This multisite prospective cohort study will characterize changes in patient-centered outcomes including function, cognition, and quality of life among older adults with advanced non-small cell lung cancer receiving chemotherapy, immunotherapy, and/or targeted therapy.
This is a pilot cluster randomized controlled trial to determine the feasibility and acceptability of training medical oncologists to use the Best Case/Worst Case-Geriatric Oncology communication tool in clinical practice with older adults with cancer (NCT05374304).
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…
Social Needs Network for Evaluation and Translation (SONNET) is a national network of applied researchers who help design, evaluate, and implement effective social health interventions to improve member health across Kaiser Permanente. The SONNET Evaluation and Research Committee (ERC) is…
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…
We are studying the genomes of SARS-CoV-2 in persons with COVID-19 with and without vaccination to identify and describe variants circulating within our patients, including variants of concern (such as Delta or Omicron. We also are assessing which shared genomic…
This project will establish a prospective cohort of white and Black cancer patients treated with immune checkpoint inhibitors, leveraging the NCI Community Oncology Research Program network infrastructure, to investigate racial differences in immune-related adverse events and their predictors, treatment delay…
This study will evaluate TracFone/CareLink program within Kaiser Permanente (KP) Digital Health Equity portfolio. It will involve engaging local leaders, end users, and KP members in the planning, implementation, and initial assessment of barriers and facilitators of the TracFone/CareLink program.
We will evaluate a culturally responsive community health worker (CHW) intervention targeting younger-onset Latinx individuals with a new type 2 diabetes (T2D) diagnosis (AURORA [Active Outreach to Younger Latinx]). The AURORA strategy centers on a CHW who will proactively conduct…
Cardiovascular events are less common in women than men in general populations; however, studies in chronic kidney disease (CKD) are less conclusive. We evaluated sex-related differences in cardiovascular events and death in adults with CKD. Prospective cohort study. 1,778 women…
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…
This study will evaluate the safety, tolerability, and efficacy of a booster dose of BNT162b2 when administered to study participants who previously received 2 doses of BNT162b2 at least 6 months prior to randomization.
This study aims to use population management to improve the quality and overall health outcomes of people with schizophrenia, schizoaffective disorder, and bipolar disorder.
This study will evaluate extended 2-dose regimens in boys and girls ages 10 to 15 who previously received 1 dose of 9vHPV vaccine and did not complete the series and in HPV vaccine-naive boys and girls ages 9 to 14.…
This phase I open-label dose-finding study will evaluate the safety, tolerability, and immunogenicity of a Sars-Cov-2 RNA vaccine candidate against COVID-19 in healthy 12-year-old children.
The goal of this project is to determine the best strategy for integrating a home-testing option for cervical cancer screening. The most sensitive screening test for cervical cancer and precancer is a PCR-based test for human papilloma virus (HPV), which…
This study will characterize the management and outcomes of KPNC patients with valvular heart disease by evaluating surveillance patterns for moderate and severe valve disease, assessing clinical outcomes in those with guideline-recommended surveillance, developing methods to ensure evidence-based follow-up and…
To evaluate the effect of inserting epidemiological information into lumbar spine imaging reports on subsequent nonsurgical and surgical procedures involving the thoracolumbosacral spine and sacroiliac joints. Analysis of secondary outcomes from the Lumbar Imaging with Reporting of Epidemiology (LIRE) pragmatic…
It has been shown that racial/ethnic disparities exist with regard to initiation of and adherence to adjuvant endocrine therapy (AET). However, the relationship among American Indian/Alaska Native (AIAN) individuals is poorly understood, particularly among those who reside in urban areas.…
Social scientific studies of social support predominantly focus on the positive associations between social support and emotional well-being. The negative aspects of social support have received much less attention. We conducted semi-structured interviews of women with breast cancer (n =…
Interventions to improve healthcare for autistic adults are greatly needed. To evaluate such interventions, researchers often use surveys to collect data from autistic adults (or sometimes, their supporters), but few survey measures have been tested for use with autistic adults.…
To compare the long-term risks of reintervention following sleeve gastrectomy (SG) and Roux-en-Y gastric bypass (RYGB) in a large surgical cohort. The use of SG has increased dramatically relative to RYGB for the treatment of obesity. However, long-term risks following…
Existing sepsis quality improvement initiatives focus on recognition and treatment of sepsis upon hospital admission. Yet many patients are evaluated in the clinic within 1 day of sepsis hospitalization. To determine the circumstances of clinic visits that precede sepsis hospitalization,…
This study examined whether adverse childhood experiences (ACEs) are associated with increased risk of having an unwanted or mistimed pregnancy. Women in two medical centers within an integrated health system were screened for ACEs during standard prenatal care (N = 745). Multinomial…
Postoperative urinary retention (POUR) is the inability to void despite a full bladder following a surgical procedure. POUR can result in painful catherization, increased patient distress, increased postoperative hospital stay, urinary tract infections, detrusor muscle dysfunction, and cardiac arrhythmias. This…
This study will examine the impacts that COVID-19 pandemic related changes in health care delivery had on health outcomes among pregnant women and their newborns in Kaiser Permanente Northern California. The study will also evaluate the clinical course of COVID-19…
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…
This study will identify the sociodemographic and health factors associated with low utilization of obstetrics/gynecology services among adult women with autism spectrum disorders and explore whether these women are at higher risk of adverse maternal and birth outcomes than women…
This study will assess the accuracy of using a natural language processing-based approach to retrospectively identify episodes of outpatient worsening heart failure in unstructured electronic health record data within an integrated health care delivery system and assess the burden and…
