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Center Newsby Joan DeClaire
Group Health and UW receive $2.4 million to study domestic violence Group Health Center for Health Studies and the University of Washington's Harborview Injury Prevention and Research Center have received a $2.4 million federal grant to conduct a study of the long-term health effects and costs of domestic violence among Group Health members. The study, sponsored by the U.S. Department of Health and Human Services, will be the largest and longest population-based investigation of the effects of domestic violence to date. Previous surveys show that domestic violence affects 25 percent of all adult women and 8 percent to 15 percent of adult men sometime in their lives. But evidence of abuse shows up in only 1 percent of people's medical records. By combining women's self-reported survey data with information from automated medical records for the first time, Group Health researchers hope to significantly increase society's understanding of the problem. "Isolated studies have shown links between domestic violence and a wide range of physical and mental health problems, but we know relatively little about long-term health effects," said Robert S. Thompson, MD, the principal investigator of the study and director of Group Health's Department of Preventive Care. "By providing an average of nine years of follow-up information on each female victim of domestic violence, this study will establish a yardstick for gauging the effectiveness of efforts to improve detection, intervention, and treatment." The researchers will randomly survey 6,667 female members of Group Health. Using methods that ensure the participants' confidentiality and safety, the study will assess whether the women have been physically, sexually, or psychologically abused by their intimate partners. This survey information will then be linked to automated records of health care services and cost, allowing the researchers to compare the health care experiences of women who have suffered from domestic violence with those who have not. In addition, the study will assess the effects of domestic violence on health status, social isolation, depression, and health habits such as smoking and drinking. Health care costs and use of services will also be compared for children of women in the two groups. The findings will help policy makers, health care organizations, and funding agencies better understand what happens to victims of domestic violence over time and allocate resources based on this knowledge, Thompson added. Fred Rivara, MD, MPH, of UW's Harborview Injury Prevention and Research Center will be a co-investigator and collaborator on the study. The four-year study is funded by the Agency for Healthcare Research and Quality, which is part of the U.S. Department of Health and Human Services. New Research Advisory Board appointed Group Health President and Chief Executive Officer Cheryl Scott has appointed a new Research Advisory Group to review research activities within the Cooperative, including investigations done by its Center for Health Studies. The group members are: Peter G. Adler, vice president of Group Health's Puget Sound Delivery System Gary Feldbau, MD, medical director of Group Health and president and chairman of the board of directors for Group Health Permanente Ruth Ballweg, director of the MEDEX Northwest Physician Assistant Program in the University of Washington's School of Medicine and a member of the Group Health Board of Trustees Mary McColl Neilson, active leader in Group Health's Senior Caucus Laura Rehrmann, president and chief executive officer of the Group Health Community Foundation Mike Wanderer, MD, a family practitioner at Group Health's Capitol Hill Family Health Center and a member of the Group Health Permanente Board of Directors Ross Prentice, MD, director of Public Health Sciences at Fred Hutchinson Cancer Research Center and professor of biostatistics in the School of Public Health and Community Medicine, University of Washington Frederick P. Rivara, MD, MPH, founding director of the Harborview Injury Prevention and Research Center (1987–2000) and professor of pediatrics at the University of Washington Joe Selby, MD, director of the Division of Research, Kaiser Permanente Northern California The establishment of this group comes at the end of a process begun in November 2000 to better define Group Health Center for Health Studies' role within the Cooperative. A study team established at that time made several recommendations, which Scott accepted. In addition to establishing the Research Advisory Group, the recommendations clarify and strengthen the Center director's reporting relationship; sustain and strengthen alignment of the Center's research with Group Health's strategic priorities for quality improvement and innovation; and simplify and clarify administrative relationships between CHS and Group Health. Through an annual review process, the Research Advisory Group will assess:
For a copy of the study team's final report, e-mail Joan DeClaire at declaire.j@ghc.org. Diana Buist named assistant investigator Diana Buist, PhD, MPH, an epidemiologist focusing on women's health, was recently promoted to assistant investigator at Group Health Center for Health Studies. Buist has worked as a research associate at the Center since 1996, primarily studying prevention and control of breast cancer and osteoporosis. Buist has special expertise in the design and analysis of longitudinal cohort studies, screening, and randomized interventions. Her articles about her research into the link between hormone replacement therapy and bone density have recently appeared in several journals of epidemiology and cancer control. Buist earned her master's degree in public health from the Yale School of Medicine in 1995. She was awarded a PhD in epidemiology from the University of Washington in 1997. Center awarded $1.3 million to study cancer care Group Health Center for Health Studies has been awarded $1.35 million from the National Cancer Institute to take part in a large, nationwide study of cancer care. The "Cancer Care Outcomes Research and Surveillance
Consortium" (CanCORS) study will examine patterns of care, health
outcomes, and patient-centered issues such as symptom control and quality
of life. The initiative is intended to improve monitoring of care
delivered to patients newly diagnosed with lung or colorectal cancer.
