Leveraging Genetic and Electronic Health Records Data to Identify Novel Targets and Drugs for Treating Alcohol Use Disorder
This pharmacoepidemiologic study conducted in collaboration with Dr. Joshua Gray at the Uniformed Services University of the Health Sciences will examine L-type calcium channel blockers (e.g., nifedipine, felodipine) as a potential novel therapeutic target for treatment of alcohol use disorder. Dr. Gray and others have shown that L-type calcium channels are genetically supported targets with theoretical and preclinical support for repurposing for treating alcohol use disorder. This study will use electronic health records data from Kaiser Permanente Northern California to examine whether patients treated with L-type calcium channel blockers have significantly greater reductions in alcohol use compared to a control group of patients.
Investigator: Sterling, Stacy
Funder: National Institute on Alcohol Abuse and Alcoholism
Evaluating delivery of a centralized LINKAGE telehealth modality to engage Addiction Medicine and Recovery Services patients across Northern California with their medical providers
This electronic-health records (EHR)-based data-only study will investigate whether virtual LINKAGE program implementation is feasible and effective at KPNC, and whether virtual LINKAGE can contribute to reducing disparities and stigma in healthcare for patients with substance use disorders (SUDs). The virtual version of the LINKAGE program is currently being implemented at Addiction Medicine and Recovery Services (AMRS) clinics across KPNC to engage patients with SUDs in their own health care. We will examine virtual LINKAGE implementation outcomes as well as compare health care engagement, health care utilization, and patient reported outcomes of current virtual LINKAGE participants to a 1:3 matched sample of eligible current non-LINKAGE participants, with the goal of determining the feasibility and effectiveness of the virtual LINKAGE program, its subjective effects on patients, and whether it has the potential to reduce disparities in health care in AMRS patients across communities in the region.
Investigator: Metz, Verena
Funder: Northern California Community Benefit Programs
Telehealth population care management by clinical pharmacists for patients with severe and persistent mental illness: Expanded assessment of clinical impact 2 years post-implementation
This study will evaluate a telehealth, clinical pharmacist-led population management program for adults with severe and persistent mental illness, which is being implemented in the Kaiser Permanente Northern California region. Through propensity score-weighted comparison with similar patients in non-program facilities, we will evaluate 2-year program outcomes including reduced risk for self-harm, improved metabolic health, and decreased high-resource medical utilization and health care costs.
Investigator: Iturralde, Estibaliz
Funder: TPMG Delivery Science Projects Program
Population Management of Post Bariatric Surgery Patients to Prevent Micronutrient Deficiencies
Bariatric surgery is the most effective long-term treatment for severe obesity. However, post-bariatric surgery patients develop vitamin malabsorption due to altered anatomy that can lead to micronutrient deficiencies. The overall goal of this study is to investigate whether the creation of a population management program specifically developed for patients who underwent bariatric surgery can improve achieving meaningful long-term compliance and postoperative outcomes. We hypothesize that population outreach significantly improves compliance in post-bariatric surgery patients, leading to a reduction in micronutrient deficiencies and associated complications.
Investigator: Choquet, Helene
Funder: TPMG Delivery Science Projects Program
Social Expression in the Treatment of Gender Dysphoria: Longitudinal Outcomes from a Novel Gender Expression Care Program
This study will measure the intermediate-term effectiveness of Gender Expression Care (GEC), and the variability in the components driving overall program effectiveness, among individuals who participate in the GEC workshop. Our hypothesis is that participation in GEC will be associated with improved confidence in social gender expression and quality of life. We anticipate that we will observe variability in effectiveness of the various GEC components, identifying opportunities for enhancing the overall effectiveness of the GEC program.
We will also conduct a qualitative study of 30 members who have completed the GEC program. We anticipate that focus group participants will provide nuanced information based on their lived experience to support correction of deficits and expansion of program strengths to improve outcomes for future GEC participants.
Investigator: Avins, Andrew
Funder: TPMG Delivery Science Projects Program
Modes of Cannabis Administration and Polysubstance Use among Women Before and During Pregnancy
Despite increasing rates of prenatal cannabis use, little is known about how women administer cannabis before and during pregnancy; various modes may be associated with different THC levels and exposures to other substances such as tobacco. This study expands on our collaboration with the Kaiser Permanente Early Start program to examine patterns and trends in modes of cannabis administration; how modes relate to socio-demographics, clinical characteristics, and polysubstance use; and how pre-pregnancy modes relate to risk of prenatal cannabis use.
Investigator: Young-Wolff, Kelly
Funder: National Institute on Drug Abuse
Clinically Actionable Pharmacogenetic Loci and Drug-Gene Combinations in the Multi-Ethnic KP Research Bank
This project will examine the new Kaiser Permanente Research Bank genomic data (N=300,000) on pharmacogenes, comparing results of genotyping with other sources of data, and to provide information about the prevalence of altered drug metabolization status in different ancestry groups, as well as data on the frequency of exposure to drug-gene combinations with potential clinical consequences of altered metabolization in the KP population. The results of this project will be useful to KP in considering the implications of pharmacogenetic testing, and also to researchers interested in using the data on pharmacogenes to better understand the health consequences of pharmacogenetic variation.
Investigator: Schaefer, Catherine
Funder: KP Research Bank
Computational Strategies to Tailor Existing Interventions for First Major Depressive Episodes to Inform and Test Personalized Interventions
The goal of this study is to develop a model examining clinical, genetic, and demographic factor relations to depression course/outcomes and treatment response, using Kaiser Permanente Northern California data and the Kaiser Permanente Research Bank to develop and apply predictive computational algorithms to inform and test interventions; prepare the model for clinical implementation using a human factors framework and stakeholder input; and translate probability thresholds into treatment recommendations.
Investigator: Erickson-Ridout, Kathryn
Funder: National Institute of Mental Health
Strategies to Tailor Existing Interventions for Depression During Pregnancy
The goal of this study is to develop a predictive model for antidepressant response and adherence in women experiencing depression during or in the year after pregnancy, and to bridge the implementation gap by identifying barriers and facilitators to model implementation in the health care system.
Investigator: Erickson-Ridout, Kathryn
Funder: TPMG Physician Researcher Program
Prioritizing diversity in polygenic risk prediction of primary open-angle glaucoma
Primary open-angle glaucoma (POAG) is a leading cause of irreversible vision loss, yet much of the genetic risk remains unaccounted for, especially in African-Americans, who have a higher risk for developing POAG. This proposal aims to bring together the largest African-descent glaucoma datasets in the world to identify novel POAG loci that may be specific to people of African descent through both genome-wide association studies and admixture mapping. We will also develop and test ancestry-specific polygenic risk scores in African-descent populations.
Investigator: Choquet, Helene
Funder: National Eye Institute
Diabetes Management in Addiction Medicine
Substance use disorder is a major risk factor for type 2 diabetes, diabetes complications, early diabetes-related mortality, and high use of costly medical care for individuals with diabetes. This study examines the clinical needs and potential care gaps that distinguish patients with comorbid diabetes and substance use disorder from those with one of these conditions alone.
Investigator: Iturralde, Estibaliz
Funder: KP National Office of Community Health
A Model to Predict Psychosis Risk from Electronic Health Records Using Natural Language Processing and Machine Learning
This study will apply sentiment analysis — a form of natural language processing — to electronic health records to create a risk score for psychosis among adolescent and young adult Kaiser Permanente members. The findings will be used to establish a foundation for technology-assisted identification of at-risk patients and to offer these patients information and resources to address psychotic symptoms.
