Faculty

David Grembowski

Professor

In health services research, we want to understand better how our complex health care system works, ultimately to improve its performance and create a system that we can be proud of.

PhD

University of Washington, 1982
Urban Planning

Washington State University, 1975
Sociology

Washington State University, 1973
Sociology

Professor, Dental Public Health Sciences

Adjunct Professor, Sociology

Department of Health Services Program Affiliations:
- PhD program in Health Services
- Social and Behavioral Sciences Track, (MPH program)
- Master of Health Administration Program
- Extended Master of Public Health Program

David Grembowski also holds an appointment in the Department of Dental Public Health Sciences in the School of Dentistry. Professor Grembowski teaches social determinants of population health and health program evaluation, and his evaluation interests address prevention and the performance of health care systems. His studies have examined efforts to improve quality by increasing access to care in integrated delivery systems; managed care and physician referrals; managed care and patient-physician relationships; cost-effectiveness of preventive services for older adults; fluoridation effects on oral health and dental demand; financial incentives and dentist adoption of preventive technologies; effects of dental insurance on dental demand, and the link between mother and child access to dental care.

Contact Information

(office)  H-693, Health Sciences Building
University of Washington
1959 NE Pacific Street
Box:  357660
Seattle, WA 98195-7660
(voice)  206-616-2921     (fax)  206-543-3964
grem@u.washington.edu
(staff contact):  Alice Gronski
(voice)  206-543-7952     (fax)  206-543-3964
agronski@u.washington.edu

Teaching Interests

Health program evaluation, U.S. health care, Medical Sociology

HSERV 510
Society and Health
HSERV 513
U.S. Health and Health Care: Population Health, Social Determinants, and Health Disparities
HSERV 522
Health Program Evaluation
HSERV 522 (Extended MPH Program)
Health Program Evaluation
HSERV 592
Social and Behavioral Sciences Seminar

Research Interests

Design and performance of health care systems; prevention; technology diffusion. Methodology interests are program evaluation and survey research.

Community of Science profile

Projects

Physician Networks and Children with Chronic Conditions

Funded by the Agency for Health Care Research and Quality. For children with asthma or diabetes, the purposes of this study are to examine whether out-of-network benefits and cost-sharing of managed health plans are associated with the likelihood of seeing an in-network vs. out-of-network physician, and secondly, to examine whether health quality and expenditures are similar or different for children seeing in-network vs. out-of-network physicians.

Linking Mother and Child Access to Dental Care

In Washington state's Medicaid population of children aged 3-6 years old, the aim is to determine whether having a mother with a regular source of dental care is associated with greater utilization of dental care and oral health in children in four racial/ethnic groups: White (non-Hispanic), Hispanic, African American, and other groups. Funded by the National Institute of Dental and Craniofacial Research.

Caries Prevention Study

Although new, effective technologies have emerged for controlling caries in children, only a minority of dentists have adopted them. A randomized trial is being conducted to determine whether financial incentives and provider education can increase dentist adoption of these technologies, and in turn, whether adoption results in reduced caries incidence and restorative services among at risk children with capitation dental insurance. Funded by NIDCR and Washington Dental Service.

Improving Access to Improve Quality: Evaluation of an Organizational Innovation

Funded by the Robert Wood Johnson Foundation, the study is an evaluation of Group Health Cooperative's "Access Initiative." This innovation includes offering patients same-day appointments to primary care physicians, allowing them direct access to most specialists, and providing physicians with a $40 million clinical information system that offers up-to-the-minute patient health information. The study will determine how the initiative affects factors such as cost, utilization of services, quality of care, member enrollment, and patient and provider satisfaction.

External Funding (sampling of current and past involvement)

Dental Care in Children With and Without Special Health Care Needs

National Institute of Dental and Craniofacial Research
PI: Lewis Dates: 12/2007 - 11/2009
We plan to use the Medical Expenditure Panel Survey data to describe and compare dental care access, utilization, expenditure and insurance coverage in children with and without special health care needs.

