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.
Prevention and treatment
Alcohol and drug use
Alcohol and drug use disorders
Physician decision support; eHealth
Implementation research; quality measurement
Alcohol and drug screening; brief alcohol interventions
Screening and brief intervention; mental health quality measurement
Primary care management of unhealthy alcohol use
Williams EC, Achtmeyer CE, Thomas RM, Grossbard JR, Lapham GT, Chavez LJ, Ludman EJ, Berger D, Bradley KA. Factors underlying quality problems with alcohol screening prompted by a clinical reminder in primary care: a multi-site qualitative study. J Gen Intern Med. 2015 Aug;30(8):1125-32. doi: 10.1007/s11606-015-3248-z. Epub 2015 Mar 3. PubMed
Lapham GT, Rubinsky AD, Shortreed SM, Hawkins EJ, Richards J, Williams EC, Berger D, Chavez LJ, Kivlahan DR, Bradley KA. Comparison of provider-documented and patient-reported brief intervention for unhealthy alcohol use in VA outpatients. Drug Alcohol Depend. 2015 Aug 1;153:159-66. doi: 10.1016/j.drugalcdep.2015.05.027. Epub 2015 May 27. PubMed
Naimi TS, Babor T, Chikritzhs T, Stockwell TR, McCambridge J, Miller P, Xuan Z, Bradley K, Blanchette JG, Kypri K, Saitz R. Let's not "relax" evidence standards when recommending risky preventive therapeutic agents. Alcohol Clin Exp Res. 2015 Jul;39(7):1275-6. doi: 10.1111/acer.12724. Epub 2015 Apr 23.
Roth JA, Bradley K, Thummel KE, Veenstra DL, Boudreau D. Alcohol misuse, genetics, and major bleeding among warfarin therapy patients in a community setting. Pharmacoepidemiol Drug Saf. 2015 Apr 8. doi: 10.1002/pds.3769 [Epub ahead of print]. PubMed
New findings indicate medical cannabis use is associated with a lower risk of moderate to severe cannabis use disorder.
A simple checklist developed at KPWHRI does well at measuring symptoms of substance use disorder.
A new primary care approach improves alcohol-related preventive care as well as care for alcohol use disorder.
Use in pregnancy and screening in primary care studied by KPWHRI’s Kiel, Matson, and Lapham.
GIST Healthcare, June 6, 2022