Group Health Research News
- Childhood obesity linked to neighborhood social and economic status
- Screening mammograms’ detection of breast cancer has improved over time
- Web- and phone-based counseling work well to quit smoking with Chantix
- Medical home pays off, improving primary care and cutting cost at two years
- Women have higher health costs for years after domestic violence ends
- People with diabetes are at higher risk of atrial fibrillation
- Patient perspective makes health information technology more valuable
- Three new affiliate investigators named
- Research highlights
- Major new funding
Childhood obesity linked to neighborhood social and economic status
Children in King County, Washington, are more likely to be obese if they live in socially disadvantaged neighbor-hoods. This is according to a team of researchers at Seattle Children's Research Institute, the University of Washington (UW), and Group Health Research Institute (GHRI). Social Science & Medicine e-published the research in June in advance of printing it.
The researchers found obesity most common in children living in neighborhoods with the least-educated females, most single-parent households, lowest median household income, highest proportion of non-white residents, and fewest homes owned. Together, these five socioeconomic factors accounted for 24 percent of the variability in childhood obesity rates across neighborhoods. » full news release and video
Screening mammograms’ detection of breast cancer has improved over time
Researchers analyzing 2.5 million screening mammo-grams performed on nearly one million women found discrimination of cancerous from non-cancerous lesions improved over a nine-year period. Results of the study are published in the May 26 online edition of the journal Radiology.
“To our knowledge, this is the first study of time trends for performance measures in a large representative sample of women undergoing screening mammography in the United States,” said lead author Laura E. Ichikawa, MS, a senior biostatistician at Group Health Research Institute. » full news release
Web- and phone-based counseling work well to quit smoking with Chantix
A randomized trial compared three ways to deliver a behavioral smoking cessation program using varenicline (Chantix®): by phone, Web, or both. Although phone counseling had greater treatment advantage for early cessation and appeared to increase medication adherence, abstinence outcomes did not differ at six months. The findings suggest the three programs are all effective treatment options when combined with varenicline. Nonprofit scientific research institute SRI International, GHRI, and Free & Clear, Inc. conducted the trial, published in the May American Journal of Preventive Medicine.» full news release
Medical home pays off improving primary care and cutting cost at two years
In a two-year evaluation at Group Health, transforming primary care into a “patient-centered medical home” model paid off. Published in the May Health Affairs, the evaluation compared the medical home prototype to Group Health’s other medical centers, showing:
- The quality of care was higher, patients reported having better experiences, and clinicians said they felt less “burned out.”
- Patients had 29 percent fewer emergency visits and 6 percent fewer hospitalizations, resulting in a net savings of $10 per patient per month.
- For every dollar Group Health invested, mostly to boost staffing, it recouped $1.50.
Women have higher health costs for years after domestic violence ends
For three years after women stop experiencing domes-tic violence, they have significantly higher health costs than do women who have not been abused, a new study has found. Abuse victims had health care costs that averaged more than $1,200 above those of non-abused women for the first two years after the abuse ended—and about $400 above others in the third year.
“Women may continue to experience physical and emotional consequences even years after their abuse ends, and that is reflected in their health care costs,” said Amy Bonomi, PhD, MPH, co-author of the study and associate professor of human development and family science at Ohio State University.
Paul Fishman, PhD, an associate investigator at Group Health Research Institute and an affiliate associate professor of health services at the University of Washington School of Public Health, led the study. It appeared in the April 23 online issue of Journal of General Internal Medicine, which will publish it in a future print issue. » full news release
People with diabetes are at higher risk of atrial fibrillation
As the U.S. population keeps aging and gaining weight, diabetes is becoming increasingly common. Some research has associated diabetes with the most common kind of chronically irregular heartbeat, called atrial fibrillation, which can raise the risk for stroke and death. But results of past studies of diabetes and atrial fibrillation have conflicted. Now in the Journal of General Internal Medicine, Dr. Sascha Dublin of Group Health Research Institute has linked diabetes to a 40 percent greater risk of developing atrial fibrillation; and she found this risk rises even higher the longer people have diabetes and the less controlled their blood sugar is. » full news release and video
Patient perspective makes health information technology more valuable
Hopes are high that health information technology will support care between office visits, boost efficiency and convenience, and help patients lead healthier lives. An evaluation in the April Health Affairs suggests how to make the most of this new approach: Routinely ask patients how they like it and what they want.
“It’s crucial to ask patients whether the health infor-mation technology they use is meeting their needs promptly and appropriately and honoring their values and preferences,” said lead author James Ralston, MD, MPH, an associate investigator at GHRI and an internist at Group Health Cooperative. » full news release and video
Three new affiliate investigators named
GHRI faculty recently appointed three new affiliate investigators—scientists employed by other organiza-tions who have a long-term collaborative relationship with GHRI:
- Nicholas L. Smith, PhD, MPH, UW Professor of Epidemiology and Director, Seattle Epidemiology and Information Resource Center and the Vietnam Era Twin (VTE) Registry, VA Puget Sound Health Care System. Dr. Smith is a cardiovascular epidemiologist who does pharmaco-epidemiologic and genetic research primarily related to venous thrombosis risk.
