After Theresa Shireman earned her bachelor’s degree in pharmacy at Drake University in Des Moines in 1985, she moved about 100 miles east to work for the University of Iowa hospital system in Iowa City. Within a few years, she became interested making the leap to management, so she enrolled in Iowa’s master’s program in pharmacy economics.
That turned out to be even bigger jump than Shireman, who has now joined Brown as professor of health services, policy and practice, first thought it would be. As she learned more about the pharmacy business, she became captivated by bigger-picture questions, such as why prescribing sometimes goes awry and why people sometimes don’t take their medicine as they should.
Such questions motivated her to pursue a career in academic research. She wanted to learn more about what makes treatments more or less effective and how they can be delivered better. A lot of money changes hands in the pharmaceutical business, but it’s often for naught, medically.
“It’s messy,” she said. “I like to try to untangle individual threads in the treatment-outcome arena to figure out: Do we know what the optimal treatment is, and are patients receiving the most effective care? If not, how can we improve the care delivered to better use scarce resources and maximize health?”
After Iowa, she studied pharmacy economics, preventive medicine and public policy to earn a Ph.D. at the University of Wisconsin. She has continued doing research on the effectiveness of medical treatments and health care delivery ever since.
“We are doing so much in healthcare that has no value,” she said. “It’s because it’s done when it shouldn’t be done or it’s not done the right way. We really don’t know how effective many treatments or policies are once they are in practice.”
Many of her studies involve analyzing Medicaid data. Her facility with that began with her first faculty job in 1997 as an assistant professor at the University of Cincinnati College of Pharmacy. She took on the state of Ohio’s contract to analyze Medicaid drug utilization data.
“It was like baptism by fire,” she said. “They just threw me in this big dataset and I had to try to make sense of all these claims.”
She came through that trial uncindered. In 2000 she moved to the University of Kansas. There she studied a wide variety of issues including why some older Medicaid patients received one painkiller vs. another, the quality of diabetes care for developmentally disabled adults, and broad patterns of health care utilization among disabled people on Medicaid.
Some of her more recent papers concern the medicines given in hopes of preserving the cardiovascular health of patients on dialysis, a costly, long-term treatment that drags many patients into poverty. Doctors don’t really know what works in large part because dialysis patients generally are excluded from clinical trials of cardiovascular medications.
“How are we going to know if the drugs work in them or not?” she said. “Let’s use the best tool we can use. Let’s take what we can from observational data.”
Now at Brown, Shireman has a new project. She plans to compare, state-by-state, how well Medicaid programs around the country provide home- and community-based care services for people with advanced multiple sclerosis. In general, the services help people stay in their homes, potentially allowing them to remain independent and save money compared to the cost of institutional care. But some states are likely meeting those goals better than others.
Shireman said she has come to Brown because it is a leading center for health services research. She expects to learn from colleagues, while also adding her pharmacy-informed perspective.
“The people at Brown in the group that I’m joining — Vince Mor and Ira Wilson and the folks in the Department of Health Services, Policy and Practice — are some of the best in the country at doing a lot of this,” she said. “It’s a chance to have a group of people who are really interested in this and want to do it. I also have some unique skills to contribute. It’s a great group of colleagues to join and collaborate with.”