Seattle-Denver Center of Innovation (COIN)

COIN Investigators & Staff

3 August 2021

COIN Investigators

David Au, MD, MS

Title: Co-Director
ProfessorDivision of Pulmonary, Critical Care and Sleep Medicine, University of Washington

Contact: David.Au@va.gov

Location: Seattle

University of Washington webpage

I am a pulmonary and critical care physician and have had a long interest in improving delivery of care to patients with COPD and lung cancer. I have particular interest in improving the reach of specialty care medicine, especially at the population level. My program has a strong emphasis in facilitating delivery and quality of care in the outpatient setting and in the primary care environment where quality of lung disease care is consistently poor. I have led a number of initiative to improve access and quality of healthcare delivery in both research and operational projects.

My search program has included diverse areas including focusing on comparative effectiveness, being a founding member of the CONCERT-CER network that led efforts at developing national CER priorities for COPD. More recently, we have focused on operationally relevant and pragmatic clinical trials targeting high impact conditions including overuse of medical services, COPD and obesity. Having roots as part of the Office of Specialty Care Evaluation Center and with a number of colleagues from Seattle, Denver and Cleveland, we have established the VA collaborative evaluation (VACE) center that seeks to provide our organizational partner with strategic information about VA healthcare delivery.

Operationally, I established the Pulmonary/Sleep pecialty Care Access Network, Extension of Community Healthcare Outcomes for VISN20 (now VA ECHO) and worked within VA Office of Veteran Access to Care (OVAC) to help conceptualize access and implement a new referral management process. I have been fortunate to be engaged with numerous organizations including Chairing the FDA Pulmonary, Allergy Drugs Advisory Committee, NCQA respiratory measurement assessment panel and VA's Pulmonary Field Advisory Committee. I have been engaged with the American Thoracic Society including chairing the ATS international meeting, behavioral sciences and health services assembly, among others. I recently rotated off the ABIM pulmonary board exam writing committee. I am an active member of the UW Pulmonary, Critical Care and Sleep Medicine Faculty where I serve on the Steering Committee of our T32 program and am the MPI of an NHLBI K12 in implementation.

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Recent Publications

The following research fields have been used to summarize Dr. Au's publication (the number in parentheis is the times that research field has appeared):

• Clinical Research (176)
• Lung (122)
• Health Services (68)
• Chronic Obstructive Pulmonary Disease (65)
• Prevention (58)
• Behavioral and Social Science (37)
• Cancer (37)
• Clinical Trials and Supportive Activities (34)
• Lung Cancer (28)
• Cardiovascular (23)
• Tobacco (19)

2021

Levy C, Au D, Ozkaynak M. Innovation and Quality Improvement: Safe or Sabotage in Nursing Homes? J Am Med Dir Assoc. 2021 Aug;22(8):1670-1671. doi: 10.1016/j.jamda.2021.06.026.
PMID: 34334162.

Donovan L, Parsons E, Epler E, McCall C, He K, Sharma R, Duan K, Spece L, Feemster L, Kapur V, Au D, Palen B. 677 Impact of Remote Continuous Positive Airway Pressure Set-up on Treatment Usage and Effectiveness. Sleep. 2021 May 3;44(Suppl2):A264–A265.
doi:10.1093/sleep/zsab072.675.

Donovan LM, Mog AC, Blanchard KN, Magid KH, Syed AS, Kelley LR, Palen BN, Parsons EC, McCall CC, Thompson W, Charlton M, Spece LJ, Kirsh S, Au DH, Sayre GG. Patient experiences with telehealth in sleep medicine: a qualitative evaluation. J Clin Sleep Med. 2021 Mar 23. doi: 10.5664/jcsm.9266. Epub ahead of print.
PMID: 33755010.

Marshall V, Stryczek KC, Haverhals L, Young J, Au DH, Ho PM, Kaboli PJ, Kirsh S, Sayre G. The Focus They Deserve: Improving Women Veterans' Health Care Access. Womens Health Issues. 2021 Feb 10:S1049-3867(20)30157-2. doi: 10.1016/j.whi.2020.12.011. Epub ahead of print.
PMID: 33582001.

Prabhu KM, Don C, Sayre GG, Kearney KE, Hira RS, Waldo SW, Rao SV, Au DH, Doll JA. Interventional Cardiologists' Perceptions of Percutaneous Coronary Intervention Quality Measurement and Feedback. Am Heart J. 2021 Feb 7:S0002-8703(21)00032-6. doi: 10.1016/j.ahj.2021.01.019. Epub ahead of print.
PMID: 33567319.

