Lab Web Site: Alyna Chien

Research Overview

Alyna T. Chien, MD, MS is an expert on the use of incentives to improve healthcare quality and spending. She has conducted a variety of studies that examine the effectiveness of payment reforms like pay-for-performance in adult and pediatric settings. She also examines unintended consequences related to incentives, with a particular focus on how incentives shape care delivery for vulnerable populations like the socioeconomically disadvantaged, racial/ethnic minorities, children, and those with disabilities.

Dr. Chien’s current research includes a study on whether revealing price information to physicians changes their ordering behavior and care quality. She is examining whether geocoding methods can improve pediatric risk adjustment models and creating a claims-based algorithm for identifying Children with Disabilities. She is also evaluating Harvard Medical School’s Academic Innovations Collaborative, a QI learning collaborative aimed at redesigning primary care delivery within the Harvard system.

About Alyna Chien, MD,MS

Dr. Chien is an Assistant Professor of Pediatrics at Harvard Medical School and practicing pediatrician at Boston Children’s Hospital. Before becoming a physician, she spent nearly a decade in community-based direct service. As a physician, she has always cared for vulnerable patient populations, working almost exclusively with patients insured by Medicaid or receiving care in a free or federally qualified health center setting. Dr. Chien serves on prominent national committees including the PCORI Advisory Panel on Disparities and the AAP Committee on Pediatric Research. She is an alumna of The University of Chicago’s Pritzker School of Medicine and The Robert Wood Johnson Clinical Scholars Program.

Key Publications

  • Chien AT, Davis AM, Chin MH, Casalino LP. Pay-for-performance, public reporting and racial disparities in health care. Med Care Res Rev. 2007;64(5 Suppl):283S-304S.
  • Chien AT, Conti RM, Pollack HA. A pediatric-focused review of the performance incentive literature. Curr Opin Pediatr. 2007;19(6):719-725.
  • Chien AT, Coleman M, Friedman-Ross LS. Qualitative insights into how pediatric pay-for-performance programs are being designed. Acad Pediatr. 2009;9(3):185-191.
  • Chien AT, Li Z, Rosenthal MB. Improving timely childhood immunizations through pay for performance in Medicaid-managed care. Health Serv Res. 2010;45(6 pt 2):1934-1947. PMCID: PMC3029849.
  • Chien AT, Kirchhoff AC, Schaefer CT, Huang ES, Brown SE, Heuer L, Graber J, Casalino LP, Chin MH. Positive and negative spillovers of the Health Disparities Collaboratives in Federally Qualified Health Centers: staff perceptions. Med Care. 2010;48(12):1050-1056.
  • Chien AT, Wroblewski K, Damberg C, Williams TR,Yanagihara D, Yakunina Y, Casalino LP. Do physician organizations located in lower socioeconomic status areas score lower on pay-for-performance measures? J Gen Intern Med. 2012;27(5):548-554. PMCID: PMC3326117.
  • Chien AT, Eastman D, Li Z, Rosenthal MB. Impact of a pay for performance program to improve diabetes care in the safety net. Prev Med. 2012;55 Suppl:S80-S85.
  • Chien AT, Rosenthal MB. Medicare's physician value-based payment modifier - Will the tectonic shift create waves? N Engl J Med. 2013;369(22):2076-2078.
  • Chien AT, Song ZS, Chernew ME, Landon BE, McNeil BJ, Schuster MA. Two-year impact of the alternative quality contract on pediatric healthcare quality and spending. Pediatrics. 2014;133(1):96-104.
  • Chien AT, Chin MH, Alexander GC, Tang H, Peek ME. Physician financial incentives and care for the underserved in the United States. Am J Manag Care. 2014;20(2):121-129.

Visit www.alynachien.org for current projects, job opportunities, and other news!

Active Projects

2012-2014       Improving Pediatric Risk Adjustment Algorithms

Boston Children’s Hospital Office of Faculty Development
Principal Investigator

Proposes to improve existing pediatric risk adjustment algorithms by increasing the amount of clinical and socio-demographic information these softwares incorporate using existing claims data, Boston Children’s Hospital’s clinical information systems, and publicly available neighborhood information that can be linked to patient addresses.

