Select LHS Program projects

KPWHRI researchers team up with partners from care delivery to present their collaborative work at an LHS Program All Hands event.

Research-care delivery partnerships in action

Developing, testing, and spreading a whole-person approach to managing chronic pain

The LHS Program is leading an Integrated Pain Management Program Pilot that aims to provide safe alternatives to opioids and increase the use of evidence-based, patient-centered non-pharmacologic approaches to chronic pain. Specific program objectives include:

• Designing a scalable primary care-based pain management approach to improve care for people with chronic pain
• Implementing and evaluating the approach in a pilot at 3 regional medical centers
• Using findings to spread successful components of the program across Kaiser Permanente Washington

Our recent project milestones include establishing a Patient Partner group that will work with us to co-develop tools to support member education and care conversations about opioids and non-opioid alternatives to pain management. We’re also making progress on adapting all the workflows and resources we're developing for use in a virtual care environment.

Creating value for our members through advanced analytics

Predictive analytics can improve clinical and operational decision making by identifying meaningful patterns in complex electronic health record (EHR) and claims data. The LHS Program brings scientists together with care delivery partners to design and implement predictive models to improve outcomes such as flu vaccination among high-risk members.

During the 2018/19 flu season, and LHS Program team piloted a predictive risk model to identify members who were at high risk for influenza-related complications, followed by outreach to encourage vaccination for these members. This brief, low-cost, targeted intervention was associated with increased vaccine uptake among high-risk patients. Based on these findings, Kaiser Permanente Washington has adopted this intervention systemwide. (See story by KING 5 News, Dec. 2, 2019.)

When COVID-19 hit, we leveraged our analytics capabilities to support Kaiser Permanente Washington's rapid response to the pandemic. Utilizing existing infrastructure from our flu vaccination intervention, we were able to rapidly deploy outreach efforts to Medicare members to make sure their care needs were being addressed. We then quickly expanded this to include outreach efforts to non-Medicare members with complex medical and social needs and other chronic conditions. Most recently, we launched work to identify member characteristics that might help us understand patterns of delaying care due to fear of contracting COVID-19 during the height of the pandemic. 

Through the LHS Program, other predictive models have been developed to:

• Prevent hospitalizations
• Avoid missed appointments
• Promote advanced care planning
• Provide services to members at high risk for suicide attempt
   

Supporting innovative design in new clinics with a member-centered, data-driven approach

Integrating high-quality mental health care into primary care for adolescents

Working with leaders and clinicians from Pediatrics, Family Practice, and Mental Health and Wellness, the LHS Program is developing and pilot testing an integrated approach to improving child and adolescent mental health care across Kaiser Permanente Washington. Our team is working with teen members, parents of teen members, and care teams at 3 primmary care clinics to design workflows for integrating mental health needs into primary care for members age 13 to 17.

Post-COVID, our project team developed a virtual approach for gathering teens' and parents' perspectives on mental health needs and have launched a series of 1:1 interviews by phone or video. Our next step is to launch a local implementation team at each of our 3 partner clinics. These teams will include clinic leaders and a primary care team members who will work with an LHS practice facilitator to develop, test, and refine the new workflows.

One key piece of work on the horizon is to apply user-centered design (UCD) techniques to help ensure our draft workflows meets the needs of both our teen members and our care teams. In the coming weeks, we'll launch UCD focus groups with teens, as well as UCD sessions with our 3 local implementation teams.
 

Improving access and service by optimizing the Community Resource Specialist (CRS) role

Kaiser Permanente Washington's new CRS role has been making a difference for our members since the original pilot study that launched the role several years ago. Across all our primary care clinics, CRSs are available to provide brief health and wellness support to members and to connect them to community-based resources to help meet social needs around things like housing, transportation, parenting support, and healthy food access. (Learn more in this blog post by CRS assistant manager and LHS partner Cindee DeWitt: Partnering with research, CRS program addresses social needs in primary care.)

Through the LHS Program, implementation scientists at KPWHRI worked with behavioral health experts at Kaiser Permanente Washington to define the core components of the CRS role, support its implementation through practice facilitation and technical assistance, and document best practices and scale-up strategies. 

The LHS Program team is also evaluating the impact of the CRS service on patient and care team outcomes. The goal of the evaluation is to use lessons learned to enhance program effectiveness at scale and to inform ongoing decision-making about the CRS program.

Contact us

For more information about Kaiser Permanente Washington's Learning Health System Program, please email us at KPWALHS@kp.org.