About the Care Improvement Research Team

The Care Improvement Research Team works to build capacity for research embedded in clinical practice. The team aims to improve access, quality, and affordability of care delivery and the health of patients, families and communities.

Our vision
CIRT’s vision is to be the model for embedded research within a learning health care system.

Our mission
CIRT’s mission is to enhance the health of individuals and populations through systematic study of ways to improve health care delivery.

The Care Improvement Team was founded in 2012 by Kaiser Permanente Southern California. Through CIRT, research scientists partner with frontline clinicians to identify research questions that are important to patients and the health professionals who take care of them. CIRT investigators bring rigor and scientific expertise to the process of improving clinical quality, while clinical partners keep the focus on the burning issues of real-world practice. Our team conducts internally focused research that fulfills a dual mission by simultaneously targeting the practical, operational needs of clinical leaders and creating and sharing generalizable knowledge with the outside world.

For more information, please contact us at CIRT-Group@kp.org.

Scientists

Adam Sharp, MD, MSc (Director)
Jaejin An, PhD
Katia Bruxvoort, PhD, MPH
Kristen Choi, PhD, MS, RN
Karen J. Coleman, PhD, MS
David Glass, PhD
Michael K. Gould, MD, MS
Erin E. Hahn, PhD, MPH
Brian S. Mittman, PhD
Claudia Nau, PhD
Sonya Negriff, PhD
Huong Q. Nguyen, PhD, RN
Kristi Reynolds, PhD, MPH
Amandeep Sahota, MD
Hui Xue, MD, MMSc

Analytic Team-Biostatistics

Ernest Shen, PhD (Biostatistics Lead)
Aileen Baecker, PhD
Brian Huang, MPH
Amy Liu, MS
Yi Luo, PhD, MS
Allen Shu, PhD
Margo Sidell, PhD
Chengyi Zheng, PhD, MS (NLP Specialist)

Analytic Team-Programming

Yi-Lin Wu, MS (Programming Lead)
Aiyu Chen, MPH
Joanie Chung, MS
Eric Haupt, ScM
Benjamin Hong, MS
Bryan Lin, MS
Jessie Liu, MS
Janet Lee Shinn, MS
Hubert Song, MS

 

Research Support

Angel Alem, MPH, MS (Program Manager)
John Chang, MPH
Beth Creekmur, MA
Bhanu Dub, MPH
Edith Fauresviun, MPH
Chunyi Hsu, MPH
Lindsay Joe Lyons, MA
Mayra Macias, MS, CHES
Corrine Munoz-Plaza, MPH
Vicky Musigdilok, MPH
Thearis Osuji, MPH
Ariadna Padilla, MBA
Stacy Park, PhD
Jose Pio, MD, MPH
Dana Pounds, MS
Emily Rozema, MPH
Sally Shaw, DrPH
Jessica Vallejo, MS

Administrative Core

Amy Vo, MBA (Fiscal Lead)
Ma Natalie Firmeza, MA (Administrative Lead)

 

2021 CIRT Proposal Review Process

CIRT project awards range between $20,000 and $100,000 per proposal, and aim to improve quality, affordability, wellness, and equitability. Funding support is generally available for one year. The CIRT team releases a request for proposals annually. The timeline for 2022 proposals is:

  • Letter of Intent announcement: May 2021
  • Letter of Intent due: July 2021
  • Request for full proposal: August 2021
  • Full proposal due: September 2021
  • Review of proposals: September to October 2021
  • Notification of award: November 2021

Eligibility criteria

Any employee of the Department of Research & Evaluation, or any physician associated with SCPMG is eligible to submit a CIRT project proposal. Directors of each division (Behavioral, Epidemiology, Health Services, Clinical Trails) and the Chair of the Regional Research Committee are eligible to nominate at least one CIRT project. Non-scientific staff should identify a scientist or experienced physician investigator to serve as a Co-Principal Investigator and project mentor.

Project timeline

CIRT projects are considered rapid-cycle projects. Funding is generally available for one year of support. It is highly recommended that all study-related activities, including analysis, be completed in the 12-month funding period. Funding extensions will be submitted to the executive sponsors for approval on a case-by-case basis.
For more information, please contact us at CIRT-Group@kp.org.

