Center for Health Equity Research and Promotion

Profile

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.