RESEARCH IN BEHAVIORAL HEALTH IN PRIMARY CARE, INFORMATICS, CHRONIC PAIN, AND SUBSTANCE USE DISORDER

Clinical Research Informatics 

Data QUEST
The Data QUEST system provides access to research datasets from a network of community-based, primary care clinics in the Washington, Wyoming, Alaska, Montana, and Idaho (WWAMI) region. Our partners within these clinics are interested in participating in research and helping catalyze health discovery. Rich data from electronic health record systems are vital to creating a dynamic learning healthcare environment that can propel discoveries forward. Impacting the health of the population requires interventions in primary care settings.

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Publications
Cole AM, Stephens KA, Keppel GA, Estiri H, Baldwin LM. Extracting Electronic Health Record Data in a Practice-Based Research Network: Processes to Support Translational Research across Diverse Practice Organizations. EGEMS (Wash DC). 2016;4(2):1206.

Lin CP, Stephens KA, Baldwin LM, Keppel GA, Whitener RJ, Echo-Hawk A, Korngiebel D. Developing Governance for Federated Community-based EHR Data Sharing. AMIA Jt Summits Transl Sci Proc. 2014;2014:71-6. eCollection 2014.

Cole AM, Stephens KA, Keppel GA, Lin CP, Baldwin LM. Implementation of a health data-sharing infrastructure across diverse primary care organizations. J Ambul Care Manage. 2014 Apr-Jun;37(2):164-70.

Stephens KA, Lin CP, Baldwin LM, Echo-Hawk A, Keppel GA, Buchwald D, Whitener RJ, Korngiebel DM, Berg AO, Black RA, Tarczy-Hornoch P. LC Data QUEST: A Technical Architecture for Community Federated Clinical Data Sharing. AMIA Jt Summits Transl Sci Proc. 2012;2012:57-62. Epub 2012 Mar 19.

Lin CP, Black RA, Laplante J, Keppel GA, Tuzzio L, Berg AO, Whitener RJ, Buchwald DS, Baldwin LM, Fishman PA, Greene SM, Gennari JH, Tarczy-Hornoch P, Stephens KA. Facilitating health data sharing across diverse practices and communities. Summit Transl Bioinform. 2010 Mar 1;2010:16-20.

Opioid Use following Traumatic Brain Injury (TBI) Study   
This observational study using retrospective chart review will combine data from the University of Washington EHR, prescription monitoring programs (PMP) and the Washington State Trauma Registry (WTR) to characterize opioid use following TBI in the trauma ICU and inpatient rehabilitation settings, and examine the association of opioid use during hospitalization on outpatient use.

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Abstract
Starosta A, Humbert A, Prado MG, Stephens KA, Hoffman J. (2022, April). Characterization of opioid use during hospital care for traumatic brain injury. [Abstract and poster]. Society of Behavioral Medicine 2022 Annual Meeting

 

COVID Study   
This study examines symptom patterns documented in routine care of individuals tested for SARS CoV-2 cohort within a large integrated health care system in Seattle, the ground zero for COVID infections in the US. Using data from electronic medical records (EMR) to capture symptom data using coded and free text data when patients presented for care, this study utilized innovations in informatics to rapidly extract and explore patterns of clinical presentation, access to testing, and variations in clinical presentation with individuals’ characteristics such as age and race. 

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Abstract
Burkhardt HA, Dobbins N, Mollis B, Au M, Ma PK, Yetisgen M, Singh A, Thompson M, Stephens KA (2021, March). Extracting COVID-19 Related Symptoms from EHR Data: A Comparison of
Three Methods
. [Abstract and poster]. American Medical Informatics Association 2021 Informatics Summit, (Virtual Meeting)

 

Flu Study   
Up to 80,000 people in the United States die from the flu each year, and more than 30 million people get sick and suffer. This study used predictive analytics to develop new tools to detect, monitor, and respond to flu outbreaks in order to enhance our ability to stop the spread of flu.

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Publications
Stephens KA, Au MA, Yetisgen M, Lutz B, Zigman Suchlsland M, Ebell MH, Thompson M. Leveraging UMLS-driven NLP to enhance identification of influenza predictors derived from electronic medical record data. bioRxiv 2020 Apr. Preprint. 

