Volume 19, Issue 1
Winter 2007
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CHS Research News
Vol 19, Issue 1, Winter 2007
Center News
by Joan DeClaire
New Findings & Highlights
Health care costs for abused women remain high years following violence
Women with a history of abuse by intimate partners have significantly higher health
care costs and utilization than women with no history of such abuse, according to a
study
conducted at Group Health. The higher costs and utilization continued long after the
abuse ended, the research team from Group Health Center for Health Studies (CHS),
the University of Washington (UW), and the Harborview Injury Prevention and Research
Center (HIPRC) found. The findings appear in the February 2007 issue of the
American Journal of Preventive Medicine.
“These results show the enormous costs of intimate partner violence (IPV)
and can justify investing in intervention programs to reduce its health effects
and prevent its recurrence,” said lead author Frederick P. Rivara, MD, MPH.
“It would also justify the costs of long-term programs to prevent this problem
from happening in the first place.”
Rivara is a researcher with HIPRC and professor of pediatrics at UW, as well as an
affiliate investigator at the CHS. The principal investigator for the study is
Robert
S. Thompson, MD, CHS senior investigator.
The study was based on telephone surveys, medical records, and utilization data
from 3,333 women, aged 18 to 64 years old. Of these, 1,546 women reported having
experienced IPV in their lifetime. The study defines IPV as both physical abuse
(slapping, hitting, kicking, or forced sex) and nonphysical abuse (threats,
chronic disparaging remarks, or controlling behavior).
The study showed:
- Annual total health care costs were 19 percent higher in women with a
history of IPV ($439 annually) compared to women without IPV in their backgrounds.
- Health care utilization was higher for all categories of service during and
after IPV compared to women who had not been abused. Women reporting IPV had 17
percent more primary care visits; 14 percent more specialist visits; and 27
percent more prescription refills. They were also more likely to use services
in the areas of mental health, substance abuse, hospital outpatient care,
emergency department care, and acute inpatient care during and after periods of IPV.
- Health care utilization was still 20 percent higher five years after women’s
abuse ceased compared to women who had never experienced IPV.
- The estimated excess costs to the health plan due to IPV are approximately $19.3
million per year for every 100,000 women enrollees aged 18–64. This estimate
is based on prevalence for IPV of 44 percent—a figure established in a study the
Group Health/UW team published in 2005.
While previous studies have shown increased health care costs and utilization among
women abused by their partners, this is the first study to determine how those factors
relate to the time of abuse. The study avoided limitations of previous studies by analyzing
a random sample from a large health plan that was representative of the community. In addition,
the researchers studied documented medical and cost records rather than relying solely the
women’s own reports. Also, the study had data on the women’s care over an average
of seven years.
“When coupled with our previous work, this study helps to complete the picture of IPV
as it is encountered in health care delivery,” said Thompson, whose research team
published papers in 2006 on the prevalence and health effects of IPV. “IPV is common,
chronic, and produces negative effects on women’s physical and mental health that are
as severe as cancer or diabetes, and that add an enormous economic burden to health care
systems. Development, implementation and evaluations of systems for the secondary prevention
of IPV are not only warranted, they are urgently needed.”
The research was funded as part of a four-year, $2.4 million grant to CHS from the
Agency for Healthcare Research and Quality.
In addition to Rivara and Thompson, study co-authors are
Melissa L. Anderson, MS,
Paul Fishman, PhD, Amy E. Bonomi, PhD, MPH,
Robert J. Reid, MD, PhD, David Carrell, PhD,
all of Group Health.
Top
Black cohosh does not relieve menopausal hot flashes
The popular herbal supplement black cohosh does not relieve hot flashes among women going
through menopause, according to a
study
by researchers from Group Health Center for Health Studies (CHS).
Published in the December 19 issue of the Annals of Internal Medicine, this
study is the first of its kind to compare various forms of black cohosh to a placebo and
to hormone therapy (estrogen with or without progestin).
“Black cohosh used alone or as part of a multibotanical supplement shows little
potential as an important therapy for relief of hot flashes,” the researchers concluded.
The herbal interventions were no better than placebo. Hormone therapy, on the other hand,
significantly reduced the frequency of hot flashes.
“We were disappointed by the findings because many women want an alternative to
hormone therapy, and many have assumed that black cohosh is a safe, effective choice,”
said
Katherine M. Newton, PhD, associate director of CHS and the principal investigator of
the study. “While hormone therapy is still the most effective treatment for hot flashes,
recent studies have shown that it poses serious risks.”