2013-2015       Using Geocoded Socioeconomic Data to Enhance Pediatric Risk Adjustment Methods

NICHD 1R21HD076442-01
Principal Investigator

This study examines the degree to which incorporating geographically based socioeconomic (SE) information advances our understanding of the risk adjustment methods needed to better match healthcare payments with pediatric patient complexity. The study will facilitate ongoing health system and policy efforts aimed at ensuring that children from low SE background have access to insurance and medical care and narrowing disparities in child health and healthcare.

2013-2015       Understanding the Use and Impact of Price Data in Health Care

Robert Wood Johnson Foundation
Principal Investigator

A mixed method randomized controlled trial to investigate whether providing physicians with real-time information about the price of imaging tests and diagnostic procedures changes test ordering rates, the appropriateness of testing, and physician perspectives on their patient relationships.

Researcher Services

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PUBLICATIONS

Publications powered by Harvard Catalyst Profiles

  1. Krikorian ML, Growdon AS, Chien AT. Assessment of Hospitalist-Subspecialist Agreement About Who Should Be in Charge and Comparison With Actual Assignment Practices. Hosp Pediatr. 2018 Aug; 8(8):479-485. View abstract
  2. Correnti CM, Klein DJ, Elliott MN, Veledar E, Saraiya M, Chien AT, Schwebel DC, Mrug S, Tortolero SR, Cuccaro PM, Schuster MA, Chen SC. Racial disparities in fifth-grade sun protection: Evidence from the Healthy Passages study. Pediatr Dermatol. 2018 Jul 02. View abstract
  3. Chien AT, Toomey SL, Kuo DZ, Van Cleave J, Houtrow AJ, Okumura MJ, Westfall MY, Petty CR, Quinn JA, Kuhlthau KA, Schuster MA. Care Quality and Spending Among Commercially Insured Children With Disabilities. Acad Pediatr. 2018 Jun 19. View abstract
  4. Blumenthal KJ, Chien AT, Singer SJ. Relationship among team dynamics, care coordination and perception of safety culture in primary care. Fam Pract. 2018 May 18. View abstract
  5. Smith AJ, Turner EL, Kinra S, Bodurtha JN, Chien AT. A Cost Analysis of Universal versus Targeted Cholesterol Screening in Pediatrics. J Pediatr. 2018 May; 196:201-207.e2. View abstract
  6. Sheridan B, Chien AT, Peters AS, Rosenthal MB, Brooks JV, Singer SJ. Team-based primary care: The medical assistant perspective. Health Care Manage Rev. 2018 Apr/Jun; 43(2):115-125. View abstract
  7. Chien AT, Kyle MA, Peters AS, Nguyen KH, Tendulkar SA, Ryan M, Hacker K, Singer SJ. Establishing Teams: How Does It Change Practice Configuration, Size, and Composition? J Ambul Care Manage. 2018 Apr/Jun; 41(2):146-155. View abstract
  8. Percac-Lima S, Pace LE, Nguyen KH, Crofton CN, Normandin KA, Singer SJ, Rosenthal MB, Chien AT. Diagnostic Evaluation of Patients Presenting to Primary Care with Rectal Bleeding. J Gen Intern Med. 2018 Apr; 33(4):415-422. View abstract
  9. Brooks JV, Singer SJ, Rosenthal M, Chien AT, Peters AS. Feeling inadequate: Residents' stress and learning at primary care clinics in the United States. Med Teach. 2017 Dec 11; 1-8. View abstract
  10. Chien AT, Newhouse JP, Iezzoni LI, Petty CR, Normand ST, Schuster MA. Socioeconomic Background and Commercial Health Plan Spending. Pediatrics. 2017 Nov; 140(5). View abstract
  11. Sinaiko AD, Chien AT. Achieving the Promise of Price Transparency. JAMA Intern Med. 2017 Jul 01; 177(7):946-947. View abstract
  12. Chien AT, Kuhlthau KA, Toomey SL, Quinn JA, Okumura MJ, Kuo DZ, Houtrow AJ, Van Cleave J, Landrum MB, Jang J, Janmey I, Furdyna MJ, Schuster MA. Quality of Primary Care for Children With Disabilities Enrolled in Medicaid. Acad Pediatr. 2017 May - Jun; 17(4):443-449. View abstract
