Ralph Gonzales, MD, MSPH

Chief Innovation Officer
Clinical Innovation Center
+1 415 514-6457

Dr. Ralph Gonzales is Associate Dean for Clinical Innovation and Chief Innovation Officer for UCSF Health. His research has played a significant role in national and global efforts to combat antimicrobial resistance by improving antibiotic prescribing practices - the body of which provides a successful roadmap for translating evidence into practice, policy and public health. Dr Gonzales’ research is multidisciplinary, patient-centered, and informed by relevant stakeholders and policy makers such as the CDC, NCQA, professional societies and community clinicians and patients. It represents the full spectrum of translational research - from practice guideline development, to implementation of innovative health care interventions, to conducting larger community-based trials to examine the comparative effectiveness of different health care interventions.
In addition, Dr. Gonzales is currently leading several project teams in designing, implementing and evaluating new ways to improve primary care-specialty care communication and care coordination, focusing on strategies that achieve the triple aim of improving quality, outcomes and decreasing costs. One includes the use of eReferrals and eConsults to streamline the referral and coordination process; another project is evaluating new team-based strategies to reduce unnecessary follow-up visits in specialty care.

Publications: 

Analysis of National Rates, Cost, and Sources of Cost Variation in Adult Spinal Deformity.

Neurosurgery

Zygourakis CC, Liu CY, Keefe M, Moriates C, Ratliff J, Dudley RA, Gonzales R, Mummaneni PV, Ames CP

Analysis of Cost Variation in Craniotomy for Tumor Using 2 National Databases.

Neurosurgery

Zygourakis CC, Liu CY, Yoon S, Moriates C, Boscardin C, Dudley RA, Lawton MT, Theodosopoulos P, Berger MS, Gonzales R

Appropriate Reconciliation of Cardiovascular Medications After Elective Surgery and Postdischarge Acute Hospital and Ambulatory Visits.

Journal of hospital medicine

Lee JS, Gonzales R, Vittinghoff E, Corbett KK, Fleischmann KE, Sehgal N, Auerbach AD

Caring Wisely: A Program to Support Frontline Clinicians and Staff in Improving Healthcare Delivery and Reducing Costs.

Journal of hospital medicine

Gonzales R, Moriates C, Lau C, Valencia V, Imershein S, Rajkomar A, Prasad P, Boscardin C, Grady D, Johnston S

Geographic and Hospital Variation in Cost of Lumbar Laminectomy and Lumbar Fusion for Degenerative Conditions.

Neurosurgery

Zygourakis CC, Liu CY, Wakam G, Moriates C, Boscardin C, Ames CP, Mummaneni PV, Ratliff J, Dudley RA, Gonzales R

Trends in Utilization and Cost of Cervical Spine Surgery Using the National Inpatient Sample Database, 2001 to 2013.

Spine

Liu CY, Zygourakis CC, Yoon S, Kliot T, Moriates C, Ratliff J, Dudley RA, Gonzales R, Mummaneni PV, Ames CP

Communicating Context in Quality Improvement Reports.

JAMA internal medicine

Gonzales R, Boscardin C, Auerbach A

Association Between Surgeon Scorecard Use and Operating Room Costs.

JAMA surgery

Zygourakis CC, Valencia V, Moriates C, Boscardin CK, Catschegn S, Rajkomar A, Bozic KJ, Soo Hoo K, Goldberg AN, Pitts L, Lawton MT, Dudley RA, Gonzales R

The added value of C-reactive protein measurement in diagnosing pneumonia in primary care: a meta-analysis of individual patient data.

CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne

Minnaard MC, de Groot JA, Hopstaken RM, Schierenberg A, de Wit NJ, Reitsma JB, Broekhuizen BD, van Vugt SF, Knuistingh Neven A, Graffelman AW, Melbye H, Rainer TH, Steurer J, Holm A, Gonzales R, Dinant GJ, van de Pol AC, Verheij TJ

Predictors of Variation in Neurosurgical Supply Costs and Outcomes Across 4904 Surgeries at a Single Institution.

