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    Last Name
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    Ralph Gonzales, MD

    TitleProfessor
    SchoolUCSF School of Medicine
    DepartmentMedicine
    Address1545 Divisadero Street
    San Francisco CA 94115
    Phone415-353-7981
    Emailralphg@medicine.ucsf.edu

       Overview 
       Overview
      Dr. Ralph Gonzales is Professor of Medicine; Epidemiology and Biostatistics at UCSF, Associate Chair for Ambulatory Care and Clinical Innovation for the Department of Medicine, and serves as Director of the UCSF Implementation Science (ImS) Program. His research plays 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.

       Interests
      Implementation Science


       Bibliographic 
       Publications
      Publications listed below are automatically derived from MEDLINE/PubMed and other sources, which might result in incorrect or missing publications. Researchers can login to make corrections and additions, or contact us for help.
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      1. Gonzales R, Metlay JP. Shifting the paradigm for promoting appropriate antibiotic use. J Gen Intern Med. 2013 Jun; 28(6):756-7.
        View in: PubMed
      2. Ackerman S, Auer R, Gonzales R. Cultural capital: accounting for power in patient-physician interactions. JAMA Intern Med. 2013 Mar 11; 173(5):393-4.
        View in: PubMed
      3. Boscardin CK, Gonzales R. The impact of demographic characteristics on nonresponse in an ambulatory patient satisfaction survey. Jt Comm J Qual Patient Saf. 2013 Mar; 39(3):123-8.
        View in: PubMed
      4. 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.
        View in: PubMed
      5. Gonzales R, Ackerman S, Handley M. Can implementation science help to overcome challenges in translating judicious antibiotic use into practice?: comment on "national trends in visit rates and antibiotic prescribing for adults with acute sinusitis" and "geographic variation in outpatient antibiotic prescribing among older adults". Arch Intern Med. 2012 Oct 22; 172(19):1471-3.
        View in: PubMed
      6. Fahimi J, Herring A, Harries A, Gonzales R, Alter H. Computed tomography use among children presenting to emergency departments with abdominal pain. Pediatrics. 2012 Nov; 130(5):e1069-75.
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      7. 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.
        View in: PubMed
      8. Schwarz EB, Burch EJ, Parisi SM, Tebb KP, Grossman D, Mehrotra A, Gonzales R. Computer-assisted provision of hormonal contraception in acute care settings. Contraception. 2013 Feb; 87(2):242-50.
        View in: PubMed
      9. Ackerman S, Gonzales R. The context of antibiotic overuse. Ann Intern Med. 2012 Aug 7; 157(3):211-2.
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      10. 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; 18(6):e217-24.
        View in: PubMed
      11. Govindarajan P, Gonzales R, Maselli JH, Claiborne Johnston S, 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. 2012 Mar 30.
        View in: PubMed
      12. Afonso AM, Ebell MH, Gonzales R, Stein J, Genton B, Senn N. The use of classification and regression trees to predict the likelihood of seasonal influenza. Fam Pract. 2012 Dec; 29(6):671-7.
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      13. 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.
        View in: PubMed
      14. Gonzales R, Handley MA, Ackerman S, O'sullivan PS. A framework for training health professionals in implementation and dissemination science. Acad Med. 2012 Mar; 87(3):271-8.
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      15. Ebell MH, Afonso AM, Gonzales R, Stein J, Genton B, Senn N. Development and validation of a clinical decision rule for the diagnosis of influenza. J Am Board Fam Med. 2012 Jan-Feb; 25(1):55-62.
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      16. Gonzales R, Handley MA. Improving glycemic control when "usual" diabetes care is not enough. Arch Intern Med. 2011 Dec 12; 171(22):1999-2000.
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      17. 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.
        View in: PubMed
      18. 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.
        View in: PubMed
      19. 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.
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      20. Sarkar U, López A, Maselli JH, Gonzales R. Adverse drug events in U.S. adult ambulatory medical care. Health Serv Res. 2011 Oct; 46(5):1517-33.
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      21. 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.
        View in: PubMed
      22. 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.
        View in: PubMed
      23. Shapiro DJ, Gonzales R, Cabana MD, Hersh AL. National trends in visit rates and antibiotic prescribing for children with acute sinusitis. Pediatrics. 2011 Jan; 127(1):28-34.
        View in: PubMed
      24. Cornia PB, Hersh AL, Lipsky BA, Newman TB, Gonzales R. Does this coughing adolescent or adult patient have pertussis? JAMA. 2010 Aug 25; 304(8):890-6.
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      25. Tang N, Stein J, Hsia RY, Maselli JH, Gonzales R. Trends and characteristics of US emergency department visits, 1997-2007. JAMA. 2010 Aug 11; 304(6):664-70.