  13. Chien AT, Ganeshan S, Schuster MA, Lehmann LS, Hatfield LA, Koplan KE, Petty CR, Sinaiko AD, Sequist TD, Rosenthal MB. The Effect of Price Information on the Ordering of Images and Procedures. Pediatrics. 2017 Feb; 139(2). View abstract
  14. Song H, Ryan M, Tendulkar S, Fisher J, Martin J, Peters AS, Frolkis JP, Rosenthal MB, Chien AT, Singer SJ. Team dynamics, clinical work satisfaction, and patient care coordination between primary care providers: A mixed methods study. Health Care Manage Rev. 2017 Jan/Mar; 42(1):28-41. View abstract
  15. Chien AT, Lehmann LS, Hatfield LA, Koplan KE, Petty CR, Sinaiko AD, Rosenthal MB, Sequist TD. A Randomized Trial of Displaying Paid Price Information on Imaging Study and Procedure Ordering Rates. J Gen Intern Med. 2017 Apr; 32(4):434-448. View abstract
  16. Schiavoni KH, Lehmann LS, Guan W, Rosenthal M, Sequist TD, Chien AT. How Primary Care Physicians Integrate Price Information into Clinical Decision-Making. J Gen Intern Med. 2017 Jan; 32(1):81-87. View abstract
  17. Berry JG, Chien AT. To Risk Adjust or Not to Risk Adjust: Should That Be the Question? JAMA Pediatr. 2016 Apr; 170(4):319-20. View abstract
  18. Chien AT, Schiavoni KH, Sprecher E, Landon BE, McNeil BJ, Chernew ME, Schuster MA. How Accountable Care Organizations Responded to Pediatric Incentives in the Alternative Quality Contract. Acad Pediatr. 2016 Mar; 16(2):200-7. View abstract
  19. Chien AT, Kuhlthau KA, Toomey SL, Quinn JA, Houtrow AJ, Kuo DZ, Okumura MJ, Van Cleave JM, Johnson CK, Mahoney LL, Martin J, Landrum MB, Schuster MA. Development of the Children With Disabilities Algorithm. Pediatrics. 2015 Oct; 136(4):e871-8. View abstract
  20. Berry JG, Zaslavsky AM, Toomey SL, Chien AT, Jang J, Bryant MC, Klein DJ, Kaplan WJ, Schuster MA. Recognizing Differences in Hospital Quality Performance for Pediatric Inpatient Care. Pediatrics. 2015 Aug; 136(2):251-62. View abstract
  21. Sinaiko AD, Chien AT, Rosenthal MB. The role of states in improving price transparency in health care. JAMA Intern Med. 2015 Jun; 175(6):886-7. View abstract
  22. Song H, Chien AT, Fisher J, Martin J, Peters AS, Hacker K, Rosenthal MB, Singer SJ. Development and validation of the primary care team dynamics survey. Health Serv Res. 2015 Jun; 50(3):897-921. View abstract
  23. Smith AJ, Chien AT. Massachusetts health reform and access for children with special health care needs. Pediatrics. 2014 Aug; 134(2):218-26. View abstract
  24. Chien AT, Chin MH, Alexander GC, Tang H, Peek ME. Physician financial incentives and care for the underserved in the United States. Am J Manag Care. 2014 Feb; 20(2):121-9. View abstract
  25. Chien AT, Song Z, Chernew ME, Landon BE, McNeil BJ, Safran DG, Schuster MA. Two-year impact of the alternative quality contract on pediatric health care quality and spending. Pediatrics. 2014 Jan; 133(1):96-104. View abstract
  26. Chien AT, Rosenthal MB. Medicare's physician value-based payment modifier--will the tectonic shift create waves? N Engl J Med. 2013 Nov 28; 369(22):2076-8. View abstract
  27. Barry CL, Chien AT, Normand SL, Busch AB, Azzone V, Goldman HH, Huskamp HA. Parity and out-of-pocket spending for children with high mental health or substance abuse expenditures. Pediatrics. 2013 Mar; 131(3):e903-11. View abstract
  28. Toomey SL, Chien AT, Elliott MN, Ratner J, Schuster MA. Disparities in unmet need for care coordination: the national survey of children's health. Pediatrics. 2013 Feb; 131(2):217-24. View abstract
  29. Chien AT, Rosenthal MB. Waste not, want not: promoting efficient use of health care resources. Ann Intern Med. 2013 Jan 01; 158(1):67-8. View abstract
  30. Chien AT, Eastman D, Li Z, Rosenthal MB. Impact of a pay for performance program to improve diabetes care in the safety net. Prev Med. 2012 Nov; 55 Suppl:S80-5. View abstract
  31. Chien AT. Can pay for performance improve the quality of adolescent substance abuse treatment? Arch Pediatr Adolesc Med. 2012 Oct; 166(10):964-5. View abstract