- Sean D. Sullivan, PhD, Pharmacist, Health Services Researcher, and Professor in the UW Schools of Pharmacy and Health Services. Dr. Sullivan also directs the Pharmaceutical Outcomes Research and Policy Program (PORPP). His research includes economic evaluation of pharmaceuticals, particularly in the areas of respiratory disorders, organ transplantation, HIV/AIDS, and mental health.
- Steven B. Zeliadt, PhD, MPH, Core Investigator in the VA Health Services Research & Development service and Research Assistant Professor with the UW Department of Health Services. Dr. Zeliadt is also an affiliate investigator at the Fred Hutchinson Cancer Research Center, where he continues to analyze data and publish from two multisite survey studies of prostate cancer treatment decision making among newly diagnosed men and their families.
Research highlights
The core design principles used in Group Health’s interpretation of the Patient-Centered Medical Home (PCMH) concept is the subject of an article in a recent issue of Studies in Health Technology Informatics. Titled “Participatory (re)design of a sociotechnical health care delivery system,” the article describes how Group Health developed its principles using a facilitated group process to translate current theories and evidence about effective primary care. Lead author and GHRI Research Associate James Tufano, PhD, MHA, explains how the principles guided subsequent system transformation activities.
Statin therapy in early old age, but not in late age, may be associated with a lower risk of Alzheimer’s disease, according to a study of 3,392 Group Health members age 65 and older enrolled in GHRI’s Adult Changes in Thought (ACT) study. Led by the UW’s Gail (Ge) Li, MD, PhD, the research confirms earlier findings from a smaller study. Dr. Li’s work was published online June 1 in the Journal of the American Geriatric Society. Co-authors include GHRI Executive Director and Senior Investigator Eric B. Larson, MD, MPH, and GHRI Affiliate Investigator Paul Crane, MD, MPH, of UW.
GHRI Senior Investigator Carolyn Rutter, PhD, published a review of current methodologies for using dynamic microsimulation models (MSMs) to estimate population-level effects of treatment and screening on disease outcomes and the comparative effectiveness of treatments. Dr. Rutter’s article, published May 18 in Medical Decision Making, presents an overview of MSM—including methods for selecting parameters to produce observed or expected results. It also examines issues related to reporting and interpreting MSM findings, which are being used more and more to guide health policy decisions.
Higher protein consumption is associated with lower risk of frailty in older women, according to a study by Jeannette Beasley, PhD, MPH, RD, former women's health post-doctorate fellow at GHRI. Published in the June Journal of the American Geriatric Society, Dr. Beasley’s research used data from the Women's Health Initiative at Fred Hutchinson Cancer Research Center to study 24,417 women age 65 to 79. The researchers found that "higher protein consumption, as a fraction of energy, is associated with a strong, independent, lower risk of incident frailty in older women." (Frailty is defined as having three or more of these components: low physical function, exhaustion, low physical activity, and unintended weight loss.)
Radiologists’ ability to distinguish cancerous from non-cancerous lesions on mammograms improved over a nine-year period, according to a Group Health study published online in Radiology on May 26. Led by GHRI Senior Biostatistician Laura E. Ichikawa, MS, the research team examined Breast Cancer Surveillance Consortium (BCSC) data on 2.5 million screening mammograms performed on nearly one million women. The research showed that an increase in the cancer detection rate outweighed an increase in false-positive test results, for a positive net effect.
Screening mammograms in women under age 40 result in high rates of callback and additional imaging tests but low rates of cancer detection, according to a study led by a researcher from the University of North Carolina at Chapel Hill (UNC) and co-authored by GHRI Associate Investigators Diana S.M. Buist, PhD,and Sebastien Haneuse, PhD. The new findings were published online May 3 in the Journal of the National Cancer Institute. Many studies have assessed mammography in women over age 40 years, but little is known about its usefulness in younger women. Although screening mammograms are not generally recommended under age 40, about 29 percent of women between 30 and 40 report having had one. The lead author from UNC, Bonnie C. Yankaskas, PhD, MPH, and her colleagues pooled data from six mammography registries that are part of the Breast Cancer Surveillance Consortium. Their study included 117,738 women who had their first mammogram between the ages of 18 and 39.
