Department of Research & Evaluation News

Kaiser Permanente Southern California’s Department of Research & Evaluation participated in the Health Care Systems Research Network annual conference on May 11 and 12. The conference, “Looking Forward and Embracing Change—Preparedness for the Future During Uncertain Times,”  was held virtually this year after being cancelled in 2020.

Over the course of the 2 days, Research & Evaluation scientists and research support staff presented findings from 5 different research studies. Topics included telehealth utilization during the COVID-19 pandemic, departmental equity, inclusion, and diversity (EID) efforts, and experiences of patients and caregivers enrolled in Kaiser Permanente Southern California home-based care services.

Disparities in outpatient and telehealth visits during the COVID-19 pandemic

Lei Qian, PhD; Stanley Xu, PhD; Lina Sy, MPH; Sungching Glenn; Vennis Hong, MPH; Dennison Ryan, MPH; Kerresa Morrissette, MPH; Steven Jacobsen, MD, PhD

The COVID-19 pandemic prompted a dramatic shift in the way that people receive health care. Outpatient visits became less available while telehealth became the norm. Dr. Lei Qian sought to study how these trends varied across different demographic groups.

“Adults ages 65 years and older had the smallest increase in telehealth visits during the pandemic among all age groups, indicating that greater barriers existed for the senior population to use telehealth services during the pandemic,” Dr. Qian said.

At the same time, the highest increases in telehealth utilization were among Hispanic and low-income patients. Virtual visits increased by over 300% among low-income patients. Dr. Qian suggests that this may be due to the flexibility and low costs associated with telehealth.

The team also studied how the combined number of visits (outpatient plus telehealth) changed through October 2020. While there was a steep drop-off in the combined number of visits in March and April 2020, visits in the Hispanic, non-Hispanic Black, and low-income groups returned to pre-pandemic levels by October.

These findings suggest that Kaiser Permanente Southern California’s robust telehealth services likely reduced some of the pandemic-related barriers to health care. As telehealth continues to expand, further research is needed to make virtual care more accessible to seniors and others who do not use telehealth services often.

Employee-led grassroots initiative in advancing equity, inclusion, and diversity in a health system-based research department: Emergence of the Kaiser Permanente Southern California EID Workgroup

Carol Flores, BA; Bhanuja Dub, MPH; Alejandra Montano, BS; Angelika Alem, MPH; Brian Mittman, PhD; and the Equity, Inclusion, and Diversity (EID) Workgroup Steering Committee

Alongside COVID-19, the murder of George Floyd last spring served as an overdue wake-up call for a much longer-standing pandemic: systemic racism.

Under the leadership of Carol Flores, 7 Research & Evaluation women from historically marginalized communities took this opportunity to write an open letter to department leadership.

The letter spelled out 5 clear objectives to address the need for changes within the department:

• Create an EID action plan
• Form an EID workgroup
• Host EID-focused workshops and seminars
• Conduct intersectional EID research
• Incorporate EID initiatives into department goals

One year later, all objectives have been met. “This has been made possible from the hard work and dedication of our workgroup members,” Flores said, referring to the 50 employees who make up the EID Workgroup.

As a health system-based research center, Research & Evaluation has the power not only to study the way that race impacts health, but also to implement solutions. This grassroots EID initiative has been an inspiring and necessary step in leveraging our department’s role in dismantling systemic racism.

Implementing a qualitative workforce needs assessment to actualize an equity, inclusion, and diversity (EID) workgroup in the Kaiser Permanente Southern California Department of Research & Evaluation

Bhanuja Dub, MPH; Alejandra Montano, BS; Carol Flores, BA

As part of the initial EID Workgroup strategic planning efforts, Bhanuja Dub, Alejandra Montano, and Carol Flores led a needs assessment using a department-wide survey. The survey asked about employees’ current satisfaction with EID-related issues, suggestions for areas of improvement, and interest in participating in and leading EID-related efforts.

Survey results were analyzed and yielded 6 overall departmental goals:

• Increase workforce diversity
• Increase community and stakeholder engagement
• Describe and promote EID research attention and appropriate methods
• Publicize EID-related funding opportunities
• Measure and track health disparities and their determinants through research
• Host EID-related training and events

The needs assessment also guided the creation of the 3 EID Workgroup subcommittees: Capacity Building, Research, and Training and Events.

With goals set and subcommittees established, the department has begun to cultivate more equity, inclusion, and diversity—both within and outside of the workplace.

Experiences of caregivers of persons living with dementia receiving home-based primary care

Jessica Vallejo, MS; Mayra Macias, MS; Maricela Garcia Shiffman, MD; Velda Mowry, NP; Omotayo Omotunde, RN; Soo Borson, MD; Huong Q. Nguyen, PhD, RN

Kaiser Permanente Southern California’s home-based primary care program is an essential benefit for homebound patients, especially for those living with advanced dementia.

As part of Dr. Huong Nguyen’s home-based primary care study, Jessica Vallejo, Mayra Macias, and Huong Nguyen interviewed family caregivers of home-based primary care patients living with dementia. The team aimed to highlight the program’s limitations and strengths from the caregiver perspective.

Most family caregivers (87%) reported that the home-based primary care program met or exceeded their expectations. As far as areas for improvement, several caregivers pointed to the need for more financial support for medical supplies and equipment and more hands-on assistance with day-to-day care activities such as bathing.

But overall, caregivers seemed to be highly satisfied, specifically citing the program’s coordinated, team-based approach and the amount of support provided. “I feel like they’ve got my back,” said the daughter of one patient.

Symptom burden is lower in Asian and Pacific Islander patients admitted to home-based palliative care, but similar among other racial/ethnic groups

Emily Rozema, MPH; Eric Haupt, ScM; Richard A. Mularski, MD, MSHS, MCR; Huong Q. Nguyen, PhD, RN; and the HomePal Research Group

Another home-based service offered by Kaiser Permanente Southern California is home-based palliative care, which is designed for homebound patients with serious illnesses such as cancer, heart failure, and end-stage renal disease.

The Edmonton Symptom Assessment System (ESAS) is a questionnaire used to assess and manage common symptoms of cancer and other serious illnesses. Higher scores indicate more severe symptoms of pain, nausea, depression, etc.

Prior studies have suggested that Black and Hispanic palliative care patients report the highest ESAS scores.

As a sub-study of Dr. Huong Nguyen’s larger home-based palliative care study (HomePal), Emily Rozema examined whether this disparity exists at Kaiser Permanente Southern California. Her team looked at racial and ethnic differences in ESAS scores upon admission to home-based palliative care.

Results showed that ESAS scores of Black and Hispanic patients were comparable to those of white patients. However, Asian and Pacific Islander patients reported much lower symptom frequency and severity than any other racial/ethnic category.

The findings suggest that further research into the drivers of racial and ethnic differences in patient-reported symptoms is warranted.