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Robert Penfold, PhD

TitleAssociate Investigator
InstitutionKaiser Permanente Washington
DepartmentHealth Research Institute
ORCID ORCID Icon0000-0003-4795-7902  Additional info
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    Collapse Overview 
    Collapse overview
    Robert Penfold, PhD, is health services research and health policy expert whose work focuses on developing strategies to optimize behavioral health care delivery and patient outcomes – particularly in children and adolescents. His research addresses practical issues such as how to reduce unnecessary use of antipsychotic medications in youth. He is also interested in understanding how cost-control policies change the way clinicians deliver and people use care and how those changes have both positive and negative effects on health.

    Dr. Penfold is a co-investigator in the Mental Health Research Network (MHRN), a resource for studies on mental health conditions ranging from autism to postnatal depression. He leads the child and adolescent focus group within MHRN. Dr. Penfold is also investigating reasons why similar patients receive different mental health treatment, such as different medications, depending on where they live or receive care.

    Dr. Penfold’s other recent and ongoing projects include:

    - A Targeted Approach to a Safer Use of Antipsychotics in Youth (SUAY), a $10 million, five-year National Institutes of Health study that is developing and testing new ways to support clinicians and families in choosing safer treatments for behavioral disorders in youth age 5 to 17.
    - Automated Outreach for Depression, a National Institute of Mental Health-funded study to decrease premature drop-out from depression treatment.
    - Natural Language Processing to Detect Medication Side Effects, a Kaiser Permanente Washington-funded study designed to better capture adverse side effects experienced by patients taking antidepressants and antipsychotics.

    Dr. Penfold has extensive experience gathering and analyzing information from large health databases, including those of Medicare and Medicaid, and the Health Care Systems Research Network’s Virtual Data Warehouse. These data and analyses allow rapid information sharing among Kaiser Permanente Washington and participating sites, which improves patient safety and timely access to effective, cutting-edge therapies.

    Before joining KPWHRI in 2010, Dr. Penfold held research and teaching positions at Nationwide Children's Hospital in Columbus, Ohio; the Winnipeg Regional Health Authority; the Manitoba Centre for Health Policy; and most recently, at Harvard Medical School in the Department of Population Medicine and Harvard Pilgrim Health Care Institute.

    Collapse Research 
    Collapse research activities and funding
    R21MH094942     (ARSENAULT, LISA N)Mar 15, 2012 - Jan 31, 2014
    Exploring the Impact of Pediatric Behavioral Health Screening on Health Care Use
    Role: Co-Principal Investigator

    R56MH117767     (PENFOLD, ROBERT B.)Aug 3, 2018 - Jul 31, 2019
    Assisted Identification and Navigation of Early Mental Health Symptoms in Youth
    Role: Principal Investigator