CIRT annual reports

Read the CIRT 2020 Annual Report.

The following annual reports highlight the team and projects from recent years.

Click each project for more details.

2021 projects

Understanding and supporting COVID-19 vaccine confidence among health care providers at Kaiser Permanente Southern California

Principal investigator: Katia Bruxvoort, PhD, MPH, Division of Epidemiologic Research
As COVID-19 vaccines become available, it is critical for Kaiser Permanente Southern California leaders to listen to health care provider concerns and to build confidence around use of these vaccines. This study aims to do this by gathering data from a range of health care providers early in 2021 and sharing actionable findings to inform development of COVID-19 vaccine web-based trainings, infographics, and/or other interventions as suggested by the data.

The study aims to improve quality by increasing COVID-19 vaccine confidence and uptake among providers so they are better equipped to recommend COVID-19 vaccines to patients. The study also aims to improve equitability, as racial/ethnic disparities are a concern both for vaccine uptake and COVID-19 outcomes.

Study Aims:
1a. Examine health care providers’ perceptions of COVID-19 vaccine effectiveness and safety
1b. Assess health care providers’ willingness to receive a COVID-19 vaccine
1c. Assess health care providers’ willingness to recommend COVID-19 vaccine to patients
2a. Examine drivers of vaccine hesitancy among health care providers
2b. Determine perceived needs for tailored interventions to support confidence in COVID-19 vaccines

Collaborators:
• SCPMG physicians: Bruno Lewin, MD, DTMH; David Bronstein, MD, MS
• Research & Evaluation: Kristin Choi, PhD, MS, RN; Corrine Munoz-Plaza, MPH
• Nursing Research: June Rondinelli, PhD, RN, CNS; Hazel Torres, MN, RN

Piloting approaches to improve cultural sensitivity and humility in the care of patients with depression

Principal investigator: Karen Coleman, PhD, MS, Division of Health Services Research & Implementation Science
Some of the biggest drivers of change at Kaiser Permanente Southern California are the Healthcare Effectiveness Data and Information Set (HEDIS) metrics created and monitored by the National Committee for Quality Assurance (NCQA). There are several behavioral health HEDIS metrics and Kaiser Permanente Southern California consistently underperforms on those dedicated to antidepressant medication management (AMM). This led to lost revenue for the health plan and numerous efforts at remediation that had limited effectiveness

Study Aims:
• To develop a culturally sensitive shared decision-making process for depression treatment options that can be easily implemented in adult primary care; and
• To train therapists and depression care managers to apply cultural humility principles within the feedback informed care initiative.

Collaborators:
• Susan Wang, MD; Medical Director, Shared Decision Making; Medical Director, Life Care Planning; West Los Angeles Medical Center
• Elizabeth Hamilton, LCSW, MPH; Clinical Practice Leader Kaiser Permanente Southern California Regional Behavioral Health Care
• Alisa Aunskul, MSHCM, Senior Consultant, Complete Care Support Programs, Behavioral Health and Depression Care Management
• Rachel Sandoval, Kaiser Permanente Southern California Regional Director Equity, Inclusion & Diversity
• Nabeel Qureshi, MPH, MPhil, Graduate Fellow at the Pardee RAND Graduate School (part of this project will be used for Mr. Qureshi’s doctoral project);
• Melanie Tervalon, MD, MPH, Melanie Tervalon Consulting Services

Kaiser Permanente Southern California member COVID-19 household transmission study

David Glass, PhD, Division of Health Services Research & Implementation Science
This study will help us determine the degree to which sending Kaiser Permanente Southern California members home contributes to the continued spread of COVID-19. Several SCPMG operational actions might result from this study to help reduce the risk of household transmission of COVID-19.
• Algorithm (predictive model) might be developed to alert physicians that certain members are at higher risk of household transmission of COVID-19.
• Physicians or care managers might ask additional questions of those being sent home with COVID-19 to better identify the risk of household transmission for that member.
• Preventive materials like masks, gloves, and information sheets might be immediately shipped and a follow-up call made to help prevent the household spread of COVID-19 in certain high-risk situations.
• Identify situations in which the risk of household transmission is so high that some option other than sending the member home should be considered or explored.

