RESEARCH

The aim of this pragmatic trial is to compare the effects of a standard home-based palliative care (HBPC) model to a more efficient tech-supported model that includes remote physician supervision/consultation on patient symptom burden and days spent at home in the last 6 months of life and family caregiving preparedness.

Our project seeks to develop metrics to measure fidelity and outcomes for the National Zero Suicide Model components implemented in each system using electronic health records and insurance claims data sources that are easily extractable and generalizable to other systems. Then, we propose to use these metrics to conduct fidelity and outcome evaluation of the various Zero Suicide Initiative approaches in each system using Interrupted Time Series Designs, which are among the strongest, pragmatic designs appropriate for evaluating care system intervention and policy changes in ‘Learning Healthcare Systems.’ We hypothesize that the implementation of various National Zero Suicide Model components will significantly reduce suicidal behavior within and across the participating systems. We seek to accomplish the following aims: 1) Collaborate with health system leaders to develop EHR metrics to measure specific quality improvement targets and care processes tailored to local Zero Suicide Initiative implementation; 2) examine the fidelity of the specific Zero Suicide Initiative care processes implemented in each system; and 3) investigate suicide attempt and mortality outcomes within and across Zero Suicide Initiative healthcare system models.

There is considerable optimism that telehealth – especially telephone and video-based visits – can transform care delivery within Kaiser Permanente (KP) and across the United States. Mental health and wellness is the service line with the greatest potential to realize the benefits of expanding telehealth and transfer learning across service lines and regions. The current project aims to improve our understanding of clinical, technical, and legal barriers and facilitators to telehealth as well as to further our ability to measure telehealth encounters and the relationship between telehealth and face-to-face care.

KPSC is one of nine sites throughout the country funded by an Innovation Award from the Centers of Medicare and Medicaid to implement a coordinated care model for depressed patients with cardiovascular disease. We have the following goals for this project: 1. To implement in three stages a multiple condition collaborative care management model in primary care clinics of care systems in states. 2. To demonstrate that this model improves care quality, patient experience and health, provider satisfaction, and total healthcare costs for the Medicare and Medicaid patients with the targeted conditions. 3. To develop role descriptions and training for the two new types of workers required for this model – care managers and care consultants. 4. To identify the costs and payment models needed by care systems to sustain and spread this care model.

The goals of this study are to assess in HIV-infected patients, the degree of association between successful general clinical care by HIV disease-treating providers (reflected in overall adherence to recommended general prevention and screening guidelines) and higher-quality HIV-specific care and related clinical outcome.

Anxiety disorders among youth are extremely common and without effective treatment can lead to depression, substance use, suicide, and deficits in functioning into adulthood. Although pediatric anxiety interventions, such as cognitive behavioral therapy and antidepressant medications, are highly efficacious, many clinicians are under-using these evidence-based treatments. We will develop and test two complementary casemix-adjusted pediatric anxiety outcome quality measures using the GAD-7 instrument: (1) a measure of whether patients are responding to treatment (treatment response) and (2) whether patients’ anxiety remitted (remission), which will provide a critical tool for improving outcomes from anxiety treatment.

High blood pressure can be missed in patients who do not have regular visits with their primary care provider. The goal of the present project is to estimate the efficacy of blood pressure assessments in specialty clinics. We will compare recognition, follow-up, and time-to-treatment between patients first recognized in specialty care to those in primary care.

The Patient Centered Outcomes Research Institute created a new Health Systems Implementation Initiative (HSII) to accelerate the adoption of scientific evidence into health care practice. Kaiser Permanente Southerna California was selected as 1 of 6 health care systems throughout the U.S. to test the implementation and institutionalization of evidence-based programs for intensive lifestyle weight management in primary care settings. The proposal tests the following two aims: 1. To use a patient and clinician partner-driven process improvement method tested in community1 and healthcare settings2,3 to implement evidence-based strategies for a 12-month virtual intensive lifestyle treatment program in patients having class I obesity (Body Mass Index [BMI] 30 – 34.99 kg/m2) with a focus on those patients who also have uncontrolled type 2 diabetes (T2D; HbA1c> 8). 2. To use data and materials collected from this implementation to create a playbook for the organization to continue the program, institutionalize it for the care of patients with class I obesity, and expand its use in other populations of patients with obesity who are identified as high priorities for the organization (such as to prevent weight regain in patients who have undergone medication or surgical treatment for their obesity and those with multiple chronic conditions for which weight loss would be beneficial).

To evaluate a remote blood pressure monitoring (RBPM) program to identify facilitators and barriers to RBPM and ultimately identify opportunities to improve the effectiveness, acceptability, appropriateness, and scalability of the program to lead to better hypertension management in the Kaiser Permanente Southern California hypertension population.

The overall goal of this mixed-method, phased evaluation approach is to document the successes, challenges, and lessons learned from implementation of the Focus Home ecosystem components, and to document the process and outcome measures for key system end-users including patients, family caregivers, and clinicians as the service, IT, and population management data analytical features of the ecosystem goes live over the next two years. 

