Johns Hopkins University is home to the world-renowned Johns Hopkins Berman Institute of Bioethics.  Established in 1995, the Berman Institute is now one of the largest centers of its kind in the world. Today, the Berman Institute consists of more than 30 core and affiliated faculty from the Johns Hopkins School of Medicine, School of Nursing, Bloomberg School of Public Health, and the Krieger School of Arts and Sciences. Faculty work collaboratively on scholarship and teaching in the Institute’s areas of focus. The Berman Institute works to achieve more ethical practices and policies relevant to human health. The mission of the Berman Institute is to identify and address key ethical issues in science, clinical care, and public health, locally and globally.

Biomedical Informatics and Data Science (BIDS) is a multidisciplinary team of investigators and specialists who seek to improve our understanding and practice of biomedicine and healthcare through first transforming and enhancing biomedical, supporting analyses and inference, and applying new knowledge through systems engineering in clinical workflows. Johns Hopkins BIDS has deep experience on biomedical knowledge and data integration, data harmonization and annotation, and application to translational research and decision support. We are actively involved in a spectrum of health information technology data standards efforts, with emphases on biomedical ontologies, classifications, data models, and transform logics. We also lead and evaluate decision and digital health interventions based on these data insights at the patient, clinician, and populations levels. Additionally, we contribute to Johns Hopkins’ infrastructure and initiatives that extend informatics capabilities to our investigators and the greater community.

BIDS research seeks to apply these principles through extramurally funded projects that leverage our strengths while contributing translational science. Programs include national scope data harmonization efforts for COVID databases and cancer data commons. We lead many collaborative coordinating centers for biomedical data science and translational research. We also lead other research programs that seek to bridge basic biomedical science and clinical practice, and contribute to the design and governance of Hopkins enterprise systems and national collaborations.

Finally, the Johns Hopkins BIDS section has reengineered our education programs to enable students, faculty, and technical members of our communities to learn and master biomedical informatics and data science principles, methods, and skills. We have active, hands-on curricular offerings spanning data generation, management, semantic and syntactic harmonization, biostatistical analyses, decision analysis, and machine-learning inferencing. We balance informed theory with practical application, and heavily leverage our portfolio of funded research activities as frameworks for advanced learning and experience.

Learn more about BIDS education opportunities

Cancer affects virtually everyone – through taking actions to prevent cancer, undergoing cancer screening, being treated for a diagnosed cancer, taking care of a loved one who has cancer, experiencing the effects of cancer survivorship, or losing someone to cancer. According to the American Cancer Society, there were nearly 14 million Americans with a history of cancer alive in 2012. They estimate that 1,660,290 new cases will be diagnosed and that 580,350 Americans will die of cancer in 2013, making cancer the second leading cause of death. The estimated overall costs for cancer in 2010 were $263.8 billion, including $102.8 billion for direct medical costs, $20.9 billion in costs of lost productivity due to illness, and $140.1 billion in costs of lost productivity due to death. 

As alluded to above, there is an entire continuum of care associated with cancer, including prevention, screening, diagnosis, treatment, survivorship, recurrence, and end-of-life. Here at Hopkins GIM, researchers are investigating issues all across the cancer continuum. Through collaborations with our colleagues in the Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, the Bloomberg School of Public Health, and across the Johns Hopkins Medical Institutions, we are investigating questions related to challenges such as determining the appropriate populations to target for genetic testing, addressing the health-related quality of life and supportive care needs of patients undergoing treatment, determining appropriate follow-up care for cancer survivors, and ensuring quality palliative care for patients at the end of life.

One of GIM's intramural collaborations is with the Cancer Outcomes & Health Services Research Interest Group, which was formed in 2006 to connect researchers across the schools of medicine, nursing, and public health working in the area of cancer outcomes and health services research. The purpose of the interest group is to (1) identify who is doing research related to cancer outcomes and health services research; (2) learn about ongoing and planned research projects; (3) discuss opportunities for collaboration; and (4) begin developing an infrastructure to support this area of research. The Interest Group has over 100 members and meets monthly for a formal presentation and group discussion. The Interest Group is sponsored by the Cancer Center, the School of Medicine’s Vice Dean for Clinical Investigation, and the Division of General Internal Medicine and is chaired by Craig Pollack, MD, MHS, and Antonio Wolff, MD.