Newton estimates that 80 percent of women experience hot flashes around the time of menopause,
which typically happens between ages 45 and 55. The average age of menopause is 51.
To conduct the study, the researchers randomly assigned 351 peri-menopausal
or post-menopausal women, aged 45 to 55, to one of five therapies:
- black cohosh (160 mg daily)
- multibotanical supplement, including black cohosh (200 mg daily), alfalfa, boron,
chaste tree, dong quai, false unicorn, licorice, oats, pomegranate, and Siberian ginseng
- multibotanical supplement plus diet counseling to increase consumption of soy
- menopausal hormone therapy (estrogen with or without progestin)
- placebo
The study was double-blinded, meaning that the study participants and the staff did not
know which treatment was assigned to any given woman. Evaluating the women at 3, 6, and
12 months, the researchers found no significant difference between the numbers of daily hot
flashes in any of the herbal supplement groups when compared to the placebo group. Specifically,
women taking the herbal treatments reduced their hot flashes by about one half an episode per day
when compared to women taking the placebo. The women taking hormone therapy reduced their hot
flashes by about bout four episodes per day when compared to placebo.
“Prior to our study, the trials of black cohosh were small and of short duration,”
explained Susan Reed, MD, co-investigator and professor of obstetrics and gynecology at the
University of Washington. “Our study was the largest and longest to date. Plus, we had
good controls with both the placebo and hormone therapy arms, allowing us to definitively
show differences between the groups taking herbs and the placebo group.”
With no strong evidence that herbal alternatives work for hot flashes, Newton suggests
several behavioral changes women can make. These include dressing in layers, sleeping in
a cooler room, keeping ice water and a fan nearby, and avoiding possible triggers such as
very hot liquids and alcohol.
Newton also notes that hot flashes decreased during the 12-month course of participation
in all the study groups, including the placebo group. “We call this the ‘
tincture of time’—that is, over time, hot flashes nearly always go away on their
own,” Newton said.
The study was funded by the National Institute on Aging and the National Center for
Complementary and Alternative Medicine.
In addition to Reed, co-investigators were
Andrea LaCroix, PhD,
Louis Grothaus, MA,
Kelly Ehrlich, MS, of Group Health; and Jane Guiltinan, ND, of Bastyr University.
Top
Technology can’t replace doctors’ judgment in reading mammograms
Radiologists should not become too dependent on the use of computer-assisted detection
(CAD) technology when reading screening mammograms because the doctors can see lesions
that CAD sometimes misses. This is according to a
study
conducted at Group Health. The research appears in the December issue of the
American Journal of Roentgenology.
“Our study shows that radiologists must continue to rely on their own judgment
when determining whether lesions seen on mammograms require further testing,” said
Stephen Taplin, MD, MPH, who led the research at Group Health before joining the National
Cancer Institute as a senior scientist.
CAD uses computer software to identify and mark areas of concern on mammograms.
Radiologists typically review the CAD-marked images after they interpret the original film.
While early CAD evaluations showed it improved cancer detection, more recent studies have
raised questions about CAD’s performance. For example, while it is believed that
CAD alerts radiologists to potential areas of concern, experts have wondered whether CAD
too frequently marks normal areas rather than only identifying problem areas that
the radiologist should have detected.
To answer these questions, the researchers at Group Health designed a
study using a sample from more than 56,000 screening mammograms taken between 1996 and 1998.
By identifying cases of breast cancer diagnosed within two years after the mammograms were taken,
they created a total set of 441 mammograms from three different groups. Included were mammograms
from women who:
- remained cancer-free two years after their mammograms
- developed breast cancer within one year, or
- developed breast cancer within 13 months to two years.
The sample was then used to test the performance of 19 radiologists, each of whom read 341
mammograms with and without CAD. The researchers then compared the results of the two approaches
for each mammogram.
This is the first study of CAD using a random sample of cases from a screened population rather
than using selected cases of visible cancers. In this way, it more closely resembles the way that
radiologists use CAD in real practice.
The study showed that CAD assistance increased radiologists’ ability to
determine that a woman without cancer was, in fact, cancer free—a quality known as
mammographic “specificity.” Overall specificity increased from 72 percent
without CAD to 75 percent with CAD. This 3 percent difference means that CAD allows 30 women in
every thousand women screened to avoid further evaluation.