The incidence of peptic ulcer disease (PUD) has been decreasing over time with Helicobacter pylori eradication and use of acid-suppressing therapies. However, PUD remains a common cause of hospitalization in the United States. We aimed to evaluate contemporary national trends…
To develop novel, scalable, and valid literacy profiles for identifying limited health literacy patients by harnessing natural language processing. With respect to the linguistic content, we analyzed 283 216 secure messages sent by 6941 diabetes patients to physicians within an integrated…
A lack of consensus on the optimal outcome measures to assess the efficacy and effectiveness of interventions for the treatment of opioid use disorder (OUD) has hampered the pooling of research data for evidence synthesis and clinical guidelines. A core…
After implementation of the Surgical Home Recovery (SHR) initiative for mastectomy within a large, integrated health delivery system, most patients are discharged on the day of the procedure. We sought to identify predictors of SHR and unplanned return to care…
In 2015, California passed Senate Bill 277 and became the third state in the United States to ban all nonmedical exemptions from school immunization requirements, effectively prohibiting religious and personal belief exemptions. This attracted grassroots opposition and considerable debate among…
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…
While the Affordable Care Act-mandated Hospital Readmission Reduction Program launched in 2012 has modestly reduced readmissions, an unintended consequence has been the shift of a significant fraction of heart failure (HF)-related care to the outpatient setting. However, little is known…
Cancer survivors face many challenges including coordinating care across multiple providers and maintaining medical records from multiple institutions. Access and utilization of online medical records could help cancer survivors manage this complexity. Here, we examined how cancer survivors differ from…
Active tuberculosis (TB) disease leads to substantial mortality but is preventable through screening and treatment for latent TB infection. Early mortality after TB diagnosis (≤1 year) is well described, but delayed mortality (>1 year) among patients with active TB is…
Clinical practice guidelines recommend routine kidney function and serum potassium testing within 30 days of initiating ACE (angiotensin-converting enzyme) inhibitor or angiotensin II receptor blocker therapy. However, evidence is lacking about whether follow-up testing reduces therapy-related adverse outcomes. We conducted…
To evaluate a Kaiser Permanente Northern California physician training tool entitled "Effective Communication without Confrontation" aimed at improving communication with vaccine-hesitant parents, building trust, and alleviating physician stress surrounding vaccination visits. Trainings were held May to July 2015. Pre- and…
The study will examine patient knowledge and experience in a Value-based insurance designs plan by surveying 1,000 patients newly enrolling in a VBID plan. The survey will collect patient knowledge of their plan, patient-reported medication behavior (including specific cost barriers…
This study will conduct focus groups with KPNC members (age 45) with newly diagnosed Type 2 diabetes to learn about members’ experiences with this new diagnosis and to identify early facilitators of and barriers to effective diabetes management in this…
Purpose. In 2018, the US Preventive Services Task Force (USPSTF) endorsed three strategies for cervical cancer screening in women ages 30 to 65: cytology every 3 years, testing for high-risk types of human papillomavirus (hrHPV) every 5 years, and cytology…
In a sample of people with HIV (PWH) enrolled in an alcohol intervention trial and followed for 12 months, we examined the association of changes in days (i.e., decrease, increase, no change [reference]) of unhealthy drinking (consuming ≥ 4/≥ 5 drinks for women/men) with…
This study will identify biochemical markers that predict type 2 diabetes mellitus in women after a pregnancy complicated by gestational diabetes mellitus (GDM). Ultimately, the results of this study may lead to improved testing and more effective, personalized interventions to…
We are using post-polypectomy surveillance, an increasingly common indication for colonoscopy in clinical practice at TPMG and across the United States, as a model for how we might risk-stratify patients for care. Patients and physicians desire more precise estimates of…
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…
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…
The SRI team will (a) assess results of previous internal and external deployments of alternatives to hospitalization, (b) define strategies to quantify the potential pool of Kaiser Permanente Northern California patients who would be eligible for such alternatives, (c) develop…
This longitudinal study of 350 women seeking prenatal care in Kaiser Permanente Northern California will compare patient satisfaction with prenatal care, maternal health and behavioral outcomes between women in group prenatal care (Centering Pregnancy) and traditional prenatal care
Pregnant women are at increased risk of seasonal influenza hospitalizations, but data about the epidemiology of severe influenza among pregnant women remain largely limited to pandemics. To describe the epidemiology of hospitalizations for acute respiratory infection or febrile illness (ARFI)…
The severity of acute kidney injury (AKI) is usually determined based on the maximum serum creatinine concentration. However, the trajectory of kidney function recovery could be an additional important dimension of AKI severity. To assess whether the trajectory of kidney…
The Bladder Cancer Quality of Life Study collected detailed and sensitive patient-reported outcomes from bladder cancer survivors in the period after bladder removal surgery, when participation in survey research may present a burden. This paper describes the study recruitment methods…
Prior studies suggest that transgender women (TW) with human immunodeficiency virus (HIV) are less likely to be virally suppressed than cisgender women (CW) and cisgender men (CM). However, prior data are limited by small sample sizes and cross-sectional designs. We…
Reports suggest that up to 50% of women with hormone receptor-positive (HR+) breast cancer (BC) do not complete the recommended 5 years of adjuvant endocrine therapy (AET). We examined the impact of an outreach program at Kaiser Permanente Northern California (KPNC)…
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…
The goals of this study are to (1) examine temporal trends in early hospital antibiotic prescribing patterns over the past 5 years, to assess for unintended consequences associated with earlier antibiotics in severe sepsis/septic shock; (2) quantify the patient-level harm…
This study will characterize type 1 and type 2 diabetes patients initiating newly prescribed continuous glucose monitors and evaluate the impact of that initiation on key clinical and utilization-based outcomes, and whether that impact differs across clinically vulnerable subgroups.
