Pittsburgh Surgical Outcomes Research Center
Transforming the conduct of clinical research

Daniel E. Hall, MD, MDiv, MHSc

  • Professor of Surgery, Anesthesiology and Perioperative Medicine
  • Medical Director, High Risk Populations and Outcomes | Wolff Center at UPMC
  • Core Faculty | Center for Bioethics and Health Law | University of Pittsburgh
  • Core Investigator | VA Center for Health Equity Research and Promotion
  • Staff Surgeon | VA Pittsburgh Healthcare System

The Rev. Daniel E. Hall, M.D., M.Div., M.H.Sc. is a tenured Professor of Surgery at the University of Pittsburgh, Staff Surgeon at the VA Pittsburgh, Core Investigator at the VA Center for Health Equity Research and Promotion, and Medical Director for High-Risk Populations and Outcomes at the Wolff Center at UPMC. Dr. Hall is a general surgeon with training in health services research, quality improvement, moral philosophy, and theology. His diverse portfolio of work aims at developing 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 earned degrees in medicine and theology from Yale University before completing his surgical training at the University of Pittsburgh and joining the faculty in 2007. He is also an ordained priest in the Episcopal Church with an interest in the theology of medicine. He has a proven track record of mentoring students, residents, and junior faculty, many of whom have won research awards at prestigious surgical conferences. The following list describes the variety of projects, data sources, and opportunities available through Dr. Hall’s lab:

VA ORD VA QUERI I50 HX003201-01 (Hall, PI: 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. The 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. Opportunities to: · Collaborate with experts in implementation science in real-world, on-the-ground system-wide quality improvement.

· Lead manuscript on pre-implementation interview data.

· Participate in multiple future manuscripts using qualitative and quantitative data.

VA ORD HSR&D 1I01HX003322 (Hall, PI 10/1/21-6/30/25) “Improving surgical decision-making by measuring and predicting the long-term loss of independence after surgery”. This study aims at characterizing and predicting long-term Loss of Independence (LOI) after surgery in order to operationalize the prediction of this adverse outcome in shared decision-making about surgery. This project utilizes sophisticated analytic methods, including trajectory analyses, along with focus groups and semi-structured interviews to design and test a decision aid. It also relies on an extraordinary dataset that links 500,000 VA surgeries to all of the data in Medicare, Medicaid, the Minimum Data Set (nursing homes), and the Corporate Data Warehouse. Opportunities to:

· Learn sophisticated data science techniques (e.g., trajectory analysis) to answer clinically meaningful questions in a representative, national sample of the nation’s largest, integrated healthcare system; there is no limit to the kind of questions you might ask in this data.

· Leverage unprecedented datasets to trace patients through the perioperative period, tracking days spent in hospital, in rehab, in home-based nursing, or at home and independent.

VA ORD HSR&D I01HX003095 (Hall, PI, 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. The approach entails linking VASQIP data to other data sources, including geocoded addresses to which we can attribute census data regarding socioeconomic status. Opportunities to:

· Explore social determinants of health in surgical outcomes

· Contribute to multiple planned manuscripts

ACS NSQIP and VASQIP Combined (2012-present): Deidentified versions of both datasets in the same location, permitting comparisons between the VA and private sector. Opportunities for:

· Global comparisons, or procedure/disease-specific exploration of clinical topics

Medicine, Religion, and Theology: Prior work focused on exploring empirical associations between religious belief and practice as well as context-specific measures of religiousness. Currently helping to lead the University of Pittsburgh Religion and Medicine Initiative, a collaboration between the Department of Religious Studies and the Center for Bioethics and Health Law. Opportunities for:

· Mentee-defined analytic or empirical study of religion, medicine, and health.

Medical Ethics and Informed Consent: Prior work used mixed methods (surveys, semi-structured interviews, ethical analysis) to explore aspects of the complicated dance between patient and surgeon, commonly called “informed consent”. Other interests include exploring the need for content-full ethical systems, the limits of procedural ethics, and the formation of virtues necessary for the practice of good medicine. Opportunities for:

· Mentee-defined and led projects on ethics.

