Kaiser Permanente has set a national goal to increase social health screening among members. Dr. Grant and his DOR Complex Care Team will work with KP National Office of Community Health in a consultative role to address barriers and facilitators…
Our DOR Complex Care Team is working with Dr. Anand Shah and his team in a consultative role to address barriers and facilitators to social health screening. This work focuses on evaluating and implementing novel informatics-based strategies to guide member…
This project examines racial and ethnic disparities in ovarian cancer patients diagnosed and treated in KPNC from 2000 to 2023. It is an ancillary study to an NCI-funded research project (R01 CA243188) led by MPIs Kushi, Doherty (University of Utah),…
Multiple morbidity is the norm in advanced COPD and contributes to high symptom burden and worse outcomes. Can distinct comorbidity profiles be identified and validated in a community-based sample of patients with COPD from a large integrated health care system…
To examine the individual and combined associations of noncardiac-related conditions and mobility limitation with morbidity and mortality in adults with heart failure (HF). We conducted a retrospective cohort study in a large, diverse group of adults with HF from five…
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…
Among older individuals with type 2 diabetes, those with poor health have greater risk and derive less benefit from tight glycemic control with insulin. To examine whether insulin treatment is used less frequently and discontinued more often among older individuals…
Diabetes prevalence is twice as high among people with severe mental illness (SMI) when compared to the general population. Despite high prevalence, care outcomes are not well understood. To compare diabetes health outcomes received by people with and without comorbid…
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…
Our prior study examined the impact of one aspect of Medicare Part D, the removal of limits on the number of reimbursable prescriptions per month (drug caps) on racial differences in chronic disease treatment among dual Medicare and Medicaid enrollees…
This multicenter Cardiovascular Research Network (CVRN) collaborative project will examine the risks and benefits of targeted medical therapies used for heart failure across the spectrum of multimorbidity burden and level of left ventricular systolic function, as well as several targeted…
Aim 1: Determine associations among body mass index (BMI), body composition variables, and tumor subtype. The amount and quality of muscle, visceral adipose tissue, and subcutaneous adipose tissue will be derived from existing pre-surgical CT scans; and ccA/ccB subtypes will…
To determine whether burden of multiple chronic conditions (MCCs) influences the risk of receiving inappropriate vs appropriate device therapies. Retrospective cohort study. Seven US healthcare delivery systems. Adults with left ventricular systolic dysfunction receiving an implantable cardioverter-defibrillator (ICD) for primary…
Most studies on adolescent screening, brief intervention, and referral to treatment (SBIRT) have examined substance use outcomes. However, it may also impact service use and comorbidity-an understudied topic. We address this gap by examining effects of SBIRT on health care…
The landmark STICH trial found that surgical revascularization compared to medical therapy alone improved survival in patients with heart failure (HF) of ischaemic aetiology and an ejection fraction (EF) ≤ 35%. However, the interaction between the burden of medical co-morbidities and…
Background: Psychiatric comorbidity is common among patients with alcohol and other drug (AOD) use disorders. To better understand how psychiatric comorbidity influences AOD treatment access in health care systems, the present study examined treatment initiation and engagement among a large,…
Background: Medical comorbidity may influence treatment initiation and engagement for alcohol and other drug (AOD) use disorders. We examined the association between medical comorbidity and Healthcare Effectiveness Data and Information Set (HEDIS) treatment initiation and engagement measures.Methods: We used electronic…
For patients with diabetes, many with multiple complex chronic conditions, using a patient portal can support self-management and coordination of health care services, and may impact the frequency of in-person health care visits. To examine the impact of portal access…
This is a retrospective cohort study of 5 million adult members of Kaiser Permanente Northern California during 2000 to 2012, linked to state-of-the-art estimates of exposure to PM2.5 (particulate matter less than 2.5 micrometers in diameter) generated at 1km x…
To investigate the implications of a cancer diagnosis on medication adherence for pre-existing comorbid conditions, we explored statin adherence patterns prior to and following a new diagnosis of breast, colorectal, or prostate cancer among a multi-ethnic cohort. We identified adults…
The Affordable Care Act (ACA) offered an unprecedented opportunity to expand insurance coverage to patients with substance use disorders (SUDs). We explored the expectations of key stakeholders for the ACA's impact on SUD care, and examined how clinical characteristics of…
To assess multimorbidity burden and its association with clinical outcomes in adults with heart failure (HF) according to sex, age, and HF type. Retrospective cohort study. Five healthcare delivery systems across the United States. Adults with HF (N=114,553). We characterized…
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…
The Advancing Geriatrics Infrastructure and Network Growth (AGING) Initiative was initiated in 2014 to bridge the Health Care Systems Research Network (HCSRN) with the Older Americans Independence Centers (OAICs, also known as “Pepper Centers”) in order to advance an interdisciplinary…
To determine the efficacy and safety of statins for primary prevention of atherosclerotic cardiovascular disease (ASCVD) events in older adults, especially those aged 80 and older and with multimorbidity. The National Institute on Aging and the National Heart, Lung and…
A large and increasing proportion of health care costs are spent caring for a small segment of medically and socially complex patients. To date, it has been difficult to identify which patients are best served by intensive care management. To…
The natural history of patients hospitalized for acute coronary syndrome (ACS) with pre-existing versus (vs) de novo heart failure (HF) has not been previously reported over an extended duration of follow-up. The IMPROVE-IT trial enrolled 18,144 patients hospitalized for ACS…
Evidence supporting the effectiveness of care management programs for complex patients has been inconclusive. However, past reviews have not focused on complexity primarily defined by multimorbidity and healthcare utilization. We conducted a systematic review of care management interventions targeting the…
To prioritize research topics relevant to the care of the growing population of older adults with multiple chronic conditions (MCCs). Survey of experts in MCC practice, research, and policy. Topics were derived from white papers, funding announcements, or funded research…
To examine if a comorbid diagnosis of knee or hip osteoarthritis (OA) in older adults with new back pain visits is associated with long-term patient-reported outcomes and back-related health care use. Prospective cohort study. Three integrated health systems forming the…
Complex patients with multiple chronic conditions often face significant challenges communicating and coordinating with their primary care physicians. These challenges are exacerbated by the limited time allotted to primary care visits. Our aim was to employ a user-centered design process…
OBJECTIVES: We examined the association between comorbidity and long-term mortality from breast cancer and other causes among African-American and white women with breast cancer.METHODS: A total of 170 African-American and 829 white women aged 40-84years were followed for up to…
BACKGROUND: Chronic obstructive pulmonary disease (COPD) is prevalent in heart failure (HF) patients, yet these patients are poorly characterized. We aimed to describe the characteristics and outcomes of patients with systolic dysfunction and COPD in a contemporary HF randomized trial.METHODS…
BACKGROUND: Patients with complex health needs are increasingly the focus of health system redesign.OBJECTIVE: To characterize complex patients, as defined by their primary care physicians (PCPs), and to compare this definition with other commonly used algorithms.DESIGN: Cohort study.SETTING: 1 hospital-based…
OBJECTIVE: To report on the management of a patient with the rare concurrence of primary hyperparathyroidism and incidentally found metastatic papillary thyroid carcinoma in an adjacent lymph node.METHODS: We present a case report, including scintigraphic and histologic documentation, and a…
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