Investigator Kristen M.J. Azar, R.N., BSN, MSN/MPH

Kristen M.J. Azar, R.N., MSN/MPH, is an Investigator at the Sutter Health Center for Health Systems Research (East Campus, currently operating as Sutter's Research Development and Dissemination) and has worked with Sutter’s Research Enterprise since 2009.

She has diverse clinical experience as a public health and preventive cardiology nurse domestically and abroad, and has worked with racial/ethnic and socioeconomically diverse populations.

Her research interests include the prevention and management of chronic illnesses such as cardiometabolic diseases and mental illness. Ms. Azar’s research is aimed at identifying and addressing health disparities and examining the impact of social determinants of health on chronic disease risk and management. She helps develop and evaluate innovative behavioral interventions and explores how technology can enhance the effectiveness of these interventions in changing health behaviors.

Dr. Azar leads a study at Sutter Health called ELEVATE-DP, or Evaluation of a Lifestyle Intervention Adapted for Clinical Practice for Diabetes Prevention. The National Institutes of Health, NIDDK-funded study was launched to examine the effectiveness of a 12-month lifestyle change program for patients at high risk for diabetes and cardiovascular disease.

Ms. Azar completed graduate training at Johns Hopkins University with a joint degree in Nursing (MSN) and Public Health (MPH) from Johns Hopkins University School of Nursing and the Johns Hopkins Bloomberg School of Public Health respectively. She completed undergraduate studies at the University of California at Berkeley (BA) and obtained a Bachelor of Science in Nursing (BSN) from Johns Hopkins University. She is a member of the Sigma Theta Tau International Honor Society of Nursing as well as the Delta Omega Honor Society for Public Health.

Sutter Health Research Enterprise
2121 N. California Blvd.
Walnut Creek, CA, 94596
(925) 287-4053
azark@sutterhealth.org

Primary Research Interests

Publications

Measuring health equity for ambulatory care sensitive conditions in a large integrated health care system: the development of an index.

We designed and implemented an index, calculated as the ratio of observed-to-expected encounters, to quantify health inequalities in healthcare systems.

Examining paradoxical session attendance and weight loss relationships in a clinic based lifestyle modification intervention

Racial and sociodemographic predictors of COVID-19 compared with influenza, appendicitis, and all-cause hospitalization: retrospective cohort analysis

Unreported SARS-CoV-2 Home Testing and Test Positivity

Lifestyle change program engagement in real-world clinical practice: a mixed-methods analysis

Racial Disparities in Pulse Oximeter Device Inaccuracy and Estimated Clinical Impact on COVID-19 Treatment Course

Measuring and promoting SARS-CoV-2 vaccine equity: development of a COVID-19 vaccine equity index

Minoritized and socioeconomically disadvantaged groups have borne a disproportionate burden of severe illness, hospitalization, and death from COVID-19.

Disparities among racially/ethnically marginalized groups in the COVID-19 pandemic persist regardless of statewide shelter-in-place policies: an analysis from northern california

We examined hospitalizations and ICU transfers by race/ethnicity and pandemic period using logistic regression.

Effectiveness of a group-based lifestyle change program versus usual care: an electronic health record, propensity score-matched cohort study

This study examines the effectiveness of a CDC and prevention-aligned lifestyle change program relative to usual care in clinical practice.

The learning health system in crisis: lessons from the novel coronavirus disease pandemic

Advocating for a learning health network that promotes collaboration between health systems, community-based organizatons, and government agencies

Disparities In outcomes among COVID-19 patients In a large health care system In California.

Our study provides real-world evidence that there are racial and ethnic disparities in the presentation of COVID-19.

Statin utilization and low-density lipoprotein cholesterol in statin-treated patients with atherosclerotic cardiovascular disease: trends from a community-based health care delivery system, 2002-2016.

Modest LDL-C lowering for secondary ASCVD prevention is likely driven by suboptimal adherence and low high-intensity statin Rx's & low tx intensification rates.

Variability in engagement and progress in efficacious integrated collaborative care for primary care patients with obesity and depression: within-treatment analysis in the RAINBOW trial.

Patients identified early in the intervention with poor engagement or progress were more likely to fail treatment at the end.

Barriers and facilitators to real-world implementation of the Diabetes Prevention Program in large healthcare systems: lifestyle coach perspectives.

