Patel Laboratory

Key investigator

• Arpan A. Patel, MD, PhD

Health services research

The Patel Laboratory is a health services research program focused on measuring and improving the quality of care delivered to individuals with chronic liver diseases, which include cirrhosis, hepatobiliary cancers, alcohol-associated liver disease, metabolic (dysfunction)-associated fatty liver disease and viral hepatitis.

The laboratory is led by Dr. Arpan A. Patel, who conducts research at UCLA and the Veterans Affairs Greater Los Angeles Healthcare System. Dr. Patel’s team includes biostatisticians, clinical and research gastroenterology fellows, residents and students. The lab’s expertise and collaborations span a number of unique disciplines including gastroenterology, liver transplantation, palliative care, general internal medicine, oncology, addiction medicine, health policy, social science, quality improvement and implementation science.

The core mission of the Patel Lab is to ensure that every individual with liver disease, especially those who are seriously ill, have adequate healthcare access and receive high quality care.

Current research projects

• Describing how individuals with cirrhosis and their caregivers experience domains of palliative care, including advance care planning, physical and psychological symptom burden, and caregiver burden
• Improving goals of care communication and documentation with patients with liver disease who are seriously ill
• Measuring quality gaps and opportunities for improvement in ambulatory and hospitalized patients with liver disease
• Understanding predictors of burnout among clinicians treating patients with liver disease