Investigator: Hirschtritt, Matthew
Funder: Garfield Memorial Fund
Brain pathologies, reserve, and cognition in aging and dementia
This study is examining racial/ethnic group similarities and differences in brain mechanisms underlying cognitive reserve and functional reserve, and their life course determinants, by conducting secondary data analysis and harmonization of existing data from 4 ongoing longitudinal studies: Alzheimer’s Disease Center cohort at UCD, KHANDLE at DOR/UCD, STAR at DOR/UCD, and LA 90 at DOR/UCD. The combined data from these 4 studies will be used to examine MRI derived brain imaging variables associated with cognitive and functional decline; develop measures of functional reserve; examine potentially modifiable factors measured in mid-life that can build cognitive and functional reserve and promote cognitive health and functional independence.
Investigator: Gilsanz, Paola
Funder: National Institute on Aging
Role of Health Care in Addressing Unhealthy Alcohol Use and Disparities among Aging Women
The use of alcohol among older women, particularly binge drinking, has been steadily increasing in recent years, leaving them vulnerable to associated health conditions. This mixed methods study uses KPNC’s EHR based alcohol registry and screening data to examine unhealthy alcohol use, and disparities in use, in women over age 50. We will also examine patterns of health care utilization associated with select health conditions among older women with unhealthy alcohol use and conduct qualitative interviews with addiction medicine staff about the changing needs of older women with unhealthy alcohol use.
Investigator: Campbell, Cynthia
Funder: National Institute on Alcohol Abuse and Alcoholism
Virtual SBIRT for Pediatric Primary Care: Increasing Access to Screening, Brief Intervention and Referral to Treatment for Alcohol and Other Drug Use via Telehealth
This type I hybrid effectiveness-implementation pragmatic randomized clinical trial will examine how virtually-delivered Screening, Brief Intervention and Referral to Treatment (V-SBIRT) can be cost-effectively implemented in pediatric primary care to improve early identification and treatment for alcohol, other drug problems, and mood symptoms, among adolescents and compare its effectiveness with traditional SBIRT. KPNC pediatric primary care clinics will be randomized to Virtual-SBIRT vs. Traditional SBIRT modalities, and implementation and patient outcomes will be examined via electronic health record data.
Investigator: Sterling, Stacy
Funder: National Institute on Alcohol Abuse and Alcoholism
The Role of Genetic and Non-Genetic Factors and Causal Mechanisms Underlying Cataract Susceptibility For Risk Prediction
Cataract is a leading cause of blindness and a major cause of impaired vision worldwide. The overall objective of this study is to better understand the role of genetic and non-genetic factors and causal mechanisms underlying the etiology of cataract and develop a prediction tool to facilitate risk-stratified screening for cataract. This study has 3 major aims: 1) to evaluate whether glaucoma, myopic refractive error, diabetes, high blood pressure, high BMI, cigarette smoking, or alcohol consumption, and other non-genetic factors are causal risk factors of cataract; 2) to develop risk prediction models of cataract susceptibility based on genetic and non-genetic risk factors; and 3) to determine the function (in the lens tissue) of novel candidate genes prioritized within genetic loci associated with cataract.
Investigator: Choquet, Helene
Funder: National Eye Institute
2021 Smoking and COVID-19 Onset and Severity in a US Integrated Healthcare Delivery System
This study examines 1) whether cigarette smoking and nicotine vaping are associated with elevated risk for onset of COVID-19 infection and worse disease severity, and 2) whether risks associated with cigarette smoking and nicotine vaping are greater among health disparity populations and those with smoking-related chronic health conditions.
Investigator: Young-Wolff, Kelly
Funder: Tobacco-Related Disease Research Program
Naturalistic longitudinal examination of electroconvulsive therapy, transcranial magnetic stimulation, and intravenous ketamine for treatment-resistant depression in a large integrated healthcare system
This prospective observational study including 1,500 KPNC adult members with treatment-resistant depression will characterize factors related to selection of electroconvulsive therapy, transcranial magnetic stimulation, or ketamine; examine success rates and predictors of each treatment type; and examine inter-facility differences in referral patterns, treatment parameters, and outcomes.
Investigator: Iturralde, Estibaliz
Funder: TPMG Delivery Science Projects Program
Epidemiology of Age-related Dementia, Mild Cognitive Impairment and Brain Pathology in a Multiethnic Cohort of Oldest-Old
The Life After 90 Study (LA90) is a collaborative study between DOR, UC Davis, and UC Irvine following a diverse cohort of approximately 1,000 KPNC members age 90 and over to examine life course risk factors of cognitive decline and dementia risk. This study is evaluating differences in dementia incidence and rate of cognitive decline by race/ethnicity; evaluating how life course experiences are related to dementia incidence and cognitive decline; and examining life course factors associated with biomarkers from braining imaging and pathology. In 2022, we intend to begin to enroll an additional 500 KPNC members age 90 and over.
Investigator: Gilsanz, Paola
Funder: National Institute on Aging
2021 Health Equity Research Supplement to Conduct Focus Groups with Black and White Women who Self-Report Cannabis Use During Pregnancy
Qualitative data are critically needed to better understand knowledge gaps, preferences, and social and cultural factors that differentially contribute to prenatal cannabis use among Black and White women. To address these important gaps in knowledge, we will conduct race-matched virtual focus groups with Black and White pregnant women who self-report cannabis use during pregnancy to learn more about what drives prenatal cannabis use, women’s understanding of harms, and barriers to quitting to inform better education and intervention materials.
Investigator: Young-Wolff, Kelly
Funder: Kaiser Permanente Division of Research
Assessing the Impact of Cannabis Legalization on Adolescent Cannabis Use and Cannabis-Related Health Conditions
Recreational cannabis legalization (RCL) has high potential to lead to increases in adolescent cannabis use and related health conditions, but few studies have examined this question and results are mixed. Using data from adolescents in KPNC”s large integrated health care delivery system from 2015-2023, we aim to: 1) Test whether RCL in California in 2018 is associated with increases in rates of cannabis use and related health conditions, 2) Examine whether post-RCL changes in rates of cannabis use and related health conditions vary among demographic and clinical subgroups, and 3) Conduct interviews with addiction medicine clinicians to understand how RCL impacts adolescent cannabis use and treatment from the provider perspective.
Investigator: Young-Wolff, Kelly
Funder: National Institute on Drug Abuse
Optimizing Care to Prevent Diabetes and Promote Cardiovascular Health Among Younger Adults with Severe Mental Illness
This K23 career development project seeks to leverage electronic health record data from KPNC and 2 health system collaborators within the Mental Health Research Network to investigate population health management strategies to prevent diabetes and improve cardiovascular health among people with serious mental health conditions. Specific aims of this project are to: (1) develop a risk prediction tool using early-stage treatment data; (2) conduct a pre-implementation qualitative study with health system stakeholders; and (3) pilot-test a clinical decision tool based on findings from Aims 1 and 2. These specific aims are supported by a training plan focused on advanced predictive analytics and machine learning; qualitative methods in implementation science; and, pragmatic clinical trial design.