  32. Wallander JL, Fradkin C, Chien AT, Mrug S, Banspach SW, Davies S, Elliott MN, Franzini L, Schuster MA. Racial/ethnic disparities in health-related quality of life and health in children are largely mediated by family contextual differences. Acad Pediatr. 2012 Nov-Dec; 12(6):532-8. View abstract
  33. Schwebel DC, Roth DL, Elliott MN, Chien AT, Mrug S, Shipp E, Dittus P, Zlomke K, Schuster MA. Marital conflict and fifth-graders' risk for injury. Accid Anal Prev. 2012 Jul; 47:30-5. View abstract
  34. Chien AT, Wroblewski K, Damberg C, Williams TR, Yanagihara D, Yakunina Y, Casalino LP. Do physician organizations located in lower socioeconomic status areas score lower on pay-for-performance measures? J Gen Intern Med. 2012 May; 27(5):548-54. View abstract
  35. Lee HC, Chien AT, Bardach NS, Clay T, Gould JB, Dudley RA. The impact of statistical choices on neonatal intensive care unit quality ratings based on nosocomial infection rates. Arch Pediatr Adolesc Med. 2011 May; 165(5):429-34. View abstract
  36. Chien AT, Kirchhoff AC, Schaefer CT, Huang ES, Brown SE, Heuer L, Graber J, Tang H, Casalino LP, Chin MH. Positive and negative spillovers of the Health Disparities Collaboratives in federally qualified health centers: staff perceptions. Med Care. 2010 Dec; 48(12):1050-6. View abstract
  37. Flaherman VJ, Chien AT, McCulloch CE, Dudley RA. Breastfeeding rates differ significantly by method used: a cause for concern for public health measurement. Breastfeed Med. 2011 Feb; 6(1):31-5. View abstract
  38. Chien AT, Li Z, Rosenthal MB. Improving timely childhood immunizations through pay for performance in Medicaid-managed care. Health Serv Res. 2010 Dec; 45(6 Pt 2):1934-47. View abstract
  39. Bardach NS, Chien AT, Dudley RA. Small numbers limit the use of the inpatient pediatric quality indicators for hospital comparison. Acad Pediatr. 2010 Jul-Aug; 10(4):266-73. View abstract
  40. Perry RC, Chien AT, Walker WJ, Fisher TL, Johnson WE. African American adolescent males' views on doctors and the health care system. J Natl Med Assoc. 2010 Apr; 102(4):312-20. View abstract
  41. Weinick RM, Chien AT, Rosenthal MB, Bristol SJ, Salamon J. Hospital executives' perspectives on pay-for-performance and racial/ethnic disparities in care. Med Care Res Rev. 2010 Oct; 67(5):574-89. View abstract
  42. Chien AT, Colman MW, Ross LF. Qualitative insights into how pediatric pay-for-performance programs are being designed. Acad Pediatr. 2009 May-Jun; 9(3):185-91. View abstract
  43. Chien AT, Chin MH. Incorporating disparity reduction into pay-for-performance. J Gen Intern Med. 2009 Jan; 24(1):135-6. View abstract
  44. Chien AT, Conti RM, Pollack HA. A pediatric-focused review of the performance incentive literature. Curr Opin Pediatr. 2007 Dec; 19(6):719-25. View abstract
  45. Chien AT, Chin MH, Davis AM, Casalino LP. Pay for performance, public reporting, and racial disparities in health care: how are programs being designed? Med Care Res Rev. 2007 Oct; 64(5 Suppl):283S-304S. View abstract
  46. Chien AT, Dudley RA. Pay-for-performance in pediatrics: proceed with caution. Pediatrics. 2007 Jul; 120(1):186-8. View abstract
  47. Chien AT, Walters AE, Chin MH. Community health center quality improvement: a systematic review and future directions for research. Prog Community Health Partnersh. 2007; 1(1):105-16. View abstract
  48. Chien A, Coker T, Choi L, Slora E, Bodnar P, Weiley V, Wasserman R, Johnson J. What do pediatric primary care providers think are important research questions? A perspective from PROS providers. Ambul Pediatr. 2006 Nov-Dec; 6(6):352-5. View abstract
  49. Chin MH, Chien AT. Reducing racial and ethnic disparities in health care: an integral part of quality improvement scholarship. Qual Saf Health Care. 2006 Apr; 15(2):79-80. View abstract