    Collapse Bibliographic 
    Collapse selected publications
    Publications listed below are automatically derived from MEDLINE/PubMed and other sources, which might result in incorrect or missing publications. Faculty can login to make corrections and additions.
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    1. Simon GE, Johnson E, Lawrence JM, Rossom RC, Ahmedani B, Lynch FL, Beck A, Waitzfelder B, Ziebell R, Penfold RB, Shortreed SM. Predicting Suicide Attempts and Suicide Deaths Following Outpatient Visits Using Electronic Health Records. Am J Psychiatry. 2018 Oct 01; 175(10):951-960. PMID: 29792051.
      View in: PubMed
    2. Lu CY, Penfold RB, Toh S, Sturtevant JL, Madden JM, Simon G, Ahmedani BK, Clarke G, Coleman KJ, Copeland LA, Daida YG, Davis RL, Hunkeler EM, Owen-Smith A, Raebel MA, Rossom R, Soumerai SB, Kulldorff M. Near Real-time Surveillance for Consequences of Health Policies Using Sequential Analysis. Med Care. 2018 May; 56(5):365-372. PMID: 29634627.
      View in: PubMed
    3. Simon GE, Johnson E, Stewart C, Rossom RC, Beck A, Coleman KJ, Waitzfelder B, Penfold R, Operskalski BH, Shortreed SM. Does Patient Adherence to Antidepressant Medication Actually Vary Between Physicians? J Clin Psychiatry. 2018 May/Jun; 79(3). PMID: 29068611.
      View in: PubMed
    4. Simon GE, Stewart C, Yarborough BJ, Lynch F, Coleman KJ, Beck A, Operskalski BH, Penfold RB, Hunkeler EM. Mortality Rates After the First Diagnosis of Psychotic Disorder in Adolescents and Young Adults. JAMA Psychiatry. 2018 Mar 01; 75(3):254-260. PMID: 29387876.
      View in: PubMed
    5. Simon GE, Stewart C, Hunkeler EM, Yarborough BJ, Lynch F, Coleman KJ, Beck A, Operskalski BH, Penfold RB, Carrell DS. Care Pathways Before First Diagnosis of a Psychotic Disorder in Adolescents and Young Adults. Am J Psychiatry. 2018 May 01; 175(5):434-442. PMID: 29361848.
      View in: PubMed
    6. Simon GE, Shortreed SM, Johnson E, Beck A, Coleman KJ, Rossom RC, Whiteside US, Operskalski BH, Penfold RB. Between-visit changes in suicidal ideation and risk of subsequent suicide attempt. Depress Anxiety. 2017 09; 34(9):794-800. PMID: 28440902.
      View in: PubMed
    7. Wu JJ, Penfold RB, Primatesta P, Fox TK, Stewart C, Reddy SP, Egeberg A, Liu J, Simon G. The risk of depression, suicidal ideation and suicide attempt in patients with psoriasis, psoriatic arthritis or ankylosing spondylitis. J Eur Acad Dermatol Venereol. 2017 Jul; 31(7):1168-1175. PMID: 28214371.
      View in: PubMed
    8. Barclay RP, Penfold RB, Sullivan D, Boydston L, Wignall J, Hilt RJ. Decrease in Statewide Antipsychotic Prescribing after Implementation of Child and Adolescent Psychiatry Consultation Services. Health Serv Res. 2017 04; 52(2):561-578. PMID: 28297075.
      View in: PubMed
    9. Penfold RB, Stewart C, Simon GE, Shortreed SM, Johnson E, Rossom RC, Operskalski B, Beck A. Antidepressant Use by Youth with Minimal or Mild Depression: Evidence from 3 Health Systems. Pediatr Qual Saf. 2017 Mar; 2(2):e017. PMID: 29862381.
      View in: PubMed
    10. Penfold RB, Burgess JF, Lee AF, Li M, Miller CJ, Nealon Seibert M, Semla TP, Mohr DC, Kazis LE, Bauer MS. Space-Time Cluster Analysis to Detect Innovative Clinical Practices: A Case Study of Aripiprazole in the Department of Veterans Affairs. Health Serv Res. 2018 02; 53(1):214-235. PMID: 28004385.
      View in: PubMed
    11. Parchman ML, Henrikson NB, Blasi PR, Buist DS, Penfold R, Austin B, Ganos EH. Taking action on overuse: Creating the culture for change. Healthc (Amst). 2017 Dec; 5(4):199-203. PMID: 27840099.
      View in: PubMed
    12. Parchman ML, Fagnan LJ, Dorr DA, Evans P, Cook AJ, Penfold RB, Hsu C, Cheadle A, Baldwin LM, Tuzzio L. Study protocol for "Healthy Hearts Northwest": a 2?×?2 randomized factorial trial to build quality improvement capacity in primary care. Implement Sci. 2016 10 13; 11(1):138. PMID: 27737719.
      View in: PubMed
    13. Simon GE, Beck A, Rossom R, Richards J, Kirlin B, King D, Shulman L, Ludman EJ, Penfold R, Shortreed SM, Whiteside U. Population-based outreach versus care as usual to prevent suicide attempt: study protocol for a randomized controlled trial. Trials. 2016 09 15; 17(1):452. PMID: 27634417.
      View in: PubMed
