMID: 34732478; PMCID: PMC8572383.
Oronce CIA, Fendrick AM, Ladapo JA, Sarkisian C, Mafi JN. The Utilization and Costs of Grade D USPSTF Services in Medicare, 2007-2016. J Gen Intern Med. 2021 Dec;36(12):3711-3718. doi: 10.1007/s11606-021-06784-8. Epub 2021 Apr 14. PMID: 33852141; PMCID: PMC8045442.
Beckman, H., Mafi, J., & Bortz, B. (2021). A 10-step program to successfully reduce low-value care. Am J Manag Care, 27(6), e208-e213.
O'Reilly-Jacob M, Mohr P, Ellen M, Petersen C, Sarkisian C, Attipoe S, Rich E. Digital health & low-value care. Healthc (Amst). 2021 Jun;9(2):100533. doi: 10.1016/j.hjdsi.2021.100533. Epub 2021 Mar 11. PMID: 33714891; PMCID: PMC9342901.
Mafi JN, Reid RO, Baseman LH, Hickey S, Totten M, Agniel D, Fendrick AM, Sarkisian C, Damberg CL. Trends in Low-Value Health Service Use and Spending in the US Medicare Fee-for-Service Program, 2014-2018. JAMA Netw Open. 2021 Feb 1;4(2):e2037328. doi: 10.1001/jamanetworkopen.2020.37328. PMID: 33591365; PMCID: PMC7887655.
Reid, R. O., Mafi, J. N., Baseman, L. H., Fendrick, A. M., & Damberg, C. L. (2021). Waste in the Medicare Program: a National Cross-Sectional Analysis of 2017 Low-Value Service Use and Spending. J Gen Intern Med, 36(8), 2478-2482. https://doi.org/10.1007/s11606-020-06061-0
Lee B, Mafi J, Patel MK, Sorensen A, Vangala S, Wei E, Sarkisian C. Quality improvement time-saving intervention to increase use of a clinical decision support tool to reduce low-value diagnostic imaging in a safety net health system. BMJ Open Qual. 2021 Feb;10(1):e001076. doi: 10.1136/bmjoq-2020-001076. PMID: 33579745; PMCID: PMC7883856.
Cuevas, M. A., Wachter, N. D., Reyes, C., Mafi, J. N., Wei, E., Carrillo, C., & Sarkisian, C. A. (2020). Seeking care for back pain or upper respiratory infections?: Survey results to inform a safety net hospital Choosing Wisely® intervention. Healthc (Amst), 8(3), 100424. https://doi.org/10.1016/j.hjdsi.2020.100424.
Mafi JN, Godoy-Travieso P, Wei E, Anders M, Amaya R, Carrillo CA, Berry JL, Sarff L, Daskivich L, Vangala S, Ladapo J, Keeler E, Damberg CL, Sarkisian C. Evaluation of an Intervention to Reduce Low-Value Preoperative Care for Patients Undergoing Cataract Surgery at a Safety-Net Health System. JAMA Intern Med. 2019 May 1;179(5):648-657. doi: 10.1001/jamainternmed.2018.8358. PMID: 30907922; PMCID: PMC6503569.
Mafi JN, May FP, Kahn KL, Chong M, Corona E, Yang L, Mongare MM, Nair V, Reynolds C, Gupta R, Damberg CL, Esrailian E, Sarkisian C. Low-Value Proton Pump Inhibitor Prescriptions Among Older Adults at a Large Academic Health System. J Am Geriatr Soc. 2019 Dec;67(12):2600-2604. doi: 10.1111/jgs.16117. Epub 2019 Sep 5. PMID: 31486549; PMCID: PMC6952216.
Mafi, J. N., & Parchman, M. (2018). Low-value care: an intractable global problem with no quick fix. BMJ Qual Saf, 27(5), 333-336. https://doi.org/10.1136/bmjqs-2017-007477 .

2. Health System Care Delivery Performance and Improvement/Population Health

What are the effects of population health and clinical point-of-care interventions on patient outcomes? We explore the performance of programs and interventions aimed at improving outcomes at the patient and population levels to provide insights into the optimal use of resources by providers towards improving the health of individuals and communities.

Keller MS, Qureshi N, Mays AM, Sarkisian CA, Pevnick JM. Cumulative Update of a Systematic Overview Evaluating Interventions Addressing Polypharmacy. JAMA Netw Open. 2024 Jan 2;7(1):e2350963. doi: 10.1001/jamanetworkopen.2023.50963. PMID: 38198136; PMCID: PMC10782233.
