Research

My Research Story

What got me into research was this: after yet another exhausting day working as a rural doctor in a mountainous town in the Philippines, I finally asked myself: 

"What would it take to improve health care so we don't see the same problems over and over?"

That led me to hang my white coat and shift to a career in research. 40-or-so publications and research projects later, I still pursue that question. 

My areas of focus are implementation science and global public health.

Implementation Science

Implementation science (IS) combines perspectives from public health, organizational management, behavioral sciences and other disciplines to analyze and address factors affecting the implementation of health interventions. Often, IS makes use of theories, models and/or frameworks that describe how interventions ideally achieve health outcomes as intended, and that help identify barriers and facilitators. 

As many health settings are not exactly ideal, my research aims to answer questions like, 

"Why is this intervention not working?" 

"How can we make it work the way it was designed?"

Health systems

My implementation science work mostly focuses on health systems. 

Health systems are groups or networks of facilities that provide care within a specific geographic area or serve a particular segment of population, and are governed or managed by an organization or agency (AHRQ, 2023). Most of the topics I work on are directly related to implementation science, such as the concept of learning health systems (LHS), and health system responsiveness, which I detail below.

In addition, my work in health systems often overlaps with other disciplines. For example, I occasionally engage in research that assesses the economic and behavioral impact of policy interventions at the health system level. 

Learning health systems

Learning health systems (LHS) are systems or networks of health facilities that are characterized by the translation of healthcare data into practice improvements; this translation is guided by a community of patients, providers and leaders oriented towards common health goals (McGinnis, et al., 2021; Friedman, 2022; Kilbourne, et al., 2025). 

This concept sounds quite idealistic and frankly, it really is. With healthcare (in the United States and globally) becoming complex and expensive, the LHS concept was developed as a response to increasing cost, inefficiency and complexity of healthcare. This concept operates on the idea that if health systems become more data-driven and if healthcare becomes more evidence-based, it would be easier for health systems to determine what works best for patients. 

But are these ideas based on reality? I'm approaching this question in these ways: 1) looking at factors affecting the ability of health systems to implement specific LHS-oriented projects and innovation programs (an example of which is the graphic shown here), and more essentially, 2) interrogating the concept of LHS implementation itself (the focus of my doctoral dissertation).

Factors affecting implementation of LHS-oriented programs

The graphic below depicts the constructs of the Organizational Theory of Implementation Effectiveness, a conceptual framework we used to analyze factors affecting the implementation of a provider feedback program in geriatric emergency departments within the U.S. Veterans health system. This LHS-oriented program was designed to prevent the prescription of potentially inappropriate medications to older Veteran (i.e., retired/former U.S. military) patients. 

The program was administered in two modes: 1) academic detailing (active, i.e., program staff actively mentored providers), and 2) dashboard (passive, i.e., providers had access to their prescribing metrics and were expected to adjust their behavior accordingly); as part of a randomized trial, facilities were assigned to carry out one of these modes (Vaughan, et al., 2023).

Initially assessed through quantitative analysis, our lead investigators Dr. Camille Vaughan and Dr. George Jackson needed to make more sense out of the numbers. Some relatively well-resourced facilities doing either mode performed worse than less-equipped ones. 

Using qualitative data, we demonstrated that implementation effectiveness was impacted by 1) situational factors (such as ongoing accreditation, which likely motivated providers in facilities further along the process to improve their prescribing practices), 2) implementation climate (i.e., whether or not the work environment was supportive to organizational change), and 3) alignment with already existing structures within the health system (Lopez, et al., 2026). 

We published this study in the Journal of the American Geriatric Society.

My dissertation topic: LHS components and implementation barriers/facilitators

In my dissertation, I aim to answer these essential questions concerning learning health systems: 1) What are the components of a learning health system? 2) What are the barriers and facilitators of implementing learning health systems? This body of work consists of a systematic review of empiric (i.e., primary data; no commentaries or thought papers) literature and interviews. 