    14. Hacker K, Penfold R, Arsenault LN, Zhang F, Soumerai SB, Wissow LS. The Impact of the Massachusetts Behavioral Health Child Screening Policy on Service Utilization. Psychiatr Serv. 2017 01 01; 68(1):25-32. PMID: 27582240.
      View in: PubMed
    15. Simon GE, Coleman KJ, Rossom RC, Beck A, Oliver M, Johnson E, Whiteside U, Operskalski B, Penfold RB, Shortreed SM, Rutter C. Risk of suicide attempt and suicide death following completion of the Patient Health Questionnaire depression module in community practice. J Clin Psychiatry. 2016 Feb; 77(2):221-7. PMID: 26930521; PMCID: PMC4993156 [Available on 02/01/17].
    16. Simon GE, Rossom RC, Beck A, Waitzfelder BE, Coleman KJ, Stewart C, Operskalski B, Penfold RB, Shortreed SM. Antidepressants are not overprescribed for mild depression. J Clin Psychiatry. 2015 Dec; 76(12):1627-32. PMID: 26580702; PMCID: PMC4866597 [Available on 12/01/16].
    17. Miller CJ, Li M, Penfold RB, Lee AF, Smith EG, Nordberg SS, Osser DN, Bajor L, Zhang F, Bauer MS. The Ascendancy of Second-Generation Antipsychotics as Frontline Antimanic Agents. J Clin Psychopharmacol. 2015 Dec; 35(6):645-53. PMID: 26488678.
      View in: PubMed
    18. Simon GE, Coleman KJ, Waitzfelder BE, Beck A, Rossom RC, Stewart C, Penfold RB. Adjusting Antidepressant Quality Measures for Race and Ethnicity. JAMA Psychiatry. 2015 Oct; 72(10):1055-6. PMID: 26352783; PMCID: PMC4776640 [Available on 10/01/16].
    19. Hacker KA, Penfold RB, Arsenault LN, Zhang F, Soumerai SB, Wissow LS. Effect of Pediatric Behavioral Health Screening and Colocated Services on Ambulatory and Inpatient Utilization. Psychiatr Serv. 2015 Nov; 66(11):1141-8. PMID: 26129994; PMCID: PMC4633707.
    20. Davis RL, Gallagher MA, Asgari MM, Eide MJ, Margolis DJ, Macy E, Burmester JK, Selvam N, Boscarino JA, Cromwell LF, Feigelson HS, Kuntz JL, Pawloski PA, Penfold RB, Raebel MA, Sridhar G, Wu A, La Grenade LA, Pacanowski MA, Pinheiro SP. Identification of Stevens-Johnson syndrome and toxic epidermal necrolysis in electronic health record databases. Pharmacoepidemiol Drug Saf. 2015 Jul; 24(7):684-92. PMID: 25914229.
      View in: PubMed
    21. Ludman EJ, McCorkle R, Bowles EA, Rutter CM, Chubak J, Tuzzio L, Jones S, Reid RJ, Penfold R, Wagner EH. Do depressed newly diagnosed cancer patients differentially benefit from nurse navigation? Gen Hosp Psychiatry. 2015 May-Jun; 37(3):236-9. PMID: 25835508; PMCID: PMC4442728.
    22. Miller CJ, Li M, Penfold RB, Lee AF, Smith EG, Osser DN, Bajor L, Bauer MS. Patterns of initiation of second generation antipsychotics for bipolar disorder: a month-by-month analysis of provider behavior. BMC Psychiatry. 2014 Nov 30; 14:339. PMID: 25433807; PMCID: PMC4256839.
    23. Bauer MS, Lee A, Miller CJ, Bajor L, Li M, Penfold RB. Effects of diagnostic inclusion criteria on prevalence and population characteristics in database research. Psychiatr Serv. 2015 Feb 01; 66(2):141-8. PMID: 25320943.
      View in: PubMed
    24. Raebel MA, Penfold R, McMahon AW, Reichman M, Shetterly S, Goodrich G, Andrade S, Correll CU, Gerhard T. Adherence to guidelines for glucose assessment in starting second-generation antipsychotics. Pediatrics. 2014 Nov; 134(5):e1308-14. PMID: 25287454.
      View in: PubMed
    25. Hacker KA, Penfold RB, Arsenault LN, Zhang F, Murphy M, Wissow LS. Behavioral health services following implementation of screening in Massachusetts Medicaid children. Pediatrics. 2014 Oct; 134(4):737-46. PMID: 25225135; PMCID: PMC4179096.
    26. Jones SM, Ludman EJ, McCorkle R, Reid R, Bowles EJ, Penfold R, Wagner EH. A differential item function analysis of somatic symptoms of depression in people with cancer. J Affect Disord. 2015 Jan 01; 170:131-7. PMID: 25240839; PMCID: PMC4253856.
    27. Lu CY, Zhang F, Lakoma MD, Madden JM, Rusinak D, Penfold RB, Simon G, Ahmedani BK, Clarke G, Hunkeler EM, Waitzfelder B, Owen-Smith A, Raebel MA, Rossom R, Coleman KJ, Copeland LA, Soumerai SB. Changes in antidepressant use by young people and suicidal behavior after FDA warnings and media coverage: quasi-experimental study. BMJ. 2014 Jun 18; 348:g3596. PMID: 24942789; PMCID: PMC4062705.
    28. Lu CY, Stewart C, Ahmed AT, Ahmedani BK, Coleman K, Copeland LA, Hunkeler EM, Lakoma MD, Madden JM, Penfold RB, Rusinak D, Zhang F, Soumerai SB. How complete are E-codes in commercial plan claims databases? Pharmacoepidemiol Drug Saf. 2014 Feb; 23(2):218-20. PMID: 24453020; PMCID: PMC4100538.
