Katharine Bradley, MD, MPH

Bradley_Katharine_A_205x293.jpg

"Our research develops ways that health care systems can use to help people avoid harm due to unhealthy alcohol and drug use—from prevention to treatment."

Katharine A. Bradley, MD, MPH 

Senior Investigator, Kaiser Permanente Washington Health Research Institute
Physician, Washington Permanente Medical Group, Internal Medicine

Biography

Kathy Bradley, MD, MPH, is a general internist whose research focuses on identifying and addressing alcohol and other substance use in primary care. For over 25 years, Dr. Bradley has conducted research that is having a lasting impact on how medical providers approach prevention and treatment of alcohol and substance use disorders. She joined Kaiser Permanente Washington Health Research Institute (KPWHRI) in 2011.

Foundational work on unhealthy alcohol use conducted in the VA.  While at the Veterans Affairs (VA) Puget Sound Health Care System, Dr. Bradley tested ways to efficiently identify unhealthy alcohol use. Her team validated the “AUDIT-C” three-item alcohol screen and a single-question screen in VA and non-VA patients. She was instrumental in helping to implement alcohol screening and brief alcohol counseling at more than 900 VA sites nationwide using performance measures and decision support in the VA's electronic health record (EHR).  Her team also linked high AUDIT-C scores with adverse health outcomes, hospitalizations, surgical complications and post-operative health care utilization, and mortality.  More recently, she and her team have demonstrated that changes in AUDIT-C scores are associated with changes in health outcomes, suggesting that AUDIT-C scores might be useful as a “vital sign” to monitor drinking over time.

Innovations to support management of alcohol use disorders in primary care. Over the past decade, Dr. Bradley has worked on management of alcohol use disorders (AUDs) in primary care. She led the National Institutes of Health's National Institute on Alcohol Abuse and Alcoholism (NIAAA) study on collaborative care for primary care patients with unhealthy drinking. This CHOICE trial (Considering Healthier Drinking Options in Collaborative Care) demonstrated that the CHOICE model of nurse care management increased the proportion of patients who took medications for alcohol use disorders, but did not improve drinking outcomes. In 2014, with her clinical partners at Kaiser Permanente Washington, she obtained a Partnership for Innovation grant (the 3:30 Project) to test proactive outreach, using an EHR registry, from primary care teams to patients with alcohol or drug use disorders, aiming for 3 visits in 30 days.  In addition, her team recently developed a patient decision aid for shared decision-making about AUDs, in the Options study funded by NIAAA.

Implementing sustained care for the full spectrum of unhealthy alcohol use in primary care. The Agency for Healthcare Research and Quality (AHRQ) funded Dr. Bradley’s team to conduct the SPARC (Sustained Patient-centered Alcohol-related Care) trial, which ended in 2018. Across all 22 primary care clinics within Kaiser Permanente Washington, SPARC tested state-of-the-art strategies for implementing alcohol screening, brief alcohol counseling, and shared decision-making for patients with AUDs.  An innovative element of the implementation was that a handout and video addressed stigma as part of the implementation.  Analyses on whether the trial increased preventive alcohol-related discussions and treatment of AUDs are in progress, but SPARC succeeded in implementing high rates of routine alcohol screening (87 percent of patients) and asking patients who report high-risk drinking about alcohol-related symptoms (74 percent).  

Leading an innovative pragmatic trial as part of NIDA’s CTN. Dr. Bradley is also a multiple principal investigator of the Health Systems Node of the National Institute on Drug Abuse (NIDA) Clinical Trials Network (CTN), along with Drs. Connie Weisner and Cynthia Campbell at Kaiser Permanente Northern California. Dr. Bradley leads the CTN PROUD (Primary care Opioid Use Disorders) trial, a pragmatic implementation trial of the Massachusetts Model of Office Based Addiction Treatment for opioid use disorder in primary care across six diverse health systems in Texas, Florida, Michigan, New York, and Washington state. She also co-leads, with Gwen Lapham, PhD, MPH, MSW, a study using EHR data to study medical cannabis. 

Mentoring the next generation of innovative investigators in implementation research. Dr. Bradley is also supported half-time by NIAAA to mentor early-career clinician-researchers interested in improving care for unhealthy alcohol use and is an affiliate professor of medicine and health services at the University of Washington.  Current mentees include Joseph Glass, PhD, MSW, who is studying implementation of mobile health applications for alcohol and other substance use disorders in medical settings and Dr. Lapham, studying implementation of high-quality alcohol and substance use care for adolescents as well as developing EHR measures for medical cannabis.

RESEARCH INTERESTS AND EXPERIENCE

  • Implementation Research

    Screening and brief intervention; mental health quality measurement

  • Chronic Illness Management

    Primary care management of unhealthy alcohol use

Recent publications

Frost MC, Glass JE, Bradley KA, Williams EC. Documented brief intervention associated with reduced linkage to specialty addictions treatment in a national sample of VA patients with unhealthy alcohol use with and without alcohol use disorders. Addiction. 2019 Oct 22. doi: 10.1111/add.14836. [Epub ahead of print]. PubMed

Steel TL, Malte CA, Bradley KA, Lokhandwala S, Hough CL, Hawkins EJ. Prevalence and variation of clinically recognized inpatient alcohol withdrawal syndrome in the Veterans Health Administration. J Addict Med. 2019 Oct 11. doi: 10.1097/ADM.0000000000000576. [Epub ahead of print]. PubMed

Williams EC, Bobb JF, Lee AK, Ludman EJ, Richards JE, Hawkins EJ, Merrill JO, Saxon AJ, Lapham GT, Matson TE, Caldeiro R, Greenberg DM, Kivlahan DR, Bradley KA. Effect of a care management intervention on 12-month drinking outcomes among patients with and without DSM-IV alcohol dependence at baseline.  J Gen Intern Med. 2019 Aug 20. doi: 10.1007/s11606-019-05261-7. [Epub ahead of print]. PubMed

Richards JE, Bobb JF, Lee AK, Lapham GT, Williams EC, Glass JE, Ludman EJ, Achtmeyer C, Caldeiro RM, Oliver M, Bradley KA. Integration of screening, assessment, and treatment for cannabis and other drug use disorders in primary care: an evaluation in three pilot sites. Drug Alcohol Depend. 2019 Jun 8;201:134-141. doi: 10.1016/j.drugalcdep.2019.04.015. [Epub ahead of print]. PubMed

 

news release

NIH-OCPL-HEAL-Initiative-image_1col.jpg

NIH awards KPWHRI 3 HEAL grants totaling over $15 million

Drs. DeBar, Bradley, and Sherman will lead projects in major new initiative to tackle national opioid crisis.

behavior change

female-doctor-explains-male-patient-1col.jpg

Patient-centered care for alcohol use disorders

Sharing CHOICE trial results, KPWHRI takes next steps to advance research on alcohol-related care at Kaiser Permanente Washington and beyond. 

behavioral health

BHI-Tacoma-South-staff_1col.jpg

BHI: Easier access, better care, less stigma

Clinicians and staff at Tacoma South describe the many ways Behavioral Health Integration is making a difference for patients

Recent News

Kaiser Permanente researchers explore patients’ marijuana use

Routinely asking about cannabis use can better serve patients by helping clinicians start conversations about risks and benefits.

Read it in News and Events.

healthy findings blog

santino-telles-1col.JPG

Behavioral Health Integration: Empowered medical assistants are at the forefront

Medical Assistant Santino Telles describes an initiative that’s improving patients’ lives — while increasing his joy and pride in his work.    

Read it in Healthy Findings