Investigator: Iturralde, Estibaliz
Funder: National Institute of Mental Health
Lifecourse health, cerebral pathology and ethnic disparities in dementia (KHANDLE Study)
The Kaiser Healthy Aging and Diverse Life Experiences (KHANDLE) Study, a collaborative study between DOR and UC Davis, follows a diverse cohort of Kaiser Permanente Northern California members who participated in at least one optional check-up (Multiphasic Health Checkups) during midlife. This study is evaluating differences in dementia incidence and rate of cognitive decline across racial/ethnic group and sexes. It uses over five decades of data to examine how early life experience, life course health, and genetics influence differences in cognitive decline and dementia by race/ethnicity and sex.
Investigator: Gilsanz, Paola
Funder: National Institute on Aging
Genetic and non-genetic factors affecting weight loss variability after bariatric surgery
Bariatric surgery is currently the most effective long-term treatment for severe obesity. However, inter-individual variability in surgery outcomes has been observed, particularly in relation to postoperative weight loss. This study aims to assess the contribution of genetic and non-genetic factors to such inter-individual variability by leveraging a large and ethnically diverse cohort with longitudinal electronic health record data. Study findings could help to develop predictive risk scores for outcomes of bariatric surgery based on genetic information along with other demographic and clinical factors. In future clinical practice, predictive risk scores could help patients be realistic about the outcomes of bariatric surgery and guide treatment strategies for patients with severe obesity.
Investigator: Choquet, Helene
Funder: Northern California Community Benefit Programs
Kaiser Permanente Northern California (KPNC) Alcohol Registry
This study will increase our understanding of the development of alcohol use disorders (AUD) and recovery from AUD, including factors that affect the likelihood of recovery success, such as quantity of alcohol consumed and the involvement of health and substance abuse comorbidities (NOT-AA-20-22) and treatment. The registry makes use of the annual Alcohol as a Vital Sign screening in primary care, and other health care data (e.g., demographics, comorbidities, pharmacy).
Investigator: Weisner, Constance
Funder: National Institute on Alcohol Abuse and Alcoholism
Embedded Mental Health Services Postdoctoral Research Training in Health Systems
This program, funded by a National Institute of Mental Health Institutional Research Training Grant (T32), has 2 Mental Health Research Network (MHRN) systems serving as postdoctoral training host sites: Henry Ford Health System (Michigan) and Kaiser Permanente Northern California. Each system recruits 2 new postdoctoral trainees per year. There are multiple mentorship opportunities from experienced local mentors at each host site, from the full network of MHRN investigators, and from an external advisory committee. The fellowship involves a combination virtual and on-site format, including 2 on-site sessions each year. The training program is interdisciplinary and expects to recruit PhD-level trainees from many disciplines, including psychology, epidemiology/public health, social work, medicine, nursing, economics, health services, economics, data science, and others.
Investigator: Sterling, Stacy
Funder: National Institute of Mental Health
Kaiser Permanente Northern California Alcohol Registry
The registry will increase understanding of the development of alcohol use disorders (AUD) and recovery from AUD, including factors that affect the likelihood of recovery success, such as quantity of alcohol consumed and the involvement of health and substance abuse comorbidities and treatment. The registry makes use of the annual Alcohol as a Vital Sign screening in primary care and other health care data such as demographics, comorbidities, and pharmacy records.
Investigator: Weisner, Constance
Funder: National Institute on Alcohol Abuse and Alcoholism
Improve Quality and Overall Health Outcomes Through Population Management to Treat Schizophrenia, Schizoaffective Disorder and Bipolar Disorder
This study aims to use population management to improve the quality and overall health outcomes of people with schizophrenia, schizoaffective disorder, and bipolar disorder.
Investigator: Iturralde, Estibaliz
Funder: TPMG Delivery Science Projects Program
Identifying Best Practices of Early Phase Pediatric Eating Disorder Care
This study examines associations between different degrees of adherence to components of the Family Based Therapy model of care for adolescent eating disorders and clinical quality outcomes among the outpatient programs in medical centers across Kaiser Permanente Northern California. We will also examine whether health disparities based on race/ethnicity exist in the outpatient treatment setting and explore system innovations and opportunities to address the needs of our patients from diverse backgrounds.
Investigator: Sterling, Stacy
Funder: TPMG Delivery Science Projects Program
Identification of genetic loci and pathways underlying hidradenitis suppurativa risk
Hidradenitis suppurativa (also named: acne inversa) is a chronic inflammatory skin condition that causes painful lumps to form under the skin usually in areas where skin rubs together such as in the armpits, groin, buttocks and under breasts. The overall scientific objective of this study is to identify and validate genetic factors associated with the risk of hidradenitis suppurativa, with the long-term goal of uncovering new therapeutic targets.
Investigator: Choquet, Helene
Funder: National Institute of Arthritis and Musculoskeletal and Skin Diseases
Implementation of Alcohol Screening and Brief Intervention in a Health System: Sustainability, Fidelity and Patient Outcomes, Covid-19 Supplement
This study examines the increase in alcohol consumption during the Covid-19 pandemic and the major shift to virtual treatment modalities for alcohol problems, with a focus on potential disparities in treatment access, by race, ethnicity, age and gender. Understanding potential inequities in access is critical to improving quality of care and outcomes for underserved populations.
Investigator: Sterling, Stacy
Funder: National Institute on Alcohol Abuse and Alcoholism
Buprenorphine Effect on Suicidal Behavior
Large observational study to evaluate the effects of initiating buprenorphine treatment on subsequent suicidal behavior among people with opioid use disorder.
Investigator: Campbell, Cynthia
Funder: National Institute of Mental Health
Alcohol-Related Care and HCV Treatment among Patients with Problematic Alcohol Use and HCV
This study will examine substance use treatment among patients with hepatitis C who have unhealthy alcohol use and how well they engage in appropriate and timely hepatitis C care. The findings will be used to conduct an intervention study aimed at improving engagement with substance use treatment and hepatitis C care in this population.
Investigator: Campbell, Cynthia
Funder: Northern California Community Benefit Programs
Statin Treatment and Incident Alzheimer’s Disease and Related Dementias in a Large, Multi-ethnic Health Plan
The study will assess the effects of statin treatment on risk of Alzheimer’s disease and related dementias, controlling for potential confounding and examining potential mediating factors among Kaiser Permanente Northern California members during the years 1996 to 2020. A second aim will examine the role of genetic factors in the association of statin treatment and dementia risk in a cohort of genotyped KPNC members.
Investigator: Schaefer, Catherine
Funder: National Institute on Aging
Addiction Telemedicine Consultation in Primary Care: Increasing Access to Pharmacotherapy and Specialty Treatment for Alcohol Problems
A cluster-randomized trial of Addiction Medicine consultation (AMC) for primary care physicians (PCPs) and patients examining the effectiveness of a telehealth AMC intervention on initiation of alcohol use treatment, anti-craving medication and/or specialty addiction treatment initiation, and on patient alcohol use outcomes.
Investigator: Sterling, Stacy
Funder: National Institute on Alcohol Abuse and Alcoholism
Smoking as a Risk Factor for COVID-19 Onset and Severity
This pilot study will use data from Kaiser Permanente Northern California electronic health records to examine whether current and former smokers are at elevated risk for COVID-19 infection and disease severity relative to never smokers. We will also look at whether any associations between smoking status and COVID-19 onset or severity are moderated by smoking-related chronic conditions or socio-demographic factors.
