Carolyn M Rutter

Carolyn M Rutter
RAND Corporation | RAND

PhD

About

210
Publications
17,783
Reads
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20,169
Citations
Introduction
I lead two project teams as PI. Both projects are focused on colorectal cancer screening: a microsimulation modeling project that is part of the Cancer Intervention and Surveillance Modeling Network (aka CISNET), and a project focused on empirical evaluation of colorectal cancer screening that is part of the NCI-funded PROSPR initiative. I also provide biostatistical support to a wide range of research projects, including the Pacific Northwest Evidence Based Practice Center.
Additional affiliations
July 2008 - December 2014
Kaiser Permanente Washington Health Research Institute
Position
  • Senior Investigator
July 2002 - June 2008
Kaiser Permanente Washington Health Research Institute
Position
  • Associate Investigator
July 2002 - June 2008
Kaiser Permanente Washington Health Research Institute
Position
  • Lead Biosatistician
Description
  • Oversaw the Unit’s successful expansion and co-location to create a cohesive group, ensured biostatistical support across projects, developed and updated policy, strengthened ties with the Biostatistics Dept. at University of Washington.
Education
September 1986 - June 1991
University of California, Los Angeles
Field of study
  • BIostatistics

Publications

Publications (210)
Article
The coronavirus disease 2019 pandemic required significant public health interventions from local governments. Early in the pandemic, RAND researchers developed a decision support tool to provide policymakers with insight into the trade-offs they might face when choosing among nonpharmaceutical intervention levels. Using an updated version of the m...
Article
Full-text available
Background Microsimulation models are mathematical models that simulate event histories for individual members of a population. They are useful for policy decisions because they simulate a large number of individuals from an idealized population, with features that change over time, and the resulting event histories can be summarized to describe ke...
Article
Background: Models can help guide colorectal cancer (CRC) screening policy. While models are carefully calibrated and validated, there is less scrutiny of assumptions about test performance. Methods: We examined the validity of the CRC-SPIN model and colonoscopy sensitivity assumptions. Standard sensitivity assumptions, consistent with published...
Article
Objective Annual fecal immunochemical tests can reduce colorectal cancer incidence and mortality. However, screening is a multi-step process and most patients do not perfectly adhere to guideline-recommended screening schedules. Our objective was to compare the reduction in colorectal cancer incidence and life-years gained based on US guideline-con...
Article
Full-text available
The COVID-19 pandemic required significant public health interventions from local governments. Although nonpharmaceutical interventions often were implemented as decision rules, few studies evaluated the robustness of those reopening plans under a wide range of uncertainties. This paper uses the Robust Decision Making approach to stress-test 78 alt...
Article
Background Dementia is a common disease that has an impact on both the affected individual and family members who provide caregiving. Simulation models can assist in setting policy that anticipates public health needs by predicting the demand for and availability of care. Objective We developed a relatively simple method for simulating the onset o...
Article
Full-text available
Importance The US Preventive Services Task Force (USPSTF) is updating its 2016 colorectal cancer screening recommendations. Objective To provide updated model-based estimates of the benefits, burden, and harms of colorectal cancer screening strategies and to identify strategies that may provide an efficient balance of life-years gained (LYG) from...
Technical Report
The coronavirus disease 2019 pandemic required significant public health interventions from local governments. Early in the pandemic, RAND researchers developed a decision support tool to provide policymakers with insight into the trade-offs they might face when choosing among nonpharmaceutical intervention levels. Using an updated version of the m...
Preprint
Full-text available
Amid global scarcity of COVID-19 vaccines and the threat of new variant strains, California and other jurisdictions face the question of when and how to implement and relax COVID-19 Nonpharmaceutical Interventions (NPIs). While policymakers have attempted to balance the health and economic impacts of the pandemic, decentralized decision-making, dee...
Preprint
Full-text available
This paper uses the Robust Decision Making approach to stress-test California's COVID-19 reopening strategy considering a range of uncertainties. These simulations reveal the characteristics of robust, non-dominated COVID-19 exit strategies.
Article
Full-text available
Objective : To identify and suggest strategies to make insufficient evidence ratings in systematic reviews more actionable. Study Design and Setting : A workgroup comprising members from the Evidence-Based Practice (EPC) Program of the Agency for Healthcare Research and Quality convened throughout 2020. We conducted iterative discussions consideri...