Whittington MD, Ho PM, Kirsh SR, Kenney RR, Todd-Stenberg J, Au DH, Simonetti J. Cost savings associated with electronic specialty consultations. Am J Manag Care. 2021 Jan 1;27(1):e16-e23. doi: 10.37765/ajmc.2021.88579.
PMID: 33471464.

Donovan LM, PalenBN, Fernandes LA, Whittington MD, Feser WJ, Blankenhorn R, Gunzburger E,Grunwald GK, Gamache J, Liao JM, Kirsh S, Au DH. The Referral Coordination Team: A Redesign of Specialty Care to Enhance Service Delivery and Value in Sleep Medicine. NEJM Catalyst Innovations in Care Delivery Vol. 2 No. 2 February 2021.
DOI:https://doi.org/10.1056/CAT.20.0403.

2020

Donovan LM, Palen BN, Syed A, Blankenhorn R, Blanchard K, Feser WJ, Magid K, Gamache J, Spece LJ, Feemster LC, Fernandes L, Kirsh S, Au DH. Nurse-led triage of new sleep referrals is associated with lower risk of potentially contraindicated sleep testing: a retrospective cohort study. BMJ Qual Saf. 2020 Dec 22:bmjqs-2020-011817. doi: 10.1136/bmjqs-2020-011817. Epub ahead of print.
PMID: 33443226.

Moldestad M, Stryczek KC, Haverhals L, Kenney R, Lee M, Ball S, Au D, Kirsh S, Sayre G, Young J. Competing Demands: Scheduling Challenges in Being Veteran-centric in the Setting of Health System Initiatives to Improve Access. Mil Med. 2020 Dec 8:usaa520. doi: 10.1093/milmed/usaa520. Epub ahead of print.
PMID: 33289838.

Griffith MF, Chen HP, Bekelman DB, Feemster LC, Spece LJ, Donovan LM, Au DH, Carey EP. Comorbid Anxiety and Depression, Though Underdiagnosed, Are Not Associated with High Rates of Low-Value Care in Patients with COPD. Ann Am Thorac Soc. 2020 Dec 11. doi: 10.1513/AnnalsATS.201912-877OC. Epub ahead of print.
PMID: 33306930.

Duan KI, Spece LJ, Wong ES, Feemster LC, Donovan LM, Griffith MF, Keller TL, Bryant AD, Au DH. Low-value Inhaled Corticosteroids in Chronic Obstructive Pulmonary Disease and the Association with Health Care Utilization and Costs. Ann Am Thorac Soc. 2020 Dec 8. doi: 10.1513/AnnalsATS.202009-1128OC. Epub ahead of print.
PMID: 33290180.

Spece LJ, Epler EM, Duan K, Donovan LM, Griffith MF, LaBedz S, Thakur N, Wiener RS, Krishnan JA, Au DH, Feemster LC. Reassessment of Home Oxygen Prescription after Hospitalization for COPD: A Potential Target for De-implementation. Ann Am Thorac Soc. 2020 Oct 19. doi: 10.1513/AnnalsATS.202004-364OC. Epub ahead of print.
PMID: 33075243.

Parikh TJ, Stryczek KC, Gillespie C, Sayre GG, Feemster L, Udris E, Majerczyk B, Rinne ST, Wiener RS, Au DH, Helfrich CD. Provider anticipation and experience of patient reaction when deprescribing guideline discordant inhaled corticosteroids. PLoS One. 2020 Sep 17;15(9):e0238511. doi: 10.1371/journal.pone.0238511. PMC7498097.
PMID: 32941462.

Harhay MO, Au DH, Dell SD, Gould MK, Redline S, Ryerson CJ, Cooke CR. Methodologic Guidance and Expectations for the Development and Reporting of Prediction Models and Causal Inference Studies. Ann Am Thorac Soc. 2020 Jun;17(6):679-682. doi: 10.1513/AnnalsATS.202002-141ED. PMC7258412.
PMID: 32275840.

Hoerster KD, Collins MP, Au DH, Lane A, Epler E, McDowell J, Barón AE, Rise P, Plumley R, Nguyen T, Schooler M, Schuttner L, Ma J. Testing a self-directed lifestyle intervention among veterans: The D-ELITE pragmatic clinical trial. Contemp Clin Trials. 2020 Aug;95:106045. doi: 10.1016/j.cct.2020.106045. Epub 2020 May 28. PMC7253950.
PMID: 32473403.

