COIN Investigators & Staff
COIN Investigators
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Kristen E. Gray, PD, MS, BS
- Title: Core Investigator
Research Assistant Professor, University of Washington, School of Public Health - Contact: Kristen.Gray2@va.gov
- Location: Seattle
- University of Washington webpage
Research Interests
Dr. Gray is an epidemiologist and health systems researcher at the HSR Seattle-Denver Center of Innovation and a Research Assistant Professor in the Department of Health Services at the University of Washington School of Public Health. She has two broad research interests: understanding and improving Veterans’ health behaviors, particularly physical activity and diet, and women’s reproductive health care delivery. Dr. Gray has a 5-year HSR Career Development Award to develop and pilot test a videoconference-delivered, partner-assisted intervention to improve weight management outcomes among men and women Veterans who are overweight or obese. She also leads an HSR Research to Impact for Veterans project to optimize women’s reproductive health care coordination during VA’s transition to the Cerner electronic health record Dr. Gray received her PhD and MS in epidemiology from the University of Washington School of Public Health and completed a post-doctoral fellowship at the Seattle-Denver Center of Innovation.
Grants & Funding
Telehealth-delivered peer support to improve quality of life among Veterans with multimorbidity
Role: Co-PI with Katherine Hoerster
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
Enhancing social support for diabetes self-management among men and women Veterans
Diabetes affects 25% of Department of Veterans Affairs (VA) patients. It requires extensive self-management, including healthy eating, being physically active, and taking medications. However, Veterans' self-management is often suboptimal.
Enhancing the quality of existing social support resources is a promising strategy, as most self-management occurs outside the clinical setting.
Therefore, the proposed research will adapt and pilot test a virtual intervention that includes Veterans and support persons and aims to reduce unsupportive (e.g., criticism) and enhance supportive behaviors to facilitate Veterans' self-management.
The research will determine whether the intervention is feasible and acceptable to Veterans and support persons and leads to improved behaviors. Women tend to have poorer self-management, disease control, and health outcomes than men and receive less social support. Examining gender differences, ignored too often in VA interventions, will also be explored.
Funder: Veterans Administration
NIH website
Publications of note:
— Gender differences in social support for diabetes self-management: A qualitative study among veterans
— A Method to Deliver Automated and Tailored Intervention Content: 24-month Clinical Trial
— 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
Recent Publications
2024
Kramer CB, Nelson KM, Sayre G, Williams JL, Spruill L, Fennell T, Gray KE, Weiner BJ, Fan V, Jones-Smith J, Rao M. "Veteran to Veteran, There's Automatically a Trust": A Qualitative Study of Veterans' Experiences in a Peer Health-Coaching Program for Hypertension. AJPM Focus. 2024 Jul 3;3(6):100257. doi: 10.1016/j.focus.2024.100257. PMID: 39415799; PMCID: PMC11481613.
PMID: 39415799.
Carpenter SM, Shetty A, Hetzel SJ, Garza K, Porter LS, Gray KE, Shaw RJ, Lewis MA, Mao L, Pabich S, Johnson HM, Yancy WS Jr, Elwert F, Voils CI. A non-randomized comparison of engagement and outcomes for in-person versus virtual delivery of the Partner2Lose weight management trial. Obes Sci Pract. 2024 Jul 23;10(4):e778. doi: 10.1002/osp4.778. PMCID: PMC11265462. PMID: 39045420.
C. Bradley Kramer, Karin M. Nelson, George Sayre, Jennifer L Williams, Leon Spruill, Tiffanie Fennell, Kristen E. Gray, Bryan J. Weiner, Vincent Fan, Jessica Jones-Smith, Mayuree Rao. “Veteran to Veteran, there's automatically a trust”: A qualitative study of Veterans’ experiences in a peer health coaching program for hypertension., AJPM Focus, 2024, 100257, ISSN 2773-0654.
DOI: 10.1016/j.focus.2024.100257.
