Faculty ProfilesRalph Gonzales, MD, MSPH
350 Parnassus Ave, Box 0361
San Francisco, CA 94117
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.
Education and Training
|Location||Degree or Training||Specialty||Date|
|University of Colorado Health Sciences Center||MSPH||Preventive Medicine & Biometrics||1997|
|University of California, San Francisco||Residency||School of Medicine||1995|
|University of California, San Francisco||M.D.||Medicine||1991|
Acute Bronchitis, Acute Respiratory Tract Infections, Antimicrobial Stewardship, Change Management, Delivery System Re-Design, Health Care Value, Implementation Science, Improvement Science, Patient-Facing Computerized Applications, Physician Behavior, Telehealth, eConsultsRelated Web Sites
- Clinical Profile at UCSF Medical Center
- Implementation Science Program at UCSF, CTSI
- Center for Health Care Value
- UCSF Continuous Process Improvement Site
- Caring Wisely Site
In the News
- Implementation Science Links Research With Real-World Practice to Improve Health (Oct 02, 2012)
- Implementation Science Q & A With Program Director Ralph Gonzales (Oct 02, 2012)
- Tracking and Treating Tuberculosis in Developing Countries (Oct 02, 2012)
Recent Articles (124)
Zygourakis CC, Liu CY, Keefe M, Moriates C, Ratliff J, Dudley RA, Gonzales R, Mummaneni PV, Ames CP. Analysis of National Rates, Cost, and Sources of Cost Variation in Adult Spinal Deformity. Neurosurgery. 2018 Mar 01; 82(3):378-387.
Zygourakis CC, Liu CY, Yoon S, Moriates C, Boscardin C, Dudley RA, Lawton MT, Theodosopoulos P, Berger MS, Gonzales R. Analysis of Cost Variation in Craniotomy for Tumor Using 2 National Databases. Neurosurgery. 2017 Dec 01; 81(6):972-979.
Lee JS, Gonzales R, Vittinghoff E, Corbett KK, Fleischmann KE, Sehgal N, Auerbach AD. Appropriate Reconciliation of Cardiovascular Medications After Elective Surgery and Postdischarge Acute Hospital and Ambulatory Visits. J Hosp Med. 2017 Sep; 12(9):723-730.
Zygourakis CC, Liu CY, Wakam G, Moriates C, Boscardin C, Ames CP, Mummaneni PV, Ratliff J, Dudley RA, Gonzales R. Geographic and Hospital Variation in Cost of Lumbar Laminectomy and Lumbar Fusion for Degenerative Conditions. Neurosurgery. 2017 Aug 01; 81(2):331-340.
Gonzales R, Moriates C, Lau C, Valencia V, Imershein S, Rajkomar A, Prasad P, Boscardin C, Grady D, Johnston S. Caring Wisely: A Program to Support Frontline Clinicians and Staff in Improving Healthcare Delivery and Reducing Costs. J Hosp Med. 2017 Aug; 12(8):662-667.
Prasad PA, Shea ER, Shiboski S, Sullivan MC, Gonzales R, Shimabukuro D. Relationship Between a Sepsis Intervention Bundle and In-Hospital Mortality Among Hospitalized Patients: A Retrospective Analysis of Real-World Data. Anesth Analg. 2017 08; 125(2):507-513.
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. Association Between Surgeon Scorecard Use and Operating Room Costs. JAMA Surg. 2017 Mar 01; 152(3):284-291.
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. The added value of C-reactive protein measurement in diagnosing pneumonia in primary care: a meta-analysis of individual patient data. CMAJ. 2016 Sep 19.
Zygourakis CC, Valencia V, Boscardin C, Nayak RU, Moriates C, Gonzales R, Theodosopoulos P, Lawton MT. Predictors of Variation in Neurosurgical Supply Costs and Outcomes Across 4904 Surgeries at a Single Institution. World Neurosurg. 2016 Dec; 96:177-183.
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. 152 A Prospective Controlled Trial of the Effect of Surgeon Cost Scorecards on Operating Room Surgical Cost Reduction. Neurosurgery. 2016 Aug; 63 Suppl 1:161-2.
