Richard W. Grant, MD, MPH

People

Kaiser Permanente Division of Research
2000 Broadway
Oakland, CA 94612

(510) 891-5993 (phone)
richard.w.grant@kp.org
Kaiser Permanente Researcher Profiles

Richard W. Grant, MD, MPH, is a research scientist at the Division of Research, Kaiser Permanente Northern California. Dr. Grant is a board-certified primary care physician. He received his medical degree from University of California, San Francisco, completed his medical residency training at Massachusetts General Hospital, and received his MPH from the Harvard School of Public Health. His research focuses on identifying and overcoming barriers to effective primary care in patients with complex diseases. He has a special interest in type 2 diabetes and related chronic conditions. Dr. Grant has published over 120 peer-reviewed scientific papers and is an Associate Editor for JAMA Internal Medicine. He is the past chair of the American Diabetes Association's Profession Practice Committee and has served on the editorial board for Diabetes Care.

Current Position(s):

Research Scientist III, Division of Research, Kaiser Permanente Northern California
Director, Delivery Science Fellowship Program
Co-Director, T32 Diabetes Fellowship
Physician, Urgent Care, Kaiser Permanente Medical Center, Oakland, CA

Section Affiliations:

Health Care Delivery and Policy

Primary Research Interests:

Type 2 diabetes and pre-diabetes
Primary care redesign
Health information technology
Clinical application of genomic data

Related Website(s):

http://profiles.ucsf.edu/richard.grant

Studies

Clinical Trial of Expanded Advance Care Planning to Address Regimen Intensity in Older Patients at High Risk for Treatment-Induced Hypoglycemia

The goal of this study is to apply the patient-centered advance care planning paradigm of values elicitation and decision-making and communication preparation to hypoglycemia-related adverse outcomes in vulnerable older patients with type 2 diabetes. This will involve a randomized clinical trial comparing a web-based diabetes-specific advanced care planning tool vs. usual care among patients 75 years and older at increased risk for hypoglycemic events.
Investigator: Grant, Richard
Funder: National Institute on Aging

Prevalence of Social Risks and Association of Social Risks with Health and Well-Being Among Non-Safety Net Middle-Aged and Older Adult Members in Kaiser Permanente Northern California

This study will gather data to estimate the prevalence of several different social and financial risk factors among adults aged 35-84 and assess whether risk factor prevalence significantly differs across age, race, health status, and income groups.
Investigator: Grant, Richard; Gordon, Nancy
Funder: Northern California Community Benefit Programs

Impact of the COVID Pandemic on KP Members with Complex Medical and Social Needs

The COVID epidemic has exposed the fragility of the social network that supports our most complex and vulnerable members. We have established an interdisciplinary team of researchers, clinicians, and operational leaders at KPNC, KPCO, KPWA to study socially determined barriers to care among adult members with complex medical & social needs. Among these patients, we propose to: 1) examine the role of self-reported barriers (e.g. financial need, housing instability, social isolation, frailty) on risk of COVID infection; 2) among COVID infected patients, examine the role of these barriers on disease severity; 3) examine the impact of social distancing & KP care re-organization on chronic medical & mental health care, and 4) re-contact previously interviewed complex patients to investigate in the impact of social distancing & KP care re-organization on their health and care. Results will help inform new care strategies for our most vulnerable members with complex medical and social needs.
Investigator: Grant, Richard
Funder: Garfield Memorial Fund

Reducing Treatment Risk in Older Patients with Diabetes: Comparative Effectiveness of Academic Detailing with and without Pre-Visit Patient Preparation

This pragmatic, randomized clinical trial will compare the effect of primary care physician academic detailing with or without patient pre-visit preparation on insulin de-prescribing rates among older patients with type 2 diabetes at high risk for insulin-related hypoglycemia. We will also examine changes in patient-reported diabetes distress, decisional confidence, and perceived quality of care. In a subset of visits from both study arms, we will also compare the content and quality of patient-provider conversations through analysis of visit audio-recordings.
Investigator: Grant, Richard
Funder: Patient-Centered Outcomes Research Institute