VA ORD VA QUERI I50 HX003201-01 (Hall, PI: 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. Opportunities to:

Collaborate with experts in implementation science in real-world, on-the-ground system-wide quality improvement.
Lead manuscript on pre-implementation interview data
Participate in multiple future manuscripts using qualitative and quantitative data

VA ORD HSR&D 1I01HX003322 (Hall, PI 10/1/21-6/30/25) “Improving surgical decision-making by measuring and predicting long-term loss of independence after surgery”.  This study aims at characterizing and predicting long-term Loss of Independence (LOI) after surgery in order to operationalize the prediction of this adverse outcome in shared decision making about surgery. This project utilizes sophisticated analytic methods, including trajectory analyses, along with focus groups and semi-structured interviews to design and test a decision aid. It also relies on an extraordinary dataset that links 500,000 VA surgeries to all of the data in Medicare, Medicaid, the Minimum Data Set (nursing homes), and the Corporate Data Warehouse. Opportunities to:

Learn sophisticated data science techniques (e.g., trajectory analysis) to answer clinically meaningful questions in a representative, national sample of the nation’s largest, integrated healthcare system; there is no limit to the kind of questions you might ask in this data.
Leverage unprecedented dataset to trace patients through the perioperative period, tracking days spent in hospital, in rehab, in home-based nursing or at home and independent.

VA ORD HSRD 01HX003215A (Hall, Co-I, Arya, PI 7/1/21-6/30/25) “PAtient-centered mUltidiSciplinary care for vEterans undergoing surgery (PAUSE): a hybrid 1 comparative effectiveness-implementation trial”. This randomized, stepped wedge implementation trial of a multidisciplinary preoperative clinic for frail Veterans in advance of surgery at the Palo Alto, Nashville and Houston VAMCs. This is led by my colleague and vascular surgeon, Shipra Arya, and is investigating a slightly different intervention for improving the outcomes of frail surgery patients. Opportunities to:

Observe and learn about large-scale implementation science, including qualitative and quantitative methods
Participate in multiple manuscripts at the schedule of the PI in California.

VA ORD HSR&D I01HX003095 (Hall, Co-I, Shireman, PI, 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. Opportunities to:

Explore social determinants of health in surgical outcomes
Contribute to multiple manuscripts planned in time, coordinated by PI in San Antonio

NIH NCATS 1U01TR002393 (Hall, Co-I, Shireman, PI, 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. Opportunities to:

Contribute to multiple manuscripts coming to fruition now through 2022
Learn sophisticated data science in a
 multi-institution team

VA Diffusion of Excellence Surgical Pause National Diffusion Practice (1/1/2021-9/30/2023). Nationally supported effort to scale the Surgical Pause through a National Diffusion Agreement to implement at 53 VA Medical Centers by September 2023. To date 45 sites are exploring or implementing the practice. Opportunities to:

Participate in nation-wide policy and culture change.
Leverage rapidly expanding dataset of preoperative frailty assessments with the RAI that can be linked to the entire electronic record.

Quality Improvement at the Wolff Center at UPMC (2015-Present). Ongoing work at UPMC on surgical risk, shared decision making, frailty, and telehealth goal clarification in advance of transferring patients to higher levels of care. Opportunities for:

Analysis of Health System data, in collaboration with the UPMC Health Plan
Lead manuscripts on the costs and charges associated with frailty, as measured by the RAI in surgical and non-surgical populations
Participate in system redesign aimed at goal-concordant, high value triage of high risk patients
Develop curriculum for improved goal clarification through Best Case Worst Case scenario planning

ACS NSQIP and VASQIP Combined (2012-present): Deidentified versions of both datasets in the same location, permitting comparisons between the VA and private sector. Opportunities for:

Global comparisons, or procedure/disease specific exploration of clinical topics

Prehabilitation: Preoperative Exercise, Nutrition & Durable Medical Equipment. Data from 3 pilot studies of interventions before major surgery (all kinds) available for analysis. Opportunities to:

Leverage pilot data to design subsequent trials or prepare grant proposals

IRB Efficiency and Quality: Conducted multi-year mixed method study of the quality and efficiency of 10 VA IRBs, including the Central IRB. Opportunities for:

Leading multiple manuscripts based on unpublished data on surveys, quality metrics, or process flow maps. 

Medicine, Religion, and Theology: Prior work focused on exploring empirical associations between religious belief and practice as well as context-specific measures of religiousness. Currently helping to lead the University of Pittsburgh Religion and Medicine Initiative, a collaboration between the Department of Religious Studies and the Center for Bioethics and Health Law. Opportunities for:

Analytic or empirical study of religion, medicine and health.

Medical Ethics and Informed Consent: Prior work used mixed methods (surveys, semi-structured interviews, ethical analysis) to explore aspects of the complicated dance between patient and surgeon, commonly called “informed consent”. Other interests include exploring the need for content-full ethical systems, the limits of procedural ethics, and the formation of virtues necessary for the practice of good medicine. Opportunities for:

Mentee-defined and led projects on ethics.