CAD assistance did not affect the radiologists’ overall ability to spot cancer where
it was present—a quality known as mammographic “sensitivity.” The doctors
performed equally well with and without CAD.
However, CAD does not mark all visible abnormalities. And when the researchers analyzed the
radiologists’ performance on mammograms with lesions that CAD did not catch, they found that
the doctors were less likely to recommend further evaluation when they were using CAD than when they
were not using CAD.
“This means that the radiologists may have been deferring to CAD and believing its
interpretation rather than their own interpretation,” said Taplin. “This is something
the originators of the technology say radiologists should not do. This study shows that it is hard to
ignore the technology, and it raises the question of whether there is a potential for CAD to do harm.”
Taplin and his co-authors recommend training for radiologists that focuses on characteristics that
CAD may miss, namely “masses, asymmetries, and architectural distortions” visible on the
mammograms. They also note that research into these visible, unmarked lesions may offer the best chance
to improve CAD-assisted mammography.
The researchers also found that breast density—a measure of the amount of fat tissue in the
breast—did not affect CAD’s performance
The study was funded by the National Cancer Institute.
Other scientists working on the study were
Carolyn Rutter, PhD,
of Group Health, and Constance Lehman, MD, PhD, of the University of Washington and Seattle Cancer Care Alliance.
Top
Panic attacks are linked to poor outcomes for diabetic patients
There is a strong link between panic episodes and increased complications from diabetes, according
to a
study
conducted at Group Health. The work appears in the November issue of General Hospital Psychiatry.
The researchers surveyed patients with diabetes about their symptoms, disability, social and emotional
function, and quality of life. They also collected data on the patients’ blood sugar levels, diabetic
complications, and other illnesses.
The team had previously reported a strong link between diabetes and depression, which often goes along
with panic disorders. They were interested in examining panic independently, however, to see whether patients
who have panic without depression would also have poor diabetic outcomes.
“Panic attacks can mimic episodes of hypoglycemia (low blood sugar), so we need a better understanding
of how the two conditions are related,” explained
Evette Ludman, PhD, lead author of the article and a
research associate at Group Health. “We don’t want people adjusting their blood sugar thinking they
are having hypoglycemia when their symptoms are actually caused by a panic disorder.”
Of the 4,385 patients surveyed, 193 reported experiencing recent episodes of panic or fear that caused
them to change their immediate behavior. After accounting for the effect of depression, panic episodes were
associated with higher blood sugar levels, increased diabetic complications and symptoms, greater disability,
and lower self-rated health and functioning.
About half of the patients with panic also reported having major depression. By contrast, only 10 percent of
patients without panic episodes had major depression.
Panic episodes may be a consequence of the diabetes itself, the researchers explain. Also, panic may interfere
with patients’ self-care and ability to follow their treatment plans.
If you have diabetes and you know that anxiety is an issue for you, you should talk to your doctor about
possible treatment for your anxiety,” advised Ludman. And doctors should carefully assess their patients
with diabetes, looking for signs of depression or panic disorders, she added.
The study was funded by the National Institute of Mental Health. Co-authors are CHS’ Senior
Investigators
Greg Simon, MD, MPH, and
Michael Von Korff, ScD;
CHS Affiliate Investigator Elizabeth Lin, MD, MPH, of Group Health Permanente; and CHS Affiliate
Investigators Wayne Katon, MD, and
Paul Ciechanowski, MD, MPH of UW.
Top
Regular follow-up important during antidepressant treatment, Simon editorial advises
Because individuals can react differently to antidepressant medications, regular follow-up is important
during the first few weeks of treatment, according to an
editorial
by Group Health psychiatrist and researcher
Greg Simon, MD, MPH.
Simon’s advice, published in the November issue of the American Journal of Psychiatry,
comes amidst several recent conflicting studies on the link between antidepressant use and suicide risk in
children and adolescents. In the absence of clear evidence—along with proof that antidepressants’
effects differ across individuals—Simon suggests that patients and providers stay well connected as drug
therapy begins.
Simon’s editorial was prompted by an article in the same journal by Robert D. Gibbons, PhD, and
colleagues, reporting that counties with higher rates of SSRI antidepressant use had lower rates of suicide
death in children and younger teens. While this finding is consistent with two other recent observational
studies, it contradicts data from several other studies, Simon comments.