Zygourakis CC, Liu C, Theodosopoulos PV, Lawton MT, Dudley A, Gonzales R. 153 Significant Interhospital Variation in Cranial Surgery Costs Using the Nationwide Inpatient Sample Database. Neurosurgery. 2016 Aug; 63 Suppl 1:162.
Wrenn K, Catschegn S, Cruz M, Gleason N, Gonzales R. Analysis of an electronic consultation program at an academic medical centre: Primary care provider questions, specialist responses, and primary care provider actions. J Telemed Telecare. 2017 Feb; 23(2):217-224.
Zygourakis CC, Yoon S, Valencia V, Boscardin C, Moriates C, Gonzales R, Lawton MT. Operating room waste: disposable supply utilization in neurosurgical procedures. J Neurosurg. 2017 Feb; 126(2):620-625.
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. External Validation of Prediction Models for Pneumonia in Primary Care Patients with Lower Respiratory Tract Infection: An Individual Patient Data Meta-Analysis. PLoS One. 2016; 11(2):e0149895.
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. The Action Research Program: Experiential Learning in Systems-Based Practice for First-Year Medical Students. Teach Learn Med. 2016; 28(2):183-91.
Ho CK, Boscardin CK, Gleason N, Collado D, Terdiman J, Terrault NA, Gonzales R. Optimizing the pre-referral workup for gastroenterology and hepatology specialty care: consensus using the Delphi method. J Eval Clin Pract. 2016 Feb; 22(1):46-52.
Khanna R, Stoddard PJ, Gonzales EN, Villagran-Flores M, Thomson J, Bayard P, Palos Lucio AG, Schillinger D, Bertozzi S, Gonzales R. An automated telephone nutrition support system for Spanish-speaking patients with diabetes. J Diabetes Sci Technol. 2014 Nov; 8(6):1115-20.
Ackerman SL, Gleason N, Monacelli J, Collado D, Wang M, Ho C, Catschegn-Pfab S, Gonzales R. When to repatriate? Clinicians' perspectives on the transfer of patient management from specialty to primary care. J Gen Intern Med. 2014 Oct; 29(10):1355-61.
Moy NY, Lee SJ, Chan T, Grovey B, Boscardin WJ, Gonzales R, Pierluissi E. Development and sustainability of an inpatient-to-outpatient discharge handoff tool: a quality improvement project. Jt Comm J Qual Patient Saf. 2014 May; 40(5):219-27.
Nguyen OK, Tang N, Hillman JM, Gonzales R. What's cost got to do with it? Association between hospital costs and frequency of admissions among "high users" of hospital care. J Hosp Med. 2013 Dec; 8(12):665-71.
Gonzales R, Anderer T, McCulloch CE, Maselli JH, Bloom FJ, Graf TR, Stahl M, Yefko M, Molecavage J, Metlay JP. A cluster randomized trial of decision support strategies for reducing antibiotic use in acute bronchitis. JAMA Intern Med. 2013 Feb 25; 173(4):267-73.
Ackerman SL, Tebb K, Stein JC, Frazee BW, Hendey GW, Schmidt LA, Gonzales R. Benefit or burden? A sociotechnical analysis of diagnostic computer kiosks in four California hospital emergency departments. Soc Sci Med. 2012 Dec; 75(12):2378-85.
Roth S, Gonzales R, Harding-Anderer T, Bloom FJ, Graf T, Stahl MS, Maselli JH, Metlay JP. Unintended consequences of a quality measure for acute bronchitis. Am J Manag Care. 2012 Jun 01; 18(6):e217-24.
Govindarajan P, Gonzales R, Maselli JH, Johnston SC, Fahimi J, Poisson S, Stein JC. 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). J Stroke Cerebrovasc Dis. 2013 Nov; 22(8):e257-63.
Gonzales R, López-Caudana AE, González-Flores T, Jayanthan J, Corbett KK, Reyes-Morales H. Antibiotic knowledge and self-care for acute respiratory tract infections in Mexico. Salud Publica Mex. 2012 Mar-Apr; 54(2):152-7.
Stein JC, Navab B, Frazee B, Tebb K, Hendey G, Maselli J, Gonzales R. A randomized trial of computer kiosk-expedited management of cystitis in the emergency department. Acad Emerg Med. 2011 Oct; 18(10):1053-9.
