Pugh, Mary JoSchool of Medicine |
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My research interests include exploration of quality of care and health care system factors associated with quality of care for older patients. I have used methods from pharmacoepidemiology and health services research to examine quality of care issues related to geriatric prescribing, epilepsy care, and chronic disease management. My future work will use information obtained from previous research to develop interventions to improve both the quality of geriatric prescribing and the quality of epilepsy care. |
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| 9/2008 - Present | Assistant Professor | UT Health Science Center at San Antonio, Epidemiology and Biostatistics, South Texas Veterans Health Care System/Audie L. Murphy Division, San Antonio, TX |
| 8/2004 - Present | Research Health Scientist | South Texas Veterans Healthcare System, San Antonio, TX |
| Year | Degree | Discipline | Institution |
| 1999 | PhD | Developmental Psychology | The Catholic University of America Washington , DC |
| 1995 | MA | Developmental Psychology | The Catholic University of America Washington , DC |
| 1992 | Counseling | Boston University Heidelberg , Germany |
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| 1989 | BA | Psychology | University of Central Florida Orlando , FL |
| 1984 | BA | Nursing | The College of St Scholastica Duluth , MN |
Development of Quality Measures- Developed quality indicators for adults with epilepsy through a CDC-funded study. Currently working with a task force from the American Academy of Neurology and American Epilepsy Society in conjunction with the American Medical Association (AMA)-convened Physician Consortium for Performance Improvement to further develop pay for performance measures that will be used to evaluate quality of care for patients with epilepsy. Recently involved in developing consensus guidelines for dosing primarily renally cleared medications for geriatric patients. |
Pharmacoepidemiology- Conducts pharmacoepidemiolgy research examining outcomes associated with variation in prescribing among older patients, and older patients with epilepsy. Studies currently funded by VA Health Services Research and Development Service and the Epilepsy Foundation examine prescribing patterns associated with quality measures or guidelines for care. These studies allow clinicians and policy makers to not only identify variation from standards of care, but also to understand the impact of high quality care on patients outcomes. |
Quality of Care Research- Conducts health services research focused on examining quality of care. Prior funded studies have focused on quality of prescribing for geriatric patients, and older patients with epilepsy. The current focus on epilepsy quality of care has led the field to begin examining quality of epilepsy care explicitly rather than focus on randomized clinical trials of treament modalities and quality of life among individuals with epilepsy. The recent development of a special interest group in the American Epilepsy Society on Quality of Care was stimulated by interest in the publication of quality measures for adults with epilepsy that derived from the CDC funded study. |
Journal Article |
| Mortensen EM, Copeland LA, Pugh MJ, Fine MJ, Nakashima BR, Restrepo MI, Malo de Molina R, Anzueto AR. Diagnosis of pulmonary malignancy after hospitalization for pneumonia (in press) American Journal of Medicine 2010 Jan;. |
| Mortensen EM, Copeland LA, Pugh MJ, Restrepo MI, de Molina RM, Nakashima B, Anzueto AR. Impact of statins and ACE inhibitors on mortality after COPD exacerbations Respiratory Research 2009 Jun;10:45-45. |
| Bokhour BG, Pugh MJ, Rao JK, Avetisyan R, Berlowitz DR, Kazis LE. Improving methods for measuring quality of care: A patient-centered approach in chronic disease Medical Care Research and Review 2009 Apr;66(2):147-166. |
| Pugh MJ, Knoefel JE, Mortensen EM, Amuan ME, Berlowits DR, Van Cott AC. New-onset epilepsy risk factors in older veterans Journal of the American Geriatrics Society 2009 Feb;57(2):237-242. |
| Hanlon JT, Aspinall S, Semla TP, Weisbord SD, Fried LF, Good CB, Fine MJ, Stone RA, Pugh MJ, Rossi MI, Handler SM. Consensus guidelines for oral dosing of primarily renally cleared medications in older adults Journal of the American Geriatrics Society 2009 Feb;57(2):335-340. |
