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Burke JP, Simpson RJ, Paoli CJ, McPheeters JT, Gandra SR. Longitudinal treatment patterns among US patients with atherosclerotic cardiovascular disease or familial hypercholesterolemia initiating lipid-lowering pharmacotherapy. J Clin Lipidol 2016; 10:1470-1480.e3. [PMID: 27919365 DOI: 10.1016/j.jacl.2016.09.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2016] [Revised: 08/23/2016] [Accepted: 09/01/2016] [Indexed: 11/19/2022]
Abstract
BACKGROUND The most recent American College of Cardiology-American Heart Association guidelines recommend high-dose statin therapy for most patients with confirmed atherosclerotic cardiovascular disease (ASCVD) and patients with high cardiovascular risk. There is limited information regarding long-term treatment patterns among these patients. OBJECTIVE To examine longitudinal treatment modifications in patients with ASCVD or familial hypercholesterolemia (FH). METHODS This retrospective analysis of administrative claims data identified patients initiating statin or ezetimibe therapy between January 1, 2007, and December 31, 2012, who had evidence of ASCVD or FH. Patients were followed for up to 3 years and up to 4 treatment episodes. After initial treatment, subsequent treatment episodes began on the date of a treatment modification, which included discontinuation, statin dose change, switching, and augmentation. RESULTS A total of 92,621 patients (mean age 64.7 years, 57.3% male) were identified; 91,740 had ASCVD, 937 had FH (56 had both). Most ASCVD (89.6%) and FH (85.8%) patients initiated on statin monotherapy. The most common treatment modification in the first treatment episode was discontinuation (ASCVD: 42.0%; FH: 58.4%); among patients who discontinued, most reinitiated therapy (70.5% of ASCVD, 76.8% of FH). Most ASCVD (68.2%) and FH (71.1%) patients initiated on moderate-dose statins; statin dose increase occurred in 10.3% of ASCVD and 18.5% of FH patients in the first episode. CONCLUSION Among patients with high cardiovascular risk, most initiated on moderate-dose statins with infrequent uptitration. In light of the recent American College of Cardiology-American Heart Association guidelines, statin initiation practices will need to change to ensure appropriate therapy for high-risk patients.
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Affiliation(s)
- James P Burke
- Health Economics and Outcomes Research, Optum, Inc, Eden Prairie, MN, USA.
| | - Ross J Simpson
- Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Carly J Paoli
- Global Health Economics, Amgen Inc., One Amgen Center Drive, Thousand Oaks, CA, USA
| | | | - Shravanthi R Gandra
- Global Health Economics, Amgen Inc., One Amgen Center Drive, Thousand Oaks, CA, USA
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Bladen L, McAtee R. Relationship of embodied nursing knowledge and client outcomes in home health. Home Health Care Serv Q 2016; 35:86-99. [PMID: 27551773 DOI: 10.1080/01621424.2016.1227008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Embodied nursing knowledge and its effects on patient outcomes are understudied in home health. The researchers performed a descriptive correlational study, in nine home health agencies in Ohio, to consider the effects of embodied nursing knowledge in expert practice in 107 registered nurses working in Medicare certified home health agencies. While statistical significance was not noted, findings of this study add to the understanding or research and the outcome improvement scores in home health. Findings also pose the question that the concepts used in acute care to improve mortality rates and patient outcome improvements may be different in home health.
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Affiliation(s)
- Laurie Bladen
- a Nursing Department , Clarion University of Pennsylvania-Venango Campus , Oil City , Pennsylvania , USA
| | - Robin McAtee
- b University of Arkansas for Medical Sciences , Lonsdale , Arkansas , USA
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Wijers IGM, Ayala A, Rodriguez-Blazquez C, Rodriguez-Laso A, Rodriguez-Rodriguez V, Forjaz MJ. Disease burden morbidity assessment by self-report: Psychometric properties in older adults in Spain. Geriatr Gerontol Int 2016; 17:1102-1108. [PMID: 27426678 DOI: 10.1111/ggi.12835] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2015] [Revised: 02/09/2016] [Accepted: 04/26/2016] [Indexed: 11/30/2022]
Abstract
AIM To carry out an analysis of the psychometric properties of the Disease Burden Morbidity Assessment (DBMA) according to the assumptions of the Classical Test Theory. METHODS A sample of 707 community-dwelling adults aged 65 years and older, living in Spain, completed the DBMA. Psychometric properties of the scale (feasibility, acceptability, scaling assumptions, reliability and construct validity) were analyzed. RESULTS The mean DBMA score was 6.8. Feasibility and acceptability were satisfactory, except for large floor effects (>50%), as well as a skewed distribution (1.8). Item-total corrected correlation ranged 0.10-0.49, item homogeneity index was 0.09 and Cronbach's alpha was 0.72. Disease burden correlated strongly with physical functioning (r = -0.56) and perceived health (r = -0.56), and moderately with depression (r = 0.41) and the Personal Wellbeing Index (r = -0.41). Exploratory factor analysis extracted five factors, explaining 44% of the variance. CONCLUSIONS The DBMA is an acceptable and valid instrument for measuring disease burden in older adults. Future studies should include Rasch analysis to further assess dimensionality and explore other measurement properties. Geriatr Gerontol 2017; 17: 1102-1108.
