Mark Williams: Improving Hospital Discharges and Targeting Social Needs for Better Health

Dr. Mark V.  Williams doesn’t want people back in the hospital. The former emergency medicine physician and current chief of the Division of Hospital Medicine at UK HealthCare says his goal is for people to understand the medications they need to take and what do when they leave the hospital, so they don’t end up coming back. 

One of his research projects, funded by the Patient Centered Outcomes Research Institute called ACHIEVE, is evaluating nationwide efforts to improve the hospital discharge process and reduce hospital readmissions. The first step was asking patients and caregivers question like these: Did you follow up with your primary care provider? Did you end up having to go back to the emergency department? What matters most to you when you’re being discharged from the hospital?

Williams says, “Right now we’re wrapping up surveying over 9,000 patients as they’ve gone through the hospital discharge process and nearly 3,000 of their caregivers, and we’ll then link that survey data to Medicare data on outcomes.” As part of the project, his research team undertook a massive data analysis effort — five million records from 380 hospitals across the U.S. By linking what hospitals describe as their care transition improvement efforts to the medical records of what happened after patients left the hospital, the researchers will see what works and where hospitals can improve processes. 

Williams wants to impact care nationally, but closer to home in Eastern Kentucky he wants to empower clinics and their patients by developing a database of local resources to address social needs — things like access to transportation, housing and food. Research has shown these factors play a critical role in health. “My personal goal was to be able to set up a platform so we could interact with these clinics, begin to touch the patients in these communities that we see too often when they get extraordinarily ill and have to be transported either by ambulance or helicopter to UK,” Williams says. 

That platform, a website called CARE-KY (, is a crowd-sourced database and currently includes more than 1,000 community resources in 27 Kentucky counties. “The worst health outcomes, unfortunately, in the United States are out in Eastern Kentucky, and I'm hopeful we'll be able to tap into all these resources and focus them on undertaking something that tangibly improves health in these communities.”

Williams is director of the UK Center for Health Services Research. “The center started in January 2014 with two people, but now we have 50 and have received more than $20 million dollars in awards, and there's hopefully more to come.”

Last May, he was one of 14 UK faculty selected as a 2018-2019 University Research Professor. Nominated by the College of Medicine, Williams was recognized for his outstanding research achievements. He says his reaction was shock and gratitude. “It's certainly an honor, but it really is recognition of what our team has been able to accomplish. The collaborations have come readily and easily. I think it reflects the University of Kentucky, the willingness of people to work with you. I'd say at other academic medical centers it's more of a competition. You can get so much more accomplished when it's a collaboration instead of a competition.”