Publications - Full list on PubMed

1. Iyengar P, Prause N, LeBrett W, Lee A, Chang L, Patel A. Opioid and nonopioid analgesic prescribing patterns of hepatologists for Medicare beneficiaries(Link is external). Clinical Gastroenterology and Hepatology. October 2024
2. Yang JO, Chittajallu P, Benhammou JN, Patel A, Pisegna JR, Tabibian J & Dong TS. Validation of a machine learning algorithm, EVendo, for presecting esophageal varices in hepatocellular carcinoma(Link is external). Digestive Diseases and Sciences. 19 June 2024
3. Patel A, Bowman CA, Prause N, Kilaru S, Nguyen A, Kogekar N, Cohen C, Channen L, Hartly A, Perumalswami P, Dietrich D, Schiano T, Woodrell C, Agarwal R. Outcomes of a 3-year quality improvement study to improve advance care planning in patients with decompensated cirrhosis. The American Journal of Gastroenterology. December 11, 2023
4. Patel A, Walling A, Kanwal F, Serper M, Hernaez R, Sundaram V, Kaplan D, Taddei T, Mahmud N. Rates, patterns, and predictors of specialty palliative care consultation among patients with ACLF. JHEP Reports. 30 November 2023
5. Bansal AD, Patel AA. Dialysis initiation for patients with decompensated cirrhosis when liver transplant is unlikely. Current Opinion in Nephrology and Hypertension. December 4, 2023
6. Benhammou JN, Leng M, Shah SC, Cholankeril G, Dong TS, Patel AA, Tong MJ. Exposure to Agent Orange and Hepatocellular Carcinoma Amongh US Military Personnel. JAMA Open Network. 2023;6(12):e2346380
7. Chen P, Simonetto DA, Sonali P, Patel A. Health disparities experienced by sexual and gender minority individuals living with or at risk chronic liver disease. Clinical Liver Disease. October 2023
8. Bangaru S, Sundaresh, Lee A, Prause N, Hao F, Dong TS, Tincopa M, Cholankeril G, Rich NE, Kawamoto, Bhattacharya D, Han SB, Patel AA, Shaheen M & Benhammou JN. Predictive Algorithm for Hepatic Steatosis Detection Using Elastography Data in the Veterans Affairs Electronic Health Records. Digestive Diseases & Sciences. 21 October 2023
9. Patel AA, Tapper EB, Kanwal F, Woodrell CD, Hansen L, Lai JC, Rogal S, McDermott C, Rakoski M, Ufere NN. Targets and study design for symptom-focused trials aimed at patients with cirrhosis: An expert consensus. Hepatology Communications. 7(6):e0135, June 2023
10. Coe C, Patel A, Lawrence D. Pharmacotherapy options for alcohol use disorder in patients with alcohol-associated liver disease: A brief guide for clinicians. Clinical Liver Disease. 21(5):p 125-129, May 2023
11. Leiter RE, Bischoff KE, Carey EC, Gelfand SL, Iyer AS, Jain N, Kramer NM, Lally K, Landzberg MJ, Lever N, Newport K, O'Donnell A, Patel A, Sciacca KR, Snaman JM, Tulsky JA, Rosa WE, Lakin JR. Top Ten Tips Palliative Care Clinicians Should Know About Delivering Specialty-Aligned Palliative Care. J. Palliat Med. 2023 Mar 31. doi: 10.1089/jpm.2023.0116
12. Lee AH, LeBrett WG, Benhammou J, Prause N, Chang L, Patel AA. Opioid Prescription Patterns and Disparities During Ambulatory Encounters in Patients with Cirrhosis. Clinical Gastroenterology and Hepatology. December 9, 2022. doi.org/10.1016/j.cgh.2022.11.016
13. Patel AA, Arnold RM, Taddei T, Woodrell CD. "Am I Going to Die?": Delivering Serious News to Patients with Liver Diseases. Gastroenterology. 12 November 22. https://doi.org/10.1053/j.gastro.2022.11.006
14. Pourmand K, Schiano TD, Motwani Y, Kriss M, Keefer, Patel AA. Burnout among transplant hepatologists in the United States. Liver Transpl. 2021 Nov 26. doi: 10.1002/lt.26375
15. Patel AA, Woodrell C, Ufere NN, Hansen L, Tandon P, Verma M, Lai J, Pinotti R, Rokaski, PEARL Workgroup. Developing priorities for palliative care research in advanced liver disease: A multidisciplinary approach. Hepatology Communications. 16 June 2021. https://doi.org/10.1002/hep4.1743 
16. Waterman BL, Ramsey SU, Whitsett MP, Patel AA, Radcliff JA, Kotler DL, Winters AC, Woodrell CD, Ufrere NN, Serper M, Walling AM, Jones CA, Kelly SG. Top ten tips palliative care clinicians should know about end-stage liver disease. Journal of Palliative Medicine. 16 Mar 2021https://doi.org/10.1089/jpm.2021.0097
17. Patel AA, Bui A, Prohl E, Bhattacharya D, Wang S, Branch AD, Perumalswani PV. Innovations in Hepatitis C Screening and Treatment. Hepatology Communications. Vol. 0, No. o, 2020.
18. Trieu H, Patel A, Wells C, Saab S, Lee EW. Disparities in Mortality and Health Care Utilization for 460,851 Hospitalized Patients with Cirrhosis and Hepatic Encephalopathy. Dig Dis Sci. 2020 Sep 14.doi: 10.1007/s10620-020-06582-y. , pp.1-8
19. Sundaram V, Jalan R., Shah P, Singal AK, Patel AA, Wu T, Noureddin M, Mahmud N, Wong RJ. Acute on chronic liver failure from nonalcoholic fatty liver disease: a growing and aging cohort with rising mortality. Hepatology. 22 September 2020. doi.org/10.1002/hep.31566
20. Kardashian A, Patel AA, Aby ES, Cusumano VT, Soroudi C, Winters AC, Wu E, Beah P, Delshad S, Kim N, Yang L. Identifying Quality Gaps in Preventive Care for Outpatients With Cirrhosis Within a Large, Academic Health Care System. Hepatology Communications. 09 September 2020. doi.org/10.1002/hep4.1594
21. Hernaez R, Patel A, Jackson L, Braun U, Walling A, Rosen H. Considerations for Prognosis, Goals of Care, and Specialty Palliative Care for Hospitalized Patients with Acute on Chronic Liver Failure. Hepatology. 2020 May 16. doi: 10.1002/hep.31316
22. Al-Samkari H, Patel A. How to Focus Our Efforts in Improving Prognostic Disclosure in Oncology. Cancer. 2020 Jun 1;126(11):2716-2717. doi: 10.1002/cncr.32767. Epub 2020 Feb 19
23. Patel A, Ufere N. Integrating Palliative Care When Managing Patients with Advanced Liver Disease. Clinical Liver Diseases. 2020 May 7;15(4):136-140.doi: 10.1002/cld.936. eCollection 2020 Apr 
24. Aby E, Winters A, Lin J, Bui A, Kawamoto J, Goetz M, Bhattacharya D, May FP, Patel A, Benhammou J. A Telephone and Mail Outreach Program Successfully Increases Uptake of Hepatocellular Carcinoma Surveillance. Hepatology Communications. PMID: 32490319 PMCID: PMC7262281 DOI: 10.1002/hep4.1511 
25. Patel A, Kogekar N, Agarwal R, Cohen C, Esteban JP, Pourmand K, Tsai E, Harty A, Pelham-Braithwaite A, Perumalswami P, Dieterich D. Improving Advance Care Planning in Outpatients with Decompensated Cirrhosis: A Pilot Study. Journal of Pain and Symptom Management. PMID: 31881290 DOI: 10.1016/j.jpainsymman.2019.12.355 
26. Patel A, Asch S, Antonio A, Kanwal F, Lorenz K, Riopelle D, Dickey A, Larkin J, Lee M, Walling A. Measuring the Quality of Palliative Care for Patients with End-Stage Liver Disease. Digestive Diseases and Sciences. 2020 Jan 11 : 1–9. doi: 10.1007/s10620-019-05983-y

Funding and support

Current

• 2018-2020 - AASLD Advanced/Transplant Hepatology Fellowship Award (2 years, $30,000): “Improving Advance Care Planning in End-Stage Liver Disease.” Principal Investigator: Arpan A. Patel, MD, PhD

Prior

• The Barbara and Joel Marcus Foundation GI Fellowship Seed Grant
• Ruth L. Kirschstein Institutioinal National Research Service Award (NRSA) for Primary Care T32 (T32HP19001)