Complex Patients: DOR Research Team

My team has been working collaboration with The Permanente Medical Group and Kaiser Foundation Health Plan to implement and evaluate care models to improve health outcomes of medically and socially complex patients. We are currently conducting a rapid cycle randmomized clinical trial to evaluate MYQOL, a new care management program developed at KP Central Valley designed to reduce hospital and emergency department readmissions among complex patients. These efforts will help guide TPMG and KFHP plans to improve the care of complex patients.
Investigator: Grant, Richard
Funder: Kaiser Foundation Health Plan

Care System Analytics to Support Primary Care Patients with Complex Medical and Social Needs

This study will leverage the rich electronic data sources within Kaiser Permanente to create pragmatic tools for improving health and equity among primary care patients with the highest medical and social needs. Aim 1: Use advanced analytic methods to predict actionable nonmedical barriers to care experienced by patients with multiple chronic conditions; Aim 2: Implement a dashboard linked to the electronic health record that will enable care providers to sort and manage registries of patients with multiple chronic conditions; and Aim 3: Pilot the use and implementation of this dashboard tool in 3 geographically distinct, high-need communities served by three Kaiser Permanente regions (Northern California, Washington, Colorado).
Investigator: Grant, Richard
Funder: Agency for Healthcare Research and Quality

CORAL Meaningful Outcomes & Missed Opportunities

A relatively small proportion of patients with complex needs represent a major source of cost and utilization. The fundamental principle that distinguishes complex needs patients from other high-cost patients with well-defined medical issues is that "complex needs" is a highly heterogeneous category with poorly defined inclusion criteria and treatment goals. To move this field forward, this 18-month, inter-regional research project aims to better define actionable subgroups of patients with complex care needs. A generalizable typology of distinct subgroups of patients with complex care needs will be created using clinical and patient-reported data and care outcomes across three Kaiser Permanente delivery systems (Kaiser Permanente Northern California, Kaiser Permanente of Colorado, and Kaiser Permanente Washington). Important unmet care needs will be identified for patients within each of the main subgroups, and a novel set of meaningful outcomes that reflect complex patients’ clinical and personal needs will be elicited using interviews and focused chart reviews.
Investigator: Grant, Richard
Funder: Garfield Memorial Fund

T32 Training Program in Diabetes Translational Research

Diabetes remains a leading cause of morbidity and mortality, and it is a significant burden to the U.S. health care system, patients, and their families. The knowledge and skills necessary to overcome the final translational block from evidence into practice require unique training in the area of delivery science, which includes health services research, translational research, and dissemination and implementation methods. To meet this need, the Kaiser Permanente Northern California Division of Research has created the Diabetes Delivery Science Training Program. This new program will directly address the need to augment the current research workforce by focusing on the skills needed to identify and overcome barriers to effective diabetes care within existing large-scale health care delivery systems. Two post-doctoral scientists will be enrolled per year for a two-year training program.
Investigator: Grant, Richard; Schmittdiel, Julie
Funder: National Institute of Diabetes and Digestive and Kidney Diseases

Supplement to T32 Training Program in Diabetes Translational Research

This administrative supplement solicited by the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) will provide two to six medical students with summer training opportunities in translational research. This supplement allows the existing T32 program based at the Kaiser Permanente Northern California Division of Research to host students who are participating in a broader NIDDK-administered program for introducing medical students to research in diabetes and diabetes prevention.
Investigator: Grant, Richard; Schmittdiel, Julie
Funder: National Institute of Diabetes and Digestive and Kidney Diseases