Sarkisian CA, Romanov A, Mafi JN. Talking With Patients About the New Anti-amyloid Alzheimer Disease Medications. Ann Intern Med. 2024 Feb;177(2):246-248. doi: 10.7326/M23-3377. Epub 2024 Jan 23. PMID: 38252943.
Leuchter, R. K., Ma, S., Bell, D. S., Hays, R. D., Vidorreta, F. J. S., Binder, S. L., & Sarkisian, C. A. (2023). Embedding research study recruitment within the patient portal preCheck-in. J Am Med Inform Assoc, 30(12), 2028-2035. https://doi.org/10.1093/jamia/ocad164 .
Leuchter RK, Gulhar R, Maynick JD, Dardick LD, Vorobiof G, Tabibiazar R, Yang RM, Sarkisian CA, Woo HE. Evaluation of an Electronic Health Record Tool to Identify Echocardiograms That Do Not Change Clinical Care. J Am Soc Echocardiogr. 2023 Dec;36(12):1329-1332. doi: 10.1016/j.echo.2023.08.019. Epub 2023 Aug 26. PMID: 37640087; PMCID: PMC11162694.
Keller MS, Qureshi N, Albertson E, Pevnick J, Brandt N, Bui A, Sarkisian CA. Comparing risk prediction models aimed at predicting hospitalizations for adverse drug events in community dwelling older adults: a protocol paper. Res Sq [Preprint]. 2023 Jan 18:rs.3.rs-2429369. doi: 10.21203/rs.3.rs-2429369/v1. PMID: 36711695; PMCID: PMC9882666.
Lee DR, Chenoweth M, Chuong LH, Villaflores CW, Cuevas M, Vangala S, Borenstein J, Kwak H, Chima-Melton C, Han M, Skootsky SA, Chan Tack T, Branagan L, Martin H, Gupta R, Phan L, Sanchez MA, Malaak MM, Dermenchyan A, Pearson KN, Altunyan M, Barakat PF, Pablo R, Sarkisian C. A Multisite Electronic Health Record Integrated Remote Monitoring Intervention for Hypertension Improvement: Protocol for a Randomized Pragmatic Comparative Effectiveness Trial. JMIR Res Protoc. 2023 Oct 30;12:e45915. doi: 10.2196/45915. PMID: 37902819; PMCID: PMC10644190.
Mafi JN, Walling AM, Villaflores C, Vangala S, Sorensen A, Cheng E, Turner A, Trutner Z, Cheng G, Arbanas JC, Waterman B, Shu S, Goldstein N, Sarkisian C. A pragmatic parallel arm randomized-controlled trial of a multi-pronged electronic health record-based clinical decision support tool protocol to reduce low-value antipsychotic prescriptions among older adults with Alzheimer's and related dementias. PLoS One. 2022 Dec 20;17(12):e0277409. doi: 10.1371/journal.pone.0277409. PMID: 36538552; PMCID: PMC9767350.
Leuchter, R. K., Jackson, N. J., Mafi, J. N., & Sarkisian, C. A. (2022). Association between Covid-19 Vaccination and Influenza Vaccination Rates. N Engl J Med, 386(26), 2531-2532. https://doi.org/10.1056/NEJMc2204560
Kojima N, Bolano M, Sorensen A, Villaflores C, Croymans D, Glazier EM, Sarkisian C. Cohort design to assess the association between post-hospital primary care physician follow-up visits and hospital readmissions. Medicine (Baltimore). 2022 Nov 18;101(46):e31830. doi: 10.1097/MD.0000000000031830. PMID: 36401424; PMCID: PMC9678564.
Mafi, J. N., Chen, A., Guo, R., Choi, K., Smulowitz, P., Tseng, C. H., Ladapo, J. A., & Landon, B. E. (2022). US emergency care patterns among nurse practitioners and physician assistants compared with physicians: a cross-sectional analysis. BMJ Open, 12(4), e055138. https://doi.org/10.1136/bmjopen-2021-055138
Shah VV, Villaflores CW, Chuong LH, Leuchter RK, Kilaru AS, Vangala S, Sarkisian CA. Association Between In-Person vs Telehealth Follow-up and Rates of Repeated Hospital Visits Among Patients Seen in the Emergency Department. JAMA Netw Open. 2022 Oct 3;5(10):e2237783. doi: 10.1001/jamanetworkopen.2022.37783. PMID: 36282505; PMCID: PMC9597390.
