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.

The major goals of the project are to evaluate the effectiveness of a web-based decision aid on improving knowledge about breast cancer screening in women age 40 to 49 and reducing decisional conflict about breast cancer screening, and to explore the acceptability and feasibility of large-scale implementation.

The goal of this mixed methods study is to develop and test interventions to reduce use of surveillance biomarkers for early stage breast cancer patients.

Mindfulness Based Cognitive Therapy (MBCT) an 8-session in-person intervention using mindfulness meditation and cognitive-behavioral strategies, has shown effectiveness in reducing residual depressive symptoms and risk for recurrence among pregnant women with histories of depression. A digital adaptation of MBCT for pregnant women, Mindful Mood Balance for Moms (MMBFM), was recently developed to overcome access barriers to in-person groups and increase potential for scale-up in OB care settings. We will address the following aims for this study: 1) Compare the clinical effectiveness (i.e. engagement and symptom reduction) of MMBFM supported by clinician vs. peer coaches among women with a history of prior depressive episodes; 2) examine specific mechanisms of action for MMBFM participants receiving clinician vs. peer coaching; 3) examine the effects of specific implementation strategies on reach of the MMBFM program; and 4) estimate the cost-effectiveness of MMBFM supported by clinician vs. peer coaches. We hypothesize that MMBFM will be more cost-effective when supported by peer vs. clinician coaches.

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).

This project focuses on implementation and effectiveness of an evidence-based guideline recommendation for systematic distress screening for breast cancer patients.

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)