Mog AC, Benson SK, Sriskantharajah V, Kelly PA, Gray KE, Callegari LS, Moy EM, Katon JG. "You want people to listen to you": Patient experiences of women's healthcare within the Veterans Health Administration. Health Serv Res. 2024 May 28. doi: 10.1111/1475-6773.14324. Epub ahead of print. PMID: 38804072
Bilodeau KS, Gray KE, McMullan DM. Extracorporeal cardiopulmonary resuscitation outcomes for children with out-of-hospital and emergency department cardiac arrest. Am J Emerg Med. 2024 Apr 7;81:35-39. doi: 10.1016/j.ajem.2024.03.035. Epub ahead of print. PMID: 38657347
Wheat CL, Wong ES, Gray KE, Stockdale SE, Nelson KM, Reddy A. Factors Associated With Use of the Preventive Health Inventory in US Veterans. JAMA Netw Open. 2024 Mar 4;7(3):e242717. doi: 10.1001/jamanetworkopen.2024.2717. PMID: 38497962
2023
Nelson KM, Taylor L, Williams JL, Rao M, Gray KE, Kramer CB, Epler E, Fennell T. Effect of a Peer Health Coaching Intervention on Clinical Outcomes Among US Veterans With Cardiovascular Risks: The Vet-COACH Randomized Clinical Trial. JAMA Netw Open. 2023 Jun 1;6(6):e2317046. doi: 10.1001/jamanetworkopen.2023.17046. PMCID: PMC10245194.
PMID: 37278999
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Katon JG, Bossick A, Carey C, Christy A, Doll K, Gatsby E, Gray KE, Lynch KE, Moy E, Owens S, Washington DL, Callegari LS. Racial Disparities in Uterine Fibroid Treatment Among Veterans Using VA Health Care. Womens Health Issues. 2023 Apr 25:S1049-3867(23)00073-7. doi: 10.1016/j.whi.2023.03.005. Epub ahead of print.
PMID: 37695621.
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Wheat CL, Gunnink EJ, Rojas J, Shah A, Nelson KM, Wong ES, Gray KE, Stockdale SE, Rosland AM, Chang ET, Reddy A. Changes in Primary Care Quality Associated With Implementation of the Veterans Health Administration Preventive Health Inventory. JAMA Netw Open. 2023 Apr 3;6(4):e238525. doi: 10.1001/jamanetworkopen.2023.8525.
PMID: 37067799
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2022
Carey CM, Katon JG, Bossick AS, Gray KE, Doll KM, Christy AY, Callegari LS. Uterine Weight as a Modifier of Black/White Racial Disparities in Minimally Invasive Hysterectomy Among Veterans with Fibroids in the Veterans Health Administration. Health Equity. 2022 Dec 16;6(1):909-916. doi: 10.1089/heq.2022.0130. PMCID: PMC9811843. PMID: 36636115
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Monty GR, Benson SK, Deeds SA, Callegari LS, Katon JG, Cordasco KM, Gray KE. "We Are Working Harder, Not Smarter:" a Qualitative Inquiry Into Care Coordination for Department of Veterans Affairs Mammograms Referred to the Community. Womens Health Issues. 2022 Dec 15:S1049-3867(22)00140-2. doi: 10.1016/j.whi.2022.11.004. Epub ahead of print. PMID: 36528428
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Gray KE, Silvestrini M, Ma EW, Nelson KM, Bastian LA, Voils CI. Gender differences in social support for diabetes self-management: A qualitative study among veterans. Patient Educ Couns. 2022 Nov 23;107:107578. doi: 10.1016/j.pec.2022.107578. Epub ahead of print. PMID: 36463824.