The goal of this project is to assist with measure development and testing for the Hospital-Wide Mortality (HWM) hybrid and HWM claims-only measures. This includes providing consulting support to the Yale Center for Outcomes Research and Evaluation team and defining…
Biospecimens are tools that have the potential to improve early identification and treatment for autism spectrum disorders (ASD) and bipolar disorders (BPD). Unfortunately, most biobanks lack racial/ethnic diversity. One challenge to including a diverse sample of youth is recruiting and…
Amid a growing geriatric population and rise in frailty-related morbidity, fall prevention represents an opportunity to improve patient outcomes and reduce health care costs. Traditional lectures on geriatric content have had limited impact on physician behaviors; however, use of multimodal…
Patients who undergo cystectomy due to bladder cancer can elect an ileal conduit or a neobladder for urinary diversion. Decision regret related to this choice is an important and undesirable patient reported outcome. Our objective was to compare the severity…
Robotic hysterectomy may offer advantages for complex cases over the conventional laparoscopic approach. To assess the association of surgical approach (robotic vs conventional) with blood loss, risks of readmission, reoperation, complications, and average operative time. In a retrospective cohort study,…
Background Despite the success of current cardiovascular disease (CVD) management programs, many patients do not achieve optimal control of CVD-related risk factors. New strategies are needed to better activate and engage these patients. Methods and Results We conducted a parallel,…
To examine racial/ethnic disparities in the prevalence of diabetes and prediabetes by BMI category. In a consortium of three U.S. integrated health care systems, 4,906,238 individuals aged ≥20 years during 2012-2013 were included. Diabetes and prediabetes were ascertained by diagnosis…
Most clinical and epidemiologic estimates of prenatal cannabis use are based on self-report, and the validity of self-reported cannabis use has not been examined in a large, representative population of pregnant women. We determined the validity of self-reported prenatal cannabis…
Recent publications have reported conflicting findings regarding associations of blood donor demographics and mortality of transfused patients. We hypothesized that the analysis of additional donor characteristics and consideration of alternative outcomes might provide insight into these disparate results. We analyzed…
Prospective enrollment of research subjects in the fast-paced emergency department (ED) is challenging. We sought to develop a software application to increase real-time clinical trial enrollment during an ED visit. The Prospective Intelligence System for Clinical Emergency Services (PISCES) scans…
Personal health records offer patients access to view their own health information and to manage their care online through secure patient portal tools. Little is known about the patient-reported experience in using health portals to manage chronic conditions. In a…
Significant research has focused individually on blood donors, product preparation and storage, and optimal transfusion practice. To better understand the interplay between these factors on measures of red blood cell (RBC) transfusion efficacy, we conducted a linked analysis of blood…
Despite favorable national trends in the incidence of end-stage renal disease (ESRD) from 2008 to 2011, ESRD incidence has been increasing recently, and less than 10% of patients with ESRD start renal replacement therapy with peritoneal dialysis (PD) in the…
This study will be one of the first to examine the relationship between health-system factors across the continuum of care (pharmacy, hospital, primary care) and health-care quality and outcomes among vulnerable, dual-eligible, managed-care members. In addition, we will use geographically-tagged…
Substance use disorders (SUDs) and psychiatric disorders are common among people with HIV (PWH) and lead to poor outcomes. Yet these conditions often go unrecognized and untreated in primary care. The Promoting Access to Care Engagement (PACE) trial currently in…
Kaiser Permanente Northern California will participate with the FDA Sentinel to validate the diagnosis of health outcomes of interest.
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…
Primary care providers (PCPs) are often challenged to address multiple patient concerns during time-limited visits. The need for PCPs to limit the number of issues addressed may have a negative impact on discussion of patient-defined visit priorities. Using data from…
The objective of this study was to test whether 2 interventions promote interest in diabetes prevention among women with a history of gestational diabetes mellitus, who face high lifetime risk for diabetes. We designed an email outreach message promoting an…
Patient centered care aims to align treatment with patient goals, especially when treatment options have equivalent clinical outcomes. For surgeries with lasting impacts that alignment is critical. To our knowledge no psychometrically tested preference elicitation measures exist to support patients…
Medication non-adherence is a major contributor to poor outcomes in diabetes. Previous research has shown an association between use of mail order pharmacy delivery and better medication adherence, but little is known about the barriers and facilitators to mail order…
Evidence regarding associations of blood donor sex with mortality among red blood cell transfusion recipients is conflicting. To study associations of donor sex and prior pregnancy with mortality of transfusion recipients. Data from 3 retrospective cohorts of transfusion recipients (the…
Assigning drug exposure is a necessary first step in examining bisphosphonate (BP) treatment in observational studies using pharmacy data. To determine whether the choice of adherence level using the proportion of days covered (PDC) affected BP exposure assignment. 10,381 female…
The overall objective of this ancillary study to the ongoing NIH-sponsored Chronic Renal Insufficiency Cohort (CRIC) study is to evaluate sleep-disordered breathing (assessed by home sleep-monitoring using the WatchPAT200 device) as a potential predictor of clinical and patient-centered outcomes in…
The HealthyFood (HF) program offers members up to 25% cash back monthly on healthy food purchases. In this randomized controlled trial, we tested the efficacy of financial incentives combined with text messages in increasing healthy food purchases among HF members.…
Purpose: A lack of national data makes it difficult to estimate, but LGB adults appear to have a higher risk of cancer. Although limited research exists to explain the disparity, we aimed to explore potential differences in access to and…
Systolic blood pressure (SBP) and its association with clinical outcomes in atrial fibrillation (AF) patients in community practice are poorly characterized. In patients with AF, we sought to (1) examine the prevalence of baseline uncontrolled hypertension and the overall change…
Best practices to facilitate high-quality shared decision-making for lung cancer screening (LCS) are not well established. In our LCS program, patients are first referred to attend a free group education class on LCS, taught by designated clinician specialists, before a…