Development and pilot testing of a measurement tool for the diagnosis of lung cancer
This project will develop and test a new method for measuring and tracking the timeliness of the patient’s cancer trajectory from first onset of symptoms to final diagnosis of lung cancer. This measure will draw information from the electronic medical record as well as from patients and their caregivers. The goal of this measure is to identify places in the diagnostic pathway where improvements are needed to improve the diagnosis and eventual outcomes for lung cancer. Funded by the Moore Foundation. 

Patient-Centered Scalable National Network for Effectiveness Research (pSCANNER) 
This study developed a stakeholder governed federated network of electronic health data as part of PCORnet, a national patient-centered clinical research network. UW is creating an online website to improve health communication for patient and clinical stakeholders using the pSCANNER network. Funded by the Patient Centered Outcomes Research Institute.

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Publications
Stephens KA, Osterhage KP, Fiore-Gartland B, Lovins TL, Keppel GA, Kim KK. Examining the Needs of Patient Stakeholders as Research Partners in Health Data Networks for Translational Research. AMIA Jt Summits Transl Sci Proc. 2019;2019:363-369. eCollection 2019.

Leaf: An Open-Source, Model-Agnostic, Data-Driven Web Application for Cohort Discovery and Translational Biomedical Research
Leaf, a successful production-supported tool at the University of Washington, collaborated with DataQUEST to develop a proof of concept use case for a multisite version of Leaf and a live OMOP network, yielding improved speed and self-service of cohort discovery within the Data QUEST Coordinating Center and the potential to support Leaf for community partners.

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Publications
Dobbins NJ, Spital CH, Black RA, Morrison JM, de Veer B, Zampino E, Harrington RD, Britt BD, Stephens KA, Wilcox AB, Tarczy-Hornoch P, Mooney SD. Leaf: an open-source, model-agnostic, data-driven web application for cohort discovery and translational biomedical research. J Am Med Inform Assoc. 2020 Jan 1;27(1):109-118.

Identification and Characterization of Patients Prescribed Statins and Warfarin
This study explored the capacity of electronic health record (EHR) data to describe cohorts of patients prescribed statin medications warfarin, and to identify cohorts of patients with evidence of adverse events related to prescription of these medications. This project was supported by the National Institutes of Health under Awards Number UL1 TR000423 and U01 GM092676-05

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Publications
Fishbein HA, Jeffries Birch R, Mathew SM, Sawyer HL, Pulver G, Poling J, Kaelber D, Mardon R, Johnson MC, Pace W, Umbel KD, Zhang X, Siegel KR, Imperatore G, Shrestha S, Proia K, Cheng Y, McKeever Bullard K, Gregg EW, Rolka D, Pavkov ME. The Longitudinal Epidemiologic Assessment of Diabetes Risk (LEADR): Unique 1.4 M patient Electronic Health Record cohortHealthcare. 2020 8(4).

LEADR: Longitudinal Epidemiologic Assessment of Diabetes Risk
This study created an electronic health record-generated patient cohort to study progression to diabetes and related morbidity, and examine the role that access to and delivery of preventive care has in the prevention and control of diabetes. Funded by the Centers for Disease Control.

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Publications
Fishbein HA, Jeffries Birch R, Mathew SM, Sawyer HL, Pulver G, Poling J, Kaelber D, Mardon R, Johnson MC, Pace W, Umbel KD, Zhang X, Siegel KR, Imperatore G, Shrestha S, Proia K, Cheng Y, McKeever Bullard K, Gregg EW, Rolka D, Pavkov ME. The Longitudinal Epidemiologic Assessment of Diabetes Risk (LEADR): Unique 1.4 M patient Electronic Health Record cohortHealthcare. 2020 8(4).

How Well are Contraceptive Guidelines Followed (CoACHD)
This study used Data QUEST data to measure adherence to national contraceptive guidelines among women of childbearing age, assessed the validity of contraceptive data from the EHR compared to manually abstracted data. Funded by the Institute of Translational Health Sciences Community Partners in Research Pilot Grant. 

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Publications
Godfrey EM, West II, Holmes J, Keppel GA, Baldwin LM. Use of an electronic health record data sharing system for identifying current contraceptive use within the WWAMI region Practice and Research Network. Contraception. 2018;98(6):476–481. PMID: 29936151; PMCID: PMC6913191.