Article
Racial disparities in colorectal cancer (CRC) incidence are widely documented. There are two potential mechanisms for these disparities: differences in access to screening, including screening follow-up, and differences in underlying risk of CRC. We reviewed the literature for evidence of these two mechanisms. We show that higher CRC incidence in b...
Article
Microsimulation models are often used to predict long-term outcomes and guide policy decisions regarding cancer screening. The United Kingdom Flexible Sigmoidoscopy Screening (UKFSS) Trial examines a one-time intervention of flexible sigmoidoscopy that was implemented before a colorectal cancer (CRC) screening program was established. Long-term stu...
Chapter
This chapter discusses validation of simulation models used to inform health policy. Confidence in a model’s validity can be weaker or stronger depending on several factors. These factors include verifying whether model specifications were implemented correctly, evaluating the extent to which model-predicted results are consistent with empirical re...
Preprint
BACKGROUND There is a lack of research on the effectiveness of online peer support groups for reducing social isolation and depressive symptoms among caregivers, and the past research has mixed results. OBJECTIVE We tested whether military caregivers who joined a new online peer support community and/or engaged with an existing online community ex...
Article
Full-text available
Background: There is a lack of research on the effectiveness of online peer support groups for reducing social isolation and depressive symptoms among caregivers, and previous research has mixed results. Objective: This study aimed to test whether military caregivers who joined a new online peer support community or engaged with an existing onli...
Article
Full-text available
Background: In 2014, the Centers for Medicare and Medicaid Services (CMS) began covering a multitarget stool DNA (mtSDNA) test for colorectal cancer (CRC) screening of Medicare beneficiaries. In this study, we evaluated whether mtSDNA testing is a cost-effective alternative to other CRC screening strategies reimbursed by CMS, and if not, under wha...
Article
Full-text available
Background: Despite the importance of characterizing colonoscopy indication for quality monitoring and cancer screening program evaluation, there is no standard approach to documenting colonoscopy indication in medical records. Methods: We applied two algorithms in three health care systems to assign colonoscopy indication to persons 50-89 years...
Article
Background: Cancer screening is a complex process encompassing risk assessment, the initial screening examination, diagnostic evaluation, and treatment of cancer precursors or early cancers. Metrics that enable comparisons across different screening targets are needed. We present population-based screening metrics for breast, cervical, and colorec...
Article
Background: Pragmatic clinical trials often use automated data sources such as electronic health records, claims, or registries to identify eligible individuals and collect outcome information. A specific advantage that this automated data collection often yields is having data on potential participants when design decisions are being made. We out...
Article
Emerging health care research paradigms such as comparative effectiveness research (CER), patient-centered outcome research (PCOR), and precision medicine (PM) share one ultimate goal: constructing evidence to provide the right treatment to the right patient at the right time. We argue that to succeed at this goal, it is crucial to have both timely...
Article
Objectives: Chronic low back pain (CLBP) and chronic neck pain (CNP) are the most common types of chronic pain, and chiropractic spinal manipulation is a common nonpharmacologic treatment. This study presents the characteristics of a large United States sample of chiropractic patients with CLBP and CNP. Methods: Data were collected from chiropra...
Article
Microsimulation models (MSMs) are used to predict population-level effects of health care policies by simulating individual-level outcomes. Simulated outcomes are governed by unknown parameters that are chosen so that the model accurately predicts specific targets, a process referred to as model calibration. Calibration targets can come from random...
Article
Background: Patients who receive an abnormal cancer screening result require follow-up for diagnostic testing, but the time to follow-up varies across patients and practices. Methods: We used a simulation study to estimate the change in lifetime screening benefits when time to follow-up for breast, cervical, and colorectal cancers was increased....
Article
In Reply To be effective, FIT for colorectal cancer screening requires follow-up colonoscopy in patients with positive results. We did not advocate for delays in colonoscopy in our Editorial. We agree with Dr Doubeni and colleagues that colonoscopy should occur as soon as possible after a positive screening result. The intent of our Editorial was t...
Article
Background and objective Little is known about the feasibility, effectiveness, and sustainability of CQI approaches in substance use disorder treatment settings. Methods In the initial phase of this study, eight programs were randomly assigned to receive a CQI intervention or to a waitlist control condition to obtain preliminary information about...
Article
Full-text available
Exposures derived from electronic health records (EHR) may be misclassified, leading to biased estimates of their association with outcomes of interest. An example of this problem arises in the context of cancer screening where test indication, the purpose for which a test was performed, is often unavailable. This poses a challenge to understanding...
