Innovative health care programs and alternative payment models seek to improve the value of care; however, population health strategies may cause harm and further exacerbate health disparities. The potential for harm is greater among people with serious illness, disability, or marginalized identities. As more health care for older adults is funded through value-based payment (VBP) models, health equity^[i] must be a key consideration for measuring population health outcomes and evaluation of health care policies and programs. Beyond the person with complex needs, measuring population health outcomes completely requires us to consider and measure spillovers to family caregivers. There is a need for causal economic research to inform state and federal health policies and ultimately improve health equity, long term care, and quality of life for persons with complex care needs and their families.

The Department of Population Health Science’s Center to Advance the Science of Complex Care: Aging, Disability and Equity (CASCADE) conducts policy and economic evaluations in the areas of long-term care, whole-person care models, and caregiver support. CASCADE serves as a hub for cross-disciplinary data-driven research and student engagement within the Department. We support faculty and students who desire to expand their expertise in causal inference methods, value-based payment policies, and risk prediction modeling. CASCADE prioritizes community engagement including patients and caregivers, health care providers and payers, policy makers, and administrators. Community partnerships promote actionable, rigorous, and equity-focused research. Our work focuses on care access, quality, and outcomes for individuals with marginalized identities by age, race, disability, gender, rurality, and the intersections of identity with social determinants of health. 

Who We Are

CASCADE is grant-funded and housed within the Department of Population Health Sciences (DPHS). Our teams consist of cross-disciplinary faculty, fellows, and student social scientists. We reach across Duke campus and Duke Medicine to engage undergraduate and graduate students who are interested in social determinants of health, complex care outcomes and policy. As core faculty affiliates at Duke-Margolis Institute for Health Policy and long-time close collaborative partners, we support the mission of Duke-Margolis through empirical data-driven analyses designed to directly inform policy.

With our expertise in caregiving, complex care, policy and payment design, we also collaborate with multiple clinical and health services entities within in Duke including Duke Center on Aging, Division of Internal Medicine, Division of Geriatrics and Palliative Care, the Duke/UNC Carolina Alzheimer’s Disease Research Center, and Durham VA Center to Accelerate Discovery and Practice Transformation.

Our founding team within DPHS:

• Courtney Van Houtven, PhD (Director)
• Brystana Kaufman, PhD (Assoc. Director)                  
• Megan Shepherd-Banigan, PhD (Assoc. Director)
• Valerie A Smith, DrPH (Head of Statistics)
• LaShaunta Glover, PhD (Faculty)
• Semra Ozdemir, PhD (Faculty)
• Matt Maciejewski, PhD (Faculty)
• Emily O’Brien (Faculty)
• Virginia Wang (Faculty)
• Wenhan Zhang (Student)
• Jie Gao (Student)
• Alli Bosquet (CRC, Senior)
• Kasey Decosimo (Research Program Leader)
• Marcia Sinclair (Program Coordinator)

What We Do

We conduct research that informs evidence-based health care policies. We conduct policy and economic evaluations in the areas of long-term care, whole-person care models, and caregiver support. Projects use rigorous quantitative and mixed methods approaches to evaluate policies and practices to enhance person- and family-centered care. Team members have expertise in quasi-experimental study designs for causal inference, economic evaluation, machine learning, and predictive modeling. Goals of our work include reduced health inequities and disparities, improved population health at a systems level, and scaling of evidence-based programs.

• Our projects include partners across Duke as well as other universities, organizations, industries, non-governmental agencies, and state and federal government agencies.
• We engage with patients, providers, caregivers, payers, policy makers, and advocates to identify factors that influence quality of care for people with complex care needs.
• We collaborate with state, federal, and health systems partners to accelerate scaling of evidence-based programs through implementation research studies and evaluations.

We accomplish these objectives with the following expertise: