Emphasis on transforming care drives continued growth of research
Care Improvement Research Team founded
The Care Improvement Research Team was formed in 2012 with the idea to bring together clinicians and scientists to implement innovative interventions into clinical practice and to reduce or eliminate the use of practices that do not provide value in improving care.
Michael K. Gould, MD, MS, then the scientific director of the Division of Health Services Research & Implementation Science, was the first leader of the Care Improvement Research Team.
“When we founded CIRT, there were virtually no similar programs in other hospitals or health systems around the country,” said Dr. Gould in a video interview in late 2019. “The idea of bringing researchers and clinical leaders and administrators together was really novel and groundbreaking.”
Through CIRT, research scientists team up with frontline clinicians to identify research questions that are important to patients and the doctors who take care of them. CIRT investigators bring rigor and scientific expertise to the process of improving clinical quality, while clinical partners keep the focus on the burning issues of real-world practice.
Early CIRT projects improved care in a variety of ways, from reducing unnecessary antibiotic prescriptions to preventing elderly patients from being readmitted to the hospital. Investigators have helped develop clinical decision tools, implement new models of care, and devise interventions to improve care delivery and health outcomes.
New divisions established to manage research program’s growth
In 2013 and 2014, the department reorganized into a divisional structure to manage the rapid growth.
“Eight years ago, we had about 60 people working at 100 South Los Robles. Now, we have more than 300. With this kind of growth, communicating about resources, staffing, and planning with all our competing priorities has become much more of a challenge,” said an announcement in Science Matters, R&E’s newsletter at the time.
Researchers and key support staff were grouped into 5 scientific divisions: Behavioral Research, Biostatistics Research, Clinical Trials Research, Epidemiologic Research, and Health Services Research & Implementation Science.
The department also established a Research Administration Division (now the Division of Shared Services) to manage the department’s infrastructure support. At the time, it included the Central Business Office, Research IT, Research Database and Clinical Informatics, Research Operations, and Research Communications.
Research changed clinical practice
The emphasis on using research to improve clinical practice and patient outcomes continued through Dr. Jacobsen’s leadership. Among those he remembered most vividly influencing clinical practice at Kaiser Permanente and abroad was work in lung cancer screening, hypertension control, microscopic hematuria, and kidney disease.
One of the success stories resulted from a partnership between Dr. Jacobsen and Ronald K. Loo, MD, the regional chief of urology for SCPMG, which began soon after Dr. Jacobsen took his new post. Dr. Loo and his colleagues wondered if existing guidelines for evaluating microscopic hematuria — blood in the urine that can’t be seen by the naked eye — might result in unnecessary tests for some patients. Up to 18% of the population can have microscopic hematuria, including many who are healthy.
The results of the study led to a new risk index and prompted a change in Kaiser Permanente guidelines in 2012. Findings also contributed to a change in guidelines from the American Urological Association in 2020. Dr. Loo and several other SCPMG physicians also conducted a follow-up study in women, which contributed to a guideline change by the American College of Obstetrics and Gynecology.
Other research-driven practice changes from that time included:
R&E scientist Kristi Reynolds, PhD, MPH; Ronald Scott, MD, of the West Los Angeles Medical Center; and others published 3 studies focused on why patients were not picking up their initial statin prescriptions. Ultimately, these studies led to the implementation of an outreach program to members who never filled their first statin order.
John J. Sim, MD, a nephrologist with the Los Angeles Medical Center, did multiple studies on kidney disease. They included a 2018 study that found patients taking prescribed hypertension medications had episodically low blood pressures — systolic blood pressure under 110mmHg — and were twice as likely to experience a fall or to faint as patients whose treated blood pressure remained at 110mmHg or above. The research led to a Best Practice Alert, with the intent of raising awareness to address the situation, evaluate the root cause, and prevent future falls and injuries.
Dr. Gould led multiple studies aimed at improving care for patients with cancer and respiratory disease. These studies drove practice changes in the evaluation of lung cancer nodules, the prevention of venous thromboembolism, and the implementation of lung cancer screening.
Over the next decade, scientists, clinicians, and others conducted research studies that prompted dozens of changes in practices. Research-driven changes included new tools in Kaiser Permanente HealthConnect, such as Best Practice Alerts and decision support tools; development of new programs and enhancement of existing Complete Care programs; implementation of new care models and interventions; and de-implementation of practices that are inefficient or less impactful.
Clinical Research Center opens
In 2017, R&E opened the Marilyn Owsley Clinical Research Center, located on the first floor of the research building in Pasadena. The center was named after Marilyn Owsley, then chief financial officer of SCPMG, who was instrumental in bringing the center from an idea to reality.
“The first-floor research clinic has a special significance to KPSC and R&E as it helped us mitigate safety and compliance risks, and significantly expanded capacity for research in KPSC,” said Annie Chen, MBA, director of research administration for the Division of Shared Services.
Before construction of the new center, R&E did not have any dedicated research clinical space in the region. The department had to secure clinical space on an ad hoc basis, which was extremely inefficient and tenuous. Study staff were often bumped from these spaces on short notice due to clinical priorities.
“This significantly limited R&E’s ability to conduct research with a clinical visit element. In many cases, it prevented us from pursuing research opportunities requiring clinical space in the first place,” she added. “When we opened the doors to the center, it opened new opportunities for R&E, including large federal awards that would not have been possible without a clinical research center.”
“The Pasadena-based center in some ways also served as a pilot to try out a model for dedicated research space that helped pave the way for the opening of a clinical research center at the Los Angeles Medical Center,” she said. “We hope there will be many more to come.”