Psychiatric diagnosis did not predict worse treatment outcome or worse side-effects among smokers enrolled in Group Health’s COMPASS cessation trial. The study, published online on April 2 in the Journal of Substance Abuse Treatment, involved behavioral counseling plus varenicline (Chantix®) and followed study participants for six months after their quit dates. It was led by GHRI Associate Investigator Jennifer McClure, PhD. Co-authors included Associate Investigator Sheryl Catz, PhD; Project Manager Julie Richards, MPH; and Affiliate Investigators Tim McAfee, MD, MPH, and Susan M. Zbikowski, PhD, both of Free & Clear, Inc.
The estimated risk of a false-positive recall after 10 screening mammograms is 63 percent—higher than previously reported, according to a Group Health study e-published March 31 in Statistical Methods in Medical Research. GHRI Associate Investigator Rebecca Hubbard, PhD, and colleagues studied data from nearly 160,000 women who had mammograms over a 13-year period at facilities associated with the Breast Cancer Surveillance Consortium, a research network of seven mammography registries nationwide. “Benefits of screening must be weighed against potential harms, such as false-positive results, which may lead to increased health care costs, patient anxiety, and other adverse outcomes associated with diagnostic follow-up procedures,” the authors wrote.
Participation in the EnhanceWellness (EW) Program—a community-based health promotion program for older adults—resulted in health benefits but not significant savings in health care costs. EW, which is not the same as the Enhance Fitness group exercise program for seniors, is a comprehensive program that includes health assessment, tailored health plans, and motivational support to achieve a self-chosen goal. The study, conducted among Group Health members and published in the March journal Preventing Chronic Disease, evaluated 218 EW participants one year after beginning the program and 654 non-participants. Charles Mayer, MD, MPH, of the University of Washington’s (UW) Health Promotion Research Center is the lead author. GHRI co-authors are Senior Investigator Ed Wagner, MD, MPH, and Affiliate Investigators James P. LoGerfo, MD, MPH, and Elizabeth Phelan, MD, MS,of the UW.
Major new funding
The Agency for Healthcare Research and Quality has awarded nearly $600,000 to GHRI to study the impact of Group Health’s primary care redesign. The two-year study will examine Group Health’s transformation to the patient-centered medical home model—which was introduced at all 26 medical centers last year—and its impacts on cost of care, quality, and patient and staff outcomes. It is the first study known to GHRI researchers that describes the use of the Lean Production System in transforming primary care.
The new award comes shortly after publication of a
two-year evaluation of the medical home prototype at Group Health’s Factoria Medical Center. Early results of the evaluation were so promising that Group Health leadership decided to spread the model throughout the organization.
Policy makers and others interested in health reform have shown strong interest in Group Health’s experience with the medical home. “There’s a growing enthusiasm for the medical home nationwide and many demonstrations are underway,” explains GHRI Associate Investigator Robert Reid, MD, PhD, the principal investigator of the study. “But Group Health is rare in its ability to produce the kind of robust data on performance and outcomes that is urgently needed.”
Group Health’s 26 clinics differ in size, geography, patient and provider mix, and practice culture—allowing researchers to discover and share information about primary care transformation in a variety of settings.
Dr. Reid also serves as associate medical director for preventive care at Group Health.
The study’s co-investigators are GHRI Associate Investigator Paul Fishman, PhD; Research Associates Clarissa Hsu, PhD, Katie Coleman, MSPH, and James Tufano PhD, MHA; Biostatistican Eric Johnson, MA; Group Health Medical Director for Primary Care Services Claire Trescott, MD; and UW’s Alan Cheadle, PhD.
Other large new grants recently awarded include:
Transition to Long-Term Opioid Use Among Older Adults with Chronic Pain: A five-year, $3,022,257 grant from National Institute on Aging. Major Goals: To better understand risk factors for sustained use of prescription opioids, and for prescription opioid dysfunction (POD), as defined above. This research will focus on the transition to long-term opioid use among adults age 40 years or older, the age-range in which use of prescription opioids is most common. This research will: (1) develop practical and efficient risk prediction models for targeting patients for risk/harm reduction programs among middle-age and older adults; (2) improve understanding of risk factors for sustained higher dose opioid use at higher dosage levels (50+ mg per day, morphine equivalent) and for adverse consequences of sustained opioid use; and (3) evaluate risk factor differences by gender and age group (middle age vs. older adults). The principal investigator is Michael R. Von Korff.
CRN Administrative Supplement—Developing a Mental Health Data Resource: Cancer Research Network Across Health Systems: A ten-month, $1,499,873 grant from National Cancer Institute. Major Goals: Establish infrastructure for a Mental Health Research Network within the HMORN. The principal investigator is Edward H. Wagner.
SHARP Area 4: Secondary Use of Electronic Health Record (EHR) Data: A four-year, $689,704 grant from the Office of the National Coordinator for Health Information Technology. Major Goals: to develop and implement novel, widely applicable methods for normalizing research-relevant patient data across multiple, geographically-dispersed health care institutions to facilitate multi-site, large-N investigations of health and health-related issues. GHRI's primary contributions to the effort include:
- Developing and applying Natural Language Processing (NLP) algorithms for extracting research-quality measures from clinical text.