Reiff, J. S., Zhang, J. C., Gallus, J., Dai, H., Pedley, N. M., Vangala, S., Leuchter, R. K., Goshgarian, G., Fox, C. R., Han, M., & Croymans, D. M. (2022). When peer comparison information harms physician well-being. Proc Natl Acad Sci U S A, 119(29), e2121730119. https://doi.org/10.1073/pnas.2121730119
Tapper, E. B., Hao, S., Lin, M., Mafi, J. N., McCurdy, H., Parikh, N. D., & Lok, A. S. (2020). The Quality and Outcomes of Care Provided to Patients with Cirrhosis by Advanced Practice Providers. Hepatology, 71(1), 225-234. https://doi.org/10.1002/hep.30695
Ladapo, J. A., Larochelle, M. R., Chen, A., Villalon, M. M., Vassar, S., Huang, D. Y. C., & Mafi, J. N. (2018). Physician Prescribing of Opioids to Patients at Increased Risk of Overdose From Benzodiazepine Use in the United States. JAMA Psychiatry, 75(6), 623-630. https://doi.org/10.1001/jamapsychiatry.2018.0544
Mafi, J. N., Gerard, M., Chimowitz, H., Anselmo, M., Delbanco, T., & Walker, J. (2018). Patients Contributing to Their Doctors' Notes: Insights From Expert Interviews. Ann Intern Med, 168(4), 302-305. https://doi.org/10.7326/m17-0583

3. Health Equity and Healthcare Value

How does the delivery of healthcare within a framework of healthcare value impact health equity among vulnerable populations? We investigate the impact of population health and clinical interventions informed by value-based care principles on issues of health disparities, access, and inequality in outcomes and healthcare delivery across communities of racial and ethnic minority groups and socio-economically disadvantaged populations.

Nguyen, K. H., Oronce, C. I. A., Adia, A. C., Yeh, J. C., & Ponce, N. (2024). Inability to Access Needed Medical Care Among Asian American, Native Hawaiian, and Pacific Islander Medicaid Enrollees. J Ambul Care Manage, 47(2), 96-103. https://doi.org/10.1097/jac.0000000000000489
Canales C, Ramirez CM, Yang SC, Feinberg SA, Grogan TR, Whittington RA, Sarkisian C, Cannesson M. A Prospective Observational Cohort Study of Language Preference and Preoperative Cognitive Screening in Older Adults: Do Language Disparities Exist in Cognitive Screening and Does the Association Between Test Results and Postoperative Delirium Differ Based on Language Preference? Anesth Analg. 2024 Feb 7. doi: 10.1213/ANE.0000000000006780. Epub ahead of print. PMID: 38324340.
Parzuchowski, A., Oronce, C., Guo, R., Tseng, C. H., Fendrick, A. M., & Mafi, J. N. (2023). Evaluating the accessibility and value of U.S. ambulatory care among Medicaid expansion states and non-expansion states, 2012-2015. BMC Health Serv Res, 23(1), 723. https://doi.org/10.1186/s12913-023-09696-x
Mafi, J. N., Craff, M., Vangala, S., Pu, T., Skinner, D., Tabatabai-Yazdi, C., Nelson, A., Reid, R., Agniel, D., Tseng, C. H., Sarkisian, C., Damberg, C. L., & Kahn, K. L. (2022). Trends in US Ambulatory Care Patterns During the COVID-19 Pandemic, 2019-2021. JAMA, 327(3), 237-247. https://doi.org/10.1001/jama.2021.24294
Leuchter RK, Sarkisian CA, Trotzky-Sirr R, Wei EK, Carrillo CA, Vangala S, Coffey C Jr, Spellberg B, Melamed O, Jeng AC, Mafi JN. Choosing Wisely interventions to reduce antibiotic overuse in the safety net. Am J Manag Care. 2023 Oct;29(10):488-496. doi: 10.37765/ajmc.2023.89367. PMID: 37870542; PMCID: PMC10994234.
Henry, T. L., Britz, J. B., Louis, J. S., Bruno, R., Oronce, C. I. A., Georgeson, A., Ragunanthan, B., Green, M. M., Doshi, N., & Huffstetler, A. N. (2022). Health Equity: The Only Path Forward for Primary Care. Ann Fam Med, 20(2), 175-178. https://doi.org/10.1370/afm.2789
Guerrero LR, Menkin JA, Trejo L, Wachter ND, Sarkisian CA. Beyond p Values: A Qualitative Evaluation of the Aging Mastery Program Implementation in Los Angeles County. Prog Community Health Partnersh. 2022;16(3):297-306. doi: 10.1353/cpr.2022.0047. PMID: 36120873; PMCID: PMC10392953.