Background Patient satisfaction with therapy is an important metric of care quality and has been associated with greater medication persistence. We evaluated the association of patient satisfaction with warfarin therapy to other metrics of anticoagulation care quality and clinical outcomes…
Surgical clinic and perioperative settings are critical touchpoints for treating smoking, yet health care systems have not typically prioritized smoking cessation among surgical patients. We evaluated the implementation of a pilot smoking cessation intervention integrated into standard perioperative care. English-speaking…
Health information, patient education, and self-management (health information and advice, HIA) tools are increasingly being made available to adults with chronic health conditions through internet-based health and mobile health (mHealth) digital information technologies. However, there is limited information about patient…
Evidence-based treatments for prediabetes can prevent and delay the development of type 2 diabetes in adults. In this review, we propose a framework for population-based diabetes prevention that links screening and prevention activities across key stakeholders. We also discuss gaps…
The risk of acute thrombotic events such as venous thromboembolism (VTE) and ischemic stroke in transgender women receiving hormone therapy was addressed in our longitudinal Study of Transition, Outcomes & Gender (STRONG), supported by the Patient-Centered Outcomes Research Institute. STRONG…
Type 1 diabetes is a complicated disease requiring constant adherence to glycemic targets and meticulous attention and vigilance of blood sugar. Individuals with type 1 diabetes are living longer than ever before, yet very little is known about how this…
Bladder cancer patients who undergo cystectomy and urinary diversion face functional and quality-of-life challenges. Little is known about these patients' experiences during decision-making, surgery, and recovery, or how they vary by treatment setting. To learn about patients' experiences with treatment…
Genetic risk and family history, which includes personal medical history, increasingly influence medical care, but optimal methods for capturing the hereditary risk of disease and the outcomes of such assessments are unknown. Using inherited cancer as a model, this study…
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…
The Pregnancy Environment and Lifestyle Study-2 (PETALS-2) aims to identify psychosocial influences on healthy lifestyle behaviors — such as healthy eating, self-weighing, and physical activity — and examine their relation to weight retention and cardiometabolic profile in the transition from…
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…
Background: Treatment initiation and engagement rates for alcohol and other drug (AOD) use disorders differ depending on where the AOD use disorder was identified. Emergency department (ED) and primary care (PC) are 2 common settings where patients are identified; however,…
Limited health literacy is a barrier to optimal healthcare delivery and outcomes. Current measures requiring patients to self-report limitations are time-consuming and may be considered intrusive by some. This makes widespread classification of patient health literacy challenging. The objective of…
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…
Background: Only 10% of patients with alcohol and other drug (AOD) disorders receive treatment. The AOD Initiation and Engagement in Treatment (AOD-IET) measure was added to the national Healthcare Effectiveness Data and Information Set (HEDIS) to improve access to care.…
Background: Cannabis use disorders (CUDs) have increased with more individuals using cannabis, yet few receive treatment. Health systems have adopted the Healthcare Effectiveness Data and Information Set (HEDIS) quality measures of initiation and engagement in alcohol and other drug (AOD)…
Background: The prevalence of opioid use disorder (OUD) has increased rapidly in the United States and improving treatment access is critical. Among patients with OUD, we examined factors associated with the Healthcare Effectiveness Data and Information Set (HEDIS) performance measures…
To reduce colorectal cancer incidence and mortality, experts recommend surveillance colonoscopy 3 years after advanced adenoma removal. Little is known about adherence to that interval. We describe patterns of and factors associated with subsequent colonoscopy among persons with ?3 adenomas…
Screening reduces colorectal cancer deaths, but?
Few population-level surveys have explored patient-centered priorities for improving colorectal cancer survivors' care. Working with patients, we designed a survey to identify care improvement and survivorship priorities. We surveyed a random sample of 4000 patients from a retrospective, population-based cohort…
Many low-risk patients with acute pulmonary embolism (PE) in the emergency department (ED) are eligible for outpatient care but are hospitalized nonetheless. One impediment to home discharge is the difficulty of identifying which patients can safely forgo hospitalization. To evaluate…
We took advantage of a change in protocol in an integrated delivery system's telephone consultation service-routing callers complaining of chest pain to physicians instead of registered nurses, whenever feasible-to explore whether tele-triage outcomes differed by staffing type. Comparing outcomes of…
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…
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…
Poor understanding of diabetes management targets is associated with worse disease outcomes. Patients may use different information than providers to assess their diabetes control. In this study, we identify the information patients use to gauge their current level of diabetes…
Kaiser Permanente Mid-Atlantic States (KPMAS) members are increasingly utilizing electronic encounter types, such as telephone appointments and secure messaging for healthcare purposes, although their impact on health outcomes is unknown. We evaluated whether use of alternative encounters by adult human…
HIV-infected individuals are at increased risk of anal cancer. Screening for anal cancer precursors using high-resolution anoscopy (HRA) may be clinically beneficial. In this study, we examined patient tolerability of this procedure. The acceptability of HRA was evaluated among HIV-infected…
Chronic obstructive pulmonary disease (COPD) is associated with the development of atrial fibrillation (AF), and may complicate treatment of AF. We examined the association between COPD and symptoms, quality of life (QoL), treatment and outcomes among patients with AF. We…
In a population of adults with newly diagnosed, early onset type 2 diabetes, this study will identify patient-, provider-, and system-level predictors of inadequate glycemic control within one year following diagnosis. A longitudinal, retrospective cohort analysis of electronic health record…
Personal health records (PHRs) offer patients a portal to view lab results, communicate with their doctors, and refill medications. Expanding PHR access to mobile devices could increase patients' engagement with their PHRs. We examined whether access to a mobile-optimized PHR…