Article
A large body of research demonstrates that colorectal cancer screening is an effective method for reducing colorectal cancer mortality.¹ Screening can detect cancer at an earlier stage, before it becomes symptomatic, and the detection and removal of adenomas can prevent cancer. Rates of colorectal cancer screening had increased until 2010, at which...
Chapter
Microsimulation models are a tool for informing health policy decisions. Models provide a structure for combining a wide range of evidence that represents the current understanding of both disease and interventions to prevent or treat disease. In the health policy context, microsimulation refers to simulation of an entire population by simulating l...
Article
Full-text available
Electronic health records and administrative databases provide rich, longitudinal data for health-related research. These data cover large, diverse populations creating excellent research opportunities, but have limitations. In particular, information is available only for individuals who are enrolled in a particular health system; thus, studies of...
Article
Full-text available
Importance: The US Preventive Services Task Force (USPSTF) is updating its 2008 colorectal cancer (CRC) screening recommendations. Objective: To inform the USPSTF by modeling the benefits, burden, and harms of CRC screening strategies; estimating the optimal ages to begin and end screening; and identifying a set of model-recommendable strategies t...
Article
Importance Colorectal cancer (CRC) remains a significant cause of morbidity and mortality in the United States. Objective To systematically review the effectiveness, diagnostic accuracy, and harms of screening for CRC. Data Sources Searches of MEDLINE, PubMed, and the Cochrane Central Register of Controlled Trials for relevant studies published fro...
Article
Full-text available
Introduction: Expert recommendations differ for colorectal cancer screening in the elderly. Recent studies suggest that healthy adults aged >75 years may benefit from screening. This study examined screening use and follow-up, and how they varied by health status within age strata, among a large cohort of elderly individuals in community settings....
Article
Background Population outreach strategies are increasingly used to improve colorectal cancer (CRC) screening. The influence of primary care on cancer screening in this context is unknown. Objective To assess associations between primary care provider (PCP) visits and receipt of CRC screening and colonoscopy after a positive fecal immunochemical (FI...
Article
The Veterans Access, Choice, and Accountability Act of 2014 addressed the need for access to timely, high-quality health care for veterans. Section 201 of the legislation called for an independent assessment of various aspects of veterans' health care. The RAND Corporation was tasked with an assessment of the Department of Veterans Affairs (VA) cur...
Article
The Veterans Access, Choice, and Accountability Act of 2014 addressed the need for access to timely, high-quality health care for veterans. Section 201 of the legislation called for an independent assessment of various aspects of veterans' health care. The RAND Corporation was tasked with an assessment of the current and projected demographics and...
Article
Introduction: Timely follow-up of abnormal tests is critical to the effectiveness of cancer screening, but may vary by screening test, healthcare system, and sociodemographic group. Methods: Timely follow-up of abnormal mammogram and fecal occult blood testing or fecal immunochemical tests (FOBT/FIT) were compared by race/ethnicity using Populat...
Article
Objective: To examine the association between thoughts of death or self-harm reported on item 9 of the Patient Health Questionnaire (PHQ) depression module and the risk of suicide attempt or suicide death over the following 2 years. Method: In 4 health care systems participating in the Mental Health Research Network, electronic records identifie...
Article
Decision-analytic models are increasingly used to inform health policy decisions. These models synthesize available data on disease burden and intervention effectiveness to project estimates of the long-term consequences of care, which are often absent when clinical or policy decisions must be made. While models have been influential in informing U...
Article
Full-text available
Background: To reduce colorectal cancer mortality, positive fecal blood tests must be followed by colonoscopy. Methods: We identified 62,384 individuals ages 50 to 89 years with a positive fecal blood test between January 1, 2011 and December 31, 2012 in four health care systems within the Population-Based Research Optimizing Screening through P...
Article
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Background: Microsimulation models synthesize evidence about disease processes and interventions, providing a method for predicting long-term benefits and harms of prevention, screening, and treatment strategies. Because models often require assumptions about unobservable processes, assessing a model's predictive accuracy is important. Methods:...
Article
Background & aims: We aimed to quantify the difference in complications from colonoscopy with vs without anesthesia services. Methods: We conducted a prospective cohort study and analyzed administrative claims data from Truven Health MarketScan Research Databases from 2008 through 2011. We identified 3,168,228 colonoscopy procedures in men and w...