Another aspect of the study will be to examine costs associated with
different treatment strategies. "This type of study has never been done on a national scale before," said Margaret T. Mandelson, PhD, a cancer epidemiologist with Group Health Center for Health Studies and the Fred Hutchinson Cancer Research Center and the lead Group Health researcher on the project. "The diversity of race, ethnicity, geography, and delivery systems represented in the project will allow investigators to look at large groups of patients who have similar diseases and see how their processes of care differ." Investigators also hope to find out how those differences are linked to various patient outcomes. "Ultimately, this may help us find ways to reduce disparities and ensure that everybody is getting the best possible care," Mandelson said. CanCORS is a national research consortium with membership from several institutions, including Harvard University Medical School, the RAND Corporation, the University of North Carolina, the University of Iowa, and the University of Alabama. Each consortium member will study and contribute data from a large population of patients newly diagnosed with lung or colorectal cancer. Investigators from the Dana Farber Cancer Institute in Boston are leading a group of five HMOs that will participate as a single member of the consortium. Group Health is one of these five HMOs. The other health plans in this group—all part of the National Cancer Institute's Cancer Research Network—are Harvard Pilgrim, Kaiser Permanente Northwest, Kaiser Permanente Hawaii, and Henry Ford Health System. This group is charged with studying a diverse population of approximately 6,500 cancer patients over a two-year period. Group Health investigators will also work with investigators from the Fred Hutchinson Cancer Research Center in Seattle to conduct an in-depth study of the cost of cancer care among all the health plans involved in its part of CanCORS. Led by Scott Ramsey, MD, PhD, an internist and economist with the Hutchinson Center, this special study will examine costs attributable to specific choices for therapy or symptom control when treating lung or colon cancer. The Group Health CanCORS research team also includes Ed Wagner, MD, MPH, and Paul Fishman, PhD. Wagner is director of the Center's MacColl Institute for Healthcare Innovation and an expert in chronic disease care. Fishman is an economist and assistant investigator with expertise in the link between costs and health outcomes.
JAMA features Center psychiatrist's views on antidepressants Health plans that restrict initial antidepressant-drug coverage to the least expensive of three popular SSRI-class medications are doing the right thing, according to Gregory Simon, MD, MPH, a psychiatrist and investigator at Group Health Center for Health Studies. In an editorial in the December 19 issue of the Journal of the American Medical Association (JAMA), Simon asserts that restrictions on first-time antidepressant prescriptions are reasonable cost-control measures—as long as patients can get the same coverage for similar drugs if the least expensive one doesn't work. Simon's comments are based on a recent study that appears in the same issue of JAMA. Led by scientists from Indiana University, the study compared the effectiveness of the three most commonly prescribed antidepressants—fluoxetine (brand name Prozac), paroxetine (Paxil), and sertraline (Zoloft). Results showed that, on average, the three drugs worked equally well among people just starting drug treatment for depression. Still, there are many individual differences. "The fact that these drugs are equally effective on average does not mean that they are equally effective for individual patients," wrote Simon, who has done extensive research on care for depression and other mental disorders. Also, evidence shows that it's impossible to predict which patients might do better on which particular drug. So individuals may need to try out one or more drugs before they find one that works and does not produce intolerable side effects, he said. That's why health plans need to provide equal coverage for those second- and third-choice drugs, Simon argued. Simon also calls for doctors to provide regular follow-up care so that prescriptions can be changed or adjusted if necessary. Simon's recommendations are consistent with Group Health's current policies related to drug coverage and care for patients who are prescribed antidepressants. |
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