Carol A. Mancuso, MD, FACP

Appointments

Associate Scientist, Hospital for Special Surgery

Associate Attending Physician, Hospital for Special Surgery

Associate Professor of Medicine, Weill Medical College of Cornell University

Associate Professor of Medicine, Weill Graduate School of Medical Sciences

Associate Attending Physician, NewYork-Presbyterian Hospital

 

Selected Publications

Mancuso CA, Peterson MGE. Different methods to assess quality of life from multiple follow-ups in a longitudinal asthma study. J Clin Epidemiol. 2004; 2004;57:45-54.

Mancuso CA, McCulloch CE, Rincon M, Charlson ME. Self-efficacy, depressive symptoms and patients' expectations predict outcomes in asthma. Medical Care 2001;39:1326-1338.

Mancuso CA, Sculco TP, Wickiewicz TL, Jones EC, Robbins L, Warren RF, Williams-Russo P. Patients' expectations of knee surgery. J Bone Joint Surg 2001;83-A:1005-1012.

Mancuso CA, Sculco TP, Salvati EA. Patients with poor preoperative functional status have high expectations of total hip arthroplasty. J Arthroplasty 2003;18:872-878.

Mancuso CA, Paget SA, Charlson ME. Adaptations made by rheumatoid arthritis patients to continue working: a pilot study of workplace challenges and successful adaptations. Arthritis Care Res 2000;13:89-99.

For more publications, please see the PubMed listing.  

Research Description

Dr. Carol A. Mancuso is a general internist and clinical epidemiologist whose specific research interests focus on quality of life outcomes in chronic diseases and patients’ experiences with the health care system. She has focused on two specific areas, asthma in primary care populations, and arthritis and its orthopedic treatments.

Improving Quality of Life and Resource Utilization Outcomes in Patients with Asthma

As a Robert Wood Johnson Generalist Physician Faculty Scholar, Dr. Mancuso conducted a longitudinal study to identify patient-centered predictors of functional decline and resource utilization in asthma patients. The results showed that more depressive symptoms, less self-efficacy and unrealistic expectations predicted worse outcomes. This work became the foundation for the development of a patient self-management program aimed at increasing asthma knowledge, self-efficacy, and asthma-related social support. The program was tested with primary care patients in a randomized controlled trial supported by the National Heart Lung and Blood Institute. The results showed that the multi-component intervention was effective in improving quality of life and resource utilization outcomes.

Increasing Physical Activity in Patients with Asthma

As a result of these studies, Dr. Mancuso also found that many asthma patients limit physical activity and avoid exercise because they are concerned about exacerbating their respiratory symptoms. Lack of exercise, however, predisposes not only to direct adverse cardiovascular events, but also to obesity, depressive symptoms, and decreased pulmonary reserve, all of which can lead to adverse asthma outcomes. In order to foster healthy physical activity in asthma patients, Dr. Mancuso is currently studying the effectiveness of a novel psychosocial intervention to foster healthy life-style activities in patients with asthma. This project, part of a consortium grant supported by the National Heart Lung and Blood Institute, is being conducted with investigators at the Weill Medical College of Cornell University. The long-term goals of this study are to promote increased physical activity and exercise without exacerbating asthma.

Improving Outcomes in Patients Treated in the Emergency Room for Asthma

Patients who present to urban emergency rooms for asthma often do not have established sources of primary care and present with severe symptoms that could have been averted with more timely care. To address the needs of patients who have severe asthma exacerbations, Dr. Mancuso will study the effectiveness of an asthma education program with patients treated in the emergency room for asthma. The goals of this multi-center trial, supported by the National Heart Lung and Blood Institute, are to decrease urgent resource utilization, increase the use of maintenance medications, decrease the use of rescue medications, and improve quality of life. The long-term objectives are to foster programs in the emergency room, a setting that has been underserved regarding asthma education, by providing evidence that cost-effective and clinically effective programs can be successfully implemented.

Patients’ Expectations and Satisfaction with Outcomes of Orthopedic Treatments for Arthritis

Dr. Mancuso has also conducted a series of studies in arthritis and outcomes of surgical management. Specifically, she has studied patients’ expectations and satisfaction of hip, knee, and shoulder surgery, and found that in addition to improvement in pain and function, patients also expect improvement in their psychological well-being as a result of surgery. These studies resulted in the development and testing of patient-derived questionnaires to measure expectations that can be used in clinical practice and in research. In a subsequent study supported by the Arthritis Foundation, Dr. Mancuso used these questionnaires to assess how pre-operative expectations affect long-term satisfaction with total hip arthroplasty. This study also measured co-variates such as personality traits, comorbidity, and operative complications. Additional studies are testing the impact of educational interventions to alter expectations of outcomes in patients scheduled to undergo hip or knee arthroplasty. The long-term goals of these randomized trials are to foster realistic expectations and improve patient satisfaction with the outcome of surgery.

Workplace Challenges in Patients with Rheumatoid Arthritis

To date, most studies of employment in patients with rheumatoid arthritis have focused on job loss. However, less is known about workplace events in patients who continued to work. To study the experiences of patients with rheumatoid arthritis who continue to work, Dr. Mancuso conducted a longitudinal study comparing the incidence of negative workplace events between employed patients with rheumatoid arthritis and healthy controls. Compared to controls, negative events were associated primarily with more fatigue and more social stress in patients with rheumatoid arthritis. These potentially modifiable variables have not been fully evaluated with respect to long-term employment in rheumatoid arthritis, and suggest possible new interventions to help patients with rheumatoid arthritis maintain employment.

Dr. Mancuso is actively involved in training future clinical researchers through her roles as the Director of the Weill Cornell Graduate School of Medical Science Masters Degree Program in Clinical Epidemiology and Health Services Research, and the Director of the Fellowship Program in Clinical Epidemiology and Health Services Research supported by the Agency for Healthcare Quality and Research.