Health Services Research studies
A Non-Inferiority Comparative Effectiveness Trial of Home-Based Palliative Care in Older Adults (HomePal)
The aim of this pragmatic trial is to compare the effects of a standard home-based palliative care (HBPC) model to a more efficient tech-supported model that includes remote physician supervision/consultation on patient symptom burden and days spent at home in the last 6 months of life and family caregiving preparedness.
An Evaluation of the National Zero Suicide Model across Learning Healthcare Systems
Our project seeks to develop metrics to measure fidelity and outcomes for the National Zero Suicide Model components implemented in each system using electronic health records and insurance claims data sources that are easily extractable and generalizable to other systems. Then, we propose to use these metrics to conduct fidelity and outcome evaluation of the various Zero Suicide Initiative approaches in each system using Interrupted Time Series Designs, which are among the strongest, pragmatic designs appropriate for evaluating care system intervention and policy changes in ‘Learning Healthcare Systems.’ We hypothesize that the implementation of various National Zero Suicide Model components will significantly reduce suicidal behavior within and across the participating systems. We seek to accomplish the following aims: 1) Collaborate with health system leaders to develop EHR metrics to measure specific quality improvement targets and care processes tailored to local Zero Suicide Initiative implementation; 2) examine the fidelity of the specific Zero Suicide Initiative care processes implemented in each system; and 3) investigate suicide attempt and mortality outcomes within and across Zero Suicide Initiative healthcare system models.
Assessing Telehealth Services for Mental Health and Wellness Care
There is considerable optimism that telehealth – especially telephone and video-based visits – can transform care delivery within Kaiser Permanente (KP) and across the United States. Mental health and wellness is the service line with the greatest potential to realize the benefits of expanding telehealth and transfer learning across service lines and regions. The current project aims to improve our understanding of clinical, technical, and legal barriers and facilitators to telehealth as well as to further our ability to measure telehealth encounters and the relationship between telehealth and face-to-face care.
Care of Mental, Physical, and Substance Use Syndromes (COMPASS)
KPSC is one of nine sites throughout the country funded by an Innovation Award from the Centers of Medicare and Medicaid to implement a coordinated care model for depressed patients with cardiovascular disease. We have the following goals for this project: 1. To implement in three stages a multiple condition collaborative care management model in primary care clinics of care systems in states. 2. To demonstrate that this model improves care quality, patient experience and health, provider satisfaction, and total healthcare costs for the Medicare and Medicaid patients with the targeted conditions. 3. To develop role descriptions and training for the two new types of workers required for this model – care managers and care consultants. 4. To identify the costs and payment models needed by care systems to sustain and spread this care model.
Developing an HIV Specific-Specific Prevention Index Using Electronic Medical Record (HIV PI)
The goals of this study are to assess in HIV-infected patients, the degree of association between successful general clinical care by HIV disease-treating providers (reflected in overall adherence to recommended general prevention and screening guidelines) and higher-quality HIV-specific care and related clinical outcome.
Diagnosis of Hypertension in Specialty Clinics
High blood pressure can be missed in patients who do not have regular visits with their primary care provider. The goal of the present project is to estimate the efficacy of blood pressure assessments in specialty clinics. We will compare recognition, follow-up, and time-to-treatment between patients first recognized in specialty care to those in primary care.
Evaluation of a Remote Blood Pressure Monitoring Program for Hypertension Management
To evaluate a remote blood pressure monitoring (RBPM) program to identify facilitators and barriers to RBPM and ultimately identify opportunities to improve the effectiveness, acceptability, appropriateness, and scalability of the program to lead to better hypertension management in the Kaiser Permanente Southern California hypertension population.
The overall goal of this mixed-method, phased evaluation approach is to document the successes, challenges, and lessons learned from implementation of the Focus Home ecosystem components, and to document the process and outcome measures for key system end-users including patients, family caregivers, and clinicians as the service, IT, and population management data analytical features of the ecosystem goes live over the next two years.
Improving care transitions and reducing readmissions
The SCAL Readmissions Reduction Steering Committee desperately needs ongoing analytical support for data-driven decision making on the provision of care transition services and interventions for the 150K annual discharges from KFH hospitals. Since 30-day readmission rates affect Medicare 5-star ratings and financial penalties, reducing avoidable readmission without causing patient harm is high priority for the organization. Care transition services are often complex and multi-component in nature and are constantly evolving. Evaluation of impact requires significant data curation efforts and advanced statistical methods to assess individual, additive or synergistic effects across the multiple intervention components. Different study designs and analytical methods will be used depending on the specific questions to maximize rigor, e.g. retrospective cohort, econometric approaches. Previous analyses have informed critical operational decisions.