Investigator: Young-Wolff, Kelly
Funder: Tobacco-Related Disease Research Program
Impact of In Utero Marijuana Exposure on Neurodevelopment, Behavior and Mental Health: A Longitudinal Birth Cohort Study
This study will investigate whether maternal prenatal marijuana use increases the risk of impairments in a child’s executive functioning and mental health, after accounting for other factors such as tobacco, alcohol, and other drug use; socioeconomic status, and maternal mental health postpartum. We will look at both the independent effects of prenatal marijuana use and the synergistic effects of concomitant substance use as well as differential effects by infant sex.
Investigator: Avalos, Lyndsay; Young-Wolff, Kelly
Funder: National Institute on Drug Abuse
Glycemic Control and Dementia: The Role of Pharmacotherapy and Vascular Complications
About 25% of people over the age of 65 are living with diabetes, with 90% of them managing type 2 diabetes. Studies have shown that older individuals with type 2 diabetes have a 51-62% higher risk of dementia than those without type 2 diabetes. This study will investigate factors for dementia among Kaiser Permanente Northern California individuals with type 2 diabetes to determine which pattern of glycemic control reduces dementia risk, adjusting for factors such as diabetes treatment and comorbidities.
Investigator: Gilsanz, Paola
The Role of Genetic Risk Factors in Keratinocyte Carcinoma Susceptibility
The goal of this proposal is to identify genetic loci that affect the risk of keratinocyte carcinoma, examine how environmental risk factors influence genetic risk, and determine whether these loci act to influence the risk of basal cell carcinoma, squamous cell carcinoma, or both.
Investigator: Choquet, Helene; Asgari, Maryam
Funder: National Cancer Institute
Genetics at an Extreme: An Efficient Genomic Study of Individuals with Clinically Severe Major Depression Receiving ECT
This
study brings together investigators from around the world to carry out a
genetics study of severe major depressive disorder (MDD) treated with
electroconvulsive therapy (ECT). The National Network of Depression Centers
and allied centers in the U.S. will carry out a genetics study that will
enroll 25,000 patients receiving ECT for severe MDD. The centers will also
carry out a genome-wide association study comparing these 25,000 cases with
50,000 non-depressed and tightly matched previously collected controls. They
will also carry out a genome-wide association study of response to ECT in the
10,000 patients with prospective follow-up data. Analysis will consider changes in measures
of depression and cognitive function, test for genetic variances associated
with these responses, and examine prediction models.
Investigator: Schaefer, Catherine
Funder: National Institute of Mental Health
Mental Health Research Network III
The Mental Health Research Network (MHRN) is a consortium of 13 health system research centers, embedded in large and diverse healthcare systems, dedicated to improving patient mental health through research, practice, and policy; with expertise in mental health research as well as disciplines such as epidemiology, health services, economics, disparities, outcomes and quality assessment, and pragmatic clinical trials. MHRN is the nation’s preeminent source of population-based research on mental health, partnering with health systems that finance and provide care of a diverse population of over 12.5 million people in 15 states to: 1) Identify research questions that matter to patients, healthcare providers, and healthcare systems; 2) Efficiently answer those questions involving real-world patients and providers; and 3) Disseminate and implement research results.
Investigator: Sterling, Stacy
Funder: National Institute of Mental Health
Pragmatic Trial of Acupuncture for Chronic Low Back Pain in Older Adults
The
goal of this project is to conduct a three-arm parallel-group randomized
clinical trial of two acupuncture interventions vs. a usual-care control
group for change in low back pain symptoms among adults at least 65 years of
age.
Investigator: Avins, Andrew
Funder: National Center for Complementary and Integrative Health
Contributions of Educational Quality and Occupational Complexity on Racial and Ethnic Inequities in Brain Health and Alzheimer’s Disease and Related Dementia
This study utilizes a lifecourse approach to evaluate the roles of education quality and occupational complexity on dementia risk and cognitive decline and to examine if patterns of educational quality and occupational complexity across the lifecourse drive racial and ethnic disparities present in dementia and late-life brain health. This study leverages information from the Kaiser Healthy Aging and Diverse Life Experiences (KHANDLE) study, which follows a diverse group of long-term members of Kaiser Permanente Northern California to evaluate the role of lifecourse health on cognitive decline, dementia, and brain imaging markers.
Investigator: Gilsanz, Paola
Funder: National Institute on Aging
Effects of Medical Products on Suicidal Ideation and Behavior: Real World Evidence
This study will provide a comprehensive program of infrastructure development, methods development, and innovative research to generate real-world evidence addressing critical gaps in the regulation of medical products. We will explore four related issues: Potential for existing medical products to precipitate suicidal ideation and behavior; potential for existing medical products to reduce risk of suicidal behavior; potential for anticipated new medical products to reduce risk of suicidal behavior; and individual variation in liability to both adverse and therapeutic effects.
Investigator: Sterling, Stacy
Funder: U.S. Food and Drug Administration
Expanding the Scope and Reach of Adolescent Substance Use Early Intervention Research
This study explores the enduring impact of screening, brief intervention, and referral to treatment (SBIRT) delivered in pediatric primary care, on young adults. We will examine substance use, mental health and medical outcomes, and health services utilization and cost over 7 years in a sample of young adults who had access to SBIRT services as part of a pragmatic, randomized trial of adolescent SBIRT originally funded by the National Institute on Alcohol Abuse and Alcoholism. A separate aim of this project involves collecting and analyzing focus group data from parents and clinicians to develop compelling strategies and usable formats for disseminating findings a study which developed machine learning models to predict the development of adolescent substance-use disorders.
Investigator: Sterling, Stacy
Funder: Conrad N. Hilton Foundation
A Randomized, Double-Blind, Noninferiority Trial of Adductor Canal Catheters for Postoperative Pain Management among Patients Undergoing Elective Unilateral Total Knee Arthroplasty
A randomized, double-blind noninferiority trial of adductor canal catheters for postoperative pain management among patients undergoing elective, unilateral, total-knee arthroplasty.
Investigator: Avins, Andrew
Funder: The Permanente Medical Group
Implementation of Alcohol Screening and Brief Intervention in a Health System: Sustainability, Fidelity, and Patient Outcomes
Using a theory-driven conceptual framework, this multimethod study examines factors that facilitate or impede the successful implementation and long-term sustainability of screening, brief intervention, and referral to treatment (SBIRT) for risky alcohol use in real-world health care settings. This study will use electronic health record data, qualitative physician and staff interviews, and patient surveys, to examine: 1) What factors predict alcohol SBIRT facility- and clinician-level implementation outcomes (rates of alcohol use screening, brief intervention, follow-up screening and intervention, referral to addiction treatment, specialty alcohol treatment initiation, and SBIRT sustainability); 2) How facility- and clinician-level implementation outcomes affect patient drinking outcomes; and 3) How brief intervention fidelity and quality is related to patient drinking outcomes. Key policy implications include improving health plan structures that facilitate alcohol SBIRT implementation and SBIRT best practices and sustainability.
Investigator: Sterling, Stacy
Funder: National Institute on Alcohol Abuse and Alcoholism
Maternal Marijuana Use During Pregnancy, Marijuana Legalization, and Adverse Obstetrical and Neonatal Outcomes: A 12-year Cohort Study
The goal of this application is to examine the association between maternal marijuana use during pregnancy and adverse obstetrical and neonatal outcomes. We aim to: 1) Examine trends in prenatal marijuana use following the legalization of marijuana for recreational purposes in California; 2) Assess whether maternal marijuana use during pregnancy is associated with the risk of adverse maternal health and pregnancy outcomes; and 3) Assess whether maternal marijuana use during pregnancy is associated with the risk of adverse fetal and neonatal outcomes.