| Hope OA, Zeber JE, Kressin NR, Bokhour B, VanCott AC, Cramer JA, Amuan ME, Knoefel JE, Pugh MJ. Setting of diagnosis and race affects appropriate treatment of older veterans with new epilepsy Epilepsia 2009 Jan;50(5):1085-1093. |
| Pugh MJ, Van Cott AC, Cramer JA, Knoefel JE, Amuan ME, Tabares J, Ramsay RE, Berlowitz DR. Trends in antiepileptic drug prescribing for older patients with new-onset epilepsy: 2000-2004 Neurology 2008 May;70(22 Pt):2171-2178. |
| Mortensen EM, Pugh MJ, Copeland LA, Restrepo MI, Cornell JE, Anzueto AR, Pugh JA. Impact of statins and ACE inhibitors on mortality for patients hospitalized with pneumonia European Respiratory Journal 2008 Mar;31(3):611-617. |
| Pugh MJ, Rosen, AK, Montez-Rath, M, Amuan, ME, Fincke, BG, Burk, M, Bierman, A, Cunningham, F, Mortensen EM, Berlowitz, DR. Potentially inappropriate prescribing for the elderly: Effects of geriatric care at the patient and health care system level Medical Care 2008 Feb;46(2):167-173. |
| Pugh MJ, Palmer FR, Parchman ML, Mortensen EM, Markides K, Espino DV. Association of suboptimal prescribing and change in lower extremity physical function over time Gerontology 2008 Feb;53(6):445-453. |
| Pugh MJ, Zeber JE, Copeland LA, Cramer JA, Tabares JV. Psychiatric disease burden profiles in adults with epilepsy: The association with health services utilization Psychiatric Services 2008 Jan;59(8):925-928. |
| Van Cott, AC, Pugh MJ. Epilepsy and the elderly Annals of Long-Term Care: Clinical Care and Aging 2008 Jan;16(1):28-32. |
| Copeland LA, Zeber JE, Pugh MJ, Mortensen EM, Restrepo MI, Lawrence VA. Postoperative complications in the seriously mentally ill: A systematic review of the literature Annals of Surgery 2008 Jan;248(1):31-38. |
| Mortensen EM, Restrepo MI, Copeland LA, Pugh JA, Anzueto A, Cornell JE, Pugh MJ. Impact of previous statin and angiotensin II receptor blocker use on mortality in patients hospitalized with sepsis Pharmacotherapy 2007 Dec;27(12):1619-1626. |
| Pugh MJ, Berlowitz DR, Montouris G, Bokhour B, Cramer JA, Bohm V, Bollinger M, Helmers S, Ettinger A, Meador KJ, Fountain N, Boggs J, Tatum WO, Knoefel J, Harden C, Mattson RH, Kazis L, Pugh M. What constitutes high quality of care for adults with epilepsy? Neurology 2007 Nov;69(21):2020-2027. |
| Zeber JE, Copeland LA, Amuan M, Cramer JA, Pugh MJ. The role of comorbid psychiatric conditions in health status in epilepsy Epilepsy & Behavior 2007 Jan;10(4):539-546. |
| Copeland LA, Mortensen EM, Zeber JE, Pugh MJ, Restrepo MI, Dalack GW. Pulmonary disease among inpatient decedents: Impact of schizophrenia Progress in Neuro-Psychopharmacology & Biological Psychiatry 2007 Jan;31(3):720-726. |
| Pugh MJ, Berlowitz DR, Kazis, L. The impact of epilepsy on older veterans Int Rev Neurobiol 2007 Jan;81:221-233. |
| Berlowitz, DR, Pugh MJ. Pharmacoepidemiology in community-dwelling elderly taking antiepileptic drugs Int Rev Neurobiol 2007 Jan;81:153-163. |
| Pugh M. Sex differences in inappropriate prescribing among elderly veterans Am J Geriatr Pharmacother 2007 Jan;5(2):147-161. |
| Perucca E, Berlowitz D, Birnbaum A, Cloyd JC, Garrard J, Hanlon JT, Levy RH, Pugh MJ. Pharmacological and clinical aspects of antiepileptic drug use in the elderly Epilepsy Res 2006 Jan;68 Su:49-63. |
| Pugh MJ, Hanlon JT, Zeber JE, Bierman A, Cornell J, Berlowitz DR. Assessing potentially inappropriate prescribing in the elderly VA population using the HEDIS 2006 quality measure Journal of Managed Care Pharmacy 2006 Jan;12(7):537-545. |
| Pugh MJ, Foreman, PJ, Berlowitz Dr. Prescribing antiepileptics for the elderly: Differences between guideline recommendations and clinical practice Drugs Aging 2006 Jan;23(11):861-875. |
| Pugh MJ, Lindblad CI, Handler, SM, Hanlon, JT. Update on drug-related problems in the elderly Am J Geriatr Pharmacother 2005 Sep;3(3):205-210. |
| Pugh MJ, Fincke BG, Bierman AS, Chang BH, Rosen AK, Cunningham FE, Amuan ME, Burk ML, Berlowitz DR. Potentially inappropriate prescribing in elderly veterans: Are we using the wrong drug, wrong dose, or wrong duration? J Am Geriatr Soc 2005 Aug;53(8):1282-1289. |
| Cramer JA, Pugh MJ. The influence of insulin use on glycemic control: How well do adults follow prescriptions for insulin? Diabetes Care 2005 Jan;28(1):78-83. |
| Pugh MJ, Copeland LA, Zeber JE, Cramer JA, Amuan ME, Cavazos JE, Kazis LE. The impact of epilepsy on health status among younger and older adults Epilepsia 2005 Jan;46(11):1820-1827. |
| Pugh MJ, Cramer J, Knoefel J, Charbonneau A, Mandell A, Kazis L, Berlowitz D. Potentially inappropriate antiepileptic drugs for elderly patients with epilepsy J Am Geriatr Soc 2004 Mar;52(3):417-422. |