Principal Investigator:Huong Q. Nguyen, PhD, RN
Funding Source:Kaiser Permanente, Southern California
Research Categories:Health Services Research
Kaiser Permanente & Strategic Partners Patient Outcomes Research To Advance Learning, (PCORI/PORTAL Network)
The PORTAL network propose to create a cohort of adults who are overweight or obese, including those who have pre-diabetes or diabetes. The cohort development activity will demonstrate that the PORTAL network is able to meet the 10 criteria for a clinical data research network specified by PCORI.
Mental Health Research Network: Embedded Research in Learning Health Systems (MHRN III)
The overall goal of MHRN is to support population-based research to evaluate and improve delivery of mental health care. The network includes 13 health systems currently part of the Health Care Systems Research Network as well as 8 health systems currently part of the INSIGHT Network (formerly the NYC CDRN of PCORnet). The Administrative Core and Methods Core support a series of research projects (approximately 20 as of this application) using a variety of methods to address a variety of questions. Each of those projects is a distinct activity subject to review and approval by one or more responsible IRBs. The Administrative Core and Methods Core will also conduct routine descriptive analyses of existing electronic records data across all participating health systems – both to monitor quality of research data warehouse tables and to identify trends in diagnosis and treatment of mental health conditions. These descriptive analyses have been performed annually for the last eight years under the previous MHRN cooperative agreements. This new cooperative agreement calls for performing these analyses each quarter.
Optimizing care delivery, quality and outcomes for people living with dementia (PLWD) and their family
We currently do not have a coordinated, effective, and scalable strategy to meet the ongoing medical and social needs of persons living with dementia (PLWD) and their families in KPSC. The goals of this project are: 1) better understand the patterns of diagnosis and care for patients with dementia, mild cognitive impairment and memory loss to identify potential improvement opportunities and 2) to generate preliminary data towards testing an integrated home-based care model for PLWD and their family caregivers.
Patient Perspectives on Clinical Approaches to Prevent Opioid Related Suicide Attempts
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.
Reducing Childhood Obesity through EHR-supported Motivational Interviewing
Rates of childhood obesity in the U.S. remain at historic highs. Primary care settings lack interventions to address the childhood obesity epidemic that are feasible and sustainable without requiring significant resources. We will test a motivational interviewing-based intervention shown to lower children’s BMI in a real-world clinical setting with the goal of halting and reversing the childhood obesity epidemic.
Risk of Cancer in Childhood and Adolescence Associated with Medical Imaging
The goal of this study it to evaluate patterns of medical imaging associated with cumulative exposure to radiation (CT, nuclear medicine, fluoroscopy, angiography, and radiography), and subsequent risk of childhood cancers.
The Virtual Visit for Women with Gestational Diabetes Mellitus (GDM)
This pilot study will address two specific aims: (1) to assess the acceptability of telemedicine technology to conduct virtual office visits alternating with regular office- based prenatal visits for women with GDM from the viewpoint of women with GDM and their health care providers using qualitative research methods, and (2) to assess the feasibility of this telemedicine-based intervention (Virtual Office Visit) for women with GDM. This information was be used to support a larger proposal to obtain funding to conduct a clinical trial to test the proposed intervention after it is refined based on input from patients and health care providers.
Trajectories of Physical Activity and Sedentary Time in Adolescent/Young Women (TAAG 3)
The major goals of this trial are to determine the effectiveness of a school and community-linked physical activity intervention to reduce the decline in physical activity in young women, a cohort who have been followed since middle school.
Translation of a Lung Cancer Palliative Care Intervention for Clinical Practice
The purpose of this study is to test the dissemination of a Palliative Care Intervention (PCI) for patients with non-small cell lung cancer (NSCLC) and their primary family caregivers (FCG)
Understanding the Impact of Increasing Use of Telehealth on Screening for Depression Across Racial and Ethnic Groups
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.
Using Computational Approaches to Optimize Asthma Care Management
This project aims to improve the accuracy of computationally identifying high-risk asthma patients, it’s assess potential impact on outcomes and to provide automated prediction result explanations for care management.