Bio


Becca Tisdale, MD, MPA is an internist and health services researcher with interests in global health cardiology and health systems. She received a B.A. with distinction in Human Biology from Stanford in 2009, followed by a master of public administration (MPA) joint degree from Sciences Po, Paris and the London School of Economics. She then matriculated at Columbia University College of Physicians and Surgeons for medical school, where she was active in global health activities, researching multidisciplinary teams in HIV care in Ethiopia and serving on the board of the student international health organization. As a global health track resident at Stanford, Becca spent time working in Rwanda through the Johnson and Johnson program and participated in the inaugural Women Leaders in Global Health conferences at Stanford and in London. In 2019-2020, she comprised one third of Stanford’s first all-woman internal medicine chief resident cohort. Outside of work, she enjoys all things French as well as running, both in races and after her toddler son.

Clinical Focus


  • Internal Medicine

Honors & Awards


  • Julian Wolfsohn Award for clinical judgment, leadership, teaching, and kindness, Stanford Internal Medicine Residency (2017)
  • Alpha Omega Alpha, Columbia University College of Physicians & Surgeons (2016)
  • Glasgow-Rubin Achievement Award for women graduates in top 10% of class, Columbia University College of Physicians & Surgeons (2016)
  • Drs. Savitt & McCormack Award for medical skill, consideration, understanding, and compassion, Columbia University College of Physicians & Surgeons (2016)

Professional Education


  • Bachelor of Arts, Stanford University, HUMBI-BA (2009)
  • Board Certification: American Board of Internal Medicine, Internal Medicine (2019)
  • Chief Residency, Stanford University Internal Medicine Residency, CA (2020)
  • Residency: Stanford University Internal Medicine Residency (2019) CA
  • Medical Education: Columbia University College of Physicians and Surgeons (2016) NY
  • MPA, Sciences Po/London School of Economics, Public Administration (2012)
  • BA, Stanford University, Human Biology (2009)

Stanford Advisors


All Publications


  • Disparity in the Setting of Incident Heart Failure Diagnosis. Circulation. Heart failure Sandhu, A. T., Tisdale, R. L., Rodriguez, F., Stafford, R. S., Maron, D. J., Hernandez-Boussard, T., Lewis, E., Heidenreich, P. A. 2021: CIRCHEARTFAILURE121008538

    Abstract

    BACKGROUND: Early heart failure (HF) recognition can reduce morbidity, yet HF is often initially diagnosed only after a patient clinically worsens. We sought to identify characteristics that predict diagnosis in the acute care setting versus the outpatient setting.METHODS: We estimated the proportion of incident HF diagnosed in the acute care setting (inpatient hospital or emergency department) versus outpatient setting based on diagnostic codes from a claims database covering commercial insurance and Medicare Advantage between 2003 and 2019. After excluding new-onset HF potentially caused by a concurrent acute cause (eg, acute myocardial infarction), we identified demographic, clinical, and socioeconomic predictors of diagnosis setting. Patients were linked to their primary care clinicians to evaluate diagnosis setting variation across clinicians.RESULTS: Of 959 438 patients with new HF, 38% were diagnosed in acute care. Of these, 46% had potential HF symptoms in the prior 6 months. Over time, the relative odds of acute care diagnosis increased by 3.2% annually after adjustment for patient characteristics (95% CI, 3.1%-3.3%). Acute care diagnosis setting was more likely for women compared with men (adjusted odds ratio, 1.11 [95% CI, 1.10-1.12]) and for Black patients compared with White patients (adjusted odds ratio, 1.18 [95% CI, 1.16-1.19]). The proportion of acute care diagnosis varied substantially (interquartile range: 24%-39%) among clinicians after adjusting for patient-level risk factors.CONCLUSIONS: A large proportion of first HF diagnoses occur in the acute care setting, particularly among women and Black patients, yet many had potential HF symptoms in the months before acute care visits. These results raise concerns that many HF diagnoses are missed in the outpatient setting. Earlier diagnosis could allow for timelier high-value interventions, addressing disparities and reducing the progression of HF.