- Developing and testing novel, secure cloud-computing-based systems to facilitate use of centrally-deployed but 100 percent locally-controlled sophisticated NLP systems for application in applied research settings.
- Identifying and addressing security and IRB-related concerns among end users of cloud-based NLP systems, including hosting a national conference dedicated to the topic.
The GHRI lead investigator is David Carrell.
Statins and Lymphoma Malignancy Risk in a Large Multi-Site Population Based Cohort: A four-year, $325,793 grant from the National Cancer Institute. Major Goals: Multisite study on the association between statin use and risk of lymphoid malignancy. The GHRI lead investigator is Leslie Spangler.
Public Health Seattle King County Healthy Eating Active Living Evaluation: A two-year, $289,798 grant from CDC. Major Goals: GHRI’s Center for Community Health & Evaluation (CCHE) will conduct a process evaluation on how well this coalition and leadership team are functioning. CCHE will conduct key informant interviews for impressions of change at the community level. CCHE will evaluate the cumulative impact of “Communities Putting Prevention to Work” as a coordinated set of interventions. The GHRI lead investigator is William L. Beery.
Efforts to Develop the Sentinel Initiative—Sequential Testing Methods Development: A one-year, $275,150 grant from Food and Drug Administration. Major Goals: This task order will develop a sequential testing approach that allows regression adjustment for confounders in a full (i.e., unmatched) cohort using estimating equations. A regression framework could improve confounding control (compared to methods that involve matching or stratification) by incorporating continuous confounders, providing a flexible foundation for future inclusion of time-varying exposures and confounders, and allowing for full use of the available cohort data. The GHRI lead investigator is Andrea Cook.
Estimating the Cumulative Risk of a False Positive Screening Mammogram: A two-year, $160,000 grant from National Cancer Institute. Major Goals: The goal of cancer screening is to reduce morbidity and mortality through the early detection of disease; but the benefits of screening must be weighed against potential harms, such as false-positive results, which may lead to increased health care costs, patient anxiety, and other adverse outcomes associated with diagnostic follow-up procedures.
- Aim 1: To describe operating characteristics of existing statistical methods for estimating the cumulative false-positive (FP) risk under scenarios likely to occur in screening mammography.
- Aim 2: To develop new statistical methods for estimation of the cumulative FP risk under dependence of the history of FP results and the screening regimen.
- Aim 3: To apply new statistical methods to analysis of the cumulative FP risk after 10 years of annual versus biennial screening using data from the Breast Cancer Surveillance Consortium (BCSC).
The principal investigator is Rebecca Hubbard.
Public Health Seattle-King County (PHSKC)—Communities Putting Prevention to Work—Tobacco: A two-year, $124,179 grant from CDC. Major Goals: A two-year CDC grant to collaborate with PHSKC evaluation unit to evaluate tobacco intervention. The GHRI lead investigator is William L. Beery.
An Open-Label, Multi-Center Study to Evaluate the Persistence Of Antibody Responses among Adolescents who Previously Received Novartis MenACWY Conjugate Vaccine or Menactra: A five-year, $102,424 grant from Novartis. Major Goals: The principal investigator is Lisa A. Jackson.
Outcomes of Community Naturopathic Medical Care for Type 2 Diabetes - Supplement: A ten-month, $99,802 grant from the National Center for Complementary and Alternative Medicine. Major Goals: This supplemental funding will permit collection of qualitative data to explore how a year of naturopathic care affects patients' perceptions on alternative approaches to healing. The principal investigator is Daniel C. Cherkin.
Pilot Study on Pre-operative Consultations: A one-year, $18,258 grant from Veterans Administration Health Services Research & Development Center of Excellence. Major Goals: Pilot study to define the prevalence of pre-operative consultations for a variety of surgeries, examine whether the prevalence varies by operative risk, and identify possible patterns of either overuse of this service or possible underuse in high-risk patients. The GHRI lead investigator is Robert J. Reid.
Multi-media Resources—Self-Management Support Guidance for Primary Care Clinicians and Patients: A two-year, $86,072 grant from the Agency for Healthcare Research and Quality. Major Goals: The purpose of the proposed project is to develop a multi-media library of implementation-oriented educational resources for providers and patients including general concepts of self-management support and specific suggestions for integrating self-management support into primary care provision. Specific aims are to: (1) Conduct an environmental scan to identify relevant evidence-based self-management materials for primary care clinicians. (2) Identify a preliminary set of gaps, plan and vet a set of new materials that should be developed to address the gaps. (3) Develop, test, and finalize the materials. (4) Compile a searchable database of educational resources. The GHRI lead investigator is Judith Schaefer.