Rachel Gold, PhD, MPH

Investigator, Kaiser Permanente Northwest Center for Health Research

Rachel Gold, PhD, MPH, is an Investigator at the Kaiser Permanente Northwest Center for Health Research, with a joint appointment at the OCHIN community health information network, where she is the Lead Research Scientist. Dr. Gold’s work centers on research conducted at OCHIN’s national network of safety net clinics. Her primary research interest is determining how electronic health records can be harnessed to improve rates of guideline-concordant primary care and reduce health disparities in the safety net setting, with a focus on optimizing the implementation of EHR-based clinical decision support tools. Dr. Gold is PI of several NIH-funded studies, involving cross-setting implementation of a quality improvement initiative from Kaiser Permanente into community health centers, which involves direct comparison of the effectiveness of several implementation support strategies. Most relevant to SONNET, she leads a study of how to help community clinics collect and act on information about patients’ social determinants of health, using EHR-based strategies and tools. She also serves / served as co-Investigator on studies evaluating: the effects of parental insurance coverage on children’s health care access and outcomes; the use of EHRs to support safety net clinics’ efforts to help their pediatric patients stay insured; the feasibility of applying national pediatric care quality measures in safety net clinics’ EHR data; and strategies for helping safety net clinics implement team-based perinatal depression identification and care.

Areas of Focus

  • Social determinants of health
  • Health disparities
  • Community health centers
  • Health information technology interventions
  • Clinical decision support
  • Implementation science - practice change in primary care

Current Work

My work explores how health information technology can help address health disparities, with a focus on the socioeconomically vulnerable patients served by our nation's safety net community health centers (CHCs). One way to do this is to ensure that CHCs have cutting-edge clinical decision support tools in their EHRs; this involves not just identifying and building effective, guideline-based tools, but also strategies for helping CHCs adopt such tools into their workflows. I lead two current studies in this area. SPREAD-NET compares how effectively different implementation strategies support CHCs' adoption of a suite of EHR tools targeting cardioprotective prescribing in patients with diabetes. The CV WIZARD study tests the effectiveness of decision support tool that provides personalized, prioritized information on a patient's CVD risks. Another way to use HIT to address disparities is to have EHRs document the social determinants of health (SDH) that impact patients' ability to act on care recommendations, and actions taken by the clinic to mitigate these barriers; like any practice change, this, too, involves HIT tool development and complex implementation strategies. I led a pilot study (ASSESS&DO) on how to integrate SDH data into CHCs' EHRs, which built a suite of EHR 'SDH Data Tools' that were activated in 700 CHCs' EHR. My current study, ASCEND, is testing an implementation support package designed to help CHCs adopt SDH collection, review, and action, using this suite of tools.

Most recent publications:

  • Advancing Social Prescribing with Implementation Science
  • Gottlieb L, Cottrell EK, Park B, Clark KD, Gold R, Fichtenberg C.
  • J Am Board Fam Med. 2018 May-Jun;31(3):315-321. doi: 10.3122/jabfm.2018.03.170249.
  • PubMed: 29743213 | Journal of the American Board of Family Medicine: Free Article
  • How 6 Organizations Developed Tools and Processes for Social Determinants of Health Screening in Primary Care: An Overview
  • LaForge K, Gold R, Cottrell E, Bunce AE, Proser M, Hollombe C, Dambrun K, Cohen DJ, Clark KD.
  • Am J Public Health. 2017 Dec;107(12):1895-1897. doi: 10.2105/AJPH.2017.304124. Epub 2017 Oct 19. No abstract available.
  • PubMed: 28990990 | The Journal of Ambulatory Care Management: Free Article
  • Developing Electronic Health Record (EHR) Strategies Related to Health Center Patients' Social Determinants of Health
  • Gold R, Cottrell E, Bunce A, Middendorf M, Hollombe C, Cowburn S, Mahr P, Melgar G.
  • Journal of the American Board of Family Medicine : JABFM. 2017; 30(4):428-447. NIHMSID: NIHMS906626
  • PubMed: 28720625 | Journal of the American Board of Family Medicine: Free Article