    View details for DOI 10.1161/CIRCHEARTFAILURE.121.008538

    View details for PubMedID 34311559

  • DISPARITIES IN VIRTUAL CARDIOLOGY VISITS AMONG VETERANS HEALTH ADMINISTRATION PATIENTS DURING THE COVID-19 PANDEMIC Tisdale, R. L., Ferguson, J. M., Van Campen, J., Greene, L., Sandhu, A., Heidenreich, P., Zulman, D. SPRINGER. 2021: S168
  • Availability of Cost-effectiveness Studies for Drugs With High Medicare Part D Expenditures. JAMA network open Tisdale, R. L., Ma, I., Vail, D., Bhattacharya, J., Goldhaber-Fiebert, J. D., Heidenreich, P. A., Sandhu, A. T. 2021; 4 (6): e2113969

    Abstract

    Importance: Prescription drug spending in the US requires policy intervention to control costs and improve the value obtained from pharmaceutical spending. One such intervention is to apply cost-effectiveness evidence to decisions regarding drug coverage and pricing, but this intervention depends on the existence of such evidence to guide decisions.Objective: To characterize the availability and quality of cost-effectiveness studies for prescription drugs with the greatest Medicare Part D spending.Design, Setting, and Participants: In this national cross-sectional analysis, publicly available 2016 Medicare drug spending records were merged with 2016 US Food & Drug Administration Orange Book data and the Tufts Medical Center Cost-Effectiveness Analysis (CEA) Registry. All studies published through 2015 that evaluated the cost-effectiveness of the 250 drugs for which Medicare Part D spending was the greatest in US-based adult patient populations were included. Data were analyzed from September 2018 to June 2020.Main Outcomes and Measures: The presence and quality of published cost-effectiveness analyses for the 250 drugs for which Medicare Part D spending was greatest in 2016 were assessed based on the inclusion of key cost-effectiveness analysis elements and global ratings by independent reviewers for the Tufts CEA Registry.Results: Medicare Part D spending on the 250 drugs in the sample totaled $122.8 billion in 2016 (84.1% of total spending). Of these 250 drugs, 91 (36.4%) had a generic equivalent and 159 (63.6%) retained some patent exclusivity. There were 280 unique cost-effectiveness analyses for these drugs, representing data on 135 (54.0%) of the 250 drugs included and 67.0% of Part D spending on the top 250 drugs. The 115 drugs (46.0%) without cost-effectiveness studies accounted for 33.0% of Part D spending on the top 250 drugs. Of the 280 available studies, 128 (45.7%) were industry sponsored. A large proportion of the studies (250 [89.3%]) did not meet the minimum quality requirements.Conclusions and Relevance: In this cross-sectional study, a substantial proportion of 2016 Medicare Part D spending was for drugs with absent or low-quality cost-effectiveness analyses. The lack of quality analyses may present a challenge in efforts to develop policies addressing drug spending in terms of value.

    View details for DOI 10.1001/jamanetworkopen.2021.13969

    View details for PubMedID 34143189

  • PREDICTORS OF SETTING OF HEART FAILURE DIAGNOSIS Tisdale, R., Stafford, R., Maron, D., Hernandez-Boussard, T., Rodriguez, F., Heidenreich, P., Sandhu, A. ELSEVIER SCIENCE INC. 2021: 676
  • Patient-Centered, Sustainable Hypertension Care: The Case for Adopting a Differentiated Service Delivery Model for Hypertension Services in Low- and Middle-Income Countries GLOBAL HEART Tisdale, R. L., Cazabon, D., Moran, A. E., Rabkin, M., Bygrave, H., Cohn, J. 2021; 16 (1)