Study Aims:
• Determine the household transmission rate of COVID-19 among Kaiser Permanente Southern California members.
• Identify trend in household transmission and whether it has decreased as protocols were developed and put in place.
• Examine the demographic characteristics of those involved in a household transmission of COVID-19.

Collaborators:
• SCPMG physicians: Bruno Lewin, MD, DTMH; David Bronstein, MD, MS
• Research & Evaluation: Kristin Choi, PhD, MS, RN; Corrine Munoz-Plaza, MPH
• Nursing Research: June Rondinelli, PhD, RN, CNS; Hazel Torres, MN, RN

Enhanced implementation of lung cancer screening and pulmonary nodule evaluation

Principal investigator: Michael K. Gould, MD, MS, Kaiser Permanente Bernard J. Tyson School of Medicine, Department of Health Systems Science
This project builds on ongoing work by the CIRT in collaboration with the Regional Lung Cancer Screening (LCS) Implementation Steering Committee to improve LCS practices for outreach, patient selection, shared decision-making, test ordering, results reporting, and follow-up of abnormal screening test results. Priorities for 2021 include the seamless transfer of data collection responsibilities to the Regional SureNet Program (with NLP support from the SSD team), continued support of the data collection needs of the Regional LCS Steering Committee, and completion of manuscripts that examine (1) the probability of cancer in incidentally detected pulmonary nodules, and (2) utilization and timeliness of pulmonary nodule evaluation. The project is especially well-aligned with the new initiative to reduce mortality from lung cancer as part of the KP National Strategic Plan for Cancer Care.

Study Aims:
• Provide benchmarking data on the utilization, appropriateness and outcomes of lung cancer screening in Kaiser Permanente Southern California members.
• Help to design, implement and evaluate novel systems to improve access to screening, screening test quality and adherence with follow-up evaluations and repeat annual screening.
• Transfer responsibility for data collection and natural language processing to the Regional SureNet Pulmonary Nodule Program and the SSD team led by Dr. Daniel Zisook in San Diego

Collaborators:
• The Regional Lung Cancer Screening Implementation Steering Committee is led by George Yuen, MD (Pulmonary Medicine) and Michael Gould, MD, MS (KPBJTSOM, CIRT), includes representation from Shared Decision-Making, Complete Care, Family Medicine, Pulmonary Medicine, Thoracic Surgery and Medical Oncology.
• The Regional SureNet program: Tim Ho, MD; Dan Zisook, MD; and Royanne Timmons

Venous thromboembolism prevention in high-risk abdominal surgery patients

Principal investigator: Michael K. Gould, MD, MS (Department of Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine)
This project builds on ongoing work by the CIRT in collaboration with the Regional VTE Steering Committee to improve venous thromboembolism (VTE) prophylaxis and patient outcomes, by extending the data collection and analysis to high-risk abdominal surgery patients. Activities in 2021 include designing, implementing and evaluating an intervention of extended duration VTE prophylaxis following abdominal surgery; and designing, implementing and evaluating a novel risk model to guide the use of chemical VTE prophylaxis in patients following non-elective abdominal surgery. This project aligns with longstanding efforts to improve safety for hospitalized patients by focusing on one of the leading preventable causes of iatrogenic death.

Study Aims:
• Implementing and evaluating the use of out of hospital, extended duration (4 weeks) chemical prophylaxis with low-molecular-weight heparin in cancer patients undergoing abdominal surgery
• Implementing and evaluating the use of a novel risk assessment model in patients undergoing non-elective abdominal surgery after being admitted through the emergency department

Collaborators:
• Regional VTE Steering Committee: Luis Moreta-Sainz, MD; Akshay Manek, MD; Daniel Lang, MD; Tim Buhl, PharmD; Antonio McBride, MSN, RN; others
• Regional Chiefs of General Surgery: Philip Mercado, MD
• Regional Chiefs of Surgical Specialties: Steven Crain, MD

Implementing systematic depression screening in medical oncology

Principal investigator: Erin Hahn, PhD, MPH, Division of Health Services Research & Implementation Science
Regional implementation of depression screening in medical oncology will help Kaiser Permanente optimize cancer care and patient outcomes and aligns with regional and national goals to demonstrate excellence in cancer care. The program is addressing a critical gap in our current oncology care program. Up-front identification and referral of distressed patients may positively impact long-term health outcomes.

