DIRECT DIFFERENCE TEAM

Anna Macedo DrPH, MPH, CIC

Clinical Data Specialist &
Account Manager

Anna Macedo is a board-certified Infection Preventionist and Doctor of Public Health with more than 12 years of experience in infection prevention, healthcare-associated infection surveillance, clinical data abstraction, regulatory reporting, and quality improvement. She brings deep expertise in applying CDC/NHSN surveillance definitions, analyzing complex infection data, and translating findings into actionable strategies that strengthen data integrity, regulatory compliance, and patient safety.

Throughout her career, Anna has held progressive infection prevention leadership roles at Saint Agnes Medical Center, where she served as Infection Preventionist and later Infection Control Manager for a 350-bed acute-care hospital. She directed the hospital-wide infection prevention and control program, oversaw regulatory and Joint Commission readiness, led epidemiologic investigations of outbreaks and communicable-disease exposures, and managed HAI data analysis and reporting. She also onboarded and managed third-party abstraction vendors, giving her a strong understanding of surveillance quality from both the healthcare organization and abstraction-vendor perspectives.

Anna’s experience includes surveillance and NHSN reporting for CLABSI, CAUTI, surgical site infections, MRSA bacteremia, and Clostridioides difficile infection. She has led multidisciplinary prevention initiatives, including work to reduce hospital-onset C. difficile using Lean methodology, and presented this work at the National Association for Professionals in Infection Control and Epidemiology conference. She also served as a Medical Specialist in Saint Agnes Medical Center Hospital Incident Command Center during the COVID-19 pandemic, developing protocols and providing subject-matter expertise for COVID-related processes.

Anna holds a Doctor of Public Health and a Master of Public Health in Infectious Diseases and Vaccinology from the University of California, Berkeley, and a Bachelor of Science in Microbiology from North Carolina State University. She maintains Certification in Infection Control (CIC) and is also a Public Health Microbiologist. Her background combines infectious-disease expertise, infection prevention leadership, healthcare data analysis, regulatory compliance, and quality improvement.

In her role with Direct Difference, Anna performs remote infection prevention abstraction and supports multiple acute-care hospital accounts. She conducts comprehensive chart reviews, applies current CDC/NHSN definitions, validates HAI data, and collaborates with client infection prevention teams to promote accurate, timely surveillance and reliable reporting.
Her combination of hands-on abstraction expertise, hospital infection prevention leadership, and data-driven quality improvement helps clients improve surveillance accuracy and support meaningful patient-safety outcomes.

Ashley Caldwell

Account Manager

Ashley Caldwell brings extensive experience in healthcare quality reporting, clinical data abstraction, and registry management to her role at Direct Difference. She combines analytical expertise and attention to detail with a collaborative approach to helping healthcare teams maintain accurate data and meet reporting requirements.

Ashley began her healthcare career in 2011 as a medical chart abstractor with Excela Health, working with Get With The Guidelines (GWTG) and CMS Core Measures. She later expanded her experience in quality coordination, clinical data abstraction, and management with O-Centrix and Carta Healthcare, developing expertise in data validation, inter-rater reliability (IRR), abstractor training, and quality reporting.

Ashley holds a Bachelor of Science in Business Management, graduating magna cum laude from the University of Pittsburgh. Her background in data management and workflow coordination supports her practical, detail-oriented approach to healthcare quality reporting.

As an Account Manager at Direct Difference, Ashley works closely with clients to coordinate abstraction services, address workflow needs, and keep reporting activities on track. Through responsive communication and hands-on support, she helps resolve challenges, maintain data quality, and build strong client partnerships focused on achieving quality reporting goals.

Deborah Liverman BSN, RN

Clinical Data Specialist & Account Manager

Deborah Liverman is a Registered Nurse with a Bachelor of Science in Nursing from Old Dominion University and 20 years of specialized experience in cardiac surgery and clinical data management. Her expertise encompasses the Society of Thoracic Surgeons (STS) Adult Cardiac and Thoracic Registries, with additional specialization in Transcatheter Valve Therapy (TVT) and Left Atrial Appendage Occlusion (LAAO) registries.

Throughout her career, Ms. Liverman has partnered closely with cardiac surgeons, cardiologists, data managers, and multidisciplinary quality teams to translate clinical data into meaningful quality improvement, identifying performance opportunities, and supporting the implementation of evidence-based strategies. She has regularly participated in multidisciplinary quality meetings, reporting cardiac surgery outcomes across multiple hospitals.

