Ethan A. Halm, MD, MPH
Internal Medicine and Clinical Sciences

Ethan A. Halm, MD, MPH is Professor of Internal Medicine and Clinical Sciences at the University of Texas, Southwestern Medical Center in Dallas, TX, and Chief of the Division of General Internal Medicine. Dr. Halm is a practicing academic general internist who is actively involved in clinical epidemiology, outcomes and health services research.
Dr. Halm's research focuses on understanding the patient, provider, and system factors that influence the quality, appropriateness, and outcomes of care, and then using these insights to develop interventions to improve quality and outcomes of care. Specific clinical topics of interest include: asthma, community-acquired pneumonia, diabetes, cerebrovascular disease, carotid endarterectomy, thromboembolic disease, and hip fracture. He research uses the tools of clinical epidemiology, outcomes, effectiveness, and health services research, risk adjustment, clinical predication rules, health psychology, behavioral medicine, and quality improvement. He has done work on: measuring overuse, underuse, and misuse in health care, developing strategies to improve quality and efficiency, practice guidelines, changing patient, physician, and organizational behavior, assessing the impact of patient health beliefs on medication adherence and self-management, examining volume-outcome relationships in health care, improving chronic disease management, health disparities, patient safety, medical errors, and cost-effective use of medications.

Active projects with opportunities for Doris Duke students include:
1. "Understanding the patient, physician, and system factors that influence adherence, self-management and outcomes among inner city asthmatics" This is a NIH funded prospective observational cohort study to identify self-regulation beliefs, medication adherence, self-management behaviors, and outcomes among inner city adults with persistent asthma.

Prior Doris Duke students have successfully completed projects working on this parent asthma cohort study including:

A. Stephen Berns: (Mount Sinai School of Medicine, NY) Berns SH, Halm EA, Sampson HA, Sicherer SH, Busse PJ, Wisnivesky JP. Food allergy as a risk factor for asthma morbidity in adults. J Asthma 2007, 44:377-81.

B. Jessica Cohen: (Mount Sinai School of Medicine, NY) Cohen, JL, Mann DM, Wisnivesky JP, Leventhal H, Mususmeci TJ, Halm EA. Assessing the Validity of Self-Reported Medication Adherence Among Inner City Asthmatic Adults. Am J Resp Crit Care Med. 2008:177. A571.

2. "Long term outcomes of carotid endarterectomy" Carotid endareterectomy (CEA) is surgery to prevent stroke by removing atherosclerotic plaque from the internal carotid artery. This is a NIH funded grant based on the New York Carotid Artery Surgery Study, a population-based cohort of 10,000 Medicare beneficiaries having stroke prevention surgery. The Specific Aims of this proposal are to:
A. Determine the generalizability of the CEA RCTs by comparing the long term outcomes of CEA (death and stroke-free survival) performed in community practice using the population-based, New York Carotid Artery Surgery (NYCAS) Medicare cohort study to those reported in the RCTs.
B. Assess the effectiveness of surgical (CEA) v. medical management of carotid disease among the elderly in community practice using two methods:
1) Comparing long term outcomes of Medicare patients who underwent CEA in NYCAS to similar patients with carotid disease in the Cardiovascular Health Study (CHS) who did not have surgery ("Between Study" analyses); and
2) Comparing long term outcomes of elders with carotid disease in CHS who were surgically (CEA) v. medically managed using propensity score methods ("Within CHS Study" analyses).
C. Examine differences in long term outcomes of CEA in the elderly according to: age, comorbidities, RCT eligibility, gender, race/ethnicity, and clinical indication (symptomatic v. asymptomatic), and develop and validate a multivariate clinical model to predict long term risk of death and stroke.
D. Identify the independent process of care, surgeon, and hospital factors that influence risk-adjusted stroke-specific survival to inform best practices and policies.