Moffett SE, Frazee BW, Stein JC, Navab B, Maselli J, Takhar SS, Gonzales R. Antimicrobial resistance in uncomplicated urinary tract infections in 3 California EDs. Am J Emerg Med. 2012 Jul; 30(6):942-9.
Westphalen AC, Hsia RY, Maselli JH, Wang R, Gonzales R. Radiological imaging of patients with suspected urinary tract stones: national trends, diagnoses, and predictors. Acad Emerg Med. 2011 Jul; 18(7):699-707.
Price EL, Mackenzie TD, Metlay JP, Camargo CA, Gonzales R. A computerized education module improves patient knowledge and attitudes about appropriate antibiotic use for acute respiratory tract infections. Patient Educ Couns. 2011 Dec; 85(3):493-8.
Stein JC, Jacoby VL, Vittinghoff E, Wang R, Kwan E, Reynolds T, McAlpine I, Gonzales R. Differential use of diagnostic ultrasound in u.s. Emergency departments by time of day. West J Emerg Med. 2011 Feb; 12(1):90-5.
Aagaard EM, Gonzales R, Camargo CA, Auten R, Levin SK, Maselli J, Metlay J. Physician champions are key to improving antibiotic prescribing quality. Jt Comm J Qual Patient Saf. 2010 Mar; 36(3):109-16.
Stearns CR, Gonzales R, Camargo CA, Maselli J, Metlay JP. Antibiotic prescriptions are associated with increased patient satisfaction with emergency department visits for acute respiratory tract infections. Acad Emerg Med. 2009 Oct; 16(10):934-41.
Levin SK, Metlay JP, Maselli JH, Kersey AS, Camargo CA, Gonzales R. Perceived social support among adults seeking care for acute respiratory tract infections in US EDs. Am J Emerg Med. 2009 Jun; 27(5):582-7.
Gonzales R, Aagaard EM, Camargo CA, Ma OJ, Plautz M, Maselli JH, McCulloch CE, Levin SK, Metlay JP. C-reactive protein testing does not decrease antibiotic use for acute cough illness when compared to a clinical algorithm. J Emerg Med. 2011 Jul; 41(1):1-7.
Wigton RS, Darr CA, Corbett KK, Nickol DR, Gonzales R. How do community practitioners decide whether to prescribe antibiotics for acute respiratory tract infections? J Gen Intern Med. 2008 Oct; 23(10):1615-20.
Gonzales R, Corbett KK, Wong S, Glazner JE, Deas A, Leeman-Castillo B, Maselli JH, Sebert-Kuhlmann A, Wigton RS, Flores E, Kafadar K. "Get smart Colorado": impact of a mass media campaign to improve community antibiotic use. Med Care. 2008 Jun; 46(6):597-605.
Cals JW, Boumans D, Lardinois RJ, Gonzales R, Hopstaken RM, Butler CC, Dinant GJ. Public beliefs on antibiotics and respiratory tract infections: an internet-based questionnaire study. Br J Gen Pract. 2007 Dec; 57(545):942-7.
Sarkar U, Piette JD, Gonzales R, Lessler D, Chew LD, Reilly B, Johnson J, Brunt M, Huang J, Regenstein M, Schillinger D. Preferences for self-management support: findings from a survey of diabetes patients in safety-net health systems. Patient Educ Couns. 2008 Jan; 70(1):102-10.
Cornia PB, Lipsky BA, Saint S, Gonzales R. Clinical problem-solving. Nothing to cough at--a 73-year-old man presented to the emergency department with a 4-day history of nonproductive cough that worsened at night. N Engl J Med. 2007 Oct 04; 357(14):1432-7.
Metlay JP, Camargo CA, MacKenzie T, McCulloch C, Maselli J, Levin SK, Kersey A, Gonzales R. Cluster-randomized trial to improve antibiotic use for adults with acute respiratory infections treated in emergency departments. Ann Emerg Med. 2007 Sep; 50(3):221-30.
Leeman-Castillo BA, Corbett KK, Aagaard EM, Maselli JH, Gonzales R, Mackenzie TD. Acceptability of a bilingual interactive computerized educational module in a poor, medically underserved patient population. J Health Commun. 2007 Jan-Feb; 12(1):77-94.
