Internal research can make care better and more affordable
The IMPROVE program turns researchers’ eyes toward making health care and coverage more effective and efficient.
As part of the IMPROVE program, researchers study the patient experience, the health of specific groups, the cost of care, and more.
Over the last several years, national guidelines for cervical cancer screening have changed.
Before adopting the new guidelines, Kaiser Permanente in Colorado clinical care leaders wanted to understand how the changes could impact care for patients.
Would these changes affect physicians’ ability to find cancer quickly? Would they pose any questions or challenges to patients? What impact would the changes have on keeping care affordable?
Larissa White, PhD, is an investigator with the Kaiser Permanente Colorado Institute for Health Research, or KPIHR. She works closely with Shauna Goldberg, a senior project manager with KPIHR. Together, they investigate how and why cancer develops in different people.
Most of the time, their work explores bigger cancer questions that affect all of society. For this project, they looked inside Kaiser Permanente in Colorado through the organization’s program called Innovative Methods to Promote Regional Operational Value and Efficiency, or IMPROVE.
The IMPROVE program
Under the IMPROVE program, KPIHR researchers collaborate with teams from both the health care delivery side and health coverage side of Kaiser Permanente. Together, they look at the patient experience, health of specific groups of patients, costs, and more, often using data from Kaiser Permanente’s electronic health record system.
They predict how proposed changes might affect how care is delivered and suggest new ways to do things better. The goal is to make Kaiser Permanente’s integrated care and coverage more effective and efficient for members and patients.
“The potential to have a rapid, positive impact on people’s health is what makes IMPROVE such a powerful program,” said P. Michael Ho, MD, PhD, the director of the IMPROVE program. “In a short time, we can go from a question to a tangible change in care. Seeing those ideas implemented and improving patient care is what makes this work so fulfilling.”
Since 2024, IMPROVE has completed 24 internal projects in Colorado, including:
Improving participation in lung cancer screening to catch cancer earlier
Standardizing best practices to manage high blood pressure in pregnant people to reduce the risk of preeclampsia
Improving Kaiser Permanente reminders to help members stay on top of checkups, tests, and other timely care, which helps find diseases earlier, when they’re easier to treat
Testing more youth for depression and anxiety to address rising rates of mental health concerns for young people
Cervical cancer screening research
In their IMPROVE project, White and Goldberg were tasked with comparing the newly proposed cervical cancer screening guidelines with the old ones.
Under the previous best practices, women 30 to 65 years old had 2 options. They could get a Pap test every 3 years, or they could get a Pap test with an HPV (for human papillomavirus) test every 5 years.
The new guidelines recommend only collecting HPV tests every 5 years. Because 99.7% of cervical cancer stems from a sustained HPV infection, one test could largely do the work of both tests.
And because the HPV test can catch cervical cancer at a similar rate with fewer procedures, the new best practice could save lives, as well as save patients money on testing and cancer treatment over time.
Fewer screenings, more questions
However, when they interviewed patients, White and Goldberg heard some concerns.
“It was as if they were saying, ‘Wait, hold on, you're going to do less screening? That must mean you're not going to capture as much cancer,’” said White. “No, this test is actually more effective.”
They also uncovered something else: Many members thought tests for cervical cancer also screened for sexually transmitted infections, or STIs.
“It meant that there may be another gap Kaiser Permanente could fulfill with further education,” said White. “Members can come in for STI screening at any time. It's a preventive, no-cost service.”
To close this gap, leaders decided to create more resources to help doctors address member concerns directly and compassionately during appointments.
At the end of the study, White and Goldberg were able to make a bigger difference than they originally thought. They were able to deliver recommendations that would make cancer screening more effective and affordable, and would also improve STI screenings, which can improve women’s health.
White described the ability to make a difference as empowering.
“If we know that we can have a direct impact on the improvement and quality of life of individuals, then that is really why we do what we do.”