Leitao Filho FS, Mattman A, Schellenberg R, Criner GJ, Woodruff P, Lazarus SC, Albert RK, Connett J, Han MK, Gay SE, Martinez FJ, Fuhlbrigge AL, Stoller JK, MacIntyre NR, Casaburi R, Diaz P, Panos RJ, Cooper JA Jr, Bailey WC, LaFon DC, Sciurba FC, Kanner RE, Yusen RD, Au DH, Pike KC, Fan VS, Leung JM, Man SP, Aaron SD, Reed RM, Sin DD. Serum IgG Levels and Risk of COPD Hospitalization: A Pooled Meta-analysis. Chest. 2020 Oct;158(4):1420-1430. doi: 10.1016/j.chest.2020.04.058. Epub 2020 May 19.
PMID: 32439504.

Ball S, Stryczek K, Stevenson L, Hearns R, Au DH, Ho PM, Aron DC. A Qualitative Evaluation of the Pain Management VA-ECHO Program Using the RE-AIM Framework: The Participant's Perspective. Front Public Health. 2020 May 15;8:169. doi: 10.3389/fpubh.2020.00169. eCollection 2020.PMID:
PMID: 32500053.

Spece LJ, Donovan LM, Griffith MF, Keller T, Feemster LC, Smith NL, Au DH. Initiating Low-Value Inhaled Corticosteroids in an Inception Cohort with Chronic Obstructive Pulmonary Disease. Ann Am Thorac Soc. 2020 May;17(5):589-595. doi: 10.1513/AnnalsATS.201911-854OC.PMID:
PMID: 31899652.

Nici L, Mammen MJ, Charbek E, Alexander PE, Au DH, Boyd CM, Criner GJ, Donaldson GC, Dreher M, Fan VS, Gershon AS, Han MK, Krishnan JA, Martinez FJ, Meek PM, Morgan M, Polkey MI, Puhan MA, Sadatsafavi M, Sin DD, Washko GR, Wedzicha JA, Aaron SD. Pharmacologic Management of Chronic Obstructive Pulmonary Disease. An Official American Thoracic Society Clinical Practice Guideline. Am J Respir Crit Care Med. 2020 May 1;201(9):e56-e69. doi: 10.1164/rccm.202003-0625ST. Erratum in: Am J Respir Crit Care Med. 2020 Sep 15;202(6):910. PMC7193862.
PMID: 32283960.

Keller T, Spece LJ, Donovan LM, Udris E, Coggeshall SS, Griffith M, Bryant AD, Casaburi R, Cooper JA Jr, Criner GJ, Diaz PT, Fuhlbrigge AL, Gay SE, Kanner RE, Martinez FJ, Panos RJ, Shade D, Sternberg A, Stibolt T, Stoller JK, Tonascia J, Wise R, Yusen RD, Au DH, Feemster LC. Association of Guideline-Recommended COPD Inhaler Regimens With Mortality, Respiratory Exacerbations, and Quality of Life: A Secondary Analysis of the Long-Term Oxygen Treatment Trial. Chest. 2020 Aug;158(2):529-538. doi: 10.1016/j.chest.2020.02.073. Epub 2020 Apr 9. PMC7417382.
PMID: 32278779.

Gamble-George JC, Longenecker CT, Webel AR, Au DH, Brown AF, Bosworth H, Crothers K, Cunningham WE, Fiscella KA, Hamilton AB, Helfrich CD, Ladapo JA, Luque A, Tobin JN, Wyatt GE; Implementation Research to Develop Interventions for People Living with HIV (PRECluDE) Consortium. ImPlementation REsearCh to DEvelop Interventions for People Living with HIV (the PRECluDE consortium): Combating chronic disease comorbidities in HIV populations through implementation research. Prog Cardiovasc Dis. 2020 Mar-Apr;63(2):79-91. doi: 10.1016/j.pcad.2020.03.006. Epub 2020 Mar 19. PMC7237329.
PMID: 32199901.

Donovan LM, Fernandes LA, Williams KM, Parsons EC, O'Hearn DJ, He K, McCall CA, Johnson KA, Kennedy MW, Syed AS, Thompson WH, Spece LJ, Feemster LC, Kirsh S, Au DH, Palen BN. Agreement of sleep specialists with registered nurses' sleep study orders in supervised clinical practice. J Clin Sleep Med. 2020 Feb 15;16(2):279-283. doi: 10.5664/jcsm.8182. Epub 2020 Jan 13. PMC7053017.
PMID: 31992435.

2019

Griffith MF, Feemster LC, Zeliadt SB, Donovan LM, Spece LJ, Udris EM, Au DH. Overuse and Misuse of Inhaled Corticosteroids Among Veterans with COPD: a Cross-sectional Study Evaluating Targets for De-implementation. J Gen Intern Med. 2020 Mar;35(3):679-686. doi: 10.1007/s11606-019-05461-1. Epub 2019 Nov 11. PMC7080925.
PMID: 31713043.