Impact of Paying for Performance on the Quality and Efficiency of Medical Care

Robert Wood Johnson Foundation
PI: Conrad Dates: 10/2007 - 03/2009
This project on quality-based financial incentives for physician group practices takes advantage of a regional natural experiment in paying for quality in Washington State during a 5-year period.

Improving Access to Improve Quality in an HMO

AHRQ - Agency for Healthcare Research and Quality
PI: Grembowski Dates: 09/2006 - 09/2008
The goal of this study is to evaluate the effect on quality of Group Health Cooperative's Access initiative plan.

Race/Ethnicity, Socioeconomic Status and Oral Health

National Institute of Dental and Craniofacial Research
PI: Grembowski Dates: 08/2006 - 07/2008
The purpose of this study is to estimate composition and context effect on low-income mothers' perceptions of oral health and their children's oral health.

National Research Service Award Institutional Research Training Grants

AHRQ - Agency for Healthcare Research and Quality
PI: Martin Dates: 07/2003 - 06/2008
The purpose of this NRSA training grant is to provide pre- and postdoctoral training in health services research, health policy and population health.

Public Health Funding and Population Health

Robert Wood Johnson Foundation
PI: Grembowski Dates: 01/2007 - 12/2007
The primary objective is to establish whether incremental changes in the expenditures of local health departments are associated with changes in the health disparities of the populations in which they serve.

Linking Mother and Child Access to Dental Care

National Institutes of Health
PI: Grembowski Dates: 06/2003 - 05/2007
The major goals of this project are to look at children aged 3-6 years old who are enrolled in Medicaid dental insurance in Washington state, and study the relationships between mothers' access to a regular source of dental care, mothers' use of a regular source of dental care, and the children's utilization of a regular source of dental care.

Improving Access to Improve Quality: Evaluation of an Organizational Innovation

Robert Wood Johnson Foundation
PI: Grembowski Dates: 11/2004 - 10/2006
The goal of this study is to evaluate the effect on quality of Group Health Cooperative's Access initiative plan.

Insurance Financing of Integrated Medicine

National Center for Complementary and Alternative Medicine
PI: Lafferty Dates: 09/2001 - 05/2005
The proposed study will use claims data from the two largest insurance plans in WA to describe the economics of CAM integration under the state model, to identify predictors of CAM utilization and cost, to investigate whether CAM is used more frequently as a complement to or an alternative for traditional care, and to locate patient groups whose healthcare costs might decrease by substituting CAM for traditional services.

Physician Networks and Children with Chronic Conditions

AHRQ - Agency for Healthcare Research and Quality
PI: Grembowski Dates: 09/2002 - 03/2005
The purposes of this study are to examine whether out-of-network and cost-sharing of managed health plans are associated with the likelihood of children with asthma and diabetes seeing an in-network vs. out-of-network physician.

Best Managed Care Practices for Children with Chronic Conditions

AHRQ - Agency for Healthcare Research and Quality
PI: Connell Dates: 07/1999 - 08/2004
The aim of this project is to identify and measure how the structural characteristics, incentives, and quality assurance efforts of managed care organizations affect 1) quality of care, 2) health and functional status, 3) satisfaction with care, 4) consumer knowledge and 5) self-efficacy among children with chronic conditions in western Washington State.

Dentist Adoption of Caries-Control Services (Project within the Comprehensive Oral Health Research Center of Discovery)

National Institutes of Health
PI: Grembowski Dates: 08/1999 - 04/2003
The aim of the three year study is to determine whether provider education and fee-for-service reimbursement of caries-control services in a capitation dental program will increase the delivery of caries-control services to at-risk children.