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      26. Hersh AL, Gonzales R. Decreasing out-of-pocket costs of antibiotics: the good, the bad, and the unknown. Arch Intern Med. 2010 Aug 9; 170(15):1314-6.
        View in: PubMed
      27. 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.
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      28. Wirtz VJ, Dreser A, Gonzales R. Trends in antibiotic utilization in eight Latin American countries, 1997-2007. Rev Panam Salud Publica. 2010 Mar; 27(3):219-25.
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      29. Fee C, Metlay JP, Camargo CA, Maselli JH, Gonzales R. ED antibiotic use for acute respiratory illnesses since pneumonia performance measure inception. Am J Emerg Med. 2010 Jan; 28(1):23-31.
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      30. Tsui JI, Maselli J, Gonzales R. Sociodemographic trends in national ambulatory care visits for hepatitis C virus infection. Dig Dis Sci. 2009 Dec; 54(12):2694-8.
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      31. Steinman MA, Yang KY, Byron SC, Maselli JH, Gonzales R. Variation in outpatient antibiotic prescribing in the United States. Am J Manag Care. 2009 Dec; 15(12):861-8.
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      32. 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.
        View in: PubMed
      33. 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.
        View in: PubMed
      34. Hersh AL, Cabana MD, Gonzales R, Shenkin BN, Cho CS. Pediatricians' perspectives on the impact of MRSA in primary care: a qualitative study. BMC Pediatr. 2009; 9:27.
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      35. 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.
        View in: PubMed
      36. Schwarz EB, Sobota M, Gonzales R, Gerbert B. Computerized counseling for folate knowledge and use: a randomized controlled trial. Am J Prev Med. 2008 Dec; 35(6):568-71.
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      37. Ranji SR, Steinman MA, Shojania KG, Gonzales R. Interventions to reduce unnecessary antibiotic prescribing: a systematic review and quantitative analysis. Med Care. 2008 Aug; 46(8):847-62.
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      38. Hersh AL, Chambers HF, Maselli JH, Gonzales R. National trends in ambulatory visits and antibiotic prescribing for skin and soft-tissue infections. Arch Intern Med. 2008 Jul 28; 168(14):1585-91.
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      39. 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.
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      40. 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.
        View in: PubMed
      41. Schwarz EB, Gerbert B, Gonzales R. Computer-assisted provision of emergency contraception a randomized controlled trial. J Gen Intern Med. 2008 Jun; 23(6):794-9.
        View in: PubMed
      42. Gonzales R, Corbett KK, Wirtz V, Dreser A. Drug Resistant Infections in Poor Countries: A shrinking window of opportunity. BMJ. 2008 Apr 26; 336(7650):948-9.
        View in: PubMed
      43. Lurie P, Cornia PB, Lipsky BA, Gonzales R. Nothing to cough at. N Engl J Med. 2008 Feb 21; 358(8):857; author reply 857.
        View in: PubMed
      44. Pletcher MJ, Kertesz SG, Kohn MA, Gonzales R. Trends in opioid prescribing by race/ethnicity for patients seeking care in US emergency departments. JAMA. 2008 Jan 2; 299(1):70-8.
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      45. 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.
        View in: PubMed
      46. 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.
        View in: PubMed
      47. 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 4; 357(14):1432-7.
        View in: PubMed
      48. Gonzales R, Auerbach A. Trainees, teams, and timely performance feedback. J Gen Intern Med. 2007 Aug; 22(8):1218-9.
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      49. Gardner RL, Sarkar U, Maselli JH, Gonzales R. Factors associated with longer ED lengths of stay. Am J Emerg Med. 2007 Jul; 25(6):643-50.
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      50. Nolt BR, Gonzales R, Maselli J, Aagaard E, Camargo CA, Metlay JP. Vital-sign abnormalities as predictors of pneumonia in adults with acute cough illness. Am J Emerg Med. 2007 Jul; 25(6):631-6.
        View in: PubMed
      51. 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.
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      52. Aspinall SL, Metlay JP, Maselli JH, Gonzales R. Impact of hospital formularies on fluoroquinolone prescribing in emergency departments. Am J Manag Care. 2007 May; 13(5):241-8.
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      53. Vanderweil SG, Pelletier AJ, Hamedani AG, Gonzales R, Metlay JP, Camargo CA. Declining antibiotic prescriptions for upper respiratory infections, 1993-2004. Acad Emerg Med. 2007 Apr; 14(4):366-9.
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      54. Schwarz EB, Gerbert B, Gonzales R. Need for emergency contraception in urgent care settings. Contraception. 2007 Apr; 75(4):285-8.
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      55. Schwarz EB, Reeves MF, Gerbert B, Gonzales R. Knowledge of and perceived access to emergency contraception at two urgent care clinics in California. Contraception. 2007 Mar; 75(3):209-13.
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      56. 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.