World neurosurgery

Zygourakis CC, Valencia V, Boscardin C, Nayak RU, Moriates C, Gonzales R, Theodosopoulos P, Lawton MT

152 A Prospective Controlled Trial of the Effect of Surgeon Cost Scorecards on Operating Room Surgical Cost Reduction.

Neurosurgery

Zygourakis CC, Valencia V, Moriates C, Boscardin C, Catschegn S, Goldberg A, Bozic K, Hoo KS, Wustrack R, Pitts LH, Dudley A, Gonzales R, Lawton MT

153 Significant Interhospital Variation in Cranial Surgery Costs Using the Nationwide Inpatient Sample Database.

Neurosurgery

Zygourakis CC, Liu C, Theodosopoulos PV, Lawton MT, Dudley A, Gonzales R

Adoption and impact of an eConsult system in a fee-for-service setting.

Healthcare (Amsterdam, Netherlands)

Gleason N, Prasad PA, Ackerman S, Ho C, Monacelli J, Wang M, Collado D, Gonzales R

Operating room waste: disposable supply utilization in neurosurgical procedures.

Journal of neurosurgery

Zygourakis CC, Yoon S, Valencia V, Boscardin C, Moriates C, Gonzales R, Lawton MT

Referring wisely: orthopedic referral guidelines at an academic institution.

The American journal of managed care

Otto ME, Senter C, Gonzales R, Gleason N

External Validation of Prediction Models for Pneumonia in Primary Care Patients with Lower Respiratory Tract Infection: An Individual Patient Data Meta-Analysis.

PloS one

Schierenberg A, Minnaard MC, Hopstaken RM, van de Pol AC, Broekhuizen BD, de Wit NJ, Reitsma JB, van Vugt SF, Graffelman AW, Melbye H, Rainer TH, Steurer J, Holm A, Gonzales R, Dinant GJ, de Groot JA, Verheij TJ

The Action Research Program: Experiential Learning in Systems-Based Practice for First-Year Medical Students.

Teaching and learning in medicine

Ackerman SL, Boscardin C, Karliner L, Handley MA, Cheng S, Gaither TW, Hagey J, Hennein L, Malik F, Shaw B, Trinidad N, Zahner G, Gonzales R

Changing Clinician Behavior When Less Is More.

JAMA internal medicine

Gonzales R, Cattamanchi A

Predicting cost of care using self-reported health status data.

BMC health services research

Boscardin CK, Gonzales R, Bradley KL, Raven MC

Optimizing the pre-referral workup for gastroenterology and hepatology specialty care: consensus using the Delphi method.

Journal of evaluation in clinical practice

Ho CK, Boscardin CK, Gleason N, Collado D, Terdiman J, Terrault NA, Gonzales R

High Rate of Hospital Admissions Among Patients with Cirrhosis Seeking Care in US Emergency Departments.

Digestive diseases and sciences

Ho CK, Maselli JH, Terrault NA, Gonzales R

Transforming the endocrine consult: asynchronous provider consultations.

Endocrine practice : official journal of the American College of Endocrinology and the American Association of Clinical Endocrinologists

Cruz ML, Gleason N, Wang M, Wrenn K, Gonzales R

Using Rapid Ethnography to Support the Design and Implementation of Health Information Technologies.

Studies in health technology and informatics

Ackerman S, Gleason N, Gonzales R

An automated telephone nutrition support system for Spanish-speaking patients with diabetes.

Journal of diabetes science and technology

Khanna R, Stoddard PJ, Gonzales EN, Villagran-Flores M, Thomson J, Bayard P, Palos Lucio AG, Schillinger D, Bertozzi S, Gonzales R

When to repatriate? Clinicians' perspectives on the transfer of patient management from specialty to primary care.

Journal of general internal medicine

Ackerman SL, Gleason N, Monacelli J, Collado D, Wang M, Ho C, Catschegn-Pfab S, Gonzales R

Development and sustainability of an inpatient-to-outpatient discharge handoff tool: a quality improvement project.

