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Julia E. Szymczak

Julia E. Szymczak, PhD

Languages spoken: English

Academic Information

Departments Primary - Internal Medicine

Divisions: Epidemiology

Julia "Julie" Szymczak, PhD is an Associate Professor in the Division of Epidemiology at the University of Utah School of Medicine, where she Co-Directs the Utah Quality Advancement Laboratory (UQuAL). Dr. Szymczak is a medical sociologist who leads research that integrates social science theory and methods into efforts to transform healthcare delivery so it is reliably safe, equitable, and high quality. Her work over the past seven years has focused on reducing the harm to patients and populations from antibiotic resistant bacteria with the following objectives: 1) characterize the social determinants of antibiotics across clinical contexts, 2) generate evidence about what works to improve how antibiotics are prescribed, and 3) advance the use of implementation science in antibiotic stewardship research. A hallmark of Dr. Szymczak's work is an interest in the influence of organizational context on efforts to modify healthcare delivery. To center this interest, her work on antibiotics has spanned both human and veterinary medicine and taken place across varied clinical contexts including pediatrics, primary care, internal medicine, surgery, emergency medicine, and critical care.

Dr. Szymczak is currently a Principal Investigator of three R01s funded by the Agency for Healthcare Research and Quality (AHRQ) to test the effectiveness of a tailored implementation strategy to improve antibiotic prescribing at the time of hospital discharge (1R01HS029482), develop a patient-directed nudge to improve outpatient antibiotic prescribing (1R01HS029328), and test the effectiveness of an antibiotic allergy delabeling intervention for patients with cancer (1R01HS029879). In each of these studies Dr. Szymczak partners in a co-leadership Multiple Principal Investigator model with clinician-scientists to ensure a rigorous interdisciplinary perspective informs the generation of evidence on changing healthcare delivery. In addition to work she leads, Dr. Szymczak contributes to the success of studies funded by the Patient Centered Outcomes Research Institute (PCORI), the U.S Centers for Disease Control and Prevention (CDC), and the National Institutes of Health. She has a particular interest in mentoring trainees and junior faculty in the use of social science theory and methods to understand implementation dynamics in healthcare.

Dr. Szymczak holds leadership positions in national and international organizations, including as a Voting Member of the Department of Health and Human Service's Presidential Advisory Council on Combating Antibiotic-Resistant Bacteria (PACCARB), as an Elected Councilor of the Society of Healthcare Epidemiology of America (SHEA) Board of Trustees, and as an Associate Editor at BMJ Quality and Safety. She lectures widely and is an engaging public speaker who is committed to translating the findings of her research so it is useful to clinicians, public health practitioners, and policy makers.

Education History

Fellowship National Institutes of Health
Center for Pediatric Clinical Effectiveness, Children's Hospital of Philadelphia
Postdoctoral Fellow
Graduate Training University of Pennsylvania
University of Pennsylvania
Undergraduate Brandeis University