Also, data from recent studies in adults find no significant difference in suicide risk among those
taking antidepressants compared to those taking a placebo. The issue is further complicated by recent
evidence that effects on suicide risk may differ depending on the antidepressant and depending on the
individual patient, explains Simon, who is also a senior investigator at Group Health Center for
Health Studies
He states that additional studies cannot give a definitive answer to the question because of
difficulties conducting this type of research. Still, he believes that observational research has
provided “some reassurance.” For example, increasing use of newer antidepressants has been
accompanied by lower rates of suicide mortality in teens and adults.
Finally, he suggests that providers caught between concerns about precipitating a suicide attempt
and concerns about untreated depression tell their patients this:
“The Food and Drug Administration requires a warning that antidepressant medications can
sometimes cause or increase thoughts of suicide. Studies in children and adolescents have shown that
antidepressants can increase suicidal thoughts. However, other studies have shown that the overall
risk of attempting suicide goes down after starting antidepressant medication. Even if antidepressants
help most people that take them, some people may have very negative reactions. Thus, it is important
that we have regular contact over the next few weeks. If you have thoughts about suicide or about
harming yourself, please contact me right away.”
Top
Research Highlights
Medicare beneficiaries with diabetes who participated in a Group Health-sponsored community-based
exercise program had slightly fewer hospitalizations 12 months after program enrollment compared with
similar enrollees who did not participate. This is according to a UW
study
published in the January 2007 issue of Diabetes Care. Although there were no significant
differences in inpatient or total health care costs between control subjects and members with any participation
in the fitness program, those who participated in the program more frequently incurred total health care costs
that were, on average, 37 percent lower than those of control subjects and 41% lower than members who did not use
the fitness program regularly. CHS Affiliate Investigators
James P. Logerfo, MD, MPH, of the
UW Health Promotion Research Center, and
Elizabeth Lin, MD, MPH, of the Group
Health medical staff are co-authors of the study. The lead author is UW’s
Huong Quynh Nguyen, PhD.
What factors are associated with depression relapse in primary care patients? Poorer medication
adherence, lower self-efficacy to manage depression, and higher scores on a childhood trauma questionnaire, according
to a Group Health
study
in the December 6, 2000 issue of the Journal of Affective Disorders. Authors include CHS Research Associate
Evette Ludman, PhD, and CHS Affiliate Investigator
Wayne Katon, MD, of the UW
Department of Psychiatry and Behavior Services. UW’s
Shamin Gopinath, MD, is the first author.
Benefits to employers may outweigh the costs of enhanced depression care according to a
Harvard University study
co-authored by CHS Senior Investigator
Greg Simon, MD, MPH, and CHS Research Associate
Evette Ludman, PhD. Led by Harvard’s
Philip Wang, MD, Dr.Ph, and
Ronald Kessler, PhD, the researchers conducted a simulation based on dozens
of existing trials and epidemiological studies. They found that providing a minimal level of enhanced care for
employees’ depression would result in a cumulative savings to employers of $2,898 per 1,000 workers over
five years. While the intervention would initially increase the use of mental health services, it ultimately
would save employers money by reducing absenteeism and turnover costs. The study appears in the December 2006
Archives of General Psychiatry.
The majority of children between the ages of 2 and 8 who are getting flu vaccine for the first time
do not get the second dose they need for the vaccine to be effective, according to
a study
led by CHS Senior Investigator
Lisa Jackson, MD, MPH. The study, which appears in the November
2006 issue of Pediatrics , is based on data from nearly 126,000 children enrolled in health
care plans across the United States that participate in the
Vaccine Safety DataLink. CHS Affiliate
Investigator Kathleen Neuzil, MD, MPH, of the
Program for Alternative
Technologies in Health (PATH) is a co-author. Neuzil and Jackson also published a
study
confirming the effectiveness of the two-dose approach to flu vaccines for young children that was published in the
October 2006 Journal of Infectious Disease.
Flu vaccine is safe for infants and small children, according to the largest population-based
study
ever conducted in this age group. Using combined databases from eight health plans including Group Health, the
researchers found very few medically attended events linked to the with trivalent inactivated influenza vaccine, and none
of the events that did occur was serious. The research looked at more than 69,000 immunizations for more than 45,000 children.