Abstract |
| Mortensen EM, Restrepo MI, Copeland LA, Pugh MJV, Nakashima B, Anzueto A. Myocardial infarction after hospitalization for pneumonia; 2009 Sep. (European Respiratory Society). |
| Lawrence V, Copeland L, Zeber J, Pugh M, Mortensen E, Restrepo M. Postoperative complications in the seriously mentaly ill: A systematic review of the literature; 2008 Jan. (Journal of General Internal Medicine; vol. 23, no. s2). |
| Mortensen EM, Leykum LK, Noel PH, Zeber JE, Pugh MJ, Lawrence VA. Organizational interventions to improve outcomes for patients with COPD; 2007 Apr. (Journal of General Internal Medicine; vol. 22, no. S 1). |
| Sanchez-Reilly SE, Zeber JE, Copeland LA, Pugh MJ, Wolff P, Karnad AB. Cancer among "Oldest of the Old": Prevalence Rates, Medical Comorbidities, and Treatment Modalities (Poster presented at America Geriatrics Society Annual Scientific Meeting); 2007 Apr. (Journal of the American Geriatrics Society; vol. 55, no. 4S). |
| Mortensen EM, Restrepo MI, Copeland LA, Anzueto AR, Pugh MJ. Association of lipophilic and hydrophilic ACE inhibitor use with pneumonia-related mortality (Poster); 2007 Apr. (Journal of General Internal Medicine; vol. 22, no. S 1). |
| Mortensen EM, Restrepo MI, Copeland LA, Anzueto AR, Pugh JA, Pugh MJ. Impact of statin and angiotensin II receptor blocker use on mortality for patients hospitalized with sepsis; 2006 Jan. (CHEST; vol. 130, no. 4). |
Editorial |
| Mortensen EM, Restrepo MI, Copeland LA, Pugh MJ, Anzueto AR. Statins and outcomes in patients with pneumonia: Not only healthy user bias BMJ 2006 Nov;333(7578):1123-1124. |
| Badgett RG, Pugh MJ. Diffusion of Innovations in Service Organizations Milbank Quarterly 2005 Mar;83(1):177-178. |
Federal |
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| Funding Agency | Veterans Affairs Health Services Research & Development |
| Title | Long-term Outcomes in Burned OEF/OIF Veterans (LOBO) |
| Status | Active |
| Period | 8/2007 - 7/2012 |
| Role | Co-Investigator |
| Grant Detail | To prospectively compare the rate of improvement in functioning for survivors of combat burns, combat nonburn trauma, and civilian burns at discharge, 1, 2, 3, and 4 years after injury. We will also compare the two military cohorts on 4-year DoD/VA healthcare utilization. |
| Funding Agency | VA Health Service Research and Development Service |
| Title | Guideline Adherence in Elders with Heart Failure and Multiple Comorbidities |
| Status | Active |
| Period | 10/2007 - 9/2011 |
| Role | Co-Investigator |
| Grant Detail | To determine the association between patient age and use of guideline-recommended medications, and explore how patient, provider, and system factors mediate the relationship between age and prescribing. |
| Funding Agency | VA/HSR&D |
| Title | Inappropriate Drug Use for Seniors: Should VA Adopt New HEDIS Measures? |
| Status | Active |
| Period | 7/2007 - 6/2011 |
| Role | Principal Investigator |
| Grant Detail | Recently, the National Committee on Quality Assurance developed measures to identify potentially inappropriate prescribing in the elderly (PIPE). These measures (2006, 2007 HEDIS PIPE) are controversial and not strongly linked to patient outcomes. Because of methodological problems with prior studies this study will assess the link between HEDIS PIPE exposure and patient outcomes in cohorts of older veterans with incident exposure to drugs included in these measures. |
| Funding Agency | National Institutes of Nursing Research |
| Title | Impact of Statins and ACE Inhibitors on Outcomes for Pneumonia and Sepsis |
| Status | Active |
| Period | 10/2007 - 6/2010 |
| Role | Co-Investigator |
| Grant Detail | Determine the association between the outpatient use of medications of interest and clinical outcomes, including 30-day mortality, length of stay (LOS), and rates of mechanical ventilation for patients hospitalized with sepsis and CAP. 2) Determine the association between the inpatient continuation of medications of interest properties and clinical outcomes for patients hospitalized with CAP and sepsis. 3) To examine the impact of medication dosage of the most commonly used ACE inhibitor and statin upon 30-day mortality for patients hospitalized with CAP and sepsis. |
| Funding Agency | VA Health Services Research and Development |
| Title | Obesity Care Practices in the Veterans Health Administration |
| Status | Active |