Cardiovascular disease continues to be the leading cause of death in the US. About 1,400,000 people die from cardiovascular disease annually. The American Heart Association estimates that 2,600 Americans die of cardiovascular disease every day. At Johns Hopkins, faculty with a particular interest in cardiovascular disease are approaching both primary and secondary prevention modalities in high risk populations, including families with premature coronary disease, people with hypertension and or obesity, and an urban community population. Studies range from genetic and molecular studies of the mechanisms of cardiovascular disease to studies of vascular properties, lifestyle interventions, and responsiveness to preventive pharmacotherapy. We also have a broad interest in the context in which intervention and prevention strategies are employed, including medical environments, alternative care systems in communities, and self-help. A considerable portion of our work is focused on genetic epidemiology and gene-environment interactions. Hopkins GIM brings together experts in cardiovascular and related research on the Hopkins campus, including faculty from Cardiology (Drs. Lewis Becker, Brian G. Kral, Jeffrey Brinker, Pamela Ouyang, and Kerry J. Stewart), Critical Care Medicine and thrombosis research (Dr. Nauder Faraday), Neurology (Dr. Paul Nyquist), Radiology (Dr. Elliott K. Fishman), Neuroradiology (Dr. David Yousem), Genetic epidemiology (Drs. M. Daniele Fallin and Rasika Mathias), and Endocrinology (Dr. Rita Kalyani). Drs. Linzhao Cheng and Zack Wang from the Institute for Cell Engineering are members of our research Division research team.

Chronic kidney disease is a worldwide public health problem. In the United States, there is a rising incidence and prevalence of kidney failure, with poor outcomes and high cost. There is an even higher prevalence of earlier stages of chronic kidney disease. Increasing evidence, accrued in the past decades, indicates that the adverse outcomes of chronic kidney disease, such as kidney failure, cardiovascular disease, and premature death, can be prevented or delayed. Earlier stages of chronic kidney disease can be detected through laboratory testing. Treatment of earlier stages of chronic kidney disease is effective in slowing the progression toward kidney failure. Initiation of treatment for cardiovascular risk factors at earlier stages of chronic kidney disease should be effective in reducing cardiovascular disease events both before and after the onset of kidney failure.

At Hopkins GIM, our faculty are investigating several different aspects of the CKD epidemic, including: (1) genetics of CKD; (2) natural history of CKD and transition to renal failure; (3) screening for CKD in the general population; (4) optimal treatment to prevent progression; (5) optimal regime once renal replacement therapy is required; and (6) epidemiology and prevention of vascular complications in end-stage renal disease.

In any given 1-year period, 9.5 percent of the population, or about 20.9 million American adults, suffer from a depressive illness. The economic cost for this disorder is high, but the cost in human suffering cannot be estimated. Depressive illnesses often interfere with normal functioning and cause pain and suffering not only to those who have a disorder, but also to those who care about them. Serious depression can destroy family life as well as the life of the ill person. Depression is also imposes a major economic burden via lost productivity. Depression may also increase the risk of a variety of other common diseases, including ischemic heart disease and type 2 diabetes. 

Most individuals with depression seek care from general internists and other primary care providers; few seek care from mental health specialists. In contrast, the care of bipolar disorder and schizophrenia are supervised by psychiatrists and other specialists.  However, these forms of serious mental illness are often complicated by medical conditions that complicate their care and confer significant mortality risk. In many cases, these comorbid conditions arise as adverse effects of antipsychotic medications. 