We surveyed cataract surgeons to gain insight into their perceptions of and attitudes about immediate sequential bilateral cataract surgery (ISBCS). Cross-sectional. All active cataract surgeons in Kaiser Permanente Northern California in 2016. Online survey that asked cataract surgeons why they…
Guidelines recommend closer outpatient follow-up for exclusively breastfed newborns, especially those with pronounced weight loss, because of increased risk of hyperbilirubinemia and dehydration that might require readmission. Our objective was to determine how feeding method and weight loss are associated…
This project examines aspects of end-of-life care for people diagnosed with adolescent and young adult cancers (ages 15 to 39 years). Current measures of end-of-life care quality were designed for older adults; a coherent set of measures to characterize high-quality…
Understand patient and system characteristics associated with performance on the Healthcare Effectiveness Data and Information Set (HEDIS) Alcohol and Other Drug (AOD) Initiation and Engagement of Treatment (IET) measures. This mixed-methods study linked patient and health system data from four…
Nonadherence to controller and overuse of reliever asthma medications are associated with exacerbations. We aimed to determine patterns of seasonal asthma medication use and to identify time period(s) during which interventions to improve medication adherence could reduce asthma morbidity. We…
Secondary prevention after an acute coronary syndrome (ACS) hospitalization is critical to prevent additional morbidity and mortality. While poor adherence to prescribed cardio-protective medications is a known problem;1;2 it is unknown whether an ACS event might motivate patients to achieve…
Renal recovery after dialysis-requiring acute kidney injury (AKI-D) is an important clinical and patient-centered outcome. Here we examined whether the pre-admission proteinuria level independently influences risk for non-recovery after AKI-D in a community-based population. All adult members of Kaiser Permanente…
The objective of this study was to compare outcomes and health care utilization of older patients who did versus did not fill opioid prescriptions within 90 days of initiating care for low back pain. For patients ≥65 years with new…
Black and Latino children experience significantly worse asthma morbidity than their white peers for multifactorial reasons. This study investigated differences in family-provider interactions for pediatric asthma, based on race/ethnicity. This was a cross-sectional study of parent surveys of asthmatic children…
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…
This study seeks to 1) assess the feasibility and challenges associated with incorporating patient-reported outcomes into Kaiser Permanente HealthConnect, implement the collection of patient-reported-outcome measures among patients newly diagnosed with metastatic pancreatic cancer, 3) characterize patient-reported physical function and associated…
A metastatic cancer diagnosis is associated with high levels of distress in patients and caregivers. Mindfulness interventions can reduce distress and improve quality of life in cancer patients. However, standard mindfulness training relies on in-person instruction, which is often not…
Patient reports of their adherence behaviors, concerns about statins, and perceptions of atherosclerotic cardiovascular disease (ASCVD) risk could inform approaches for improving adherence to statin therapy. We examined these factors and their associations with adherence. We conducted telephone interviews among…
To characterize decision-making processes and outcomes among men expressing early-treatment preferences for low-risk prostate cancer. We conducted telephone surveys of men newly diagnosed with low-risk prostate cancer in 2012 to 2014. We analyzed subjects who had discussed prostate cancer treatment…
A cornerstone of patient-centered outcome research is direct patient involvement throughout the research process. Identifying and prioritizing research topics is a critical but often overlooked point for involvement, as it guides what research questions are asked. We assess the feasibility…
Cardiovascular disease (CVD) is the leading cause of death in the US. Many patients do not benefit from traditional disease management approaches to CVD risk reduction. Here we describe the rationale, development, and implementation of a multi-component behavioral intervention targeting…
Diabetic polyneuropathy is a highly prevalent and costly complication of diabetes that is frequently underdiagnosed and undertreated in primary care settings. In this article, we discuss challenges in the management of diabetic polyneuropathy symptoms, including diagnostic complexity, the limited efficacy…
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,…
Secondary analysis of the Back Pain Outcomes using Longitudinal Data (BOLD) cohort study. To characterize associations of self-reported race/ethnicity with back pain (BP) patient-reported outcomes (PROs) and health care utilization among older adults with a new episode of care for…
A quasi-experimental longitudinal study to evaluate the impact of KPHI WellRx -- a program intended to engage patients more effectively in their self-care -- among a diverse cohort of patients with diabetes. The study will evaluate: (1) the offering of…
Involving patients as partners in research is a defining characteristic of patient-centered outcomes research (PCOR). While patients' experiential knowledge of a health condition or treatment may yield research priorities not reflected by researchers and policy makers, the methods for identifying…
People socially connected with each other often share health risks, possibly due to shared environments and behaviors. In a cohort study, we examined whether incidence of diabetes was different for individuals with recently diagnosed partners compared to individuals similar on…
The Centers for Medicare and Medicaid Services (CMS) Medicare Star program provides incentives to health plans when their patients with diabetes meet adherence targets to angiotensin-converting enzyme inhibitors/angiotensin II receptor blockers (ACEIs/ARBs) and statins. While a link between adherence and…
This study investigates demographic and clinical factors associated with initiation, continuation, and adherence to behavioral health treatment (BHT) among children with autism spectrum disorder. Among 293 insured children referred for applied behavior analysis (ABA) based BHT, 23% never initiated treatment.…
Electronic health records (EHRs) present healthcare delivery systems with scalable, cost-effective opportunities to promote lifestyle programs among patients at high risk for type 2 diabetes, yet little consensus exists on strategies to enhance patient engagement. We explored patient perspectives on…
INTRODUCTION: Diabetes Prevention Programs (DPPs) have shown that healthy eating and moderate physical activity are effective ways of delaying and preventing type 2 diabetes in people with impaired glucose tolerance. We assessed willingness to pay for DPPs from the perspective…
While lifestyle programs to prevent type 2 diabetes are increasingly available, the drivers of patient engagement in them remain poorly understood. This study aims to identify characteristics of patient subgroups at risk for poor engagement, providing a basis for future…
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.
