Seattle-Denver Center of Innovation (COIN)

COIN Investigators & Staff

COIN Investigators

Katherine Hoerster, PhD, MPH

Title:Core Investigator
Associate Professor, University of Washington, School of Medicine

Contact: Katherine.Hoerster@va.gov

Location: Seattle

University of Washington webpage

Research Interests

See Dr. Hoerster's Dimensions profile that includes: publications, grants, datasets, patents and clinical trials

My research focuses on understanding and addressing the contextual factors like social support and policy that affect health and health behavior. I’m also fortunate to work with Veterans with PTSD as a staff psychologist in the VA Puget Sound-Seattle PTSD Outpatient Clinic. Last, I’m invested in maximizing research impact by communicating about science to the public and policymakers.

Sharing Research Findings with Participants
Recently Dr. Hoerster's research team sent letters of their findings to the ~500 Veterans who participated in the VA Health Systems Research and Development Service (HSR) study.
"Sharing back with them (the study participants) is our most important dissemination step yet. We are so grateful to our study participants for their partnership."

The study protocol included this wording:
"Participant "Thank you" letter: We will send a thank you letter to randomized participants, including a link to the published primary results manuscript. We view this concluding step as essential to sharing findings with some of our most important collaborators in the research process: the study participants themselves."
Download a sample letter.

The research lead to this paper in JAMA
"Effect of a Remotely Delivered Self-directed Behavioral Intervention on Body Weight and Physical Health Status Among Adults With Obesity: The D-ELITE Randomized Clinical Trial"

As a clinician, it is a true honor to get to work alongside Veterans with PTSD and other mental health conditions as they pursue recovery and a full and meaningful life. I hope that the research I do builds on those meaningful relationships to bring health to Veterans throughout the country.

One of the most powerful tools for healing I’ve observed is Veterans partnering with other Veterans to provide support and solve problems. Through research and clinical work I hope to be a facilitator of Veteran-driven solutions that promote resilience, joy, and well-being.

The following images visualize Dr. Hoerster's work. The word cloud is drawn from publication titles. The research collaboration map shows research relationships (click the image to enlarge):

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Grants

DVD Lifestyle Intervention (D-ELITE)

Role: PI
More than a third of US Veterans who receive care through the VHA are obese, putting them at higher risk for multiple chronic severe health conditions.
The VA National Center for Health Promotion and Disease Prevention (NCP) prioritizes developing evidence-based programs that are scalable, cost-efficient, and serve a diverse veteran population. While the VA's MOVE! program is a practical lifestyle intervention for obesity, but its reach has been limited. Some Veterans may best achieve weight loss with in-person group visits or by internet and mobile technology-intensive programs, while others with a population-based, self-directed program that uses minimal technology.
This trial will examine the effectiveness of a proven 12-month pragmatic self-directed, low-technology, and low-resource DVD-based lifestyle intervention targeting modest, clinically meaningful weight loss and increased physical activity among obese Veterans. If successful, this trial may help ease the burden that obesity places on Veterans and the health care system.
Funder: Veterans Administration
NIH website
Publications of note:
Testing a self-directed lifestyle intervention among veterans: The D-ELITE pragmatic clinical trial
Initiating Low-Value Inhaled Corticosteroids in an Inception Cohort with Chronic Obstructive Pulmonary Disease

Telehealth-delivered peer support to improve quality of life among Veterans with multimorbidity

Role: Co-PI with Kristen Gray
Multimorbidity is common among Veterans and results in poor health-related quality of life (HRQoL). It contributes to high health care utilization and costs. Patients with multimorbidity need to engage in self-management for many of their chronic conditions. Patients with multimorbidity experience significant barriers to self-management. Due to the limitations of traditional primary care visits, they need additional support to engage in self-management optimally. Peer support delivered by trained Veteran peer health coaches is well-suited to fill this need.
Limited research has evaluated the effectiveness of peer support in multimorbidity. The proposed study seeks to assess whether a telehealth-delivered peer health coaching intervention improves HRQoL compared to usual VA care among high-risk patients with multimorbidity.
It also aims to understand barriers and facilitators to implement the program in VA if it is effective. This research may enhance VA’s ability to provide services to Veterans with multimorbidity and improve health outcomes.
Funder: Veterans Administration
NIH website

MOVED BY LOVE: MOVE! Disparities for Black Veterans Lowered through Veteran Engagement

Role: Co-PI
The purpose of this mixed methods project is to identify barriers and facilitators to weight loss among Black Veterans participating in MOVE! in order to inform changes to care to reduce disparities in weight loss between Black and non-Black Veterans.
Funder: Veterans Administration, National Center for Health Promotion and Disease Prevention

Pragmatic Obstructive Sleep Apnea Weight Loss Trial Assessing Effectiveness and Reach (POWER)

Role: Co-I with Lucas Donovan
Obstructive sleep apnea (OSA) is an obesity-related condition that affects 1.3 million Veterans, reduces the quality of life, and is associated with a greater risk of cardiovascular disease. Despite the potential of weight loss to reverse OSA, the real-world impact is limited.
Veterans seldom receive weight loss services due to a lack of counseling and poor accessibility of current weight loss offerings. Furthermore, there is uncertainty around the benefits of modest weight loss in achieving meaningful outcomes in OSA.
This trial will examine the effectiveness of a population health approach to weight loss care among Veterans with OSA. We will use a remote lifestyle-based weight loss intervention that is self-directed, low-technology, and likely low-cost.
We propose a pragmatic trial of proactively delivering this novel intervention among patients with newly diagnosed OSA. We will test whether such an intervention improves weight and meaningful outcomes, including sleep-related quality of life, sleep symptoms, and cardiovascular risk.
Funder: Veterans Affairs
NIH website
Publications of note:
Sleep Apnea, Obesity, and Readmissions: Real Risks or Residual Confounding?

MOVE!+UP: Testing a Tailored Weight Management Program for Veterans with PTSD

Role: PI
Posttraumatic Stress Disorder (PTSD) is common among Veterans and results in poor psychological functioning, quality of life, and physical health. For Veterans, this includes having disproportionately high rates of obesity, partly due to PTSD symptoms interfering with physical activity and a healthy diet.
Unfortunately, Veterans with PTSD have poorer weight loss outcomes than those without PTSD in VA’s existing weight management program, MOVE!.
Based on pilot work, it appears that a weight management program that augments standard PTSD care and targets PTSD-related barriers to weight loss improves weight and PTSD symptoms.
Whether it improves these issues more than routine VA care requires study, which is the focus of the proposed research. The proposed study also seeks to understand factors that would interfere with and facilitate implementing the program in VA if it is effective.
This Veteran-centered, tailored weight loss program may efficiently benefit both the physical and mental health of Veterans with PTSD, addressing standard care limitations.
Funder: Veterans Administration
NIH website
Publications of note:
— Testing a tailored weight management program for veterans with PTSD: The MOVE! + UP randomized controlled trial

Multiphase Optimization Trial of Incentives for Veterans to Encourage Walking Role

Role: Co-I with Paul Hebert
Regular physical activity is associated with reduced risk of several diseases important to Veterans, including cardiovascular disease and diabetes. Physical activity is also associated with better mental health. Walking is a safe and effective way to get the recommended amount of physical activity.
Unfortunately, more than 1 in 3 Veterans over age 45 meet the definition of physically inactive. Behavioral economics suggests that our inability to start and stick to an exercise routine may result from “present bias,” which is a tendency to value the immediate reward of remaining sedentary over large rewards of long-run physical activity. Patient incentives may overcome present bias by moving the rewards for healthy behaviors forward in time.
In the proposed study, we will determine the optimal design for an incentive program that gives Veterans tangible, timely rewards for walking an average target number of steps per day. If effective, an incentive program may be an economical way to improve Veterans’ physical and mental health without taxing the healthcare delivery system.
Funder: Veterans Affairs
NIH website

Measuring the Longitudinal Relationships between Obesity, Weight Management Interven6tion and Medical Expenditure

Role: Co-I with Edwin Wong (PI: Matthew Maciejewski)
About 68% of Veterans are considered overweight or obese. Their weight increases their risk for hypertension, type 2 diabetes mellitus, coronary heart disease, and osteoarthritis. These clinical risks lead obese patients to incur disproportionately high health expenditures.
No prior VA studies have examined the natural history of weight gain, long-term expenditures of normal weight, overweight and obese Veterans, or changes in weight and expenditures attributable to the MOVE! program.
We propose to examine 20-year patterns of VA weight and VA expenditures for Veterans to characterize the long-run scope of the health and economic impacts of obesity in the VA.
Results on these long-term trends will provide context for our proposed evaluation of MOVE!'s clinical and economic impacts on participants. Including identification of specific Veterans subgroups that experience above-average benefits from MOVE!
Funder: Veterans Administration
NIH website
Publications of note:
— BMI Trends for Veterans Up to 10 Years After VA Enrollment Following Military Discharge

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Recent Publications

2024

Wong ES, Stechuchak KM, Smith VA, Hung A, Dennis PA, Hoerster KD, Maciejewski ML. Differences in healthcare costs over 10 years following discharge from military service by weight trajectory. Obes Res Clin Pract. 2024 Apr 1:S1871-403X(24)00038-3. doi: 10.1016/j.orcp.2024.03.008. Epub ahead of print.
PMID: 38565463.
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Smith VA, Stechuchak KM, Wong ES, Hung A, Dennis PA, Hoerster KD, Blalock DV, Raffa SD, Maciejewski ML. Association Between a National Behavioral Weight Management Program and Veterans Affairs Health Expenditures. Med Care. 2024 Apr 1;62(4):235-242. doi: 10.1097/MLR.0000000000001981. Epub 2024 Mar 8.
PMID: 38458985.
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Breland JY, Tanksley L Sr, Borowitz MA, Houseknecht D, Muhammad N, Raffa SD, Hoerster KD. Black Veterans Experiences with and Recommendations for Improving Weight-Related Health Care: A Photovoice Study. J Gen Intern Med. 2024 Mar 4. doi: 10.1007/s11606-024-08628-7. Epub ahead of print.
PMID: 38438635.
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2023

Hung A, Wong ES, Dennis PA, Stechuchak KM, Blalock DV, Smith VA, Hoerster K, Vimalananda VG, Raffa SD, Maciejewski ML. Real World Use of Anti-Obesity Medications and Weight Change in Veterans. J Gen Intern Med. 2023 Nov 14. doi: 10.1007/s11606-023-08501-z. Epub ahead of print.
PMID: 37962730.
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Blalock DV, Pura JA, Stechuchak KM, Dennis PA, Maciejewski ML, Smith VA, Hung A, Hoerster KD, Wong ES. BMI Trends for Veterans Up to 10 Years After VA Enrollment Following Military Discharge. J Gen Intern Med. 2022 Oct 11:1–8. doi: 10.1007/s11606-022-07818-5. Epub ahead of print. PMCID: PMC9552734.
PMID: 36219304.
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2022

Donovan LM, McDowell JA, Pannick AP, Pai J, Bais AF, Plumley R, Wai TH, Grunwald GK, Josey K, Sayre GG, Helfrich CD, Zeliadt SB, Hoerster KD, Ma J, Au DH. Protocol for a pragmatic trial testing a self-directed lifestyle program targeting weight loss among patients with obstructive sleep apnea (POWER Trial). Contemp Clin Trials. 2023 Nov 5;135:107378. doi: 10.1016/j.cct.2023.107378. Epub ahead of print.
PMID: 37935303
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Hoerster KD, Hunter-Merrill R, Nguyen T, Rise P, Barón AE, McDowell J, Donovan LM, Gleason E, Lane A, Plumley R, Schooler M, Schuttner L, Collins M, Au DH, Ma J. Effect of a Remotely Delivered Self-directed Behavioral Intervention on Body Weight and Physical Health Status Among Adults With Obesity: The D-ELITE Randomized Clinical Trial. JAMA. 2022 Dec 13;328(22):2230-2241. doi: 10.1001/jama.2022.21177.
PMID: 36511927.
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Blalock DV, Pura JA, Stechuchak KM, Dennis PA, Maciejewski ML, Smith VA, Hung A, Hoerster KD, Wong ES. BMI Trends for Veterans Up to 10 Years After VA Enrollment Following Military Discharge. J Gen Intern Med. 2022 Oct 11:1–8. doi: 10.1007/s11606-022-07818-5. Epub ahead of print. PMCID: PMC9552734.
PMID: 36219304.
Learn more about this publication on Dimensions

Romano EFT, Baquero B, Hicks O, Gardner VA, Shannon KL, Hoerster KD. "No One Should Feel Like They're Unsafe": Mobility Justice Photovoice as a Youth Advocacy Tool for Equitable Community Mobility. Fam Community Health. 2022 Aug 4. doi: 10.1097/FCH.0000000000000344. Epub ahead of print.
PMID: 35943214.
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Persad-Clem R, Hoerster KD, Romano EFT, Huizar N, Maier KJ. Climate to COVID, global to local, policies to people: a biopsychosocial ecological framework for syndemic prevention and response in behavioral medicine. Transl Behav Med. 2022 May 25;12(4):516-525. doi: 10.1093/tbm/ibac021.
PMID: 35613005
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Gray KE, Hoerster KD, Spohr SA, Breland JY, Raffa SD. National Veterans Health Administration MOVE! Weight Management Program Participation During the COVID-19 Pandemic. Prev Chronic Dis. 2022 Mar 10;19:E11. doi: 10.5888/pcd19.210303.
PMID: 35271436.
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2021

Hendrickson RC, Slevin RA, Hoerster KD, Chang BP, Sano E, McCall CA, Monty GR, Thomas RG, Raskind MA. The Impact of the COVID-19 Pandemic on Mental Health, Occupational Functioning, and Professional Retention Among Health Care Workers and First Responders. J Gen Intern Med. 2021 Dec 16. doi: 10.1007/s11606-021-07252-z. Epub ahead of print.
PMID: 34918181

Robustelli BL, Campbell SB, Greene PA, Sayre GG, Sulayman N, Hoerster KD. Table for two: Perceptions of social support from participants in a weight management intervention for veterans with PTSD and overweight or obesity. Psychol Serv. 2021 Sep 13. doi: 10.1037/ser0000577. Epub ahead of print.
PMID: 34516204

Gray KE, Hoerster KD, Taylor L, Krieger J, Nelson KM. Improvements in physical activity and some dietary behaviors in a community health worker-led diabetes self-management intervention for adults with low incomes: results from a randomized controlled trial. Transl Behav Med. 2021 Aug 23:ibab113. doi: 10.1093/tbm/ibab113. Epub ahead of print.
PMID: 34424331.

Chen JA, Jakupcak M, McCann R, Fickel JJ, Simons CE, Campbell DG, Stryczek KC, Hoerster KD, Chaney EF, Oishi SM, Miner MN, Bonner LM, Fortney JC, Felker BL. Posttraumatic stress disorder collaborative care: A quality improvement study in veterans affairs primary care. Fam Syst Health. 2021 Jun;39(2):198-211. doi: 10.1037/fsh0000623.
PMID: 34410768.

Hoerster KD, Tanksley L, Sulayman N, Bondzie J, Brier M, Damschroder L, Coggeshall S, Houseknecht D, Hunter-Merrill R, Monty G, Saelens BE, Sayre G, Simpson T, Wong E, Nelson K. Testing a tailored weight management program for veterans with PTSD: The MOVE! + UP randomized controlled trial. Contemp Clin Trials. 2021 Jun 16;107:106487. doi: 10.1016/j.cct.2021.106487. Epub ahead of print.
PMID: 34144246

Firth CL, Baquero B, Berney R, Hoerster KD, Mooney SJ, Winters M. Not quite a block party: COVID-19 street reallocation programs in Seattle, WA and Vancouver, BC. SSM Popul Health. 2021 Mar 9;14:100769. doi: 10.1016/j.ssmph.2021.100769. PMCID: PMC7966863.
PMID: 33748391

2020

Hoerster KD, Gray K, Raffa SD. Weight Management and Healthy Lifestyles. JAMA Intern Med. 2020 Oct 1;180(10):1403-1404. doi: 10.1001/jamainternmed.2020.2765.
PMID: 32833002

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. PMID: ; PMCID: PMC7253950.
PMID: 32473403

Campbell SB, Gray KE, Hoerster KD, Fortney JC, Simpson TL. Differences in functional and structural social support among female and male veterans and civilians. Soc Psychiatry Psychiatr Epidemiol. 2020 Apr 6;. Doi: 10.1007/s00127-020-01862-4. [Epub ahead of print] PubMed
PMID: 32249329

Hoerster KD, Tanksley L, Simpson T, Saelens BE, Unützer J, Black M, Greene P, Sulayman N, Reiber G, Nelson K. Development of a Tailored Behavioral Weight Loss Program for Veterans With PTSD (MOVE!+UP): A Mixed-Methods Uncontrolled Iterative Pilot Study. Am J Health Promot. 2020 Jul;34(6):587-598. doi: 10.1177/0890117120908505. Epub 2020 Mar 12. PMID: ; PMCID: PMC7478932.
PMID: 32162528

Haibach JP, Hoerster KD, Dorflinger L, McAndrew LM, Cassidy DG, Goodrich DE, Bormann JE, Lowery J, Asch SM, Raffa SD, Moin T, Peterson AL, Goldstein MG, Neal-Walden T, Talcott GW, Hunter CL, Knight SJ. Research translation for military and veteran health: research, practice, policy. Transl Behav Med. 2020 Feb 11:ibz195. doi: 10.1093/tbm/ibz195. Epub ahead of print.
PMID: 32043529

2019

Browne KC, Hoerster KD, Piegari R, Fortney JC, Nelson KN, Post EP, Fihn SD, Mori AM, Trivedi RB. Clinical Care Quality Among Veterans Health Administration Patients With Mental Illness Following Medical Home Implementation. Psychiatr Serv. 2019 Sep 1;70(9):816-823. doi: 10.1176/appi.ps.201800474. Epub 2019 Jul 16.
PMID: 31310189

Hoerster KD, Campbell S, Dolan M, Stappenbeck CA, Yard S, Simpson T, Nelson KM. PTSD is associated with poor health behavior and greater Body Mass Index through depression, increasing cardiovascular disease and diabetes risk among U.S. veterans. Prev Med Rep. 2019 Jun 28;15:100930. doi: 10.1016/j.pmedr.2019.100930. eCollection 2019 Sep. PMC6627033
PMID: 31338278

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