Stryczek K, Lea C, Gillespie C, Sayre G, Wanner S, Rinne ST, Wiener RS, Feemster L, Udris E, Au DH, Helfrich CD. De-implementing Inhaled Corticosteroids to Improve Care and Safety in COPD Treatment: Primary Care Providers' Perspectives. J Gen Intern Med. 2020 Jan;35(1):51-56. doi: 10.1007/s11606-019-05193-2. Epub 2019 Aug 8. PMC6957635.
PMID: 31396814.

Donovan LM, Coggeshall SS, Spece LJ, Griffith MF, Palen BN, Parsons EC, Todd-Stenberg JA, Glorioso TJ, Carey EP, Feemster LC, Zeliadt SB, Kirsh S, Au DH. Use of In-Laboratory Sleep Studies in the Veterans Health Administration and Community Care. Am J Respir Crit Care Med. 2019 Sep 15;200(6):779-782. doi: 10.1164/rccm.201902-0313LE. PMC7330508
PMID: 31206308.

Donovan LM, Malte CA, Spece LJ, Griffith MF, Feemster LC, Zeliadt SB, Au DH, Hawkins EJ. Center Predictors of Long-Term Benzodiazepine Use in Chronic Obstructive Pulmonary Disease and Post-traumatic Stress Disorder. Ann Am Thorac Soc. 2019 Sep;16(9):1151-1157. doi: 10.1513/AnnalsATS.201901-048OC. PMC6812159
PMID: 31113231.

Graney BA, Au DH, Barón AE, Cheng A, Combs SA, Glorioso TJ, Paden G, Parsons EC, Rabin BA, Ritzwoller DP, Stonecipher JJ, Turvey C, Welsh CH, Bekelman DB. Advancing Symptom Alleviation with Palliative Treatment (ADAPT) trial to improve quality of life: a study protocol for a randomized clinical trial. Trials. 2019 Jun 13;20(1):355. doi: 10.1186/s13063-019-3417-1. PMC6567600
PMID: 31196156.

Luo G, Stone BL, Koebnick C, He S, Au DH, Sheng X, Murtaugh MA, Sward KA, Schatz M, Zeiger RS, Davidson GH, Nkoy FL. Using Temporal Features to Provide Data-Driven Clinical Early Warnings for Chronic Obstructive Pulmonary Disease and Asthma Care Management: Protocol for a Secondary Analysis. JMIR Res Protoc. 2019 Jun 6;8(6):e13783. doi: 10.2196/13783. PMC6592592
PMID: 31199308.

Griffith MF, Feemster LC, Donovan LM, Spece LJ, Krishnan JA, Lindenauer PK, McBurnie MA, Mularski RA, Au DH. Poor Metered-Dose Inhaler Technique Is Associated with Overuse of Inhaled Corticosteroids in Chronic Obstructive Pulmonary Disease. Ann Am Thorac Soc. 2019 Jun;16(6):765-768. doi: 10.1513/AnnalsATS.201812-889RL. PMC6543465
PMID: 30763114.

Reinke LF, Vig EK, Tartaglione EV, Rise P, Au DH. Symptom Burden and Palliative Care Needs Among High-Risk Veterans With Multimorbidity. J Pain Symptom Manage. 2019 May;57(5):880-889. doi: 10.1016/j.jpainsymman.2019.02.011. Epub 2019 Feb 19.
PMID: 30794938.

Lederer DJ, Au DH, Cooke CR, Dell SD, Gould MK, Redline S, Kotloff RM. AnnalsATS: New Developments and Advice for Authors. Ann Am Thorac Soc. 2019 May;16(5):540-542. doi: 10.1513/AnnalsATS.201902-143ED.
PMID: 31042094.

Stefan MS, Shieh MS, Spitzer KA, Pekow PS, Krishnan JA, Au DH, Lindenauer PK. Association of Antibiotic Treatment With Outcomes in Patients Hospitalized for an Asthma Exacerbation Treated With Systemic Corticosteroids. JAMA Intern Med. 2019 Mar 1;179(3):333-339. doi: 10.1001/jamainternmed.2018.5394. PMC6439702
PMID: 30688986.

Helfrich CD, Hartmann CW, Parikh TJ, Au DH. Promoting Health Equity through De-Implementation Research. Ethn Dis. 2019 Feb 21;29(Suppl 1):93-96. doi: 10.18865/ed.29.S1.93. eCollection 2019. PMC6428172
PMID: 30906155.

