In 2018, Dr. Peter Watson gave his presidential address to the Ulster Medical Society by asking the question, “What is a Physician”. He talked about how a physician parallels a detective with evidence-based learning, as they both observe, recognize patterns, create a methodology based on the evidence then publish their findings.
Kimberly Fisher, MD, Division of Pulmonary, Allergy and Critical Care, embodies evidence-based learning; whether it is mentoring, in her own practice, or in her own research. For this, she is this month’s Chair Spotlight.
The common theme of her research, a focus on increasing uptake of underutilized evidence-based treatments and practices, as well as provider-patient communication has been the foundation of her research.
Dr. Fisher’s first research project was a quality improvement project at UMMH that focused on limiting unnecessary blood transfusions in the intensive care unit. When looking back she explained, “I became interested in the topic of potentially avoidable blood transfusions, after seeing some benchmark data that indicated that our ICUs (along with many others) were transfusing patients more liberally than strong evidence suggested was appropriate. With the support of the Critical Care Operations Committee, we created an interdisciplinary working group to address potentially avoidable blood transfusions. Over time, we were able to change transfusion practices to the evidence-based restrictive transfusion practice currently in place. This project is what started my interest in implementation science.”
Subsequently, she worked on increasing the use of NIV (non-invasive ventilation) for patients with respiratory failure in the ICU and her research on provider-patient communication, which focused on communication following a breakdown in care and the importance of an apology.
At the start of the COVID-19 pandemic, Dr. Fisher, with her mentor, Professor Kathy Mazor, EdD, Division of Geriatric Medicine and Associate Director of the Meyers Primary Care Institute, started to think about what aspect of the pandemic their research expertise could help address. It was Kathy’s idea to think ahead on views of a potential vaccine.
Dr. Fisher was surprised, “This was really prescient of Kathy, given that a vaccine did not seem to be on the horizon at the time.”
Together they developed the questions for the survey and administered it as part of an omnibus survey that NORC (survey company) administers every two weeks. This allowed them a quick turnaround of the survey and a representative sample of the US population. The survey went out in April 2020.
The findings of the survey were published in Annals of Internal Medicine. Dr. Fisher shared how the results of the survey were quite alarming, as their findings identified race and education (a marker for lower health literacy and socioeconomic status) as strong predictors of COVID-19 vaccine hesitancy. These predictors overlapped the same groups shown to be disproportionately impacted by COVID-19.
The research not only provided awareness towards vaccine hesitancy but ultimately served as an important tool to limit the racial and ethnic disparities during the pandemic. From here, Dr. Fisher lead the Worcester COVID-19 Vaccination Campaign which is a joint endeavor between the Meyers Primary Care Institute, City of Worcester Division of Public Health, and the Health Foundation of Central Massachusetts, where they encourage vaccinations of vulnerable populations, through the use of trusted messengers (PCPs and community based-organization staff).
Where does Dr. Fisher go from here? She is currently conducting a study showing, how some individuals who were originally reluctant to be vaccinated in January 2021, have since decided to get vaccinated because the CDC relaxed mask guidelines which made them more concerned about infection.
Aside from the vaccination efforts, she has most recently examined what patients understand their outpatient clinic notes, which is of increasing relevance in the context of the Information Blocking Rule that recently went into place.
Additionally, she recently received an R01 from the National Institute of Minority Health and Health Disparities to develop and test an intervention to support evidence-based PCP recommendations for vaccination to their patients.