| Period | 4/2006 - 6/2010 |
| Role | Co-Investigator |
| Grant Detail | To describe variations in the provision of obesity care practices in the VHA, and examine system, provider, and patient-level factors that predict these variations; examine the impact of obesity care practices on BMI and other important clinical outcomes; and identify longitudinal patterns (latent classes) of BMI trends over time and predictors of latent class membership. |
| Funding Agency | VA Health Services Research & Development |
| Title | Tracking OEF/OIF Transition from DOD to VA |
| Status | Complete |
| Period | 4/2008 - 9/2008 |
| Role | Co-Investigator |
| Grant Detail | The study will determine the feasibility of PHI transmission from a DOD medical treatment facility to VA, and will estimate rates of transition to the VA healthcare system of critically injured OEF/OIF military personnel treated at the Department of Defense (DOD) Brooke Army Medical Center (BAMC). The project will characterize types and timing of care subsequently received in the VA, and look at treatment retention in VA for at-risk subgroups, focusing on mental health care. |
| Funding Agency | Dept of Veterans Affairs, Health Services Research and Development |
| Title | Appropriateness and Effectiveness of Antiepileptic Drug Use for Older Veterans |
| Status | Complete |
| Period | 7/2005 - 9/2008 |
| Role | Principal Investigator |
| Grant Detail | This study will enhance understanding of factors associated with adoption of clinical recommendations for newly diagnosed older patients with epilepsy, and will begin to identify barriers to their adoption. |
| Funding Agency | Veterans Affairs HSR&D |
| Title | Systematic Review and Tracking Database for CPG Implementation Research |
| Status | Complete |
| Period | 9/2003 - 8/2008 |
| Role | Co-Investigator |
| Grant Detail | Systematically review the literature on organizational strategies of implementing evidence-based medicine into clinical practice; designed to improve the quality of care provided to veterans with QUERI diseases high prevalence, chronic conditions (e.g., diabetes, CHF, colon cancer, schizophrenia, depression, etc.) |
| Funding Agency | VA Health Services Research and Development Service |
| Title | Multifaceted Assessment of Coordination of Care for OEF-OIF Veterans |
| Status | Complete |
| Period | 8/2007 - 2/2008 |
| Role | Principal Investigator |
| Grant Detail | To provide timely and valuable information to improve the transition from DoD to VA care for OEF/OIF service members/veterans.1) describe care coordination experiences from the perspective of both the patient and health care providers of the healthcare team and 2) identify factors that are most helpful or harmful to facilitate or inhibit transition and clinical care. |
| Funding Agency | CDC |
| Title | Examining the Validity of Community Based Screening Questions for Assessing Epilepsy (CDC II) |
| Status | Complete |
| Period | 10/2005 - 9/2007 |
| Role | Co-Investigator |
| Grant Detail | This study will 1) assess the sensitivity, specificity and predictive value positive and negative for the epilepsy core items for a spectrum of epilepsy patients that cut across both clinic and community based populations; 2) examine the reliability and validity for each of the five epilepsy core items using psychometric methods. (Site PI) |
| Funding Agency | CDC |
| Title | Examining Epilepsy Care Using a Multifaceted Approach (CDCI) |
| Status | Complete |
| Period | 10/2004 - 9/2007 |
| Role | Co-Investigator |
| Grant Detail | The long term goal of the grant is to identify and evaluate quality of epilepsy care for adults.(Site PI) |
Private |
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| Funding Agency | Epilepsy Foundation |
| Title | Potential Drug Interactions: Is Exposure Linked to Patient Outcomes? |
| Status | Complete |
| Period | 7/2008 - 6/2009 |
| Role | Principal Investigator |
| Grant Detail | Many older patients with epilepsy are taking drugs that interact with their antiepileptic drugs (AEDs). Few studies have described the extent to which epilepsy patients are exposed to potential drug interactions (PDI), and studies examining the impact of PDI on patient outcomes in actual clinical practice have not been published to date. This retrospective, longitudinal cohort study will compare adverse outcomes in patients with and without AED-PDI exposures over a period of 3-4 years (depending upon year of epilepsy onset). |