Publications by authors named "Erin Keast"
Clinical trials continue to struggle with recruiting diverse participants that include historically underrepresented and minoritized patients, who are typically patients in non-white racial and ethnic groups and have low income (Medicaid). Enrolling diverse participants will benefit the health sciences by providing more generalizable findings. The Cancer Financial Experience project (CAFÉ) study sought to improve financial distress by providing financial navigation for newly diagnosed cancer patients, and intentionally recruited diverse participants.
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- Adverse social determinants of health significantly increase the risk of chronic health conditions, yet there's a lack of research on whether communities have adequate services to address these needs.
- A geospatial analysis was conducted to assess the coverage of social care providers in relation to the locations of Kaiser Permanente Northwest members suffering from various health-related social needs (HRSNs), such as food insecurity and transportation issues.
- The results showed that 97-98% of members with HRSNs lived within a 30-minute travel distance to a provider, indicating effective service availability, although some rural patients faced challenges in reaching care.
Introduction: Extended-release buprenorphine (XR-Bup) is associated with reduced opioid use and opioid negative urine drug screens. Little is known about its use in outpatient addiction care provided within health systems.
Methods: Individuals prescribed XR-Bup were identified from electronic health records; chart abstraction was conducted.
Article Synopsis
- The study looked at older patients (65 years and up) who needed dental care and checked if they had any social needs like money problems or being alone.
- Out of 754 patients, about 28% had at least one social need, with the most common being feeling isolated and having financial issues.
- Patients with one social need were more likely to take care of their health issues after the dental visit compared to those who didn't have any social needs.
Article Synopsis
- The study looked at how social needs like food insecurity and social isolation affect older adults' health care visits.
- It analyzed data from almost 10,000 older Medicare members to see if their social issues led to more trips to the emergency room or hospital.
- Results showed that financial problems, housing issues, and feeling isolated could lead to more emergency visits, especially for those with financial strain.
Article Synopsis
- The CHARM study focused on providing genetic testing and risk management for cancer to underserved populations, addressing barriers to access in low-income and low-literacy groups.
- Conducted at Kaiser Permanente Northwest and Denver Health from 2018 to 2020, the study monitored participants for an average of 15.4 months to evaluate the use of cancer screenings and surgical procedures after receiving genetic test results.
- Although only a small percentage of participants received actionable recommendations, those who did showed moderate engagement in risk management practices, indicating that the study successfully increased access to genetic services and preventive care without leading to overuse of these services.
Article Synopsis
- Screening adherence for mammography and MRI is crucial for individuals with inherited genetic variants linked to higher breast cancer risk, yet it remains low in practice.
- A study assessed the percentage of time individuals adhered to annual mammograms and breast MRIs, revealing an average adherence of 48% for mammograms and 34% for MRIs among those with certain genetic variants.
- The findings suggest a need for further research to understand and improve adherence to these important screening practices, particularly for those with pathogenic variants in breast cancer-associated genes.
The Association Between Social Isolation and Memory Loss Among Older Adults.
J Am Board Fam Med
December 2022
Article Synopsis
- Social isolation in older adults is linked to negative health effects, including memory loss, particularly among those enrolled in Medicare at large health care systems.
- A study involving Medicare members aged 65 and older showed that individuals who reported feeling socially isolated were more likely to experience memory loss compared to those who felt less isolated.
- The findings highlight the importance of addressing social isolation, suggesting that interventions may help reduce isolation and potentially lessen memory loss in older adults.
Introduction: COVID-19 has created additional challenges for the analysis of non-randomized interventions in health system settings. Our objective is to evaluate these challenges and identify lessons learned from the analysis of a medically tailored meals (MTM) intervention at Kaiser Permanente Northwest (KPNW) that began in April 2020.
Methods: We identified both a historical and concurrent comparison group.
The Association Between Social Isolation and Memory Loss Among Older Adults.
J Am Board Fam Med
September 2022
Article Synopsis
- Social isolation can make older people feel lonely and might lead to memory problems.
- In a study of Medicare members over 65, those who felt lonely were more likely to report memory loss.
- Finding ways to help people feel less isolated could help protect their memory in the future.
Purpose: Effective approaches to communicate genomic information are needed to ensure equitable care. In a randomized controlled superiority trial, we tested a novel practice model that aims to make genetic counseling inclusive, by making the communication accessible, relational, and actionable (ARIA).
Methods: In total, 696 English- and Spanish-speaking patients aged 18 to 49 years, enriched for individuals from historically underserved backgrounds, were randomized in 1:1 ratio to ARIA or usual care.
Article Synopsis
- Germline genetic testing for hereditary cancer susceptibility can lead to preventative actions like prophylactic surgeries in unaffected individuals, specifically in a study within the Kaiser Permanente Northwest health system from 2010 to 2018.
- The study analyzed data from 1020 individuals tested for high-risk genetic variants, finding only a small percentage opted for recommended risk-reducing surgeries such as mastectomy and hysterectomy based on their results.
- Results indicate that the use of risk-reducing surgeries is lower than expected, suggesting that other factors beyond genetic test outcomes and guidelines influence individuals' decisions to undergo prophylactic procedures, warranting further investigation.
Background: There is an urgent need for evidence on how interventions can prevent or mitigate cancer-related financial hardship. Our objectives are to compare self-reported financial hardship, quality of life, and health services use between patients receiving a financial navigation intervention versus a comparison group at 12 months follow-up, and to assess patient-level factors associated with dose received of a financial navigation intervention.