Investigator: Young-Wolff, Kelly; Avalos, Lyndsay
Funder: National Institute on Drug Abuse
Mentoring Alcohol-Use Intervention Research in Health Care Settings
This research will examine the relationship of alcohol use and depression over time using data based in the electronic health record (EHR), in the context of health care. We will conduct secondary analysis of depression and hazardous drinking patterns in an HIV-positive patient alcohol intervention trial sample (n = 614). We will also examine use of EHR tools and other factors associated with reduction in hazardous drinking over time (e.g., use of patient portals and secure messaging) in order to develop additional EHR-assisted alcohol interventions.
Investigator: Silverberg, Michael; Satre, Derek
Funder: National Institute on Alcohol Abuse and Alcoholism
ICLIC-MS for Enhancing Outcomes Research and Clinical Care in Multiple Sclerosis
The goal of this project is 1) to collect longitudinal measures of cognitive function, quality of life, and physical disability on a multi-ethnic sample of 3,000 individuals with multiple sclerosis (MS), using a web-based interface, Clinical and Longitudinal Information Collection for MS (ICLIC-MS); 2) to use these data in conjunction with already-collected data on genetic and environmental factors that affect risk of MS to better understand factors that influence progression of MS; and 3) to develop a report to provide information to treating neurologists about changes in cognitive function, quality of life, and physical disability that can be used to inform treatment of MS.
Investigator: Schaefer, Catherine
Funder: National Institute of Nursing Research
Investigating the Effects of KIR and HLA Gene Polymorphisms on Psoriasis
The goal of this project is to investigate the effects of genetic polymorphisms in the KIR and HLA genes on psoriasis and psoriatic arthritis.
Investigator: Jorgenson, Eric
Funder: University of California, Los Angeles
Evaluating the Impact of Changes in Opioid Prescribing Across Health Systems Implementing Zero Suicide
Henry Ford Health System, Kaiser Permanente Colorado, Kaiser Permanente Northern California, Kaiser Permanente Northwest, and Kaiser Permanente Southern California are implementing the National Zero Suicide Model (NZSM), and have received funding from the National Institute of Mental Health to evaluate fidelity and suicide outcomes. This presents a unique opportunity to study the NZSM within the context of large, diverse systems with defined patient populations, thus enabling measurement of suicide attempt and death outcomes. This mixed-methods project seeks to optimize metrics for measurement of specific care processes in each region using longitudinal electronic health records (EHRs) with discrete data fields that are easily extractable and generalizable to other systems. Parallel change in opioid prescribing across systems will be analyzed and its impact evaluated as a system-level means reduction approach within the context of NZSM implementation.
Investigator: Sterling, Stacy
Funder: National Institute of Mental Health
A Pragmatic Trial of Parent-Focused Prevention in Pediatric Primary Care: Implementation and Adolescent Health Outcomes in Three Health Systems
This study involves a partnership between Kaiser Permanente Northern California, Kaiser Permanente Colorado, Henry Ford Health System, and the University of Washington Social Development Research Group. The collaborators will conduct a pragmatic trial testing the feasibility and health impact of delivering an evidence-based, universal prevention program to parents of 11- and 12-year-olds in a pediatric primary care setting. Study objectives are to determine whether: 1) pediatric primary care clinics are a viable location for recruiting and engaging families in parent-focused prevention programs, 2) programs can be delivered with adequate fidelity, 3) stakeholders (parents, physicians and clinic staff, and program providers) are satisfied with the delivery of parent-focused prevention programs in pediatric primary care settings, and 4) program delivery is effective in preventing early initiation of substance use, depression and anxiety symptoms, delinquent behavior, and other risky behaviors common in adolescence.
Investigator: Sterling, Stacy
Funder: National Center for Complementary and Integrative Health
Optimizing a Scalable Intervention to Maximize Guideline-recommended Diabetes Testing after Gestational Diabetes Mellitus
Guideline-recommended postpartum screening is a critical step toward diabetes prevention after a diagnosis of gestational diabetes mellitus (GDM). However, patient uptake of postpartum screening remains suboptimal and uneven across racial/ethnic groups. This creates a missed opportunity for diabetes prevention or early treatment, particularly among minority women at highest risk. The goals of this project are to identify, refine, and assess the acceptability of individual components of a theory-driven outreach intervention that is feasible to implement in health system settings and designed to motivate racially/ethnically diverse women with GDM to complete postpartum screening. The results will inform future research aimed at equitably increasing screening uptake among diverse women at high risk for diabetes.
Investigator: Brown, Susan
Funder: Northern California Community Benefit Programs
Genetic Etiology of Abdominal Hernia Susceptibility
The objective of this project is to investigate the genetic mechanisms that drive the development of abdominal hernias. This study has three major aims: 1) to investigate the shared and individual genetic risks of different types of abdominal hernia, 2) to examine the genetic risk factors underlying recurrence of hernias in individual patients, and 3) to investigate the genetic pathways and biological mechanisms through which abdominal hernia risk loci act.
Investigator: Choquet, Helene
Funder: National Institute of Diabetes and Digestive and Kidney Diseases
Developing a Prescription Opioid Registry in Diverse Health Systems
Building on past research, this project will establish the infrastructure to expand a prescription opioid registry across diverse health systems in the Addiction Research Network. Harmonized electronic health record data elements will be used to examine how changes in opioid use are associated with other patient outcomes, such as emergency department service utilization, benzodiazepine use, and use of other non-opioid medications (e.g., nonsteroidal anti-inflammatory drugs [NSAIDs] and gabapentin), and how this may vary by patient characteristics and across health systems.
Investigator: Campbell, Cynthia
Funder: National Institute on Drug Abuse
A Prospective, Observational Study Designed to Quantify the Serious Risks of Misuse, Abuse and Addiction Associated with Long-Term Use of Opioid Analgesics for Management of Chronic Pain Among Patients Prescribed ER/LA Opioid Analgesics
The goal of this Food and Drug Administration-mandated study is to provide quantitative estimates of the serious risks of misuse, abuse, addiction, overdose, and death associated with long-term use of opioid analgesics for management of chronic pain, among patients prescribed extended-release and long-acting (ER/LA) opioid products. Patients will be recruited and interviewed across several health system sites.
Investigator: Campbell, Cynthia
Funder: Syneos Health
Antidepressant Use and the Risk of Primary Open Angle Glaucoma
The goal of this project is to address the following research question: Does the use of antidepressant treatment, specifically, selective serotonin reuptake inhibitors (SSRIs) and serotonin and norepinephrine reuptake inhibitors (SNRIs), reduce the risk of primary open angle glaucoma?
Investigator: Jorgenson, Eric
Funder: Northern California Community Benefit Programs
Impact of the Regional Opioid Safety Initiative on Patients and the Health System
Investigator: Campbell, Cynthia
Funder: The Permanente Medical Group
The Bipolar Sequencing Consortium for Combined Analyses and Follow-Up
The International Bipolar Sequencing Consortium brings together whole-genome and exome sequence data from multiple case-control and family studies of bipolar disorder for the purpose of investigating the genetic architecture of this condition. Data from multiple institutions and studies will be combined and harmonized to examine associations of genetic variation with bipolar disorder. De-identified exome sequence data from 483 individuals with bipolar disorder and 483 matched controls will be provided from the Multi-Ethnic Genome-wide Association Study of Bipolar Disorder at Kaiser Permanente Northern California, which will participate in analyses of the harmonized dataset from all study sites.
