CANDIDATE: As a rheumatologist and former Yale Robert Wood Johnson Clinical Scholar, my career objective is to reduce morbidity and mortality from rheumatic disease by using technology to target therapies more effectively. I hope to use my diverse experiences to pursue innovative, high impact research on how best to incorporate novel technologies into clinical practice. ENVIRONMENT: I will join the Yale faculty in 2006 and pursue my research career in a supportive academic environment. My mentorship team is Dr. Joseph Craft, my Sponsor and Chief of Rheumatology;Dr. Liana Fraenkel, an experienced health services researcher;Dr. Ronald Scott Braithwaite, an expert in meta-analysis and computer simulation modeling;and Dr. John Concato, a leading expert in research methodology and clinical epidemiology. I have crafted a thorough career development plan, providing me the skills in decision analysis and simulation modeling necessary for the completion of my project. RESEARCH PROJECT: Rheumatoid arthritis (RA) is a common debilitating disease, leading to $10 billion a year in direct medical costs. Early treatment improves long-term outcomes. Magnetic resonance imaging (MRI) has been proposed as a tool for early RA risk stratification, but the incremental cost-effectiveness of adding MRI to usual early RA management in order to target treatment is unknown. The goal of this proposal is to assess the cost-effectiveness of using MRI to risk stratify early RA patients. The research involves performing meta-analyses of MRI performance data and therapeutic efficacy data in early RA, as well as estimating the costs associated with adding MRI to usual early RA management. I will then use this information to construct a Monte Carlo simulation model, determining the incremental cost-effectiveness of adding MRI to usual early RA management. RELEVANCE: This research will provide a rational framework for defining 'best practices'in RA patient care. My work will allow clinicians and researchers to more rapidly apply clinical data as it becomes available and will promptly inform the design of both future clinical trials and healthcare policy. The results will address an important unanswered question in Rheumatology that would otherwise require years of costly prospective research.