Study Aims:
Based on results from our pragmatic cluster randomized trial, our overarching aim is to implement systematic depression screening for all newly diagnosed cancer patients within SCPMG. Over the past year we have engaged with clinical and administrative stakeholders to design tailored workflows.
• Design and apply health IT tools to support implementation of the depression screening program.
• Develop and provide ‘train-the-trainer’ programs to local oncology teams and depression care management.
• Complete the staggered rollout of the oncology-based screening program in each oncology site, proactively assessing and addressing barriers to implementation.

Collaborators:
• Regional Chief of Oncology: Farah Brasfield, MD
• Lead Oncology Department Administrator: Olivia Robles, RN, MSN
• Chiefs of Oncology
• Depression Care Management

Developing and testing an equitable risk stratification tool to identify patients for serious illness care in the era of COVID-19

Principal investigator: Claudia Nau, PhD, Division of Behavioral Research
The Care Improvement Research Teams is supporting the Kaiser Permanente Southern California regional Dignified Journey team in evaluating and comparing 2 end-of-life indices currently under consideration for implementation at Kaiser Permanente Southern California. In the process, we develop a play book/template that may support evaluation of future EPIC risk scores without relying on the proprietary built-in validation tools that are not fully transparent.

• We will provide an updated, parsimonious Kaiser Permanente Southern California EOL tool that capitalizes on the strength of both risk scores and input from clinicians and the literature.
• We will provide, to our knowledge, the first EOL decision support tool that accounts for COVID-19.
• Our EOL will be one of the first indices that has been developed to assure that it does not discriminate against people of color. We will further assess if our EOL index can help alleviate • racial/ethnic disparities in LCP/SPC as referrals may be more systematic when assisted by our decision support tool.
• Eventually this tool can help to support a staged approach to serious illness care. It may improve shared decision making, timeliness and access to palliative medicine, and allocation of health care resources.

Study aims::
• Build an advisory group including stakeholders from CMI, clinical analysis and operations leaders who have been previously engaged in developing risk stratification tools for the serious illness population.
• Explore how we can combine existing strategies into a single approach that provides an equitable risk stratification tool that accounts for COVID.
• Pilot the adapted model in one medical center.

Collaborators:
• Research & Evaluation: Huong Nguyen, PhD, RN
• Peter Khang, MD, MPH, FAAP, Regional Chief GPCC, Physician Director, Dignified Journeys
• Susan Wang, MD, FAAHPM, HMDC, Medical Director SCPMG Shared Decision Making, Life Care Planning, and Serious Illness Care
• Lori Viveros, MPH, Regional Director Life Care Planning, GPCC, Administrative Lead Dignified Journeys

Implementation and evaluation of an enhanced Adverse Childhood Experiences (ACEs) screening and referral system in pediatric primary care

Principal investigator: Sonya Negriff, PhD, Division of Behavioral Research
We expect that tailoring the evaluation of ACEs-related need and partnering with community organizations will have an immediate impact by providing the appropriate services to curtail the accumulation of ACEs, which disproportionally affect minority and low-income people. By narrowing outreach and treatment to high-risk children, we will also free resources to strengthen case management for this most vulnerable group.

