Top 10 stories of our science from 2017

Efforts to improve flu prediction, vaccine awareness, cancer screening, and back pain treatment were among KPWHRI’s most compelling stories last year.

In 2017, Group Health became part of something larger than itself: Kaiser Permanente. Through the Health Care Systems Research Network, Group Health Research Institute had long collaborated with colleagues at Kaiser Permanente research centers. Then we became the newest of them. Also in 2017, the Institute’s founding director, Ed Wagner, MD, MPH, retired; David C. Grossman, MD, MPH, was appointed chair of the U.S. Preventive Services Task Force; and several accomplished scientists joined our ranks.

Throughout these transitions, Kaiser Permanente Washington Health Research Institute (KPWHRI) researchers have worked with leaders and clinicians at Kaiser Permanente Washington to launch a Learning Health System Program that weaves research into care delivery. Here is just a small selection of 10 significant stories from among many in the past year’s topnotch work:

1. Gauging flu vaccine effectiveness—and predicting seasons

Michael L. Jackson, PhD, an associate investigator, is developing a “flucaster” for this flu season, including when various forms of the virus may peak—and end. Newsweek wrote about this experimental predictor. Kaiser Permanente Washington is one of 5 sites nationwide that contribute information to the U.S. Influenza Vaccine Effectiveness Network. Dr. Jackson and colleagues reported in the New England Journal of Medicine that, although the injected inactivated flu vaccine reduced the risk of influenza illness in 2015-2016, the live-attenuated nasal spray vaccine, FluMist, performed poorly among U.S. children.

2. Vaccine hesitancy tackled in new way, through peers

A KPWHRI team tested a new way to approach parents who are hesitant to have their children vaccinated: training parents who vaccinate their children to discuss why they value immunization. Parent volunteers show promise as advocates to help protect communities against contagious diseases, according to Clarissa Hsu, PhD, an assistant investigator, and Jennie Schoeppe, MPH, MS, a research associate/program manager at KPWHRI’s Center for Community Health and Evaluation, and colleagues. Time and Seattle magazines reported on their findings.

3. Mailing kits boosts colon cancer screening long-term

Over 5 years, Kaiser Permanente Washington members who were mailed fecal tests were up to date on recommended screening for colorectal cancer screening 30 percent more of the time than were those who received usual care. Beverly Green, MD, MPH, an associate investigator and Kaiser Permanente family physician, led the research team that published these results in Cancer. This work supports Kaiser Permanente programs that mail test kits to members.

4. Mind-body therapy found cost-effective for back pain

Mindfulness-based stress reduction may provide cost-saving treatment for low back pain compared to usual care—and cognitive behavioral therapy seems cost-effective. These findings are timely, as the opioid crisis is forcing doctors to change how they treat chronic pain, shifting toward nondrug remedies and psychological interventions. Daniel C. Cherkin, PhD, a senior investigator emeritus, led the team that did this research, published in Spine with KPWHRI and RAND colleagues. The New York Times quoted him about it.

5. Sharing the best innovations in primary care

Innovative primary care practices across the country engage health professional and lay staff thoroughly in patient care, helping to free providers up to focus on tasks that only they can perform. And this lets the practices meet the expectations of a patient-centered medical home. Dr. Wagner led Learning from Effective Ambulatory Practices, a national program of the Robert Wood Johnson Foundation, and published its observations in BMC Family Practice.

6. Coaching physicians on value-based care 

Kaiser Permanente Washington’s physician mentoring program to reduce specialty referral rates is feasible and acceptable. Increasing the appropriateness of referrals has the potential to provide patient-centered care, reduce system costs, and improve physician satisfaction. Leah Tuzzio, MPH, a research associate, and colleagues published in The Permanente Journal.

7. How to reduce opioid risk

Long-term implementation of opioid dose and risk reduction initiatives was not associated with lower rates of prescription opioid use disorder among prevalent chronic opioid therapy patients. This, despite success in lowering patients’ opioid doses. Extreme caution should be exercised for patients with chronic non-cancer pain until benefits of this treatment and attendant risks are clarified, warn Michael Von Korff, ScD, a senior investigator, and colleagues. They published in the International Journal of Drug Policy.

8. Patients’ marijuana use explored

Routinely asking about cannabis use can serve patients by helping clinicians start conversations about risks and benefits, according to a study at Kaiser Permanente Washington conducted since the state legalized nonmedical cannabis use in 2014. The team, led by Katharine Bradley, MD, MPH, senior investigator, and Gwen Lapham, PhD, research associate, , published results in the Journal of the American Board of Family Medicine.

9. Studying social factors that affect health

KPWHRI is focusing more on the social factors that affect health, in keeping with Kaiser Permanente’s mission “to improve the health of our membership and the communities we serve.” These factors—including education, employment, income, safety, housing, and family and social support—can affect people’s health more than health care does. In November 2017 KPWHRI, with some University of Washington (UW) School of Public Health faculty members, convened “From Health Care to Health: A Summit to Address Community and Social Factors.” Although commonly called “determinants,” these factors can be overcome with effective intervention, according to Gregory Simon, MD, MPH, senior investigator and Kaiser Permanente Washington psychiatrist. Helping with such interventions at Kaiser Permanente Washington are community resource specialists. Dr. Hsu led the creation and study of this new role.

10. Moving to Health

How can your neighborhood nudge you toward healthier behavior? A new study is another example of KPWHRI’s commitment to understanding factors other than health care that influence health. Led by David Arterburn, MD, MPH, senior investigator, with multidisciplinary UW collaborators, the study will investigate which specific characteristics of different neighborhoods most affect neighborhood rates of obesity and type 2 diabetes—and exercise and healthy eating. This video explains the recently funded study.

As the Institute prepares to host AcademyHealth’s Annual Research Meeting in 2018, we keep moving onward and upward.

by Rebecca Hughes