Key factors that could serve as barriers or facilitators in the implementation of DPP in large healthcare systems, from the perspective of lifestyle coaches.

Differing views regarding diet and physical activity: adolescents versus parents' perspectives.

Aligning parents' and teens' differing expectations and behaviors for supporting effective teen weight management could be incorporated into interventions.

Effect of an intervention for obesity and depression on patient-centered outcomes: an RCT.

intervention for obesity and depression that improved weight and depressive symptoms may also confer benefits for quality of life and psychosocial functioning.

Early weight loss and treatment response: data from a lifestyle change program in clinical practice.

Percentage weight change at 12 weeks from baseline can serve as a single indicator of nonresponse at the completion of the 12-month lifestyle change program.

Serious mental illness and health-related factors associated with regional emergency department utilization.

Findings indicate heterogeneity in regional utilization patterns among frequent ED utilizers, with mental illness increasing the likelihood of multi-ED use.

Implementation of a group-based diabetes prevention program within a healthcare delivery system.

Variation in the implementation of the DPP within a large multi-site healthcare system may affect effectiveness. Consider alternatives to anticipate barriers.

Longitudinal weight outcomes from a behavioral lifestyle intervention in clinical practice.

A lifestyle change program in clinical practice is associated with modest weight loss, sustained through 24 months, in setting of cardiometabolic risk factors.

Short-term weight trajectories and long-term weight outcomes from a lifestyle intervention in real-world clinical practice.

With relationship between magnitudes of short- and long-term wt change, individual wt trajectories may be useful in identifying non-responders who need alt tx.

Mobile applications for weight management: theory-based content analysis.

Study goal was to evaluate diet/nutrition and anthropometric tracking apps based on incorporation of features consistent with theories of behavior change.

Incorporation of whole, ancient grains into a modern Asian Indian diet to reduce the burden of chronic disease.

Practical recommendations for culturally sensitive carbohydrate modification in a modern Asian Indian diet to reduce type 2 diabetes and cardiovascular disease.

Racial/ethnic differences in dyslipidemia patterns.

No studies have comprehensively examined the prevalence of dyslipidemia among diverse racial/ethnic minority groups--Asian Americans, Mexican-Americans, blacks.

Baseline obesity status modifies effectiveness of adapted diabetes prevention program lifestyle interventions for weight management in primary care.

To examine whether baseline obesity severity modifies the effects of two different, primary care-based, technology-enhanced lifestyle interventions among overweight or obese adults with prediabetes and/or metabolic syndrome.

Accuracy of data entry of patient race/ethnicity/ancestry and preferred spoken language in an ambulatory care setting.

To describe data collection methods and to audit staff data entry of patient self-reported race/ethnicity/ancestry and preferred spoken language information.

Festival foods in the immigrant diet.

This paper explores the role that festival foods, foods that were once eaten a few times a year & on special occasions, play in the regular diet of immigrants.

Racial/ethnic differences in the prevalence of proteinuric and nonproteinuric diabetic kidney disease.

To examine racial/ethnic differences in the prevalence of diabetic kidney disease (DKD) with and without proteinuria, in an outpatient health care organization.

HOMBRE: A randomized controlled trial to compare two approaches to weight loss for overweight and obese Latino men (men with choices to improve well-being and decrease chronic disease risk).

HOMBRE compares two approaches to weight loss for overweight and obese Latino men.

A framework for examining the function of digital health technologies for weight management.

We categorized use & function of eHealth tools for wt mgmt to create a novel framework for eHealth interventions and to evaluate them.

Behavioral lifestyle interventions for moderate and severe obesity: a systematic review.

Comprehensive and intensive behavioral interventions can result in clinically significant, albeit modest, weight loss in this obese subpopulation.

Virtual small groups for weight management: an innovative delivery mechanism for evidence-based lifestyle interventions among obese men.

Virtual small groups may be an effective means of allowing face-to-face group interaction, while overcoming some barriers to access.

A fully automated diabetes prevention program, Alive-PD: program design and randomized controlled trial protocol.

Randomized trial will provide rigorous evidence regarding the efficacy of this Internet-based program in preventing progression to diabetes.

Reconsidering the age thresholds for type II diabetes screening in the U.S.