Pre-Visit Prioritization for Complex Primary Care Patients with Diabetes

Patients with type 2 diabetes are increasingly living with multiple concurrent conditions and complicated medical regimens. For these patients, diabetes management decisions and treatment goals must be addressed within the larger context of other competing health concerns. In parallel, clinical advances have led to a substantial increase in the number of tasks that primary care providers must perform during each visit. These twin trends present a formidable challenge to effective diabetes primary care. This study addresses the hypothesis that among complex patients not meeting diabetes management goals, an approach to help patients explicitly prioritize all health issues (both related and unrelated to diabetes) prior to each primary care visit will result in more effective diabetes management over time. To test this hypothesis, the project will involve design, implementation, and evaluation of a web-based tool linked to electronic health records that will enable complex patients to easily define care priorities from an inclusive list.
Investigator: Grant, Richard
Funder: National Institute of Diabetes and Digestive and Kidney Diseases

CTSI Institutional Career Development Core

The Clinical and Translational Science Institute (CTSI) facilitates the rapid translation of research to improvements in patient and community health. It is a cross-school, campus-wide institute with scientist leaders at its helm. To achieve its goals, CTSI provides infrastructure, services and training to support clinical and translational research. To advance its mission, it develops broad coalitions and partnerships at the local and national levels to enable a transformation of the research environment.
Investigator: Grant, Richard
Funder: National Center for Advancing Translational Sciences

Mentored Research to Improve Care for Complex Patients With Diabetes

K24 Midcareer Investigator Awards in Patient-Oriented Research are designed to support established scientists with a track record of mentoring to devote time to research mentorship for junior investigators. The overarching goal of this K24 award is to develop innovative approaches to improving the care of complex patients with type 2 diabetes, including the growing number of Latinos with diabetes, by developing new care models and innovative tools to support patients and providers in achieving more effective diabetes primary care. Specific research aims are to: 1) Examine the relationship between patient visit priorities and PCP care plans; 2) Adapt pre-visit prioritization for Low-English-Proficiency and Spanish-speaking Latinos; and 3) Learn how to effectively implement alternative health IT platforms such as smart phones, interactive voice response, and other novel modalities for pre-visit prioritization. The project will provide ample mentored research opportunities for highly promising mentees with an interest and passion for patient-oriented research to improve the care of patients with type 2 diabetes.
Investigator: Grant, Richard
Funder: National Institute of Diabetes and Digestive and Kidney Diseases

Multi-Component Behavioral Intervention for Complex Patients with CVD Risk

Disease management programs have had success in CVD risk factor control among uncomplicated patients but often fall short in more complex patients. New approaches are needed to address the multiple barriers faced by CVD patients with complex medical and behavioral comorbidity. We propose to develop and implement a multi-component intervention that includes patient activation, patient engagement, broad brush screening for undiagnosed behavioral health conditions, and creation of personal care plans tailored to each individuals unique set of barriers, motivators, and clinical goals. By focusing on core health skills and cross-cutting barriers to care in high risk patients not meeting clinical treatment goals, we are designing this intervention to be widely generalizable to all patients with multiple complex chronic conditions. We will conduct a randomized clinical trial of the intervention vs. usual care to examine effectiveness on proximal outcomes and CVD risk factor control.
Investigator: Grant, Richard
Funder: National Heart, Lung, and Blood Institute

Aligning the Visit Priorities of Complex Patients and their Primary Care Providers

The primary care visit is a key opportunity for catalyzing changes in care for complex patients with multiple heath issues. With too many items to address in the time allotted, however, the decision of which items to focus on requires prioritization. Prior studies have shown that: 1) patients and providers often have discordant priorities, 2) this discordance is associated with less effective care (e.g., poor adherence, lack of medication intensification), and, conversely, 3) collaborative interactions with informed, activated patients and prepared providers lead to better clinical outcomes. We hypothesize that a systematic approach that enables patients and providers to align visit priorities will result in more effective, patient-centered care because explicitly negotiated management decisions that address both patient and provider priorities are more likely to be adopted. This project will include focus groups and a pilot clinical trial examining impact on patient-centered outcomes.
Investigator: Grant, Richard
Funder: Patient-Centered Outcomes Research Institute

Highlighted Publications

Use of Latent Class Analysis and k-Means Clustering to Identify Complex Patient Profiles

Author(s): Grant RW; McCloskey J; Hatfield M; Uratsu C; Ralston JD; Bayliss E; Kennedy CJ

JAMA Netw Open. 2020 Dec 01;3(12):e2029068. Epub 2020-12-01.