    View details for DOI 10.5334/gh.978

    View details for Web of Science ID 000693421100001

  • Trends in Left Ventricular Ejection Fraction for Patients With a New Diagnosis of Heart Failure. Circulation. Heart failure Tisdale, R. L., Haddad, F., Kohsaka, S., Heidenreich, P. A. 2020: CIRCHEARTFAILURE119006743

    Abstract

    BACKGROUND: The left ventricular ejection fraction (LVEF) guides treatment of heart failure, yet this data has not been systematically collected in large data sets. We sought to characterize the epidemiology of incident heart failure using the initial LVEF.METHODS: We identified 219 537 patients in the Veterans Affairs system between 2011 and 2017 who had an LVEF documented within 365 days before and 30 days after the heart failure diagnosis date. LVEF was obtained from natural language processing from imaging and provider notes. In multivariate analysis, we assessed characteristics associated with having an initial LVEF <40%.RESULTS: Most patients were male and White; a plurality were within the 60 to 69 year age decile. A majority of patients had ischemic heart disease and a high burden of co-morbidities. Over time, presentation with an LVEF <40% became slightly less common, with a nadir in 2015. Presentation with an initial LVEF <40% was more common in younger patients, men, Black and Hispanic patients, an inpatient presentation, lower systolic blood pressure, lower pulse pressure, and higher heart rate. Ischemic heart disease, alcohol use disorder, peripheral arterial disease, and ventricular arrhythmias were associated with an initial LVEF <40%, while most other comorbid conditions (eg, atrial fibrillation, chronic obstructive pulmonary disease, malignancy) were more strongly associated with an initial LVEF >50%.CONCLUSIONS: For patients with heart failure, particularly at the extremes of age, an initial preserved LVEF is common. In addition to clinical characteristics, certain races (Black and Hispanic) were more likely to present with a reduced LVEF. Further studies are needed to determine if racial differences are due to patient or health systems issues such as access to care.

    View details for DOI 10.1161/CIRCHEARTFAILURE.119.006743

    View details for PubMedID 32867526

  • Association Between Neighborhood Social Risk and Hospital Readmission Reduction Penalties Under the New Stratified Approach: Is Dual Eligibility Adjustment Enough? Circulation. Cardiovascular quality and outcomes Sandhu, A. T., Tisdale, R., Joynt Maddox, K. E., Heidenreich, P. A. 2020: CIRCOUTCOMES119006353

    View details for DOI 10.1161/CIRCOUTCOMES.119.006353

    View details for PubMedID 32600063

  • Novel Graduate Medical Education in the Era of a Novel Virus Journal of Graduate Medical Education Tisdale, R., Filsoof, A., Singhal, S. 2020
  • How Much Time are Physicians and Nurses Spending Together at the Patient Bedside? Journal of hospital medicine Sang, A. X., Tisdale, R. L., Nielsen, D., Loica-Mersa, S., Miller, T., Chong, I., Shieh, L. 2019; 14: E1–E6

    Abstract

    BACKGROUND: Bedside rounding involving both nurses and physicians has numerous benefits for patients and staff. However, precise quantitative data on the current extent of physician-nurse (MD-RN) overlap at the patient bedside are lacking.OBJECTIVE: This study aimed to examine the frequency of nurse and physician overlap at the patient beside and what factors affect this frequency.DESIGN: This is a prospective, observational study of time-motion data generated from wearable radio frequency identification (RFID)-based locator technology.SETTING: Single-institution academic hospital.MEASUREMENTS: The length of physician rounds, frequency of rounds that include nurses simultaneously at the bedside, and length of MD-RN overlap were measured and analyzed by ward, day of week, and distance between patient room and nursing station.RESULTS: A total of 739 MD rounding events were captured over 90 consecutive days. Of these events, 267 took place in single-bed patient rooms. The frequency of MD-RN overlap was 30.0%, and there was no statistical difference between the three wards studied. Overall, the average length of all MD rounds was 7.31 ± 0.58 minutes, but rounding involving a bedside nurse lasted longer than rounds with MDs alone (9.56 vs 5.68 minutes, P < .05). There was no difference in either the length of rounds or the frequency of MD-RN overlap between weekdays and weekends. Finally, patient rooms located farther away from the nursing station had a lower likelihood of MD-RN overlap (Pearson's r = -0.67, P < .05).CONCLUSION: RFID-based technology provides precise, automated, and high-throughput time-motion data to capture nurse and physician activity. At our institution, 30.0% of rounds involve a bedside nurse, highlighting a potential barrier to bedside interdisciplinary rounding.