To examine the optimal age cut-point for opportunistic universal screening, compared to targeted screening recommended by USPSTF and ADA guidelines.

The Electronic CardioMetabolic Program (eCMP) for patients with cardiometabolic risk: a randomized controlled trial.

eCMP is a 6-month program utilizing video conferencing, online tools, and didactic videos to decrease cardiometabolic risk.

Dyslipidemia in special ethnic populations.

Culturally-tailored prevention and intervention should be provided to the minority populations with elevated risk for dyslipidemia.

Diabetes prevention and weight loss with a fully automated behavioral intervention by email, web, and mobile phone: a randomized controlled trial among persons with prediabetes.

Alive-PD improved glycemic control, body weight, BMI, waist circumference, TG/HDL ratio, and diabetes risk. As a fully automated system, the program has high potential for scalability and could potentially reach many of the 86 million US adults who have prediabetes as well as other at-risk groups.

Applying the Pragmatic-Explanatory Continuum Indicator Summary model in a primary care-based lifestyle intervention trial.

The PRECIS tool revealed that the E-LITE trial design was very pragmatic in nature. Its results and the adoption of the intervention into practice also suggest

Current Science on Consumer Use of Mobile Health for Cardiovascular Disease Prevention: A Scientific Statement From the American Heart Association.

KEYWORDS: AHA Scientific Statements; cardiovascular diseases; consumer health information; electronic mail; lifestyle; mobile health; prevention and control

Dyslipidemia in special ethnic populations.

Culturally-tailored prevention and intervention should be provided to the minority populations with elevated risk for dyslipidemia and considerably more research is needed to determine the best approaches to helping specific subgroups.

Impact of education on weight in newly diagnosed type 2 diabetes: every little bit helps.

Even relatively small "doses" of health education may help in promoting weight loss and may potentially reduce cardiometabolic risk.

Research Studies

eCMP (electronic Cardiometabolic Program)

To develop an electronically delivered Cardiometabolic Program to reduce DM and CAD in obese adults in lifestyle and stress management group coaching program.

Investigator: Kristen M.J. Azar R.N., BSN, MSN/MPH, Investigator

HOMBRE (Hombres con Opciones para Mejorar el Bienestar y bajar el Riesgo de Enfermedades crónicas)

A pragmatic, comparative effectiveness trial: obese Latino men will receive, by random assignment, the HOMBRE intervention or a minimal intensity intervention.

Investigator: Kristen M.J. Azar R.N., BSN, MSN/MPH, Investigator

Major Depressive Disorder

Purpose is to use EHR to understand the management of major depressive disorder in a large healthcare system, to incorporate pt-reported data in care workflow.

Investigator: Kristen M.J. Azar R.N., BSN, MSN/MPH, Investigator

Severe Mental Illness and Patterns of Emergency Department Utilization

Purpose is to provide descriptive info for improving health outcomes by identifying a subgroup of high-frequency ER patients who may have severe mental illness.

Investigator: Kristen M.J. Azar R.N., BSN, MSN/MPH, Investigator

Suicidality and Major Depressive Disorder: Examining Screening, Detection and Follow-up Care Within a Large Multispecialty Healthcare System

To examine suicidality screening and its impact on suicide attempts and patient care, including implementation of standardized inpatient suicidality screening.

Investigator: Kristen M.J. Azar R.N., BSN, MSN/MPH, Investigator

Teen Lifestyle Balance: Obesity Management and Prevention in Primary Care

The goal of this project is to adapt an evidence-based group lifestyle intervention for adults (the Group Lifestyle Balance curriculum) for overweight and obese PAMF adolescent patients and to identify the most effective method of delivering this new intervention to this patient population.

Investigator: Kristen M.J. Azar R.N., BSN, MSN/MPH, Investigator

Understanding Non-clinical Determinants of Long-term Hospital Stays Among High Utilizing Patients at ABSMC

Collect info to inform pt care and identify strategies to more efficiently transition high utilizers to more appropriate care arrangements.

Investigator: Kristen M.J. Azar R.N., BSN, MSN/MPH, Investigator

Understanding the Needs and Experiences of High Utilizers at the Emergency Department of Highland Hospital

Gather insights from pts in the ER to help address unmet clinical and social needs in the underserved in Alameda County.

Investigator: Kristen M.J. Azar R.N., BSN, MSN/MPH, Investigator