James D. Ralston, MD, MPH

“My work focuses on helping patients who live with common chronic health conditions.”

James D. Ralston, MD, MPH

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

Biography

James Ralston MD, MPH, is an internal medicine physician and senior investigator in health services and health informatics. His research mission is improving the health and care of patients living with common ongoing illnesses. His current areas of emphasis include understanding and honoring the priorities of patients living with multiple chronic conditions.

Dr. Ralston’s research focuses on developing and evaluating communication technologies that foster continuous care and a closer connection between patients and primary care teams. His commitment to finding effective ways to redesign care spans all stages of research, from project development to complete translation of results into clinical practice.

Examples of Dr. Ralston’s research projects include:

  • The Valuing Important Things in Active Lives (VITAL) study to improve care for people with multiple chronic conditions including diabetes, heart disease, and arthritis. VITAL uses participatory design methods with patients and providers to design and evaluate interactive care plans.
  • The Seeing Priorities study to build and test a single, trusted tool for individuals with multiple chronic conditions that illuminates connections between personal values and chronic illness management. The tool helps visualize, track, and share what matters most for self-management and care. 
  • Understanding and addressing differences in patient use of online health care services that could lead to care disparities.
  • Testing online care management of blood sugar control using an electronic health record shared with patients with type 2 diabetes. Control improved in patients receiving online care management in addition to usual care.
  • Validating and evaluating a clinical tool to identify patients with type 2 diabetes at risk of severe low blood sugar. This national collaboration uses Kaiser Permanente and Veterans Administration electronic health record data and machine learning methods.
  • Testing innovative engagement methods such as photos taken by study participants to document their values to ensure that patient priorities guide self-management plans and clinical care.
  • Working with primary care teams and clinics in rural and underserved areas to improve the care of their patients with chronic conditions.

Dr. Ralston is also a University of Washington affiliate professor in health services and biomedical informatics, where he serves on the committees of PhD and master’s degree students.

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Research interests and experience

Recent publications

Henrikson NB, Blasi PR, Corsmo JJ, Sheffer Serdoz E, Scrol A, Greene SM, Matthews TL, Ralston JD. "You really do have to know the local context": IRB administrators and researchers on the implications of the NIH Single IRB mandate for multisite genomic studies. J Empir Res Hum Res Ethics. 2019 Jul;14(3):286-295. doi: 10.1177/1556264619850440. Epub 2019 May 22. PubMed

Vizer LM, Eschler J, Koo BM, Ralston J, Pratt W, Munson S. "It's not just technology, it's people": constructing a conceptual model of shared health informatics for tracking in chronic illness management. J Med Internet Res. 2019 Apr 29;21(4):e10830. doi: 10.2196/10830. PubMed

Karter AJ, Warton EM, Moffet HH, Ralston JD, Huang ES, Miller DR, Lipska KJ. Revalidation of the hypoglycemia risk stratification tool using ICD-10 codes. Diabetes Care. 2019 Feb 14. pii: dc18-2154. doi: 10.2337/dc18-2154. [Epub ahead of print]. PubMed

O'Leary K, Tanghe D, Pratt W, Ralston J. Collaborative health reminders and notifications: insights from prototypes. AMIA Annu Symp Proc. 2018 Dec 5;2018:837-846. eCollection 2018. PubMed

Tchesnokova VL, Rechkina E, Larson L, Ferrier K, Weaver JL, Schroeder DW, She R, Butler-Wu SM, Aguero-Rosenfeld ME, Zerr D, Fang FC, Ralston J, Riddell K, Scholes D, Weissman S, Parker K, Spellberg B, Johnson JR, Sokurenko EV. Rapid and extensive expansion in the U.S. of a new multidrug-resistant escherichia coli clonal group, sequence type ST1193. Clin Infect Dis. 2018 Jun 29. doi: 10.1093/cid/ciy525. [Epub ahead of print]. PubMed

Aronson S, Babb L, Ames D, Gibbs RA, Venner E, Connelly JJ, Marsolo K, Weng C, Williams MS, Hartzler AL, Liang WH, Ralston JD, Devine EB, Murphy S, Aronson S, Babb L, Ames D, Gibbs RA, Venner E, Connelly JJ, Marsolo K, Weng C, Williams MS, Hartzler AL, Liang WH, Ralston JD, Devine EB, Murphy S, Chute CG, Caraballo PJ, Kullo IJ, Freimuth RR, Rasmussen LV, Wehbe FH, Peterson JF, Robinson JR, Wiley K, Overby Taylor C, eMERGE Network EHRI Working Group. Empowering genomic medicine by establishing critical sequencing result data flows: the eMERGE example. J Am Med Inform Assoc. 2018 May 31. pii: 5026196. doi: 10.1093/jamia/ocy051. [Epub ahead of print]. PubMed

Lim CY, Berry ABL, Hirsch T, Hartzler AL, Wagner EH, Ludman EJ, Ralston JD. Understanding what is most important to individuals with multiple chronic conditions: a qualitative study of patient's perspectives. J Gen Intern Med. 2017 Aug 28. doi: 10.1007/s11606-017-4154-3. [Epub ahead of print]. PubMed

Karter AJ, Warton EM, Lipska KJ, Ralston JD, Moffet HH, Jackson GG, Huang ES, Miller DR. Development and validation of a tool to identify patients with type 2 diabetes at high risk of hypoglycemia-related emergency department or hospital use. JAMA Intern Med. 2017 Oct 1;177(10):1461-1470. doi: 10.1001/jamainternmed.2017.3844. PubMed

Berry A, Lim C, Hartzler AL, Hirsch T, Ludman E, Wagner EH, Ralston J. Creating conditions for patients’ values to emerge in clinical conversations: perspectives of health care team members. DIS (Des Interact Syst Conf). 2017 Jun;2017:1165-1174. doi: 10.1145/3064663.3064669. PubMed

Berry ABL, Lim C, Hartzler AL, Hirsch T, Ludman E, Wagner EH, Ralston JD. Eliciting values of patients with multiple chronic conditions: evaluation of a patient-centered framework. AMIA Annu Symp Proc. 2018 Apr 16;2017:430-439. eCollection 2017. PubMed

 

VITAL Study

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The Valuing Important Things in Active Lives (VITAL) study is a three-year project funded by the Agency for Healthcare Research and quality.

Learn about the VITAL study.

research into communication

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Patients may not be telling their doctors what matters to them most

KPWHRI’s VITAL study discovers six domains that people with chronic illness too rarely discuss with their care providers.

Read about it & watch the video in News and Events.

recent news

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Young adults with cancer speak about balancing hope and risk

The first Clare Project study asked about values and care preferences. Project leaders are now building on that foundation.

Chronic Illness

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New tool pinpoints diabetes patients at highest risk for hypoglycemia

Dr. James Ralston worked with Kaiser Permanente Northern California’s Dr. Andrew Karter and colleagues.

Read it in Healthy Findings.

Studying patient reminders

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REMIND study

The REMIND study is a three-year project to redesign reminders and notifications for patients with chronic and preventive health care needs.