Selected Publications

Journal Article

  1. Fanaroff AC, Patel MS, Chokshi N, Coratti S, Farraday D, Norton L, Rareshide C, Zhu J, Klaiman T, Szymczak JE, Russell LB, Small DS, Volpp KGM (2024). Effect of Gamification, Financial Incentives, or Both to Increase Physical Activity Among Patients at High Risk of Cardiovascular Events: The BE ACTIVE Randomized Controlled Trial. Circulation. (Read full article)
  2. Murray JL, Leung DT, Hanson OR, Ahmed SM, Pavia AT, Khan AI, Szymczak JE, Vaughn VM, Patel PK, Biswas D, Watt MH (2024). Drivers of inappropriate use of antimicrobials in South Asia: A systematic review of qualitative literature. PLOS Glob Public Health, 4(4), e0002507. (Read full article)
  3. Szymczak JE, Petty LA, Gandhi TN, Neetz RA, Hersh A, Presson AP, Lindenauer PK, Bernstein SJ, Muller BM, White AT, Horowitz JK, Flanders SA, Smith JD, Vaughn VM (2024). Protocol for a parallel cluster randomized trial of a participatory tailored approach to reduce overuse of antibiotics at hospital discharge: the ROAD home trial. Implement Sci, 19(1), 23. (Read full article)
  4. Szymczak JE, Hayes AA, Labellarte P, Zighelboim J, Toor A, Becker AB, Gerber JS, Kuppermann N, Florin TA (2023). Parent and Clinician Views on Not Using Antibiotics for Mild Community-Acquired Pneumonia. Pediatrics, 153(2). (Read full article)
  5. Vaughn VM, Krein SL, Hersh A, Buckel WR, White AT, Horowitz J, Patel PK, Gandhi TN, Petty LA, Spivak ES, Bernstein SJ, Malani AM, Johnson LB, Neetz RA, Flanders SA, Galyean P, Kimball E, Bloomquist K, Zickmund T, Zickmund SL, Szymczak JE (2023). Excellence in Antibiotic Stewardship: A mixed methods study comparing High, Medium, and Low Performing Hospitals. Clin Infect Dis. (Read full article)
  6. Serletti L, Dutcher L, Degnan KO, Szymczak JE, Cluzet V, David MZ, Cressman L, Glassman LW, Hamilton KW, Centers for Disease Control and Prevention CDC Prevention Epicenters Program (2023). Analysis of seasonal variation of antibiotic prescribing for respiratory tract diagnoses in primary care practices. Antimicrob Steward Healthc Epidemiol, 3(1), e147. (Read full article)
  7. Vaughn VM, Gupta A, Petty LA, Malani AN, Osterholzer D, Patel PK, Younas M, Bernstein SJ, Burdick S, Ratz D, Szymczak JE, McLaughlin E, Czilok T, Basu T, Horowitz JK, Flanders SA, Gandhi TN (2023). A Statewide Quality Initiative to Reduce Unnecessary Antibiotic Treatment of Asymptomatic Bacteriuria. JAMA Intern Med, 183(9), 933-941. (Read full article)
  8. Hamm RF, Levine LD, Szymczak JE, Parry S, Srinivas SK, Beidas RS (2023). An innovative sequential mixed-methods approach to evaluating clinician acceptability during implementation of a standardized labor induction protocol. BMC Med Res Methodol, 23(1), 195. (Read full article)
  9. Szymczak JE, Getz KD, Madding R, Shuster S, Aftandilian C, Arnold SD, Collier AB, Gramatges MM, Henry M, Hijiya N, Mian A, Raetz E, Fisher BT, Aplenc R (2023). Child and family perceptions of satisfaction with neutropenia management in pediatric acute myeloid leukemia. Pediatr Blood Cancer, 70(8), e30420. (Read full article)
  10. Szymczak JE, Fiks AG, Craig S, Mendez DD, Ray KN (2023). Access to What for Whom? How Care Delivery Innovations Impact Health Equity. J Gen Intern Med, 38(5), 1282-1287. (Read full article)
  11. Glassman LW, Szymczak JE (2022). The influence of social class and institutional relationships on the experiences of vaccine-hesitant mothers: a qualitative study. BMC Public Health, 22(1), 2309. (Read full article)
