DF/HCC Program Affiliation

Breast Cancer
Outcomes Research

Research Abstract

My research focuses on quality of care in surgery and surgical oncology, particularly patient safety, disparities, healthcare utilization, and quality measurement. During residency, I earned a Masters of Public Health from Harvard as part of a two-year research fellowship. My current research activity builds upon the studies I performed during this fellowship.
The first set of projects study patient safety and my mentor is Dr. Atul Gawande at BWH CSPH. During residency, I worked with a multi-disciplinary team to explore the impact of human factors on performance and safety in the operating room (OR). We identified communication and workload as the 2 most important system features. During my surgical oncology fellowship, I performed several studies to investigate these issues further. We used malpractice claims to identify recurring patterns in communication breakdowns, leading to several quality improvement initiatives. A second project investigated the counting protocol, a source of high workload during an operation. We performed a randomized, controlled trial to determine if bar codes could help track sponges in the OR.
My other research interest is quality of care in surgical oncology and Dr. Jane Weeks at DFCI COPR is my mentor. I am interested in developing methods for measuring quality and understanding variations in utilization and quality at both the patient and institution level. Surgical volume has been proposed as a proxy to measure quality. During residency, we developed a new methodology to empirically determine the optimal threshold for defining “high volume”. I used data from the National Comprehensive Cancer Network (NCCN) to demonstrate socioeconomic (SES) variations in the utilization of post-mastectomy reconstruction. Last year, I explored the role that patient-provider interactions play in the etiology of these socioeconomic differences. One potential explanation for variations in the use of surgical procedures lies in structural differences at the institutional level and the fact that patients of similar SES may cluster within institutions. I am currently using data from NCCN and SEER-Medicare to explore this hypothesis.

Publications

• Greenberg CC, Regenbogen SE, Lipsitz SR, Diaz-Flores R, Gawande AA.The frequency and significance of discrepancies in the surgical count.Ann Surg 2008 Aug;248(2):337-41.
  18650646
• Greenberg CC, Schneider EC, Lipsitz SR, Ko CY, Malin JL, Epstein AM, Weeks JC, Kahn KL.Do variations in provider discussions explain socioeconomic disparities in postmastectomy breast reconstruction?.J Am Coll Surg 2008 Apr;206(4):605-15.
  18387464
• Greenberg CC, Diaz-Flores R, Lipsitz SR, Regenbogen SE, Mulholland L, Mearn F, Rao S, Toidze T, Gawande AA.Bar-coding surgical sponges to improve safety: a randomized controlled trial.Ann Surg 2008 Apr;247(4):612-6.
  18362623
• Greenberg CC, Regenbogen SE, Studdert DM, Lipsitz SR, Rogers SO, Zinner MJ, Gawande AA.Patterns of communication breakdowns resulting in injury to surgical patients.J Am Coll Surg 2007 Apr;204(4):533-40.
  17382211
• Christian CK, Gustafson ML, Roth EM, Sheridan TB, Gandhi TK, Dwyer K, Zinner MJ, Dierks MM.A prospective study of patient safety in the operating room.Surgery 2006 Feb;139(2):159-73.
  16455323
• Christian CK, Niland J, Edge SB, Ottesen RA, Hughes ME, Theriault R, Wilson J, Hergrueter CA, Weeks JC.A multi-institutional analysis of the socioeconomic determinants of breast reconstruction: a study of the National Comprehensive Cancer Network.Ann Surg
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