Virtual Research Office

Therapeutic intensification for uncontrolled hypertension

Principal investigator: Jaejin An, PhD, Division of Epidemiologic Research
Study objective:
To evaluate providers’ hypertension treatment intensification according to the KPSC treatment algorithm for uncontrolled hypertension
Study design:
A retrospective cohort study + semi-structured provider interviews
• Q1: How often do providers intensify hypertension medications when the blood pressure (BP) goals are not met?
• Q2: What are the patient, healthcare system, and provider-related barriers and facilitators associated with therapeutic intensification?
• Q3: What are the BP outcomes for those who intensified treatment compared with patients who did not?
Impact:
Around 20% of our hypertension population (~184,000 members) still have uncontrolled BP. We will be able to further improve the KPSC hypertension program, raise hypertension control among our members, prevent cardiovascular disease and death, and save costs.

Improving computerized clinical decision support alerts

Principal investigator: Lewei Duan, PhD, MS, Division of Health Services Research & Implementation Science
Research question:
How do we improve the BPAs in our system to achieve a high performing, highly-sensitive and specific, less burdensome, informative decision support system?
Hypotheses and study aims:
We hypothesize that the current KPSC BPA program contains a number of low-value and otherwise problematic BPAs.
• Aim 1: Use proper quantitative measures to identify low-value, interruptive BPA clusters
We hypothesize that efforts to improve BPA operation and reduce low-value BPAs will increase BPA usability, provider satisfaction, compliance, and fit with clinical workflow.
• Aim 2: Implement a ClickBuster-like program to improve the low-value BPA clusters identified from Aim 1
Impact:
This study will provide insights of existing electronic reminder systems in our organization and the way our clinicians think of and interact with them. Together with our collaborators, we will develop a systematic approach to facilitate a data-driven and feedback-oriented BPA improvement framework that is feasible and tailored to KPSC’s values and needs.

Systematic evaluation of KPSC peer-to-peer (P2P) support programs

Principal investigators: Thearis Osuji, MPH, Division of Health Services Research & Implementation Science, and Kerry Litman, MD
Summary:
Since 2013, Kaiser Permanente has supported the implementation of peer-to-peer (P2P) support programs that address several chronic conditions across regions. KP peer mentors (volunteers) are expected to: provide emotional support, help with problem solving, assist with accessing community resources, accompany patients to doctor visits, surgery, procedures, and treatments, provide the perspective of experience, and offer encouragement and hope.
This study has 2 overarching aims:
1. We will establish a working group comprised of clinical, operations, and programmatic stakeholders to identify and develop plans for implementing process metrics and patient-reported outcomes that can be used to further evaluate cancer P2P programs (Measure P2P).
2. To help facilitate the development of a more rigorous evaluation while also providing data to facilitate program improvement, we will conduct a qualitative study using the Consolidated Framework for Implementation Research (CFIR) to assess factors that support or hinder successful implementation of breast cancer P2P programs (Implement P2P).
Clinical impact:
Although results are mixed and P2P program designs vary greatly, evidence suggests that cancer P2P programs may have some positive effects on patient outcomes such as quality of life and symptoms such as fatigue and coping. KPSC has made significant investments in its P2P programs. The regional program manager (hired in June 2022) is committed to continuous program improvement using data and research findings.

Immediate post-placental intrauterine device insertion: Comparative analysis of outcome measures including complication rates and effects on reproductive life planning

Principal investigator: Asma J. Saraj, MD
Objectives:
• Compare IUD-related complication rates in women receiving Immediate post placental IUD (IPP-IUD) insertion to interval Postpartum IUD insertion (Day1 – 12 week)
• Compare pregnancy incidence in women receiving IUD insertion to other contraceptive methods in the 18 months following delivery.
Study design:
• A retrospective cohort study
• Electronic health records (EHR) utilization for data collection
• Assess Incidence rate, cumulative incidence, and adjusted hazard ratios of IUD expulsion, malfunction, IUD removal, IUD-related uterine perforation, postpartum infection, and postpartum hemorrhage
• Review of Pregnancy touch points for study subjects in the18 months following delivery

Effect of a pharmacist-led multipronged educational intervention on benzodiazepine and sedative-hypnotic drug prescribing among ambulatory adult patients

Principal investigators: Steven Steinberg, MD, Patricia Gray, PharmD
Summary:
Benzodiazepines and nonbenzodiazepine sedative-hypnotics are among the most prescribed psychiatric medications for the management of anxiety and insomnia. However, use of sedative-hypnotics is associated with increased risk of adverse events including death. In early 2019, KPSC implemented the MedTAC (Medication Treatment Appropriateness Committee) Initiatives Program to improving safer prescribing of sedative hypnotics.
Using a multi-method (quantitative + qualitative) study design, we aim to:
• Evaluate the impact of the MedTAC program on initiation and chronic use of sedative-hypnotics at KPSC
• Assess differential program effects across age, gender, and race & ethnicity groups
• Understand factors influencing program implementation across KPSC facilities
Clinical impact:
• Facilitate reduction of inappropriate prescription of sedative-hypnotics across all patients served by KPSC
• Improve the MedTAC program to be more patient-centric and responsive to diverse KPSC community
• Identify strategies to reduce variation in the effects of the MedTAC program and achieve equity across age, gender, and race and ethnicity groups

Evaluation of a remote blood pressure monitoring program for hypertension management

Principal investigator: Kristi Reynolds, PhD, Division of Epidemiologic Research
Summary:
In 2019, Kaiser Permanente Southern California implemented a home/remote blood pressure monitoring (RBPM) program to monitor patients’ BP. The program is intended to promote self-directed home-based medical care and improve BP control. We propose to evaluate the program to identify opportunities to improve the effectiveness, acceptability, appropriateness, and scalability of RBPM. We will conduct a retrospective cohort study and semi-structured patient interviews to answer the following questions.
• Are clinic BP measurements and RBPM measurements in the first week of enrollment moderately correlated?
• Is there a cost-benefit to use RBPM?
• Which patients benefit from RBPM and sustain BP control up to 1 year post program?
• What are common facilitators and barriers experienced by patients enrolled in the RBPM program?
Clinical impact:
Hypertension is widely recognized as the most important risk factor for cardiovascular disease. KPSC has over 923,000 patients with hypertension and over 27% (or 252,000) of these patients have uncontrolled BP or no recent BP. The use of remote medical services increased during the COVID-19 pandemic and its use is likely to play an increasing role in hypertension management. We aim to identify opportunities to improve the program to lead to better hypertension management in the KPSC hypertension population.

Increasing pediatricians’ provision of digital self-care tools to adolescents (ages 13 to 17) with mild-to-moderate depressive symptoms

Principal investigator: Davida Becker, PhD ScM
Summary:
Kaiser Permanente has been developing a digital ecosystem to provide members with evidence-based digital mental health and wellness tools. Digital mental health tools have shown positive effects for anxiety and depression among adolescents. General pediatricians do not routinely provide digital mental health tools to adolescents who screen positive for mild or moderate depressive symptoms. Our project will evaluate the feasibility, acceptability, and effectiveness of having pediatricians provide a referral to a digital mental health tool for adolescents who screen positive for mild or moderate depressive symptoms.
• Aim 1: To refine and test a workflow and communication strategy with 6 to 8 general pediatricians and other frontline staff to use to provide a digital mental health tool to adolescents (age 13 to 17) with positive screens for mild to moderate depressive symptoms.
• Aim 2: To describe adolescents’ engagement with a digital mental health tool when referred by their pediatrician.
• Aim 3: To compare depressive symptoms and mental well-being at follow-up for adolescents who screen positive for mild or moderate depressive symptoms at a well-care visit and are offered a digital mental health tool compared to those who are not offered one.
Clinical impact:
The U.S. is facing a current mental health crisis among adolescents. Mental health services remain out of reach for many young people. New service delivery models and tools are needed to better support young people’s mental and emotional well-being. Our study will provide real world data on benefits and challenges of incorporating digital mental health tool referrals into care for adolescents.

Observed role of cooling on hemodynamics in inpatient dialysis (ORCHID), continuation

Principal investigator: Hui Xue, MD, MMSc
Guideline-directed medical therapy (GDMT) and coronary artery disease (CAD) testing may be underutilized among heart failure (HF) patients.
• Aim 1: Describe GDMT use among discharged HF patients to identify missed opportunities and assess whether GDMT at discharge is associated with improved utilization outcomes.
• Aim 2: Describe CAD testing among discharged HF patients to identify missed opportunities and whether testing is associated with improved utilization outcomes.
Clinical implications:
Our findings will provide data to inform clinical decision particularly at time of discharge. It may eventually allow for standardization of discharge protocols to maximize care for this highly vulnerable population.

The initiation of guideline-directed medical therapy during hospitalization for congestive heart failure patients and its impact on post-discharge outcomes, continuation

Principal investigator: Cheng-wei Huang, MD
Guideline-directed medical therapy (GDMT) and coronary artery disease (CAD) testing may be underutilized among heart failure (HF) patients.
• Aim 1: Describe GDMT use among discharged HF patients to identify missed opportunities and assess whether GDMT at discharge is associated with improved utilization outcomes.
• Aim 2: Describe CAD testing among discharged HF patients to identify missed opportunities and whether testing is associated with improved utilization outcomes.
Clinical implications:
Our findings will provide data to inform clinical decision particularly at time of discharge. It may eventually allow for standardization of discharge protocols to maximize care for this highly vulnerable population.

Prevalence, trend, care delivery and disparity in mental health conditions in children, adolescents, and young adults among KPSC members, continuation

Principal investigator: Anny Xiang, PhD, Division of Biostatistics Research
Summary:
Depression is a serious mental health disorder affecting millions of children especially adolescents. With the 2022 CIRT funding, we assessed the prevalence and incidence and trend of depression and anxiety in children and adolescents and young adults (ages 5 to 22 years) with a clinical diagnosis using diagnosis codes in KPSC EMR from 2017 to 2021. Our preliminary data showed that both prevalence and incidence of depression and anxiety increased substantially from 2017 to 2021 in these age groups, with higher rate of depression among adolescents and steeper increase in girls. Both overweight/obesity and underweight were associated with higher rate of depression. The continuation of the CIRT project in 2023 will address following questions:
• What were the clinical care and trajectories for those with an incidence diagnosis of depression and were there any disparities?
• What were the depression screening rate at pediatric primary care and adherence rate to follow-up and specialty care for those with potential risk for depression and were there any disparities?
Clinical impact:
As rates of childhood depression rise, it is critical for health care providers to identify children currently in need and to prepare for children who will require mental health support in the future. This is particularly important considering that early disorders are a risk for persistent mental health problems into adulthood. Completing this study will provide critically needed data to help our clinicians and operational leaders identify gaps and improve our evidence based clinical practices.

Improving care transitions and reducing readmissions: Medically tailored meals for Medi-Cal members, continuation

Principal investigator: Huong Nguyen, PhD, RN, Division of Health Services Research & Implementation Science
In January 2022, California launched CalAIM, a statewide initiative to revamp its Medi-Cal program to provide comprehensive, whole-person care for patients with the greatest medical and social needs. CalAIM requires managed Medi-Cal plans offer medically tailored meals (MTM) and other approved community supports to address unmet social needs with the expectation that addressing unmet needs will ultimately reduce beneficiaries’ use of high-cost acute care services. Building on learnings from our evaluation of the Medicare home-delivered meals program, we propose to conduct process and outcome evaluation of the newly implemented Medi-Cal MTM program for patients at high risk for malnutrition to inform operational decision-making.
• Aim 1: Determine the level of uptake and patient satisfaction with a 12-week MTM benefit across key sociodemographic and clinical characteristics in 2 cohorts: 1) malnutrition identified during a hospitalization and 2) stable, ambulatory patients who screen positive for malnutrition with proactive outreach
• Aim 2: Assess changes in diet quality, functioning and health-related quality of life before and after MTM; describe patient experiences with MTM.
• Aim 3 (exploratory): Assess the effects of MTM on the composite outcome of days alive and at home and the individual utilization components (inpatient/observation stays, ED visits, ambulatory care visits and virtual encounters) at 90- and 180-days post-discharge compared to 2 propensity score matched comparison groups.
Study design: This project will use an observational design (Aim 1: descriptive; Aim 2: single group, pre-post quantitative and qualitative assessment; Aim 3: quasi-experimental with 2 matched comparison groups) since all eligible patients must be offered the benefit and therefore, we cannot randomize patients.

Implementation and evaluation of an enhanced Adverse Childhood Experiences (ACEs) screening and referral system in pediatric primary care, continuation

Principal investigator: Sonya Negriff, PhD, Division of Behavioral Research
This proposal will continue our 2022 CIRT project to evaluate the implementation of a new ACEs screening and referral system in pediatric primary care across the region.
• Aim 1: Examine the impact of ACEs screening in pediatric primary on visit to social medicine as screening is implemented regionally. We will compare the volume of referrals to Social Medicine for the first 6 months of implementation compared to the same time period 1 year and 2 years prior (to account for COVID-19 related impact on encounters).
• Aim 2: Assess delivery of services for children screening positive for ACEs. We will examine the rate of completed visits to behavioral health for the first 6 months after implementation and compare this to the same time period 1 and 2 years prior.
• Aim 3: Examine the rates of positive ACEs screening and referrals to Social Medicine and Behavioral Health by service area to determine hot spots of high need areas.
Clinical impact:
This work will provide critical data to determine the workload needs for Pediatric social workers and Behavioral Health providers as ACEs screening is broadly implemented across KPSC. This will demonstrate the impact that ACEs screening will have on the Region, the importance of the social worker for triaging the child to tailor their referrals, and the service regions that may have higher ACEs burden among the members they serve.