Moy ML, Harrington KF, Sternberg AL, Krishnan JA, Albert RK, Au DH, Casaburi R, Criner GJ, Diaz P, Kanner RE, Panos RJ, Stibolt T, Stoller JK, Tonascia J, Yusen RD, Tan AM, Fuhlbrigge AL; LOTT Research Group. Characteristics at the time of oxygen initiation associated with its adherence: Findings from the COPD Long-term Oxygen Treatment Trial. Respir Med. 2019 Mar;149:52-58. doi: 10.1016/j.rmed.2019.02.004. Epub 2019 Feb 13. PMC6424633
PMID: 30803886.

Doll JA, Jones WS, Lokhnygina Y, Culpepper S, Parks RL, Calhoun C, Au DH, Patel MR. PREPARED Study: A Study of Shared Decision-Making for Coronary Artery Disease. Circ Cardiovasc Qual Outcomes. 2019 Feb;12(2):e005244. doi: 10.1161/CIRCOUTCOMES.118.005244.
PMID: 30764651.

Press VG, Au DH, Bourbeau J, Dransfield MT, Gershon AS, Krishnan JA, Mularski RA, Sciurba FC, Sullivan J, Feemster LC. Reducing Chronic Obstructive Pulmonary Disease Hospital Readmissions. An Official American Thoracic Society Workshop Report. Ann Am Thorac Soc. 2019 Feb;16(2):161-170. doi: 10.1513/AnnalsATS.201811-755WS. PMC6812156
PMID: 30707066.

Rinne ST, Wiener RS, Chen Y, Rise P, Udris E, Feemster LC, Au DH. Reply to Kardos: Extent of Overuse of Inhaled Corticosteroids in Chronic Obstructive Pulmonary Disease. Am J Respir Crit Care Med. 2019 Jan 15;199(2):249-250. doi: 10.1164/rccm.201809-1732LE.
PMID: 30278144.

Donovan LM, Feemster LC, Udris EM, Griffith MF, Spece LJ, Palen BN, He K, Parthasarathy S, Strohl KP, Kapur VK, Au DH. Poor Outcomes Among Patients With Chronic Obstructive Pulmonary Disease With Higher Risk for Undiagnosed Obstructive Sleep Apnea in the LOTT Cohort. J Clin Sleep Med. 2019 Jan 15;15(1):71-77. doi: 10.5664/jcsm.7574. PMC6329538
PMID: 30621828.

Donovan LM, Malte CA, Spece LJ, Griffith MF, Feemster LC, Engelberg RA, Au DH, Hawkins EJ. Risks of Benzodiazepines in Chronic Obstructive Pulmonary Disease with Comorbid Posttraumatic Stress Disorder. Ann Am Thorac Soc. 2019 Jan;16(1):82-90. doi: 10.1513/AnnalsATS.201802-145OC. PMC6344455
PMID: 30309243.

2018

Rinne ST, Lindenauer PK, Au DH. Intensive Intervention to Improve Outcomes for Patients With COPD. JAMA. 2018 Dec 11;320(22):2322-2324. doi: 10.1001/jama.2018.17508. PMID: 30419098.

Donovan LM, Feemster LC, Billings ME, Spece LJ, Griffith MF, Rise PJ, Parsons EC, Palen BN, O'Hearn DJ, Redline S, Au DH, Kapur VK. Risk of Cardiovascular Disease Related to Smoking Is Greater Among Women With Sleep-Disordered Breathing. J Clin Sleep Med. 2018 Nov 15;14(11):1929-1935. doi: 10.5664/jcsm.7496. PMID: 30373694. PMC6223561

Rinne ST, Wiener RS, Chen Y, Rise P, Udris E, Feemster LC, Au DH. Impact of Guideline Changes on Indications for Inhaled Corticosteroids among Veterans with Chronic Obstructive Pulmonary Disease. Am J Respir Crit Care Med. 2018 Nov 1;198(9):1226-1228. doi: 10.1164/rccm.201803-0554LE. PMID: 29969041. PMC6221578

Spece LJ, Donovan LM, Griffith MF, Collins MP, Feemster LC, Au DH. Quality of Care Delivered to Veterans with COPD Exacerbation and the Association with 30-Day Readmission and Death. COPD. 2018 Oct;15(5):489-495. doi: 10.1080/15412555.2018.1543390. PMID: 30822247. PMC6400327

Spece LJ, Epler EM, Donovan LM, Griffith MF, Collins MP, Feemster LC, Au DH. Role of Comorbidities in Treatment and Outcomes after Chronic Obstructive Pulmonary Disease Exacerbations. Ann Am Thorac Soc. 2018 Sep;15(9):1033-1038. doi: 10.1513/AnnalsATS.201804-255OC. PMD: 30079748. PMC6322042