Leuchter, R. K., Villaflores, C. W. A., Norris, K. C., Sorensen, A., Vangala, S., & Sarkisian, C. A. (2021). Racial Disparities in Potentially Avoidable Hospitalizations During the COVID-19 Pandemic. Am J Prev Med, 61(2), 235-239. https://doi.org/10.1016/j.amepre.2021.01.036
Oronce, C. I. A., Adia, A. C., & Ponce, N. A. (2021). US Health Care Relies on Filipinxs While Ignoring Their Health Needs: Disguised Disparities and the COVID-19 Pandemic. JAMA Health Forum, 2(7), e211489. https://doi.org/10.1001/jamahealthforum.2021.1489
Shellito AD, Dworsky JQ, Kirkland PJ, Rosenthal RA, Sarkisian CA, Ko CY, Russell MM. Perioperative Pain Management Issues Unique to Older Adults Undergoing Surgery: A Narrative Review. Ann Surg Open. 2021 Sep;2(3):e072. doi: 10.1097/AS9.0000000000000072. PMID: 34870279; PMCID: PMC8635081.
Oronce, C. I. A., Miake-Lye, I. M., Begashaw, M. M., Booth, M., Shrank, W. H., & Shekelle, P. G. (2021). Interventions to Address Food Insecurity Among Adults in Canada and the US: A Systematic Review and Meta-analysis. JAMA Health Forum, 2(8), e212001. https://doi.org/10.1001/jamahealthforum.2021.2001
Oronce, C. I. A., & Fortuna, R. J. (2020). Differences in Rates of High-Value and Low-Value Care Between Community Health Centers and Private Practices. J Gen Intern Med, 35(4), 994-1000. https://doi.org/10.1007/s11606-019-05544-z
Marshall LW, Carrillo CA, Reyes CE, Thorpe CL, Trejo L, Sarkisian C. Evaluation of Recruitment of Older Adults of Color into a Community-Based Chronic Disease Self-Management Wellness Pathway Program in Los Angeles County. Ethn Dis. 2020 Nov 19;30(Suppl 2):735-744. doi: 10.18865/ed.30.S2.735. PMID: 33250620; PMCID: PMC7683029.
Chang E, Lin V, Goh R, Chan C, Ong MK, Hui E, Sarkisian C. Differences Between Current and Desired Physician Hypertension Management Roles Among Chinese American Seniors: a Qualitative Study. J Gen Intern Med. 2020 Dec;35(12):3471-3477. doi: 10.1007/s11606-020-06012-9. Epub 2020 Sep 21. PMID: 32959351; PMCID: PMC7728951.
Saadi A, Kim AY, Menkin JA, Carrillo CA, Reyes CE, Sarkisian CA. Mistrust of Researchers Correlates with Stroke Knowledge among Minority Seniors in a Community Intervention Trial. J Stroke Cerebrovasc Dis. 2020 Jan;29(1):104466. doi: 10.1016/j.jstrokecerebrovasdis.2019.104466. Epub 2019 Nov 14. PMID: 31734125; PMCID: PMC8286880.
Oronce, C. I. A., Scannell, C. A., Kawachi, I., & Tsugawa, Y. (2020). Association Between State-Level Income Inequality and COVID-19 Cases and Mortality in the USA. J Gen Intern Med, 35(9), 2791-2793. https://doi.org/10.1007/s11606-020-05971-3
Scannell, C. A., Oronce, C. I. A., & Tsugawa, Y. (2020). Association Between County-Level Racial and Ethnic Characteristics and COVID-19 Cases and Deaths in the USA. J Gen Intern Med, 35(10), 3126-3128. https://doi.org/10.1007/s11606-020-06083-8
Menkin JA, McCreath HE, Song SY, Carrillo CA, Reyes CE, Trejo L, Choi SE, Willis P, Jimenez E, Ma S, Chang E, Liu H, Kwon I, Kotick J, Sarkisian CA. "Worth the Walk": Culturally Tailored Stroke Risk Factor Reduction Intervention in Community Senior Centers. J Am Heart Assoc. 2019 Mar 19;8(6):e011088. doi: 10.1161/JAHA.118.011088. PMID: 30836804; PMCID: PMC6475057.