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Center for Health Equity Research and Promotion

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Daniel Hall, MD, MDiv, MHSc, FACS

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CHERP COIN Investigator

Core Investigator, CHERP Staff Surgeon, VAPHS, VHA Innovation Ecosystem

Professor of Surgery, University of Pittsburgh.


The Rev. Daniel E. Hall, M.D., M.Div, M.H.Sc., is a general surgeon with training in health services research, quality improvement, moral philosophy, and theology. His diverse portfolio of work aims to develop reliable systems of healthcare delivery that are both technically excellent and directed toward the normative good of human flourishing, conceptualized as the well-functioning of the whole person as appropriate to each patient's vocation. Methods include statistical modeling of large datasets, surveys, qualitative interviews, focus groups, decision support, quality improvement, and implementation science. His specific interests include the measurement and mitigation of surgical frailty, long term loss of independence after surgery, shared decision making, medical ethics, and the formation of virtues necessary for the practice of good medicine.

Dr. Hall is Professor of Surgery and Anesthesiology & Perioperative Medicine at the University of Pittsburgh and Core Investigator at the VA Center for Health Equity Research and Promotion. He is Medical Director, High Risk Populations and Outcomes, Wolff Center at the University of Pittsburgh Medical Center, Core Faculty, Center for Biostatistics and Health Law, University of Pittsburgh, and Staff Surgeon, VA Pittsburgh Healthcare System.

Research, Clinical, and/or Academic Interests

Surgical Frailty: Dr. Hall is interested in how the syndrome of frailty can be used to identify patients at greatest risk for perioperative morbidity and mortality, and leveraging that information to support and improve the perioperative decision making for these patients. He is particularly interested in how preoperative palliative care consultation can improve decision-making and outcomes through explicitly negotiated and documented surgical buy-in, time limited trials and overarching goals of surgical therapy. He is also investigating ways to prehabilitate frail patients before surgery to mitigate frailty-associated risks.

Long term Loss of Independence: Dr. Hall is working to define, measure, model, and predict trajectories of long-term loss of independence after emergency and elective surgery. The approach combines data from the VA Surgical Quality Improvement Program, Medicare, Medicaid, Minimum Dataset and other VA sources arranged on a shared chronology to define the setting and duration of healthcare utilization in the year following surgery.

Shared Decision Making: Dr. Hall is working to develop care pathways to optimize the shared decision making process for high risk, frail patients—both before surgery and at presentation to ICUs. Elicitation of patient values is critical in this context but challenging to accomplish. One promising approach that he is working to implement is Best Case Worst Case scenario planning that uses storytelling to elicit patient preferences regarding a discrete choice between possible treatment options.

Medical Decision Making and the Clinical Encounter: Dr. Hall is interested in examining the secular and religious influences that shape the moral imagination of both physicians and patients, and he is interested in the role these formative influences play in the clinical encounter and in medical decision making. This research builds on continuing work that examines the associations between religious belief and practice and various health outcomes.

Dr. Hall earned degrees in medicine and theology from Yale University before completing his surgical training at the University of Pittsburgh. He is also an ordained priest in the Episcopal Church with interests in the theology of medicine. He was the first John Templeton Fellow in Religion and Medicine at Duke University where his research focused on epistemology, moral philosophy, religious measurement, and the ways in which medical decision-making is influenced by religious and secular worldviews. He has published and lectured on ethics and the role religion plays in the context of clinical medicine. His clinical interests focus on both minimally invasive, emergency general surgery, and surgical palliative care.

Dr. Hall is a Co-Principal Investigator of a five-year HSR&D QUERI initiative, Safer Aging through Geriatrics-Informed Evidence-based practices (SAGE). He leads the implementation of the evidence-based practice, "What Matters -- Surgical Pause." The "Surgical Pause" ascertains what matters to patients by identifying Veterans at risk for poor postoperative outcomes and triggering a structured conversation aimed at clarifying patient's goals and expectations prior to surgical decision making.