 

Antibiotic Prescribing for Children in Family Medicine Clinics
This study aimed to provide a comprehensive characterization of antibiotic use for pediatric patients in family medicine clinics in order to identify opportunities for antibiotic stewardship. Funded by Seattle Children’s Clinical Research Scholars Program Award.

 

Data Quality Testing Tools and Procedures
A series of studies have been used to define standardized data quality procedures and develop a tool to test electronic health records data as it is refreshed in a data sharing infrastructure.

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Explore data quality tools on GitHub

Publications
West I. DQe-c Report Standard Operating Procedures V2. December 2016

Estiri H, Stephens KA, Klann JG, Murphy SN. Exploring completeness in clinical data research networks with DQe-c. J Am Med Inform Assoc. 2018 Jan 1;25(1):17-24. PMID: 29069394; PMCID: PMC6481389.

Estiri H, Stephens K. DQe-v: A Database-Agnostic Framework for Exploring Variability in Electronic Health Record Data Across Time and Site Location. EGEMS (Wash DC). 2017 May 10;5(1):3. PMID: 29930954; PMCID: PMC5994933.

Estiri H, Chan YF, Baldwin LM, Jung H, Cole A, Stephens KA. Visualizing Anomalies in Electronic Health Record Data: The Variability Explorer Tool. AMIA Jt Summits Transl Sci Proc. 2015;2015:56-60. eCollection 2015. PMID: 26306237; PMCID: PMC4525227.

 

IBH-PC: Integrating Behavioral Health and Primary Care 
This study implemented and evaluated specific practice improvement strategies to generate a greater degree of behavioral health-primary care integration than usual, co-located behavioral health and primary care. Funded by the Patient Centered Outcomes Research Institute. 

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Publications

Crocker AM, Kessler R, van Eeghen C, Bonnell LN, Breshears RE, Callas P, Clifton J, Elder W, Fox C, Frisbie S, Hitt J, Jewiss J,  Kathol R, Clark Keefe K, O’Rourke-Lavoie J, Leibowitz GS, Macchi CR, McGovern M, Mollis B, Mullin DJ, Nagykaldi Z, Natkin LW, Pace W, Pinckney RG, Pomeroy D, Pond A, Postupack R, Reynolds P, Rose GL, Scholle SH, Sieber WJ, Stancin T, Stange KC, Stephens KA, Teng T, Waddell EN, Littenberg B. Integrating Behavioral Health and Primary Care (IBH-PC) to improve patient-centered outcomes in adults with multiple chronic medical and behavioral health conditions: study protocol for a pragmatic cluster-randomized control trial. Trials. 2021 March; 22(200).

Model Agnostic Framework for Integrated Behavioral Health 
Leveraging work with the IBH-PC study, this study culminated in the development of a model agnostic framework for fully integrated mental and medical care within primary care and other settings. This set of processes and structures stretch across models of integrated care and was adopted as the community standard by the Institute for Clinical Systems Improvement (ICSI) in Minnesota, who lead the MN Health Collaborative, which includes a statewide effort to improve IBH in primary care through their Mental Health Collaborative.

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Publications

Stephens KA, van Eeghen C, Mollis B, Au M, Brennhofer SA, Martin M, Clifton J, Witwer E, Hansen A, Monkman J, Buchanan G, Kessler R. Defining and measuring core processes and structures in integrated behavioral health in primary care: a cross-model framework. Transl Behav Med. 2020 Aug 7;10(3):527-538.

In the news
Framework helps primary care practices integrate behavioral health 

Chronic Pain

2Morrow
This study evaluates a prescription digital therapeutic (PDT) program, 2MRx-CP, created by 2Morrow, a digital health company that creates evidence-based digital health programs focused on behavioral change. 2MRx-CP is a tool for people with chronic pain that can be prescribed by a primary care provider. It will be used on patient smartphones and will deliver chronic pain education, screening tools, self-management with the goal of facilitating PCPs’ ability to manage their patients with chronic pain effectively.

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2morrow website

 

Lumbar Imaging with Reporting of Epidemiology (LIRE)
A large pragmatic, cluster-randomized controlled trial testing the effectiveness of a simple, inexpensive, and easy to deploy intervention to reduce subsequent tests and treatments for back pain. The goal of the trial is to reduce subsequent tests and treatments, including cross-sectional imaging (such as magnetic resonance and computed tomography), opioid prescriptions, spinal injections, or surgery.