Managed Care and Physician Satisfaction: Managed Care II

AHRQ - Agency for Healthcare Research and Quality
PI: Grembowski Dates: 09/2001 - 09/2002
The major goals of this project are to evaluate (1) whether primary physician dissatisfaction is harming patient-physician relationships and health outcomes; and (2) patient satisfaction with specialists and outcomes. Secondary data from a previous Physician Referral Study will be used.

Managed Care and the Patient-Physician Relationship

Robert Wood Johnson Foundation
PI: Grembowski Dates: 09/1999 - 06/2000
To strengthen the patient-provider relationship through information analysis between managed care, quality of P/P relationships, and health outcomes

Selected Publications

Grembowski D, Spiekerman C, Del Aguila MA, Anderson M, Reynolds D, Ellersick A, Foster J, Choate L. Randomized pilot study to disseminate caries-control services in dentist offices. BMC Oral Health. 2006 May 3;6(1):7+.

Grembowski D, Paschane MS, Diehr P, Katon W, Martin D, Patrick DL. Managed care, physician job satisfaction, and the quality of primary care. Journal of General Internal Medicine. 2005 Mar;20(3):271-7.

Grembowski D, Martin D, Patrick D, Diehr P, Katon W, Williams B, Engleberg R, Novak L, Dickstein D, Deyo R, Goldberg H. Managed care, access to mental health specialists, and outcomes among primary care patients with depressive symptoms. Journal of General Internal Medicine, 2002;17(4):258-269

Grembowski D, Patrick DL, Williams B, Diehr P, Martin DP. Managed care and patient-rated quality of care from primary physicians. Med Care Res Rev 2005;62:31-55.

Grembowski D, Ulrich CM, Paschane D, Diehr P, Katon W, Martin D, Patrick DL, Velicer C. Managed care and primary physician satisfaction. Journal of the American Board of Family Practice. 2003;16(5):383-93.

Grembowski DE, Martin D, Diehr P, Patrick DL, Williams B, Novak L, Deyo R Katon W, Dickstein D, Engelberg R, Goldberg H. Managed care, access to specialists, and outcomes among primary care patients with pain. Health Services Research. February 38(1,Part I): 1-19, 2003.

Grembowski DE, Cook KS, Patrick DL, Roussel AE. Managed Care and the US Health Care System: A social exchange perspective. Social Science & Medicine 2002; 54(8):1167-1180.

Grembowski D. The Practice of Health Program Evaluation. Thousand Oaks, CA: Sage Publications, 2001.
More Info

Dissertation, Thesis and Capstone Committees (recent graduates)

2007

Chair, dissertation committee for Beverly Court

Critical access hospital legislation: Impact on rural hospitals and rural residents

2007

Chair, thesis committee for DeAnn Cromp

Barriers and facilitators to smoking cessation among homeless populations

2006

Chair, thesis committee for Curry Jones

African American Glaucoma Health Needs Assessment in the State of Georgia

2006

Member, thesis committee for Jessica Knaster

An evaluation of Planned Parenthood of Western Washington's Teen Clinic program

2006

Member, thesis committee for Janel Lauer

Evaluating the use of Bright Futures health promotion materials with parents of young children with special needs

2006

Chair, thesis committee for Sarah Pulliam

A client-centered program evaluation of an adult day health program for people living with AIDS

2006

Chair, thesis committee for Yingying Zhou

Impact evaluation for China Youth Reproductive Health Project-- The effects of the life-planning skills training program.

2005

Chair, thesis committee for Jacque Ives

A process evaluation of Health Trek: A nutrition and media literacy program for middle school youth in Washington State

2005

Member, dissertation committee for Bonnie Lind

The use of complementary and alternative medicine under insurance coverage in Washington State

2004

Member, thesis committee for Patricia Segura

Evaluation of the characteristics and infection status of female sex workers participating in an STI/HIV mobile prevention team outreach program

2004

Member, thesis committee for Maile Taualii

Utilization of Urban Indian Health Programs

2004

Member, thesis committee for Jessica Young

A process evaluation of the teen health center at Ballard High School