RESEARCH

The Patient Centered Outcomes Research Institute created a new Health Systems Implementation Initiative (HSII) to accelerate the adoption of scientific evidence into health care practice. Kaiser Permanente Southerna California was selected as 1 of 6 health care systems throughout the U.S. to test the implementation and institutionalization of evidence-based programs for intensive lifestyle weight management in primary care settings. The proposal tests the following two aims: 1. To use a patient and clinician partner-driven process improvement method tested in community1 and healthcare settings2,3 to implement evidence-based strategies for a 12-month virtual intensive lifestyle treatment program in patients having class I obesity (Body Mass Index [BMI] 30 – 34.99 kg/m2) with a focus on those patients who also have uncontrolled type 2 diabetes (T2D; HbA1c> 8). 2. To use data and materials collected from this implementation to create a playbook for the organization to continue the program, institutionalize it for the care of patients with class I obesity, and expand its use in other populations of patients with obesity who are identified as high priorities for the organization (such as to prevent weight regain in patients who have undergone medication or surgical treatment for their obesity and those with multiple chronic conditions for which weight loss would be beneficial).

Depression will be the greatest source of global disease by 2030, affecting Black, Hispanic, and Asian communities. Our work has shown that compared to White patients, Black, Hispanic, and Asian patients were less likely to receive any depression treatment and if treated, less likely to receive a partial or full course of psychotherapy or medication. If patients do not receive treatment, most will not experience improvement or remission of their depression. However, the evidence is not clear about the benefits of a partial vs full course of treatment because real-world population-based studies rarely include the treatment course in outcome analyses. Two important unanswered questions for implementation research on depression treatment disparities are 1) what factors contribute to patients not receiving treatment and 2) if treated, does a partial course confer similar benefits to a full course? We will address these questions by using 1) the NIMHD Framework adaptation for depression that addresses the role of health systems specifically to establish the determinants of disparities in depression treatment and outcomes and 2) a learning health systems approach to ensure our findings have an impact on practice. The following aims will be accomplished with a sample of Black (N=44,934), Hispanic (N=113,207), Asian (N=16,505), and White (N=179,502) patients in 5 health systems in 7 states (CA,TX,GA,MN,MI,ND,WI): AIM 1. Test the factors in the NIMHD Framework for mental health contributing to racial disparities in treatment (none, partial or full course) for patients with moderate-to-severe symptoms of depression; AIM 2. Examine the mediating effect of treatment on racial disparities in improvement and remission of depression symptoms; AIM 3. Address factors in the NIMHD Framework for mental health that cannot be addressed in models for AIM 1 and AIM 2 by incorporating the lived experiences of Black, Hispanic and Asian patients and their providers; and AIM 4. Combine the findings from AIMS 1 – 3 to create a set of recommendations for research and practice to improve depression care in large health settings.

Existing and proposed mental health quality measures may be biased against health systems, facilities, and clinicians serving more Black and Hispanic patients, measuring the patients they serve rather than the quality of care they provide. This research will use detailed records data from five large health systems to evaluate potential biases in existing and proposed measures and evaluate alternatives to reduce biases.

About 20% of US young adults have high blood pressure (BP), however, the optimal BP screening and treatment strategies in young adults are unknown. Many young adults are not aware of their high BP, and are not recommended for BP lowering medication, partly due to the lack of evidence. The overall goal of this study is to determine the optimal BP screening intervals and identify subgroups of young adults with high cardiovascular risk who may benefit most from BP lowering medications.

The current US atherosclerotic cardiovascular disease (ASCVD) risk prediction tools are limited by failing to include data on social determinants of health (SDOH) and important US ethnic groups. The overall goal of this project is to improve ASCVD risk assessment for both primary and secondary prevention by drawing from more contemporary data sources. Results of this study will improve lipid-lowering therapy use and may reduce health inequities.

This study will incorporate the voice of the patient and provider stakeholders as part of the implementation of the Zero Suicide framework in three health settings from the NIMH-funded parent award as well as the Southcentral Foundation which is an Alaska Native-owned, nonprofit health care organization serving nearly 65,000 American Indian/Alaskan Native people living in and around Anchorage, Alaska. Our scientific premise is that by 1) understanding the stakeholder perspective on the role of health systems in opioid-related overdoses, and 2) involving these stakeholders in all aspects of developing strategies that health systems can use to prevent opioid-related overdoses within the implementation of the Zero Suicide framework, we will have a much greater impact on reducing the mortality rates associated with opioid use.

This observational, data-only study will use diagnostic and treatment data from the electronic medical records (EMR) and administrative systems from three Kaiser regions (Northwest, Southern California, and Georgia) including depression screening rates, rates of depression treatment initiation and receipt of different depression treatment services. The overall goal is to examine how race/ethnicity impacts these services. The study aims are: Aim 1: Examine how race/ethnicity impacts receipt of screening for depression in all settings or service types for adults at 3 sites, including examining unadjusted differences, and differences controlling for other patient-level factors (age, socioeconomic status, insurance coverage, other social determinants of health). Aim 2: Controlling for severity of depression symptoms (PHQ-9 category) and other sociodemographic characteristics, do racial and ethnic groups of patients have different patterns of depression diagnosis and treatment initiation compared to White patients? Aim 3: Do racial and ethnic groups of patients who screen positive for depression (PHQ-9 score above 9) have different longer-term outcomes compared to White patients? Aim 4: Explore whether response to depression treatment is associated with treatment outcomes, and whether these outcomes are different for racial and ethnic groups of patients compared to White patients.