PhD Student Bradley Kramer Awarded $1.2 Million PCORI Grant for CHW Home-Visits to Combat Asthma
Second-year Health Services PhD student Bradley Kramer has been awarded a $1.2M grant by the Patient-Centered Outcomes Research Institute (PCORI). Brad is a co-Principal Investigator of this grant, which is housed at Public Health - Seattle & King County. The project team also includes other University of Washington researchers: Dr. Jim Stout of UW Pediatrics will join Brad as Co-PI, and Dr. Bryan Weiner, Brad’s doctoral dissertation committee chair, will be a co-investigator, and the implementation science expert.
The project is based on a PCORI randomized trial that the team completed last year. That study found that community health worker (CHW) home-visiting programs can substantially improve outcomes related to asthma health and quality of life, among children and adults with out-of-control asthma in Seattle and South King County. Says Brad, “We also saw some indications that when patients’ primary care doctors were engaged with both the patients and their CHW, there were additional health benefits. I think that future work can show how clinical and community program linkages can strengthen health programming and outcomes. To that end, our asthma program continues to stress the importance of the patient’s primary care practitioner, and we emphasize two-way communication that allows the CHW to share what is happening in the patient’s home, and to be an extension of the care team.”
Brad was invited to the PCORI Annual Meeting on November 1st to present the team’s findings and share best practices of utilizing CHWs in care and research. In addition, Brad and the CHW team recently won the CHW Section Award at the American Public Health Association (APHA) Annual Meeting 2018.
Reflecting on the importance of these issues, Brad says, “Studies led by Dr. Jim Krieger and conducted out of the county health department over the past two decades have repeatedly provided evidence for the benefits of CHW home-visits for asthma, across various settings and with clinical populations. Krieger’s studies in King County have also shown a cost savings for the overall health system. This asthma programming provides the triple-aim for which the health care system strives: patient-centered care that improves health and saves the system money. Moreover, the patient receives care that is more culturally competent and care that addresses many of the broader social factors. There are many factors beyond health care that are impacting the lives and health of the patients and their families, and the CHWs take the time to address these many needs, not just providing health care.”
Brad has found synergies between his classroom studies and his research, observing that “the entire first year of the Health Services PhD program has reinforced these same issues. In the first of three core courses, Health Systems and Policy, we learn how the health care system can address access, cost, and quality concerns, the very same issues that our asthma program is designed to tackle. In the second course, Health Policy Research, we learn how research can inform policy. For example, the evaluation results from this new PCORI award directly align with a set of demonstration projects happening right now in Washington State, which allow the Center for Medicare and Medicaid Services to consider how they can fund health care delivery differently. And the third core course, focuses on the social determinants of health, and how to address not just health care, but other social needs and health inequities, which is the heart and soul of our asthma program, and why it works so well. By combining my practical experience in the delivery system with my classroom learning, I have been able to effectively frame my work and research proposals to create meaningful system wide changes.”
This PCORI grant is the natural next step in Brad’s personal, professional, and academic journey. Brad recalls, “I spent four years managing the King County Asthma Program and supervising our incredible CHWs, who are going into homes and improving lives across our county. This has been the most amazing and enriching four years. When you do work every day that you know is effective in creating profound improvements for the people that you serve, you want to come back for more, and continue giving back to the job and the community.”
Brad is taking what he has learned in the asthma program and applying it to his work at the Veteran’s Affairs (VA) Center for Outcomes and Innovation. Says Brad, “During my time in the PhD program, I have been working with two investigators to test and develop similar programs for two other chronic diseases – hypertension and Chronic Obstructive Pulmonary Disease (COPD). The VA has a phenomenal health system and it is a great privilege to work there. These types of community-driven prevention programs have the potential for profoundly positive impact. One of the most powerful components of this program is the shared life experience between the CHW and their client. At the VA, we are training veterans to work with other fellow veterans to improve self-management for their disease. I am interviewing the veterans after they exit the program, and this peer mentor structure is working very well.”
Considering his involvement in this specific project, Brad says, “I joined the team at the King County Health Department in 2014 to manage the initial PCORI comparative effectiveness trial. After Dr. Krieger retired from the health department, Dr. Jim Stout assumed leadership of the grant and the asthma program, with myself as the administrative lead. Since then, Dr. Stout and I have been proudly maintaining our high-performing team of CHWs, made possible in part by the health department’s strong infrastructure. At this time of Medicaid reform, under the 1115 Medicaid waiver processes and the statewide Healthier Washington innovation model, we are working with our communities to determine how our CHW program can be most supportive, such as allowing more clinicians to refer to the asthma program and training other CHWs across the state. I am delighted to have received this PCORI award, which fits perfectly into that puzzle. Dr. Bryan Weiner is a new member to our team, and will be leading our evaluation at the program level.
Our project is an excellent example of the academic-health department, and Public Health – Seattle & King County and UW leadership have recently signed a formal letter recognizing this partnership. Our co-leadership across the two institutions is well demonstrated by shared grant administration, resulting in both improved local health service delivery, and in our proven record of producing high-quality results that advance the field.”
Looking towards the future, Brad says, “While I’m at the UW for my PhD program, I want to gain the skills to help facilitate getting programs like our asthma program into the hands of those who need them the most. I am working with my mentor, Dr. Bryan Weiner, to learn how to more effectively scale up and disseminate effective, evidence-based health services programs. I hope to continue to work in settings that have one foot in the delivery system and that contribute to the fields of public health and policy through high quality evaluation.”
To learn more about Brad’s work, visit:
- Grant and project details: https://www.pcori.org/research-results/2018/disseminating-community-health-worker-training-guidelines-practice-g2p-project
- PCORI randomized trial that provided the foundation for the grant project: https://www.pcori.org/research-results/2013/guidelines-practice-g2p-reducing-asthma-health-disparities-through-guideline
- Brad’s presentation at PCORI Annual Meeting on November 1st: https://www.pcori.org/events/2018/2018-pcori-annual-meeting-breakout-session-improving-care-community-how-effectively
Photo: Joyce McCraney and Bradley Kramer