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Affiliation(s)
- Irene G M Wijers
- Department of Preventive Medicine and Quality Management, General University Hospital Gregorio Marañón, Madrid, Spain
| | - Alba Ayala
- National School of Public Health, Institute of Health Carlos III and REDISSEC, Madrid, Spain
| | | | - Angel Rodriguez-Laso
- Department of Pharmacology and Biotechnology, Universidad Europea, Madrid, Spain
| | | | - Maria João Forjaz
- National School of Public Health, Institute of Health Carlos III and REDISSEC, Madrid, Spain
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Bayliss EA, McQuillan DB, Ellis JL, Maciejewski ML, Zeng C, Barton MB, Boyd CM, Fortin M, Ling SM, Tai-Seale M, Ralston JD, Ritchie CS, Zulman DM. Using Electronic Health Record Data to Measure Care Quality for Individuals with Multiple Chronic Medical Conditions. J Am Geriatr Soc 2016; 64:1839-44. [PMID: 27385077 DOI: 10.1111/jgs.14248] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To inform the development of a data-driven measure of quality care for individuals with multiple chronic conditions (MCCs) derived from an electronic health record (EHR). DESIGN Qualitative study using focus groups, interactive webinars, and a modified Delphi process. SETTING Research department within an integrated delivery system. PARTICIPANTS The webinars and Delphi process included 17 experts in clinical geriatrics and primary care, health policy, quality assessment, health technology, and health system operations. The focus group included 10 individuals aged 70-87 with three to six chronic conditions selected from a random sample of individuals aged 65 and older with three or more chronic medical conditions. MEASUREMENTS Through webinars and the focus group, input was solicited on constructs representing high-quality care for individuals with MCCs. A working list was created of potential measures representing these constructs. Using a modified Delphi process, experts rated the importance of each possible measure and the feasibility of implementing each measure using EHR data. RESULTS High-priority constructs reflected processes rather than outcomes of care. High-priority constructs that were potentially feasible to measure included assessing physical function, depression screening, medication reconciliation, annual influenza vaccination, outreach after hospital admission, and documented advance directives. High-priority constructs that were less feasible to measure included goal setting and shared decision-making, identifying drug-drug interactions, assessing social support, timely communication with patients, and other aspects of good customer service. Lower-priority domains included pain assessment, continuity of care, and overuse of screening or laboratory testing. CONCLUSION High-quality MCC care should be measured using meaningful process measures rather than outcomes. Although some care processes are currently extractable from electronic data, capturing others will require adapting and applying technology to encourage holistic, person-centered care.
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Affiliation(s)
- Elizabeth A Bayliss
- Institute for Health Research, Kaiser Permanente Colorado, Denver, Colorado. .,Department of Family Medicine, University of Colorado School of Medicine, Aurora, Colorado.
| | - Deanna B McQuillan
- Institute for Health Research, Kaiser Permanente Colorado, Denver, Colorado
| | - Jennifer L Ellis
- Institute for Health Research, Kaiser Permanente Colorado, Denver, Colorado
| | - Matthew L Maciejewski
- Health Services Research and Development, Durham Veterans Affairs Medical Center, Durham, North Carolina.,Division of General Internal Medicine, Department of Medicine, Duke University Medical Center, Durham, North Carolina
| | - Chan Zeng
- Institute for Health Research, Kaiser Permanente Colorado, Denver, Colorado
| | - Mary B Barton
- National Committee for Quality Assurance, Washington, District of Columbia
| | - Cynthia M Boyd
- Division of Geriatric Medicine and Gerontology, Department of Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Martin Fortin
- Department of Family Medicine, Faculté de Médecine et des Sciences de la Santé, Université de Sherbrooke, Quebec, Canada
| | - Shari M Ling
- Centers for Medicare and Medicaid Services, Baltimore, Maryland
| | - Ming Tai-Seale
- Palo Alto Medical Foundation Research Institute, Palo Alto, California
| | - James D Ralston
- Group Health Research Institute, Group Health Cooperative, Seattle, Washington
| | - Christine S Ritchie
- Department of Medicine, University of California at San Francisco, San Francisco, California
| | - Donna M Zulman
- Center for Innovation to Implementation, Veterans Affairs Palo Alto Health Care System, Menlo Park, California.,Division of General Medical Disciplines, Stanford University, Stanford, California
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Multimorbidity: conceptual basis, epidemiological models and measurement challenges. BIOMEDICA 2016; 36:188-203. [PMID: 27622480 DOI: 10.7705/biomedica.v36i2.2710] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/11/2015] [Revised: 08/19/2015] [Indexed: 12/21/2022]
Abstract
The growing number of patients with complex clinical profiles related to chronic diseases has contributed to the increasingly widespread use of the term 'multimorbidity'. A suitable measurement of this condition is essential to epidemiological studies considering that it represents a challenge for the clinical management of patients as well as for health systems and epidemiological investigations. In this context, the present essay reviews the conceptual proposals behind the measurement of multimorbidity including the epidemiological and methodological challenges it involves. We discuss classical definitions of comorbidity, how they differ from the concept of multimorbidity, and their roles in epidemiological studies. The various conceptual models that contribute to the operational definitions and strategies to measure this variable are also presented. The discussion enabled us to identify a significant gap between the modern conceptual development of multimorbidity and the operational definitions. This gap exists despite the theoretical developments that have occurred in the classical concept of comorbidity to arrive to the modern and multidimensional conception of multimorbidty. Measurement strategies, however, have not kept pace with this advance. Therefore, new methodological proposals need to be developed in order to obtain information regarding the actual impact on individuals' health and its implications for public health.