Her experience includes facilitating quality outcome monitoring and using surgical registry data to inform strategic changes across multi-hospital systems.

Ms. Liverman also served as a member of a 17-hospital statewide nonprofit consortium in Virginia, bringing together hospitals, cardiac surgeons, cardiologists, data managers, and healthcare leaders to benchmark outcomes, share best practices, and implement evidence-based protocols to improve patient care.

Her work has extended to clinical research and multi-facility outcomes analysis. She has collaborated with cardiology departments by providing longitudinal outcomes data across multiple facilities, contributing to the publication, “Implementation of a continuous quality improvement program for percutaneous coronary intervention and cardiac surgery program,” published in the American Heart Journal, Volume 152, Issue 2, pages 379–385, August 2006.

Misti joined Direct Difference in 2011 in contract management, bringing a strong foundation in healthcare operations, financial management, and business processes. Recognized for her leadership and contributions to operational performance, she advanced to Chief Operating Officer in 2014. Her progression reflects a deep understanding of how operations, financial stewardship, technology, and strategic execution align to drive organizational growth.

As Chief Operating Officer, Misti provides executive leadership and operational oversight for Direct Difference, helping shape business strategy, strengthen internal processes, and ensure consistent delivery of high-quality services. She is committed to continuous improvement, collaborative leadership, and responsive client service. Her ability to connect operational strategy, financial discipline, and organizational priorities helps Direct Difference adapt to evolving client needs, strengthen performance, and deliver lasting value.

Holly Rotan MSN, APRN, AGACNP-BC

Nurse Practitioner | Clinical Data Specialist & Account Manager

Holly Rotan is an experienced healthcare professional with a diverse clinical background spanning emergency medicine, trauma, hospital medicine, critical care, and healthcare quality improvement. She brings a unique perspective to clinical data abstraction through her combination of advanced clinical practice, quality expertise, and direct experience with complex inpatient care.

Holly earned her Bachelor of Science in Nursing from the University of South Carolina and began her nursing career in emergency and trauma care. Following eight years of emergency nursing, she transitioned into a quality-focused role supporting the implementation of sepsis as a CMS Core Measure. As team lead for her hospital’s sepsis committee, she helped develop processes to support measure compliance and led provider education focused on sepsis recognition, documentation, and evidence-based care.

In 2015, Holly earned her Master of Science in Nursing and began practicing as an Acute Care Nurse Practitioner.

Her advanced practice career has focused primarily on inpatient medicine, including hospital medicine and critical care in the ICU at Cleveland Clinic Florida. Her clinical experience provides a valuable understanding of the connection between bedside care, clinical documentation, quality measures, and regulatory requirements.

In addition to her clinical practice, Holly serves as an Account Manager and Clinical Data Specialist with Direct Difference, working with healthcare organizations and abstraction teams to support accurate data abstraction, measure compliance, validation, education, and performance improvement. Her clinical background enables her to collaborate effectively with physicians and clinical teams and to provide documentation and quality education that is practical, relevant, and actionable.

Holly brings to Direct Difference a combination of advanced clinical expertise, quality improvement experience, and a strong understanding of clinical documentation and quality measurement. She views clinical data abstraction not simply as data collection, but as an opportunity to identify meaningful performance gaps and support improvements in patient care and clinical outcomes.

Katherine Reese RN

Clinical Data Specialist & Account Manager

Katherine Reese is a Registered Nurse with more than a decade of progressive experience across nursing, utilization management, clinical appeals, case management, quality and performance improvement, and clinical data abstraction. Her diverse clinical and quality background provides a broad perspective on patient care, healthcare operations, regulatory requirements, and the importance of accurate clinical data.

Throughout her career, Katherine has held leadership and clinical roles in utilization management and hospital quality. Her experience includes FPPE and OPPE oversight, peer review, readmission and mortality review, regulatory surveys, denial management, and medical-necessity determinations. This combination of clinical and operational experience enables her to evaluate complex cases while maintaining a strong focus on clinical integrity, regulatory compliance, and quality outcomes.