Simon J. Hambidge, MD, PhD, from
Kaiser Permanente Colorado is lead author of the study,
published in the October 25, 2006 issue of the Journal of the American Medical Association. CHS
co-authors included Senior Investigator
Lisa Jackson, MD, MPH, and
Robert L. Davis, MD, MPH,
a former CHS senior investigator now at the
Centers for Disease Control and Prevention.
Breast cancer patients over age 75 are less likely than younger patients to receive standard, effective
treatments, according to a study
co-authored by CHS Associate Investigator
Diana Buist, PhD, MPH. Published in the September 2006 issue of
the Journal of Clinical Oncology, the study included 1,859 women aged 65 or older who had been diagnosed with
Stage I or Stage II breast cancer at one of six large health plans, including Group Health. Compared to women aged 65 to 69,
women aged 75 to 79 were three times more likely to receive non-standard primary therapy, and women aged 80 or older were
almost six times more likely to receive non-standard primary therapy. The study took into account risk of recurrence and
the presence of other chronic health problems. Tools to help older patients and their physicians weigh the risks and benefits
of treatment are critically needed, wrote
Shelly M. Enger, PhD, of
Kaiser Foundation Research
Institute in Northern California, the lead author of the study.
Because the painkiller celecoxib (Celebrex) is linked to cardiovascular risks, it has no role as a chemopreventive
agent, according to an
editorial
in the August 31, 2006, issue of New England Journal of Medicine by
Bruce Psaty, MD, PhD, a
CHS senior investigator and University of Washington professor of Epidemiology, and
John D. Potter, PhD,
head of the Division of Public Health Sciences at
Fred Hutchinson Cancer Research Center
and affiliate investigator at CHS. Psaty and Potter were commenting on two studies in that same issue that show Celebrex is
an effective agent for reducing the risk of recurrence of colorectal polyps. Both studies, however, demonstrated significant
cardiovascular risks.
To optimize care for patients with both depression and diabetes, training for case managers should include an
active model of problem-solving therapy that includes motivational interviewing and ensures the patient’s
effective engagement in treatment. This is according to a paper
co-authored by CHS Research Associates
Evette Ludman, PhD, and
Judith Schaefer, PhD.
Published in the September 2006 issue of Chronic Illness, the paper analyzes consultations between depression care
specialists and patients in nine Group Health primary care clinics. The lead author is
Linda Gask, PhD, a
researcher at the University of Manchester and former fellow with CHS’
MacColl Institute.
Lack of clear regulatory authority, chronic under-funding, organizational problems, and a scarcity of post-approval
data about drugs' risks and benefits have hampered the U.S. Food and Drug Administration's ability to evaluate and
address the safety of prescription drugs after they have reached the market, says a new
report
from the Institute of Medicine.
Bruce Psaty, MD, PhD, a CHS senior investigator and UW professor
of Epidemiology, is a co-author of the report, titled “The Future of Drug Safety.” Released September 22, 2006,
the report offers a broad set of recommendations to ensure that consideration of safety extends through the entire time
the product is marketed and used.
Mammography screenings conducted by radiologists at 188 mammography centers across the United States surpass
national performance recommendations, according to an audit conducted by researchers from CHS and six other research
institutions. Reviewing nearly 2.6 million screening exams assessed by 807 radiologists, the study found that cancer is
detected at a rate of 4.8 per 1,000 women. About 10 percent of the mammograms in the study yielded abnormal finding.
Robert D. Rosenberg, MD, of the
University of New Mexico,
was the lead researcher for the study,
published in the October 2006 issue of Radiology. Co-authors included
CHS’
Diana Buist, PhD, MPH;
William Barlow, PhD;
Linn Abraham, MS; and CHS Affiliate Investigator Constance Lehman, MD, PhD.
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New Funding
The following grants are among several projects recently funded at CHS:
Improving Access to Improve Quality in an HMO: A two-year, $427,143 grant from Agency for Healthcare
Research and Quality to study Group Health's patient-centered access initiatives for 2002–2006 and to establish
impact of key initiatives on cost, utilization, and quality of care. The CHS lead investigator is
James D. Ralston.