Type 2 diabetes already affects 20 million Americans, and its prevalence is rising to epidemic proportions worldwide. At Hopkins, GIM research faculty, with National Institutes of Health and American Diabetes Association support, are combating diabetes across a range of fronts including clinical, social, genetic, and molecular epidemiology; health services research; psychology and health behavior; and randomized, controlled trials. Our focus is on prevention of diabetes and its complications, effective management of diabetes by development of and application of evidence-based treatment strategies, and by the identification of novel risk factors that can be modified by clinical treatment, behavior change, and/or public health policy. Hopkins GIM is proud to serve as a collaborative home for diabetes researchers across the Hopkins campus, including faculty from Endocrinology (Drs. Sherita Golden and Rita Kalyani), Cardiology (Dr. Kerry Stewart), Pathology (Dr. Mark Halushka), Physical Medicine and Rehabilitation (Dr. Pegah Touradji), and Nursing (Dr. Jerilyn Allen).

According to the U.S. Department of Health and Human Services, health disparities are differences in health that are closely linked with social or economic disadvantage. Health disparities adversely affect groups of people who have systematically experienced greater social and/or economic obstacles to health based on their racial or ethnic group; religion; socioeconomic status; gender; age; mental health; cognitive, sensory, or physical disability; sexual orientation; geographic location; or other characteristics historically linked to discrimination or exclusion. Groups currently experiencing poorer health status are expected to grow as a proportion of the total U.S. population; therefore, the future health of America as a whole will be influenced substantially by our success or failure in improving the health of these groups. A national focus on disparities in health status is particularly important as major changes unfold in the way in which health care is delivered and financed.

Eliminating racial and ethnic disparities in health will require enhanced efforts at preventing disease, promoting health and delivering appropriate care. This will necessitate improved collection and use of standardized data to correctly identify all high risk populations and monitor the effectiveness of health interventions targeting these groups. Eliminating health disparities will also require new knowledge about the determinants of disease, causes of health disparities, and effective interventions for prevention and treatment. It will require improving access to the benefits of society, including quality preventive and treatment services, as well as innovative ways of working in partnership with health care systems, state and local governments, tribal governments, academia, national and community-based organizations, and communities. Hopkins GIM faculty are working on several health disparities focus areas identified by the Department of Health and Human Services--Cancer screening and management; Cardiovascular Disease; Diabetes; HIV/AIDS, and Patient-Provider Communication--with particular attention to the health of African Americans.

AIDS (acquired immunodeficiency syndrome) was first reported in the United States in 1981, and has since become a major worldwide epidemic. AIDS is caused by HIV (human immunodeficiency virus). More than 900,000 cases of AIDS have been reported in the United States since 1981. As many as 950,000 Americans may be infected with HIV, one-quarter of whom are unaware of their infection. The epidemic is growing most rapidly among minority populations and is a leading killer of African-American males ages 25 to 44. According to the Centers for Disease Control and Prevention (CDC), AIDS affects nearly seven times more African Americans and three times more Hispanics than whites. At Hopkins, general internists work closely with their colleagues in infectious disease to treat and investigate HIV/AIDS with particular attention to 1) the organization, costs, and quality of care; 2) comorbid medical and mental illness in people with HIV/AIDS; and 3) metabolic complications of antiretroviral therapy.

High blood pressure affects 65 million Americans. Another 59 million Americans have prehypertension, which increases their chances of developing Research Training Program in Behavioral Aspects of Heart and Vascular Diseases. People over 55 have a 90 percent chance of developing high blood pressure in their lifetime. High blood pressure is a major risk factor for 3 of the 10 leading causes of death in the United States: heart disease (#1), stroke (#3), and kidney disease (#9) (source: National Center for Health Statistics). As the United States population becomes older—and increasingly overweight and obese—high blood pressure will become an even bigger problem. Hypertension imposes an especially heavy burden on the health of African Americans. Hypertension can be prevented by lifestyle modification, including weight loss and salt reduction, but the achievement of these goals in primary care has been disappointing. At Johns Hopkins, GIM faculty are engaged in the investigation and treatment of hypertension across the full range of its natural history.