Current Position(s):

Section Affiliations:

Primary Research Interests:

Related Website(s):

Studies

Clinical Trial of Expanded Advance Care Planning to Address Regimen Intensity in Older Patients at High Risk for Treatment-Induced Hypoglycemia

Prevalence of Social Risks and Association of Social Risks with Health and Well-Being Among Non-Safety Net Middle-Aged and Older Adult Members in Kaiser Permanente Northern California

Impact of the COVID Pandemic on KP Members with Complex Medical and Social Needs

Reducing Treatment Risk in Older Patients with Diabetes: Comparative Effectiveness of Academic Detailing with and without Pre-Visit Patient Preparation

Complex Patients: DOR Research Team

Care System Analytics to Support Primary Care Patients with Complex Medical and Social Needs

CORAL Meaningful Outcomes & Missed Opportunities

T32 Training Program in Diabetes Translational Research

Supplement to T32 Training Program in Diabetes Translational Research

Pre-Visit Prioritization for Complex Primary Care Patients with Diabetes

CTSI Institutional Career Development Core

Mentored Research to Improve Care for Complex Patients With Diabetes

Multi-Component Behavioral Intervention for Complex Patients with CVD Risk

Aligning the Visit Priorities of Complex Patients and their Primary Care Providers

Highlighted Publications

Use of Latent Class Analysis and k-Means Clustering to Identify Complex Patient Profiles

Use and Discontinuation of Insulin Treatment Among Adults Aged 75 to 79 Years With Type 2 Diabetes

Publications

Sodium-Glucose Cotransporter 2 Inhibitors vs Sulfonylureas: The Price of Prevention

The Epic Sepsis Model Falls Short-The Importance of External Validation

Engaging patients in population-based chronic disease management: A qualitative study of barriers and intervention opportunities

Visit Content Analysis: Doctor-Patient Communication in Patients with Type 2 Diabetes

Disclosure of New Type 2 Diabetes Diagnoses to Younger Adults: a Qualitative Study

Reappraising Medical Syntax-Does Race Belong in the First Line of the Patient History?

Sex-Based Differences Entangling With Electronic Health Record Documentation

Use of Latent Class Analysis and k-Means Clustering to Identify Complex Patient Profiles

Observational Study Design Challenges-The Case of Fluoroquinolones and Aortic Disease

Exploiting nonsystematic covariate monitoring to broaden the scope of evidence about the causal effects of adaptive treatment strategies

Continuation of Angiotensin-Converting Enzyme Inhibitors and Angiotensin Receptor Blockers in the Face of Kidney Disease Progression-Safe and Possibly Life Saving

Initial Glycemic Control and Care Among Younger Adults Diagnosed With Type 2 Diabetes

Primary Care Practitioners' Perspectives on Burnout and What to Do About It

Changing Results-Engage and Activate to Enhance Wellness: A Randomized Clinical Trial to Improve Cardiovascular Risk Management

Use and Discontinuation of Insulin Treatment Among Adults Aged 75 to 79 Years With Type 2 Diabetes

Portal Use Among Patients With Chronic Conditions: Patient-reported Care Experiences

Patient-Defined Visit Priorities in Primary Care: Psychosocial Versus Medically-Related Concerns

Patients with complex chronic conditions: Health care use and clinical events associated with access to a patient portal

Association of Anxiety With High-Cost Health Care Use Among Individuals With Type 2 Diabetes

Evidence supports prediabetes treatment

Targeted learning with daily EHR data

Translating/Creating a Culturally Responsive Spanish-Language Mobile App for Visit Preparation: Case Study of "Trans-Creation"