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Miller HN, Voils CI, Cronin KA, Jeanes E, Hawley J, Porter LS, Adler RR, Sharp W, Pabich S, Gavin KL, Lewis MA, Johnson HM, Yancy WS Jr, Gray KE, Shaw RJ. A Method to Deliver Automated and Tailored Intervention Content: 24-month Clinical Trial. JMIR Form Res. 2022 Sep 6;6(9):e38262. doi: 10.2196/38262. PMID: 36066936
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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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Gray KE, Rao M, Gunnink E, Eschenroeder L, Geyer JR, Nelson KM, Reddy A. Home Telehealth in the Veterans Health Administration: Trends and Correlates of Length of Enrollment from 2010 to 2017. J Gen Intern Med. 2022 Mar 1:1–8. doi: 10.1007/s11606-022-07452-1. Epub ahead of print. PMCID: PMC8886698. PMID: 35230624
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2021
Benson LS, Magnusson SL, Gray KE, Quinley K, Kessler L, Callegari LS. Early pregnancy loss in the emergency department, 2006-2016. J Am Coll Emerg Physicians Open. 2021 Nov 5;2(6):e12549. doi: 10.1002/emp2.12549. PMCID: PMC8571073. PMID: 34766105
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.
2020
Bossick AS, Katon JG, Gray KE, Ma EW, Callegari LS. Concomitant Bilateral Salpingo-Oophorectomy at Hysterectomy: Differences by Race and Menopausal Status in the Veterans Affairs Health Care System, 2007-2014. J Womens Health (Larchmt). 2020 Oct 23. doi: 10.1089/jwh.2020.8503. Epub ahead of print. PMID: 33095114.
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.
Katon JG, Callegari LS, Bossick AS, Fortney J, Gerber MR, Lehavot K, Lynch KE, Ma E, Smith R, Tartaglione E, Gray KE. Association of Depression and Post-Traumatic Stress Disorder with Receipt of Minimally Invasive Hysterectomy for Uterine Fibroids: Findings from the U.S. Department of Veterans Affairs. Womens Health Issues. 2020 Sep-Oct;30(5):359-365. doi: 10.1016/j.whi.2020.06.005. Epub 2020 Jul 22. PMID: 32712008.
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.
Gray KE, Ma EW, Callegari LS, Magnusson SL, Tartaglione EV, Christy AY, Katon JG. Understanding Variation in Availability and Provision of Minimally Invasive Hysterectomy: A Qualitative Study of Department of Veterans Affairs Gynecologists. Womens Health Issues. 2020 May-Jun;30(3):200-206. doi: 10.1016/j.whi.2020.02.003. Epub 2020 Apr 3. PMID: 32253057.
2019
Katon JG, Bossick AS, Doll KM, Fortney J, Gray KE, Hebert P, Lynch KE, Ma EW, Washington DL, Zephyrin L, Callegari LS. Contributors to Racial Disparities in Minimally Invasive Hysterectomy in the US Department of Veterans Affairs. Med Care. 2019 Dec;57(12):930-936. doi: 10.1097/MLR.0000000000001200. PMID: 31730567.
Goldstein KM, Bastian LA, Duan-Porter W, Gray KE, Hoggatt KJ, Kelly MM, Wilson SM, Humphreys K, Klap R, Yano EM, Huang GD. Accelerating the Growth of Evidence-Based Care for Women and Men Veterans. Womens Health Issues. 2019 Jun 25;29 Suppl 1:S2-S5. doi: 10.1016/j.whi.2019.05.004. PMID: 31253238.
Katon JG, Zephyrin L, Meoli A, Hulugalle A, Bosch J, Callegari L, Galvan IV, Gray KE, Haeger KO, Hoffmire C, Levis S, Ma EW, Mccabe JE, Nillni YI, Pineles SL, Reddy SM, Savitz DA, Shaw JG, Patton EW. Reproductive Health of Women Veterans: A Systematic Review of the Literature from 2008 to 2017. Semin Reprod Med. 2018 Nov;36(6):315-322. doi: 10.1055/s-0039-1678750. Epub 2019 Apr 19. PMC6613775 PMID: 31003246.