Medical education research may include evaluation of the transfer or acquisition of knowledge, attitudes or skills in any topic relevant to human health among any type of learner, including health professionals, students in the health professions, and patients. Topics often fall into one of the six professional core competencies (i.e., patient care, medical knowledge, practice-based learning and improvement, interpersonal and communication skills, systems-based practice, and professionalism) defined by the Accreditation Council of Graduate Medical Education. Legitimate outcome measures include changes in knowledge, attitudes, skills, behaviors, and even patient outcomes. 

The Division of General Internal Medicine has faculty actively pursuing medical education research throughout all of medical training (i.e. medical school, residency training, and continuing medical education) as well as patient education. Areas of study have included patient care, medical knowledge, clinical skills, communication skills, ethics, and professionalism. Funding has come not only from NIH grants but from an internal, philanthropic-based scholarship fund, The Osler Fund for Clinical Scholars. The Johns Hopkins Internet Learning Center was also developed by members of the Division as a teaching and evaluation tool for medical residents that has launched several medical education studies.

During the past 20 years, obesity among adults has risen significantly in the United States. The latest data from the National Center for Health Statistics show that a third of U.S. adults 20 years of age and older—over 100 million people—are obese. This increase is not limited to adults, but has also affected young people. Among youth, 18 percent of children aged 6-11 years and 21 percent of teens aged 12–19 years are considered obese. These rates of obesity have substantial implications for Americans’ health. Being obese increases the risk of many diseases and health conditions, including: 1) High blood pressure (hypertension); 2) High cholesterol (dyslipidemia); 3) Type 2 diabetes; 4) Coronary heart disease (heart attack); 4) Stroke; 5) Gallbladder disease; 6) Arthritis; 7) Sleep apnea; and 8) Some cancers (endometrial, breast, and colon).

Although one of the national health objectives for the year 2020 is to reduce the prevalence of obesity among adults by 10 percent, current data indicate that the situation is not improving. Hopkins GIM faculty members are investigating obesity across the full range of its natural history and complications, as well as working to combat the epidemic by researching various strategies and interventions.

Research in the Palliative Medicine Program seeks to:

• Identify and fix common symptoms by developing new methods of patient-reported outcomes.
• Develop new ways to fix common and uncommon symptoms such as dyspnea, malignant ascites and chronic pain.
• Develop better ways to communicate goals of care and life planning with compassion and maintained hope.
• Increase knowledge about the impact of palliative care alongside usual care.
• Expand palliative care to populations not previously studied, such as phase I patients.

Learn more about Palliative Care research

Pharmacoepidemiology is the study of the utilization and effects of drugs in large numbers of people; it provides an estimate of the probability of beneficial effects of a drug in a population and the probability of adverse effects. It can be called a bridge science spanning both clinical pharmacology and epidemiology. Pharmacoepidemiology concentrates on clinical patient outcomes from therapeutics by using methods of clinical epidemiology and applying them to understanding the determinants of beneficial and adverse drug effects, effects of genetic variation on drug effect, duration-response relationships, clinical effects of drug-drug interactions, and the effects of medication non-adherence. Pharmacovigilance is a part of pharmacoepidemiology that involves continual monitoring, in a population, for unwanted effects and other safety concerns arising in drugs that are already on the market. Pharmacoepidemiology sometimes also involves the conduct and evaluation of programmatic efforts to improve medication use on a population basis. 

Hopkins GIM faculty members have a growing presence in the field of pharmacoepidemiology. The Center for Drug Safety and Effectiveness at Johns Hopkins was launched in 2012 and is co-directed by general internists Jodi Segal, MD, MPH and G. Caleb Alexander, MD, MS, with Sonal Singh, MD, MPH as an Associate Director along with Kenneth Shermock, PharmD, PhD. The goal of the Center is to improve the safe and effective use of medications. Drawing on the combined expertise of the Johns Hopkins School of Medicine and the Johns Hopkins Bloomberg School of Public Health, the Center serves as a nexus for individuals at Johns Hopkins who are involved in research, education, clinical programs and public service to improve prescription drug use and pharmaceutical policy in the United States and around the world. In addition to its work with trainees and junior faculty, the Center is actively initiating partnerships and collaborations with a variety of other stakeholders vested in addressing core problem areas ranging from prescription drug abuse to barriers to accessible and affordable medicines in developing countries.

