Steven Handler, MD, PhD
- Biomedical Informatics
- Clinical and Translational Informatics
- Adverse Drug Reactions
- Adverse Drug Events
- Medication management
- Medication adherence
- Patient Safety
- Patient Safety Culture
- Process and Quality Improvement
- Transitional care
Appointments and Positions
Assistant Professor of Biomedical Informatics
Assistant Professor of Geriatric Medicine
Assistant Professor of Clinical and Translational Research
Director, Clinical Informatics, Department of Biomedical Informatics
Graduate Faculty of the University of Pittsburgh School of Medicine
Core Faculty of the RAND-University of Pittsburgh Health Institute (RUPHI)
Medical Director for Long-term Care Health information technology at the University of Pittsburgh Medical Center (UPMC)
Co-Director of the University of Pittsburgh Geriatric Pharmaceutical Outcomes and Gero-Informatics Research and Training Program
Core Faculty of the Biomedical Informatics Training Program
Current Research Projects and Collaborations
Improving the Identification of Actionable Adverse Drug Events Associated with Acute Kidney Injury in Nursing Homes
The goal of this study is to determine if the addition of patient characteristics (i.e., clinical context) to a clinical surveillance system can improve identification of actionable adverse drug events caused by acute kidney injury and reduce alert burden/fatigue in nursing homes
Transforming the role of the hospital pharmacist to improve patients’ access, adherence, and self-management of medication after discharge (PI: Kim Coley, PharmD and Sandra Kane-Gill, PharmD
The goal of this quality improvement initiative is to enhance and evaluate a recently implemented pharmacy patient-care model at UPMC-Presbyterian Shadyside using a tool that will enable the pharmacist to engage the patient in the process of shared decision-making for medication self-management.
Reduce AVoidable hospitalizations using Evidence-based interventions for Nursing facilities in Western Pennsylvania (RAVEN). (Co-PIs: Charles Reynolds, MD and Katy Lanz, DNP)
UPMC will implement an intervention in 19 nursing facilities in the western region of Pennsylvania. UPMC Community Provider Services has created a program called “RAVEN” (Reduce AVoidable hospitalizations using Evidence-based interventions for Nursing facilities in western Pennsylvania). The goals of the program are to: 1) reduce the frequency of avoidable hospital admissions and readmissions among nursing facility residents, 2) Improve nursing facility resident health outcomes; 3) improve the bi-directional process of transitional care between hospitals and nursing facilities; 4) reduce overall health care spending without restricting access to care or choice of providers, and; 5) facilitate knowledge transfer and culture change within partner nursing facilities to sustain these best practices over the long-term. This program will include facility-based nurse practitioners to assist with determining resident care plan goals, and conduct acute change in condition assessments. It will also implement evidence-based clinical communication tools such as INTERACT and others recommended by the American Medical Directors Association to assist in structuring and standardizing clinical assessments and recommendations. The intervention will also provide support from innovative telehealth and information technologies to connect participating nursing facilities into the Western PA Health Information Exchange.
Pilot study to determine the feasibility of using telemedicine to assist nurse practitioners with managing acute change in condition and palliative care assessments of nursing home residents (PI: Steven M. Handler, MD, PhD, CMD)
The primary goal of this quality improvement project is to determine the feasibility of using telemedicine to assist nurse practitioners with managing acute change in condition and palliative care assessments of UPMC nursing home patients. To assess feasibility, we intend to utilize web-based surveys to quantify the perception of these services in terms of quality of the medical care provided, quality of the equipment used, and perceived barriers to implementation, both before and following each telemedicine encounter.
Pittsburgh Older American Independence Center (Pepper Center)
The specific aims are to develop interventions to improve function and independence in older adults with balance disorders, integrate studies of physiologic, biomechanical and psychosocial mechanisms affecting balance with clinical studies, and foster multidisciplinary research and research training.
A Multicenter Evaluation of off-label Medication use and Adverse Drug Events in Adult Intensive Care Unit Patients.
The goal of this a multi-center, comparative, prospective evaluation is to is to determine the incidence of ADRs associated with off-label drug use and elucidate if off-label drug use is an independent risk factor for the development of ADRs in ICU patients. These data will be used to develop a pharmacy practice model for prevention of ADRs from off-label drug use by incorporating clinical decision support into an alerting system.
Study of Post-Acute Care for Medicare Beneficiaries
The purpose of this Contract/Task Order is to outline the medical record review services required by the U.S. Department of Health and Human Services, Office of Inspector General (OIG) as part of a series of studies regarding quality of care and patient safety among Medicare beneficiaries discharged from hospitals to post-acute care settings. The quality of care will be assessed by first developing a global nursing home-specific trigger tool and then applying it to a random sample of 1,100 Medicare beneficiaries.
An Examination of Resident Abuse in Assisted Living Facilities
This project proposes to examine resident abuse in assisted living facilities (ALFs). Six categories of elder abuse will be examined (i.e., verbal, physical, material, psychological, medication, and sexual abuse). The proposal has three specific aims: (1) Examine resident abuse from family and staff reported by nurse aides in a nationally representative sample of ALFs; (2) Expand the scope of our understanding of resident abuse by including medication abuse in ALFs; and (3) Identify facility practices in ALFs that nurse aides and Directors of Nursing believe prevent or contribute to abuse of residents.