Venous thromboembolism prevention in abdominal surgical patients with cancer, continuation

Principal investigator: Michael K. Gould, MD, MS, Kaiser Permanente Bernard J. Tyson School of Medicine
Summary:
Perioperative venous thromboembolism (VTE) is especially common in abdominal surgery patients with cancer. In prior research, we found that most perioperative VTE events in this population occur 1-2 months following hospital discharge in patients who received adequate in-hospital pharmacological prophylaxis with heparin or low-molecular-weight heparin. This suggests that implementation of extended-duration, post-discharge prophylaxis, an intervention whose safety and effectiveness is supported by multiple randomized, controlled trials, may be necessary to reduce VTE in this high-risk population. Accordingly, this project has the following aims:
• Aim 1: Continue to support the KPSC Regional Chiefs of General Surgery by evaluating the effect of a novel post-discharge order set and accompanying physician education to encourage the use of post-discharge VTE prophylaxis in abdominal surgery patients with cancer.
• Aim 2 (exploratory): Examine the association between cancer stage and perioperative VTE risk in this population.
Anticipated impact:
By completing these aims, we will demonstrate the effectiveness of a decision support intervention to encourage use of post-discharge prophylaxis following abdominal cancer surgery, and we will test a novel hypothesis about a possible neglected risk factor for perioperative VTE in this population.

Implementing systematic distress screening in medical oncology, continuation

Principal investigator: Erin E. Hahn, PhD, MPH, Division of Health Services Research & Implementation Science
Summary:
Screening for depression and anxiety in patients diagnosed with cancer is a critical element of high-quality cancer care. Based on results from our cluster randomized trial on implementation of systematic PHQ-9 screening in oncology, we have now disseminated the screening program across all SCPMG oncology clinics. We developed and disseminated detailed trainings, supportive materials, and IT solutions (e.g., initiated a regional POE, trainings on updated PHQ format). Additionally, we provide ongoing audit and feedback of performance data including proportion screened, PHQ scores, and proportion appropriately referred for behavioral health services based on score.
Purpose:
In this continuation project, we propose to transition the program to a centralized regional team and will formalize a plan to handoff the documented clinical workflows and the capture/sharing of screening metrics for future quality reporting and to ensure sustainment and ownership of the program.
Clinical impact:
To date, over 7000 patients newly diagnosed with cancer have been screened. The program offers tremendous value to our members, our oncology teams, and to the KP Excellence in Cancer Care initiative by identifying, referring, and treating patients who experience depression and anxiety, the majority of whom have not otherwise been screened or have a relationship with a behavioral health clinician.

Enhanced implementation of lung cancer screening, continuation

Principal investigator: Michael K. Gould, MD, MS, Kaiser Permanente Bernard J. Tyson School of Medicine
Summary:
Lung cancer screening (LCS) with low-radiation dose CT has been shown to reduce lung cancer mortality by at least 20% in high-risk current and former smokers. The effectiveness of LCS within KPSC is limited by underuse in the target population, excessive use in those unlikely to benefit, missing details about smoking history in electronic health records, and challenges engaging members in shared decision-making. To meet these challenges, this project has the following aims:
• Aim 1 (ongoing): Continue working with the Regional Lung Cancer Screening Steering Committee to provide data on the uptake, appropriateness and outcomes of lung cancer screening among KPSC members, and help to design, implement and evaluate tools to improve access to screening and adherence with follow-up evaluations and repeat annual screening.
• Aim 2 (new for 2023):  Evaluate the effectiveness of a recently implemented, novel best practice alert to limit inappropriate LCS screening by alerting ordering providers when a patient does not meet eligibility criteria.
• Aim 3 (new for 2023):Examine adherence to repeat annual screening and identify factors associated with adherence, including potentially actionable factors at the patient, clinician and medical center levels.
Anticipated impact:
Completion of these aims will reduce inappropriate screening and inform future efforts to expand the reach of LCS at KPSC to include a greater fraction of the target population.

Evaluating the impact of implementing HEAR(T) for urgent care encounters with patients suspected for acute coronary syndrome

Principal investigator: Adam L. Sharp, MD, MSc, Division of Health Services Research & Implementation ScienceStudy aims:
• Describe the 30-day outcomes for patients with a HEAR(T) score in KPSC urgent care departments
• Determine the impact of implementing the HEAR(T) score on troponin testing for chest pain encounters evaluated in urgent care
• Evaluate the impact of implementing the HEAR(T) score on emergency department transfers, hospitalization/observation, and non-invasive cardiac testing among encounters evaluated in urgent care
Collaborators:
• Matt Smith, MD, Los Angeles Medical Center
• Jarlath Ryan, MD, Los Angeles Medical Center
• Darryl Palmer-Toy, MD, PhD, SCPMG
• Hedyeh Shafi, MD, SCPMG
• Ji Yeon Kim, MD, SCPMG
• Kenneth Robinson, MD, Panorama City Medical Center
• Molly Jancis, MD, Panorama City Medical Center
• Nitin Dhamija, MD, Riverside Medical Center

Prevalence, trend, care delivery, and disparity in mental health conditions in children, adolescents, and young adults among KPSC members

Principal investigator: Anny H. Xiang, PhD, Division of Biostatistics Research
Study aims:
• Characterize prevalence and trend of depression and anxiety among children (age 5 to 12 years), adolescents (ages 13 to 18 years), and young adults (ages 19 to 25 years) from 2015 to 2021 and potential disparities by age, sex, race/ethnicity and SES
• Characterize prevalence and duration of FIC care with TPI and potential disparities among individuals identified in Aim 1 who had depression and/or anxiety diagnosis in 2017 to 2021
• To assess trajectories of depression symptoms by PHQ-9 and/or anxiety symptoms by GAD-7 for individuals with depression/anxiety and their associations with dose (duration) of FIC care with TPII received
Collaborators:
• Siddhartha Kumar, MD, West Covina Medical Offices
• Juan-Carlos Zuberbuhler, MD, West Los Angeles Medical Center
• Breda Velasquez, MD, San Diego Medical Center
• Ashley Zucker, MD, Fontana Medical Center
• Joseph Spitzer, MD, Baldwin Park Medical Center
• Sonya Negriff, PhD, SCPMG
• Sarah Carter, DPhil, MA, SCPMG