According to the Substance Abuse and Mental Health Services Administration, in 2013, 8.2% of the U.S. population age 12 and older met criteria for substance abuse or dependence in the previous year. Rates for at-risk substance use are higher with an estimated 9.4% reporting past month illicit drug use and nearly one quarter, 22.9% reporting past month binge drinking. The health burden of substance use is great and includes: harmful effects of acute intoxication, substance use associated injury and violence, and the consequences of numerous medical and psychiatric disorders associated with chronic alcohol, tobacco and other drug use. One in four deaths in the U.S. is attributed to alcohol, tobacco, and/or illicit drugs.

A 2006 Institute of Medicine report recommended better coordination of mental health and substance-related services with general health care services. Hopkins GIM faculty work closely with their colleagues in the Department of Psychiatry and Behavioral Sciences, Welch Center for Prevention, Epidemiology and Clinical Research, and the Schools of Nursing and Public Health in several innovative treatment programs, in curriculum development and medical education, and in the following research areas: 1) race/ethnicity and gender differences in risks for, progression of, and services for at-risk substance use and use disorders; 2) screening and brief intervention for hazardous substance use in diverse medical and community-based settings; 3) the impact of alcohol and other drug use on adherence and health outcomes in HIV-infected persons; 4) relationship between trauma exposure and substance use; and 5) the impact of substance use on chronic disease management, healthcare utilization, and mortality.

Behavioral Medicine is the interdisciplinary field concerned with the development and integration of behavioral, psychosocial, and biomedical science knowledge and techniques relevant to the understanding of health and illness, and the application of this knowledge and these techniques to prevention, diagnosis, treatment and rehabilitation. As such, behavioral medicine constitutes a core discipline for general internal medicine. Hopkins GIM is home to one of the nation’s oldest training grants in behavioral and preventive medicine, Research Training Program in Behavioral Aspects of Heart and Vascular Diseases, sponsored by the NHLBI and co-directed by Dr. Felicia Hill-Briggs and the founding program director Dr. David Levine. An enhanced behavioral science curriculum features content in Lifestyle and Behavior Change and Maintenance, Social and Cultural Factors, and Cognition/Neuropsychology of Heart and Vascular Diseases.

The American Heritage Dictionary defines statistics as: "The mathematics of the collection, organization, and interpretation of numerical data, especially the analysis of population characteristics by inference from sampling." The Merriam-Webster's Collegiate Dictionary definition is: "A branch of mathematics dealing with the collection, analysis, interpretation, and presentation of masses of numerical data." The steps of statistical analysis involve collecting information, evaluating it, and drawing conclusions.

Statisticians provide crucial guidance in determining what information is reliable and which predictions can be trusted. They often help search for clues to the solution of a scientific mystery, and sometimes keep investigators from being misled by false impressions. Statisticians help determine the sampling and data collection methods, monitor the execution of the study and the processing of data, and advise on the strengths and limitations of the results. They must understand the nature of uncertainties and be able to draw conclusions in the context of particular statistical applications.

Statistical planning, analysis, and inference is so crucial to the kind of research conducted by Hopkins GIM researchers that the Division has built a cadre of in-house methodologists, trained in epidemiology and biostatistics, who work side-by-side with content-oriented clinical researchers and their trainees.

The average physician conducts between 140,000 and 160,000 medical interviews in the lifetime of his or her practice, making it the most frequently used medical procedure. Strong evidence links interpersonal processes of care to a variety of positive outcomes. For example, in studies done by faculty at Johns Hopkins and elsewhere, patients who report greater involvement in medical care are more satisfied with their physicians, report more understanding, reassurance and perceived control over their illness, and have improvements in medical conditions. Patients who explicitly report being treated with respect and dignity have higher trust, are more adherent to care and are more likely to receive optimal preventive care.