Enhancing the Detection and Management of Adverse Drug Events in the Nursing Home
The long-term objective of the proposed project is to improve patient safety with respect to medications in nursing homes (NH). The short-term objectives, or specific aims, of this proposed project are to determine if NH patients managed by physicians who receive active medication monitoring alerts have more adverse drug effects (ADE) detected, have a faster ADE management response time, and can result in more cost-savings from a societal perspective compared to usual care. The study includes a cluster randomized controlled trial among eighty-six NH physicians working in one of four NHs in Southwestern Pennsylvania.
University of Pittsburgh Program for Pharmaceutical Outcomes Research in Aging
The overall goal of this project is to build a strong research program in Pharmaceutical Outcomes Research in Aging. The specific aims are to create an educational series that provides a solid foundation of knowledge and skills in geriatric pharmaceutical outcomes research, to build a cadre of well-trained investigators in the field, and to provide experiential learning and support for data management and analysis of pharmaceutical data.
Handler SM, Cheung PW, Culley CM, Perera S, Kane-Gill S, Kellum JA, Marcum ZA. Determining the Incidence of Drug-Associated Acute Kidney Injury in Nursing Home Residents. Journal of the American Medical Directors Association (In press).
Bayoumi I, Balas MA, Handler SM, Dolovich L, Hutchison B, Hollbrook A. The effectiveness of computerized drug-lab alerts: A systematic review and meta-analysis. International Journal of Medical Informatics (In press).
Castle NG, Wagner LM, Ferguson-Rome JC, Men A, Handler SM. Hand Hygiene Deficiency Citations in Nursing Homes. Journal of Applied Gerontology (In press).
Castle NG, Handler SM, Wagner LM. Potential Prescription Drug Misuse in Assisted Living. Research in Gerontology Nursing (Epub ahead of print). 2013 Sept 16:1-8. PMID: 24044781.
Handler SM, Boyce RD, Ligons FM, Perera S, Nace DA, Hochheiser H. Use and Perceived Benefits of Mobile Devices by Physicians in Preventing Adverse Drug Events in the Nursing Home. Journal of the American Medical Director Association (Epub ahead of print). 2013 Oct 2. PMID: 24094901
Schwarz EB, Parisi, SM, Handler SM, Koren G, Fischer GS. Patient-reported Counseling about Medication-induced Birth Defects with Clinical Decision Support in Primary Care. Journal of Women’s Health 2013; 22(10):817-24 PMID: 23930947 PMCID: PMC3837561
Romagnoli KM, Handler SM, Ligons FM, Hochheiser H. Home Health Care Nurses’ Perceptions of the Post-hospitalization Information Needs of Geriatric Patients. BMJ: Quality and Safety 2013:22 (4 Apr) 324-332 PMID: 23362507
Wagner LM, Castle NG, Handler SM. The use of Health Information Technology for Adverse Event Reporting in Nursing Homes: Barriers and Facilitators. Geriatric Nursing 2013:34 (2 Mar): 112-115 PMID: 23266459.
Marcum ZA, Sevick MA, Handler SM. Medication Non-Adherence: A Diagnosable and Treatable Medical Condition. Journal of the American Medical Association (JAMA) 2013:309 (20 May):2105-6. PMID: 23695479
Thorpe-Jamison PT, Cullet CM, Perera S, Handler SM. Evaluating the Impact of Computer-Generated Rounding Reports on Physician Workflow in the Nursing Home: A Feasibility Time-Motion Study. Journal of the American Medical Directors Association. 2013 May 14(5):358:62. PMID: 23318665.
Marcum ZA, Rovesti KL, Behrens MC, Logsdon MW, Myers J, Francis SD, Aspinall SL, Hanlon JT, Handler SM. Utility of an adverse drug event trigger tool in Veterans Affairs nursing facilities. Consultant Pharmacist. 2013:28 (2 Feb):99-109 PMID: 23395810
Roshanov PS, Fernandes N, Wilczynski J, Handler SM, Haynes RB. Features of effective computerized clinical decision support. British Medical Journal (BMJ) 2013;14 (Feb);346:f657 PMID: 23412440
Nace DA, Handler SM, Hoffman EL, Perera S. Impact of the Rasing Immunizations Safely and Effectively (RISE) Program on Healthcare Worker Immunization Rates in Long-term Care Settings. Journal of the American Medical Directors Association. 2012:13 (9 Nov):806-10. PMID: 23031265 PMCID: PMC3650646
Marcum ZA, Pugh MV, Amuan ME, Aspinall SL, Handler SM, Ruby CM, Hanlon JT. Prevalence of Potentially Preventable Unplanned Hospitalizations Caused by Therapeutic Failures and Adverse Drug Withdrawal Events among Older Veterans. The Journal of Gerontology: Biological Sciences and Medical Sciences 2012;67(8 Aug):867-874. PMID: 22389461 PMCID: PMC3403866.
Gellad WF, Aspinall SL, Handler SM, Stone RA, Castle N, Semla TP, Good CB, Fine MF, Dysken J, Hanlon JT. Use of Antipsychotics Among Older Residents in VA Nursing Homes. Medical Care. 2012:50 (11 Nov):954-960 PMID: 23047785 PMCID: PMC3746977