Evaluating the RRC/CIRT COVID-19 decision support tool portfolio: COVAS, COVID-IMV, and COVID-HDI

Principal investigator: Beth Creekmur, MA, Division of Health Services Research & Implementation Science
Study aims:
• Evaluate provider utilization of the COVAS, COVID-IMV, and COVID-HDI following AURA implementation
• Compare COVID-HDI and EPIC-DI performance
• Validate the COVAS, COVID-IMV, and COVID-HDI using non-contemporaneous data
Collaborators:
Organizational partners
• Akshay Jivraj Manek, MD, SCPMG
• Sergio E. Mendoza Sida, MD, SCPMG
Clinical partners
• Cheng-Wei (Charlie) Huang, MD, Los Angeles Medical Center
• Luis M. Moreta-Sainz, MD, Los Angeles Medical Center
Research & Evaluation team members: Stephanie Tovar, Rebecca Butler, Aiyu Chen

The initiation of guideline-directed medical therapy during hospitalization for congestive heart failure patients and its impact on post-discharge outcomes

Principal investigator: Cheng-Wei Huang, MD, Los Angeles Medical Center
Study aims:
• Describe the initiation of GDMT with CHF hospitalization,
• Assess outcomes post-discharge by comparing those who were started on GDMT to those who were not
• Identify variables associated with adverse discharge outcomes
• Identify any health disparities if present
Collaborators:
• Mingsum Lee, MD, PhD, Department of Cardiology, Los Angeles Medical Center
• Joon S. Park, MD, Department of Hospital Medicine, Los Angeles Medical Center
• Stefanie S. Wu, MD, Department of Hospital Medicine, Los Angeles Medical Center
• Christopher C. Subject, MD, Los Angeles Medical Center
• Huong Nguyen, RN, PhD, SCPMG

Has the KPSC choice to discontinue a nationally mandated test used to determine readiness for discharge in preterm infants affected the incidence of the post-discharge adverse events for which it was devised?

Principal investigator: David Braun, MD, Panorama City Medical Center
Study aims: To determine if the KPSC practice change to discontinue the CSRR affected the frequency of post-discharge adverse events in preterm infants overall or in preterm infant subgroups with certain patient characteristics.
Collaborators:
• Darios Getahun, MD, MPH, PhD, SCPMG
• Jiaxiao Shi, PhD, SCPMG
• Marianna Volodarskiy, MSN, RN, NE-BC, SCPMG
• Anthony Burgos, MD, MPH, Downey Medical Center
• Rohit Passi, MD, South Bay Medical Centery
• Calvin Dong, BA, MPH, EMBA, CPHQ , Downey Medical Center
• Kevin Litam, MS, SCPMG
• Quinn Hong, BS, SCPMG

Investigating disparities in telephone appointment and video appointment visits among chronic kidney disease patients: lessons of the COVID-19 pandemic and looking to the future

Principal investigator: Hui Zhou, PhD, MS, Division of Biostatistics Research
Study aims:
• Compare the successful TAV/VAV rate among patients with CKD stage 3 to 4, by different age groups, gender, and racial/ethnic groups
• Assess neighborhood differences in the rate of successful adapt TAV/VAV care
• Assess health outcomes among patients who successfully underwent TAV/VAV, those who only had in-person visits and those who did not have any visit
• Assess medication prescription and fill patterns between patients who successfully underwent TAV/VAV and those who failed
Collaborators:
• Margo Sidell, ScD, MSPH, SCPMG
• Don McCarthy, SCPMG
• John Sim, MD, Los Angeles Medical Center
• Benjamin Broder, MD, PhD, SCPMG
• Anthony Morena, MD, Hollywood Romaine Medical Center
• Emma Dolan, MPP, MPH, Los Angeles Medical Center

“Endoscopy first” versus “surgery first”: an analysis of organ-sparing tissue resection techniques across the gastrointestinal tract, versus comparative surgery, in a large, integrated health care organization

Principal investigator: Karl Kwok, MD, Los Angeles Medical Center
Study aims:
Aim 1: to compare clinical outcomes, including (a) polyp/lesion recurrence rate; (b) procedure-related morbidity; and (c) mortality of patients who underwent endoscopy versus traditional surgery.
Aim 2: to evaluate and compare healthcare utilization, including (a) ER visits; (b) GI outpatient visits; (c) operating room use; and (d) days in hospital of patients who underwent endoscopy versus traditional surgery.
Collaborators:
• Kevin Kao, MD, Downey Medical Center
• Andrew Giap, MD, Anaheim Medical Center
• Brian Lim, MD, MCR, FASGE, Riverside Medical Center
• Victoria O’Connor, MD, FACS, Los Angeles Medical Center
• Vikram Attaluri, MD, FACS, FASCRS, Los Angeles Medical Center
• Chun Chao, PhD, SCPMG
• Wansu Chen, PhD, SCPMG
• Emily Joy Flynn, MSHCA, MBA, RN, SCPMG
• Tyler Nieves, RN, SCPMG

Retrospective regional review of the risk factors for intracranial hemorrhage, morbidity, and mortality in transported preterm infants of 32 weeks gestation or less, as compared to a control group

Principal investigator: Kim-chi Bui, MD, Los Angeles Medical Center
Study aims:
• To identify potentially modifiable factors that could reduce complications and morbidity in the preterm infants
Collaborators:
• Afshan Abbasi, MD, Bellflower Medical Center
• Marielle Hahn Nguyen, MD, OC Anaheim Medical Center
• Ashley Nicole Brantley, Los Angeles Medical Center
• Sharon Burdick, RN, Los Angeles Medical Center
• Darios Getahun, MD, MPH, PhD, SCPMG
• Anny Xiang, PhD, MS, SCPMG

Kaiser Permanente ASCVD Safety Program: statin initiation and follow-up of lipid panels among patients with high LDL-C

Principal investigator: Matthew T. Mefford, PhD, Division of Epidemiologic Research
Study aims:
• Among patients with high LDL-C (≥190 mg/dL), assess new statin orders, statin fills, and follow-up lipid panel completion before and after implementation of the high LDL-C SureNet program
• Examine factors associated with ordering a statin, filling a statin, and completing a follow-up lipid panel before and after implementation of the high LDL-C SureNet program
• Assess patient reasons for filling or not filling a new statin prescription and completing or not completing follow-up labs
• Assess physician perceptions of the high LDL-C SureNet program
Collaborators:
Department of Research & Evaluation
• Kristi Reynolds, PhD, MPH, SCPMG
• Teresa Harrison, SM, SCPMG
• Hui Zhou, PhD, MS, SCPMG
Regional/clinical collaborators
• Tracy M. Imley, MD, CPHQ, Coastline Medical Offices
• Ronald D. Scott, MD, Culver Marina Medical Offices
• Royann Timmins, RN, SCPMG
• Michael H. Kanter, MD, CPPS, KPSOM
• Mark A. Sanders, MS, KPSOM

