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Active Studies

Adult and Family Medicine

Impact of Regional Prescription Opioid Safety Initiative on Patients and the Health System (Q2’18 – Q2’20)

Principal Investigator: C Campbell
Co-Principal and Co-Investigators: A Rubinstein

The goal of this study is to understand how the KPNC Regional Opioid Safety Initiative has changed prescribed opioid use region-wide and how these changes impacted health services use, overdose and mortality, which will inform regional pain care and potential next steps for the initiative.

Outreach for Colorectal Cancer Screening in African Americans Ages 45-49 (Q1’18 – Q4’19)

Principal Investigator: T Levin
Co-Principal and Co-Investigators: N Chawla, M Landau, M Sanchez-Garcia

Guidelines recommend earlier colorectal cancer (CRC) screening for African Americans due to observed higher incidence of disease and earlier disease onset compared to whites. This study will evaluate acceptance and uptake of CRC screening through centralized fecal immunochemical test (FIT) kit mailings, completion of follow-up colonoscopy for FIT- positive patients and diagnostic yield compared to patients ages 50-54. Patient experiences and reasons for screening decisions will also be evaluated.

Electronic inbox management strategies and stress among primary care physicians (Q3’17 – Q2’19)

Principal Investigator: T Lieu
Co-Principal and Co-Investigators: J East, M Reed, M Ballesca, M Warton, S Prausnitz, A Montoya, L Emerso, G Mark

The use of electronic messaging has become a key mode of communication with physicians and their patients and other clinical staff with its use increasing in recent years and for the foreseeable future. This study will evaluate whether variability in physicians’ strategies for managing the electronic inbox is associated with multitasking and with stress and identify pragmatic interventions to reducing inbox-related distress based on the findings.

Assessment of Fracture Risk and Prevention Measures within KPNC (Q1’19 – Q4’20)

Principal Investigator: J Lo
Co-Principal and Co-Investigators: K Hamman, M Ramaswamy, R Hui

A systematic evaluation comparing the effectiveness the intervention approaches of the KPNC Osteoporosis Program and a high risk secondary fracture prevention to assess gaps in care and identification of factors associated with bisphosphonate initiation and optimal adherence are critical for informing implementation targets in the future.

Cardiology

THRIVE (The Heart failure Readmission Intervention by Variable Early followup) Study (Q1’17- Q4 ’18)

Principal Investigators: A Go, K Lee

This study will evaluate regional practice patterns and variation for Myocardial Perfusion Imaging (MPI), coronary CT angiography (CTA) and Stress Echo (SE) in adults with suspected coronary heart disease.

Variation and Barriers in Cardiac Imaging Tests for Suspected Coronary Heart Disease in KPNC (Q1’18 – Q4’19)

Principal Investigator: J Rana
Co-Principal and Co-Investigator: A Go

This study is a pragmatic randomized trial to definitively determine the effectiveness of telephone follow-up compared to clinic follow- up in adults after heart failure hospitalizations.

Optimizing Management and Outcomes for Patients with Valvular Heart Disease (Q1’18- Q4’20) Physician Researcher Program project Physician Researcher Program project

Principal Investigator: M Solomon
Co-Investigator: A Go

The goal of this study is to evaluate practice patterns and clinical outcomes based on surveillance patterns of patients with moderate to severe valve disease.

Dermatology

Comparative effectiveness of teledermatology to diagnose rash (Q1’19- Q4’20)

Principal Investigator: L Herrinton
Co-Principal: S Marwaha

This study will research the difference in care quality and efficiency across teledermatology modalities to diagnose rashes.

Emergency Medicine

KP-specific Cardiac History and Risk Summaries: Standardizing Emergency Work-ups Around Risk Data (STEWARD) Chest Pain Project - Phase 1 (Q3’16 - Q4’17)

Principal Investigator: M Reed
Co-Principal and Co-Investigators: D Mark, U Chettipally, D Vinson, D Ballard, M Kene

This study examines KPNC ED chest pain care and outcomes to determine KPNC-specific risk estimates among patients with chest pain presenting to KPNC EDs. It will: 1) examine the performance of existing externally-developed risk stratification tools and while deriving KPNC-specific risk estimates, and 2) validate data elements for a patient cardiac history summary and mockup of a web- based shared decision aid.

Improving stroke prevention for high-risk Afib by discharge redesign using electronic clinical decision support (Q3’17 - Q2’19) Physician Researcher Program project Physician Researcher Program project

Principal Investigator: D Vinson
Co-Investigators: M Reed, D Mark, D Ballard, U Chettipally, B Kea, A Elms, A Go

The management of anticoagulation-naïve patients presenting to the Emergency Department with atrial fibrillation or flutter will be the basis for the development and evaluation of a clinical decision support system and physician education program.