Feemster LC, Saft HL, Bartlett SJ, Parthasarathy S, Barnes T, Calverley P, Curtis JR, Hickam DH, Mularski RA, Au DH, Chlan LL, Reinke LF, Cooke CR, Cox CE, Krishnan JA, Rubin E, Shah S, Sullivan DR, Kross EK; American Thoracic Society Behavioral Sciences and Health Services Research Assembly and Nursing Assembly. Patient-centered Outcomes Research in Pulmonary, Critical Care, and Sleep Medicine. An Official American Thoracic Society Workshop Report. Ann Am Thorac Soc. 2018 Sep;15(9):1005-1015. doi: 10.1513/AnnalsATS.201806-406WS. PMD: 30168741. PMC6850728

Heffner JL, Krebs P, Johnson H, Greene PA, Klein DE, Feemster LC, Slatore CG, Au DH, Zeliadt SB. Smokers' Inaccurate Beliefs about the Benefits of Lung Cancer Screening. Ann Am Thorac Soc. 2018 Sep;15(9):1110-1113. doi: 10.1513/AnnalsATS.201804-259RL. PMD: 29877728.

Sayre GG, Neely EL, Simons CE, Sulc CA, Au DH, Michael Ho P. Accessing Care Through the Veterans Choice Program: The Veteran Experience. J Gen Intern Med. 2018 Oct;33(10):1714-1720. doi: 10.1007/s11606-018-4574-8. Epub 2018 Jul 23. PMID: 30039494. PMC6153225

Zeng YQ, Au DH, Cai S, Carey E, Jiang F, Chen Y, Liu ZJ, Chen P. Effect of a Patient Education Intervention on Asthma Control and Patient-Doctor Relationship. Chin Med J (Engl). 2018 May 5;131(9):1110-1112. doi: 10.4103/0366-6999.230736. PMD: 29692384. PMC5937322

Krishnan JA, Au DH. Time to Converge FDA Decisions and Evidence Syntheses for Long-Acting Muscarinic Antagonists and SMART in Guidelines for the Treatment of Asthma. JAMA. 2018 Apr 10;319(14):1441-1443. doi: 10.1001/jama.2018.2029. PMD: 29554261.

Williams EC, Bryson CL, Sun H, Au DH, Bradley KA. Association Between Alcohol Use and Angina Symptoms Among Outpatients From the Veterans Health Administration. J Addict Med. 2018 Mar/Apr;12(2):143-149. doi: 10.1097/ADM.0000000000000379. PMD: 29334512. PMC5847476

Wiener RS, Koppelman E, Bolton R, Lasser KE, Borrelli B, Au DH, Slatore CG, Clark JA, Kathuria H. Patient and Clinician Perspectives on Shared Decision-making in Early Adopting Lung Cancer Screening Programs: a Qualitative Study. J Gen Intern Med. 2018 Jul;33(7):1035-1042. doi: 10.1007/s11606-018-4350-9. Epub 2018 Feb 21. PMD: 29468601. PMC6025674

Helfrich CD, Rose AJ, Hartmann CW, van Bodegom-Vos L, Graham ID, Wood SJ, Majerczyk BR, Good CB, Pogach LM, Ball SL, Au DH, Aron DC. How the dual process model of human cognition can inform efforts to de-implement ineffective and harmful clinical practices: A preliminary model of unlearning and substitution. J Eval Clin Pract. 2018 Feb;24(1):198-205. doi: 10.1111/jep.12855. Epub 2018 Jan 5. PMD: 29314508. PMC5900912

Yusen RD, Criner GJ, Sternberg AL, Au DH, Fuhlbrigge AL, Albert RK, Casaburi R, Stoller JK, Harrington KF, Cooper JAD Jr, Diaz P, Gay S, Kanner R, MacIntyre N, Martinez FJ, Piantadosi S, Sciurba F, Shade D, Stibolt T, Tonascia J, Wise R, Bailey WC; LOTT Research Group *; LOTT Research Group. The Long-Term Oxygen Treatment Trial for Chronic Obstructive Pulmonary Disease: Rationale, Design, and Lessons Learned. Ann Am Thorac Soc. 2018 Jan;15(1):89-101. doi: 10.1513/AnnalsATS.201705-374SD. PMD: 29087741. PMC5822416

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Grants & Funding

The following research categories have been used to summarize Dr. Au's grants/funding (the number in parentheis is the times that research category has appeared):

