About

James Dziura, MPH, PhD, is a Professor of Emergency Medicine, Biostatistics, and Medicine (Endocrinology) at Yale School of Medicine. He has been a biostatistician at Yale since 2002 and has co-authored over 200 peer-reviewed articles with a diverse group of Yale investigators. Dr. Dziura serves as the Co-Director of the Yale Center for Analytical Sciences (YCAS) and the Director of the Yale Data Coordinating Center, where he oversees data coordinating and biostatistical efforts for multiple clinical trials. His primary research interests include the coordination of multicenter clinical trials, with notable roles as the PI of the data coordinating center for the RUPP Autism Network study and as the Director of the Data Coordinating Center for the Autism Biomarkers Consortium for Clinical Trials (ABC-CT). He is also involved in a large pragmatic cluster-randomized trial for the prevention of serious fall injuries. Dr. Dziura has contributed extensively to emergency medicine research, focusing on evaluating diagnostic tools, behavioral interventions, and prognostic factors in emergency department settings. Additionally, his research encompasses the epidemiology and treatment of metabolic disorders such as obesity and diabetes, with a focus on mechanisms of insulin resistance, behavioral approaches to weight reduction, and metabolic consequences of obesity in children.

Research topics

• Medicine
• Internal medicine
• Physical therapy
• Psychology
• Immunology
• Gerontology
• Emergency medicine
• Psychiatry
• Developmental psychology
• Environmental health
• Surgery
• Intensive care medicine
• Genetics
• Virology
• Medical physics
• Physical medicine and rehabilitation
• Biology

Selected publications

• The association between long-term opioid therapy and composite infection-related dental outcomes

  PLoS ONE · 2026-02-02

  articleOpen access

  BACKGROUND: The Food and Drug Administration's warning that transmucosal buprenorphine, a partial opioid agonist used to treat opioid use disorder and chronic pain, may cause dental disease opens questions about potential class-wide adverse effects involving more widely prescribed opioid analgesics. METHODS: This was a retrospective matched national cohort study of patients in care at the Department of Veterans Affairs (VA) between October 2010-September 2019. Patients prescribed LTOT were matched 1:2 to patients not prescribed LTOT on age, sex, service region, and VA dental coverage. Cox regression models estimated the association between LTOT and a composite infection-related dental outcome (CIDO). Sensitivity analyses excluded patients with cancer, restricted to patients with comprehensive dental coverage, and to patients with ≥180 days of follow-up time, respectively. RESULTS: The cohort comprised 2,173,435 patients including 787,825 (36%) receiving LTOT; 612,101 (28%) experienced CIDO. In both simple and multivariable regression models, LTOT exposure was associated with greater CIDO risk; HR (95% CI) =1.24 (1.23, 1.25); aHR (95% CI) =1.08 (1.07, 1.08), respectively; p < 0.001. Sensitivity analyses showed similar results except among patients with full dental coverage for whom CIDO rates were substantially higher and LTOT was not statistically significantly associated with risk. CONCLUSIONS: he observed positive association between LTOT and CIDO in this large VA sample may inform patient-provider discussions and decision-making around use of LTOT. High CIDO rates among patients with full VA dental coverage may reflect their unique vulnerability to dental infection associated with service-related dental or disabling conditions. Limitations include risk for ascertainment bias, unclear generalizability to a broader clinical population, and the potential for residual confounding.

  PublisherDOI

• Health System, Community-Based, or Usual Dementia Care for Persons With Dementia and Caregivers

