Donald A. Goldmann

Dr. Don Goldmann’s research interests fall under five overarching themes:

1. Epidemiology and control of healthcare associated Infections in newborns and other hospitalized populations: My early career focused on elucidating risk factors for neonatal nosocomial infections, especially bloodstream infections. I was part of a team that developed and validated a physiological risk score for neonatal outcomes, SNAP. I continue to be involved in studying the epidemiology and prevention of neonatal infections, as well as healthcare associated infections in other patient populations (including patients in institutions in low-income countries).
2. Antibiotic resistance and stewardship: I developed the first example of a standardized order set for antibiotic prescribing, demonstrating a major reduction in the inappropriate use of antibiotics for prophylaxis. In 1996, I published consensus guidance on preventing the emergence and spread of antibiotic resistance in JAMA – guidelines that remain among the core principles of antibiotic stewardship today. I led a CDC HICPAC taskforce that issued national recommendations for the appropriate use of Vancomycin and measures to control the emergence of Vancomycin Resistant Enterococci (VRE). I was the PI on the first NIAID-sponsored RCT of methods to reduce spread of Methicillin-Resistant S. aureus (MRSA) and VRE. I tested methods developed in the US in low-income settings, such as a NICU in Manila, demonstrating the challenges faced by these institutions in controlling the spread of resistance. I am core faculty on the national Vermont Oxford antibiotic stewardship MOOC and virtual learning community.
3. Improvement/implementation science: Over the past two decades, I have increasingly turned my attention to quality improvement, implementation science, and comparative effectiveness research of quality improvement interventions. I am Chief Scientific Officer, Emeritus at the Institute for Healthcare Improvement. I am especially interested in the impact of policy and payment on health care outcomes, prevention of harm, overuse of tests and procedures, QI measurement, and the potential for technology to improve patient outcomes and population health.
4. Program design and evaluation: It has become apparent that most ambitious demonstration projects to improve health outcomes fail. My colleague, Gareth Parry, and I have studied the reasons for these disappointing results and believe that a major reason is the use of fixed protocol designs that do not allow investigators to amend their approach based on conditions and context in intervention sites. Bayesian theory and improvement science provide a more flexible, dynamic approach to design and evaluation of large programs. We favor the embedding evaluators in action research project designs.
5. Translational research: Although my research focuses on the “right end” of the translational pathway – translating research evidence into effective practice at-scale, it is important to understand the earlier translational steps in the pathway. Accordingly, I have been a contributor to two major pragmatic bench research efforts – a program to understand the pathogenesis of E. coli meningitis in neonates and develop approaches to protecting infants, and development of a candidate vaccine for Staphylococcal infection. This experience has kept me familiar with rapid advances in science so that I can insure that the work of implementers and improvers “speaks” to scientific progress.