In her role with Direct Difference, Katherine serves as an Account Manager and Clinical Data Specialist, managing a portfolio of approximately 30 healthcare facilities and coordinating clinical data abstractors across multiple programs. Her areas of responsibility include Sepsis, Stroke, Outpatient (OP) measures, Joint measures, electronic clinical quality measures (eCQMs), and Tumor Registry abstraction. She provides client coordination, operational oversight, and quality support to promote accurate and timely data abstraction across diverse clinical programs.

Katherine brings a strong commitment to patient advocacy, clinical integrity, and safe, appropriate, high-quality care to her work with Direct Difference. Her experience spanning bedside nursing, complex case management, utilization review, quality improvement, and clinical data abstraction allows her to serve as a knowledgeable partner to hospital teams and support the reliable data needed for quality reporting and performance improvement.

Margaret Ann Thibodeaux RN

Clinical Data Specialist &
Account Manager

Margaret Ann Thibodeaux is a seasoned healthcare quality and clinical data leader with more than 30 years of experience advancing regulatory compliance, clinical reporting integrity, and quality performance across complex healthcare environments. She brings deep expertise in hospital quality operations, CMS Core Measures, clinical data abstraction, case management, and healthcare informatics, with a practical focus on aligning accurate data with measurable improvement.

During more than 20 years with Ben Taub General Hospital, a Level I trauma center within Harris Health System, Margaret progressed from Surgical/Trauma ICU nursing leadership into quality management and Core Measures oversight. As a Core Measure Outcome Specialist, she led activities supporting CMS and Joint Commission requirements, including data validation, performance analysis, reporting, staff education, survey readiness, and quality improvement initiatives. Her work also included patient safety reviews, performance outlier analysis, and support for root-cause analysis and FMEA activities.

Margaret’s academic and professional credentials reinforce her cross-functional perspective on quality, data, and clinical operations. She holds a Master of Science in Health Informatics from Walden University, a Master of Science in Management Information Systems from Bellevue University, and a Bachelor of Science in Nursing from the University of Texas Health Science Center at Houston. She also holds the Certified Case Manager (CCM) credential and Six Sigma Lean and Design for Six Sigma training.

At Direct Difference, Margaret serves as a Clinical Data Specialist and Account Manager, partnering with healthcare organizations to strengthen abstraction quality, promote reliable reporting, and support performance improvement across clinical quality programs. Her leadership perspective bridges clinical practice, quality measurement, technology, and data integrity, enabling partners to meet compliance expectations while improving the consistency and usefulness of their quality data.

Patricia Walker, RN-BC, BSN, CPHQ, CVAHP

Clinical Data Specialist & Account Manager

Patricia Walker is a Registered Nurse and healthcare quality leader with more than 25 years of experience in patient safety, quality improvement, clinical data analysis, and organizational performance. Her expertise includes using clinical data and evidence-based strategies to strengthen patient safety, improve outcomes, and support organizational performance.

Throughout her career, Patricia has held quality and patient safety leadership roles at UC Irvine Medical Center, Ronald Reagan UCLA Medical Center, Cedars-Sinai Medical Center, Providence Saint Joseph Medical Center, and Children’s Health. At UC Irvine Medical Center, she led a team of nurse and business analysts and oversaw strategic quality and performance improvement initiatives, including eCQM development, readmission and mortality review, regulatory readiness, and collaboration with physician and nursing leadership. Her leadership contributed to national recognition, including a Vizient Top 10 Patient Safety and Quality Award and the #1 Vizient mortality performance ranking.

Patricia holds a Bachelor of Science in Nursing from Western Governors University and maintains certifications in Healthcare Quality (CPHQ), Value Analysis (CVAHP), and Gerontological Nursing (RN-BC). Her experience encompasses CMS compliance, Core Measures, clinical documentation improvement, patient safety, regulatory readiness, evidence-based practice, and clinical value analysis.

In her role as Account Manager with Direct Difference, Patricia partners with hospital clients and leadership teams to support quality initiatives, interpret clinical performance data, and identify opportunities for improvement. She brings a strong combination of clinical expertise, quality leadership, and data-driven performance improvement to help clients navigate complex quality requirements and strengthen the reliability and impact of their quality data.

Sarah Lopez, RN, BSN, CBIC

Infection Prevention Clinical Liaison

Sarah Lopez is a Registered Nurse with more than 26 years of healthcare experience, including more than a decade of dedicated expertise in Infection Prevention. Throughout her career, she has focused on strengthening patient safety and infection prevention through collaboration, education, evidence-based practice, and meaningful engagement with healthcare teams.