Purpose The first hybrid closed loop (HCL) system, which automates insulin delivery but requires user inputs, was approved for treatment of type 1 diabetes (T1D) by the US Food and Drug Administration in September 2016. The purpose of this study…
Providing culturally competent care to the growing number of limited-English proficiency (LEP) Latinos with diabetes in the United States is challenging. To evaluate changes in risk factor control among LEP Latinos with diabetes who switched from language-discordant (English-only) primary care…
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…
This network participates in PCORI's Clinical Data Research Network (CDRN) program to enhance the nation's capacity to conduct comparative effectiveness research by creating a national electronic data infrastructure. This program promotes the development of data networks and engages patients, clinicians,…
In this study, we will examine how diabetes patients with limited health literacy interact with their healthcare providers via secure messages (emails). We will employ computational linguistics and qualitative methods to develop and validate a novel "linguistic complexity profile” (LCP)…
This randomized trial is based in primary care and focuses on management of prescription opioids among chronic pain patients. The intervention uses a patient activation approach to self-management for these patients and to link them to existing health plan resources.
This project is a continuation of a study we recently conducted to identify and prioritize treatment outcomes of relevance to patients with diabetic peripheral neuropathy (DPN). DPN affects 30% to 50% of all adults with diabetes and symptoms such as…
Risk factors associated with developing opioid use disorders (OUD) are documented, but less is known about different pathways to initiation of opioids or opioid dependence, or how such pathways affect treatment engagement. We recruited 283 adults with electronic medical record…
Contraceptive decision support tools (DSTs) have been suggested as a way to provide patient-centered contraceptive care, but little is known about the role they play in women's decision-making. The aim of this study is to understand patients' perceptions of the…
This mixed-method, comparative effectiveness study will compare costs, complications, patient- and family-centered outcomes related to urinary diversion. Study participants will include bladder cancer patients undergoing cystectomy and their family caregivers within three Kaiser Permanente regions with a membership base of…
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…
PURPOSE OF REVIEW: Heart failure is a global pandemic and there has been a growing effort to enroll patients from different geographical regions in randomized controlled trials. In this review, we examined regional variation in both patient characteristics and outcomes…
Patient use of health IT tools to interact with healthcare providers and delivery systems, including exchanging secure messages with their medical providers and using other web-based tools, has great potential to increase patient access to care, change the way healthcare…
The potential for efficacious lifestyle interventions to prevent type 2 diabetes hinges on patient engagement in real-world healthcare settings. Yet patient engagement strategies are suboptimal and attrition is often high, particularly for ethnic minority women who bear disproportionate burdens of…
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…
We examined the role of language and culture in the interactions between Spanish-speaking Latino patients with poorly controlled diabetes - a fast-growing population in the United States - and their primary care providers. We conducted four focus groups with 36…
Collaborative partnerships between community-based academic residency training programs and schools of public health, represent an innovative approach to training future physician leaders in population management and public health. In Kaiser Permanente Northern California, development of residency-Masters in Public Health (MPH)…
OBJECTIVE: Adolescents with Type 1 diabetes (T1D) are vulnerable to diabetes-related distress and often struggle to complete self-management tasks needed to maintain blood glucose values in target range. One way that youth with T1D handle problems is through avoidant coping.…
Language barriers negatively impact health care access and quality for US immigrants. Latinos are the second largest immigrant group and the largest, fastest growing minority. Health care systems need simple, low cost and accurate tools that they can use to…
Using cross-sectional survey data, we assessed the association between chronic illness burden and health-related self-efficacy, evaluating whether patient-centered communication is associated with self-efficacy and if that relationship varies by chronic illness burden. Data were from the Health Information National Trends…
Online access to health records and the ability to exchange secure messages with physicians can improve patient engagement and outcomes; however, the digital divide could limit access to web-based portals among disadvantaged groups. To understand whether sociodemographic differences in patient…
Due to the concerns about the overtreatment of low-risk prostate cancer, active surveillance (AS) is now a recommended alternative to the active treatments (AT) of surgery and radiotherapy. However, AS is not widely utilized, partially due to psychological and decision-making…
Patients managing type 1 diabetes have access to new technologies to assist in management. This manuscript has two aims: 1) to briefly review the literature on diabetes technology use and how this relates to psychological factors and 2) to present…
OBJECTIVE: Medicare Part D claims indicate medication purchased, but people who are not fully adherent may extend prescription use beyond the interval prescribed. This study assessed concordance between Part D claims and medication possession at a study visit in relation…
Adolescents with type 1 diabetes have an increased risk for a variety of emotional and behavioral challenges as well as negative diabetes outcomes. This study was designed to compare the effectiveness of a depression-prevention, resilience promotion program with an advanced…
Challenges to effective pharmacologic management of symptomatic diabetic peripheral neuropathy include the limited effectiveness of available medicines, frequent side effects, and the need for ongoing symptom assessment and treatment titration for maximal effectiveness. We present here the rationale and implementation…
Intensive care unit diaries have been shown to improve post-critical illness recovery, however, prior reports of diary implementation are heterogeneous. We sought to construct a common framework for designing and implementing Intensive Care Unit diaries based on prior studies. We…
The purpose of this study was to explore communication barriers as independent predictors and potential mediators of variation in clinical recognition of diabetic peripheral neuropathy (DPN). In this cross-sectional analysis, we estimated the likelihood of having a DPN diagnosis among…