In the news

• Dr. Patel appointed senior quality officer (SQO) for UCLA Health (2024)
• Dr. Patel selected AASLD vice chair of Public Health/Healthcare Delivery Special Interest Group Steering Committee (2023)
• Dr. Patel joined editorial board of Liver Transplantation (2022)
• Dr. Patel was selected as an at-large steering committee member in AASLD Public Health/Healthcare Delivery Special Interest Group. His three-year term will begin January 2022. (2021)
• Dr. Patel was recognized as subspecialty teacher of the year by the UCLA Internal Medicine Residency Program for the quality education he provides and impact he has on trainees. (2021)
• Dr. Patel will serve a two-year term as a member of the AGA Government Affairs Committee and the PAC Board of Advisors. The AGA PAC is the voluntary membership, bipartisan political arm of the American Gastroenterology Association. As the only PAC dedicated to gastroenterology, its mission is to increase its members’ presence on Capitol Hill and support legislators who protect the needs of GI patients and health care professionals. (2021)
• Dr. Patel received a $20,000 one-year pilot grant from the Southern California Research Center for ALPD and Cirrhosis. The grant, Patient Navigation for Hospitalized Patients with Alcohol-Associated Liver Disease: A Feasibility Pilot Study, involves using implementation science methods to integrate alcohol use disorder brief treatment strategies in patients who are hospitalized. Dr. Patel is working with the UCLA liver transplantation team and addiction psychiatry services on this effort. (2021)
• Dr. Patel was awarded a U.S. Department of Veteran Affairs Health Services Research & Development grant through the Center for the Study of Healthcare, Innovation, Implementation, and Policy (CSHIIP) for his project, Detecting behavioral change among healthcare professionals regarding goals of care communication. (2020)
• Dr. Patel was recently named a 2020 Research Scholar from the American Academy for Hospice and Palliative Medicine (AAHPM). This award is granted to select early career investigators who have the potential to make significant impact in palliative care research.

Extramural collaborators

• Ritu Agarwal, MD – Mount Sinai Medical Center
• Lissi Hansen, RN, PhD – Oregon Health Science University
• Ruben Hernandez, MD, PhD – Baylor College of Medicine
• George Ioannou, MD, MSc – University of Washington
• Ani Kardashian, MD – USC Keck Medical Center
• Laurie Keefer PhD – Mount Sinai Medical Center
• Saro Khemichian, MD – USC Keck Medical Center
• Jennifer Lai, MD, MBA – University of California, San Francisco
• Ponni Perumalswami, MD – Mount Sinai Medical Center
• Kamron Pourmand, MD – Mount Sinai Medical Center
• Mina Rakoski, MD – Loma Linda University Medical Center
• Thomas Schiano, MD – Mount Sinai Hospital
• Vinay Sundaram, MD, MSc – Cedars-Sinai Medical Center
• Puneeta Tandon, MD, MSc – University of Alberta
• Nneka Ufere, MD – Massachusetts General Hospital
• Manisha Verma, MD, MPH – Albert Einstein Medical Center
• Christopher Woodrell, MD – Mount Sinai Medical Center

Past GI fellows

• Adam Winters, MD

Current residents

• Aileen Bui
• Jonathan Lin

About Dr. Patel

Dr. Patel earned his bachelor of science at Pennsylvania State University and received his medical degree from Jefferson Medical College, where he graduated summa cum laude and was awarded membership in Alpha Omega Alpha (AOA) and the Gold Humanism Honor Society (GHHS). He completed his internship and residency at the Hospital of the University of Pennsylvania before beginning his fellowship training at the Vatche and Tamar Manoukian Division of Digestive Diseases at UCLA in 2014.
 
During fellowship, Dr. Patel joined the UCLA Specialty Training and Advanced Research (STAR) and the NRSA (National Research Service Award) T32 Primary Care Research Fellowship programs through the Department of Medicine. This support allowed him to complete a PhD in health policy and management through the Fielding School of Public Health at UCLA in 2020. His thesis focused on describing advance care planning in patients with decompensated cirrhosis at liver transplant centers. Dr. Patel also completed additional clinical training in transplant hepatology at the Icahn School of Medicine at Mount Sinai from 2018 to 2019. During this year, he was awarded the opportunity to serve as a visiting scholar at the Hastings Center. In 2020, Dr. Patel joined the faculty at the UCLA Vatche and Tamar Manoukian Division of Digestive Diseases as an assistant clinical professor of medicine.
 
Dr. Patel’s research focuses on describing, measuring and improving the quality of palliative care delivered to patients with serious liver-related illnesses, as well as its effect on their caregivers. He has particular interests in improving communication regarding goals of care, caregiver burden, symptom management and end of life care. In 2018, he was the recipient of the Advanced/Transplant Hepatology Fellowship Award, which provided funding for his project, “Improving Advance Care Planning in End Stage Liver Disease.”
 
Dr. Patel’s research has been published in a number of journals, including JAMA Internal Medicine, Annals of Internal Medicine, Hepatology, Clinical Gastroenterology and Hepatology, Journal of Pain and Symptom Management, Liver Transplantation, Clinical Liver Diseases, and Digestive Diseases and Sciences. He is an active member of the American Association for the Study of Liver Diseases (AASLD) and the American Academy of Hospice and Palliative Medicine (AAHPM).