Doctor as Designer
Joyce Lee, MD, MPH

Research

 

 

Research

I am a pediatric translational researcher and was named the Robert P. Kelch Professor of Pediatrics in 2016. As one of the few individuals across the country who has completed dual training in Pediatric Endocrinology and Pediatric Health Services Research and a Master in Public Health, my research agenda focuses on the overarching themes of obesity and type 1 and type 2 diabetes. Because of my specialized training, I have been able to approach these problems from a unique vantage point, using a variety of methodologies including applied clinical research, epidemiologic analyses of nationally representative data, state transition modeling, cost-effectiveness analysis, as well as design and emerging technologies (design ethnography, participatory design, human-centered design, quality improvement science, and digital/social media communications). To date, I have 100 peer-reviewed publications, and I am first or senior author on 58 of those publications. You can link to my CV here.

At the 2016 Pediatric Academic Societies meeting, I was the first recipient of the Paul Kaplowitz, MD, Endowed Lectureship for my contributions to quality and cost-effective care in Pediatric Endocrinology, an award sponsored by the American Academy of Pediatrics and the Pediatric Endocrine Society. My major research contributions have included studies evaluating recommended screening guidelines for type 2 diabetes for overweight and obese children, studies evaluating the link between overweight and obesity and timing of puberty and chronic disease risk factors, studies focused on quality measurement and quality of care for overweight and obese children, and research in health outcomes for type 1 diabetes.

My current work is focused on:

•Creating learning health systems in obesity and diabetes using the methods of clinical informatics, quality improvement, and patient-centered participatory design

•Biomarker discovery for prediabetes and diabetes in children

•Creating opportunities for patient-driven open science research using the tools of social media

•Use of emerging technologies for supporting patient engagement with health data

I also lead an interdisciplinary collaborative called HealthDesignBy.Us, which supports the creation of maker movement for healthcare, creating opportunities for patients and caregivers to co-create tools, technologies, and systems for healthcare.


 

Highlights of my research contributions:

1. I have conducted a series of studies that have important policy implications for the screening and diagnosis of diabetes in children and adolescents, assessing the test performance, efficacy, and cost-effectiveness of Hemoglobin A1c and a variety of other screening methods for prediabetes and diabetes.

Lee JM, Gebremariam A, Wu E, LaRose J, Gurney JG. Evaluation of nonfasting tests to screen for childhood and adolescent dysglycemia. Diabetes Care 2011;34(12):2597-602. PMCID: PMC3220868

Lee JM, Wu E, Herman WH, Tarini BA, Yoon EY. Diagnosis of diabetes using Hemoglobin a1c: should recommendations in adults be extrapolated to adolescents? J Pediatr 2011;158(6):947-952.e3. PMCID: PMC3210198

Wu E, Kazzi N, Lee JM. Cost-effectiveness of screening strategies for identifying pediatric diabetes and dysglycemia. JAMA Pediatr. 2013 Jan 1;167(1):32-9. PMCID: PMC3837695

Lee JM, Eason A, Nelson C, Kazzi NG,* Cowan AE, Tarini BA. Screening practices for identifying type 2 diabetes in adolescents.  J Adolesc Health. 2013 Feb;54(2):139-43. doi: 10.1016/j.jadohealth.2013.07.003. Epub 2013 Aug 20.

Vajravelu ME, Lee JM. Identifying Prediabetes and Type 2 Diabetes in Asymptomatic Youth: Should HbA1c Be Used As a Diagnostic Approach? Curr Diab Rep. 2018 Jun 4;18(7):43.

2. I have studied the impact of emerging technologies (mobile technology and social media) and the maker movement on health outcomes through a research collaboration with the Nightscout community,  a global online community of 30,000 patients and caregivers with diabetes who have created their own do it yourself technology innovations for diabetes. I am also collaborating with the community to create opportunities for patient-driven open science research using the Open Humans platform.  Please learn more about studies using the Nightscout data commons here.

Lee JM, Hirschfeld E, Wedding J. A Patient-Designed Do-It-Yourself Mobile Technology System for Diabetes: Promise and Challenges for a New Era in Medicine. JAMA. 2016 Apr 12;315(14):1447-8. Link. Supplement Link.

