BFAM Member Spotlights

Meet the members of the Stanford Medicine Black Faculty Affinity Meetings (BFAM), a network created through OFDD's Community Support Initiative. BFAM is intended to provide networking and social engagement opportunities for Stanford Medicine faculty across all clinical lines and departments.

Alyce S. Adams, PhD

Epidemiology and Population Health & Medicine (PCOR)

Associate Director, Health Equity and Community Engagement, Stanford Cancer Institute

Faculty Advisory Board, Stanford Impact Labs

Research Interests
Health services and policy research; Health Equity; Chronic Disease Treatment & Outcomes

Something you wouldn’t know just by looking at me.
I was in a rock band in graduate school.

What are some of your favorite restaurants?
Chez Maman, Chubby Noodle

What are some of your favorite social activities?
Finding new restaurants; sporting events (Warriors, Giants); symphony

Full Stanford Profile

Stanford Medicine Innovation Professor and Professor of Epidemiology and Population Health, of Health Policy and, by courtesy, of Pediatrics (Endocrinology)

asadams@stanford.edu

Bio

Dr. Adams is the inaugural Stanford Medicine Innovation Professor and Professor of Health Policy, Epidemiology and Population Health and of Pediatrics (by Courtesy). She also serves as Associate Chair for Health Equity and Community Engagement for Stanford Health Policy, Associate Director for Health Equity and Community Engagement in the Stanford Cancer Institute, and as Associate Director for Stanford Impact Labs. Focusing on racial and socioeconomic disparities in chronic disease treatment outcomes, Dr. Adams' interdisciplinary research seeks to evaluate the impact of changes in drug coverage policy on access to essential medications, understand the drivers of disparities in treatment adherence among insured populations, and test strategies for maximizing the benefits of treatment outcomes while minimizing harms through informed decision-making. Prior to joining Stanford School of Medicine, Dr. Adams was Associate Director for Health Care Delivery and Policy and a Research Scientist at the Kaiser Permanente Division of Research, as well as a Professor at the Bernard J. Tyson Kaiser Permanente School of Medicine. From 2000 to 2008, she was an Assistant Professor in the Department of Population Medicine (formerly Ambulatory Care and Prevention) at Harvard Medical School and Harvard Pilgrim Health Care. She received her PhD in Health Policy and an MPP in Social Policy from Harvard University. She is a member of the Board of Directors for AcademyHealth and a former recipient of the John M. Eisenberg Excellence in Mentoring Award from Agency for Healthcare Research and Quality.

Publications

HbA1c variability associated with dementia risk in people with type 2 diabetes. Alzheimer's & dementia : the journal of the Alzheimer's Association Moran, C., Whitmer, R. A., Dove, Z., Lacy, M. E., Soh, Y., Tsai, A. L., Quesenberry, C. P., Karter, A. J., Adams, A. S., Gilsanz, P. 2024 More

Abstract

Although poor glycemic control is associated with dementia, it is unknown if variability in glycemic control, even in those with optimal glycosylated hemoglobin A1c (HbA1c) levels, increases dementia risk.Among 171,964 people with type 2 diabetes, we evaluated the hazard of dementia association with long-term HbA1c variability using five operationalizations, including standard deviation (SD), adjusting for demographics and comorbidities.The mean baseline age was 61 years (48% women). Greater HbA1c SD was associated with greater dementia hazard (adjusted hazard ratio = 1.15 [95% confidence interval: 1.12, 1.17]). In stratified analyses, higher HbA1c SD quintiles were associated with greater dementia hazard among those with a mean HbA1c < 6% (P = 0.0004) or 6% to 8% (P < 0.0001) but not among those with mean HbA1c ≥ 8% (P = 0.42).Greater HbA1c variability is associated with greater dementia risk, even among those with HbA1c concentrations at ideal clinical targets. These findings add to the importance and clinical impact of recommendations to minimize glycemic variability.We observed a cohort of 171,964 people with type 2 diabetes (mean age 61 years). This cohort was based in Northern California between 1996 and 2018. We examined the association between glycosylated hemoglobin A1c (HbA1c) variability and dementia risk. Greater HbA1c variability was associated with greater dementia hazard. This was most evident among those with normal-low mean HbA1c concentrations.