The Impact of Chlamydia Control Programs on Chlamydia Prevalence, Chlamydia Re-infection Rates, and
Reproductive Outcomes: A nine-month, $84,900 grant from Centers for Disease Control to evaluate, via
the automated databases at Group Health Cooperative, secular trends in the prevalence of Chlamydia trachomatis
infection over a 10-year interval. Concurrent trends in C. trachomatis re-infection, and reproductive
outcomes (PID, ectopic pregnancy, tubal factor infertility) will also be evaluated. These results,
along with reports of similar assessments using data from British Columbia, Canada, will inform the design
of more complex studies designed to further evaluate the relationship between Chlamydia screening and adverse
reproductive outcomes. The CHS lead investigator is
Delia Scholes.
Assessing and Improving Radiologists' Mammography Interpretive Skills: A three-year, $640,016
grant from American Cancer Society to improve radiologists’ interpretive skills by rigorously evaluating
factors that influence performance measures. The team will design and test strategies to improve performance
in a national sample of 321 radiologists from the Breast Cancer Surveillance Consortium (BCSC). The principal
investigators are Diana S. Buist and
Diana Miglioretti.
Breast Cancer Surveillance in a Defined Population—Administrative Supplement: A four-year,
$101,965 grant from National Cancer Institute to support analyses on local and pooled surveillance data.
The principal investigator is
Diana S. Buist.
Cancer Research Network (CRN) Administrative Supplement—Diffusion of Treatment for Ovarian
Cancer: A five-month, $101,938 grant from National Cancer Institute. Recent randomized trials suggest
that the use of intraperitoneal chemotherapy in women with appropriately debulked ovarian cancer improves survival.
This grant will allow CRN to study the feasibility of participation in a collaborative study with the National
Comprehensive Cancer Network to examine the use over time of intraperitoneal therapy and its impacts on outcomes
and costs of care. The principal investigator is
Ed Wagner.
Mild Cognitive Impairment (MCI), Insulin and Cholesterol in a Community-Based Sample—A five-year, $1,362,492 grant from National Institute on Aging to determine the incidence and progression of
MCI in a community-based cohort of older adults; to perform annual follow-up assessments for subjects with MCI
for determining change over time; to determine whether cardiovascular risk factors shown to increase the risk
of Alzheimer’s Disease are associated with the diagnosis and progression of MCI; to establish a platform
for exploratory analyses of interactions with other risk factors such as APoE genotype, gender, and body mass
index. The CHS lead investigator is
Eric B. Larson.
Bariatric surgery: A three-year, $155,040 grant from Veteran's Administration (VA) to study
morbidly obese veterans who had bariatric surgery in VA medical centers from 2000 to 2005 with those who did not.
The study will examine survival rates, health care use and expenditures, and patient-level predictors of survival
and adverse events. The CHS lead investigator is
David E. Arterburn.
Long-term Opioid Management of Chronic Pain—Trends and Risks: A four-year, $2,457,037
grant from National Institute on Drug Abuse to study 1) use of prescribed opioids for chronic back pain—
including trends in patients’ long term use, abuse, and adverse events; 2) to assess risks of abuse and
other adverse events by age, gender, social area, type of opioid prescribed, co-occurring psychoactive medicine
use, and physician prescribing patterns; 3) to determine whether a prior history of substance abuse affects
prescribing of short-term and long-term opioid treatment and risks of prescribed opioid abuse; and 4) to develop
population-based surveillance methods to monitor and reduce risks of adverse outcomes of long-term opioid therapy
among chronic pain patients. The principal investigator is
Michael R. Von Korff.
A Randomized Trial of Liaison Psychiatry in Primary Care: A five-year, $3,294,887 grant from
National Institute of Mental Health to conduct a randomized, controlled trial of the impact of an integrated
intervention versus usual care for patients with chronic illness (major depression/dysthymia with diabetes
and/or coronary heart disease with evidence of poor disease control) in improving both depression and medical
disease outcomes. The CHS lead investigator is
Michael R. Von Korff.
Effect of Yoga Versus Stretching on Chronic Back Pain: A four-year, $1,962,609 grant from
National Center for Complementary and Alternative Medicine to determine whether yoga is a more effective treatment
than conventional therapeutic exercise for patients with chronic low back pain, and if so, to look for physical,
psychological (cognitive and affective), and hormonal changes that may be responsible for this. The principal
investigator is
Karen J. Sherman.
Therapeutic Massage for Generalized Anxiety Disorder: A three-year, $624,000 grant from
National Center for Complementary and Alternative Medicine to lay the groundwork for a full-scale, randomized
clinical trial to evaluate the effectiveness, safety, and costs of massage for generalized anxiety disorder
by conducting a randomized pilot trial. The principal investigator is
Karen J. Sherman.