Next generation sequencing testing to inform clinical decision-making for non-small cell lung cancer in a large integrated health care delivery system

Principal investigator: Reina Haque, PhD, Division of Epidemiologic Research, and Eric McGary, MD, PhD, MPH, West Los Angeles Medical Center
Study aims:
• Assemble a group of patients who underwent NGS testing (STRATA Oncology product) between 2019 and June 2021 diagnosed with advanced NSCLC. Propose a cross-sectional study over 3 years (2019-2021) to determine the health care and patient outcomes below
• Examine the effectiveness of NGS testing (tissue failure rates, time to NGS results), distribution of NGS testing, and prevalence of targetable driver mutations by patient’s demographic and clinical characteristics
• Examine health care outcomes in patients with advanced NSCLC who underwent NGS testing

CONTINUATION PROPOSALS FROM PREVIOUS YEARS

Developing and testing an equitable risk stratification tool to identify patients for serious illness care in the era of COVID-19
• Principal investigator: Claudia Nau, PhD, Division of Behavioral Research
Implementing systematic distress screening in oncology
• Principal investigator: Erin E. Hahn, PhD, MPH, Division of Health Services Research & Implementation Science
A Bayesian latent phenotype model to estimate risk for COVID-19 in the presence of multiple and/or missing biomarker data
• Principal investigator: Ernest Shen, PhD, Division of Health Services Research & Implementation Science
Observed role of cooling on hemodynamics in inpatient dialysis (ORCHID)
• Principal investigator: Hui Xue, MD, MMSc, San Diego Medical Center
Improving care transitions and reducing readmissions
• Principal investigator: Huong Nguyen, PhD, RN, Division of Health Services Research & Implementation Science
Piloting approaches to improve cultural sensitivity and humility in the care of patients with depression
• Principal investigator: Karen J. Coleman, PhD, Division of Health Services Research & Implementation Science
Enhanced implementation of lung cancer screening
• Principal investigator: Michael K. Gould, MD, MS, Kaiser Permanente Bernard J. Tyson School of Medicine
Venous thromboembolism prevention in high-risk abdominal surgery patients
• Principal investigator: Michael K. Gould, MD, MS, Kaiser Permanente Bernard J. Tyson School of Medicine
Implementation and evaluation of an enhanced Adverse Childhood Experiences (ACEs) screening and referral system in pediatric primary care
• Principal investigator: Sonya Negriff, PhD, Division of Behavioral Research

Understanding and supporting COVID-19 vaccine confidence among health care providers at Kaiser Permanente Southern California

Principal investigator: Katia Bruxvoort, PhD, MPH, Division of Epidemiologic Research
As COVID-19 vaccines become available, it is critical for Kaiser Permanente Southern California leaders to listen to health care provider concerns and to build confidence around use of these vaccines. This study aims to do this by gathering data from a range of health care providers early in 2021 and sharing actionable findings to inform development of COVID-19 vaccine web-based trainings, infographics, and/or other interventions as suggested by the data.
The study aims to improve quality by increasing COVID-19 vaccine confidence and uptake among providers so they are better equipped to recommend COVID-19 vaccines to patients. The study also aims to improve equitability, as racial/ethnic disparities are a concern both for vaccine uptake and COVID-19 outcomes.
Study Aims:
1a. Examine health care providers’ perceptions of COVID-19 vaccine effectiveness and safety
1b. Assess health care providers’ willingness to receive a COVID-19 vaccine
1c. Assess health care providers’ willingness to recommend COVID-19 vaccine to patients
2a. Examine drivers of vaccine hesitancy among health care providers
2b. Determine perceived needs for tailored interventions to support confidence in COVID-19 vaccines
Collaborators:
• SCPMG physicians: Bruno Lewin, MD, DTMH; David Bronstein, MD, MS
• Research & Evaluation: Kristin Choi, PhD, MS, RN; Corrine Munoz-Plaza, MPH
• Nursing Research: June Rondinelli, PhD, RN, CNS; Hazel Torres, MN, RN

Piloting approaches to improve cultural sensitivity and humility in the care of patients with depression

Principal investigator: Karen Coleman, PhD, MS, Division of Health Services Research & Implementation Science
Some of the biggest drivers of change at Kaiser Permanente Southern California are the Healthcare Effectiveness Data and Information Set (HEDIS) metrics created and monitored by the National Committee for Quality Assurance (NCQA). There are several behavioral health HEDIS metrics and Kaiser Permanente Southern California consistently underperforms on those dedicated to antidepressant medication management (AMM). This led to lost revenue for the health plan and numerous efforts at remediation that had limited effectiveness
Study Aims:
• To develop a culturally sensitive shared decision-making process for depression treatment options that can be easily implemented in adult primary care; and
• To train therapists and depression care managers to apply cultural humility principles within the feedback informed care initiative.
Collaborators:
• Susan Wang, MD; Medical Director, Shared Decision Making; Medical Director, Life Care Planning; West Los Angeles Medical Center
• Elizabeth Hamilton, LCSW, MPH; Clinical Practice Leader Kaiser Permanente Southern California Regional Behavioral Health Care
• Alisa Aunskul, MSHCM, Senior Consultant, Complete Care Support Programs, Behavioral Health and Depression Care Management
• Rachel Sandoval, Kaiser Permanente Southern California Regional Director Equity, Inclusion & Diversity
• Nabeel Qureshi, MPH, MPhil, Graduate Fellow at the Pardee RAND Graduate School (part of this project will be used for Mr. Qureshi’s doctoral project);
• Melanie Tervalon, MD, MPH, Melanie Tervalon Consulting Services

Kaiser Permanente Southern California member COVID-19 household transmission study