View details for DOI 10.1002/alz.14066

View details for PubMedID 38959429
Representativeness of Patients With Lung Cancer in an Integrated Health Care Delivery System. The Permanente journal Yang, M. Z., Liu, R., Von Behren, J., Lin, K., Adams, A. S., Kushi, L. H., Quesenberry, C. P., Velotta, J. B., Wong, M. L., Young-Wolff, K. C., Gomez, S. L., Shariff-Marco, S., Sakoda, L. C. 2024: 1-10 More

Abstract

Observational research is important for understanding the real-world benefits of advancements in lung cancer care. Integrated health care systems, such as Kaiser Permanente Northern California, have extensive electronic health records suitable for such research, but the generalizability of their populations is often questioned.Leveraging data from the California Cancer Registry, the authors compared distributions of demographic and clinical characteristics, in addition to neighborhood and environmental conditions, between patients diagnosed with lung cancer from 2015 through 2019 at Kaiser Permanente Northern California, National Cancer Institute-designated cancer centers (NCICCs), and all other non-NCICC hospitals within the same catchment area.Of 20,178 included patients, 30% were from Kaiser Permanente Northern California, 8% from NCICCs, and 62% from other non-NCICC hospitals. Compared to NCICC patients, Kaiser Permanente Northern California patients were more similar to other non-NCICC patients on most characteristics. Compared to other non-NCICC patients, Kaiser Permanente Northern California patients were slightly older, more likely to be female, and less likely to be Hispanic or Asian/Pacific Islander and to reside in lower socioeconomic status (SES) neighborhoods. In contrast, NCICC patients were younger, less likely to be female or from non-Asian/Pacific Islander minoritized racial groups, and more likely to present with early-stage disease and adenocarcinoma and to reside in neighborhoods with higher SES and lower air pollution than Kaiser Permanente Northern California or other non-NCICC patients.Patients from Kaiser Permanente Northern California, compared to NCICCs, are more broadly representative of the underlying patient population with lung cancer.Research using electronic health record data from integrated health care systems can contribute generalizable real-world evidence to benchmark and improve lung cancer care.

View details for DOI 10.7812/TPP/24.028

View details for PubMedID 38980792
Interventions Addressing Health-Related Social Needs Among Patients with Cancer. Journal of the National Cancer Institute Graboyes, E. M., Lee, S. C., Lindau, S. T., Adams, A. S., Adjei, B. A., Brown, M., Sadigh, G., Incudine, A., Carlos, R. C., Ramsey, S. D., Bangs, R. 2024 More

Abstract

Health-related social needs (HRSN) are prevalent among cancer patients, associated with substantial negative health consequences, and drive pervasive inequities in cancer incidence, severity, treatment choices and decisions, and outcomes. To address the lack of clinical trial evidence to guide HRSN interventions among cancer patients, the National Cancer Institute Cancer Care Delivery Research Steering Committee convened experts to participate in a Clinical Trials Planning Meeting with the goal of designing studies to screen for and address HRSNs among cancer patients. In this commentary, we discuss the rationale for, and challenges of, designing and testing HRSN interventions in alignment with the National Academy of Sciences, Engineering, and Medicine 5A's Framework. Evidence for food, housing, utilities, interpersonal safety, and transportation HRSN interventions is analyzed. Evidence regarding HRSNs and delivery of HRSN interventions differ in maturity and applicability to cancer context, with transportation problems having the most maturity and interpersonal safety the least. We offer practical recommendations for HRSN interventions among cancer patients and the caregivers, families, and friends who support their HRSN. Cross-cutting (ie, HRSN-agnostic) recommendations include leveraging navigation (eg, people, technology) to identify, refer, and deliver HRSN interventions; addressing HRSNs through multilevel interventions; and recognizing that HRSNs are states, not traits, that fluctuate over time. HRSN-specific interventions are recommended and pros and cons of addressing more than one HRSN concurrently are characterized. Considerations for collaborating with community partners are highlighted. The need for careful planning, strong partners, and funding is stressed. Finally, we outline a future research agenda to address evidence gaps.

View details for DOI 10.1093/jnci/djad269

View details for PubMedID 38175791
Clinical impacts of an integrated electronic health record-based smoking cessation intervention during hospitalisation. BMJ open Banerjee, S., Alabaster, A., Adams, A. S., Fogelberg, R., Patel, N., Young-Wolff, K. 2023; 13 (12): e068629 More

