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

Glass JE, Bobb JF, Lee AK, Richards JE, Lapham GT, Ludman E, Achtmeyer C, Caldeiro RM, Parrish R, Williams EC, Lozano P, Bradley KA. Study protocol: a cluster-randomized trial implementing Sustained Patient-centered Alcohol-related Care (SPARC trial). Implement Sci. 2018;13(1):108. doi: 10.1186/s13012-018-0795-9. PubMed

Lapham GT, Lee AK, Caldeiro RM, Glass JE, Carrell DS, Richards JE, Bradley KA. Prevalence of behavioral health conditions across frequency of cannabis use among adult primary care patients in Washington state. J Gen Intern Med. J Gen Intern Med. 2018 Nov;33(11):1833-1835. doi: 10.1007/s11606-018-4558-8. PubMed

Williams EC, McGinnis KA, Edelman EJ, Matson TE, Gordon AJ, Marshall BDL, Bryant KJ, Rubinsky AD, Lapham GT, Satre DD, Richards JE, Catz SL, Fiellin DA, Justice AC, Bradley KA. Level of alcohol use associated with HIV care continuum targets in a national U.S. sample of persons living with HIV receiving healthcare. AIDS Behav. 2018 Jul 9. pii: 10.1007/s10461-018-2210-6. doi: 10.1007/s10461-018-2210-6. [Epub ahead of print]. PubMed

Williams EC, McGinnis KA, Bobb JF, Rubinsky AD, Lapham GT, Skanderson M, Catz SL, Bensley KM, Richards JE, Bryant KJ, Edelman EJ, Satre DD, Marshall BDL, Kraemer KL, Blosnich JR, Crystal S, Gordon AJ, Fiellin DA, Justice AC, Bradley KA. Changes in alcohol use associated with changes in HIV disease severity over time: a national longitudinal study in the Veterans Aging Cohort. Drug Alcohol Depend. 2018 May 24;189:21-29. doi: 10.1016/j.drugalcdep.2018.04.022.[Epub ahead of print]. PubMed

 

Research

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HEAL responds to double crisis: Opioids and COVID-19

Health care is increasingly online—KPWHRI is studying telehealth options for opioid use disorder and chronic pain.

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Stopping the opioid epidemic: A KPWHRI priority

The latest on our research on chronic pain and opioids—and how the results influence health policy and clinical practice.

news release

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NIH awards over $15 million in HEAL grants to KPWHRI

Drs. DeBar, Bradley, and Sherman lead projects in initiative to tackle opioid crisis.

behavior change

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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. 

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.