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Do Patient- and Parent-reported Outcomes Measures for Children With Congenital Hand Differences Capture WHO-ICF Domains? Clin Orthop Relat Res 2015; 473:3549-63. [PMID: 26286444 PMCID: PMC4586230 DOI: 10.1007/s11999-015-4505-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Patient- and parent-reported outcome measures (PROMs) are increasingly used to evaluate the effectiveness of surgery for congenital hand differences (CHDs). Knowledge of an existing outcome measure's ability to assess self-reported health, including psychosocial aspects, can inform the future development and application of PROMs for CHD. However, the extent to which measures used among children with CHD align with common, accepted metrics of self-reported disability remains unexplored. QUESTIONS/PURPOSES We reviewed studies that used PROMs to evaluate surgery for CHD to determine (1) the number of World Health Organization-International Classification of Functioning, Disability and Health (WHO-ICF) domains covered by existing PROMs; (2) the proportion of studies that used PROMs specifically validated among children with CHD; and (3) the proportion of PROMs that targets patients and/or parents. METHODS We performed a comprehensive review of the literature through a bibliographic search of MEDLINE®, PubMed, and EMBASE from January 1966 to December 2014 to identify articles related to patient outcomes and surgery for CHD. We evaluated the 42 studies that used PROMs to identify the number and type of WHO-ICF domains captured by existing PROMs for CHD and the proportion of studies that use PROMs validated for use among children with CHD. The most common instruments used to measure patient- and parent-reported outcomes after reconstruction for CHD included the Prosthetic Upper Extremity Functional Index (PUFI), Disabilities of the Arm, Shoulder, and Hand questionnaire, Childhood Experience Questionnaire, and Pediatric Quality of Life Inventory. RESULTS Current PROMs that have been used for CHD covered a mean of 1.3 WHO-ICF domains (SD ± 1.3). Only the Child Behavior Checklist and the Piers-Harris Children's Self-Concept Scale captured all ICF domains (body functions and structures, activity, participation, and environmental factors). The PUFI, the only PROM validated specifically for children with congenital longitudinal and transverse deficiency, was used in only four of 42 studies. Only 13 of the 42 studies assessed patient-reported outcomes, whereas five assessed both patient- and parent-reported outcomes. CONCLUSIONS The PROMs used to assess patients after CHD surgery do not evaluate all WHO-ICF domains (ie, body structure, body function, environmental factors, and activity and participation) and generally are not validated for children with CHD. Given the psychological and sociological aspects of CHD illness, a PROM that encompasses all components of the biopsychosocial model of illness and validated in children with CHD is desirable. LEVEL OF EVIDENCE Level III, therapeutic study.