Joint Commission journal on quality and patient safety

Moy NY, Lee SJ, Chan T, Grovey B, Boscardin WJ, Gonzales R, Pierluissi E

Emergency department visits in the neonatal period in the United States.

Pediatric emergency care

Lee HC, Bardach NS, Maselli JH, Gonzales R

Patient attitudes about specialty follow-up care by telephone.

The American journal of managed care

Eng JA, Hunter CJ, Handley MA, Boscardin CK, Gonzales R, Ackerman SL

One size does not fit all: evaluating an intervention to reduce antibiotic prescribing for acute bronchitis.

BMC health services research

Ackerman SL, Gonzales R, Stahl MS, Metlay JP

Shifting the paradigm for promoting appropriate antibiotic use.

Journal of general internal medicine

Gonzales R, Metlay JP

Cultural capital: accounting for power in patient-physician interactions.

JAMA internal medicine

Ackerman S, Auer R, Gonzales R

The impact of demographic characteristics on nonresponse in an ambulatory patient satisfaction survey.

Joint Commission journal on quality and patient safety

Boscardin CK, Gonzales R

A cluster randomized trial of decision support strategies for reducing antibiotic use in acute bronchitis.

JAMA internal medicine

Gonzales R, Anderer T, McCulloch CE, Maselli JH, Bloom FJ, Graf TR, Stahl M, Yefko M, Molecavage J, Metlay JP

Computed tomography use among children presenting to emergency departments with abdominal pain.

Pediatrics

Fahimi J, Herring A, Harries A, Gonzales R, Alter H

Benefit or burden? A sociotechnical analysis of diagnostic computer kiosks in four California hospital emergency departments.

Social science & medicine (1982)

Ackerman SL, Tebb K, Stein JC, Frazee BW, Hendey GW, Schmidt LA, Gonzales R

Computer-assisted provision of hormonal contraception in acute care settings.

Contraception

Schwarz EB, Burch EJ, Parisi SM, Tebb KP, Grossman D, Mehrotra A, Gonzales R

The context of antibiotic overuse.

Annals of internal medicine

Ackerman S, Gonzales R

Unintended consequences of a quality measure for acute bronchitis.

The American journal of managed care

Roth S, Gonzales R, Harding-Anderer T, Bloom FJ, Graf T, Stahl MS, Maselli JH, Metlay JP

Regional differences in emergency medical services use for patients with acute stroke (findings from the National Hospital Ambulatory Medical Care Survey Emergency Department Data File).

Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association

Govindarajan P, Gonzales R, Maselli JH, Johnston SC, Fahimi J, Poisson S, Stein JC

The use of classification and regression trees to predict the likelihood of seasonal influenza.

Family practice

Afonso AM, Ebell MH, Gonzales R, Stein J, Genton B, Senn N

A framework for training health professionals in implementation and dissemination science.

Academic medicine : journal of the Association of American Medical Colleges

Gonzales R, Handley MA, Ackerman S, O'sullivan PS

Antibiotic knowledge and self-care for acute respiratory tract infections in Mexico.

Salud publica de Mexico

Gonzales R, López-Caudana AE, González-Flores T, Jayanthan J, Corbett KK, Reyes-Morales H

Development and validation of a clinical decision rule for the diagnosis of influenza.

Journal of the American Board of Family Medicine : JABFM

Ebell MH, Afonso AM, Gonzales R, Stein J, Genton B, Senn N

Improving glycemic control when "usual" diabetes care is not enough.

Archives of internal medicine

Gonzales R, Handley MA

A randomized trial of computer kiosk-expedited management of cystitis in the emergency department.

Academic emergency medicine : official journal of the Society for Academic Emergency Medicine

Stein JC, Navab B, Frazee B, Tebb K, Hendey G, Maselli J, Gonzales R

Antimicrobial resistance in uncomplicated urinary tract infections in 3 California EDs.

The American journal of emergency medicine

Moffett SE, Frazee BW, Stein JC, Navab B, Maselli J, Takhar SS, Gonzales R

Radiological imaging of patients with suspected urinary tract stones: national trends, diagnoses, and predictors.