Studies that have directly observed patient-physician communication have demonstrated a positive effect of physician communication behaviors on patient outcomes including pain relief, satisfaction, compliance, and recall of information. In their interactions with African-American patients, physicians have been shown to exhibit less nonverbal attention, empathy, courtesy, and information giving, to adopt a more “narrowly biomedical” communication style, to spend less time providing health education, chatting and answering questions, and to be more verbally dominant and exhibit more negative emotional tone than with white patients. Finally, studies have found that physicians offer more information and have a more positive affect with patients for whom they report having a great deal of respect, that patients are fairly well able to judge whether or not their physician has respect for them.

Faculty in Hopkins GIM have interests and expertise in examining a variety of the interpersonal aspects of health care delivery. Faculty use standard methods such as direct observation of patient-provider encounters using audiotaped analysis and patient experience of care using patient ratings, and have forged novel areas such as the impact of race/ethnicity on the patient-provider relationship and the impact of healthcare providers’ attitudes on patient experiences and outcomes.

Comparative effectiveness research is research aimed evaluating and comparing the implications and outcomes of two or more health care strategies to address a particular medical condition. The goal of comparative effectiveness research is to generate better information about the risks and benefits and costs of different treatment options in order to provide health-care decision makers—including patients, clinicians, purchasers, and policymakers—with up-to-date, evidence-based information about their treatment options to make informed health care decisions. 

In the Division of General Internal Medicine, investigators design and conduct comparative effectiveness studies in diverse fields including in diabetes, obesity, and depression management. Several of the active projects are funded by the DEcIDE Network of the Agency for Healthcare Research and Quality. Since 2005, this Network has funded practical studies about the outcomes, comparative clinical effectiveness, safety, and appropriateness of health care items and services.

A randomized control trial (RCT) is a scientific procedure most commonly used in testing medicines or medical procedures. It is a trial that uses randomized control. This is considered the most reliable form of scientific evidence because it eliminates all forms of cognitive bias. The basic idea is that treatments are allocated to subjects at random. This ensures that the different treatment groups are 'statistically equivalent'. 

Sellers of medicines throughout the ages have had to convince their consumers that the medicine works. As science has progressed, public expectations have risen, and government health budgets have become ever tighter, pressure has grown for a reliable system to do this. Moreover, the public's concern for the dangers of medical interventions has spurred both legislators and administrators to provide an evidential basis for licensing or paying for new procedures and medications. In the United States, new medicines must undergo trials to earn FDA approval.  Such trials are typically sponsored by the manufacturer and progress from smaller phase I and II studies designed to establish side effects and optimal dose to larger phase III studies designed to establish efficacy against placebo or against an existing drug. 

In contrast, RCTs in Hopkins GIM focus not on industry-sponsored tests of new drugs, but rather on NIH-funded tests of (a) behavioral interventions, (b) health care interventions, (c) dietary modifications, (d) low-cost minerals or food supplements, or (e) comparative efficacy between drugs already on the market.

Epidemiology is the scientific study of factors affecting the health and illness of individuals and populations, and serves as the foundation for interventions made in the interest of public health and preventive medicine. It is considered a cornerstone methodology of public health research, and is highly regarded in evidence-based medicine for identifying risk factors for disease and determining optimal treatment approaches to clinical practice. 

Many research-oriented GIM Divisions focus narrowly on one or two aspects of epidemiology, like clinical decision-making, meta-analysis, or pharmacoepidemiology. Because of its close, historic relationship with the Department of Epidemiology at the Johns Hopkins Bloomberg School of Public Health, Hopkins GIM offers unparalleled scope and depth, encompassing topics of traditional interest to generalists, but extending to clinical trials and emerging areas, like social, molecular, and genetic epidemiology. The unifying features of epidemiologic research conducted by Hopkins GIM faculty are: 1) commitment to a multi-disciplinary approach; and 2) rapid translation from epidemiologic discovery into clinical and public health practice. 