Little is known about how neighborhood crime may relate to health in diabetes patients. We examined associations between individuals' perceptions of neighborhood safety or violent crime and stress, physical activity, body mass index (BMI) or hemoglobin A1c (HbA1c) in a…
Patients and clinicians have begun to recognize the advantages and disadvantages of buprenorphine relative to methadone, but factors that influence choices between these two medications remain unclear. For example, we know little about how patients' preferences and previous experiences influence…
More than a third of middle-aged or older women suffer from urinary incontinence, but less than half undergo evaluation or treatment for this burdensome condition. With national organizations now including an assessment of incontinence as a quality performance measure, providers…
The Patient-Centered Outcomes Research Institute (PCORI) created a new national network infrastructure to enable large-scale observational comparative effectiveness research across diverse clinical care settings. As part of testing the feasibility of this effort, each clinical data research network (CDRN) was…
To understand when patients use secure e-mail messaging with healthcare providers across several types of questions or concerns, associations between out-of-pocket costs for in-person visits and use of secure messaging, and to examine patient-reported impacts on care-seeking behavior and overall…
Improving the ability to risk-stratify patients is critical for efficiently allocating resources within healthcare systems. The purpose of this study was to evaluate a physician-defined complexity prediction model against outpatient Charlson score (OCS) and a commercial risk predictor (CRP). Using…
Engaging stakeholders in the research process has the potential to improve quality of care and the patient care experience. Online patient community surveys can elicit important topic areas for comparative effectiveness research. Stakeholder meetings with substantial patient representation, as well…
To investigate the prevalence, predictors, and costs associated with unused results from self-monitoring of blood glucose (SMBG). Observational cohort study. We studied 7320 patients with type 2 diabetes mellitus who were not prescribed insulin and who reported SMBG. Patients reported…
Health care delivery systems that are designed to understand and meet patient preferences for care have the potential to improve health outcomes and reduce disparities. Studies that rigorously assess patient care preferences in minority and underserved populations, stakeholder engagement, and…
The Kaiser Permanente & Strategic Partners Patient Outcomes Research To Advance Learning (PORTAL) network engages four healthcare delivery systems (Kaiser Permanente, Group Health Cooperative, HealthPartners, and Denver Health) and their affiliated research centers to create a new national network infrastructure…
BACKGROUND: Regular physical activity can help prevent chronic diseases, yet only half of US adults meet national physical activity guidelines. One barrier to physical activity is a lack of safe places to be active, such as bike paths and sidewalks.…
With the aging of the population and continuing advances in health care, patients seen in the primary care setting are increasingly complex. At the same time, the number of screening and chronic condition management tasks primary care providers are expected…
Although research suggests that mail order pharmacy use is associated with greater medication adherence and cardiovascular disease risk factor control, no research has examined the potential impact of mail order pharmacy use on patient safety and utilization. To compare safety…
Patient-provider relationships influence diabetes care; less is known about their impact on online patient portal use. Diabetes patients rated provider communication and trust. In this study, we linked responses to electronic medical record data on being a registered portal user…
Shared breast cancer treatment decision-making between patients and physicians increases patient treatment satisfaction and compliance and is influenced by physician-related factors. Attitudes and behaviors about patient involvement in breast cancer treatment decisions and treatment-related communication were assessed by specialty among…
OBJECTIVE: To examine the attitudes of US patients about the use of placebo treatments in medical care. DESIGN: One time telephone surveys. SETTING: Northern California. PARTICIPANTS: 853 members of Kaiser Permanente Northern California, aged 18-75, who had been seen by…
Genetic testing for chronic disease susceptibility may motivate young adults for preventive behavior change. This nationally representative survey gave 521 young adults hypothetical scenarios of receiving genetic susceptibility results for heart disease, type 2 diabetes, and stroke and asked their…
A patient's sense of his/her standing in the social hierarchy may impact interpersonal processes of care (IPC) within the patient-provider encounter. We investigated the association of perceived social position with patient-reported IPC. We used survey data from the Diabetes Study…
BACKGROUND: Poor medication refill adherence contributes to poor cardiometabolic control and diabetes outcomes. Studies linking communication between patients and health care providers to adherence often use self-reported adherence and have not explored differences across communication domains or therapeutic indications. METHODS:…
Primary prevention of diabetes is increasingly recognized by both health plans and employers as an important strategy to improve the health of insured populations. As a part of the Natural Experiments in Translation for Diabetes (NEXT-D) network, the Kaiser Permanente…
Health coaching can improve lifestyle behaviors known to prevent or manage chronic conditions such as diabetes. However, little is known about the patient experience with telephonic coaching programs in real-world care settings. We examined patient satisfaction, patient's perceived success in…
Breast cancer patients have voiced dissatisfaction regarding their education on breast cancer-related lymphedema risk and risk reduction strategies from their clinicians. Informing patients about lymphedema can contribute to decrease their risk of developing the condition, or among those already affected,…
BACKGROUND: Analyses from double-blind randomized trials have reported lower mortality among participants who were more adherent to placebo compared with those who were less adherent. We explored this phenomenon by analyzing data from the placebo arm of the Heart and…
OBJECTIVES: We examined whether interpersonal processes of care (IPC) were associated with cesarean delivery. METHODS: We performed a cross-sectional study of 1308 postpartum women at Kaiser Permanente Medical Center in Walnut Creek, CA (KP-WC), and San Francisco General Hospital (SFGH)…
PURPOSE: Mindfulness-based stress reduction (MBSR), typically taught in eight weekly classes, helps patients cope with illness, including cancer. Current research is almost exclusively based on post-treatment class attendance. Research suggests that short courses and alternative delivery techniques may also be…