A cornerstone of Sarah’s leadership philosophy is the belief that respect, trust, and teamwork are essential to achieving sustainable improvement. She recognizes that successful infection prevention is not achieved by one individual or department, but through the collective commitment of the entire healthcare team. This philosophy was demonstrated in 2016 when Sarah and her employer were recognized with an APIC Heroes in Infection Prevention award for “Teamwork and Creativity that Created Success.” The award recognized the team’s ability to work collaboratively, embrace positive change, and foster a culture focused on improving outcomes for patients.

Sarah brings a continuous-improvement mindset to her work, recognizing that healthcare practices and regulatory expectations continue to evolve. She is committed to staying informed of emerging guidance, current evidence, and evolving best practices, and helping healthcare teams translate this knowledge into practical approaches that strengthen infection prevention, patient safety, and quality outcomes.

As an Infection Prevention Clinical Liaison with Direct Difference, Sarah serves as a trusted resource and partner to hospital quality and infection prevention teams. She brings together clinical expertise, regulatory awareness, and a collaborative approach to help organizations strengthen their infection prevention practices, support quality initiatives, and identify opportunities for improvement.

Her guiding principle is simple: when we engage people, build trust, and work together toward a common goal, we create stronger teams—and better outcomes for patients.

Stephanie van der Kraan RN, BSN, BA, MSL, CPHQ

Clinical Data Specialist & Account
Manager

Stephanie van der Kraan is a healthcare quality professional and clinical analyst with two decades of experience spanning bedside nursing, clinical data abstraction, patient safety, and multi-hospital quality leadership. She brings extensive expertise in clinical data analysis and registry abstraction, with a strong focus on data accuracy, integrity, and meaningful quality improvement.

Stephanie has more than 11 years of experience with the Vascular Quality Initiative (VQI) Registry, overseeing complex clinical data abstraction and quality improvement activities across diverse healthcare settings. As a lead analyst supporting five hospitals ranging from 36 to 654 beds, she facilitated multidisciplinary best-practice teams in vascular surgery, thoracic surgery, emergency response, and cardiac arrest care. Her experience also includes leading root-cause analyses of serious safety events, identifying system vulnerabilities, and supporting evidence-based improvements that resulted in sustained gains in safety and performance.

Her leadership contributed to the transformation of a small corporate quality department into a 100-member Institute of Safety and Quality.
With a strong clinical foundation that includes emergency department nursing in a Level I trauma center and leadership in a progressive pulmonary unit, Stephanie brings a clinically grounded perspective to quality and data analysis. Her multidisciplinary background enables her to connect clinical practice, data integrity, patient safety, and performance improvement while working collaboratively with healthcare teams.

In her role as Account Manager with Direct Difference, Stephanie combines her clinical expertise, registry experience, and quality leadership to support hospital partners with complex clinical data abstraction and quality improvement initiatives. She is committed to advancing healthcare quality through rigorous data analysis, collaborative leadership, and compassionate advocacy for patients and healthcare teams.

Wendy Malagon

Clinical Data Specialist & Account Manager

Wendy Malagon is a Clinical Data Specialist with more than 10 years of experience in clinical data abstraction, CMS Core Measures, GWTG-Stroke Registry abstraction, and multi-system quality reporting. Since beginning her abstraction career in 2015, she has developed expertise in abstraction accuracy, regulatory requirements, and quality reporting, while building strong, collaborative relationships with hospital partners and healthcare teams.

Prior to her career in clinical data abstraction, Wendy served as a Research Intern at Moffitt Cancer Center, where she developed experience organizing, interpreting, and translating complex clinical data. This research background provided a strong foundation for her work in healthcare quality and data abstraction and strengthened her ability to apply analytical thinking to clinical information.

Wendy holds a Bachelor’s degree in Psychology with a minor in Behavioral Healthcare from the University of South Florida, earned in 2014. Her multidisciplinary background in psychology, behavioral healthcare, research, and clinical data abstraction provides a unique perspective in supporting hospitals with the Inpatient Psychiatric Quality Reporting (IPFQR) Program.

In her role with Direct Difference, Wendy combines her expertise in clinical data abstraction and quality reporting with a collaborative approach to client partnership. She supports hospital teams in navigating complex quality reporting requirements while promoting accurate, reliable, and meaningful clinical data to support quality measurement and performance improvement.