Lee JM, Newman MW, Gebremariam A, Choi P, Lewis D, Nordgren W, Costik J, Wedding J, West B, Benovich Gilby N, Hannemann C, Pasek J, Garrity A, Hirschfeld E. Real-World Use and Self-Reported Health Outcomes of a Patient-Designed Do-it-Yourself Mobile Technology System for Diabetes: Lessons for Mobile Health. Diabetes Technol Ther 2017 Feb 28. Link.

Kaziunas E, Lindtner S, Ackerman MS and Lee JM. Lived data: Tinkering with bodies, code and care work. Human-Computer Interaction, Special Issue on The Examined Life: Personal Uses of Personal Data. (Forthcoming)

White K, Gebremariam A, Lewis D, Nordgren W, Wedding J, Pasek J, Garrity A, Hirschfeld E, Lee JM. Motivations for Participation in an Online Social Media Community for Diabetes J Diabetes Sci Technol. 2018 Jan 1:1932296817749611. doi: 10.1177/1932296817749611. Link.

Awori J, Lee JM, A Maker Movement for Health: A New Paradigm for Health Innovation. JAMA Pediatr. 2017;171(2):107-108. PMID: 27992620

3. I have conducted a number of studies focused on measuring health utilization, costs, cost-effectiveness, and health policy issues for children with diabetes.

Lee JM, Sundaram V, Sanders L, Chamberlain L, Wise P. Health care utilization and costs of publicly-insured children with diabetes in California. J Pediatr. 2015 May 28. doi: 10.1016/j.jpeds.2015.04.067. [Epub ahead of print]

Wolfgram PM, Sarrault J, Clark SJ, Lee JM. State-to-state variability in Title V coverage for children with diabetes. J Pediatr 2013 Apr;162(4):873-5. doi: 10.1016/j.jpeds.2012.12.009. Epub 2013 Jan 13.

Lee JM, Davis MM, Gebremariam A, Kim C. Age and sex differences in hospitalizations associated with diabetes. J Womens Health (Larchmt) 2010 Nov;19(11):2033-42. Epub 2010 Oct 12.

Lee JM, Okumura MJ, Freed GL, Menon RK, Davis MM. Trends in hospitalizations for diabetes among children and young adults: United States, 1993-2004. Diabetes Care 2007;30:3035-3039.

Lee JM, Rhee K, O'Grady MJ, Basu A, Winn A, John P, Meltzer DO, Kollman C, Laffel LM, Lawrence JM, Tamborlane WV, Wysocki T, Xing D, Huang ES. Health utilities for children and adults with type 1 diabetes. Med Care 2011 Oct;49(10):924-31.

4. I have completed a number of epidemiologic studies linking obesity with a variety of outcomes in childhood. I have shown that girls with excess weight have earlier onset of puberty compared with their normal weight girls, but that obese boys have a later onset of puberty compared with their normal weight boys. I have also conducted studies to evaluate associations of overweight and obesity with hyperinsulinemia, hyperlipidemia, and inflammation and I have conducted modeling studies to evaluate the long-term health policy implications of childhood obesity.

Lee JM, Appugliese D, Kaciroti N, Corwyn RF, Bradley RH, Lumeng JC. Weight status in young girls and the onset of puberty. Pediatrics 2007;119:624-630.   

Lee JM, Kaciroti N, Appugliese D, Corwyn RF, Bradley RH, Lumeng JC. Body mass index and timing of pubertal initiation in boys. Arch Pediatr Adolesc Med 2010;164(2):139-44.

Lee, JM, Wasserman R, Kaciroti N, Gebremariam A, Steffes J, Dowshen S, Harris D, Serwint J, Abney D, Smitherman L, Reiter E, Herman-Giddens, ME. Timing of puberty in overweight versus obese boys. Pediatrics. 2016 Feb 137(2):e20150164. doi: 10.1542/peds.2015-0164. Epub 2016 Jan 27.

Lee JM, Okumura MJ, Davis MM, Herman WH, Gurney JG.  Prevalence and determinants of insulin resistance among U.S. adolescents: A population based study. Diabetes Care 2006;29:2427-2432.