David Glass, PhD, Division of Health Services Research & Implementation Science
This study will help us determine the degree to which sending Kaiser Permanente Southern California members home contributes to the continued spread of COVID-19. Several SCPMG operational actions might result from this study to help reduce the risk of household transmission of COVID-19.
• Algorithm (predictive model) might be developed to alert physicians that certain members are at higher risk of household transmission of COVID-19.
• Physicians or care managers might ask additional questions of those being sent home with COVID-19 to better identify the risk of household transmission for that member.
• Preventive materials like masks, gloves, and information sheets might be immediately shipped and a follow-up call made to help prevent the household spread of COVID-19 in certain high-risk situations.
• Identify situations in which the risk of household transmission is so high that some option other than sending the member home should be considered or explored.
Study Aims:
• Determine the household transmission rate of COVID-19 among Kaiser Permanente Southern California members.
• Identify trend in household transmission and whether it has decreased as protocols were developed and put in place.
• Examine the demographic characteristics of those involved in a household transmission of COVID-19.
Collaborators:
• SCPMG physicians: Bruno Lewin, MD, DTMH; David Bronstein, MD, MS
• Research & Evaluation: Kristin Choi, PhD, MS, RN; Corrine Munoz-Plaza, MPH
• Nursing Research: June Rondinelli, PhD, RN, CNS; Hazel Torres, MN, RN

Enhanced implementation of lung cancer screening and pulmonary nodule evaluation

Principal investigator: Michael K. Gould, MD, MS, Kaiser Permanente Bernard J. Tyson School of Medicine, Department of Health Systems Science
This project builds on ongoing work by the CIRT in collaboration with the Regional Lung Cancer Screening (LCS) Implementation Steering Committee to improve LCS practices for outreach, patient selection, shared decision-making, test ordering, results reporting, and follow-up of abnormal screening test results. Priorities for 2021 include the seamless transfer of data collection responsibilities to the Regional SureNet Program (with NLP support from the SSD team), continued support of the data collection needs of the Regional LCS Steering Committee, and completion of manuscripts that examine (1) the probability of cancer in incidentally detected pulmonary nodules, and (2) utilization and timeliness of pulmonary nodule evaluation. The project is especially well-aligned with the new initiative to reduce mortality from lung cancer as part of the KP National Strategic Plan for Cancer Care.
Study Aims:
• Provide benchmarking data on the utilization, appropriateness and outcomes of lung cancer screening in Kaiser Permanente Southern California members.
• Help to design, implement and evaluate novel systems to improve access to screening, screening test quality and adherence with follow-up evaluations and repeat annual screening.
• Transfer responsibility for data collection and natural language processing to the Regional SureNet Pulmonary Nodule Program and the SSD team led by Dr. Daniel Zisook in San Diego
Collaborators:
• The Regional Lung Cancer Screening Implementation Steering Committee is led by George Yuen, MD (Pulmonary Medicine) and Michael Gould, MD, MS (KPBJTSOM, CIRT), includes representation from Shared Decision-Making, Complete Care, Family Medicine, Pulmonary Medicine, Thoracic Surgery and Medical Oncology.
• The Regional SureNet program: Tim Ho, MD; Dan Zisook, MD; and Royanne Timmons

Venous thromboembolism prevention in high-risk abdominal surgery patients

Principal investigator: Michael K. Gould, MD, MS (Department of Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine)
This project builds on ongoing work by the CIRT in collaboration with the Regional VTE Steering Committee to improve venous thromboembolism (VTE) prophylaxis and patient outcomes, by extending the data collection and analysis to high-risk abdominal surgery patients. Activities in 2021 include designing, implementing and evaluating an intervention of extended duration VTE prophylaxis following abdominal surgery; and designing, implementing and evaluating a novel risk model to guide the use of chemical VTE prophylaxis in patients following non-elective abdominal surgery. This project aligns with longstanding efforts to improve safety for hospitalized patients by focusing on one of the leading preventable causes of iatrogenic death.
Study Aims:
• Implementing and evaluating the use of out of hospital, extended duration (4 weeks) chemical prophylaxis with low-molecular-weight heparin in cancer patients undergoing abdominal surgery
• Implementing and evaluating the use of a novel risk assessment model in patients undergoing non-elective abdominal surgery after being admitted through the emergency department
Collaborators:
• Regional VTE Steering Committee: Luis Moreta-Sainz, MD; Akshay Manek, MD; Daniel Lang, MD; Tim Buhl, PharmD; Antonio McBride, MSN, RN; others
• Regional Chiefs of General Surgery: Philip Mercado, MD
• Regional Chiefs of Surgical Specialties: Steven Crain, MD

Implementing systematic depression screening in medical oncology

Principal investigator: Erin Hahn, PhD, MPH, Division of Health Services Research & Implementation Science
Regional implementation of depression screening in medical oncology will help Kaiser Permanente optimize cancer care and patient outcomes and aligns with regional and national goals to demonstrate excellence in cancer care. The program is addressing a critical gap in our current oncology care program. Up-front identification and referral of distressed patients may positively impact long-term health outcomes.
Study Aims:
Based on results from our pragmatic cluster randomized trial, our overarching aim is to implement systematic depression screening for all newly diagnosed cancer patients within SCPMG. Over the past year we have engaged with clinical and administrative stakeholders to design tailored workflows.
• Design and apply health IT tools to support implementation of the depression screening program.
• Develop and provide ‘train-the-trainer’ programs to local oncology teams and depression care management.
• Complete the staggered rollout of the oncology-based screening program in each oncology site, proactively assessing and addressing barriers to implementation.
Collaborators:
• Regional Chief of Oncology: Farah Brasfield, MD
• Lead Oncology Department Administrator: Olivia Robles, RN, MSN
• Chiefs of Oncology
• Depression Care Management

Developing and testing an equitable risk stratification tool to identify patients for serious illness care in the era of COVID-19

Principal investigator: Claudia Nau, PhD, Division of Behavioral Research
The Care Improvement Research Teams is supporting the Kaiser Permanente Southern California regional Dignified Journey team in evaluating and comparing 2 end-of-life indices currently under consideration for implementation at Kaiser Permanente Southern California. In the process, we develop a play book/template that may support evaluation of future EPIC risk scores without relying on the proprietary built-in validation tools that are not fully transparent.
• We will provide an updated, parsimonious Kaiser Permanente Southern California EOL tool that capitalizes on the strength of both risk scores and input from clinicians and the literature.
• We will provide, to our knowledge, the first EOL decision support tool that accounts for COVID-19.
• Our EOL will be one of the first indices that has been developed to assure that it does not discriminate against people of color. We will further assess if our EOL index can help alleviate • racial/ethnic disparities in LCP/SPC as referrals may be more systematic when assisted by our decision support tool.
• Eventually this tool can help to support a staged approach to serious illness care. It may improve shared decision making, timeliness and access to palliative medicine, and allocation of health care resources.
Study aims::
• Build an advisory group including stakeholders from CMI, clinical analysis and operations leaders who have been previously engaged in developing risk stratification tools for the serious illness population.
• Explore how we can combine existing strategies into a single approach that provides an equitable risk stratification tool that accounts for COVID.
• Pilot the adapted model in one medical center.
Collaborators:
• Research & Evaluation: Huong Nguyen, PhD, RN
• Peter Khang, MD, MPH, FAAP, Regional Chief GPCC, Physician Director, Dignified Journeys
• Susan Wang, MD, FAAHPM, HMDC, Medical Director SCPMG Shared Decision Making, Life Care Planning, and Serious Illness Care
• Lori Viveros, MPH, Regional Director Life Care Planning, GPCC, Administrative Lead Dignified Journeys