Existing and proposed mental health quality measures may be biased against health systems, facilities, and clinicians serving more Black and Hispanic patients, measuring the patients they serve rather than the quality of care they provide. This research will use detailed records data from five large health systems to evaluate potential biases in existing and proposed measures and evaluate alternatives to reduce biases.

The SCAL Readmissions Reduction Steering Committee desperately needs ongoing analytical support for data-driven decision making on the provision of care transition services and interventions for the 150K annual discharges from KFH hospitals. Since 30-day readmission rates affect Medicare 5-star ratings and financial penalties, reducing avoidable readmission without causing patient harm is high priority for the organization. Care transition services are often complex and multi-component in nature and are constantly evolving. Evaluation of impact requires significant data curation efforts and advanced statistical methods to assess individual, additive or synergistic effects across the multiple intervention components. Different study designs and analytical methods will be used depending on the specific questions to maximize rigor, e.g. retrospective cohort, econometric approaches. Previous analyses have informed critical operational decisions.

The PORTAL network propose to create a cohort of adults who are overweight or obese, including those who have pre-diabetes or diabetes. The cohort development activity will demonstrate that the PORTAL network is able to meet the 10 criteria for a clinical data research network specified by PCORI.

We currently do not have a coordinated, effective, and scalable strategy to meet the ongoing medical and social needs of persons living with dementia (PLWD) and their families in KPSC. The goals of this project are: 1) better understand the patterns of diagnosis and care for patients with dementia, mild cognitive impairment and memory loss to identify potential improvement opportunities and 2) to generate preliminary data towards testing an integrated home-based care model for PLWD and their family caregivers.

This study will incorporate the voice of the patient and provider stakeholders as part of the implementation of the Zero Suicide framework in three health settings from the NIMH-funded parent award as well as the Southcentral Foundation which is an Alaska Native-owned, nonprofit health care organization serving nearly 65,000 American Indian/Alaskan Native people living in and around Anchorage, Alaska. Our scientific premise is that by 1) understanding the stakeholder perspective on the role of health systems in opioid-related overdoses, and 2) involving these stakeholders in all aspects of developing strategies that health systems can use to prevent opioid-related overdoses within the implementation of the Zero Suicide framework, we will have a much greater impact on reducing the mortality rates associated with opioid use.

The goal of this study it to evaluate patterns of medical imaging associated with cumulative exposure to radiation (CT, nuclear medicine, fluoroscopy, angiography, and radiography), and subsequent risk of childhood cancers.

This pilot study will address two specific aims: (1) to assess the acceptability of telemedicine technology to conduct virtual office visits alternating with regular office- based prenatal visits for women with GDM from the viewpoint of women with GDM and their health care providers using qualitative research methods, and (2) to assess the feasibility of this telemedicine-based intervention (Virtual Office Visit) for women with GDM. This information was be used to support a larger proposal to obtain funding to conduct a clinical trial to test the proposed intervention after it is refined based on input from patients and health care providers.

The major goals of this trial are to determine the effectiveness of a school and community-linked physical activity intervention to reduce the decline in physical activity in young women, a cohort who have been followed since middle school.

The purpose of this study is to test the dissemination of a Palliative Care Intervention (PCI) for patients with non-small cell lung cancer (NSCLC) and their primary family caregivers (FCG)

This observational, data-only study will use diagnostic and treatment data from the electronic medical records (EMR) and administrative systems from three Kaiser regions (Northwest, Southern California, and Georgia) including depression screening rates, rates of depression treatment initiation and receipt of different depression treatment services. The overall goal is to examine how race/ethnicity impacts these services. The study aims are: Aim 1: Examine how race/ethnicity impacts receipt of screening for depression in all settings or service types for adults at 3 sites, including examining unadjusted differences, and differences controlling for other patient-level factors (age, socioeconomic status, insurance coverage, other social determinants of health). Aim 2: Controlling for severity of depression symptoms (PHQ-9 category) and other sociodemographic characteristics, do racial and ethnic groups of patients have different patterns of depression diagnosis and treatment initiation compared to White patients? Aim 3: Do racial and ethnic groups of patients who screen positive for depression (PHQ-9 score above 9) have different longer-term outcomes compared to White patients? Aim 4: Explore whether response to depression treatment is associated with treatment outcomes, and whether these outcomes are different for racial and ethnic groups of patients compared to White patients.

This project aims to improve the accuracy of computationally identifying high-risk asthma patients, it’s assess potential impact on outcomes and to provide automated prediction result explanations for care management.

Rates of childhood obesity in the U.S. remain at historic highs. Primary care settings lack interventions to address the childhood obesity epidemic that are feasible and sustainable without requiring significant resources. We will test a motivational interviewing-based intervention shown to lower children’s BMI in a real-world clinical setting with the goal of halting and reversing the childhood obesity epidemic.