• Clinical Research (12)
• Lung (8)
• Health Services (8)
• Chronic Obstructive Pulmonary Disease (7)
• Clinical Trials and Supportive Activities (7)
• Comparative Effectiveness Research (6)
• Behavioral and Social Science (4)
• Prevention (3)
• Nutrition (2)
• Cardiovascular (2)
• Obesity (2)

Current/Recent Grants

University of Washington Implementation Science Training Program (UW-ISTP)K12

Grant number: K12HL137940

Funding amount: $2,524,548.00

Start/End date: 9/1/2017 - 8/31/2022

Abstract:
The University of Washington Implementation Sciences Training Program (UW-ISTP) proposes to recruit and train a new generation of researchers focused on the science of dissemination and implementation. We will utilize our extensive experience in training multidisciplinary clinician scientists and our ongoing implementation science research programs as the foundation and source of this new K12 program focused on implementation science research. Our long term goal is to produce scientists with mastery of cutting edge implementation science (IS) methodology, grounded in a rich research environment that includes not only a critical mass of trainees and faculty, but also a robust opportunity to directly engage in ongoing research studies. The UW- ISTP will provide an unparalleled opportunity that provides the skills necessary to become independent clinician scientists whose impact will be on improving health at a population level. Drs. David H. Au, J. Randall Curtis and Bryan J. Weiner will serve as leadership for the UW-ISTP. These leaders marry 1) implementation science from the Department of Health Services, 2) established mentors within pulmonary and critical care medicine and health services, 3) robust research programs contained within the UW Department of Health Services, Division of Pulmonary and Critical Care Medicine, Cambia Palliative Care Center of Excellence (PCCE), and the VA Health Services Research and Development (HSR&D) Center of Innovation (COIN), 4) our multiple NHBLI funded T32 and VA post-doctoral fellowships. Our overall aims are to: 1. Provide scholars with multidisciplinary didactic and experiential training that will allow them to: a. Develop and use theoretical frameworks to advance the science of implementation b. Build implementation science methods expertise, including pragmatic interventions that incorporate the healthcare context c. Engage patients and operational stakeholders from research inception to completion d. Design and conduct studies to test theoretical IS constructs within research projects/programs e. Lead and evaluate the adoption and spread of evidence-based interventions into clinical practice, enterprise/health systems level solutions and policy 2. Engage K12 scholars in utilizing the world-class opportunities afforded by UW, Group Health Research Institute/Kaiser Permanente of Washington (GHRI/KPW) and the VA HSR&D. We will exploit existing opportunities from ongoing projects, existing data infrastructure, mentoring teams, real-world clinical settings and organizational and patient stakeholders. 3. Foster a critical mass of junior investigators interacting across T2-T4 translational scientists developing collaborations and facilitating productivity.

Public Health Relevance Statement:
Advances of modern medicine are often not translated into clinical practice. The goal of the University of Washington Implementation Science Program is to train future implementation scientists focused on pulmonary, critical care, and palliative care medicine. Ultimately, the program is designed to lead to improvements in population health by using implementation science to expedite adoption of evidence-based care.

Funder: National Heart Lung and Blood Institute

NIH website: https://reporter.nih.gov/project-details/9990844

AdvanCing High quality COPD care for people with immune dysfunction by implementing Evidence-based management through proactive E-consults (ACHIEVE)