Visit Planning Using a Waiting Room Health IT Tool: The Aligning Patients and Providers Randomized Controlled Trial

Prompting Patients with Poorly Controlled Diabetes to Identify Visit Priorities Before Primary Care Visits: a Pragmatic Cluster Randomized Trial

Primary Care Physician Stress Driven by Social and Financial Needs of Complex Patients

Knowing How to Ask Good Questions: Comparing Latinos and Non-Latino Whites Enrolled in a Cardiovascular Disease Prevention Study

Automated symptom and treatment side effect monitoring for improved quality of life among adults with diabetic peripheral neuropathy in primary care: a pragmatic, cluster, randomized, controlled trial.

Association of Medical Scribes in Primary Care With Physician Workflow and Patient Experience

Prevalence and predictors of delayed clinical diagnosis of Type 2 diabetes: a longitudinal cohort study

Research to Change Health Delivery Systems: On the Outside Looking in?

Association of behavioral health factors and social determinants of health with high and persistently high healthcare costs

Which Complex Patients Should Be Referred for Intensive Care Management? A Mixed-Methods Analysis

A systematic review of care management interventions targeting multimorbidity and high care utilization

Six-Year Diabetes Incidence After Genetic Risk Testing and Counseling: A Randomized Clinical Trial

Influence of Language and Culture in the Primary Care of Spanish-Speaking Latino Adults with Poorly Controlled Diabetes: A Qualitative Study

Communicating Through a Patient Portal to Engage Family Care Partners

CREATE Wellness: A multi-component behavioral intervention for patients not responding to traditional Cardiovascular disease management

Crossing the Research to Quality Chasm: A Checklist for Researchers and Clinical Leadership Partners

Association of Patient-Physician Language Concordance and Glycemic Control for Limited-English Proficiency Latinos With Type 2 Diabetes

Identification of the joint effect of a dynamic treatment intervention and a stochastic monitoring intervention under the no direct effect assumption

Overcoming barriers to diabetic polyneuropathy management in primary care

Transforming Care for Complex Patients: Addressing Interconnected Medical, Social, and Behavioral Challenges

User-Centered Design of a Tablet Waiting Room Tool for Complex Patients to Prioritize Discussion Topics for Primary Care Visits

Community Health Workers: A Missing Piece of the Puzzle for Complex Patients With Diabetes?

The Diabetes Telephone Study; Design and challenges of a pragmatic cluster randomized trial to improve diabetic peripheral neuropathy treatment

Association of Acculturation and Health Literacy with Prevalent Dysglycemia and Diabetes Control Among Latinos in the Boston Area Community Health (BACH) Survey

Pre-visit prioritization for complex patients with Diabetes; Randomized Trial Design and Implementation within an Integrated Health Care system

Health IT-assisted population-based preventive cancer screening: a cost analysis

Evaluating a Model to Predict Primary Care Physician-Defined Complexity in a Large Academic Primary Care Practice-Based Research Network

Randomized Trial of a Health IT Tool to Support Between-Visit-Based Laboratory Monitoring for Chronic Disease Medication Prescriptions

The Study to Understand the Genetics of the Acute Response to Metformin and Glipizide in Humans (SUGAR-MGH): Design of a pharmacogenetic Resource for Type 2 Diabetes

Changes in physical activity among adults with diabetes: a longitudinal cohort study of inactive patients with Type 2 diabetes who become physically active

Electronic Health Records and the Evolution of Diabetes Care: A Narrative Review

Building Equity Improvement into Quality Improvement: Reducing Socioeconomic Disparities in Colorectal Cancer Screening as Part of Population Health Management

Patients who self-monitor blood glucose and their unused testing results

Building a Career as a Delivery Science Researcher in a Changing Health Care Landscape

Trends in the Evidence Level for the American Diabetes Association's "Standards of Medical Care in Diabetes" From 2005 to 2014

Defining patient complexity from the primary care physician's perspective: a cohort study.