Gonzales R, Camargo CA, MacKenzie T, Kersey AS, Maselli J, Levin SK, McCulloch CE, Metlay JP. Antibiotic treatment of acute respiratory infections in acute care settings. Acad Emerg Med. 2006 Mar; 13(3):288-94.
Flanders SA, Dudas V, Kerr K, McCulloch CE, Gonzales R. Effectiveness of ceftriaxone plus doxycycline in the treatment of patients hospitalized with community-acquired pneumonia. J Hosp Med. 2006 Jan; 1(1):7-12.
Stein J, Louie J, Flanders S, Maselli J, Hacker JK, Drew WL, Gonzales R. Performance characteristics of clinical diagnosis, a clinical decision rule, and a rapid influenza test in the detection of influenza infection in a community sample of adults. Ann Emerg Med. 2005 Nov; 46(5):412-9.
Louie JK, Hacker JK, Gonzales R, Mark J, Maselli JH, Yagi S, Drew WL. Characterization of viral agents causing acute respiratory infection in a San Francisco University Medical Center Clinic during the influenza season. Clin Infect Dis. 2005 Sep 15; 41(6):822-8.
Pletcher MJ, Fernandez A, May TA, Westphal JR, Gamez CA, Hersh DF, Gonzales R. Unintended consequences of a quality improvement program designed to improve treatment of alcohol withdrawal in hospitalized patients. Jt Comm J Qual Patient Saf. 2005 Mar; 31(3):148-57.
Gonzales R, Corbett KK, Leeman-Castillo BA, Glazner J, Erbacher K, Darr CA, Wong S, Maselli JH, Sauaia A, Kafadar K. The "minimizing antibiotic resistance in Colorado" project: impact of patient education in improving antibiotic use in private office practices. Health Serv Res. 2005 Feb; 40(1):101-16.
Corbett KK, Gonzales R, Leeman-Castillo BA, Flores E, Maselli J, Kafadar K. Appropriate antibiotic use: variation in knowledge and awareness by Hispanic ethnicity and language. Prev Med. 2005 Feb; 40(2):162-9.
Pletcher MJ, Maselli J, Gonzales R. Uncomplicated alcohol intoxication in the emergency department: an analysis of the National Hospital Ambulatory Medical Care Survey. Am J Med. 2004 Dec 01; 117(11):863-7.
Hall MC, Kieke B, Gonzales R, Belongia EA. Spectrum bias of a rapid antigen detection test for group A beta-hemolytic streptococcal pharyngitis in a pediatric population. Pediatrics. 2004 Jul; 114(1):182-6.
Flanders SA, Stein J, Shochat G, Sellers K, Holland M, Maselli J, Drew WL, Reingold AL, Gonzales R. Performance of a bedside C-reactive protein test in the diagnosis of community-acquired pneumonia in adults with acute cough. Am J Med. 2004 Apr 15; 116(8):529-35.
Gonzales R, Sauaia A, Corbett KK, Maselli JH, Erbacher K, Leeman-Castillo BA, Darr CA, Houck PM. Antibiotic treatment of acute respiratory tract infections in the elderly: effect of a multidimensional educational intervention. J Am Geriatr Soc. 2004 Jan; 52(1):39-45.
Nowbar S, Burkart KM, Gonzales R, Fedorowicz A, Gozansky WS, Gaudio JC, Taylor MR, Zwillich CW. Obesity-associated hypoventilation in hospitalized patients: prevalence, effects, and outcome. Am J Med. 2004 Jan 01; 116(1):1-7.
Harris RH, MacKenzie TD, Leeman-Castillo B, Corbett KK, Batal HA, Maselli JH, Gonzales R. Optimizing antibiotic prescribing for acute respiratory tract infections in an urban urgent care clinic. J Gen Intern Med. 2003 May; 18(5):326-34.
O'Brien MM, Gonzales R, Shroyer AL, Grunwald GK, Daley J, Henderson WG, Khuri SF, Anderson RJ. Modest serum creatinine elevation affects adverse outcome after general surgery. Kidney Int. 2002 Aug; 62(2):585-92.