Improving Risk Stratification of E.D. Patients with Acute Heart Failure: External Validation of the STRATIFY Tool (Q3’18 - Q2’20)

Principal Investigator: D Sax
Co-Principal and Co-Investigators: M Reed, CREST Network

This study will conduct a retrospective cohort study of patients presenting to KPNC Emergency Department between 2015-2017 with acute heart failure to test two clinical decision tools and determine KPNC-specific risk estimates for a 30 day serious adverse event.

KP-specific cardiac history and risk summaries: Standardizing Emergency Work-ups Around Risk Data (STEWARD) Chest Pain Project – Phase 3 (Q1’19-Q4’20)

Principal Investigators: D Mark, M Reed
Co-Investigators: D Ballard, H Dinh, C Karadi, M Kene, D Sax, D Vinson

This project will examine the impact of the KP-specific emergency department electronic clinical decision support tool for acute chest pain on short-term health care delivery and patient outcome measures.

Gastroenterology

Optimization of diagnosis, surveillance of colonic sessile serrated adenomas (Q1’18-Q4’19) Physician Researcher Program project

Principal Investigator: D Li

Approximately 20-30% of colorectal cancer cases develop from serrated polyps, particularly Sessile serrated adenoma (SSA). This study will measure the variation in the rate of SSA detection among pathologists and diagnosis among gastroenterologists and provide evidence for formulating plans to monitor and improve the quality of SSA diagnosis

Gyn-oncology

Surgical Referral and Outcomes of Standardized Ultrasound Reporting of Adnexal Masses (Q1’18 - Q4’20) Physician Researcher Program project

Co-Investigator: L Herrinton

Within KPNC, there are approximately 26,000 pelvic ultrasounds annually that report an adnexal mass. This study will look at how to maximize detection of malignancy while minimizing unnecessary surgery and potentially low-value follow-up exams.

Hospital Medicine

VentViz: Empowering Clinicians to Optimize Mechanical Ventilation and ARDS Care Through Data Visualization (Q3’16 – Q2’18)

Principal Investigator: V Liu
Co-Principal and Co-Investigators: G Escobar, G Marelich

Acute respiratory distress syndrome (ARDS) is a rapidly progressive disease of the lungs that manifests with low blood oxygen levels and, ultimately, respiratory failure. To address gaps in ARDS care, this study will to develop a ventilator/ARDS data visualization tool that empowers clinicians to improve their care for ventilated patients

Infectious Diseases

Effectiveness and Safety of Interferon-free Treatment for Hepatitis C Virus (HCV) Infection in a Clinical Practice Setting (Q4’16 - Q3’18)

Principal Investigators: M Silverberg
Co-Principal and Co-Investigators: J Marcus, C Quesenberry, D Witt, J Lai, M Pauly, J Ready, S Seo, D Kom, J Champsi

Based on one of the largest cohorts of HCV patients treated with interferon-free regimens in routine clinical practice, the study will identify the demographic and clinical predictors of treatment failure and serious adverse events during treatment and evaluate long- term outcomes to inform ongoing screening approaches for hepatocellular carcinoma and extrahepatic outcomes, such as chronic kidney disease, after achieving HCV cure.

Neurology

Assessing Door-to-Needle Times and Outcomes of Stroke Patients Receiving Acute Thrombolysis Therapy (Q4’17 – Q3’19)

Principal Investigators: M Nguyen-Hunh
Co-Principal and Co-Investigators: J Klingman, A Flint

KPNC has implemented Stroke EXPRESS which virtually connects centralized stroke expert neurologists with patients and stroke-trained neurologists via secure video link to improve treatment time. This study will determine if there is an association between door-to-needle (DTN) times of acute stroke patients receiving IV thrombolysis and mortality at 90-day posttreatment, pre and post implementation of Stroke EXPRESS. The study will also evaluate DTN time and 90-day functional outcomes as part of Stroke EXPRESS care.

Ob/Gyn

Effects of Prenatal Screening Biochemical Analyte Levels on Pregnancy Outcome (Q4’16 - Q3’18)

Principal Investigator: E Gunderson
Co-Principal and Co-Investigators: C Quesenberry, J Collingham, L Manace-Brenman, C Norem, J Turocy, D Walton

This project addresses the following research question: Does increased antenatal monitoring of pregnancies with abnormal prenatal analyte screening levels improve or alter perinatal outcomes?

Glyburide vs. Insulin for the Treatment of Women with Gestational Diabetes in KPNC (Q3’17 – Q2’19)

Principal Investigator: M Hedderson
Co-Principal and Co-Investigators: R Neugebauer, Y Crites, A Regenstein

Gestational diabetes mellitus (GDM) is one of the most common pregnancy complications and women with GDM are at increased risk for several perinatal complications. If diet therapy doesn’t lead to glycemic control then medication is initiated. This research will use a cohort study design of women with GDM from 2007-2016 to compare the effectiveness and safety of glyburide and insulin at improving neonatal and maternal outcomes.