Role: PI with KRISTINA ANNE CROTHERS, Co-PI & CHRISTIAN D HELFRICH, Co-PI

Grant number: U01HL142103

Funding amount: $2,114,951.00

Start/End date: 8/15/2018 - 5/31/2022

Abstract:
As HIV-infected (HIV+) patients age, chronic obstructive pulmonary disease (COPD) is one of the most prevalent comorbid diseases. Of concern among patients with HIV infection, COPD confers substantial morbidity and is associated with increased mortality. Yet, COPD is underdiagnosed and often inappropriately managed in HIV+ patients, likely worsening the morbidity associated with COPD. Optimizing the management of COPD includes improving uptake of recommended and discontinuation of ineffective and harmful practices. Accurate diagnosis of COPD can identify individuals who will benefit – and those who will not benefit – from COPD therapies. Appropriate use of long-acting inhalers to control COPD improves symptoms, health-related quality of life, functional status, and decrease risk for exacerbations. Discontinuation of inappropriate inhalers – particularly inhaled corticosteroids – can minimize harms from side effects that may be particularly problematic in HIV+ persons, given their concomitant immuno-compromise, multimorbidity, and polypharmacy. We propose to test an intervention to optimize COPD care that promotes effective, evidence-based care and de-implements inappropriate therapies for COPD in HIV+ patients. We are a multidisciplinary team of key stakeholders and investigators with expertise in COPD, HIV and implementation science, with prior experience studying similar interventions. The intervention, grounded in the chronic care model, facilitates specialist support of primary care, which includes infectious disease (ID) physicians who serve as the primary care providers for their HIV+ patients in the ID clinic. Rather than relying on referral-driven specialty care, which may be a barrier to access, we will have pulmonologists proactively support HIV providers to manage a population of HIV+ patients with COPD, delivering real-time evidence-based recommendations tailored to the individual HIV+ patient. We will leverage the Department of Veterans Affairs (VA) clinical and informatics infrastructures to communicate between team members developing the recommendations and patients' clinical providers through the electronic health record as a proactive (i.e., pulmonary-initiated) E-consult. To offset potential increases in ID providers' workload, we will draft recommendations as preliminary orders for providers to review and endorse (sign), modify or cancel at their discretion, preserving autonomy. We will use a modified stepped-wedge intervention design, with outcomes evaluated using the RE-AIM (Reach, Effectiveness, Adoption, Implementation and Maintenance) framework. We will evaluate barriers and facilitators of optimal COPD care for HIV+ patients, and of effective adoption, implementation and maintenance of a proactive E-consult program, guided by the Consolidated Framework for Implementation Research. This intervention can enhance the sustainable uptake of proven-effective interventions into routine clinical practice for HIV+ patients, who are at risk of disparities in COPD care and poor health outcomes from COPD.

Public Health Relevance Statement:
Chronic obstructive pulmonary disease (COPD) is very common and associated with morbidity and mortality in HIV-infected patients. However, COPD is often underdiagnosed and care is suboptimal. We propose to test an intervention to proactively support primary care providers of HIV-infected patients and make evidence-based recommendations to improve the care and health of their patients with COPD.

Funder: National Heart Lung and Blood Institute

NIH website: https://reporter.nih.gov/project-details/9966024

Health through Obesity care for PatiEnts with COPD (HOPE)

Grant number: U01HL128868

Funding amount: $1,187,513.00

Start/End date: 8/1/2015 - 7/31/2021

Abstract:
Approximately 70% of patients with Chronic Obstructive Pulmonary Disease (COPD) are obese or overweight. Tobacco smoking that causes COPD also is associated with other poor health habits that can lead to obesity and cardiovascular disease. Symptoms of COPD are often non-specific and include dyspnea and exercise intolerance. COPD treatment guidelines recommend stepped escalation of inhaled medications to improve these symptoms, but make little mention of the effect of co-existing obesity or weight loss interventions because of insufficient evidence. Cardiovascular disease is a leading cause of mortality among patients with COPD, and obesity is associated with important risk factors for cardiovascular disease including dyslipidemia, hypertension, and diabetes. Comprehensive lifestyle interventions that include calorie-controlled healthy eating, increased physical activity, and behavioral self-management strategies consistently result in modest, clinically significant weight loss and associated reductions in cardiovascular risk factors. That overweight and obese patients with COPD would not only reap similar clinical benefits from modest weight loss is an intuitive - but untested - concept. Therefore, we propose to conduct a highly valid, multicenter, patient-level randomized, pragmatic clinical trial to produce first-ever data on the effectiveness of a self-directed 12-month evidence-based lifestyle intervention targeting modest weight loss and increased physical activity among overweight and obese patients with COPD. We aim to serve as a Protocol Leadership Group (PLG) for the National Heart, Lung, and Blood Institute's "Multi-Site Clinical Trials for the Pulmonary Trials Cooperative (PTC)" in order to test if intervention participants have better outcomes through 24 months of follow-up compared to usual care control patients in terms of weight loss, exercise tolerance using the 6-Minute Walk Test, and dyspnea using the Borg dyspnea score. Secondary outcomes include, generic health-related quality of life using the SF-12, and major cardiovascular risk factors using Framingham risk score (including lipids), central obesity by waist circumference and blood pressure. We will oversee enrollment of 1000 patients at multiple clinical sites eventually chosen and contracted by the PTC's Network Management Core (NEMO). As the PLG for our proposed HOPE trial, we will cooperate with NEMO and will provide trial oversight, data management and reporting, and safety monitoring.

Public Health Relevance Statement:
Most patients with COPD are overweight or obese, and obesity and COPD share many symptoms such as dyspnea, exercise intolerance, and poor health status. COPD treatment guidelines recommend medications to improve these symptoms, but make little mention of weight loss as a possible treatment because of lack of evidence. This trial tests the effectiveness of a lifestyle intervention targeting modest weight loss and increase physical activity among overweight and obese patients with COPD.

Funder: National Heart Lung and Blood Institute

NIH website: https://reporter.nih.gov/project-details/9542374

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