Dr. Daniel Hall and colleagues have developed and executed a national diffusion agreement for the Surgical Pause Practice, which screens frail Veterans before surgery so that the care plan can be optimized. They also developed a national CPRS (computerized patient record system) template to facilitate frailty assessment with the Risk Analysis Index (RAI). In addition, pilot testing is underway at 11 VAMCs with a national release date of September 22, 2021.

Funded Research

  • VA ORD VA QUERI I50 HX003201-01 (10/1/20-9/30/25) "Implementing the Age-Friendly Health System in VHA: Using Evidence-based Practice to Improve Outcomes in Older Adults." Randomized, stepped wedge implementation of 4 "Age-Friendly" interventions, including the Surgical Pause across the 5 VAMCs in VISN 4 aimed at testing the impact of preoperative frailty screening as a trigger for Best Case Worst Case goal clarification before choosing surgical or nonoperative management. Primary outcome is "healthy home days" calculated using the VA's Residential History File. Secondary outcomes include perioperative mortality, length of stay, readmission and postoperative complications as measured by VASQIP. Role: Principal Investigator
  • VA ORD HSRD 01HX003215A (7/1/21-6/30/25) "PAtient-centered mUltidiSciplinary care for vEterans undergoing surgery (PAUSE): a hybrid 1 comparative effectiveness-implementation trial." This study involves a stepped wedge randomized trial of frailty screening and interdisciplinary review at VAMCs in Palo Alto, Houston and Nashville. The primary aim is to test the effectiveness of the PAUSE trial intervention vs usual care in improving 30- and 180-day mortality, non-home discharge, rehospitalizations and home-time for patients undergoing surgical evaluation. Other aims examine how the intervention's effect is moderated and the contextual factors that influence the implementation of the intervention in surgical services. Role: Co-Investigator
  • VA ORD HSR&D 1I01HX003322 (10/1/21-6/30/25) "Improving surgical decision-making by measuring and predicting long-term loss of independence after surgery." This study leverages unique VA data resources, including the Residential History File, to (1) characterize common trajectories of postoperative loss of independence (LOI) in the 365 days after to describe clinically meaningful heterogeneity in the patters of healthcare utilization; (2) adapt the RAI to predict long-term loss of independence and explore alternative models for LOI prediction; and (3) explore key stakeholders' perspectives on how LOI risk prognosis might better align shared decisions about surgical treatment with patients' values and goals. Role: Principal Investigator
  • VA ORD HSR&D I01HX003095 (7/1/21-12/31/25) "Understanding the Effect of Rurality and Social Risk Factors on Barriers to Care and Surgical Outcomes." This study aims to identify social risk factors and levels of care fragmentation that affect surgical outcomes to inform VA quality metric policy and institutional resource allocation. In particular we aim to examine the impact of race, ethnicity, socioeconomic status and rurality on surgical outcomes, care fragmentation and resource allocation. Approach entails linking VASQIP data to other data sources, including geocoded addresses to which we can attribute census data regarding socioeconomic status. Role: Co-Investigator
  • VA CSR&D I01CX002150 (10/1/21-9/30/25) "Metformin Benefits Lower Extremities with Intermittent Claudication (MOBILE_IC)." This clinical trial is testing the ability of metformin therapy to improve walking performance in nondiabetic patients suffering from intermittent claudication in a quadruple blinded, placebo controlled clinical trial. Participants will be recruited at the VA Pittsburgh Healthcare System. Role: Co-Investigator
  • NIH NCATS 1U01TR002393 (08/1/18-07/31/22) "Harnessing the Power of CTSA-CDRN Data Networks: Using Social Determinants of Health, Frailty and Functional Status to Identify At Risk Surgery Patients and Improve Risk Adjustment." This project uses the identified versions of the ACS NSQIP registry at San Antonio, UPMC, UNC, and Baylor to expand the list of variables through the electronic records of each institution, including natural language processing of free text notes. The data are then deidentified and merged at the coordinating site to explore social determinants of surgical outcomes, including geocoded addresses, rurality, census data and the Area Deprivation Index. Role: Co-Investigator