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Ryan A, Wallace E, O'Hara P, Smith SM. Multimorbidity and functional decline in community-dwelling adults: a systematic review. Health Qual Life Outcomes 2015. [PMID: 26467295 DOI: 10.1186/s12955‐015‐0355‐9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Multimorbidity affects up to one quarter of primary care populations. It is associated with reduced quality of life, an increased risk of mental health difficulties and increased healthcare utilisation. Functional decline is defined as developing difficulties with activities of daily living and is independently associated with poorer health outcomes. The aim of this systematic review was to examine the association between multimorbidity and functional decline and to what extent multimorbidity predicts future functional decline. METHODS A systematic literature search (1990-2014) and narrative analysis was conducted. INCLUSION CRITERIA Population; Community-dwelling adults (≥18 years), Risk; Multimorbidity defined as the presence of ≥2 chronic medical conditions in an individual, Primary outcome; Physical functional decline measured using a validated instrument, Study design; cross-sectional or cohort studies. The following databases were included: PubMed, EMBASE, CINAHL, the Cochrane Library and the International Research Community on Multimorbidity (IRCMo) publication list. Methodological quality assessment of included studies was conducted with a suitable risk of bias tool. RESULTS A total of 37 studies were eligible for inclusion (28 cross-sectional studies and 9 cohort studies). The majority of cross-sectional studies (n = 24/28) demonstrated a consistent association between multimorbidity and functional decline. Twelve of these studies reported that increasing numbers of chronic condition counts were associated with worsening functional decline. Nine cohort studies included 14,133 study participants with follow-up periods ranging from one to six years. The majority (n = 5) found that multimorbidity predicted functional decline. Of the five studies that reported the impact of increasing numbers of conditions, all reported greater functional decline with increasing numbers of conditions. One study examined disease severity and found that this also predicted greater functional decline. Overall, cohort studies were of good methodological quality but were mixed in terms of participants, multimorbidity definitions, follow-up duration, and outcome measures. CONCLUSIONS The available evidence indicates that multimorbidity predicts future functional decline, with greater decline in patients with higher numbers of conditions and greater disease severity. This review highlights the importance of considering physical functioning when designing interventions and systems of care for patients with multimorbidity, particularly for patients with higher numbers of conditions and greater disease severity.
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Affiliation(s)
- Aine Ryan
- HRB Centre for Primary Care Research, Department of General Practice, Royal College of Surgeons in Ireland, 123 St. Stephen's Green, Dublin 2, Ireland. .,Department of Population Health Sciences, Royal College of Surgeons in Ireland, Beaux Lane House, Lower Mercer Street, Dublin 2, Ireland.
| | - Emma Wallace
- HRB Centre for Primary Care Research, Department of General Practice, Royal College of Surgeons in Ireland, 123 St. Stephen's Green, Dublin 2, Ireland
| | - Paul O'Hara
- South East Training Programme for General Practice, General Practice Training Department, Waterford Regional Hospital, Dunmore Road, Waterford, Ireland
| | - Susan M Smith
- HRB Centre for Primary Care Research, Department of General Practice, Royal College of Surgeons in Ireland, 123 St. Stephen's Green, Dublin 2, Ireland
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Ryan A, Wallace E, O'Hara P, Smith SM. Multimorbidity and functional decline in community-dwelling adults: a systematic review. Health Qual Life Outcomes 2015; 13:168. [PMID: 26467295 PMCID: PMC4606907 DOI: 10.1186/s12955-015-0355-9] [Citation(s) in RCA: 219] [Impact Index Per Article: 24.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2015] [Accepted: 09/18/2015] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Multimorbidity affects up to one quarter of primary care populations. It is associated with reduced quality of life, an increased risk of mental health difficulties and increased healthcare utilisation. Functional decline is defined as developing difficulties with activities of daily living and is independently associated with poorer health outcomes. The aim of this systematic review was to examine the association between multimorbidity and functional decline and to what extent multimorbidity predicts future functional decline. METHODS A systematic literature search (1990-2014) and narrative analysis was conducted. INCLUSION CRITERIA Population; Community-dwelling adults (≥18 years), Risk; Multimorbidity defined as the presence of ≥2 chronic medical conditions in an individual, Primary outcome; Physical functional decline measured using a validated instrument, Study design; cross-sectional or cohort studies. The following databases were included: PubMed, EMBASE, CINAHL, the Cochrane Library and the International Research Community on Multimorbidity (IRCMo) publication list. Methodological quality assessment of included studies was conducted with a suitable risk of bias tool. RESULTS A total of 37 studies were eligible for inclusion (28 cross-sectional studies and 9 cohort studies). The majority of cross-sectional studies (n = 24/28) demonstrated a consistent association between multimorbidity and functional decline. Twelve of these studies reported that increasing numbers of chronic condition counts were associated with worsening functional decline. Nine cohort studies included 14,133 study participants with follow-up periods ranging from one to six years. The majority (n = 5) found that multimorbidity predicted functional decline. Of the five studies that reported the impact of increasing numbers of conditions, all reported greater functional decline with increasing numbers of conditions. One study examined disease severity and found that this also predicted greater functional decline. Overall, cohort studies were of good methodological quality but were mixed in terms of participants, multimorbidity definitions, follow-up duration, and outcome measures. CONCLUSIONS The available evidence indicates that multimorbidity predicts future functional decline, with greater decline in patients with higher numbers of conditions and greater disease severity. This review highlights the importance of considering physical functioning when designing interventions and systems of care for patients with multimorbidity, particularly for patients with higher numbers of conditions and greater disease severity.
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Affiliation(s)
- Aine Ryan
- HRB Centre for Primary Care Research, Department of General Practice, Royal College of Surgeons in Ireland, 123 St. Stephen's Green, Dublin 2, Ireland.
