Katharine Bradley, MD, MPH

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"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

Steel TL, Bradley KA. Improving Care for Inpatient Alcohol Withdrawal Syndrome: Addressing the Lack of Rigorous Research on a Common Condition. Ann Am Thorac Soc. 2021;18(10):1622-1623. doi: 10.1513/AnnalsATS.202105-591ED. PubMed

Matson TE, Bradley KA, Lapham GT. Self-reported practices of frontline cannabis dispensary workers and the implications for clinicians. JAMA Netw Open. 2021;4(9):e2125262. doi: 10.1001/jamanetworkopen.2021.25262. PubMed

Hallgren KA, Matson TE, Oliver M, Witkiewitz K, Bobb JF, Lee AK, Caldeiro RM, Kivlahan D, Bradley KA. Practical assessment of alcohol use disorder in routine primary care: performance of an alcohol symptom checklist. J Gen Intern Med. 2021 Aug 16. doi: 10.1007/s11606-021-07038-3. [Epub ahead of print]. PubMed

Bagley SM, Chavez L, Braciszewski JM, Akolsile M, Boudreau DM, Lapham G, Campbell CI, Bart G, Yarborough BJH, Samet JH, Saxon AJ, Rossom RC, Binswanger IA, Murphy MT, Glass JE, Bradley KA. Receipt of medications for opioid use disorder among youth engaged in primary care: data from 6 health systems. Addict Sci Clin Pract. 2021;16(1):46. doi: 10.1186/s13722-021-00249-3. PubMed

 

Research

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Increasing opioid use disorder treatment in primary care

A trial led by KPWHRI researchers found that adding nurse care managers helped more people get needed treatment.

Research

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Is medical use of cannabis as risky as nonmedical use?

New findings indicate medical cannabis use is associated with a lower risk of moderate to severe cannabis use disorder.

New findings

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Better tools for assessing substance use disorder

A simple checklist developed at KPWHRI does well at measuring symptoms of substance use disorder.

Research

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Better care for patients who drink alcohol

A new primary care approach improves alcohol-related preventive care as well as care for alcohol use disorder.

KPWHRI In the Media

Kathy Bradley on implementing universal alcohol screening as part of routine care

NIAAA releases new materials to screen and treat alcohol use disorder as alcohol-related deaths spiked

GIST Healthcare, June 6, 2022