Group Health’s top 10 research findings of 2016

GHRI Adjunct Investigator and Group Health Physician Dr. Elizabeth Lin leads a session in mindfulness-based stress reduction.

In a year of surprises, we could still count on Group Health producing a variety of practical results, to improve people’s health.

Here are just 10 of the year’s many significant findings from Group Health Research Institute (GHRI):

1. Mindfulness meditation eases back pain

Compared to usual care, mindfulness-based stress reduction (a form of meditation training) and cognitive behavioral therapy lessened chronic low back pain and improved functioning in Group Health patients. The JAMA study led by Dan Cherkin, PhD, now a GHRI senior investigator emeritus, showed these effects persisted at one year. More than 100 news outlets covered the results, including the New York Times, NPR, Reuters, Seattle magazine, and Washington Post. It was even parodied in The Onion. Read our news release and Dr. Cherkin’s blog post and watch JAMA’s video. To come: a cost analysis.

2. Weight loss persists long term after bariatric surgery

Bariatric surgery kept weight off for a decade in a large multisite study of Veterans Affairs patients around the country. Results were best for those who had Roux-en-Y gastric bypass surgery. Senior Investigator David Arterburn, MD, MPH, coauthored the study, which JAMA Surgery published. Read NPR's story and Dr. Arterburn’s blog post.

3. Colonoscopy seems safer without deep sedation

In a large national data set, use of deep sedation during colonoscopy is rising—and is linked to a 13 percent higher risk of any complication within 30 days, according to Associate Investigator Karen Wernli, PhD, in Gastroenterology. These complications include higher risk of perforation, bleeding, abdominal pain, complications due to anesthesia, and stroke. Unlike many settings, Group Health’s Group Practice does not routinely use deep sedation with propofol during colonoscopy, instead using moderate sedation. Read Dr. Wernli’s blog post and watch her in a video.

4. Dementia rates keep falling, while absolute numbers rise

GHRI Executive Director Eric B. Larson, MD, MPH, coauthored a JAMA Internal Medicine study showing good news about dementia: The rates of new dementia cases in older American retirees continue to decrease. That’s likely related to better socioeconomic status and control of risk factors.   The number of cases is still rising, because of aging of the population. The large national study received wide media coverage. Read our news release and blog post.

5. Team care for teen depression is cost-effective

Collaborative care for adolescent depression had already proven effective in a randomized clinical trial at nine Group Health primary care clinics. Now its cost-effectiveness has been proven in a JAMA Pediatrics study by Senior Research Associate Evette Ludman, PhD, and colleagues including Affiliate Investigator Laura Richardson, MD, MPH. Read Dr. Ludman’s blog post.

6. Pharmacy outreach increases statin use—but not costs—for people with diabetes

After Group Health launched a systemwide effort to improve preventive care for members at risk of cardiovascular disease, greater statin use was linked to reductions in strokes and heart attacks and lower likelihood of death for cardiovascular reasons. Although increased statin use raised drug costs, the total cost of care didn’t change, probably because the increase in medication costs was offset by fewer treatments for cardiovascular events. The research team included Senior Investigator James D. Ralston, MD, MPH, and Affiliate Investigator David Grembowski, PhD, in the Journal of Managed Care & Specialty Pharmacy. Read Dr. Ralston’s blog post.

7. One antidepressant controls weight long term

Bupropion (Wellbutrin) was the only antidepressant that tended to be linked to weight loss over two years in Group Health patients. This antidepressant should be the first choice for overweight and obese patients with depression, according to Dr. Arterburn and Senior Investigator Greg Simon, MD, MPH, in the Journal of Clinical Medicine. Media coverage included NIH Research Matters. Read our news release.

8. TBI is linked to Parkinson’s and Parkinson-related brain defects

When people have a history of a traumatic brain injury (TBI) with loss of consciousness, they are more likely to develop Parkinson’s disease, parkinsonian features, microscopic strokes (microinfarcts), and Lewy bodies (which play a role in Parkinson's disease and Lewy body dementia). Dr. Larson and Affiliate Investigator Paul Crane, MD, MPH, published in JAMA Neurology. Media coverage was widespread given rising concerns over head trauma in football players. Read Dr. Larson’s blog post.

9. Low-dose aspirin can help prevent colon cancer

GHRI participates in the Evidence‑based Practice Center called Kaiser Permanente Research Affiliates, whose evidence reviews inform recommendations by the U.S. Preventive Services Task Force. As part of this work, Associate Investigator Jessica Chubak, PhD, was the first author of an Annals of Internal Medicine evidence review showing that low-dose aspirin can help lower the risk for colon cancer—not only heart attacks and stroke—in middle-aged people at cardiovascular risk.

10. Evidence insufficient for screening for skin cancer—and for blood lipids in children

Other widely reported evidence reviews with first authors from GHRI included findings that don’t support recommending skin cancer screening for all adults (by Dr. Wernli)—or lipid screening for all children and teens to find familial hypercholesterolemia or multifactorial dyslipidemia (by Senior Investigator Paula Lozano, MD, MPH). The reviews were published in JAMA.

And now? Onward and upward through 2017.

by Rebecca Hughes