- Department of Population Health Sciences, Royal College of Surgeons in Ireland, Beaux Lane House, Lower Mercer Street, Dublin 2, Ireland.
| | - Emma Wallace
- HRB Centre for Primary Care Research, Department of General Practice, Royal College of Surgeons in Ireland, 123 St. Stephen's Green, Dublin 2, Ireland
| | - Paul O'Hara
- South East Training Programme for General Practice, General Practice Training Department, Waterford Regional Hospital, Dunmore Road, Waterford, Ireland
| | - Susan M Smith
- HRB Centre for Primary Care Research, Department of General Practice, Royal College of Surgeons in Ireland, 123 St. Stephen's Green, Dublin 2, Ireland
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Durkin M, Pesa J, Lopatto J, Halpern R, Van Voorhis D, Korrer S. Comparison of Real-world Outcomes Between Patients Treated with Tapentadol ER or Oxycodone CR. JOURNAL OF HEALTH ECONOMICS AND OUTCOMES RESEARCH 2015; 2:221-232. [PMID: 37663585 PMCID: PMC10471404 DOI: 10.36469/9905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/05/2023]
Abstract
Background: The objective of this study was to compare health care utilization and costs between matched cohorts of chronic pain patients treated with the opioids tapentadol extended release (ER) or oxycodone controlled release (CR). Methods: This retrospective study used claims data from the Optum Research Database. Commercial and Medicare Advantage adult patients with ≥1 prescription fill for oxycodone CR or tapentadol ER between September 1, 2011 and September 30, 2012 were eligible. The date of the first observed oxycodone CR or tapentadol ER claim was the index date. Patients had continuous health plan enrollment for 6 months before and after the index date, ≥ 90 days supply of opioid therapy, and no index drug claims in the preindex period. Patients were propensity score matched in a 1:2 ratio (tapentadol ER : oxycodone CR). Results: The attributes of the matched cohorts (1,120 tapentadol ER and 2,240 oxycodone CR patients) appeared similar. In the 6 month post-index period, lower proportions of the tapentadol ER cohort than the oxycodone CR cohort had ≥1 inpatient stay (14.6% versus 20.5%; p<0.001) and ≥1 emergency department visit (33.4% versus 37.5%; p=0.021). The tapentadol ER compared with the oxycodone CR cohort had higher mean pharmacy costs ($4,263 versus $3,694; p <0.001), lower mean inpatient costs ($3,625 versus $6,309; p<0.001), and lower mean total healthcare costs ($16,510 versus $19,330; p=0.004). Conclusions: During follow-up, total mean healthcare costs were lower among tapentadol ER patients than oxycodone CR patients, and tapentadol ER patients were less likely to have an inpatient admission or emergency department visit.
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Affiliation(s)
- Mike Durkin
- Janssen Scientific Affairs, LLC, Titusville, New Jersey, USA
| | | | | | - Rachel Halpern
- Optum, Health Economics and Outcomes Research, Eden Prairie, Minnesota, USA
| | - Damon Van Voorhis
- Optum, Health Economics and Outcomes Research, Eden Prairie, Minnesota, USA
| | - Stephanie Korrer
- Optum, Health Economics and Outcomes Research, Eden Prairie, Minnesota, USA
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Jackson R, Shiozawa A, Buysman EK, Altan A, Korrer S, Choi H. Flare frequency, healthcare resource utilisation and costs among patients with gout in a managed care setting: a retrospective medical claims-based analysis. BMJ Open 2015; 5:e007214. [PMID: 26109113 PMCID: PMC4480013 DOI: 10.1136/bmjopen-2014-007214] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES For most gout patients, excruciatingly painful gout attacks are the major clinical burden of the disease. The goal of this study was to assess the association of frequent gout flares with healthcare burden, and to quantify how much lower gout-related costs and resource use are for those with infrequent flares compared to frequent gout flares. DESIGN Retrospective cohort study. SETTING Administrative claims data from a large US health plan. PARTICIPANTS Patients aged 18 years or above, and with evidence of gout based on medical and pharmacy claims between January 2009 and April 2012 were eligible for inclusion. Patient characteristics were assessed during a 12-month baseline period. OUTCOME MEASURES Frequency of gout flares, healthcare costs and resource utilisation were assessed in the 12 months following the first qualifying gout claim. Generalised linear models were employed to assess the impact of flare frequency on cost outcomes after adjusting for covariates. RESULTS 102,703 patients with gout met study inclusion criteria; 89,201 had 0-1 gout flares, 9714 had 2 flares, and 3788 had 3+ flares. Average counts of gout-related inpatient stays, emergency room visits and ambulatory visits were higher among patients with 2 or 3+ flares, compared to those with 0-1 flares (all p<0.001). Adjusted annual gout-related costs were $1804, $3014 and $4363 in those with 0-1, 2 and 3+ gout flares, respectively (p<0.001 comparing 0-1 flares to 2 or 3+ flares). CONCLUSIONS Gout-related costs and resource use were lower for those with infrequent flares, suggesting significant cost benefit to a gout management plan that has a goal of reducing flare frequency.