Timing of Adverse Events with Inpatient Misoprostol for Cervical Ripening: Implications for Outpatient Use (Q1’18 – Q4’18) Rapid Analysis Program project

Principal Investigator: V Mohta

Within KPNC, approximately 4,000 women annually receive misoprostol for cervical ripening at the beginning of their inpatient induction of labor. This project will study inpatient data to establish the safety of an outpatient protocol for induction of labor with misoprostol.

Oncology

Evaluation of the Effectiveness and Implementation of Regionalized Care of Testicular Cancer (Q1’18 – Q4’19)

Principal Investigator: L Herrinton
Co-Principal and Co-Investigators: A Harzstark

Testicular Cancer Redesign is one of the first of several rare diseases to test and implement an analytic/visualization workflow to enable population management and regional specialization of testicular cancer care. This study will evaluate the effectiveness of Redesign on rates of use guideline-adherent utilization. Factors that contributed to the success and those that posed barriers to adoption and maintenance of Testicular Cancer Redesign will also be evaluated.

A Pilot Pragmatic Trial of mHealth Mindfulness Intervention to Improve Quality of Life among Metastatic Cancer Patients and their Caregivers (Q1’18 – Q4’19)

Principal Investigator: A Kubo
Co-Principal and Co-Investigators: T Kolevska, Y Li, A Avins, M Reed, C Quesenberry,

The objectives of the study are to assess acceptability, feasibility and efficacy of incorporating a mindfulness app intervention as part of palliative care. Preliminary efficacy of the intervention based on patient reported outcomes and health care utilization will be evaluated along with qualitative feedback on the intervention from patients, clinicians and caregivers.

PRISM (Q3’17 – Q2’19)

Principal Investigator: T Lieu
Co-Principal and Co-Investigators: D Baer, L Herrinton, D Buzkov, D Ng, S Prausnitz, L Liu, R Neugebauer, S Van Den Eeden

This study will extend the Cancer Wizard tool to generate prognostic information for pancreatic cancer. The Cancer Wizard generates individualized prognostic information based on a cancer patient’s diagnosis, stage, age, sex and other factors. The study will also create and test learning tools to help oncologists interpret the information and conduct a pilot study on the effects of Cancer Wizard on oncologists’ workflow and satisfaction.

Evaluating Outcomes and Efficiency of Consolidated Multidisciplinary Care for Head and Neck Cancer (Q1’19 – Q4’20)

Principal Investigator: C Meltzer
Co-Principal Investigators: N Nguyen, L Sakoda

Evaluate the impact of the consolidated multidisciplinary care program for head and neck cancers on better health outcomes and efficiency gains.

Genetic testing of women with hereditary breast and ovarian cancer syndrome (Q1’19-Q4’20)

Principal Investigator: B Powell
Co-Principal Investigator: L Kushi

This study will identify the gaps in appropriate utilization of multi-gene panel testing to identify women at increased inherited breast and ovarian cancer risk and provide guideline concordant management.

Pilot Study of the Ascertainment of Physical Function in Pancreatic Cancer Patients using Patient Reported Outcome and Clinician Reported Outcome Measures with an Electronic Medical Record (Q1’18 – Q4’19)

Principal Investigators: S Van Den Eeden
Co-Principal and Co-Investigators: P Srivastava

This pilot study will assess the optimal ways to incorporate the collection of patient reported outcomes (PRO) and clinical reported outcomes (CRO) into an electronic medical record (EMR). A prospective clinical series of patients with newly diagnosed metastatic pancreatic cancer and the primary oncologists will be queried on physical function status. The study will describe the relationship between PRO and CRO physical function score change and other clinical events captured in the EMR related to escalation of treatment and care.

Pediatrics

Evaluation of pilot programs of screening for adverse childhood experiences (ACE) in pediatric primary care (Q1’18–Q4’19)

Principal Investigator: P Espinas
Co-Principal Investigator: S Sterling

This study will examine the feasibility and acceptability of the ACE screening and intervention protocol, prevalence of a history of ACE exposure, severity and patient characteristics of those that screen positive.

Urology

Development of the KP Prostate Cancer Risk Calculator (Q3’17- Q3’20) Physician Researcher Program project

Principal Investigator: J Presti
Co-Investigator: A Avins

This study will develop a calculator to estimate risk of any prostate cancer, high-grade cancer or indolent cancer.

Surgery – Vascular

Current Outcomes and Management of Asymptomatic Carotid Stenosis (Q4’17- Q4’20) Physician Researcher Program project

Principal Investigator: R Chang
Co-Investigators: M Nguyen-Huynh, H Hua, B Hill, R Faruqi, J Klingman, A Avins

A retrospective cohort study that focuses on the comparative effectiveness of carotid endarterectomy surgery vs medical therapy for stroke risk reduction in patients with severe asymptomatic carotid stenosis and perioperative complication rates and long-term outcomes following surgery.