Lee JM, Gebremariam A, Card-Higginson P, Shaw JL, Thompson, JW, Davis MM.  Poor performance of body mass index as a marker for hypercholesterolemia in children and adolescents.  Arch Pediatr Adolesc Med 2009;163(8):716-23.

Singer K,* Eng D,* Lumeng CN, Gebremariam A., Lee JM. The relationship between body fat mass percentiles and inflammation in children. Obesity (Silver Spring). 2014 May;22(5):1332-6. doi: 10.1002/oby.20710. Epub 2014 Feb 18.

Lee JM, Pilli S, Gebremariam A, Keirns CC, Davis MM, Vijan S, Freed GL, Herman WH, Gurney JG. Getting heavier, younger:  Birth cohort effects on obesity over the life course. Int J Obes (Lond). 2010 Apr;34(4):614-23. Epub 2009 Dec 1.

Lee JM, Lee H.* Obesity reduction within a generation: The dual roles of prevention and treatment. Obesity (Silver Spring) 2011 Oct;19(10):2107-10. doi: 10.1038/oby.2011.199. Epub 2011 Jun 30.

Lee JM, Gebremariam A, Vijan S, Gurney JG. Excess body mass index years, a measure of degree and duration of excess weight, and risk for incident diabetes. Arch Pediatr Adolesc Med 2012 Jan;166(1):42-8. doi: 10.1001/archpedi.166.1.42.

5. I have conducted work focused on the development of pediatric quality measures for childhood obesity.  I was a funded co-investigator on a grant supported through the Children's Health Insurance Program Reauthorization Act (CHIPRA) of 2009 and lead the team that developed national quality measures focused on overweight and obesity in children, which included conducting a comprehensive literature review, convening a national expert panel, and drafting, prioritizing, refining, and testing the quality measures. ·    These measures were submitted to the National Quality Measures Clearinghouse (NQMC) at the Agency for Healthcare Research and Quality (AHRQ).

Lee JM, Freed GL, Shevrin CA, McCormick JA, Gebremariam A, Madden BW, Dombkowski KJ for the Quality Measurement, Evaluation, Testing, Review, and Implementation Consortium. Documentation of BMI percentile and weight classification for children. National Quality Measures Clearinghouse (NQMC). Rockville (MD): Agency for Healthcare Research and Quality (AHRQ). Published November 23, 2015.

Lee JM, Freed GL, Shevrin CA, McCormick JA, Gebremariam A, Madden BW, Dombkowski KJ for the Quality Measurement, Evaluation, Testing, Review, and Implementation Consortium. Communication of weight classification for children who are overweight or obese. National Quality Measures Clearinghouse (NQMC). Rockville (MD): Agency for Healthcare Research and Quality (AHRQ). Published November 23, 2015.

Lee JM, Freed GL, Shevrin CA, McCormick JA, Gebremariam A, Madden BW, Dombkowski KJ for the Quality Measurement, Evaluation, Testing, Review, and Implementation Consortium. Hypertension screening for children who are overweight or obese. National Quality Measures Clearinghouse (NQMC). Rockville (MD): Agency for Healthcare Research and Quality (AHRQ). Published November 23, 2015.

Lee JM, Freed GL, Shevrin CA, McCormick JA, Gebremariam A, Madden BW, Dombkowski KJ for the Quality Measurement, Evaluation, Testing, Review, and Implementation Consortium. Follow-up visits for children who are obese or overweight with a weight-related comorbidity. National Quality Measures Clearinghouse (NQMC). Rockville (MD): Agency for Healthcare Research and Quality (AHRQ). Published November 23, 2015.

Lee JM, Freed GL, Shevrin CA, McCormick JA, Gebremariam A, Madden BW, Dombkowski KJ for the Quality Measurement, Evaluation, Testing, Review, and Implementation Consortium. Parent report of discussion of weight concerns for child. National Quality Measures Clearinghouse (NQMC). Rockville (MD): Agency for Healthcare Research and Quality (AHRQ). Published November 23, 2015.

 

 

Publications

For a full list of my publications, please see my CV.