Investigator Spotlight

5 Questions for Researchers

Larry Allen

Larry Allen, MD, MHS

Professor, Medicine

‚ÄčAssociate Division Head for Clinical Affairs, Cardiology

‚ÄčMedical Director, Advanced Heart Failure

Dr. Larry Allen is the Associate Division Head for Clinical Affairs in Cardiology, Medical Director of Advanced Heart Failure, and Co-Director of the Colorado Program for Patient Centered Decisions located at ACCORDS on the University of Colorado Anschutz Medical Campus. Dr. Allen’s research interests include anticipating progression into end-stage heart failure and then helping patients make tough choices regarding invasive therapies and palliative options. Dr. Allen recently completed the PCORI-funded DECIDE-LVAD trial on patient decision support and is working on the AHA-funded EPIC-HF trial on patient engagement in heart failure medication prescribing. Meanwhile, Dr. Allen keeps himself clinically grounded by regularly seeing patients with heart failure, LVADs, and transplants, and is consistently voted as one of Denver’s “Top Doctors” in 5280 Magazine. He enjoys skiing and hiking with his family.

1. Why is your area of science important?
I am fundamentally a heart failure clinician and have always been interested in how to help patients navigate severe, life-threatening diseases. That often includes the provision of life-saving therapies, but it also involves anticipating progression into end-stage disease, helping patients make tough choices regarding invasive therapies, and introducing palliative options. That has led me from research in clinical trials, to risk modeling, to shared decision making, and implementation science. 

2. What was important in your Health Services Research training?
Having formal education in a wide range of methods has really helped me tackle clinical questions from a variety of angles and enabled me to engage a breadth of collaborators. For me that involved basic science in undergrad and medical school, clinical trials experience at the Duke Clinical Research Institute, and a Masters in Health Sciences during my cardiology fellowship.  

3. What are the major take-home messages your current research provides?

  • Proactive care is generally better than reactive care; Clinical inertia is real.
  • Complex health care is best navigated by engaging patients.
  • There are worse things than death. 

4. What are your goals or areas for future research?

Assessing the value of different care options from the patient’s perspective should be much easier than it is today. 

5. What advice do you have for researchers who want to work in this area? OR What is the most important advice you have received from your mentors?
I’ve been told that the secret to research success is focus, focus, focus … but my most enjoyable projects and lasting research relationships have come from having an open mind and just wanting to help where needed. 

Heather De Keyser

Heather De Keyser, MD, MSCS

Associate Professor of Pediatrics, Section on Pediatric Pulmonology

Dr. De Keyser is an Associate Professor in the Department of Pediatrics, Section on Pediatric Pulmonology, practicing at Children’s Hospital Colorado.  She completed an undergraduate education with honors at Washington University in St. Louis, and her medical degree from the University of Colorado School of Medicine.  A true Coloradoan at heart, she then completed her residency and fellowship at the University of Colorado School of Medicine Pediatrics and Pediatric Pulmonary programs respectively.  While in her pulmonary fellowship, she obtained an additional Master of Clinical Science from the University of Colorado, Denver. Her clinical interests include medication adherence and health behavior change for children with asthma, and she pursued training in health services research through the SCORE (Surgical/subspecialists Clinical Outcomes Research) program at ACCORDS.  Her research currently focuses on using mobile technology including electronic medication monitoring to both evaluate and improve adherence to inhaled medications in children and adolescents with asthma.  She is currently funded through a K23 award from the National Heart, Lung, and Blood Institute to evaluate long-term adherence patterns and develop intervention programs for adolescents with asthma using mixed methods research design.  

1. Why is your area of science important?
Medication adherence is a problem universally across chronic diseases, and children with chronic diseases represent an even more challenging population. Estimated adherence rates for high-risk children with asthma are well below 50%, and low adherence to medications is associated with an increased risk for asthma-related morbidity. There are many good medications available for children with asthma, however, if adherence is low (due to any number of factors ranging from individual and family level factors to systemic factors including social determinants of health), these medications cannot truly benefit patients in the way it was intended.  My research helps to find ways to work with children and families to adopt healthy behaviors around medication use to improve quality of life and decrease costs to the healthcare system.  

2. What was important in your Health Services Research training?
I realized that health services research was key to the type of work I wanted to do early on in my research career. I was puzzled by the fact that good medications exist, and yet outcomes in the real world did not match those of clinical trials. I realized that Health Services Research could help to bridge the gap between the traditional biomedical research paradigm, and real-world experience using strategies such as qualitative methods, dissemination and implementation research, and pragmatic trial design. By learning about how to implement these strategies, a whole new world of funding opportunities and research designs was made available to me. And I would be remiss not to say that the mentorship I received through the SCORE program was the most important factor in my career trajectory. I have continued this relationship for many years with my mentor, Dr. Allison Kempe, and hope to continue it for many more!

3. What are the major take-home messages your current research provides?

One of the biggest messages is that there is a gap in communication and understanding between providers and patients when it comes to medication adherence behaviors. Patients may vastly over-report their adherence to medications for many reasons, and if providers are unaware of patients’ true use patterns, they are not able to provide optimal care. While not perfect, technological strategies such as electronic medication monitoring can help to bridge this gap and allow for improved communication between patients and their care team. Parents may also be unaware of their child’s adherence, particularly teens. Patients may have many reasons why they don’t fully adhere to treatment regimens and finding ways to discuss these in non-judgmental ways as well as strategizing with patients about how to create healthy habits is critical to creating systems for patients that actually work.   

4. What are your goals or areas for future research?

I would like to develop interventions that help to improve medication adherence and other health-related behaviors for children and adolescents with asthma, in order to decrease the burden of disease and improve their quality of life. Future directions include tailored intervention strategies based on known medication use behaviors, as well as the implementation of these interventions in the real-world setting.  

5. What advice do you have for researchers who want to work in this area?

Some of the most important pieces of advice I have received is to remember - that when you are saying yes to something, you are automatically saying no to something else. I think academic researchers (particularly women) have a tendency to feel that they have to accept every opportunity that comes their way, or feel the need to take on more responsibilities than they can handle because they don’t want to let someone down. I was told that I should evaluate every opportunity and ask myself: does this fit with my short-term or long-term career goals? The answer has to be yes if it is something that I will commit my full attention to. I will admit, I am a work in progress in this area, but I am working on it every day!