Study Aims:
• Test a clinically informed individualized approach to screen children with ACEs and identify appropriate services based on type of ACEs and child/family need using a social worker triage system.
• Assess delivery of services for children screening positive for ACEs and effectiveness of a case manager follow-up for referral completion

Collaborators:
• Primary collaborator: Mercie DiGangi, DO, Pediatrics Bellflower MOB
• Other clinical collaborators: Tracy Bush, MSW, LCSW Regional Lead Social Medicine; Christine Hall MD, Chief of Pediatrics Downey Medical Center; Megan Jones, MD, Asst Chief of Pediatric
• Psychiatry, Downey; Claudia Lucio, LCSW Pediatric Social Worker Bellflower MOB.
• R&E: Margo Sidell, PhD, Biostatistician; Karen Coleman, PhD
• Community Partner: Louise Godbold, Director Echo Parenting

To scan or not to scan: Utilization of transient elastography in a tertiary care center before and after implementation of an electronic medical record-based clinical decision support tool

Principal investigator: Amandeep Sahota, MD, Los Angeles Medical Center Transplant Surgery
The Fib-4 Aura-based clinical decision support tool with fibrosis calculator and recommendation guideline is accessible to throughout the Kaiser Permanente system. This study will determine the benefit of Fib-4 Aura-based clinical decision support tool to our members and health care system. This study will identify a path forward for this clinical decision support tool in terms of content, applicability and visibility.

Study Aims:
• Determine the impact of Fib-4 Aura-based clinical decision support tool on management practices for persons aged ≥18 years at KP LAMC between January 2016 – November 2020.
• Determine the demographic and clinical characteristics of this population.
• Determine the impact of Fib-4 Aura-based clinical decision support tool on patient outcomes.

Collaborators:
• Rasham Mittal, MD, Liver Transplant
• Libby Stein, MD, Internal Medicine

Evaluating the impact of high-sensitivity Troponin implementation on patient outcomes and health care utilization for Kaiser Permanente Southern California members

Principal investigator: Adam L. Sharp, MD, MSc, Division of Health Services Research & Implementation Science

This project aims to build off previous improvements in the emergency management of patients with suspected acute coronary syndrome. It is unclear how changing our Troponin testing will impact serious patient outcomes and the world-class care we currently provide. The proposed project will provide the necessary resources to assist with implementation of this large-scale project (physician education, changes to the electronic health record, and evaluation).

Study Aims:
• Compare the impact of hsTn vs cTn decision support algorithm on 30-day outcomes
• Compare the impact of hsTn vs cTn decision support algorithm on hospitalizations and cardiac testing

Collaborators:
• Regional Chiefs: Matt Smith, MD, Emergency Medicine; Tim Cotter, MD, Cardiology; Dan Huynh, MD, Hospital Medicine

Observed role of cooling on hemodynamics in inpatient dialysis (ORCHID)

Principal investigator: Hui Xue, MD, MMSc, Nephrology, San Diego Medical Center
If inpatient cooled dialysate is found to be effective in preventing intradialytic hypotension, we can encourage medical centers to set their default HD temperature to 35.5 degrees C to improve clinical outcomes and reduce costs associated with IDH. If cooled dialysate is ineffective in preventing intradialytic hypotension, we can cease this practice and improve patient comfort.

Study Aims:
• To establish baseline frequency and impact of intradialytic hypotension during hemodialysis performed in acute inpatient setting using dialysate at 37°C
To monitor if dialysate cooling to 35.5°C can reduce the occurrence of intradialytic hypotension, and the frequency of using corrective measurements, such as albumin or hypertonic and impact on average hospital stay days, overall 30 day rehospitalization rate, and mortality rate

Collaborators:
• Behzad Alimohammadi, MD, and Stephanie Cheung, MD

2020 projects

Optimizing care delivery, quality, and outcomes for people living with dementia (PLWD) and their family

Principal investigator: Huong Q. Nguyen, PhD, RN
Despite Kaiser Permanente Southern California’s imperative to reduce avoidable emergency departments visits and admissions for ambulatory care sensitive conditions, very little if any attention has been given to evaluating effective models of proactive and coordinated care for high risk, homebound members with advanced dementia and multiple chronic conditions. This study aims to investigate the uptake of home-based primary care and hospital at home services by a unique and hard to reach population of geographically remote patients/caregivers, and to better understand the patterns of health care utilization and outcomes for the entire community of Kaiser Permanente Southern California members with Alzheimer’s disease-related dementias and memory loss to identify other potential improvement opportunities.