BACKGROUND: Randomized controlled trials have reported lower mortality among patients who adhere to placebo compared with those who do not. We explored this phenomenon by reanalyzing data from the placebo arm of the Beta Blocker Evaluation of Survival Trial (BEST),…
Latinos have higher rates of diabetes and diabetes-related complications compared to non-Latinos. Clinical diabetes self-management tools that rely on innovative health information technology (HIT) may not be widely used by Latinos, particularly those that have low literacy or numeracy, low…
Some expert guidelines recommend time-scheduled opioid dosing over pain-contingent dosing for patients receiving chronic opioid therapy (COT). The premise is that time-scheduled dosing results in more stable opioid blood levels and better pain relief, fewer adverse effects, less reinforcement of…
OBJECTIVE: To assess the association of limited English proficiency (LEP) and physician language concordance with patient reports of clinical interactions. METHODS: Cross-sectional survey of 8638 Kaiser Permanente Northern California patients with diabetes. Patient responses were used to define English proficiency…
CONTEXT: Nonadherence to statin therapy is associated with poor cardiovascular outcomes. OBJECTIVE: We explored factors and perceptions that contribute to statin therapy nonadherence. DESIGN: We conducted a qualitative study that was based on three patient focus groups using a structured…
OBJECTIVE: Reasons for failing to initiate prescribed insulin (primary nonadherence) are poorly understood. We investigated barriers to insulin initiation following a new prescription. RESEARCH DESIGN AND METHODS: We surveyed insulin-naive patients with poorly controlled type 2 diabetes, already treated with…
BACKGROUND: Little is known about drug cost communications of Medicare Part D beneficiaries with chronic conditions such as diabetes. The purpose of this study is to assess Medicare Part D beneficiaries with diabetes' levels of communication with physicians regarding prescription…
BACKGROUND: Many patients with diabetes have poor blood pressure (BP) control. Pharmacological therapy is the cornerstone of effective BP treatment, yet there are high rates both of poor medication adherence and failure to intensify medications. Successful medication management requires an…
BACKGROUND: Colorectal cancer (CRC) is one of the leading causes of cancer-related deaths in the United States. Randomized controlled trials have shown that annual screening fecal occult blood testing (FOBT) reduces CRC mortality and incidence. However, patient compliance with FOBT…
OBJECTIVES: To determine the role of information sources in the treatment decision-making process of men diagnosed with local stage prostate cancer. Diagnosed men have access to a large number of information sources about therapy, including print and broadcast media, the…
PURPOSE: To describe the concerns raised by health plan members, providers and purchasers related to studying the comparative effectiveness of therapeutics using cluster randomized trials (CRTs) within health plans. An additional goal was to develop recommendations for increasing acceptability. METHODS:…
BACKGROUND & AIMS: Little is known about the effects of alcohol use and sociodemographics on the risk of Barrett's esophagus, a precursor to esophageal adenocarcinoma. We evaluated the association between alcohol use, alcohol type, sociodemographic profiles, other lifestyle factors, and…
OBJECTIVE: The goal was to examine the factors influencing parental satisfaction with neonatal intensive care for moderately premature infants in 10 hospitals in Massachusetts and California. METHODS: A total of 677 infants without major anomalies or chromosomal disorders who were…
BACKGROUND: Despite ethical imperatives, informing research participants about the results of the studies in which they take part is not often performed. This is due, in part, to the costs and burdens of communicating with each participant after publication of…
BACKGROUND: The Patient Assessment of Chronic Illness Care (PACIC) has potential for use as a patient-centered measure of the implementation of the Chronic Care Model (CCM), but there is little research on the relationship between the PACIC and important behavioral…
The identification, referral and specific treatment of midlife patients in primary care who are distressed by mood, anxiety, sleep and stress-related symptoms, with or without clinically confirmed menopausal symptoms, are confounded by many structural issues in the delivery of women's…
OBJECTIVE: The incidence of esophageal adenocarcinoma has been increasing rapidly among many countries. Antioxidant intake is a potentially modifiable protective factor, although the results from individual studies are inconclusive. We conducted a systematic review and statistical synthesis of studies that…
There is widespread concern about the ability of the current model of clinical research to keep pace with the growing need for testing new approaches to disease management and prevention. In response, important innovations are emerging in critical areas of…
OBJECTIVE: To evaluate the associations between abdominal obesity and gastro-oesophageal reflux disease (GORD), and their interactions with ethnicity and gender. DESIGN: A cross-sectional study. Participants completed detailed symptom questionnaires and underwent a standardised examination, including anthropometric measurements. SETTING: A large…
We examined the patient activation measure's (PAM's) association with process and health outcomes among adults with chronic conditions. Patients with high PAM scores were significantly more likely to perform self-management behaviors, use self-management services, and report high medication adherence, compared…
OBJECTIVE: We examined factors associated with screening for albuminuria and initiation of ACE inhibitor or angiotensin receptor blocker (ARB) treatment in diabetic patients. RESEARCH DESIGN AND METHODS: We conducted surveys and medical record reviews for 5,378 patients participating in a…
OBJECTIVE: We sought to assess longitudinal association between self-monitoring of blood glucose (SMBG) and glycemic control in diabetic patients from an integrated health plan (Kaiser Permanente Northern California). RESEARCH DESIGN AND METHODS: Longitudinal analyses of glycemic control among 1) 16,091…
PURPOSE: For depressed older primary care patients, this study aimed to examine (a) characteristics associated with depression treatment preferences; (b) predictors of receiving preferred treatment; and (c) whether receiving preferred treatment predicted satisfaction and depression outcomes. DESIGN AND METHODS: Data…
BACKGROUND: Postpartum hospital stays seem likely to remain limited even under new laws which mandate that insurers cover 48-hour hospitalization after uncomplicated delivery. Clinicians, who are increasingly practicing in capitated arrangements, need better information to maximize clinical benefit to mothers…
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