Investigator: Schaefer, Catherine
Funder: National Institute of Mental Health
Evaluation of a Clinical Quality Improvement Pilot of Adverse Childhood Experiences Screening and Brief Intervention in Pediatric Primary Care
This study will evaluate a quality improvement pilot project being conducted at pediatrics departments in the greater Kaiser Permanente Southern Alameda County area. The pilot project involves screening children at 1-to-5-year-old well child visits for adverse childhood experiences or trauma exposure and providing clinical follow-up and information and referral services for those who screen positive. This project aims to 1) evaluate the acceptability to clinicians of screening for adverse childhood experiences, 2) measure screening rates for adverse childhood experiences following the change in workflow, 3) evaluate the acceptability of such screening to parents, and 4) examine overall prevalence of adverse childhood experiences or trauma exposure among parents of patients receiving pediatric care. The study will test how demographic characteristics (race and ethnicity, age, gender, socio-economic status, insurance type) and clinical factors, including medical and psychiatric diagnoses, relate to prevalence and number of adverse childhood experiences and examine associations between such experiences and health and mental health comorbidities, as well as care services utilization.
Investigator: Sterling, Stacy
Funder: The Permanente Medical Group
Extension of the Consortium to improve OutcoMes in HIV/Aids, Alcohol, Aging & multi-Substance (COMpAAAS)
With support from the National Institute on Alcohol Abuse and Alcoholism, the Consortium to improve OutcoMes in HIV/Aids, Alcohol, Aging & multi-Substance (COMpAAAS) has analyzed data from patients in the Veterans Administration Cohort Study. This project seeks to extend this consortium to include Kaiser Permanente and the antiretroviral therapy cohort collaboration at the University of Bristol as new partners to increase sample diversity and representation of people living with HIV. The primary goals of the study are to evaluate the risk of alcohol and tobacco exposure on mortality, hospitalizations, comorbidities, and physiologic frailty for people living with HIV and matched HIV-uninfected controls. Each of the collaborating sites will share aims and study protocols, and will coordinate data management, statistical analysis, and reporting of results to increase sample size, include diverse populations, enhance comparability and generalizability, and maximize impact, as well as utilize resources efficiently.
Investigator: Silverberg, Michael; Satre, Derek
Funder: National Institute on Alcohol Abuse and Alcoholism
An Evaluation of the National Zero Suicide Model Across Learning Health Care Systems
This study seeks to develop metrics for evaluation of the Zero Suicide model across five integrated health care systems. These metrics will be used to investigate model fidelity and suicide behavior outcomes across sites. More specifically, this project aims to: 1) Collaborate with health system leaders to develop electronic health record metrics to measure specific quality improvement targets and care processes tailored to local National Zero Suicide Model implementation, 2) Examine the quality and fidelity of the specific National Zero Suicide Model care processes implemented in each system, and 3) Investigate suicide attempt and suicide mortality outcomes within and across systems.
Investigator: Sterling, Stacy
Funder: National Institute of Mental Health
Risk-Based Breast Cancer Screening and Surveillance in Community Settings
The major goal of this project is to maintain and expand the San Francisco Mammography Registry and to evaluate the performance of mammography in an ethnically diverse population.
Investigator: Avins, Andrew
Funder: National Cancer Institute
Population-Based Screening and Brief Intervention in Primary Care: Health and Drinking Outcomes, Cost and Utilization
In June 2013, Kaiser Permanente Northern California incorporated alcohol screening, brief intervention, and referral to treatment (SBIRT) into the clinical workflow of its Adult Medicine program, alongside other preventive health measures (e.g., smoking screening, exercise, cancer screening, etc.). SBIRT has demonstrated effectiveness in improving drinking outcomes among primary care patients. However, these patients frequently have comorbid conditions that also require management by primary care physicians. Beyond drinking outcomes, what if any additional beneficial health outcomes can be attributed to SBIRT for primary care patients who drink above recommended guidelines? Using population-level data, this observational, prospective cohort study will examine the effects of system-wide implementation of alcohol SBIRT in adult primary care within Kaiser Permanente Northern California, with a focus on health and drinking outcomes, as well as health care utilization and costs, over time.
Investigator: Sterling, Stacy
Funder: National Institute on Alcohol Abuse and Alcoholism
Recreational and Medical Use of Cannabis in a Time of Legalization and Changing Attitudes
This study will survey a sample of patients with pain about their use of medical marijuana. The goal is to describe patterns of use, mode, medical conditions, or symptoms for which medical marijuana is used, as well as perceived benefits, side effects, and patient experience of communication about its use with providers.
Investigator: Campbell, Cynthia
Funder: Northern California Community Benefit Programs
The Role of Refractive Error in the Etiology of Glaucoma
The specific aims of this study are to: 1) Determine whether refractive error predicts the development of glaucoma due to direct effects or shared etiology, or both, by conducting a series of genetic analyses of the two conditions; and 2) Determine the contribution of refractive error (myopia) and relevant biological pathways in the development of glaucomatous neurodegeneration.
Investigator: Choquet, Helene
Funder: National Eye Institute
Identifying Risk Factors for Prenatal Substance and Polysubstance Use
The overarching goal of this K01 study is to identify recent trends in prenatal substance use and develop data-driven, evidence-based, generalizable predictive models to identify women at greatest risk for continued substance use in pregnancy. Specifically, we aim to: 1) Comprehensively establish trends in prenatal substance and polysubstance use (2009-2017); 2) Develop predictive statistical models of clinical and demographic characteristics to identify women at greatest risk for continuing to use substances during pregnancy; and 3) Conduct qualitative interviews with women who quit vs. persisted in substance use during pregnancy.
Investigator: Young-Wolff, Kelly
Funder: National Institute on Drug Abuse
Cognitive Function and Physical Disability in White, Black and Hispanic MS Patients
Cognitive impairment, physical disability and progressive disease are common but understudied clinical outcomes that substantially impact quality of life for individuals with multiple sclerosis (MS). Systematic assessment of cognitive function, disability and progression is neither routinely performed, nor results captured electronically, for most MS patients undergoing medical care. To help address this gap, we have recently developed and validated a new guided, web-based interface (ICLIC-MS) for longitudinal data collection of MS-validated measures for these important outcomes and other symptoms. We will recruit and collect comprehensive data on cognitive function, physical disability and disease progression over three years from a multi-ethnic cohort of 600 individuals with confirmed MS or clinically isolated syndrome (CIS). The study will be nested in the Kaiser Permanente (KP) MS Research Program which is part of the KP Medical Care Program in the Northern California Region.
Investigator: Schaefer, Catherine
Funder: National Multiple Sclerosis Society
Primary Care-Based Interventions to Reduce Alcohol Use among HIV Patients
This randomized clinical trial uses a health plan’s electronic medical record (EMR) alcohol screen and examines innovative behavioral interventions and their cost effectiveness for hazardous drinking within a large HIV primary care clinic.
Investigator: Weisner, Constance
Funder: National Institute on Alcohol Abuse and Alcoholism
Supplement for Integrating Addiction Research in Health Systems: the Addiction Research Network
This study examines factors influencing performance measures of treatment initiation and engagement for alcohol and drugs across seven health care systems.