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People and Programs
New director of operations named
Helga Ding joined Group Health Center for Health Studies (CHS) in November as its new director
of operations. She formerly worked as the medical center administrator for Group Health’s
Capitol Hill Campus and Consultative Specialty Services.
In her new position, Ding oversees CHS’ research operations, finance, information technology,
grants and contract administration, administrative operations, human resources, and facilities.
Ding has been with Group Health for ten years, working in progressively more challenging managerial and
leadership positions at the Cooperative, including specialty team manager from 1997 to1999, and service
line director from 1999 to 2003. In her current position, she oversees the daily operational and financial
performance of specialty services located at the Capitol Hill Campus which includes about 200 nursing,
clinical, and administrative staff; and more than 100 specialty physicians.
Ding has a bachelor’s degree in Biology from Stanford University and received her dental
training (Doctor of Dental Surgery degree) at UCLA. She practiced as a family dentist in the San
Francisco Bay area for a number of years and also managed her brother’s oral maxillo-facial
surgery practice before earning both a master’s degree in business administration in 1996 and a
master’s degree in health administration in 1997, both from the University of Washington.
Faculty Update
CHS Senior Investigator
David Grossman, MD, MPH,
gave a presentation at a research workshop sponsored by the Institute of Medicine’s Committee
on Adolescent Health Care Services and Models of Carein Washington, D.C., on
January 22, 2007. He presented an overview of evidence behind various models and systems of care for teens,
including the medical home and
chronic care models. Grossman is director
of Group Health’s Department of Preventive Care.
CHS Associate Investigator
Katherine Newton, PhD, presented the results of the Center's
study
on herbal alternatives for menopause to the National Advisory Council on Aging meeting at
the National Institute of Aging in Bethesda, Maryland on January 31, 2007.
CHS Senior Investigator
Lisa Jackson, MD, MPH, serves on the
Food and Drug
Administration panel that recently recommended approval of
a new five-in-one
vaccine for children. According to news reports,
the vaccine could eliminate seven of the 23 federally recommended shots children are given through the age
of 18 months.
CHS Senior Investigator
Greg Simon, MD, MPH, was recently elected to
the board of the Depression and Bipolar Support Alliance,
a patient-directed organization focusing on education, support, and research.
CHS was well represented by Research Associate
Sarah Greene, MPH,
during the Fifth Steering Committee Meeting of
NIH Roadmap Clinical Research Investigators
in Bethesda, Maryland December 5 and 6, 2006. Greene gave three presentations at the meeting, titled “
Building momentum toward better human subjects protections processes.” Her topics were: 1) “Challenges
for Multi-Center Human Research and Local IRB Review in 2006,” a report on work by the
Coordinated
Clinical Studies Network (CCSN) that, in addition to Greene, involved
Associate
Investigator
Rob Reid, MD, PhD, and
Human Subjects Review Manager Barbara
Young, PhD ; 2) “Alternative Models to Local IRB Review,” a presentation on work involving
all 15 research centers in the CCSN; and 3) “PRISM: Group Health Readability Toolkit,” a project
led by Research Specialist Jessica Ridpath and involving Greene,
Survey Manager Cheryl Wiese, MA ;
Senior Investigator
Michael Von Korff, ScD , and others.
CHS Executive Director
Eric B. Larson, MD, MPH, received the 2006
Laureate Award from the Washington Chapter of the American College of Physicians (ACP) on November 4,
2006. The award is given each year to honor those who have demonstrated “commitment to
excellence in medical care, education, or research, and service to their community, their chapter,
and ACP.” Since 1998, Larson has served nationally as a regent for ACP, the country’s
largest medical specialty society. He was chair of its Board of Regents from 2004 to 2005.
CHS Assistant Investigator
David Arterburn, MD, MPH, has been appointed to the
Adult Obesity Measurement Advisory Panel of National Committee on Quality Assurance (NCQA).
This private not-for-profit organization sets nationally standardized HEDIS (Health Plan Employer
Data Information Set) measures that are used to determine quality of care. As part of the panel,
Arterburn will help to identify, prioritize, and develop measures that can be used by providers,
health plans, public agencies, policy makers, and others to track progress toward reducing obesity
in the United States.
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