Implementation and evaluation of an enhanced Adverse Childhood Experiences (ACEs) screening and referral system in pediatric primary care

Principal investigator: Sonya Negriff, PhD, Division of Behavioral Research
We expect that tailoring the evaluation of ACEs-related need and partnering with community organizations will have an immediate impact by providing the appropriate services to curtail the accumulation of ACEs, which disproportionally affect minority and low-income people. By narrowing outreach and treatment to high-risk children, we will also free resources to strengthen case management for this most vulnerable group.
Study Aims:
• Test a clinically informed individualized approach to screen children with ACEs and identify appropriate services based on type of ACEs and child/family need using a social worker triage system.
• Assess delivery of services for children screening positive for ACEs and effectiveness of a case manager follow-up for referral completion
Collaborators:
• Primary collaborator: Mercie DiGangi, DO, Pediatrics Bellflower MOB
• Other clinical collaborators: Tracy Bush, MSW, LCSW Regional Lead Social Medicine; Christine Hall MD, Chief of Pediatrics Downey Medical Center; Megan Jones, MD, Asst Chief of Pediatric
• Psychiatry, Downey; Claudia Lucio, LCSW Pediatric Social Worker Bellflower MOB.
• R&E: Margo Sidell, PhD, Biostatistician; Karen Coleman, PhD
• Community Partner: Louise Godbold, Director Echo Parenting

To scan or not to scan: Utilization of transient elastography in a tertiary care center before and after implementation of an electronic medical record-based clinical decision support tool

Principal investigator: Amandeep Sahota, MD, Los Angeles Medical Center Transplant Surgery
The Fib-4 Aura-based clinical decision support tool with fibrosis calculator and recommendation guideline is accessible to throughout the Kaiser Permanente system. This study will determine the benefit of Fib-4 Aura-based clinical decision support tool to our members and health care system. This study will identify a path forward for this clinical decision support tool in terms of content, applicability and visibility.
Study Aims:
• Determine the impact of Fib-4 Aura-based clinical decision support tool on management practices for persons aged ≥18 years at KP LAMC between January 2016 – November 2020.
• Determine the demographic and clinical characteristics of this population.
• Determine the impact of Fib-4 Aura-based clinical decision support tool on patient outcomes.
Collaborators:
• Rasham Mittal, MD, Liver Transplant
• Libby Stein, MD, Internal Medicine

Evaluating the impact of high-sensitivity Troponin implementation on patient outcomes and health care utilization for Kaiser Permanente Southern California members

Principal investigator: Adam L. Sharp, MD, MSc, Division of Health Services Research & Implementation Science

This project aims to build off previous improvements in the emergency management of patients with suspected acute coronary syndrome. It is unclear how changing our Troponin testing will impact serious patient outcomes and the world-class care we currently provide. The proposed project will provide the necessary resources to assist with implementation of this large-scale project (physician education, changes to the electronic health record, and evaluation).
Study Aims:
• Compare the impact of hsTn vs cTn decision support algorithm on 30-day outcomes
• Compare the impact of hsTn vs cTn decision support algorithm on hospitalizations and cardiac testing
Collaborators:
• Regional Chiefs: Matt Smith, MD, Emergency Medicine; Tim Cotter, MD, Cardiology; Dan Huynh, MD, Hospital Medicine

Observed role of cooling on hemodynamics in inpatient dialysis (ORCHID)

Principal investigator: Hui Xue, MD, MMSc, Nephrology, San Diego Medical Center
If inpatient cooled dialysate is found to be effective in preventing intradialytic hypotension, we can encourage medical centers to set their default HD temperature to 35.5 degrees C to improve clinical outcomes and reduce costs associated with IDH. If cooled dialysate is ineffective in preventing intradialytic hypotension, we can cease this practice and improve patient comfort.
Study Aims:
• To establish baseline frequency and impact of intradialytic hypotension during hemodialysis performed in acute inpatient setting using dialysate at 37°C
To monitor if dialysate cooling to 35.5°C can reduce the occurrence of intradialytic hypotension, and the frequency of using corrective measurements, such as albumin or hypertonic and impact on average hospital stay days, overall 30 day rehospitalization rate, and mortality rate
Collaborators:
• Behzad Alimohammadi, MD, and Stephanie Cheung, MD

Optimizing care delivery, quality, and outcomes for people living with dementia (PLWD) and their family

Principal investigator: Huong Q. Nguyen, PhD, RN
Despite Kaiser Permanente Southern California’s imperative to reduce avoidable emergency departments visits and admissions for ambulatory care sensitive conditions, very little if any attention has been given to evaluating effective models of proactive and coordinated care for high risk, homebound members with advanced dementia and multiple chronic conditions. This study aims to investigate the uptake of home-based primary care and hospital at home services by a unique and hard to reach population of geographically remote patients/caregivers, and to better understand the patterns of health care utilization and outcomes for the entire community of Kaiser Permanente Southern California members with Alzheimer’s disease-related dementias and memory loss to identify other potential improvement opportunities.

Implementing systematic depression screening in medical oncology

Principal investigator: Erin Hahn, PhD, MPH
Implementing systematic depression screening in medical oncology is an evidence-based guideline-recommended practice, and our recent pragmatic trial found that we can integrate this practice with minimal workflow disruption while effectively identifying and referring highly distressed patients. Regional implementation of depression screening in medical oncology will help our region optimize cancer care and patient outcomes and aligns with our regional and national goals to demonstrate excellence in cancer care.
With CIRT funding and support, and the partnership of the SCPMG oncology chiefs, we set out to spread the screening intervention across SCPMG medical centers, leveraging the lessons learned in the randomized trial. Critical elements of the screening program include adaptable workflow design, assignment of accountable staff, and audit and feedback of performance data. Using resources and tools developed during the trial, which include detailed guidance on screening, scoring, and referral processes and supportive training materials, we will use implementation science methods to guide the spread of this effective practice.
This project includes 2 arms:
1. Engage in implementation planning with key stakeholders (department administrators, oncology social workers, nursing teams, oncologists, quality leaders) to develop an implementation blueprint for regional rollout. This includes working with Quality and Complete Care teams to develop POE reminders and tracking.
2. Lead a staggered rollout of the oncology-based screening program in partnership with oncology DAs, proactively assessing and addressing barriers to implementation. We will evaluate uptake and fidelity of the screening program over a 12-month period.