    View details for DOI 10.12788/jhm.3204

    View details for PubMedID 31112496

  • What's in a Name? Factors That Influence the Usage of Generic Versus Trade Names for Cardiac Medications Among Healthcare Providers CIRCULATION-CARDIOVASCULAR QUALITY AND OUTCOMES Ouyang, D., Tisdale, R., Cheng, P., Chi, J., Chen, J. H., Ashley, E. 2018; 11 (8)
  • Acetaminophen or Tylenol? A Retrospective Analysis of Medication Digital Communication Practices. Journal of general internal medicine Ouyang, D., Tisdale, R., Ashley, E., Chi, J., Chen, J. H. 2018

    View details for PubMedID 29717410

  • EMR-based handoff tool improves completeness of internal medicine residents' handoffs. BMJ open quality Tisdale, R. L., Eggers, Z., Shieh, L. 2018; 7 (3): e000188

    Abstract

    Background: The majority of adverse events in healthcare involve communication breakdown. Physician-to-physician handoffs are particularly prone to communication errors, yet have been shown to be more complete when systematised according to a standardised bundle. Interventions that improve thoroughness of handoffs have not been widely studied.Aim: To measure the effect of an electronic medical record (EMR)-based handoff tool on handoff completeness.Intervention: This EMR-based handoff tool included a radio button prompting users to classify patients as stable, a 'watcher' or unstable. It automatically pulled in EMR data on the patient's 24-hour vitals, common lab tests and code status. Finally, it provided text boxes labelled 'Active Issues', 'Action List (To-Dos)' and 'If/Then' to fill in.Implementation and evaluation: Written handoffs from general and specialty (haematology, oncology, cardiology) Internal Medicine resident-run inpatient wards were evaluated on a randomly chosen representative sample of days in April and May 2015 at Stanford University Medical Center, focusing on a predefined set of content elements. The intervention was then implemented in June 2015 with postintervention data collected in an identical fashion in August to September 2016.Results: Handoff completeness improved significantly (p<0.0001). Improvement in inclusion of illness severity was notable for its magnitude and its importance in establishing a consistent mental model of a patient. Elements that automatically pulled in data and those prompting users to actively fill in data both improved.Conclusion: A simple EMR-based handoff tool providing a mix of frameworks for completion and automatic pull-in of objective data improved handoff completeness. This suggests that EMR-based interventions may be effective at improving handoffs, possibly leading to fewer medical errors and better patient care.

    View details for DOI 10.1136/bmjoq-2017-000188

    View details for PubMedID 30019013

  • What's in a Name? Factors That Influence the Usage of Generic Versus Trade Names for Cardiac Medications Among Healthcare Providers. Circulation. Cardiovascular quality and outcomes Ouyang, D. n., Tisdale, R. n., Cheng, P. n., Chi, J. n., Chen, J. H., Ashley, E. n. 2018; 11 (8): e004704

    View details for PubMedID 30354370

  • Stress and Anxiety Scores in First and Repeat IVF Cycles: A Pilot Study. PloS one Turner, K., Reynolds-May, M. F., Zitek, E. M., Tisdale, R. L., Carlisle, A. B., Westphal, L. M. 2013; 8 (5)

    View details for DOI 10.1371/journal.pone.0063743

    View details for PubMedID 23717472