Katharine A. Bradley, MD, MPH
Senior Investigator, GHRI
Group Health Physician, Internal Medicine
Research interests and experience
- Behavior change: alcohol misuse
- Mental health: alcohol use disorders
- Health informatics: physician decision support; eHealth
- Health services and economics: implementation research; quality measurement
- Preventive medicine: alcohol screening; brief alcohol interventions
- Implementation research: screening and brief intervention; mental health quality measurement
- Chronic illness management: primary care management of alcohol misuse
Are people who consume alcohol—but who aren’t dependent on it—drinking to levels that can harm their health? Could the risk be effectively detected and addressed in primary care? Kathy Bradley has been exploring these questions since the late 1980s, when researchers recognized that risky drinking accounts for more illness and death than alcohol addiction, which is much less common.
A general internist, Dr. Bradley concentrates on identifying and addressing unhealthy alcohol use in primary care. Research shows that even a short discussion with a health care provider can help patients reduce risky drinking. In 5 to 15 minutes, a counseling intervention typically advises drinking below recommended limits or abstaining, connects drinking to the patient’s health concerns, and helps the patient set change goals. The recent National Commission on Prevention Priorities ranked alcohol screening and brief alcohol counseling the third-highest priority among prevention recommendations for adults.
While at the Veterans Affairs (VA) Puget Sound Health Care System, Dr. Bradley discovered ways to more efficiently identify unhealthy alcohol use. Her team validated the “AUDIT-C” three-item alcohol screen and a single-question screen, which have been validated in non-VA populations in the U.S. and elsewhere. They also linked high AUDIT-C scores with adverse health outcomes, including decreased medication adherence and increases in fractures and trauma; hospitalizations for liver disease, gastrointestinal bleeding, and pancreatitis; surgical complications and post-op care utilization; and mortality. An ongoing VA study is evaluating whether decreasing unhealthy drinking, reflected by decreased AUDIT-C scores, is associated with improved health outcomes. If so, AUDIT-C scores could be used as a “vital sign” to monitor drinking.
Dr. Bradley was instrumental in helping implement alcohol screening and brief alcohol counseling at more than 900 VA sites—and in developing their national performance measures. Using performance measures and decision support in an electronic medical record (EMR), yearly alcohol screening rates have topped 95 percent since 2007. Her team also developed and tested an EMR-based clinical reminder that provides decision support for brief alcohol counseling. Performance incentives and decision support are linked to increased rates of alcohol counseling.
Currently, Dr. Bradley is developing studies of performance measures of brief alcohol counseling, as well as studies that use clinical informatics to support efficient alcohol screening and brief alcohol counseling within Group Health. She’s also leading the National Institute of Health’s National Institute on Alcohol Abuse and Alcoholism study on Collaborative Care for Primary Care Patients with unhealthy drinking: “Considering Healthier Drinking Options In Collaborative Care (CHOICE) Trial.”
Dr. Bradley has co-directed several Health Services Research Fellowships at the University of Washington and VA, led the Alcohol Misuse Workgroup of the VA Substance Use Disorders Quality Enhancement Research Initiative (QUERI), and provided primary care to female veterans for 17 years.
Bradley KA, Kivlahan DR. Bringing patient-centered care to patients with alcohol use disorders. JAMA. 2014;311(18):1861-2. doi: 10.1001/jama.2014.3629. PubMed
Williams EC, Rubinsky AD, Chavez LJ, Lapham GT, Rittmueller SE, Achtmeyer CE, Bradley KA. An early evaluation of implementation of brief intervention for unhealthy alcohol use in the U.S. Veterans Health Administration. Addiction. 2014 Apr 29. doi: 10.1111/add.12600 [Epub ahead of print]. PubMed
Williams EC, Bradley KA, Balderson BH, McClure JB, Grothaus L, McCoy K, Rittmueller SE, Catz SL. Alcohol and associated characteristics among older persons living with HIV on antiretroviral therapy. Subst Abus. 2014 Mar 13 [Epub ahead of print]. PubMed
Callegari LS, Zhao X, Nelson KM, Lehavot K, Bradley KA, Borrero S. Associations of mental illness and substance use disorders with prescription contraception use among women veterans. Contraception. 2014 Mar 6. pii: S0010-7824(14)00097-3. doi: 10.1016/j.contraception.2014.02.028. [Epub ahead of print].
Delaney KE, Lee A, Lapham GT, Rubinsky AD, Chavez LJ, Bradley KA. Inconsistencies between alcohol screening results based on AUDIT-C scores and reported drinking on the AUDIT-C questions: prevalence in two national samples. Addict Sci Clin Pract. 2014 Jan 27;9(1):2. doi: 10.1186/1940-0640-9-2.
Williams EC, Rubinsky AD, Lapham GT, Chavez LJ, Rittmueller SE, Hawkins EJ, Grossbard J, Kivlahan DR, Bradley KA. Prevalence of clinically recognized alcohol and other substance use disorders among VA outpatients with unhealthy alcohol use identified by routine alcohol screening. Alcohol Drug Depend. 2013 Nov 27 [Epub ahead of print]. PubMed
Lapham GT, Rubinsky AD, Heagerty PJ, Achtmeyer C, Williams EC, Hawkins EJ, Maynard C, Kivlahan DR, Au D, Bradley KA. Probability and predictors of patients converting from negative to positive screens for alcohol misuse. Alcohol Clin Exp Res. 2013 Oct 7. doi: 10.1111/acer.12260. [Epub ahead of print]. PubMed
Lapham GT, Rubinsky AD, Heagerty PJ, Williams EC, Hawkins EJ, Maynard C, Kivlahan DK, Bradley KA. Annual rescreening for alcohol misuse: diminishing returns for some patient subgroups. Med Care. 2013 Oct;51(10):914-21. doi: 10.1097/MLR.0b013e3182a3e549. PubMed
Rubinsky AD, Bishop MJ, Maynard C, Henderson WG, Hawn MT, Harris AH, Beste LA, Tønnesen H, Bradley KA. Postoperative risks associated with alcohol screening depend on documented drinking at the time of surgery. Drug Alcohol Depend. 2013 Oct 1;132(3):521-7. doi: 10.1016/j.drugalcdep.2013.03.022. Epub 2013 May 16. PubMed
Bradley KA, Chavez LJ, Lapham GT, Williams EC, Achtmeyer CE, Rubinsky AD, Hawkins EJ, Saitz R, Kivlahan DR. When quality measures undermine quality: bias in a quality measure for follow-up for alcohol misuse. Psychiatr Serv. 2013 Oct;64(10):1018-25. doi: 10.1176/appi.ps.201200449. Epub 2013 Jul 15. PubMed
To view more publications, please see Dr. Bradley’s CV.