  JAMA · 2025-01-29 · 18 citations

  letterOpen access

  Importance: The effectiveness of different approaches to dementia care is unknown. Objective: To determine the effectiveness of health system-based, community-based dementia care, and usual care for persons with dementia and for caregiver outcomes. Design, Setting, and Participants: Randomized clinical trial of community-dwelling persons living with dementia and their caregivers conducted at 4 sites in the US (enrollment June 2019-January 2023; final follow-up, August 2023). Interventions: Participants were randomized 7:7:1 to health system-based care provided by an advanced practice dementia care specialist (n = 1016); community-based care provided by a social worker, nurse, or licensed therapist care consultant (n = 1016); or usual care (n = 144). Main Outcomes and Measures: Primary outcomes were caregiver-reported Neuropsychiatric Inventory Questionnaire (NPI-Q) severity score for persons living with dementia (range, 0-36; higher scores, greater behavioral symptoms severity; minimal clinically important difference [MCID], 2.8-3.2) and Modified Caregiver Strain Index for caregivers (range, 0-26; higher scores, greater strain; MCID, 1.5-2.3). Three secondary outcomes included caregiver self-efficacy (range, 4-20; higher scores, more self-efficacy). Results: Among 2176 dyads (individuals with dementia, mean age, 80.6 years; 58.4%, female; and 20.6%, Black or Hispanic; caregivers, mean age, 65.2 years; 75.8%, female; and 20.8% Black or Hispanic), primary outcomes were assessed for more than 99% of participants, and 1343 participants (62% of those enrolled and 91% still alive and had not withdrawn) completed the study through 18 months. No significant differences existed between the 2 treatments or between treatments vs usual care for the primary outcomes. Overall, the least squares means (LSMs) for NPI-Q scores were 9.8 for health system, 9.5 for community-based, and 10.1 for usual care. The difference between health system vs community-based care was 0.30 (97.5% CI, -0.18 to 0.78); health system vs usual care, -0.33 (97.5% CI, -1.32 to 0.67); and community-based vs usual care, -0.62 (97.5% CI, -1.61 to 0.37). The LSMs for the Modified Caregiver Strain Index were 10.7 for health system, 10.5 for community-based, and 10.6 for usual care. The difference between health system vs community-based care was 0.25 (97.5% CI, -0.16 to 0.66); health system vs usual care, 0.14 (97.5% CI, -0.70 to 0.99); and community-based vs usual care, -0.10 (97.5% CI, -0.94 to 0.74). Only the secondary outcome of caregiver self-efficacy was significantly higher for both treatments vs usual care but not between treatments: LSMs were 15.1 for health system, 15.2 for community-based, and 14.4 for usual care. The difference between health system vs community-based care was -0.16 (95% CI, -0.37 to 0.06); health system vs usual care, 0.70 (95% CI, 0.26-1.14); and community-based vs usual care, 0.85 (95% CI, 0.42 to 1.29). Conclusions and Relevance: In this randomized trial of dementia care programs, no significant differences existed between health system-based and community-based care interventions nor between either active intervention or usual care regarding patient behavioral symptoms and caregiver strain. Trial Registration: ClinicalTrials.gov Identifier: NCT03786471.

  PublisherOA PDFDOI

• Riding With Alcohol-Impaired Drivers in Fatal Crashes: Modeling Historical Trends and Future Projections Using a System Dynamics Approach

  Journal of Studies on Alcohol and Drugs · 2025-02-06 · 1 citations

  article

  OBJECTIVE: The purpose of this study was to investigate factors contributing to the decline in the number of passengers riding with alcohol-impaired drivers involved in fatal crashes since 1982 and to examine the impact of simulated interventions on this group through 2050. METHOD: Historical data were obtained from the Fatality Analysis Reporting System. We applied linear regression to analyze changes in the average numbers of passengers per alcohol-impaired young driver involved in fatal crashes between 1982 and 2020 by age and sex. We also extended our existing system dynamics simulation model developed to examine driving-while-impaired (DWI) behaviors of U.S. male and female drivers ages 15 to 24 and explored riding-with-an-impaired-driver (RWI) behaviors and corresponding interventions. We conducted sensitivity analyses to examine the likely trajectories of alcohol-impaired drivers' passengers in fatal crashes across multiple scenarios through 2050. RESULTS: Our findings show that the decline in passengers of alcohol-impaired drivers in fatal crashes primarily stems from a decrease in the number of impaired drivers rather than a change in the average number of passengers per impaired driver. The simulation model replicated historical trends from 1982 to 2020, and the sensitivity analyses show that the policies reducing DWI trips also decrease RWI trips. CONCLUSIONS: Wide adoption of a comprehensive strategy combining increased enforcement, an alcohol truth campaign, the provision of alternative transportation, and the enactment of a new DWI restrictive law could significantly reduce the number of passengers in fatal crashes involving alcohol-impaired drivers while minimizing possible unintended consequences.