  12. Schnellinger EM, Cantu E, Kimmel SE, Szymczak JE (2022). A Conceptual Model for Sources of Differential Selection in Lung Transplant Allocation. Ann Am Thorac Soc. (Read full article)
  13. Anesi GL, Dress E, Chowdhury M, Wang W, Small DS, Delgado MK, Bayes B, Szymczak JE, Glassman LW, Barreda FX, Weiner JZ, Escobar GJ, Halpern SD, Liu VX (2022). Among-Hospital Variation in ICU Admission Practices and Associated Outcomes for Patients with Acute Respiratory Failure. Ann Am Thorac Soc. (Read full article)
  14. Vaughn VM, Giesler DL, Mashrah D, Brancaccio A, Sandison K, Spivak ES, Szymczak JE, Wu C, Horowitz JK, Bashaw L, Hersh AL (2022). Pharmacist gender and physician acceptance of antibiotic stewardship recommendations: An analysis of the reducing overuse of antibiotics at discharge home intervention. Infect Control Hosp Epidemiol, 44(4), 1-8. (Read full article)
  15. Ding L, Szymczak JE, Evans E, Canepa E, Martin AE, Contractor F, Aplenc R, Joseph G, Winestone LE (2022). Factors that contribute to disparities in time to acute leukemia diagnosis in young people: an in depth qualitative interview study. BMC Cancer, 22(1), 531. (Read full article)
  16. Dutcher L, Degnan K, Adu-Gyamfi AB, Lautenbach E, Cressman L, David MZ, Cluzet V, Szymczak JE, Pegues DA, Bilker W, Tolomeo P, Hamilton KW (2021). Improving Outpatient Antibiotic Prescribing for Respiratory Tract Infections in Primary Care: A Stepped-Wedge Cluster Randomized Trial. Clin Infect Dis, 74(6), 947-956. (Read full article)
  17. Szymczak J, Trautner B (2021). Support to scale antibiotic stewardship in long-term care homes: how much is enough? BMJ Qual Saf, 31(2), 79-82. (Read full article)
  18. Livorsi DJ, Drainoni ML, Reisinger HS, Nanda N, McGregor JC, Barlam TF, Morris AM, Szymczak JE (2021). Leveraging implementation science to advance antibiotic stewardship practice and research. Infect Control Hosp Epidemiol, 43(2), 139-146. (Read full article)
  19. Woods-Hill CZ, Xie A, Lin J, Wolfe HA, Plattner AS, Malone S, Chiotos K, Szymczak JE (2022). Numbers and narratives: how qualitative methods can strengthen the science of paediatric antimicrobial stewardship. JAC Antimicrob Resist, 4(1), dlab195. (Read full article)
  20. Nampoothiri V, Bonaconsa C, Surendran S, Mbamalu O, Nambatya W, Ahabwe Babigumira P, Ahmad R, Castro-Sanchez E, Broom A, Szymczak J, Zingg W, Gilchrist M, Holmes A, Mendelson M, Singh S, McLeod M, Charani E (2021). What does antimicrobial stewardship look like where you are? Global narratives from participants in a massive open online course. JAC Antimicrob Resist, 4(1), dlab186. (Read full article)
  21. Li LX, Szymczak JE, Keller SC (2021). Antibiotic stewardship in direct-to-consumer telemedicine: translating interventions into the virtual realm. J Antimicrob Chemother, 77(1), 13-15. (Read full article)
  22. Walter JK, Hill DL, Schall TE, Szymczak JE, Parikh S, DiDomenico C, Carroll KW, Nye RT, Feudtner C (2021). An Interprofessional Team-Based Intervention to Address Barriers to Initiating Palliative Care in Pediatric Oncology: A Multiple-Method Evaluation of Feasibility, Acceptability, and Impact. J Pain Symptom Manage, 62(6), 1135-1144. (Read full article)
  23. Saine ME, Szymczak JE, Moore TM, Bamford LP, Barg FK, Forde KA, Schnittker J, Holmes JH, Mitra N, Lo Re V 3rd (2021). The impact of disease-related knowledge on perceptions of stigma among patients with Hepatitis C Virus (HCV) infection. PLoS One, 16(10), e0258143. (Read full article)