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Affiliation(s)
- Robert Jackson
- Takeda Pharmaceuticals International, Inc, Deerfield, Illinois, USA
| | - Aki Shiozawa
- Takeda Pharmaceuticals International, Inc, Deerfield, Illinois, USA
| | | | | | | | - Hyon Choi
- Massachusetts General Hospital/Harvard Medical School, Boston, Massachusetts, USA
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Dwyer AA, Quinton R, Pitteloud N, Morin D. Psychosexual development in men with congenital hypogonadotropic hypogonadism on long-term treatment: a mixed methods study. Sex Med 2015; 3:32-41. [PMID: 25844173 PMCID: PMC4380912 DOI: 10.1002/sm2.50] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
Introduction Congenital hypogonadotropic hypogonadism (CHH) is a rare, genetic, reproductive endocrine disorder characterized by absent puberty and infertility. Limited information is available on the psychosocial impact of CHH and psychosexual development in these patients. Aim The aim of this study was to determine the impact of CHH on psychosexual development in men on long-term treatment. Methods A sequential mixed methods explanatory design was used. First, an online survey (quantitative) was used to quantify the frequency of psychosexual problems among CHH men. Second, patient focus groups (qualitative) were conducted to explore survey findings in detail and develop a working model to guide potential nursing and interdisciplinary interventions. Main Outcome Measures Patient characteristics, frequency of body shame, difficulty with intimate relationships, and never having been sexually active were assessed. Additionally, we collected subjective patient-reported outcomes regarding the impact of CHH on psychological/emotional well-being, intimate relationships, and sexual activity. Results A total of 101 CHH men on long-term treatment (>1 year) were included for the analysis of the online survey (mean age 37 ± 11 years, range 19–66, median 36). Half (52/101, 51%) of the men had been seen at a specialized academic center and 37/101 (37%) reported having had fertility-inducing treatment. A high percentage of CHH men experience psychosexual problems including difficulty with intimate relationships (70%) and body image concerns/body shame (94/101, 93%), and the percentage of men never having been sexually active is five times the rate in a reference group (26% vs. 5.4%, P < 0.001). Focus groups revealed persisting body shame and low self-esteem despite long-term treatment that has lasting impact on psychosexual functioning. Conclusions CHH men frequently experience psychosexual problems that pose barriers to intimate relationships and initiating sexual activity. These lingering effects cause significant distress and are not ameliorated by long-term treatment. Psychosexual assessment in CHH men with appropriate psychological support and treatment should be warranted in these patients. Dwyer AA, Quinton R, Pitteloud N, and Morin D. Psychosexual development in men with congenital hypogonadotropic hypogonadism on long-term treatment: A mixed methods study. Sex Med 2015;3:32–41.
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Affiliation(s)
- Andrew A Dwyer
- Endocrinology, Diabetes & Metabolism Service, Centre Hospitalier Universitaire Vaudois Lausanne, Switzerland ; Institut universitaire de formation et de recherche en soins, University of Lausanne Lausanne, Switzerland
| | - Richard Quinton
- Institute of Genetic Medicine and the Royal Victoria Infirmary, University of Newcastle-upon-Tyne Newcastle-upon-Tyne, UK
| | - Nelly Pitteloud
- Endocrinology, Diabetes & Metabolism Service, Centre Hospitalier Universitaire Vaudois Lausanne, Switzerland ; Department of Physiology, Faculty of Biology & Medicine, University of Lausanne Lausanne, Switzerland
| | - Diane Morin
- Institut universitaire de formation et de recherche en soins, University of Lausanne Lausanne, Switzerland
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Trick WE, Deamant C, Smith J, Garcia D, Angulo F. Implementation of an audio computer-assisted self-interview (ACASI) system in a general medicine clinic: patient response burden. Appl Clin Inform 2015; 6:148-62. [PMID: 25848420 DOI: 10.4338/aci-2014-09-ra-0073] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2014] [Accepted: 01/26/2015] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Routine implementation of instruments to capture patient-reported outcomes could guide clinical practice and facilitate health services research. Audio interviews facilitate self-interviews across literacy levels. OBJECTIVES To evaluate time burden for patients, and factors associated with response times for an audio computer-assisted self interview (ACASI) system integrated into the clinical workflow. METHODS We developed an ACASI system, integrated with a research data warehouse. Instruments for symptom burden, self-reported health, depression screening, tobacco use, and patient satisfaction were administered through touch-screen monitors in the general medicine clinic at the Cook County Health & Hospitals System during April 8, 2011-July 27, 2012. We performed a cross-sectional study to evaluate the mean time burden per item and for each module of instruments; we evaluated factors associated with longer response latency. RESULTS Among 1,670 interviews, the mean per-question response time was 18.4 [SD, 6.1] seconds. By multivariable analysis, age was most strongly associated with prolonged response time and increased per decade compared to < 50 years as follows (additional seconds per question; 95% CI): 50-59 years (1.4; 0.7 to 2.1 seconds); 60-69 (3.4; 2.6 to 4.1); 70-79 (5.1; 4.0 to 6.1); and 80-89 (5.5; 4.1 to 7.0). Response times also were longer for Spanish language (3.9; 2.9 to 4.9); no home computer use (3.3; 2.8 to 3.9); and, low mental self-reported health (0.6; 0.0 to 1.1). However, most interviews were completed within 10 minutes. CONCLUSIONS An ACASI software system can be included in a patient visit and adds minimal time burden. The burden was greatest for older patients, interviews in Spanish, and for those with less computer exposure. A patient's self-reported health had minimal impact on response times.