Evidence-based medicine is the integration of best research evidence with clinical expertise and patient values. Evidence-based medicine is an interdisciplinary approach which uses techniques from science, engineering, biostatistics and epidemiology, such as meta-analysis, decision analysis, risk-benefit analysis, and randomized controlled trials to deliver “ the right care at the right time to the right patient.” (Source : AHRQ)

Evidence-Based Medicine (EBM) aims for the ideal that healthcare professionals should make "conscientious, explicit, and judicious use of current best evidence" in their everyday practice. The practice of evidence-based medicine uses systematic reviews of the medical literature to evaluate the best evidence on specific clinical topics (evidence synthesis). The evidence is then translated into practice by medical practitioners who select treatment options for specific cases based on the best research, patient preferences and individual patient characteristics (knowledge translation). Evidence-based medicine practitioners engage in life-long learning and are committed to the continuing education of professionals and patient communities.

Genetic Epidemiology is defined by an amalgam of methods garnered from traditional epidemiology, population and family-based epidemiology, from statistics, and importantly, from bioinformatics. Together, specific aspects of these disciplines are applied to the study of genes and environment, and of gene environment interactions. Both quantitative and qualitative traits may be of interest. Genetic epidemiology uses unique case-control, family, and population-based designs, and genotyping from multiple sources. Our goal has been to learn about genetic susceptibility to disease and genetic determinants of therapeutic responsiveness. A full series in genetic epidemiology is offered in The Johns Hopkins Bloomberg School of Public Health.

Health services research is the multidisciplinary field of scientific investigation that studies how social factors, financing systems, organizational structures and processes, health technology, and personal behaviors affect access to health care, quality and cost of health care, and ultimately our health and well-being. The main goals of health services research are to identify the most effective ways to organize, manage, finance, and deliver high-quality care; reduce medical errors; and improve patient safety. Many Hopkins GIM faculty are experts in health services research, with interests organized around specific content areas.

Outcomes research seeks to understand the end results of particular health care practices and interventions. End results include effects that people experience and care about, such as change in the ability to function. In particular, for individuals with chronic conditions—where cure is not always possible—end results include quality of life as well as mortality. By linking the care people get to the outcomes they experience, outcomes research has become the key to developing better ways to monitor and improve the quality of care. Supporting improvements in health outcomes is a strategic goal of the Agency for Healthcare Research and Quality. 

Outcomes research has altered the culture of clinical practice and health care research by changing how we assess the end results of health care services. In doing so, it has provided the foundation for measuring the quality of care. The results of AHRQ outcomes research are becoming part of the "report cards" that purchasers and consumers can use to assess the quality of care in health plans. For public programs such as Medicaid and Medicare, outcomes research provides policymakers with the tools to monitor and improve quality both in traditional settings and under managed care. Outcomes research is the key to knowing not only what quality of care we can achieve, but how we can achieve it. Several faculty members in Hopkins GIM are internationally recognized experts in outcomes research.  

Qualitative research is a field of inquiry that crosscuts disciplines and subject matters.  There are three major approaches to qualitative research: ethnography (drawn from anthropology); phenomenology (drawn from philosophy) and grounded theory (drawn from sociology).  Typically, the research questions addressed by qualitative methods are discovery-oriented, descriptive and exploratory in nature.  Qualitative researchers aim to gather an in-depth understanding of human behavior and the reasons that govern human behavior.  Various aspects of behavior could be based on deeply held values, personal perspectives, experiences and contextual circumstances.  

Qualitative research investigates the why and how of decision making, not just what, where, and when.  Therefore, the need is for smaller but focused samples rather than large random samples. Qualitative analysis involves categorizing data into patterns as the primary basis for organizing and reporting results.  Qualitative researchers typically rely on several methods for gathering information: (1) participation in the setting, (2) direct observation, (3) in depth interviews, (4) focus groups, and (5) analysis of documents and materials. 

Although it is common to draw a distinction between qualitative and quantitative aspects of scientific investigation, a mixed-methods approach (a combination of qualitative and quantitative techniques) is often used.  Qualitative research is, in some cases, instrumental to developing an understanding of a phenomenon as a basis for quantitative research. In other cases, it can inform or enrich our understanding of quantitative results.  Similarly, quantitative research may inform, or be drawn upon in the process of qualitative research.