  24. Getz KD, Szymczak JE, Li Y, Madding R, Huang YV, Aftandilian C, Arnold SD, Bona KO, Caywood E, Collier AB, Gramatges MM, Henry M, Lotterman C, Maloney K, Mian A, Mody R, Morgan E, Raetz EA, Rubnitz J, Verma A, Winick N, Wilkes JJ, Yu JC, Fisher BT, Aplenc R (2021). Medical Outcomes, Quality of Life, and Family Perceptions for Outpatient vs Inpatient Neutropenia Management After Chemotherapy for Pediatric Acute Myeloid Leukemia. JAMA Netw Open, 4(10), e2128385. (Read full article)
  25. Schmidt H, Spieker AJ, Luo T, Szymczak JE, Grande D (2021). Variability in Primary Care Physician Attitudes Toward Medicaid Work Requirement Exemption Requests Made by Patients With Depression. JAMA Health Forum, 2(10), e212932. (Read full article)
  26. Szymczak JE (2021). Mandates are not magic bullets: Leveraging context, meaning and relationships to increase meaningful use of prescription monitoring programs. Pharmacoepidemiol Drug Saf, 30(7), 979-981. (Read full article)
  27. Farr BD, Otto CM, Szymczak JE (2021). Expert Perspectives on the Performance of Explosive Detection Canines: Operational Requirements. Animals (Basel), 11(7). (Read full article)
  28. Farr BD, Otto CM, Szymczak JE (2021). Expert Perspectives on the Performance of Explosive Detection Canines: Performance Degrading Factors. Animals (Basel), 11(7). (Read full article)
  29. Lavigne SH, Louis S, Rankin SC, Zaoutis TE, Szymczak JE (2021). How companion animal veterinarians in the United States perceive financial constraints on antibiotic decision-making. Vet Rec, 188(12), e62. (Read full article)
  30. Wang R, Degnan KO, Luther VP, Szymczak JE, Goren EN, Logan A, Shnekendorf R, Hamilton KW (2021). Development of a Multifaceted Antimicrobial Stewardship Curriculum for Undergraduate Medical Education: The Antibiotic Stewardship, Safety, Utilization, Resistance, and Evaluation (ASSURE) Elective. Open Forum Infect Dis, 8(6), ofab231. (Read full article)
  31. Szymczak JE, Keller SC, Linder JA (2020). "I Never Get Better Without an Antibiotic": Antibiotic Appeals and How to Respond. Mayo Clin Proc, 96(3), 543-546. (Read full article)
  32. Kim C, Szymczak JE, Schnellinger EM, Herman DJ, Kennedy LA, Talati NJ, Hamilton KW (2020). Survey to determine the relative importance of clinical factors used to make empiric antibiotic decisions. Infect Control Hosp Epidemiol, 42(1), 93-95. (Read full article)
  33. Saine ME, Szymczak JE, Moore TM, Bamford LP, Barg FK, Schnittker J, Holmes JH, Mitra N, Lo Re V 3rd (2020). Determinants of stigma among patients with hepatitis C virus infection. J Viral Hepat, 27(11), 1179-1189. (Read full article)
  34. Cowden C, Mwananyanda L, Hamer DH, Coffin SE, Kapasa ML, Machona S, Szymczak JE (2020). Healthcare worker perceptions of the implementation context surrounding an infection prevention intervention in a Zambian neonatal intensive care unit. BMC Pediatr, 20(1), 432. (Read full article)
  35. Redding LE, Muller BM, Szymczak JE (2020). Small and Large Animal Veterinarian Perceptions of Antimicrobial Use Metrics for Hospital-Based Stewardship in the United States. Front Vet Sci, 7, 582. (Read full article)
  36. Szymczak JE, Muller BM, Shakamuri NS, Hamilton KW, Gerber JS, Laguio-Vila M, Dumyati GK, Fridkin SK, Guh AY, Reddy SC, Lautenbach E, CDC Prevention Epicenters Program (2020). Prescriber perceptions of fluoroquinolones, extended-spectrum cephalosporins, and Clostridioides difficile infection. Infect Control Hosp Epidemiol, 41(8), 914-920. (Read full article)
  37. Maliha G, Nepps ME, Tamma PD, Dodds Ashley E, Szymczak JE, Kolesar E, Hamilton KW (2020). Legal implications of antibiotic stewardship programs. Infect Control Hosp Epidemiol, 41(7), 757-764. (Read full article)