Academic emergency medicine : official journal of the Society for Academic Emergency Medicine

Westphalen AC, Hsia RY, Maselli JH, Wang R, Gonzales R

Adverse drug events in U.S. adult ambulatory medical care.

Health services research

Sarkar U, López A, Maselli JH, Gonzales R

Differential use of diagnostic ultrasound in u.s. Emergency departments by time of day.

The western journal of emergency medicine

Stein JC, Jacoby VL, Vittinghoff E, Wang R, Kwan E, Reynolds T, McAlpine I, Gonzales R

Does this coughing adolescent or adult patient have pertussis?

JAMA

Cornia PB, Hersh AL, Lipsky BA, Newman TB, Gonzales R

Trends and characteristics of US emergency department visits, 1997-2007.

JAMA

Tang N, Stein J, Hsia RY, Maselli JH, Gonzales R

Physician champions are key to improving antibiotic prescribing quality.

Joint Commission journal on quality and patient safety

Aagaard EM, Gonzales R, Camargo CA, Auten R, Levin SK, Maselli J, Metlay J

Trends in antibiotic utilization in eight Latin American countries, 1997-2007.

Revista panamericana de salud publica = Pan American journal of public health

Wirtz VJ, Dreser A, Gonzales R

ED antibiotic use for acute respiratory illnesses since pneumonia performance measure inception.

The American journal of emergency medicine

Fee C, Metlay JP, Camargo CA, Maselli JH, Gonzales R

Sociodemographic trends in national ambulatory care visits for hepatitis C virus infection.

Digestive diseases and sciences

Tsui JI, Maselli J, Gonzales R

Variation in outpatient antibiotic prescribing in the United States.

The American journal of managed care

Steinman MA, Yang KY, Byron SC, Maselli JH, Gonzales R

Antibiotic prescriptions are associated with increased patient satisfaction with emergency department visits for acute respiratory tract infections.

Academic emergency medicine : official journal of the Society for Academic Emergency Medicine

Stearns CR, Gonzales R, Camargo CA, Maselli J, Metlay JP

Perceived social support among adults seeking care for acute respiratory tract infections in US EDs.

The American journal of emergency medicine

Levin SK, Metlay JP, Maselli JH, Kersey AS, Camargo CA, Gonzales R

Pediatricians' perspectives on the impact of MRSA in primary care: a qualitative study.

BMC pediatrics

Hersh AL, Cabana MD, Gonzales R, Shenkin BN, Cho CS

C-reactive protein testing does not decrease antibiotic use for acute cough illness when compared to a clinical algorithm.

The Journal of emergency medicine

Gonzales R, Aagaard EM, Camargo CA, Ma OJ, Plautz M, Maselli JH, McCulloch CE, Levin SK, Metlay JP

Computerized counseling for folate knowledge and use: a randomized controlled trial.

American journal of preventive medicine

Schwarz EB, Sobota M, Gonzales R, Gerbert B

National trends in ambulatory visits and antibiotic prescribing for skin and soft-tissue infections.

Archives of internal medicine

Hersh AL, Chambers HF, Maselli JH, Gonzales R

How do community practitioners decide whether to prescribe antibiotics for acute respiratory tract infections?

Journal of general internal medicine

Wigton RS, Darr CA, Corbett KK, Nickol DR, Gonzales R

"Get smart Colorado": impact of a mass media campaign to improve community antibiotic use.

Medical care

Gonzales R, Corbett KK, Wong S, Glazner JE, Deas A, Leeman-Castillo B, Maselli JH, Sebert-Kuhlmann A, Wigton RS, Flores E, Kafadar K

Computer-assisted provision of emergency contraception a randomized controlled trial.

Journal of general internal medicine

Schwarz EB, Gerbert B, Gonzales R

Drug Resistant Infections in Poor Countries: A shrinking window of opportunity.

BMJ (Clinical research ed.)

Gonzales R, Corbett KK, Wirtz V, Dreser A

Nothing to cough at.