Article
Full-text available
Background: Primary care providers and health systems have prominent roles in guiding effective cancer screening. Objective: To characterize variation in screening abnormality rates and timely initial follow-up for common cancer screening tests. Design: Population-based cohort undergoing screening in 2011, 2012, or 2013 at seven research cente...
Article
USA states have begun legislating mammographic breast density reporting to women, requiring that women undergoing screening mammography who have dense breast tissue (Breast Imaging Reporting and Data System [BI-RADS] density c or d) receive written notification of their breast density; however, the impact that misclassification of breast density wi...
Article
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Electronic health data are potentially valuable resources for evaluating colonoscopy screening utilization and effectiveness. The ability to distinguish screening colonoscopies from exams performed for other purposes is critical for research that examines factors related to screening uptake and adherence, and the impact of screening on patient outc...
Article
To examine whether the effects of a nurse navigator intervention for cancer vary with baseline depressive symptoms. Participants were enrolled in a randomized controlled trial of a nurse navigation intervention for patients newly diagnosed with lung, breast or colorectal cancer (N=251). This exploratory analysis used linear regression models to est...
Article
Full-text available
Studies linking cholesterol levels to the development of colorectal neoplasia are inconsistent, and Mendelian randomization has been suggested as a way to help avoid problems with confounding and reverse causation. We genotyped individuals who received a colonoscopy at Group Health (1998-2007) for 96 of 102 single-nucleotide polymorphisms identifie...
Article
Objective: Describe the prevalence of colonoscopy before age 50, when guidelines recommend initiation of colorectal cancer screening for average risk individuals. Method: We assembled administrative health records that captured receipt of colonoscopy between 40 and 49-years of age for a cohort of 204,758 50-year-old members of four US health pla...
Article
Analysis of cancer screening effectiveness is challenging in part because of competing tests, which are additional screening tests that identify the condition of interest. For example, studies investigating screening with faecal occult blood tests to prevent colorectal cancer mortality need to consider the occurrence of screening colonoscopy. This...
Article
Precise diagnostic coding of procedures is of critical importance for accurate billing, determination of patient co-pays and deductibles, retrospective analysis of results, and development of performance metrics. For example, whether a colonoscopy is coded as diagnostic or therapeutic, screening or surveillance has important implications for determ...
Article
Full-text available
Electronic health records (EHRs) are increasingly used by medical providers and offer a wide-reaching source of information on utilization of preventive services. Numerous measures used for quality assessment and public reporting are estimated based on EHR data. However, sources of error and misclassification can lead to over- or under-estimation o...
Article
Background: Numerous studies have assessed associations between lipid levels and risk of colorectal neoplasia, but findings have been inconsistent. Recent genetic studies have identified >100 loci associated with lipid levels. Knowledge of the magnitude and direction of genetic effects permits evaluation of allele scores that can serve as proxies f...
Article
Background/Aims Clinical text is an integral part of research at Group Health Research Institute (GHRI), supporting ongoing projects and new research proposals. Our clinical notes are stored in a single, full-text-indexed table that is populated nightly with all new notes in Group Health’s Electronic Medical Record (EMR). These notes include those...
Article
Full-text available
Background: Harms and benefits of cancer screening depend on age and comorbid conditions, but reliable estimates are lacking. Objective: To estimate the harms and benefits of cancer screening by age and comorbid conditions to inform decisions about screening cessation. Design: Collaborative modeling with 7 cancer simulation models and common d...
Article
Full-text available
Purpose: Telephone- and Internet-based communication are increasingly common in primary care, yet there is uncertainty about how these forms of communication affect demand for in-person office visits. We assessed whether use of copay-free secure messaging and telephone encounters was associated with office visit use in a population with diabetes....
Article
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Reducing colorectal cancer (CRC) mortality by promoting screening has been a national goal for two decades. The National Cancer Institute's Population-based Research Optimizing Screening through Personalized Regimens (PROSPR) consortium is the first federal initiative to foster coordinated, transdisciplinary research evaluating the entire cancer sc...
Article
Full-text available
Background: We describe patterns of colorectal cancer screening uptake in a U.S. insured population as individuals become newly eligible for screening at age 50 and assess temporal trends and patient characteristics with screening uptake. Methods: We identified a cohort of 81,223 men and women who were members of Group Health and turned 50 years...