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      57. Aagaard E, Maselli J, Gonzales R. Physician practice patterns: chest x-ray ordering for the evaluation of acute cough illness in adults. Med Decis Making. 2006 Nov-Dec; 26(6):599-605.
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      58. Aagaard EM, Nadler P, Adler J, Maselli J, Gonzales R. An interactive computer kiosk module for the treatment of recurrent uncomplicated cystitis in women. J Gen Intern Med. 2006 Nov; 21(11):1156-9.
        View in: PubMed
      59. Steinman MA, Ranji SR, Shojania KG, Gonzales R. Improving antibiotic selection: a systematic review and quantitative analysis of quality improvement strategies. Med Care. 2006 Jul; 44(7):617-28.
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      60. Schwarz EB, Maselli J, Gonzales R. Contraceptive counseling of diabetic women of reproductive age. Obstet Gynecol. 2006 May; 107(5):1070-4.
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      61. Hart AM, Pepper GA, Gonzales R. Balancing acts: deciding for or against antibiotics in acute respiratory infections. J Fam Pract. 2006 Apr; 55(4):320-5.
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      62. 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.
        View in: PubMed
      63. 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.
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      64. Schwarz EB, Maselli J, Norton M, Gonzales R. Prescription of teratogenic medications in United States ambulatory practices. Am J Med. 2005 Nov; 118(11):1240-9.
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      65. Tsui JI, Pletcher MJ, Vittinghoff E, Seal K, Gonzales R. Hepatitis C and hospital outcomes in patients admitted with alcohol-related problems. J Hepatol. 2006 Feb; 44(2):262-6.
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      66. 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.
        View in: PubMed
      67. 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.
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      68. Metlay JP, Camargo CA, Bos K, Gonzales R. Assessing the suitability of intervention sites for quality improvement studies in emergency departments. Acad Emerg Med. 2005 Jul; 12(7):667-70.
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      69. Linder JA, Huang ES, Steinman MA, Gonzales R, Stafford RS. Fluoroquinolone prescribing in the United States: 1995 to 2002. Am J Med. 2005 Mar; 118(3):259-68.
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      70. MacDougall C, Guglielmo BJ, Maselli J, Gonzales R. Antimicrobial drug prescribing for pneumonia in ambulatory care. Emerg Infect Dis. 2005 Mar; 11(3):380-4.
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      71. 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.
        View in: PubMed
      72. 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.
        View in: PubMed
      73. 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.
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      74. 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 1; 117(11):863-7.
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      75. Aagaard E, Gonzales R. Management of acute bronchitis in healthy adults. Infect Dis Clin North Am. 2004 Dec; 18(4):919-37; x.
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      76. Gonzales R, Cooper RJ, Hoffman JR. Strategies to diagnose and treat group A streptococcal pharyngitis. JAMA. 2004 Jul 14; 292(2):167; author reply 167-8.
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      77. 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.
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      78. Steinman MA, Sauaia A, Maselli JH, Houck PM, Gonzales R. Office evaluation and treatment of elderly patients with acute bronchitis. J Am Geriatr Soc. 2004 Jun; 52(6):875-9.
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      79. 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.
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      80. 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 1; 116(1):1-7.
        View in: PubMed
      81. 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.
        View in: PubMed
      82. Gonzales R. A 65-year-old woman with acute cough illness and an important engagement. JAMA. 2003 May 28; 289(20):2701-8.
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      83. 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.
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      84. Steinman MA, Gonzales R, Linder JA, Landefeld CS. Changing use of antibiotics in community-based outpatient practice, 1991-1999. Ann Intern Med. 2003 Apr 1; 138(7):525-33.
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      85. Steinman MA, Landefeld CS, Gonzales R. Predictors of broad-spectrum antibiotic prescribing for acute respiratory tract infections in adult primary care. JAMA. 2003 Feb 12; 289(6):719-25.
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      86. Hoffman JR, Cooper RJ, Gonzales R. Choosing an optimal strategy to assess and treat adults with pharyngitis. Clin Infect Dis. 2003 Jan 15; 36(2):235-6.
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      87. 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.
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      88. Oboler SK, Prochazka AV, Gonzales R, Xu S, Anderson RJ. Public expectations and attitudes for annual physical examinations and testing. Ann Intern Med. 2002 May 7; 136(9):652-9.
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      89. Hambidge SJ, Davidson AJ, Gonzales R, Steiner JF. Epidemiology of pediatric injury-related primary care office visits in the United States. Pediatrics. 2002 Apr; 109(4):559-65.
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      90. Flanders S, Gonzales R. Antibiotic prescribing: can we make it easier? J Gen Intern Med. 2002 Feb; 17(2):160-1.
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      91. Gonzales R, Steiner JF, Maselli J, Lum A, Barrett PH. Impact of reducing antibiotic prescribing for acute bronchitis on patient satisfaction. Eff Clin Pract. 2001 May-Jun; 4(3):105-11.
        View in: PubMed
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