Department of Research & Evaluation News

Rulin Hechter, MD, PhD, is an infectious disease epidemiologist in the Department of Research & Evaluation who focuses on the prevention and treatment of HIV and other sexually transmitted infections. She received her medical training from Suzhou Medical College and her master’s degree in epidemiology and biostatistics from Fudan University, both in China. She received her PhD in epidemiology from the University of California, Los Angeles. She joined Research & Evaluation shortly after receiving her PhD in 2009. In addition to her work as a research scientist, Dr. Hechter is an assistant professor at the Kaiser Permanente Bernard J. Tyson School of Medicine and an adjunct assistant professor of epidemiology at UCLA.

You seem to research a wide range of topics. Can you give an example of how the research projects are tied together?

My research focuses on populations who are vulnerable to vaccine preventable infectious disease, HIV, and other sexually transmitted infections. I also study substance abuse, as well as disparities in health care utilization. Recent projects have examined disparities in HPV vaccine uptake among adolescents, uptake of COVID-19 vaccines among patients with HIV, and the impact of electronic patient reminders on hepatitis B vaccine uptake and completion.

An example of how one research project led to another was when I conducted chart review in one of my HIV research projects. I noticed a substantially high prevalence of mental health and substance use problems among people living with HIV, especially among young men who have sex with men. Those mental health and substance use problems in turn affect their HIV care and adherence to treatment. Similarly, transgender and gender non-conforming persons are also at a higher risk for HIV infection and they often face mental health and substance use problems and unique barriers to health care. So that led to a new area of research for me. One recent study examined risk of HIV and barriers to taking daily pre-exposure prophylaxis (PrEP) for HIV prevention among transgender and gender non-conforming persons.

You’ve been studying trends in opioid use. Why is this an important topic of research?

Over the past 2 decades, the public health crisis of substance misuse and addiction in the United States has grown. Drug overdoses have killed almost a million people since 1999. Use of opioids, including commonly prescribed opioids, synthetic opioids, and heroin, increased considerably recently. At least one type of opioid is a factor in 72% of all drug overdose deaths. It is really important to examine the risk factors for opioid misuse and addiction and identify ways we can intervene to prevent these terrible outcomes.  According to CDC data, the COVID-19 pandemic has only made this issue worse.

Is there any preliminary information from this work you can share with us?

We recently evaluated the impact of clinician-level interventions implemented in 2013 and the 2016 CDC guidelines for prescribing opioids for chronic pain on opioid use among Kaiser Permanente Southern California members. The study looked only at adults who do not have cancer. We found a steady decline in both prevalence and incidence of chronic high-dose opioid use as well as concurrent use of opioids and other sedative-hypnotics between 2013 and 2020. This finding likely reflects efforts in tapering to lower doses for patients on chronic opioid use, as well as prescribing behavior changes in treating new patients with noncancer chronic pain. We are also evaluating the potential effects of tapering and tapering pattern on the risk of subsequent overdose.

You recently published on the development a natural language processing algorithm to identify suicidal ideation in The Permanente Journal. Please tell us what the main takeaways from that study were, and what’s next.

I worked with Fagen Xie, PhD, who is first author for this paper. We looked at suicidal attempt and suicidal ideation, which is a broad term used to describe a range of contemplations, wishes, and preoccupations with death and suicide that could be an important predictor for the risk of self-inflicted firearm injury and death. Suicidal ideation and suicide attempts are often under-coded in electronic health records and it is very time consuming to identify those events from the text in clinical notes with detailed chart review.

We developed a natural language processing algorithm to spot relevant notes and identify those events from the health records of patients receiving care from 2010 to 2018. With this algorithm, we were able to identify over 1 million recent or current events of suicidal ideation and suicide attempts, and about 293,000 past events documented in clinical notes. This is a great example of how to use technology to access information from our electronic health record system. The algorithm has great potential for research that will inform and facilitate future suicide prevention efforts.

When you are not at work, how do you like to spend your spare time?

When I am not at work, I like to spend time with my family and friends traveling and experiencing various cultures and interesting food. In 2018 we met an adorable store cat in Amsterdam. After we returned, we adopted a brown tabby cat and named him Mochi. He has been a very dear family member to all of us. I also enjoy visual and performing art. I like to go to museums and concerts. I have taken an oil painting class with my daughter for the last 5 years and I enjoy having my own paintings decorating my office and home.

Image: Dr. Hechter and her daughter Isabel in Paris in 2018. Dr. Hechter definitely wants to return after the pandemic.