December 10, 2018

Kaiser Permanente Washington research tackled problems like obesity, suicide—and care that doesn’t promote health

It’s been a productive year for Kaiser Permanente Washington Health Research Institute (KPWHRI), but we didn’t do it alone: Our work is strengthened by a wealth of collaborations, including with the University of Washington (UW) and the seven other Kaiser Permanente research centers across the country. In 2018, we hosted AcademyHealth’s national meeting, the Learning Health System (LHS) Program kept driving continuous learning between our region’s research and care delivery, and helped improve health in many ways.  Here are just 10:

1. Weight-loss surgery benefits abound

Two large bariatric-surgery collaborations bore fruit. In the Health Care Systems Research Network (HCSRN) study of people with diabetes and severe obesity, bariatric surgery was linked to far lower rates of various diabetes complications, including heart attacks, strokes, and deaths—as well as small-blood-vessel diseases of the eyes, kidneys, feet, and hands (watch video). And the National Patient-Centered Clinical Research Network (PCORnet) Bariatric Study associated bypass and sleeve gastrectomy (but not adjustable gastric banding) with similarly large, long-term weight loss in teens—and linked gastric bypass surgery to more long-term weight loss than sleeve or (especially) band in adults (watch video). Study leader David Arterburn, MD, MPH, was widely quoted in the news media.

2. Low-value care isn’t worth doing

We identified several tests that don’t improve health. For instance, compared to mammography alone, screening breast MRI led to more biopsies, finding fewer cancers, regardless of personal history of breast cancer, in a Breast Cancer Surveillance Consortium (BCSC) study led by Diana Buist, PhD (profiled here). Women with simple ovarian cysts were not at increased risk of ovarian cancer and don’t need follow-up imaging, according to a study led by Diana Miglioretti, PhD (profiled here). Gaia Pocobelli, PhD, and Sascha Dublin, MD, PhD (watch video), discovered that switching to a new screening approach increased diagnoses without improving health outcomes. So Kaiser Permanente Washington switched back. And Michael Parchman, MD, MPH, is leading Taking Action on Overuse to help health care teams stop providing low-value care.

3. To help prevent suicide, we worked on predicting it

A Mental Health Research Network study combined data from electronic health records with results from standardized depression questionnaires to predict suicide risk after mental health specialty and primary care outpatient visits. The goal is to target those who need interventions most, according to study leader Greg Simon, MD, MPH (profiled here).

4. Community resource specialists help our patients

The Learning to Integrate Neighborhoods and Clinical Care (LINCC) study, led by Clarissa Hsu, PhD, has ended, but it recently reported its results: A new community health worker role, developed with input from various stakeholders, helps patients to connect with community resources and meet behavioral and social needs that affect their health. As all our primary care clinics get community resource specialists, the LHS Program is providing comprehensive implementation support and evaluating clinic and patient outcomes.

5. Kaiser Permanente improves the health of the communities we serve

Allen Cheadle, PhD, and Elena Kuo, PhD, MPH, spent much of the past decade evaluating Kaiser Permanente’s Community Health Initiatives. In 2018, the Center for Community Health and Evaluation (CCHE) team produced a 12-article report on these efforts to improve health outcomes and prevent obesity in 60 U.S. communities. Also this year, Maggie Jones, MPH, succeeded Dr. Cheadle as CCHE director.

6. Kaiser Permanente promotes gun safety

David Grossman, MD, MPH, is co-leading Kaiser Permanente’s new Task Force on Firearm Injury Prevention. Kaiser Permanente has invested $2 million in research to prevent gun injuries and death. Gun safety is crucial for families with high-risk teens, according to Dr. Grossman, because most parents of teens with depression and substance abuse don’t store guns safely.

7. Living lab sheds more light on aging

The Adult Changes in Thought (ACT) study continued to be a rich resource for collaborations studying resilience and ways to avoid Alzheimer’s disease and other dementias. The joint UW–KPWHRI study of Kaiser Permanente Washington patients age 65 and older includes inquiries into brain MRI scan data, possible effects of air pollution (watch video), eye conditions that may help screen for Alzheimer’s disease (watch video), and what patients understand about dementia prevention (watch video about the ACT study).

8. Flucasting predicted influenza patterns, and bird flu vaccine trial launched

Michael L. Jackson, PhD, MPH, used his Flucaster model to predict state and national patterns of infection with different influenza strains—with regular updates. Through the LHS Program, he also used predictive analytics to identify patients most likely to need hospitalization—so they could be contacted to come in for their flu shots. And Lisa Jackson, MD, MPH, is leading a national trial to explore improving immune responses to H7N9 bird flu vaccine.

9. We continued to address the opioid crisis

A variety of KPWHRI researchers are working on seeking solutions to stop the opioid epidemic and help patients to find safe, effective ways to manage chronic pain. For instance, Karen Sherman, PhD, found that patient-doctor trust withstood the opioid risk reduction initiative at Kaiser Permanente Washington. And Michael Parchman, MD, MPH, is leading a team-based approach to improving opioid management in primary care.

10. Integrative non-drug therapies treat back pain at reasonable cost

Karen Sherman, PhD, and Dan Cherkin, PhD, produced much of the evidence in an Institute for Clinical and Economic Review (ICER) report about the advantages of integrative non-drug therapies over much conventional medical and surgical treatment for back pain. That report jibed with the internationally focused Lancet Low Back Pain Series, which Dr. Cherkin helped lead.

The year isn’t over yet; there’s more to come. And 2019 will see us host the annual meeting of Kaiser Permanente’s Center for Effectiveness & Safety Research (CESR), launch the statewide CATALyST collaboration to train learning health system researchers, and continue the national Delta Center initiative for value-based payment and care. So here’s to the success we shared with our community in 2018, and to the health we’ll share in many years ahead!

 

By Rebecca Hughes