The New England journal of medicine

Lurie P, Cornia PB, Lipsky BA, Gonzales R

Public beliefs on antibiotics and respiratory tract infections: an internet-based questionnaire study.

The British journal of general practice : the journal of the Royal College of General Practitioners

Cals JW, Boumans D, Lardinois RJ, Gonzales R, Hopstaken RM, Butler CC, Dinant GJ

Preferences for self-management support: findings from a survey of diabetes patients in safety-net health systems.

Patient education and counseling

Sarkar U, Piette JD, Gonzales R, Lessler D, Chew LD, Reilly B, Johnson J, Brunt M, Huang J, Regenstein M, Schillinger D

Trainees, teams, and timely performance feedback.

Journal of general internal medicine

Gonzales R, Auerbach A

Factors associated with longer ED lengths of stay.

The American journal of emergency medicine

Gardner RL, Sarkar U, Maselli JH, Gonzales R

Vital-sign abnormalities as predictors of pneumonia in adults with acute cough illness.

The American journal of emergency medicine

Nolt BR, Gonzales R, Maselli J, Aagaard E, Camargo CA, Metlay JP

Cluster-randomized trial to improve antibiotic use for adults with acute respiratory infections treated in emergency departments.

Annals of emergency medicine

Metlay JP, Camargo CA, MacKenzie T, McCulloch C, Maselli J, Levin SK, Kersey A, Gonzales R

Impact of hospital formularies on fluoroquinolone prescribing in emergency departments.

The American journal of managed care

Aspinall SL, Metlay JP, Maselli JH, Gonzales R

Declining antibiotic prescriptions for upper respiratory infections, 1993-2004.

Academic emergency medicine : official journal of the Society for Academic Emergency Medicine

Vanderweil SG, Pelletier AJ, Hamedani AG, Gonzales R, Metlay JP, Camargo CA

Need for emergency contraception in urgent care settings.

Contraception

Schwarz EB, Gerbert B, Gonzales R

Acceptability of a bilingual interactive computerized educational module in a poor, medically underserved patient population.

Journal of health communication

Leeman-Castillo BA, Corbett KK, Aagaard EM, Maselli JH, Gonzales R, Mackenzie TD

Physician practice patterns: chest x-ray ordering for the evaluation of acute cough illness in adults.

Medical decision making : an international journal of the Society for Medical Decision Making

Aagaard E, Maselli J, Gonzales R

An interactive computer kiosk module for the treatment of recurrent uncomplicated cystitis in women.

Journal of general internal medicine

Aagaard EM, Nadler P, Adler J, Maselli J, Gonzales R

Contraceptive counseling of diabetic women of reproductive age.

Obstetrics and gynecology

Schwarz EB, Maselli J, Gonzales R

Balancing acts: deciding for or against antibiotics in acute respiratory infections.

The Journal of family practice

Hart AM, Pepper GA, Gonzales R

Antibiotic treatment of acute respiratory infections in acute care settings.

Academic emergency medicine : official journal of the Society for Academic Emergency Medicine

Gonzales R, Camargo CA, MacKenzie T, Kersey AS, Maselli J, Levin SK, McCulloch CE, Metlay JP

Effectiveness of ceftriaxone plus doxycycline in the treatment of patients hospitalized with community-acquired pneumonia.

Journal of hospital medicine

Flanders SA, Dudas V, Kerr K, McCulloch CE, Gonzales R

Prescription of teratogenic medications in United States ambulatory practices.

The American journal of medicine

Schwarz EB, Maselli J, Norton M, Gonzales R

Hepatitis C and hospital outcomes in patients admitted with alcohol-related problems.

Journal of hepatology

Tsui JI, Pletcher MJ, Vittinghoff E, Seal K, Gonzales R

Characterization of viral agents causing acute respiratory infection in a San Francisco University Medical Center Clinic during the influenza season.

Clinical infectious diseases : an official publication of the Infectious Diseases Society of America

Louie JK, Hacker JK, Gonzales R, Mark J, Maselli JH, Yagi S, Drew WL

Assessing the suitability of intervention sites for quality improvement studies in emergency departments.