We are about to submit a protocol paper of the systematic review and present an evidence map of existing empiric LHS literature at an upcoming conference. We are also drawing up plans for the interview phase of the project.

I am hoping to be able to defend this dissertation sometime in 2027.

The systematic review is registered in PROSPERO.

Health system responsiveness

Health system responsiveness is a concept that measures how well health systems are able to meet the expectations of patients seeking care. 

Conceptually, it is the intersection of the following aspects of patient experience in healthcare settings: access to support, confidentiality, communication, dignity, promptness, quality of surrounndings, choice and decision-making (Mirzoev & Kane, 2017).

An offshoot of a consulting project I did in the Philippines prior to my PhD, this project aims to measure public perception of patients on how well their healthcare facility responded to their needs. We did a survey of selected regions, and conducted a series of focus group discussions that aimed to represent perceptions from patients living in rural and urban areas. 

A common weakness of household surveys is the inherent imbalance of respondent demographics, based on which segment of the population would be most likely to be present at home at the time of the survey. The figure below is reflective of that reality, which shows how household surveys skew towards working age females who stay at home to raise their families. This prompted a mixed methods approach that led us to a less-biased estimation of factors that affect perception of health system responsiveness.

We are currently finalizing the manuscript for our mixed methods analysis, which integrates results from the survey and the focus group discussion. We are planning to publish a separate article focusing on the analysis of quantitative survey results, which allows for the identification of specific factors that were seen to influence metrics related to health system responsiveness.

I categorize this topic under my implementation science work, as a lot of what we have been seeing in interim results concern barriers and facilitators towards becoming a health system that is responsive to patient needs. We also aim to propose edits to the conceptual framework of responsiveness, based on our results.

Works Cited

Agency for Healthcare Research and Quality. (2023, January). Defining Health Systems. https://www.ahrq.gov/chsp/defining-health-systems/index.html

Friedman, C. P. (2022). What is unique about learning health systems? Learning Health Systems, 6(3), e10328. https://doi.org/10.1002/lrh2.10328 

Kilbourne, A. M., Vinson, A., McInnis, M., Leibrecht, C., & Daumit, G. (2025). Learning health systems for community-based mental health. World Psychiatry, 24(1), 50–51. https://doi.org/10.1002/wps.21268

Koplan, J. P., Bond, T. C., Merson, M. H., Reddy, K. S., Rodriguez, M. H., Sewankambo, N. K., & Wasserheit, J. N. (2009). Towards a common definition of global health. Lancet (London, England), 373(9679), 1993–1995. https://doi.org/10.1016/S0140-6736(09)60332-9 

Lopez, J. C. F., Morris, I. J., Vaughan, C. P., Burningham, Z. R., Kelleher, J. L., Vandenberg, A. E., King, H. A., Hastings, S. N., Stevens, M. B., & Jackson, G. L. (2026). Factors Affecting Implementation of the EQUIPPED Medication Safety Program for Older Veterans in the Emergency Department: A Qualitative Analysis. Journal of the American Geriatrics Society, jgs.70587. https://doi.org/10.1111/jgs.70587 

McGinnis, J. M., Fineberg, H. V., & Dzau, V. J. (2021). Advancing the Learning Health System. New England Journal of Medicine, 385(1), 1–5. https://doi.org/10.1056/NEJMp2103872 

Mirzoev, T., & Kane, S. (2017). What is health systems responsiveness? Review of existing knowledge and proposed conceptual framework. BMJ Global Health, 2(4), e000486. https://doi.org/10.1136/bmjgh-2017-000486 

Vaughan, C. P., Burningham, Z., Kelleher, J. L., McGwin, G., Jasien, C. L., Hastings, S. N., Stevens, M. B., Morris, I., Jackson, G. L., & Group, T. E. V. I. Q. (2023). A cluster-randomized trial of two implementation strategies to deliver audit and feedback in the EQUIPPED medication safety program. Academic Emergency Medicine, 30(4), 340–348. https://doi.org/10.1111/acem.14697