  38. Triantafillou V, Kopsidas I, Kyriakousi A, Zaoutis TE, Szymczak JE (2019). Influence of national culture and context on healthcare workers' perceptions of infection prevention in Greek neonatal intensive care units. J Hosp Infect, 104(4), 552-559. (Read full article)
  39. Kohut MR, Keller SC, Linder JA, Tamma PD, Cosgrove SE, Speck K, Ahn R, Dullabh P, Miller MA, Szymczak JE (2019). The inconvincible patient: how clinicians perceive demand for antibiotics in the outpatient setting. Fam Pract, 37(2), 276-282. (Read full article)
  40. Saine ME, Moore TM, Szymczak JE, Bamford LP, Barg FK, Mitra N, Schnittker J, Holmes JH, Lo Re V 3rd (2020). Validation of a modified Berger HIV stigma scale for use among patients with hepatitis C virus (HCV) infection. PLoS One, 15(2), e0228471. (Read full article)
  41. Hill DL, Walter JK, Szymczak JE, DiDomenico C, Parikh S, Feudtner C (2019). Seven Types of Uncertainty When Clinicians Care for Pediatric Patients With Advanced Cancer. J Pain Symptom Manage, 59(1), 86-94. (Read full article)
  42. Clapp JT, Diraviam SP, Lane-Fall MB, Szymczak JE, Muralidharan M, Chung JJ, Gutsche JT, Curley MAQ, Berns JS, Fleisher LA (2019). Nephrology in the Academic Intensive Care Unit: A Qualitative Study of Interdisciplinary Collaboration. Am J Kidney Dis, 75(1), 61-71. (Read full article)
  43. Morris AM, Calderwood MS, Fridkin SK, Livorsi DJ, McGregor JC, Mody L, Moehring RW, Pakyz AL, Stenehjem E, Szymczak JE, Tamma PD (2019). Research needs in antibiotic stewardship. Infect Control Hosp Epidemiol, 40(12), 1334-1343. (Read full article)
  44. Vaughn VM, Szymczak JE, Newton DW, Fakih MG (2019). Addressing the Overuse of Cultures to Optimize Patient Care. Ann Intern Med, 171(7_Suppl), S73-S74. (Read full article)
  45. Szymczak JE (2018). Are Surgeons Different? The Case for Bespoke Antimicrobial Stewardship. Clin Infect Dis, 69(1), 21-23. (Read full article)
  46. Szymczak JE, Kitt E, Hayes M, Chiotos K, Coffin SE, Schriver ER, Patton AM, Metjian TA, Gerber JS (2019). Threatened efficiency not autonomy: Prescriber perceptions of an established pediatric antimicrobial stewardship program. Infect Control Hosp Epidemiol, 40(5), 522-527. (Read full article)
  47. Gerber JS, Ross RK, Szymczak JE, Xiao R, Localio AR, Grundmeier RW, Rettig SL, Teszner E, Canning DA, Coffin SE (2019). Infections after pediatric ambulatory surgery: Incidence and risk factors. Infect Control Hosp Epidemiol, 40(2), 150-157. (Read full article)
  48. Szymczak JE, Klieger SB, Miller M, Fiks AG, Gerber JS (2017). What Parents Think About the Risks and Benefits of Antibiotics for Their Child's Acute Respiratory Tract Infection. J Pediatric Infect Dis Soc, 7(4), 303-309. (Read full article)
  49. Szymczak JE (2018). Beyond barriers and facilitators: the central role of practical knowledge and informal networks in implementing infection prevention interventions. BMJ Qual Saf, 27(10), 763-765. (Read full article)
  50. Hill DL, Walter JK, Casas JA, DiDomenico C, Szymczak JE, Feudtner C (2018). The codesign of an interdisciplinary team-based intervention regarding initiating palliative care in pediatric oncology. Support Care Cancer, 26(9), 3249-3256. (Read full article)
  51. Szymczak JE, Lee G, Klieger SB, Woods C, Creech CB, Gilsdorf JR, Dennehy P, Zaoutis T (2018). Multifaceted but Invisible: Perceptions of the Value of a Pediatric Cognitive Specialty. Hosp Pediatr, 8(7), 385-393. (Read full article)
  52. Szymczak JE, Schall T, Hill DL, Walter JK, Parikh S, DiDomenico C, Feudtner C (2018). Pediatric Oncology Providers' Perceptions of a Palliative Care Service: The Influence of Emotional Esteem and Emotional Labor. J Pain Symptom Manage, 55(5), 1260-1268. (Read full article)
