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Our Team

Meet the teams from MGH and Johns Hopkins who have led the vision and operations of the National Home-Based Primary Care Learning Network since 2012.

Christine Ritchie, MD, MSPH, FACP, FAAHPM
Minaker Chair in Geriatrics and Director of Research for the Division of Palliative Care and Geriatric Medicine at Massachusetts General Hospital
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Bruce Leff, MD
Professor of Medicine, Johns Hopkins University School of Medicine
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Orla Sheehan, MD
Assistant Professor, Johns Hopkins University School of Medicine
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Jane Taylor, MBA, MHA, Ed.D
Quality Improvement Coach
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Edward Pham, BS
Clinical Research Coordinator II, Massachusetts General Hospital
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Katie Fitch, CNP
Project Director, Massachusetts General Hospital
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Christine Ritchie, MD, MSPH, FACP, FAAHPM
Minaker Chair in Geriatrics and Director of Research for the Division of Palliative Care and Geriatric Medicine at Massachusetts General Hospital

Dr. Christine Ritchie is the Minaker Chair in Geriatrics and Director of Research for the Division of Palliative Care and Geriatric Medicine at Massachusetts General Hospital (MGH). At MGH, she is also working to establish the Center for Aging and Serious Illness at the Mongan Institute. Prior to joining MGH, Dr. Ritchie was the Harris Fishbon Distinguished Professor in Clinical Translational Research and Aging in the Division of Geriatrics, Department of Medicine at the University of California San Francisco (UCSF). Dr. Ritchie is a board certified geriatrician and palliative care physician with long-standing experience in clinical care delivery and
advanced illness research. With Dr. Bruce Leff, Dr. Ritchie co-leads the National Home-based Primary Care Learning Network, where they are seeking to improve care for homebound older adults through research, quality improvement and policy initiatives. Dr. Ritchie served as medical director of Clinical Programs in the UCSF Office of Population Health and Accountable Care. She is also an inaugural member of the NIH-funded national Palliative Care Research Cooperative. She is an Associate Editor for the Journal of Palliative Medicine, serves on the Editorial Board of the Journal of Gerontology: Medical Sciences, and is on the Board of the American Academy of Hospice and Palliative Medicine.

Bruce Leff, MD
Professor of Medicine, Johns Hopkins University School of Medicine

Dr. Leff is Professor of Medicine at the Johns Hopkins University School of Medicine in the Division of Geriatric Medicine and Gerontology. He holds a joint appointment in the Department of Health Policy and Management at the Johns Hopkins University Bloomberg School of Public Health, and in the Johns Hopkins School of Nursing, Department of Community and Public Health.

He is the Director of the Center for Transformative Geriatric Research and is past Associate Director of the JHOME program.  His principal areas of health services research relate to the development, evaluation and dissemination of innovative models of health service delivery for older adults including Hospital at Home, Guided Care, home-based primary care, and others.  His research interests also include issues related to the care of people with multiple chronic conditions, the development of quality indicators for home-based medical care and quality improvement, guideline development and case-mix issues. He is the author of more than 200 peer-reviewed publications and book chapters. Dr. Leff has a strong interest in health policy and is a recent Health and Aging Policy Fellow and has served on multiple National Quality Forum and Centers for Medicare & Medicaid Services Technical Expert Panels. Dr. Leff cares for patients in the acute, ambulatory and home settings and is an award-winning teacher and mentor.

He currently serves as the Chair of the Geriatric Medicine Board of the American Board of Internal Medicine (ABIM) and is Chair-elect of the ABIM Council.  He is past -President and current board member of the American Academy of Home Care Physicians, and past-member of the Board of Regents of the American College of Physicians.  He serves on the editorial board of the Annals of Internal Medicine and is a Care Redesign Thought Leader for the New England Journal of Medicine Catalyst.

Dr. Leff received his medical degree from the New York University School of Medicine and completed residency in primary care internal medicine at the Johns Hopkins Bayview Medical Center, and a fellowship in geriatric medicine and gerontology at the Johns Hopkins University School of Medicine, in Baltimore.

Orla Sheehan, MD
Assistant Professor, Johns Hopkins University School of Medicine

Dr. Sheehan is a Geriatrician who sees her primary role as an advocate for older people. She completed her undergraduate medical training and PhD in University College Dublin, Ireland. She also holds a Masters in Stroke Medicine from the University of Krems, Austria. She completed her internship, residency and both geriatric and internal medicine fellowships in Ireland. In addition to her clinical experience caring for frail older adults with multiple chronic conditions and teaching qualifications she has extensive knowledge of many aspects of research including study design, epidemiology, data acquisition, data entry, statistics, laboratory analysis and manuscript preparation. She led Ireland’s first population-based TIA epidemiology study and her PhD focused on examining the clinical, etiological and serum biomarkers that predict stroke after TIA. Since moving to the U.S., she has assumed a front-line role in the implementation of several research projects including the Roybal pilot project “Engaging Family Members in Addressing Medication Regimen Complexity in Home Health Care” and a number of projects to develop quality indicators for frail elderly patients with multiple chronic conditions (MCCs) receiving home based care. She is a co-investigator on a number of complex multisite studies specifically the Caring for Adults Recovering from the Effects of Stroke (CARES) study and the Caregiving Transitions Study. She leads analyses of NHATS and REGARDS CMS linked data examining healthcare utilization of people with MCCs and the effects of caregivers and other factors on that utilization.

Jane Taylor, MBA, MHA, Ed.D
Quality Improvement Coach

Jane Taylor is an Improvement Advisor and Learning Designer.  She supports learning collaboratives and innovation projects by providing expertise in improvement approaches and measurement. She has advised collaboratives for both adult and pediatric populations.  She is interested in the integration of transformative learning, improvement science, and clinical improvement as well as engaging persons in their care. Jane has an Ed.D. from Columbia University, Teachers College in Adult Learning and Leadership.  In her spare time, she plays the violin and is a competitive amateur ballroom dancer. Jane is a trusted friend and colleague to many; a sister, wife and aunt.     

Edward Pham, BS
Clinical Research Coordinator II, Massachusetts General Hospital

Edward Pham is a Clinical Research Coordinator II at the Center for Aging and Serious Illness. He recently graduated from the University of Massachusetts Amherst with a Bachelor’s degree in biochemistry and has worked on research projects investigating the mechanisms of aging and cancer biology. Having connected with senior patients since he was thirteen years old as a volunteer caregiver, hospice volunteer, and medical assistant, Edward is passionate about addressing senior health disparities and advancing the field of palliative care. 

Katie Fitch, CNP
Project Director, Massachusetts General Hospital

Katie Fitch is a Project Director at the Center for Aging and Serious Illness. In this role she directs the Clinical Coordinating Center for the PCORI-SPIRE Study.

Katie received her Master’s degree in nursing from the MGH Institute of Health Professions and her Bachelor’s degree in International Studies from the University of Washington. Prior to joining CASI, Katie worked as a MGH Clinical Research Nurse Practitioner conducting research to improve the understanding of metabolic complications of HIV, including cardiovascular disease and was the Project Manager of the Clinical Coordinating Center for the REPRIEVE trial; an NIH funded, multicenter trial that demonstrated the efficacy of a statin to prevent atherosclerotic cardiovascular disease events among individuals living with HV. Clinically, Katie has worked as a nurse practitioner at the Boston Health Care for the Homeless Program. She helped to start the Age Positively Program at the MGH Infectious Disease Clinic, a program focused on the health of people aging with HIV, and she has worked in the Lipid and Metabolism Clinic also at MGH.