  PublisherDOI

• Prevalence and patient-level factors associated with common antibiotic allergy labels among patients undergoing hematopoietic stem cell transplants: a cross-sectional study

  The Journal of Allergy and Clinical Immunology In Practice · 2025-10-28

  articleOpen access
  PublisherOA PDFDOI

• Implementation facilitation improves readiness for emergency department-initiated buprenorphine to treat opioid use disorder

  Journal of Substance Use and Addiction Treatment · 2025-12-01

  articleOpen access
  PublisherOA PDFDOI

• Predicting Agitation Events in the Emergency Department Through Artificial Intelligence

  JAMA Network Open · 2025-05-07 · 9 citations

  articleOpen access

  Importance: Agitation events are increasing in emergency departments (EDs), exacerbating safety risks for patients and clinicians. A wide range of clinical etiologies and behavioral patterns in the emergency setting make agitation prediction difficult in this setting. Objective: To develop, train, and validate an agitation-specific prediction model based on a large, diverse set of past ED visit data. Design, Setting, and Participants: This cohort study included electronic health record data collected from 9 ED sites within a large, urban health system in the Northeast US. All ED visits featuring patients aged 18 years or older from January 1, 2015, to December 31, 2022, were included in the analysis and modeling. Data analysis occurred between May 2023 and September 2024. Exposures: Variables that served as potential exposures of interest, encompassing demographic information, patient history, initial vital signs, visit information, mode of arrival, and health services utilization. Main Outcomes and Measures: The primary outcome of agitation was defined as the presence of an intramuscular chemical sedation and/or violent physical restraint order during an ED visit. A clinical model was developed to identify risk factors that predict agitation development during an ED visit prior to symptom onset. Model performance was measured using area under the receiver operating characteristic curve (AUROC) and area under the precision recall curve (PR-AUC). Results: The final cohort comprised 3 048 780 visits. The cohort had a mean (SD) age of 50.2 (20.4) years, with 54.7% visits among female patients. The final artificial intelligence model used 50 predictors for the primary outcome of predicting agitation events. The model achieved an AUROC of 0.94 (95% CI, 0.93-0.94) and a PR-AUC of 0.41 (95% CI, 0.40-0.42) in cross-validation, indicating good discriminative ability. Calibration of the model was evaluated and demonstrated robustness across the range of predicted probabilities. The top predictors in the final model included factors such as number of past ED visits, initial vital signs, medical history, chief concern, and number of previous sedation and restraint events. Conclusions and Relevance: Using a cross-sectional cohort of ED visits across 9 hospitals, the prediction model included factors for detecting risk of agitation that demonstrated high accuracy and applicability across diverse patient populations. These results suggest that clinical application of the model may enhance patient-centered care through preemptive deescalation and prevention of agitation.

  PublisherOA PDFDOI

• Clinical profile and long-term outcomes of chest pain patients with coronary microvascular dysfunction from the emergency department – results from the Yale-CMD registry

  Microvascular Research · 2025-10-17

  articleOpen access
  PublisherOA PDFDOI

• A Measurement Science Framework to Optimize CDS for Opioid Use Disorder Treatment in the ED

  Applied Clinical Informatics · 2025-08-01

  articleOpen access

  In the emergency department-initiated buprenorphine for opioid use disorder (EMBED) trial, a clinical decision support (CDS) tool had no effect on rates of buprenorphine initiation in emergency department (ED) patients with opioid use disorder. The Agency for Healthcare Research and Quality (AHRQ) recently released a CDS Performance Measure Inventory to guide data-driven CDS development and evaluation. Through partner co-design, we tailored AHRQ inventory measures to evaluate EMBED CDS performance and drive improvements.Relevant AHRQ inventory measures were selected and adapted using a partner co-design approach grounded in consensus methodology, with three iterative, multidisciplinary partner working group sessions involving stakeholders from various roles and institutions; meetings were followed by postmeeting surveys. The co-design process was divided into conceptualization, specification, and evaluation phases building on the Centers for Medicare and Medicaid Services' measure life cycle framework. Final measures were evaluated in three EDs in a single health system from January 1, 2023, to December 31, 2024.The partner working group included 25 members. During conceptualization, 13 initial candidate metrics were narrowed to 6 priority categories. These were further specified and validated as the following measures, presented with preliminary values based on the use of the current (i.e., preoptimization) EMBED CDS: eligible encounters with CDS engagement, 5.0% (95% confidence interval: 4.3-5.8%); teamwork on ED initiation of buprenorphine, 39.9% (32.5-47.3%); proportion of eligible users who used EMBED, 58.3% (50.9-65.8%); time spent on EMBED, 29.0 seconds (20.4-37.7 seconds); proportion of buprenorphine orders placed through EMBED, 6.5% (3.4-9.6%); and task completion, 13.8% (8.9-18.7%) for buprenorphine order/prescription.A measurement science framework informed by partner co-design was a feasible approach to develop measures to guide CDS improvement. Subsequent research could adapt this approach to evaluate other CDS applications.