  53. Keller SC, Tamma PD, Cosgrove SE, Miller MA, Sateia H, Szymczak J, Gurses AP, Linder JA (2017). Ambulatory Antibiotic Stewardship through a Human Factors Engineering Approach: A Systematic Review. J Am Board Fam Med, 31(3), 417-430. (Read full article)
  54. Szymczak JE, Getz KD, Madding R, Fisher B, Raetz E, Hijiya N, Gramatges MM, Henry M, Mian A, Arnold SD, Aftandilian C, Collier AB, Aplenc R (2017). Identifying patient- and family-centered outcomes relevant to inpatient versus at-home management of neutropenia in children with acute myeloid leukemia. Pediatr Blood Cancer, 65(4). (Read full article)
  55. Gaw CE, Hamilton KW, Gerber JS, Szymczak JE (2018). Physician Perceptions Regarding Antimicrobial Use in End-of-Life Care. Infect Control Hosp Epidemiol, 39(4), 383-390. (Read full article)
  56. Elango S, Szymczak JE, Bennett IM, Beidas RS, Werner RM (2017). Changing Antibiotic Prescribing in a Primary Care Network: The Role of Readiness to Change and Group Dynamics in Success. Am J Med Qual, 33(2), 154-161. (Read full article)
  57. Gerber JS, Ross RK, Bryan M, Localio AR, Szymczak JE, Wasserman R, Barkman D, Odeniyi F, Conaboy K, Bell L, Zaoutis TE, Fiks AG (2017). Association of Broad- vs Narrow-Spectrum Antibiotics With Treatment Failure, Adverse Events, and Quality of Life in Children With Acute Respiratory Tract Infections. JAMA, 318(23), 2325-2336. (Read full article)
  58. Szymczak JE (2015). Infections and interaction rituals in the organisation: clinician accounts of speaking up or remaining silent in the face of threats to patient safety. Sociol Health Illn, 38(2), 325-39. (Read full article)
  59. Szymczak JE, Smathers S, Hoegg C, Klieger S, Coffin SE, Sammons JS (2015). Reasons Why Physicians and Advanced Practice Clinicians Work While Sick: A Mixed-Methods Analysis. JAMA Pediatr, 169(9), 815-21. (Read full article)
  60. Szymczak JE (2014). Seeing risk and allocating responsibility: talk of culture and its consequences on the work of patient safety. Soc Sci Med, 120, 252-9. (Read full article)
  61. Szymczak JE, Feemster KA, Zaoutis TE, Gerber JS (2014). Pediatrician perceptions of an outpatient antimicrobial stewardship intervention. Infect Control Hosp Epidemiol, 35 Suppl 3, S69-78. (Read full article)
  62. Szymczak JE, Bosk CL (2012). Training for efficiency: work, time, and systems-based practice in medical residency. J Health Soc Behav, 53(3), 344-58. (Read full article)
  63. Szymczak JE, Brooks JV, Volpp KG, Bosk CL (2010). To leave or to lie? Are concerns about a shift-work mentality and eroding professionalism as a result of duty-hour rules justified? Milbank Q, 88(3), 350-81. (Read full article)


  1. Szymczak JE, Linder JA (2023). "Cultural" Variation in Antibiotic Prescribing: Have Regional Differences Had Their Day? Open Forum Infect Dis, 10(2), ofad025. (Read full article)


  1. Hamm RF, Wang E, Szymczak JE, Levine LD (2023). Implementation of a calculator to predict cesarean during labor induction: a qualitative evaluation of the patient perspective. [Letter to the editor]. Am J Obstet Gynecol MFM, 5(6), 100968. (Read full article)
  2. Szymczak JE (2021). Structural Factors, Power, and the Physician Sex Pay Gap. [Letter to the editor]. JAMA Pediatr, 175(8), 868. (Read full article)
  3. Thampi N, Szymczak JE, Leis JA (2020). Applying behavioral frameworks to antimicrobial stewardship. [Letter to the editor]. Infect Control Hosp Epidemiol, 41(5), 628-630. (Read full article)