Carol M. Ashton, M.D., M.P.H.

Co-Director of Center for Outcomes Research
John F., Jr. and Carolyn Bookout Professor of Surgical Quality and Outcomes Sciences
Department of Surgery
Methodist Hospital Research Institute
Email: cashton@tmhs.org Discipline: Medicine, Health Services Research

Investigator Award
Improving the Evidence Base for Invasive Therapeutic Procedures
Award Year: 2007 Despite the American fascination with high-tech medicine, new treatments don't always deliver desired cures or improvements. While pharmaceutical products must be rigorously tested and approved by the U.S. Food and Drug Administration before going to market, any surgeon or interventionist can provide a new therapeutic procedure without valid scientific proof of its effectiveness. This can pose real problems for people seeking to make health care decisions - whether it's a physician considering how to treat a medical problem, a health plan deciding whether to cover a procedure, or a patient considering surgery. Oftentimes, the evidence needed to make those decisions simply doesn't exist. Carol M. Ashton, M.D., M.P.H., and Nelda P. Wray, M.D., M.P.H. explore how studies that generate evidence of what works bestby comparing alternatives can be applied to surgical and other therapeutic procedures. They examine how payment incentives might be used to encourage physicians and patients to help generate the data needed to quantify the risks and benefits of procedures and to create the evidence upon which more informed treatment decisions can be made. Their project, Improving the Evidence Base for Invasive Therapeutic Procedures, should help inform the design of payment policies to promote the use of procedures with scientifically proven benefits and reduce the use of those for which safer, more effective, and less expensive alternatives exist.

Background

Carol M. Ashton is the John F., Jr. and Carolyn Bookout Professor of Surgical Quality and Outcomes Sciences and co-director of the Center for Outcomes Research at Houston Methodist Hospital. She holds an M.D. from the University of Texas Medical Branch in Galveston. She completed an internal medicine residency at the Baylor College of Medicine Affiliated Hospitals and is board-certified in internal medicine. She also holds an M.P.H. from the University of Texas School of Public Health. In July 2008 she joined The Methodist Hospital in Houston, Texas as research scientist in the department of surgery and senior member of The Methodist Hospital Research Institute. Between 2006 and 2008 she served as professor of medicine in the division of preventive medicine at the University of Alabama School of Medicine. Before that Dr. Ashton was on the faculty of Baylor College of Medicine and a full-time VA physician at the Houston VA Medical Center. She served as chief of Baylor's Section of Health Services Research from 2003-6. From 1998-2006 she served as director of the Houston Center for Quality of Care and Utilization Studies, a VA-funded health services research center of excellence, a center she helped establish in 1990. Dr. Ashton has an extensive history of federal and non-federal sponsored research. Her work includes several analyses of the effects of policy changes on the utilization rates of health services in the Veterans Health Administration, two of which were published in the New England Journal of Medicine. Other research has included the effects of problems in doctor-patient communication on the rates of use and outcomes of health services in minority patients. She served as co-editor-in-chief of Medical Care from 2000-6. In 2004 she received VA's highest health services research award, the Under Secretary for Health's Award for Outstanding Achievement in HSR. Dr. Ashton's enduring research interest is the assessment and improvement of quality of care. She is pursuing a research agenda devoted to improving the scientific evidence base for invasive therapeutic procedures.