Kathy Bradley, MD, MPH, is a general internist whose research focuses on identifying and addressing alcohol and other substance use in primary care. For over 25 years, Dr. Bradley has conducted research that is having a lasting impact on how medical providers approach prevention and treatment of alcohol and substance use disorders. She joined Kaiser Permanente Washington Health Research Institute (KPWHRI) in 2011.
Foundational work on unhealthy alcohol use conducted in the VA. While at the Veterans Affairs (VA) Puget Sound Health Care System, Dr. Bradley tested ways to efficiently identify unhealthy alcohol use. Her team validated the “AUDIT-C” three-item alcohol screen and a single-question screen in VA and non-VA patients. She was instrumental in helping to implement alcohol screening and brief alcohol counseling at more than 900 VA sites nationwide using performance measures and decision support in the VA's electronic health record (EHR). Her team also linked high AUDIT-C scores with adverse health outcomes, hospitalizations, surgical complications and post-operative health care utilization, and mortality. More recently, she and her team have demonstrated that changes in AUDIT-C scores are associated with changes in health outcomes, suggesting that AUDIT-C scores might be useful as a “vital sign” to monitor drinking over time.
Innovations to support management of alcohol use disorders in primary care. Over the past decade, Dr. Bradley has worked on management of alcohol use disorders (AUDs) in primary care. She led the National Institutes of Health's National Institute on Alcohol Abuse and Alcoholism (NIAAA) study on collaborative care for primary care patients with unhealthy drinking. This CHOICE trial (Considering Healthier Drinking Options in Collaborative Care) demonstrated that the CHOICE model of nurse care management increased the proportion of patients who took medications for alcohol use disorders, but did not improve drinking outcomes. In 2014, with her clinical partners at Kaiser Permanente Washington, she obtained a Partnership for Innovation grant (the 3:30 Project) to test proactive outreach, using an EHR registry, from primary care teams to patients with alcohol or drug use disorders, aiming for 3 visits in 30 days. In addition, her team recently developed a patient decision aid for shared decision-making about AUDs, in the Options study funded by NIAAA.
Implementing sustained care for the full spectrum of unhealthy alcohol use in primary care. The Agency for Healthcare Research and Quality (AHRQ) funded Dr. Bradley’s team to conduct the SPARC (Sustained Patient-centered Alcohol-related Care) trial, which ended in 2018. Across all 22 primary care clinics within Kaiser Permanente Washington, SPARC tested state-of-the-art strategies for implementing alcohol screening, brief alcohol counseling, and shared decision-making for patients with AUDs. An innovative element of the implementation was that a handout and video addressed stigma as part of the implementation. Analyses on whether the trial increased preventive alcohol-related discussions and treatment of AUDs are in progress, but SPARC succeeded in implementing high rates of routine alcohol screening (87 percent of patients) and asking patients who report high-risk drinking about alcohol-related symptoms (74 percent).
Leading an innovative pragmatic trial as part of NIDA’s CTN. Dr. Bradley is also a multiple principal investigator of the Health Systems Node of the National Institute on Drug Abuse (NIDA) Clinical Trials Network (CTN), along with Drs. Connie Weisner and Cynthia Campbell at Kaiser Permanente Northern California. Dr. Bradley leads the CTN PROUD (Primary care Opioid Use Disorders) trial, a pragmatic implementation trial of the Massachusetts Model of Office Based Addiction Treatment for opioid use disorder in primary care across six diverse health systems in Texas, Florida, Michigan, New York, and Washington state. She also co-leads, with Gwen Lapham, PhD, MPH, MSW, a study using EHR data to study medical cannabis.
Mentoring the next generation of innovative investigators in implementation research. Dr. Bradley is also supported half-time by NIAAA to mentor early-career clinician-researchers interested in improving care for unhealthy alcohol use and is an affiliate professor of medicine and health services at the University of Washington. Current mentees include Joseph Glass, PhD, MSW, who is studying implementation of mobile health applications for alcohol and other substance use disorders in medical settings and Dr. Lapham, studying implementation of high-quality alcohol and substance use care for adolescents as well as developing EHR measures for medical cannabis.
Prevention and treatment
Alcohol and drug use
Alcohol and drug use disorders
Physician decision support; eHealth
Implementation research; quality measurement
Alcohol and drug screening; brief alcohol interventions
Screening and brief intervention; mental health quality measurement
Primary care management of unhealthy alcohol use
Matson TE, Carrell DS, Bobb JF, Cronkite DJ, Oliver MM, Luce C, Ghitza UE, Hsu CW, Campbell CI, Browne KC, Binswanger IA, Saxon AJ, Bradley KA, Lapham GT. Prevalence of medical cannabis use and associated health conditions documented in electronic health records among primary care patients in Washington state. JAMA Netw Open. 2021 May 3;4(5):e219375. doi: 10.1001/jamanetworkopen.2021.9375. PubMed
Steel TL, Giovanni SP, Katsandres SC, Cohen SM, Stephenson KB, Murray B, Sobeck H, Hough CL, Bradley KA, Williams EC. Should the CIWA-Ar be the standard monitoring strategy for alcohol withdrawal syndrome in the intensive care unit? Addict Sci Clin Pract. 2021;16(1):21. doi: 10.1186/s13722-021-00226-w. PubMed
Tsui JI, Akosile MA, Lapham GT, Boudreau DM, Johnson EA, Bobb JF, Binswanger IA, Yarborough BJH, Glass JE, Rossom RC, Murphy MT, Cunningham CO, Arnsten JH, Thakral M, Saxon AJ, Merrill JO, Samet JH, Bart GB, Campbell CI, Loree AM, Silva A, Stotts AL, Ahmedani B, Braciszewski JM, Hechter RC, Northrup TF, Horigian VE, Bradley KA. Prevalence and medication treatment of opioid use disorder among primary care patients with hepatitis C and HIV. J Gen Intern Med. 2021 Feb 10. doi: 10.1007/s11606-020-06389-7. [Epub ahead of print]. PubMed
Campbell CI, Saxon AJ, Boudreau DM, Wartko PD, Bobb JF, Lee AK, Matthews AG, McCormack J, Liu DS, Addis M, Altschuler A, Samet JH, LaBelle CT, Arnsten J, Caldeiro RM, Borst DT, Stotts AL, Braciszewski JM, Szapocznik J, Bart G, Schwartz RP, McNeely J, Liebschutz JM, Tsui JI, Merrill JO, Glass JE, Lapham GT, Murphy SM, Weinstein ZM, Yarborough BJH, Bradley KA. PRimary Care Opioid Use Disorders treatment (PROUD) trial protocol: a pragmatic, cluster-randomized implementation trial in primary care for opioid use disorder treatment. Addict Sci Clin Pract. 2021;16(1):9. doi: 10.1186/s13722-021-00218-w. PubMed
A new primary care approach improves alcohol-related preventive care as well as care for alcohol use disorder.
Use in pregnancy and screening in primary care studied by KPWHRI’s Kiel, Matson, and Lapham.
Health care is increasingly online—KPWHRI is studying telehealth options for opioid use disorder and chronic pain.
The latest on our research on chronic pain and opioids—and how the results influence health policy and clinical practice.
GIST Healthcare, June 6, 2022