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Publications
Jarvik JG, Meier EN, James KT, Gold LS, Tan KW, Kessler LG, Suri P, Kallmes DF, Cherkin DC, Deyo RA, Sherman KJ, Halabi SS, Comstock BA, Luetmer PH, Avins AL, Rundell SD, Griffith B, Friedly JL, Lavallee DC, Stephens KA, Turner JA, Bresnahan BW, Heagerty PJ. The Effect of Including Benchmark Prevalence Data of Common Imaging Findings in Spine Image Reports on Health Care Utilization Among Adults Undergoing Spine Imaging: A Stepped-Wedge Randomized Clinical Trial. JAMA Netw Open. 2020 Sep 1;3(9):e2015713.

Jarvik JG, Comstock BA, James KT, Avins AL, Bresnahan BW, Deyo RA, Luetmer PH, Friedly JL, Meier EN, Cherkin DC, Gold LS, Rundell SD, Halabi SS, Kallmes DF, Tan KW, Turner JA, Kessler LG, Lavallee DC, Stephens KA, Heagerty PJ. Lumbar Imaging With Reporting Of Epidemiology (LIRE)–Protocol for a pragmatic cluster randomized trial. Contemp Clin Trials. 2015 Nov;45(Pt B):157-163.

 

Pilot Trial of Opioid Taper Support (POTS)
A randomized controlled trial for a prescription opioid taper support intervention. This intervention aims to prevent opioid misuse and adverse events among patients receiving chronic opioid therapy for chronic non-cancer pain without evidence of current substance abuse.
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Publications
Sullivan MD, Turner JA, DiLodovico C, D’Appollonio A, Stephens K, Chan YF. Prescription Opioid Taper Support for Outpatients With Chronic Pain: A Randomized Controlled Trial. J Pain. 2017 Mar;18(3):308-318.

Stephens KA, Ward A. Patient selection for spinal cord stimulators: mental health perspective. Curr Pain    Headache Rep. 2014 Mar;18(3):398.

 

Collaborative Care for Chronic Pain and Behavioral Health in Washington State
Collaborative Care for Chronic Pain and Behavioral Health in Washington State for Labor and Industries (Dept of Labor and Industries). The goal of this study is to launch a new behavioral health stepped collaborative care program for injured workers in Washington State who suffer from chronic pain and behavioral health issues.

 

Substance Use Disorders

Opioid: Team-Based Safe Opioid Prescribing  
This study implemented and evaluated a “team-based best practices” approach to safe opioid prescribing for chronic non-cancer pain across 20 rural health clinics. Funded by the Agency for Health Care Research and Quality.

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Publications
Parchman ML, Penfold RB, Ike B, Tauben D, Von Korff M, Stephens M, Stephens KA, Baldwin LM. Team-Based Clinic Redesign of Opioid Medication Management in Primary Care: Effect on Opioid Prescribing. Ann Fam Med. 2019 Jul;17(4):319-325. PMID: 31285209; PMCID: PMC6827656.

 

Incidence of Alcohol Use Disorder (AUD) Diagnosis and Treatment  
This study evaluated the incidence of AUD and alcohol-related medical diagnoses, use of FDA-approved and off-label AUD medications, and use of behavioral health services. Funded by the Pacific Northwest Node of the NIDA Clinical Trials Network. 

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Publications
Hallgren KA, Witwer E, West I, Baldwin LM, Donovan D, Stuvek B, Keppel GA, Mollis B, Stephens KA. Prevalence of documented alcohol and opioid use disorder diagnoses and treatments in a regional primary care practice-based research network. J Subst Abuse Treat. 2020 Mar;110:18-27. PMID: 31952624. PMCID: PMC7255441

 

Chronic Disease Management for Patients with Substance Use Disorders
This study explored whether primary care patients with chronic diseases (i.e., hypertension, diabetes, obesity) have worse outcomes if diagnosed with a substance use disorder, and to identify predictive factors associated with good outcomes in chronic disease management, including integrated behavioral health services. Funded by the Pacific Northwest Node of the NIDA Clinical Trials Network.

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Publications
Stephens KA, West I, Hallgren KA, Mollis B, Ma K, Donovan D, Stuvek B, Baldwin LM. Service Utilization and Chronic Condition Outcomes among Primary Care Patients with Substance Use Disorders and Co-Occurring Chronic Conditions. J Subst Abuse Treat. 2020 Mar; 112S:49-55. PMC7274163