Celebrating Dr. Collen and 50 years of Delivery Science
With more than 5,500 studies published in peer-reviewed journals, more than 60 investigators and 600 staff members, and funding topping $125 million in 2020, the Division of Research continues to make seminal contributions to health services research in the areas of behavioral health and aging, cancer, cardiovascular and metabolic disease, genetics, health care policy and delivery, infectious diseases, vaccine safety and effectiveness, and women's and children's health. The Division's rich clinical databases and disease registries allow for population-based studies that cannot be done anyplace else in the world.
Under the leadership of its fifth director, Tracy A. Lieu, MD, MPH, the Division continues and expands its involvement in delivery science research to improve service delivery, prevention, and clinical outcomes in health care. In addition to its own long history of conducting such research, the Division is a partner in the inter-regional Kaiser Permanente Center for Effectiveness and Safety Research (CESR). This collaboration serves as the foundation for discovering the best treatments for patients across the health care spectrum.
On November 12, 2013, colleagues and friends from around the nation and world joined in wishing a happy 100th birthday to the Division's founder, Morris F. Collen, MD. Less than a year later, they celebrate his life and contributions to Kaiser Permanente and the fields of health care science and medical informatics upon his death on September 24, 2014.
In 2012, the Division celebrated its 50th anniversary, with four of its five directors, scientists and staff, and leaders of Kaiser Permanente Northern California and The Permanente Medical Group.
A New Era of DOR Collaborations
The Cardiovascular Research Network (CVRN), a new research arm of the HMO Research Network (now the Health Care Systems Research Network), aims to provide a unique national resource that leverages the network's cardiovascular expertise, diverse community-based population, and rich electronic data systems.
The Research Program on Genes, Environment and Health (RPGEH), now one of the largest such research projects in the United States, is established to examine genetic and environmental factors that influence common diseases such as heart disease, cancer, diabetes, high blood pressure, Alzheimer's disease, asthma, and depression. The goal of this research program is to discover which genes and environmental factors are linked to specific diseases.
The Clinical Trials Program (CTP) seeks to improve the design, implementation, and reporting of interventional and clinical trials throughout Kaiser Permanente Northern California.
Ushering In Large-Scale Collaborative Research
In 1993, Morris Collen, MD is honored by the American College of Medical Informatics (ACMI) as the first recipient of the highest honor it bestows, the Morris F. Collen, MD, Medal for Outstanding Contributions to the Field of Medical Informatics. ACMI president W. Edward Hammond, PhD, says, "His work at Kaiser taught us that computers can be effective in health care and that it is cheaper to keep people well than to treat them when they become ill." ACMI describes Collen as a leader whose own efforts as a pioneer in the field stand out as the embodiment of creativity, intellectual rigor, perseverance, and personal integrity. Today, the award is given to researchers in the field who best exemplify the teaching and practice of Morris Collen.
Under the direction of its third director, Gary Friedman, MD, the Division conducts important research on:
- The etiology, prevention and early detection of cancers.
- Prevention and treatment of cardiovascular disease and diabetes.
- The determinants of health care utilization.
- Population-based approaches to chronic diseases.
Early research on the effects of socioeconomic status, race, and ethnicity on health care and outcomes, lays the foundation for the Division's ongoing involvement with health disparities research.
In 1994, the Division is the founding member of the HMO Research Network (now the Health Care Systems Research Network), ushering in an era of large-scale collaborations seeking to integrate research and practice for the improvement of health and health care in diverse populations.
The Division's fourth director, Joseph Selby, MD, MPH, supports the development of additional programs to enhance large-scale, population-based research in epidemiology, genetics, and clinical delivery and outcomes.
A Major Research Operation in Epidemiology
During the tenure of second director Edmund Van Brunt, MD, the Division continues to build the databases and staff necessary for a major undertaking in epidemiology and health services research.
In 1985, the Division opens a research clinic to support the Coronary Artery Risk Development in Young Adults (CARDIA) study — a longitudinal study of heart health and disparities that continues to this day and has resulted in more than 600 published papers. The Kaiser Permanente Vaccine Study Center is founded the same year to monitor vaccine safety and effectiveness.
This decade also is distinguished by important published work in the areas of health screening for colon cancer. A group of researchers at the Division, led by Joseph Selby, MD, MPH, takes a closer look at the effectiveness of flexible sigmoidoscopy. In a case-controlled study, screening sigmoidoscopy is shown to reduce mortality from colorectal cancers. Findings result in the Kaiser Permanente Colon Cancer Prevention Program (COCAP) and lead the U.S. Preventive Services Task Force to recommend colorectal cancer screening for the first time.
Early Pioneers of An Integrated Medical Record
Research on the Multiphasic health check-up is quickly followed by grants from the U.S. Food and Drug Administration to develop and pilot a health care information system, or electronic medical record. The project provides an early demonstration of what computers can do for medicine and leads to a long list or peer-reviewed publications, along with the ongoing multiphasic studies.
As computerized databases such as the membership file, hospital discharges, and cancer registry appear, the Division becomes heavily involved in the science of population health. Investigators, including Gary Friedman, MD, MS, contribute important research about the impacts of smoking and other risk factors on the occurrence of heart disease in the diverse Kaiser Permanente population.
By 1973, a computer medical record exists for all health plan members. These earliest records are still used in research today, and they allow the Division of Research to develop a data-based research agenda. For the first time, researchers can use computer-generated data to test their hypotheses, whether they are interested in adverse drug reactions, the efficacy of a medical treatment, or other aspects of medical care.
Using Computers to Improve Patient Care
Founding physician Sidney Garfield, MD, always known for his vision, says it is time to figure out how to use computers in Kaiser Permanente. He dispatches Morris Collen, MD, with an undergraduate degree in electrical engineering, to the first national conference looking at computers and medicine. Upon his return, Collen is asked to create a program to explore the use of computers to create better medical methods and improve patient care.
In 1961, Collen becomes founding director of Medical Methods Research, later renamed the Division of Research.
In 1962, the Division of Research receives its first grant from the United States Public Health Service to automate the multiphasic exam. Three years later, the health plan's Oakland and San Francisco clinics begin offering automated multiphasic health testing to all members.
By the early 1960s, multiphasic exams have been underway for a decade and are the perfect test to see if an electronic medical record is possible. In the late 1960s, the Division's Edmund (Ted) van Brunt, MD, pilots a computer-based patient medical record system with a database that supports both patient care and health services research. Kaiser Permanente becomes one of a handful of places in the world to start this pioneering work. The multiphasic research team goes on to publish more than 500 papers in more than 75 research journals over 16 years.
Multiphasic Exams for All Members
In 1951, Morris F. Collen, MD, initiates what was a revolutionary concept for the times — the multiphasic screening exam.
Multiphasic exams began as a response to a post-war shortage of physicians and labor leader Harry Bridges' desire that all members of the Longshoremen's Union West be given annual check-up exams. Collen turns to Lester Breslow, MD, a young public health doctor who had published the results of an experiment named "multiphasic screening" that uses technicians and lab workers to do blood testing, chest X-rays, and other screening techniques. Following his lead, Collen is soon overseeing exams on 150 longshoremen a day in the Pier 18 union hall.
New Health Care Plan Partners With Research
Kaiser Permanente begins providing medical care during the Great Depression and World War II. As early as the August 1942 dedication of the Permanente Foundation Hospital in Oakland, California, industrialist Henry J. Kaiser announces that one of the key purposes of the Health Plan is "to provide funds for research."
Morris F. Collen, MD, a founder of Kaiser Permanente, publishes his first peer-reviewed article on aspirin's analgesic effects on pain in 1946.