Evaluating the impact of high-sensitivity troponin implementation on patient outcomes and health care utilization for Kaiser Permanente Southern California members

Principal investigator: Adam Sharp, MD, MS
This project aims to build off previous improvements in the emergency management of patients with suspected acute coronary syndrome. It is unclear how changing our Troponin testing will impact serious patient outcomes and the world class care we currently provide. This project provides the necessary resources to assist with implementation of this large-scale project (physician education, health connect changes, and evaluation).

Enhanced implementation of lung cancer screening

Principal investigator: Michael Gould, MD, MS
This project builds on ongoing work by the CIRT in collaboration with the Regional Lung Cancer Screening (LCS) Implementation Steering Committee to improve LCS practices for outreach, patient selection, shared decision-making, test ordering, results reporting, and follow-up of abnormal screening test results. The overarching goals of the program are to: (1) reduce inappropriate use of screening among Kaiser Permanente Southern California members who do not meet standard eligibility criteria and are unlikely to benefit; and (2) improve access to and the effectiveness of LCS among individuals who are at high risk for death from lung cancer and therefore most likely to benefit. The project is especially well aligned with the new initiative to reduce mortality from lung cancer as part of the Kaiser Permanente National Strategic Plan for Cancer Care.

Developing methods to improve access to behavioral health care services using patient-reported outcomes

Principal investigator: Karen Coleman, PhD, MS
In response to the increasing demands for behavioral health care services at KPSC, the Department of Behavioral Health has implemented a program called Kaiser Permanente External Provider (KPEP) using the composite Behavioral Health Index (BHI) from a patient-reported outcomes collection platform to direct patients to the level of care they need based upon their condition acuity. Although the algorithm has been implemented, its validity and clinical utility has not been evaluated and the symptom acuity cut-offs used for triage have a limited empirical basis, and the BHI is not used anywhere outside of Behavioral Health and has not been directly linked to instruments which other departments use for treatment decisions (i.e. the Patient Health Questionnaire [PHQ9]).
This project has the potential to affect clinical operations in the following ways: 1) it will insure that patients with mental health conditions receive the best treatment tailored for their needs improving satisfaction with care; 2) it will reduce the access burden in Behavioral Health and improve enrollment rates in the depression care management program, Center for Healthy Living stress management and wellness classes, and the Center for Healthy Living wellness phone coaching program; and 3) it will ensure that Kaiser Permanente Southern California meets and/or exceeds the new HEDIS Depression Remission and Response targets when they are publicly reported in 2021.

Improving care transitions and reducing readmissions

Principal investigator: Huong Q. Nguyen, PhD, RN
This project is evaluating the effectiveness of interventions/services to improve care transitions and reduce avoidable readmissions. These findings will contribute to health system efforts to maintain high Medicare star ratings and lower financial penalties for KPSC.
The study aims to:
1. Determine which subgroup of patients benefit most (lower 30-day inpatient and observation stay readmission) from the current post-discharge telephone calls and follow-up clinic visits
o Explore which patients are most appropriate for clinic vs. video vs. phone visits
2. Collaborate with heart failure TCP champions to evaluate the effects of de-implementing the routine 2-day home health visit post discharge
o Assess opportunities to improve care transition for patients with heart failure
3. Determine patterns of care transition interventions that is associated with reduced 30-day readmission and mortality for patients with sepsis
4. Determine the impact of on-demand physician consultation for home health RNs on patient use of urgent care services, ED visits and hospitalizations while receiving home health services.
o Describe the classes of acute issues escalated and/or resolved by the MD consultation service
o Determine subgroups of patients who would benefit most from this service

Prevention in high-risk abdominal surgical patients

Principal investigator: Michael Gould, MD, MS
This project builds on ongoing work by the CIRT in collaboration with the Regional VTE Steering Committee to improve venous thromboembolism (VTE) prophylaxis and patient outcomes, by extending the data collection and analysis to high-risk abdominal surgery patients. The project involves retrospective analysis of observational data to identify VTE risk factors, measure adherence with recommended VTE prophylaxis, and examine VTE outcomes in two subpopulations prioritized by the regional chiefs of General Surgery as one of their chiefs’ goals for 2020-2021: (1) patients undergoing abdominal surgery for cancer; and (2) abdominal surgery patients admitted through the emergency department. This project aligns with longstanding efforts to improve safety for hospitalized patients by focusing on one of the leading preventable causes of iatrogenic death.

Evaluating the impact of implementing an age-adjusted D-dimer threshold for emergency department encounters with patients suspected for pulmonary embolus

Principal investigator: Adam Sharp, MD, MS
This project aimed to help SCPMG to understand the impact of changing the reported reference threshold for D-dimer values on patient outcomes and care efficiency. The team investigated whether KPSC laboratory D-dimer thresholds for patients over age 50 years impacted 30-day patient outcomes or use of advanced diagnostic imaging. Study findings indicate that increasing the D-dimer lab threshold was safe and did NOT increase 30-day adverse events; and advanced imaging declined post intervention, but not significantly. This indicates an opportunity for improvement with future implementation strategies.

Developing guidance for embedded research on adaptable, multi-component interventions

Principal investigator: Brian Mittman, PhD
This project builds on two CIRT-hosted research expert conferences to produce practice-relevant guidance and tools for use by CIRT scientists and their KPSC operational partners to improve our design, evaluation and refinement of multi-component adaptable healthcare innovations (e.g., health promotion and chronic disease management programs, readmissions reduction and palliative care programs).
The guidance and tools produced through this project are expected to enhance our ability to design and deploy more effective programs for improving KPSC clinical care and performance in all areas for which multi-component, adaptable interventions are used, including KPSC work to improve performance on key quality measures, to achieve regional Chiefs’ goals, to reduce patient safety risks, and other benefits.

Adapting and implementing an integrated care model for youth with autism spectrum disorder and psychiatric comorbidity: Phase 3

Principal investigators: Karen J. Coleman, PhD, MS and Brian Mittman, PhD

The project is designed to conduct a feasibility trial to address two main issues in the treatment of children with autism spectrum disorder (ASD): 1) children with ASD have high rates of co-occurring mental health conditions that if left untreated, could interfere with their response to treatment for their ASD; and 2) healthcare systems typically demonstrate poor coordination between service systems and providers to identify co-occurring mental health needs and to support access to appropriate mental health treatment in a timely fashion.
The operational impact of this project is to improve access to mental health services for children with ASD so that the California state-mandated treatment for ASD is as effective as possible. More effective treatment of co-morbid mental health conditions could result in a need for less intensive ASD treatment and thus potentially cost saving for the organization.