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Affiliation(s)
- W E Trick
- Collaborative Research Unit, Department of Medicine, Cook County Health & Hospitals System , Chicago, Illinois
| | - C Deamant
- Division of General Medicine, Department of Medicine, Cook County Health & Hospitals System , Chicago, Illinois
| | - J Smith
- Collaborative Research Unit, Department of Medicine, Cook County Health & Hospitals System , Chicago, Illinois
| | - D Garcia
- Collaborative Research Unit, Department of Medicine, Cook County Health & Hospitals System , Chicago, Illinois
| | - F Angulo
- Collaborative Research Unit, Department of Medicine, Cook County Health & Hospitals System , Chicago, Illinois
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O'Connor K, Vizcaino M, Ibarra JM, Balcazar H, Perez E, Flores L, Anders RL. Multimorbidity in a Mexican Community: Secondary Analysis of Chronic Illness and Depression Outcomes. ACTA ACUST UNITED AC 2015; 2:35-47. [PMID: 26640817 DOI: 10.15640/ijn.v2n1a4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
The aims of this article are: 1) to examine the associations between health provider-diagnosed depression and multimorbidity, the condition of suffering from more than two chronic illnesses; 2) to assess the unique contribution of chronic illness in the prediction of depression; and 3) to suggest practice changes that would address risk of depression among individuals with chronic illnesses. Data collected in a cross-sectional community health study among adult Mexicans (n= 274) living in a low income neighborhood (colonia) in Ciudad Juárez, Chihuahua, Mexico, were examined. We tested the hypotheses that individuals who reported suffering chronic illnesses would also report higher rates of depression than healthy individuals; and having that two or more chronic illnesses further increased the risk of depression.
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Affiliation(s)
- Kathleen O'Connor
- Student co-author. University of Texas, El Paso, Interdisciplinary PhD Program, College of Health Sciences, 500 University, El Paso TX 79968
| | - Maricarmen Vizcaino
- Student co-author. University of Texas, El Paso, Interdisciplinary PhD Program, College of Health Sciences, 500 University, El Paso TX 79968
| | - Jorge M Ibarra
- Adjunct Faculty, University of Texas, El Paso, School of Nursing and Statistical Consulting Laboratory, 500 University, El Paso TX 79968
| | - Hector Balcazar
- Regional Dean, The University of Texas School of Public Health at Houston El Paso Regional Campus, 1101 N. Campbell, CH 410, El Paso, Texas 79902
| | - Eduardo Perez
- Universidad Autónoma de Ciudad Juárez; Juárez, Chihuahua, Mexico
| | - Luis Flores
- Instituto Mexicano de Seguridad Social; Juárez, Chihuahua, Mexico
| | - Robert L Anders
- University of Texas, El Paso, School of Nursing, 500 University, El Paso TX 79968
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Pirani E, Salvini S. Is temporary employment damaging to health? A longitudinal study on Italian workers. Soc Sci Med 2015; 124:121-31. [DOI: 10.1016/j.socscimed.2014.11.033] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Hardy MA, Acciai F, Reyes AM. How health conditions translate into self-ratings: a comparative study of older adults across Europe. JOURNAL OF HEALTH AND SOCIAL BEHAVIOR 2014; 55:320-41. [PMID: 25138200 PMCID: PMC4669051 DOI: 10.1177/0022146514541446] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
Abstract
Using data from the Survey of Health, Ageing and Retirement in Europe, we examine how respondents translate morbidity and disability into self-rated health (SRH), how national populations differ in SRH, and how normative and person-specific reporting styles shape SRH. We construct proxy variables that allow us to specify cultural differences in reporting styles and individual differences in relative rating behavior. Using generalized logistic regression, we find that both of these dimensions of subjectivity are related to SRH; however, their inclusion does not significantly alter the connection between SRH and the set of disease and disability indicators. Further, country differences in SRH persist after controlling for all these factors. Our findings suggest that observed country differences in SRH reflect compositional differences, cultural differences in reporting styles, and perceptions of how health restricts typical activities. SRH also seems to capture underlying but unmeasured health differences across populations.