    29. Hacker KA, Penfold R, Arsenault L, Zhang F, Murphy M, Wissow L. Screening for behavioral health issues in children enrolled in Massachusetts Medicaid. Pediatrics. 2014 Jan; 133(1):46-54. PMID: 24298005; PMCID: PMC3876180.
    30. Penfold RB, Stewart C, Hunkeler EM, Madden JM, Cummings JR, Owen-Smith AA, Rossom RC, Lu CY, Lynch FL, Waitzfelder BE, Coleman KJ, Coleman KA, Ahmedani BK, Beck AL, Zeber JE, Simon GE. Use of antipsychotic medications in pediatric populations: what do the data say? Curr Psychiatry Rep. 2013 Dec; 15(12):426. PMID: 24258527.
      View in: PubMed
    31. Wagner EH, Ludman EJ, Aiello Bowles EJ, Penfold R, Reid RJ, Rutter CM, Chubak J, McCorkle R. Nurse navigators in early cancer care: a randomized, controlled trial. J Clin Oncol. 2014 Jan 01; 32(1):12-8. PMID: 24276777; PMCID: PMC3867643.
    32. Penfold RB, Zhang F. Use of interrupted time series analysis in evaluating health care quality improvements. Acad Pediatr. 2013 Nov-Dec; 13(6 Suppl):S38-44. PMID: 24268083.
      View in: PubMed
    33. Austin SB, Penfold RB, Johnson RL, Haines J, Forman S. Clinician identification of youth abusing over-the-counter products for weight control in a large U.S. integrated health system. J Eat Disord. 2013; 1:40. PMID: 24999418; PMCID: PMC4081803.
    34. Mohr DC, Bauer MS, Penfold RB. Changes in VA psychiatrists' attitudes about work environment and turnover during mental health service enhancement. Psychiatr Serv. 2013 Jun; 64(6):563-9. PMID: 23494206.
      View in: PubMed
    35. Penfold RB, Kilbourne AM, Mohr DC, Lai Z, Seibert MN, Bauer MS. Heterogeneity in aripiprazole diffusion for bipolar disorder treatment in the Veterans Health Administration. Psychiatr Serv. 2012 Dec; 63(12):1178-85. PMID: 23026866.
      View in: PubMed
    36. Bajor LA, Lai Z, Goodrich DE, Miller CJ, Penfold RB, Myra Kim H, Bauer MS, Kilbourne AM. Posttraumatic stress disorder, depression, and health-related quality of life in patients with bipolar disorder: review and new data from a multi-site community clinic sample. J Affect Disord. 2013 Feb 20; 145(2):232-9. PMID: 23021820; PMCID: PMC3557557.
    37. Hacker K, Penfold R, Zhang F, Soumerai SB. Impact of electronic health record transition on behavioral health screening in a large pediatric practice. Psychiatr Serv. 2012 Mar; 63(3):256-61. PMID: 22267253; PMCID: PMC3704213.
    38. Andrade SE, Lo JC, Roblin D, Fouayzi H, Connor DF, Penfold RB, Chandra M, Reed G, Gurwitz JH. Antipsychotic medication use among children and risk of diabetes mellitus. Pediatrics. 2011 Dec; 128(6):1135-41. PMID: 22106077.
      View in: PubMed
    39. Penfold RB, Rusinak D, Lieu TA, Shefer A, Messonnier M, Lee GM. Financing and systems barriers to seasonal influenza vaccine delivery in community settings. Vaccine. 2011 Dec 06; 29(52):9632-9. PMID: 22036886.
      View in: PubMed
    40. Penfold RB, Kullgren JT, Miroshnik I, Galbraith AA, Hinrichsen VL, Lieu TA. Reliability of a patient survey assessing cost-related changes in health care use among high deductible health plan enrollees. BMC Health Serv Res. 2011 May 27; 11:133. PMID: 21619647; PMCID: PMC3116474.
    41. Kullgren JT, Galbraith AA, Hinrichsen VL, Miroshnik I, Penfold RB, Rosenthal MB, Landon BE, Lieu TA. Health care use and decision making among lower-income families in high-deductible health plans. Arch Intern Med. 2010 Nov 22; 170(21):1918-25. PMID: 21098352; PMCID: PMC4004054.
    42. Penfold RB, Kelleher KJ, Wang W, Strange B, Pajer K. Pediatric uptake of a newly available antipsychotic medication. Pediatrics. 2010 Mar; 125(3):475-82. PMID: 20142282.
      View in: PubMed
    43. Penfold RB, Wang W, Pajer K, Strange B, Kelleher KJ. Spatio-temporal clusters of new psychotropic medications among Michigan children insured by Medicaid. Pharmacoepidemiol Drug Saf. 2009 Jul; 18(7):531-9. PMID: 19367576.
      View in: PubMed
    44. Penfold RB, Kelleher KJ. Use of surveillance data in developing geographic dissemination strategies: a study of the diffusion of olanzapine to Michigan children insured by medicaid. Clin Ther. 2007 Feb; 29(2):359-70; discussion 358. PMID: 17472829.
      View in: PubMed
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