Implementing systematic depression screening in medical oncology

Principal investigator: Erin Hahn, PhD, MPH
Implementing systematic depression screening in medical oncology is an evidence-based guideline-recommended practice, and our recent pragmatic trial found that we can integrate this practice with minimal workflow disruption while effectively identifying and referring highly distressed patients. Regional implementation of depression screening in medical oncology will help our region optimize cancer care and patient outcomes and aligns with our regional and national goals to demonstrate excellence in cancer care.
With CIRT funding and support, and the partnership of the SCPMG oncology chiefs, we set out to spread the screening intervention across SCPMG medical centers, leveraging the lessons learned in the randomized trial. Critical elements of the screening program include adaptable workflow design, assignment of accountable staff, and audit and feedback of performance data. Using resources and tools developed during the trial, which include detailed guidance on screening, scoring, and referral processes and supportive training materials, we will use implementation science methods to guide the spread of this effective practice.
This project includes 2 arms:
1. Engage in implementation planning with key stakeholders (department administrators, oncology social workers, nursing teams, oncologists, quality leaders) to develop an implementation blueprint for regional rollout. This includes working with Quality and Complete Care teams to develop POE reminders and tracking.
2. Lead a staggered rollout of the oncology-based screening program in partnership with oncology DAs, proactively assessing and addressing barriers to implementation. We will evaluate uptake and fidelity of the screening program over a 12-month period.

Evaluating the impact of high-sensitivity troponin implementation on patient outcomes and health care utilization for Kaiser Permanente Southern California members

Principal investigator: Adam Sharp, MD, MS
This project aims to build off previous improvements in the emergency management of patients with suspected acute coronary syndrome. It is unclear how changing our Troponin testing will impact serious patient outcomes and the world class care we currently provide. This project provides the necessary resources to assist with implementation of this large-scale project (physician education, health connect changes, and evaluation).

Enhanced implementation of lung cancer screening

Principal investigator: Michael Gould, MD, MS
This project builds on ongoing work by the CIRT in collaboration with the Regional Lung Cancer Screening (LCS) Implementation Steering Committee to improve LCS practices for outreach, patient selection, shared decision-making, test ordering, results reporting, and follow-up of abnormal screening test results. The overarching goals of the program are to: (1) reduce inappropriate use of screening among Kaiser Permanente Southern California members who do not meet standard eligibility criteria and are unlikely to benefit; and (2) improve access to and the effectiveness of LCS among individuals who are at high risk for death from lung cancer and therefore most likely to benefit. The project is especially well aligned with the new initiative to reduce mortality from lung cancer as part of the Kaiser Permanente National Strategic Plan for Cancer Care.

Developing methods to improve access to behavioral health care services using patient-reported outcomes

Principal investigator: Karen Coleman, PhD, MS
In response to the increasing demands for behavioral health care services at KPSC, the Department of Behavioral Health has implemented a program called Kaiser Permanente External Provider (KPEP) using the composite Behavioral Health Index (BHI) from a patient-reported outcomes collection platform to direct patients to the level of care they need based upon their condition acuity. Although the algorithm has been implemented, its validity and clinical utility has not been evaluated and the symptom acuity cut-offs used for triage have a limited empirical basis, and the BHI is not used anywhere outside of Behavioral Health and has not been directly linked to instruments which other departments use for treatment decisions (i.e. the Patient Health Questionnaire [PHQ9]).

This project has the potential to affect clinical operations in the following ways: 1) it will insure that patients with mental health conditions receive the best treatment tailored for their needs improving satisfaction with care; 2) it will reduce the access burden in Behavioral Health and improve enrollment rates in the depression care management program, Center for Healthy Living stress management and wellness classes, and the Center for Healthy Living wellness phone coaching program; and 3) it will ensure that Kaiser Permanente Southern California meets and/or exceeds the new HEDIS Depression Remission and Response targets when they are publicly reported in 2021.