Methods: The Cancer Financial Experience (CAFÉ) study is a multi-site randomized controlled trial (RCT) with individual-level randomization.
Purpose: Individuals having genomic sequencing can choose to be notified about pathogenic variants in genes unrelated to the testing indication. A decision aid can facilitate weighing one's values before making a choice about these additional results.
Methods: We conducted a randomized trial (N = 231) comparing informed values-choice congruence among adults at risk for a hereditary cancer syndrome who viewed either the Optional Results Choice Aid (ORCA) or web-based additional findings information alone.
Introduction: Use of kidney replacement therapy (KRT) prediction models for guiding arteriovenous fistula (AVF) referrals in advanced chronic kidney disease (CKD) is unknown. We aimed to compare a hypothetical approach using a KRT prediction model developed in Kaiser Permanente Northwest to estimated glomerular filtration rate (eGFR) for AVF referrals.
Methods: Our retrospective cohort consisted of patients with stage G4 CKD in Kaiser Permanente Northwest followed by nephrology.
Background: A critical step in access to genetic testing for hereditary cancer syndromes is referral for genetic counseling to assess personal and family risk. Individuals meeting testing guidelines have the greatest need to be evaluated. However, referrals to genetics are underutilized in US patients with hereditary cancer syndromes, especially within traditionally underserved populations, including racial and ethnic minorities, low-income, and non-English speaking patients.
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- - The study investigates cost patterns for patients diagnosed with de novo stage IV or recurrent advanced cancers, focusing on breast, colorectal, and lung cancers between 2000 and 2012 across three health systems in the U.S.
- - It finds that patients with cancer recurrence within one year of initial diagnosis incur significantly higher costs prior to diagnosis compared to others, and those with de novo stage IV disease have greater costs in the post-diagnosis period.
- - The results indicate distinct cost trajectories for different types of cancer diagnoses, suggesting that future research should differentiate between de novo and recurrent cases to better understand resource use and planning.
Background: The integration of medical care into the dental setting has been shown to facilitate the closure of care gaps among patients with unmet needs. However, little is known about whether program effectiveness varies depending on whether the care gap is related to preventive care or disease management.
Materials And Methods: We used a matched cohort study design to compare closure of care gaps between patients aged 65+ who received care at a Kaiser Permanente Northwest (KPNW) Medical-Dental Integration (MDI) clinic or a non-MDI dental clinic between June 1, 2018, and December 31, 2019.
Introduction: The use of data from wearable sensors, smartphones, and apps holds promise as a clinical decision-making tool in health and mental health in primary care medicine. The aim of this study was to determine provider perspectives about the utility of these data for building digitally based decision-making tools.
Methods: This mixed quantitative and qualitative cross-sectional survey of a convenience sample of primary-care clinicians at Kaiser Permanente Northwest was conducted between April and July 2019 online via Institute for Translational Health Sciences' Research Electronic Data Capture.
Background: Repeated use of chemical irritants for crowd-control by local and federal law enforcement during sustained racial justice protests in the U.S. has raised concerns about potential adverse health effects.
View Article and Find Full Text PDFIntroduction: Assessment and counseling by healthcare providers can successfully increase physical activity; however, a valid instrument to effectively measure physical activity is needed. This study examines the validity of the Exercise Vital Sign tool by comparing Exercise Vital Sign data collected at Kaiser Permanente Northwest with accelerometry data.
Methods: Participants (n=521) completed accelerometer monitoring and had ≥1 Exercise Vital Sign measurement in their electronic medical record.
Background: The integration of medical and dental care in the dental setting offers a unique opportunity to close medical care gaps, such as providing immunizations and laboratory-based tests, compared with traditional nonintegrated settings.
Methods: We used a matched cohort study design among patients 65 years or older (n = 2,578) with an index dental visit to the Kaiser Permanente Northwest medical-dental integration (MDI) program from June 1, 2018, through December 31, 2019. MDI patients were matched 1:1 to non-MDI controls (n = 2,578) on 14 characteristics.
Purpose: Patients' chronic disease burden can influence the likelihood that providers will recommend cancer screening and that patients will participate in it. Using data from the STOP CRC pragmatic study, we examined associations between chronic disease burden and colorectal cancer screening recommendation and use.
Methods: Participating STOP CRC clinics (n = 26) received either usual care or training to implement a mailed fecal immunochemical test (FIT) outreach program.
Importance: Whether guideline-concordant lung nodule evaluations lead to better outcomes remains unknown.
Objective: To examine the association between the intensity of lung nodule diagnostic evaluations and outcomes, safety, and health expenditures.
Design, Setting, And Participants: This comparative effectiveness research study analyzed health plan enrollees at Kaiser Permanente Washington in Seattle, Washington, and Marshfield Clinic in Marshfield, Wisconsin, with an incidental lung nodule detected between January 1, 2005, and December 31, 2015.
Background: Colorectal cancer (CRC) is the 3rd leading cancer killer among men and women in the US. The Strategies and Opportunities to STOP Colon Cancer in Priority Populations (STOP CRC) project aimed to increase CRC screening among patients in Federally Qualified Health Centers (FQHCs) through a mailed fecal immunochemical test (FIT) outreach program. However, rates of completion of the follow-up colonoscopy following an abnormal FIT remain low.
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