Abstract

To assess the effects of an electronic health record (EHR) intervention that prompts the clinician to prescribe nicotine replacement therapy (NRT) at hospital admission and discharge in a large integrated health system.Retrospective cohort study using interrupted time series (ITS) analysis leveraging EHR data generated before and after implementation of the 2015 EHR-based intervention.Kaiser Permanente Northern California, a large integrated health system with 4.2 million members.Current smokers aged ≥18 hospitalised for any reason.EHR-based clinical decision supports that prompted the clinician to order NRT on hospital admission (implemented February 2015) and discharge (implemented September 2015).Primary outcomes included the monthly percentage of admitted smokers with NRT orders during admission and at discharge. A secondary outcome assessed patient quit rates within 30 days of hospital discharge as reported during discharge follow-up outpatient visits.The percentage of admissions with NRT orders increased from 29.9% in the year preceding the intervention to 78.1% in the year following (41.8% change, 95% CI 38.6% to 44.9%) after implementation of the admission hard-stop intervention compared with the baseline trend (ITS estimate). The percentage of discharges with NRT orders increased acutely at the time of both interventions (admission intervention ITS estimate 15.5%, 95% CI 11% to 20%; discharge intervention ITS estimate 13.4%, 95% CI 9.1% to 17.7%). Following the implementation of the discharge intervention, there was a small increase in patient-reported quit rates (ITS estimate 5.0%, 95% CI 2.2% to 7.8%).An EHR-based clinical decision-making support embedded into admission and discharge documentation was associated with an increase in NRT prescriptions and improvement in quit rates. Similar systemic EHR interventions can help improve smoking cessation efforts after hospitalisation.

View details for DOI 10.1136/bmjopen-2022-068629

View details for PubMedID 38056936
Disparities in Preoperative Goals of Care Documentation in Veterans. JAMA network open Wu, A., Giannitrapani, K. F., Garcia, A., Bozkurt, S., Boothroyd, D., Adams, A. S., Kim, K. M., Zhang, S., McCaa, M. D., Morris, A. M., Shreve, S., Lorenz, K. A. 2023; 6 (12): e2348235 More

Abstract

Preoperative goals of care discussion and documentation are important for patients undergoing surgery, a major health care stressor that incurs risk.To assess the association of race, ethnicity, and other factors, including history of mental health disability, with disparities in preoperative goals of care documentation among veterans.This retrospective cross-sectional study assessed data from the Veterans Healthcare Administration (VHA) of 229 737 veterans who underwent surgical procedures between January 1, 2017, and October 18, 2022.Patient-level (ie, race, ethnicity, medical comorbidities, history of mental health comorbidity) and system-level (ie, facility complexity level) factors.Preoperative life-sustaining treatment (LST) note documentation or no LST note documentation within 30 days prior to or on day of surgery. The standardized mean differences were calculated to assess the magnitude of differences between groups. Odds ratios (ORs) and 95% CIs were estimated with logistic regression.In this study, 13 408 patients (5.8%) completed preoperative LST from 229 737 VHA patients (209 123 [91.0%] male; 20 614 [9.0%] female; mean [SD] age, 65.5 [11.9] years) who received surgery. Compared with patients who did complete preoperative LST, patients tended to complete preoperative documentation less often if they were female (19 914 [9.2%] vs 700 [5.2%]), Black individuals (42 571 [19.7%] vs 2416 [18.0%]), Hispanic individuals (11 793 [5.5%] vs 631 [4.7%]), or from rural areas (75 637 [35.0%] vs 4273 [31.9%]); had a history of mental health disability (65 974 [30.5%] vs 4053 [30.2%]); or were seen at lowest-complexity (ie, level 3) facilities (7849 [3.6%] vs 78 [0.6%]). Over time, despite the COVID-19 pandemic, patients undergoing surgical procedures completed preoperative LST increasingly more often. Covariate-adjusted estimates of preoperative LST completion demonstrated that patients of racial or ethnic minority background (Black patients: OR, 0.79; 95% CI, 0.77-0.80; P <.001; patients selecting other race: OR, 0.78; 95% CI, 0.74-0.81; P <.001; Hispanic patients: OR, 0.78; 95% CI, 0.76-0.81; P <.001) and patients from rural regions (OR, 0.91; 95% CI, 0.90-0.93; P <.001) had lower likelihoods of completing LST compared with patients who were White or non-Hispanic and patients from urban areas. Patients with any mental health disability history also had lower likelihood of completing preoperative LST than those without a history (OR, 0.93; 95% CI, 0.92-0.94; P = .001).In this cross-sectional study, disparities in documentation rates within a VHA cohort persisted based on race, ethnicity, rurality of patient residence, history of mental health disability, and access to high-volume, high-complexity facilities.

View details for DOI 10.1001/jamanetworkopen.2023.48235

View details for PubMedID 38113045

View details for PubMedCentralID PMC10731481

see all 119 publications

BFAM Member Spotlights

Alyce S. Adams, PhD

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