Investigator: Weisner, Constance
Funder: National Institute on Drug Abuse
Prescription Opioid Management in Chronic Pain Patients: A Patient-Centered Activation Intervention
This randomized trial of a patient activation approach to self-management is based in primary care and focuses on management of prescription opioids among patients with chronic pain.
Investigator: Weisner, Constance; Campbell, Cynthia
Funder: Patient-Centered Outcomes Research Institute
The Impact of Health Care Reform on Addiction and HIV Series
This study examines the impact of the Affordable Care Act (ACA) on substance use disorder (SUD) treatment, including SUD patients with HIV, in the context of a large health care delivery system
Investigator: Weisner, Constance
Funder: National Institute on Drug Abuse
Feasibility of Screening for Adverse Childhood Experiences (ACES) in a Prenatal Population
This study examines the feasibility and acceptability of adopting ACEs screening in two Kaiser Permanente Northern California women’s health clinics. Results of this patient- and clinician-focused study will inform the viability of implementing ACEs screening as part of usual prenatal care and can be used to develop improved screening protocols.
Investigator: Young-Wolff, Kelly
Funder: Northern California Community Benefit Programs
Detection, Treatment and Follow-up of Unrecognized Behavioral Health Problems in the Emergency Department
Behavioral health (BH) problems frequently exacerbate medical conditions of emergency department (ED) patients and contribute to ongoing suboptimal healthcare utilization. Because non-crisis BH problems are often undetected in the ED, we evaluate an innovative model of care that incorporates a BH resource person in the ED to address the BH concerns of non-critical ED patients. This evaluation study examines the feasibility and impact of this model of care on patients’ service utilization patterns in a before/after interventional study design. We characterize the types and scope of BH problems among all adult (18+ years old) patients with non-critical medical conditions presenting for care in the San Leandro Medical Center ED during a 16-month period (8 months pre-implementation of the BH resource person and 8 months post). Our research questions are: (1) To what extent does this model of care improve the detection, brief treatment, and follow-up of ED patients with non-crisis BH conditions? (2) What is its impact on ED patient flow as well as care team attitudes toward behavioral problems? We will use the electronic health record to characterize BH diagnoses and symptomatology among the non-critical ED population as well as to measure rates of specialty BH treatment (Psychiatry and Chemical Dependency) referral, initiation and engagement, ED and primary care utilization, and use of KPNC electronic resources, such as the patient portal. We also examine the feasibility of embedding a BH resource person in the ED.
Investigator: Sterling, Stacy
Funder: Northern California Community Benefit Programs
Video Consultation to Increase Integration of Primary Care and Addiction Medicine and Improve Alcohol-Related Health Outcomes
KPNC has been a leader in implementing alcohol SBIRT as part of routine primary care with its Alcohol as a Vital Sign initiative, which involves medical assistants (MAs) screening all patients in Adult Medicine and Family Practice for alcohol problems, and primary care providers (PCPs) delivering brief advice to patients who screen positive. However, brief primary-care interventions have been less successful at addressing the needs of patients with more severe alcohol problems. For this pilot study, we will utilize existing technologies to develop and pilot the use of KPNC secure video consultations by Addiction Medicine clinicians with patients and physicians in primary care. The team has already formed strong working relationships with key stakeholders in KPNC Primary Care, Addiction Medicine, and Information Technology.
Investigator: Sterling, Stacy
Funder: Garfield Memorial Fund
Early Vascular Contributions to Dementia Risk in African-Americans
This is a lifecourse study of vascular risk and brain aging in a well-characterized population of 1,200 elderly African-Americans that will close the gap in knowledge regarding midlife risk and protective factors for cognitive decline. The data collected, in conjunction with extensive electronic medical records spanning decades, will allow for a cost-effective, efficient approach for an observational study of cumulative vascular risk and brain aging. Our overall objective is to understand the magnitude of cognitive decline and long-term contributions of vascular disease on cognitive impairment and brain injury in African-Americans, an understudied and rapidly expanding segment of the elderly population.
Investigator: Whitmer, Rachel
Funder: National Institute on Aging
Replication of PheWAS for TRPV4 Variant in Kaiser Permanente GERA Cohort
We will use the RPGEH GERA cohort to investigate associations of genetic variation (SNP genotypes) with several related conditions, including congestive heart failure, chronic kidney disease, and possibly related phenotypes. Our first objective will be to replicate findings of association of a specific genetic variant with a number of phenotypes, including congestive heart failure, pulmonary edema, and kidney disease. We will utilize the same phenotype definitions as in the original analysis, based on algorithmic extraction of electronic medical record data. In parallel, we will pursue our second and third objectives, which focus on a more in-depth analysis of the role of genome-wide variation in congestive heart failure and kidney disease. This will involve the development of deep phenotypes for these conditions that utilize extensive characterization of these conditions using KPNC electronic records.
Investigator: Schaefer, Catherine
Funder: GlaxoSmithKline PLC
Development of Predictive Models for the Development of Adolescent Substance Use Problems
The objective of this study is to develop models to predict the development of substance use disorders (SUDs) among adolescents in four health systems: KPNC, KPHI, Henry Ford and Geisinger. We will focus on EHR data available during study period from birth cohorts with dates of birth occurring during 1997-2003 to examine the predictors of developing a SUD between the ages of 12-18. We will use the data infrastructure and resources of the Addiction Research Network of the HCSRNs VDW to develop predictive models for the development of adolescent SUDs. The four systems offer significant geographic, demographic, delivery design, and socioeconomic and epidemiological diversity, enhancing the generalizability of findings while also providing significant coverage of the national population. The goal is to identify high risk children for feasible, cost-effective, targeted prevention and intervention.
Investigator: Sterling, Stacy
Funder: Conrad N. Hilton Foundation
Carotid Revascularization and Medical Management for Asymptomatic Carotid Stenosis Trial (CREST-2)
Carotid revascularization for primary prevention of stroke (CREST-2) is two independent multi-center, randomized controlled trials of carotid revascularization and intensive medical management versus medical management alone in patients with asymptomatic high-grade carotid stenosis. One trial will randomize patients in a 1-to-1 ratio to endarterectomy versus no endarterectomy, and another will randomize patients in a 1-to-1 ratio to carotid stenting with embolic protection versus no stenting. Medical management will be uniform for all randomized treatment groups and will be centrally directed. The purpose of this trial is to determine the best way to prevent strokes in people who have a high amount of blockage of their carotid artery but no stroke symptoms related to that blockage.
Investigator: Nguyen-Huynh, Mai; Avins, Andrew; Chang, Robert
Funder: National Institute of Neurological Disorders and Stroke
PGRN Administration Coordination Hub
This is the Administrative Coordination Hub for the Pharmacogenomics Research Network (PGRN). The main areas of responsibility include meetings support, communications and coordination of nascent network collaborations.
Investigator: Jorgenson, Eric
Impact of Health Reform on Smoking and Treatment Utilization
The overall objective of this study is to examine how the implementation of landmark health care legislation has impacted the population of smokers in a private health care delivery system, their treatment utilization, and their smoking cessation outcomes over time. New insured smokers through Medicaid expansion and CA exchanges are likely to be a vulnerable group, with a higher prevalence of comorbidities, and unique barriers to utilization of tobacco treatment. The study is designed to test whether newly insured patients have a higher percentage of comorbidities and differential use of tobacco cessation counseling. Further, the study will test whether variation in benefit plan and coverage among post-ACA new member smokers differentially impacts tobacco cessation counseling utilization and smoking cessation outcomes longitudinally.