  PublisherOA PDFDOI

• An adaptive simulation intervention decreases emergency physician physiologic stress while caring for patients during COVID-19: A randomized clinical trial

  PLoS ONE · 2025-09-03

  articleOpen accessCorresponding

  BACKGROUND: Stressful work environments and burnout in emergency medicine (EM) physicians adversely impact patient care quality. The future EM workforce will need to prioritize clinician well-being to ensure optimal patient care. METHODS: This prospective, randomized, controlled study aimed to determine whether an adaptive simulation intervention, COVID-19 Responsive Intervention: Systems Improvement Simulations (CRI:SIS), decreased physiologic stress as measured by heart rate variability (HRV) in front-line EM physicians during the COVID-19 pandemic. HRV was measured with smart shirts and self-reported State-Trait Anxiety Inventory (STAI) were collected at baseline and during four 8-hour clinical shifts for all participants. The intervention group (n = 40) received a 3-hour virtual educational simulation intervention consisting of four simulation scenarios (CRI:SIS). The control group (n = 41) received no simulation intervention. RESULTS: There were no significant differences in demographics between groups. HRV data collected from 81 physicians across a total of 324 clinical shifts showed an increase in HRV (decrease in physiologic stress) in shifts immediately following CRI:SIS in the intervention group as measured by a root mean square standard deviation (RMSSD) difference of 11.55 ms (95% CI, -19.90 to -3.20; P = 0.007) compared to the control group. Post-intervention STAI did not significantly differ between intervention and control. CONCLUSION: An adaptive simulation-based educational intervention led to decreased physiologic stress (increased HRV) among emergency physicians who received a simulation education intervention. Reduced physiologic stress generated by adaptive simulation interventions may improve both patient safety and clinician well-being.

  PublisherOA PDFDOI

• Face perception, attention, and memory as predictors of social change in autistic children

  Journal of Neurodevelopmental Disorders · 2025-08-30 · 1 citations

  articleOpen access

  Social perception and attention markers have been identified that, on average, differentiate autistic from non-autistic children. However, little is known about how these markers predict behavior over time at both short and long time intervals. We conducted a large multisite, naturalistic study of 6- to 11-year-old children diagnosed with ASD (n = 214). We evaluated three markers of social processing: social perception via the ERP N170 Latency to Upright Faces; social attention via the Eye Tracking (ET) OMI (Oculomotor Index of Gaze to Human Faces) that captures percent looking to faces from three tasks; and social cognition via the NEPSY Face Memory task. Each was evaluated in predicting social ability and autistic social behaviors derived from parental interviews and questionnaires about child behavior at + 6 months (T3) and + 4 years (T4). Adjusting for baseline performance, time between measurements, age, and sex, our results suggest differential prognostic relations for each of the markers. The ERP N170 Latency to Upright Faces showed limited prognostic relations, with a significant relation to short term changes in face memory. The ET OMI was related to face memory over both short and long term. Both the ET OMI and Face Memory predicted long-term autistic social behavior scores. In the context of a large-scale, rigorous evaluation of candidate markers for use in future clinical trials, our primary markers had significant but small-effect prognostic capability. The ET OMI and Face Memory showed significant long-term predictive relations, with increased visual attention to faces and better face memory at baseline related to increased social approach and decreased autistic social behaviors 4 years later.

  PublisherOA PDFDOI

Recent grants

• Administrative Core

  NIH · $138.5M · 2015–2026

• Optimizing Tobacco Dependence Treatment in the Emergency Department

  NIH · $2.7M · 2016–2021

Frequent coauthors

• Lawrence David Scahill

  116 shared

• Cynthia Brandt

  VA Connecticut Healthcare System

  111 shared

• Fangyong Li

  103 shared

• Denis G. Sukhodolsky

  Yale University

  90 shared

• Gail D’Onofrio

  Yale University

  74 shared

• John T. Walkup

  Lurie Children's Hospital

  69 shared

• Sabine Wilhelm

  Massachusetts General Hospital

  69 shared

• Alan L. Peterson

  68 shared

Labs

• Safdar LabPI

  Cameron HunterAfsheen Nasir, MBBSIvan VelasquezRebecca Gordon MSUchechi Okoronkwo, BS Danielle Paquette, BS Dana Lee, MD candidate Carolyn Brokowski, PhD

Education

• Ph.D., Endocrinology & Metabolism

  Yale University

• Other

  Yale University