Academic emergency medicine : official journal of the Society for Academic Emergency Medicine

Metlay JP, Camargo CA, Bos K, Gonzales R

Antimicrobial drug prescribing for pneumonia in ambulatory care.

Emerging infectious diseases

MacDougall C, Guglielmo BJ, Maselli J, Gonzales R

Fluoroquinolone prescribing in the United States: 1995 to 2002.

The American journal of medicine

Linder JA, Huang ES, Steinman MA, Gonzales R, Stafford RS

Unintended consequences of a quality improvement program designed to improve treatment of alcohol withdrawal in hospitalized patients.

Joint Commission journal on quality and patient safety

Pletcher MJ, Fernandez A, May TA, Westphal JR, Gamez CA, Hersh DF, Gonzales R

Appropriate antibiotic use: variation in knowledge and awareness by Hispanic ethnicity and language.

Preventive medicine

Corbett KK, Gonzales R, Leeman-Castillo BA, Flores E, Maselli J, Kafadar K

The "minimizing antibiotic resistance in Colorado" project: impact of patient education in improving antibiotic use in private office practices.

Health services research

Gonzales R, Corbett KK, Leeman-Castillo BA, Glazner J, Erbacher K, Darr CA, Wong S, Maselli JH, Sauaia A, Kafadar K

Management of acute bronchitis in healthy adults.

Infectious disease clinics of North America

Aagaard E, Gonzales R

Office evaluation and treatment of elderly patients with acute bronchitis.

Journal of the American Geriatrics Society

Steinman MA, Sauaia A, Maselli JH, Houck PM, Gonzales R

Performance of a bedside C-reactive protein test in the diagnosis of community-acquired pneumonia in adults with acute cough.

The American journal of medicine

Flanders SA, Stein J, Shochat G, Sellers K, Holland M, Maselli J, Drew WL, Reingold AL, Gonzales R

Antibiotic treatment of acute respiratory tract infections in the elderly: effect of a multidimensional educational intervention.

Journal of the American Geriatrics Society

Gonzales R, Sauaia A, Corbett KK, Maselli JH, Erbacher K, Leeman-Castillo BA, Darr CA, Houck PM

Obesity-associated hypoventilation in hospitalized patients: prevalence, effects, and outcome.

The American journal of medicine

Nowbar S, Burkart KM, Gonzales R, Fedorowicz A, Gozansky WS, Gaudio JC, Taylor MR, Zwillich CW

Optimizing antibiotic prescribing for acute respiratory tract infections in an urban urgent care clinic.

Journal of general internal medicine

Harris RH, MacKenzie TD, Leeman-Castillo B, Corbett KK, Batal HA, Maselli JH, Gonzales R

Changing use of antibiotics in community-based outpatient practice, 1991-1999.

Annals of internal medicine

Steinman MA, Gonzales R, Linder JA, Landefeld CS

Choosing an optimal strategy to assess and treat adults with pharyngitis.

Clinical infectious diseases : an official publication of the Infectious Diseases Society of America

Hoffman JR, Cooper RJ, Gonzales R

Modest serum creatinine elevation affects adverse outcome after general surgery.

Kidney international

O'Brien MM, Gonzales R, Shroyer AL, Grunwald GK, Daley J, Henderson WG, Khuri SF, Anderson RJ

Public expectations and attitudes for annual physical examinations and testing.

Annals of internal medicine

Oboler SK, Prochazka AV, Gonzales R, Xu S, Anderson RJ

Epidemiology of pediatric injury-related primary care office visits in the United States.

Pediatrics

Hambidge SJ, Davidson AJ, Gonzales R, Steiner JF

Antibiotic prescribing: can we make it easier?

Journal of general internal medicine

Flanders S, Gonzales R

Impact of reducing antibiotic prescribing for acute bronchitis on patient satisfaction.

Effective clinical practice : ECP

Gonzales R, Steiner JF, Maselli J, Lum A, Barrett PH