Corey Bills, MD, MPH, is based at the University of Colorado Anschutz, but his professional interests are global. He spends three to four weeks a year working overseas and focuses much of his research on global health concerns.
Both at home and abroad, Bills is a key player in efforts to improve the delivery of emergency health services in rural and resource-challenged areas. His work has taken him from South Asia to West Africa to Central America.
“Most of my work is around emergency care development and research into acute care globally and domestically,” he says. “I try to think about how those issues interrelate in the global community.”
Bills is an associate professor in the CU Anschutz Department of Emergency Medicine and is a core member of its Global Emergency Care Initiative. He’s a senior investigator at the Colorado School of Public Health’s Center for Global Health. And he’s co-director of the recently established Collaborating Centre of Acute Care at the World Health Organization (WHO).
For more than 20 years, Bills has worked in the West African nation of Liberia. Partnering with the country’s Ministry of Health and global nonprofit groups, he’s supported the development of emergency and acute care in an economically challenged nation that has faced successive civil wars and a deadly Ebola virus outbreak in recent decades.
He is the lead author of recently published research evaluating the success of a package of simple, low-cost emergency care improvements at a hospital in Monrovia, Liberia’s capital. Overall, he says, the impact of emergency-care improvements in resource-limited areas remains understudied.
Health care issues faced in resource-challenged and rural areas overseas “have corollaries domestically,” Bills says. “Around the Mountain West, hospitals close in rural communities all the time. There are conversations about how you deliver care in those communities in the same way we would in Denver and Aurora.”
Bills was an undergrad at Middlebury College in Vermont, a school where global engagement is a hallmark. He studied abroad in India and Tibet, and after graduating in 2001, he worked in international development with the International Rescue Committee,a global humanitarian organization that helps refugees and displaced people facing war, persecution, and natural disasters around the world.
“My work with them was primarily focused in West Africa around adolescent education in Liberia, Sierra Leone, and Guinea,” Bills says. “That was my first introduction to Liberia, which was at the tail end of a long conflict.” An estimated quarter-million people were killed in successive civil wars in which children were forced into combat.
Initially, Bills did not intend to go to medical school, but he had an interest in public health issues, so in 2007 he earned his MPH degree at Columbia University with a focus on health issues related to forced migration – the involuntary movement of people due to threats such as conflict and persecution.
Bills’ path took him to medical school at the University of Chicago, followed by a residency in emergency medicine, and then to Stanford University as a fellow in global health. After four years on faculty on the medical campus at the University of California, San Francisco, Bills joined CU Anschutz in 2019 and practices at UCHealth University of Colorado Hospital (UCH).
Photo at top: Redemption Hospital in Monrovia, Liberia, in a 2018 photo. Photo by Corey Bills.
Left: Corey Bills, MD, MPH, with a research and training team at Redemption Hospital. Right: The hospital's emergency entrance. Photos provided by Corey Bills.
The nation of Liberia was established two centuries ago as a resettlement area for free and formerly enslaved Black Americans. Today, it’s one of the world’s poorest nations, with more than half of the population living in poverty, especially in rural areas.
Over the two decades that Bills has been working in Liberia, efforts have been underway to rebuild a public health system that was decimated by civil wars and lacked effective government support, he says. Global non-governmental organizations (NGOs), such as the International Rescue Committee and Doctors Without Borders, helped prop up the system. As peace and stability have gradually returned, the national Ministry of Health has assumed a greater role in managing public health, but NGOs still play an important part.
In 2014-16, a deadly outbreak of the Ebola virus in Liberia and neighboring countries killed thousands and overwhelmed hospitals. One was Redemption Hospital, a 200-bedfacility in an impoverished area of Monrovia that was forced to close temporarily.
After the outbreak, decontamination and renovation allowed the hospital to reopen, but critical gaps in the hospital’s infrastructure, equipment, and staffing remained.Also, Bills says, Liberia lacked graduate emergency-medicine training programs for physicians as they’re known in the United States.
The challenges were stark, he says: “How do you improve care? How do you build back health systems better? What do you do, knowing they may not have the money to do a lot of things?”
Redemption Hospital in Monrovia, Liberia, in a 2018 photo. Photo by Corey Bills.
It was about that time that the WHO was broadening its efforts to develop emergency care in resource-challenged settings. “One of the ways they thought they could be most useful was to promote simple tools that were not cost-prohibitive to improve the quality of care,” Bills says.
His recent paper– “Implementation of a Package of Emergency Care Interventions and Clinical Outcomes,” published in JAMA Network Open –evaluated one such set of interventions in the emergency unit at Redemption Hospital, which Bills describes as “small, largely cramped, and full of patients. Most of the direct patient care is performed by the nursing staff,with one or two physician assistants at most. A physician provides oversight,but isn’t there 100% of the time. The provider workload is incredibly spectacular.”
The interventions, introduced in 2019, included things that might be taken for granted at a fully-resourced U.S. hospital: A triage system to prioritize the sickest patients, standardized medical forms, dedicated beds for the most critical patients, and focused emergency care training through bedside teaching.
Comparing outcomes for 344 patients before these changes with those of 1,073 patients during the program, Bills and his colleagues found improvements in patient survival and better quality of care. Emergency-unit deaths fell from 13.5% to 7.1%, waiting time to see a doctor was reduced from an average of 102 minutes to 52 minutes, and hospital stays were shortened from an average of nine days to 4.6 days.
“To have the mortality rate cut in half by any intervention, that’s hard to come by,” Bills says.
Tourniquets are applied in a training exercise at Redemption Hospital. Photo by Corey Bills.
In this hemisphere, Bills is the principal investigator on a project supported by the Laerdal Foundation to offer a community first aid response course in Belize, a Central American nation known to tourists as a resort and diving destination, but which also has elevated levels of poverty in some areas.
The course is for community members without medical training, he says. “In a lot of places there, you can’t call 911 to get people quickly from, say, the scene of a road accident to a hospital. So the main idea is for people in the community to be able to provide direct aid quickly.”
The first cohort– members of the national police system from throughout Belize – was trained recently, with the intention of having participants return home and train others.
In addition to his global studies, Bills cites complementary programs at CU Anschutz Emergency Medicine, such as the new cultural care initiative, led by Maddie Ross, MD, MPH, to help emergency department patients who primarily speak a language other than English connect with primary care and community resources.
Bills notes that Aurora, site of CU Anschutz, is a diverse city where immigrants make up a significant portion of the population.
“This is an incredibly gratifying place for me to work,” he says. “I get the best of both worlds: I get to think about health as it exists in other countries, and I get to think about it as it exists out our back door.”