September 21, 2016

Researchers: Improving care for our members and the world

Kaiser Permanente researchers improve care for our members and communities, resulting in fewer heart attacks, improved diabetes control among others.

Kaiser Permanente has more than 153 researchers in seven regions working to ensure that members receive high-quality, affordable, evidence-based health care. Their research has resulted in members having fewer heart attacks, improved diabetes control, more effective weight management programs, fewer surgery complications and hospital readmissions, better HIV care and more effective disease prevention programs. Here are a few of their stories:

Kim Vesco, MD, MPH: Helping women manage weight gain during pregnancy

More than half of women in the United States are already overweight or obese at the start of pregnancy, and almost half of pregnant women gain more than they should during pregnancy, according to new data from the Centers for Disease Control and Prevention.

Kim Vesco MD, MPH, is familiar with these statistics. Having delivered thousands of babies as a Kaiser Permanente obstetrician, she’s seen a lot of complications resulting from this extra weight.

“Obese women have a higher chance of developing preeclampsia (high blood pressure) and gestational diabetes, and they also have an increased chance of having a big baby that will need to be delivered by cesarean section,” says Dr. Vesco, who is also a researcher at the Kaiser Permanente Center for Health Research in Portland, Oregon.

There can be longer-term effects too. Kaiser Permanente research shows that the mother’s extra pregnancy weight also changes the baby’s metabolism, increasing the likelihood that the baby will become an overweight or obese child.

“We need to do a better job advising women about how much weight they should gain during pregnancy, and then give them the right tools to help them manage their weight gain,” says Dr. Vesco.


As a doctor, she knew she could only influence her own patients, but with her research she knew she could reach thousands, perhaps millions of pregnant women. Her first step was to design a study that encouraged obese women to gain little or no weight during pregnancy.

The result was a novel program called Healthy Moms, funded by the National Institutes of Health. It showed that by attending weekly meetings, keeping food diaries and tracking their weight, obese women could substantially decrease their weight gain and still have healthy babies.

The Healthy Moms program ended in 2014. Since then Dr. Vesco has applied what she learned during the study to help all pregnant women manage their weight gain. She developed a toolkit that includes a video to help women determine how much weight they should gain, and tips for healthy eating. The kit also includes instructions to help providers track weight gain at each pre-natal visit.

Dr. Vesco is also attacking the problem from another angle. She’s a co-investigator on the PREPARE study that uses telephone counseling to help overweight and obese women lose weight before they become pregnant. Dr. Vesco is hopeful that her research will lead to fewer complications and healthier moms and babies.
 


Allison Naleway, PhD: Improving vaccine safety and effectiveness

Allison Naleway, PhD, is one of nearly a dozen Kaiser Permanente researchers who monitor the safety of vaccines as part of the national Vaccine Safety Datalink, a collaborative project of the Centers for Disease Control and Prevention and eight integrated health care organizations, including four regions of Kaiser Permanente. These researchers use electronic health records to conduct studies about rare and serious events following immunization.
 


“I think there is still a public perception out there that vaccines aren’t safe, but that’s not what we find in our research. There are some mild side effects to vaccines, and in very rare cases people have experienced serious reactions. But that should not prevent people from being vaccinated because vaccines prevent disease and save lives,” says Naleway, an epidemiologist with the Center for Health Research who has published numerous articles on the flu vaccine, vaccination during pregnancy and the HPV vaccine.
 


Beth Liles, MD: Helping members make better decisions about cancer screening and treatment

Most health experts agree that people at average risk for colon cancer should begin screening at 50, but opinions differ about when women should begin screening for breast cancer. Some experts say women should have their first mammogram at age 40, others say women can wait until they are 50.

“For many women in their 40s, the likelihood of mammography detecting a life-threatening cancer is low, so the guidelines say we should discuss the pros and cons of mammography with our younger patients,” says Beth Liles, MD, a primary care physician and Kaiser Permanente researcher at the Center for Health Research.

Dr. Liles is testing shared-decision making tools to determine which one will best help doctors and patients to have productive discussions about breast cancer screening.
 


Dr. Liles also conducts research to improve screening for colon cancer. In 2014, she published a paper that showed simple, at-home fecal tests will detect most colorectal cancers. These tests are widely used by Kaiser Permanente, and consequently Kaiser Permanente has some of the the highest colon cancer screening rates in the nation.

Screening with fecal tests helps to detect colorectal cancer early, when it is more treatable. When colorectal cancer is caught early the 5-year survival rate is over 90 percent, according to the American Cancer Society.
 


Gloria Coronado, PhD: Improving cancer screening in the community

Researcher Gloria Coronado, PhD, is sharing what Kaiser Permanente has learned about colon cancer screening with the wider world, specifically community health clinics.

“Patients at these clinics often have little access to screening because of barriers such as no insurance, lack of knowledge and lack of follow-up testing if cancer is detected,” says Coronado, a cancer disparities researcher at the Center for Health Research.
 


Through the federally funded STOP Colon Cancer study, Coronado is mailing in-home screening tests to thousands of community health clinic patients in Washington, Oregon and California. In a pilot project, screening rates among patients in Oregon increased by a whopping 40 percent.

“That’s a big increase,” says Coronado. "We're doing this because there is a pronounced health disparity in colorectal cancer screening, and we’re hoping that if we catch these cancers in the early stages, we can save more lives among this underserved community,” added Coronado.

Read more about our latest studies and how Kaiser Permanente research is improving the health of our members and the public.