Investigator: Young-Wolff, Kelly
Funder: Tobacco-Related Disease Research Program
Lifecourse Health, Cerebral Pathology and Ethnic Disparities in Dementia
Although there are marked ethnic disparities in rates of dementia, almost nothing is known about early life contributors to dementia in ethnic minority groups, nor if the trajectory of cognitive decline or transition to cognitive impairment varies across ethnic groups. This lifecourse study of ethnic disparities in the epidemiology of dementia will use over five decades of data in relation to cognitive decline and brain pathology. The overall objectives are to define ethnic disparities in dementia incidence and to advance our understanding of such disparities by assessing early and midlife risk factors for cognitive impairment and MRI markers of brain injury.
Investigator: Whitmer, Rachel
Funder: National Institute on Aging
Genome-Wide Study of Hearing Impairment
More than 25% of individuals over age 65 and 50% of individuals over age 80 suffer from varying levels of age-related hearing impairment (AHRI), and adults are losing hearing at earlier ages than in the past. There is strong evidence that both genetic and environmental factors play a role in AHRI. This is a genome-wide association study that is orders of magnitude larger than previous studies in a cohort of 100,000 individuals nested in the Kaiser Research Program on Genes, Environment, and Health. This project provides an efficient and innovative opportunity to obtain a comprehensive understanding of how these genetic factors impact AHRI, which may help identify individuals at greater risk. Understanding the genetic factors will also lead to better understanding of the underlying biological mechanisms of AHRI, which may improve potential treatments.
Investigator: Schaefer, Catherine
Funder: University of California, San Francisco, Project Grant
An Evaluation of the KPNC Abdominal Aortic Aneurysm Screening Program
The objective of this study is to evaluate a new Northern California screening program for abdominal aortic aneurysm (AAA) in terms of its effect among relevant patients on their AAA-related outcomes of care and processes of care. Aneurysms of the infrarenal portion of the abdominal aorta are generally asypmptomatic until they rupture, an event that is usually fatal. Clinical trials have shown that, despite the risk associated with interventions, repair of the aneurysm results in a lower overall and cardiovascular mortality among male smokers, aged 65-75. KPNC will invite all members in this group to a one-time ultrasound screening appointment in a stepped fashion across all facilities. We will take advantage of this stepped program implementation to investigate the effect of an invitation to screening vs. the control membership awaiting screening; the primary outcomes are total mortality, AAA-related mortality and the need for emergent surgery for a ruptured AAA.
Investigator: Avins, Andrew
Funder: Center for Effectiveness and Safety Research
Mindfulness and Migraine: A Randomized Controlled Trial
The goal of this study is to conduct a randomized clinical trial of a mindfulness-based stress reduction intervention versus a usual care control for the prevention of recurrent migraine in adults.
Investigator: Avins, Andrew
Funder: National Center for Complementary and Alternative Medicine
Evaluation of SBIRT for Adolescents in School and Pediatric Health Settings
This study examines the effectiveness of a group intervention (“Teen MPower”) for adolescents with behavioral health problems at improving patient outcomes and increasing specialty behavioral health treatment access, and examining barriers to and facilitators of implementation. Behavioral health problems – depression, anxiety, stress and alcohol and drug use – are highly prevalent among adolescents, nationally and within KPNC. These problems are associated with costly utilization, cause significant distress and morbidity, and if left unaddressed, often require specialty psychiatric or chemical dependency treatment. This group intervention offers a potentially cost-effective alternative to individualized interventions. We use a randomized controlled trial design to implement two study arms, Teen MPower Groups and Individual Brief Intervention sessions. We assess patients at intake, immediately post-intervention, and at 6 months to collect patient outcomes (e.g. substance use, mood and anxiety symptoms, and related problems stressors). We use Health Connect data to compare specialty treatment engagement. We closely observe the implementation process to examine the factors which may facilitate or impede implementation. This study will take place in two settings: KP Oakland Pediatrics and high schools in Minnesota, and the two study components are conducted completely independently, aside from regular collaborative calls between the study teams. The study will compare effectiveness of different aspects of the model by site.
Investigator: Sterling, Stacy
Funder: Conrad N. Hilton Foundation
BioBank Northern California – Regional
The KP Research Bank aims to recruit 280,000 members (200,000 in the general cohort, 30,000 in the cancer cohort, and 50,000 in the pregnancy cohort) total across all regions, to increase the overall Biobank collection to 500,000 (410,000 in the general cohort, 30,000 in the cancer cohort, and 60,000 in the pregnancy cohort). Members will be consented to provide a biospecimen and complete a survey. Regions will participate in the recruitment and other Research Bank-related efforts, including scientific, strategic and operational.
Investigator: Schaefer, Catherine
Funder: Kaiser Foundation Research Institute
Implementation and Effectiveness of a Perioperative Smoking Cessation Program
This study assesses the implementation and effectiveness of a perioperative smoking cessation intervention integrated into usual care for patients who smoke who are scheduled for elective surgery. Results will inform the feasibility of a real-world intervention in day-to-day practice that could be easily implemented in most perioperative settings.
Investigator: Young-Wolff, Kelly
Funder: Northern California Community Benefit Programs
Predictors of Late-Life Cognitive Health in Type 1 Diabetes
There is evidence that middle aged-adults with Type 1 diabetes have deficits in cognitive function and are more likely to be diagnosed with depression . Although it is well established that elderly individuals with type 2 diabetes are at double the risk of cognitive impairment and dementia, it remains unknown whether elderly individuals with Type 1 diabetes are also at greater risk for accelerated cognitive aging. The goal of this study is to characterize the extent of cognitive decline in a cohort of elderly individuals with Type 1 diabetes. Aims will focus on examining the role of insulin, depression, and hyper/hypoglycemic events on cognitive decline.
Investigator: Whitmer, Rachel
Funder: National Institute on Aging
Buprenorphine and Substance Abuse Services for Prescription Opioid Dependence
This study is a randomized trial of adjunctive substance abuse services in combination with buprenorphine treatment for opioid abuse/dependence. We will examine treatment as usual vs. case management/telephonic support, and outcomes of medication compliance, substance use and psychiatric severity.
Investigator: Campbell, Cynthia; Constance Weisner
Funder: National Institute on Drug Abuse
The Impact of Health Care Reform on Addiction and HIV Services
To examine the impact of the ACA on treatment for individuals with drug use disorders and who are HIV+. We will examine how this population changes after 2014 enrollment, and subsequent substance abuse treatment and HIV treatment utilization. We will examine findings for different coverage groups, and explore organizational response to changes in this population. The study uses EMR data supplemented by qualitative interviews with patients and providers.
Investigator: Campbell, Cynthia
Funder: National Institute on Drug Abuse
A Pragmatic Trial of Lumbar Image Reporting with Epidemiology (LIRE2)
The goal of this investigation is to study the effect of providing descriptive epidemiologic information to primary care providers on lumbar spine imaging reports. A pilot study by this group found that including information about the prevalence of abnormal radiographic findings among normals on the radiology reports of lumbar spine imaging reduced health-care utilization and the prescription of opiods to patients with low back pain who had abnormalities on the lumbar spine imaging. This will be a multicenter study using cluster-randomization techniques.
Investigator: Avins, Andrew
Funder: National Center for Complementary and Alternative Medicine