Improving care transitions and reducing readmissions

Principal investigator: Huong Q. Nguyen, PhD, RN
This project is evaluating the effectiveness of interventions/services to improve care transitions and reduce avoidable readmissions. These findings will contribute to health system efforts to maintain high Medicare star ratings and lower financial penalties for KPSC.

The study aims to:
1. Determine which subgroup of patients benefit most (lower 30-day inpatient and observation stay readmission) from the current post-discharge telephone calls and follow-up clinic visits
o Explore which patients are most appropriate for clinic vs. video vs. phone visits
2. Collaborate with heart failure TCP champions to evaluate the effects of de-implementing the routine 2-day home health visit post discharge
o Assess opportunities to improve care transition for patients with heart failure
3. Determine patterns of care transition interventions that is associated with reduced 30-day readmission and mortality for patients with sepsis
4. Determine the impact of on-demand physician consultation for home health RNs on patient use of urgent care services, ED visits and hospitalizations while receiving home health services.
o Describe the classes of acute issues escalated and/or resolved by the MD consultation service
o Determine subgroups of patients who would benefit most from this service

Prevention in high-risk abdominal surgical patients

Principal investigator: Michael Gould, MD, MS
This project builds on ongoing work by the CIRT in collaboration with the Regional VTE Steering Committee to improve venous thromboembolism (VTE) prophylaxis and patient outcomes, by extending the data collection and analysis to high-risk abdominal surgery patients. The project involves retrospective analysis of observational data to identify VTE risk factors, measure adherence with recommended VTE prophylaxis, and examine VTE outcomes in two subpopulations prioritized by the regional chiefs of General Surgery as one of their chiefs’ goals for 2020-2021: (1) patients undergoing abdominal surgery for cancer; and (2) abdominal surgery patients admitted through the emergency department. This project aligns with longstanding efforts to improve safety for hospitalized patients by focusing on one of the leading preventable causes of iatrogenic death.

Evaluating the impact of implementing an age-adjusted D-dimer threshold for emergency department encounters with patients suspected for pulmonary embolus

Principal investigator: Adam Sharp, MD, MS
This project aimed to help SCPMG to understand the impact of changing the reported reference threshold for D-dimer values on patient outcomes and care efficiency. The team investigated whether KPSC laboratory D-dimer thresholds for patients over age 50 years impacted 30-day patient outcomes or use of advanced diagnostic imaging. Study findings indicate that increasing the D-dimer lab threshold was safe and did NOT increase 30-day adverse events; and advanced imaging declined post intervention, but not significantly. This indicates an opportunity for improvement with future implementation strategies.

Developing guidance for embedded research on adaptable, multi-component interventions

Principal investigator: Brian Mittman, PhD
This project builds on two CIRT-hosted research expert conferences to produce practice-relevant guidance and tools for use by CIRT scientists and their KPSC operational partners to improve our design, evaluation and refinement of multi-component adaptable healthcare innovations (e.g., health promotion and chronic disease management programs, readmissions reduction and palliative care programs).

The guidance and tools produced through this project are expected to enhance our ability to design and deploy more effective programs for improving KPSC clinical care and performance in all areas for which multi-component, adaptable interventions are used, including KPSC work to improve performance on key quality measures, to achieve regional Chiefs’ goals, to reduce patient safety risks, and other benefits.

Adapting and implementing an integrated care model for youth with autism spectrum disorder and psychiatric comorbidity: Phase 3

Principal investigators: Karen J. Coleman, PhD, MS and Brian Mittman, PhD

The project is designed to conduct a feasibility trial to address two main issues in the treatment of children with autism spectrum disorder (ASD): 1) children with ASD have high rates of co-occurring mental health conditions that if left untreated, could interfere with their response to treatment for their ASD; and 2) healthcare systems typically demonstrate poor coordination between service systems and providers to identify co-occurring mental health needs and to support access to appropriate mental health treatment in a timely fashion.

The operational impact of this project is to improve access to mental health services for children with ASD so that the California state-mandated treatment for ASD is as effective as possible. More effective treatment of co-morbid mental health conditions could result in a need for less intensive ASD treatment and thus potentially cost saving for the organization.