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Raebel MA, Xu S, Goodrich GK, Schroeder EB, Schmittdiel JA, Segal JB, O'Connor PJ, Nichols GA, Lawrence JM, Kirchner HL, Elston Lafata J, Butler M, Newton KM, Steiner JF. Initial antihyperglycemic drug therapy among 241 327 adults with newly identified diabetes from 2005 through 2010: a surveillance, prevention, and management of diabetes mellitus (SUPREME-DM) study. Ann Pharmacother 2014; 47:1280-91. [PMID: 24259692 DOI: 10.1177/1060028013503624] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Among adults with incident diabetes, data are lacking about first antihyperglycemic initiation and whether medication choice aligns with recommendations. OBJECTIVE To identify predictors of initiating any antihyperglycemic, and specifically sulfonylurea versus metformin. METHODS This retrospective cohort study included 241 327 patients from 11 US health systems, 2005 through 2010. Assessments included antihyperglycemic initiation within 6 months of diabetes identification, first medication initiated, and initiation predictors. RESULTS Only 40.3% (n = 97 350) started any antihyperglycemic; 75.2% (n = 73 221) started metformin. Glycosylated hemoglobin (HbA1c) predicted initiating any antihyperglycemic (HbA1c >9%, relative risk [RR] = 3.94, 95% CI = 3.82, 4.07, vs HbA1c >6.5%-7%). Age modified the HbA1c effect: at higher HbA1c, likelihood of starting antihyperglycemics differed little across ages; at lower HbA1c, older patients were less likely to start antihyperglycemics (P < .001). Individuals with elevated serum creatinine (SCr) were more likely to started on sulfonylurea (SCr = 1.4-2, RR = 2.21 [2.05, 2.39]; SCr >2, RR = 2.75 [2.30, 3.29] vs normal SCr), particularly as HbA1c increased: patients with HbA1c 8%-9% and SCr >2 were 5.59 times (2.94, 10.65) more likely to start sulfonylurea versus those with HbA1c >6.5%-7% and normal SCr. Age predicted sulfonylurea initiation (20-39 years, RR = 0.87 [0.79, 0.95]; ≥ 80 years, RR = 2.41 [2.20, 2.65] vs 50-59 years). CONCLUSIONS Among adults with incident diabetes, metformin was generally the first antihyperglycemic initiated. However, 59.7% did not start any antihyperglycemic at diabetes identification. HbA1c and age predict antihyperglycemic initiation; SCr and age predict sulfonylurea initiation.
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Affiliation(s)
- Marsha A Raebel
- Kaiser Permanente Colorado Institute for Health Research, Denver, CO, USA
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Medina-Solís CE, Pontigo-Loyola AP, Pérez-Campos E, Hernández-Cruz P, Avila-Burgos L, Mendoza-Rodríguez M, Maupomé G. Edentulism and other variables associated with self-reported health status in Mexican adults. Med Sci Monit 2014; 20:843-52. [PMID: 24852266 PMCID: PMC4043565 DOI: 10.12659/msm.890100] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2013] [Accepted: 12/27/2013] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND To determine if edentulism, controlling for other known factors, is associated with subjective self-report health status (SRH) in Mexican adults. MATERIAL AND METHODS We examined the SRH of 13 966 individuals 35 years and older, using data from the National Survey of Performance Assessment, a cross-sectional study that is part of the technical collaboration between the Ministry of Health of Mexico and the World Health Organization, which used the survey instrument and sampling strategies developed by WHO for the World Health Survey. Sociodemographic, socioeconomic, medical, and behavioral variables were collected using questionnaires. Self-reported health was our dependent variable. Data on edentulism were available from 20 of the 32 Mexican states. A polynomial logistic regression model adjusted for complex sampling was generated. RESULTS In the SRH, 58.2% reported their health status as very good/good, 33.8% said they had a moderate health status, and 8.0% reported that their health was bad/very bad. The association between edentulism and SRH was modified by age and was significant only for bad/very bad SRH. Higher odds of reporting moderate health or poor/very poor health were found in women, people with lower socio-economic status and with physical disabilities, those who were not physically active, or those who were underweight or obese, those who had any chronic disease, and those who used alcohol. CONCLUSIONS The association of edentulism with a self-report of a poor health status (poor/very poor) was higher in young people than in adults. The results suggest socioeconomic inequalities in SRH. Inequality was further confirmed among people who had a general health condition or a disability. Dentists and health care professionals need to recognize the effect of edentulism on quality of life among elders people.
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Affiliation(s)
- Carlo Eduardo Medina-Solís
- Academic Area of Dentistry of Health Sciences Institute, Autonomous University of Hidalgo State, Pachuca, Hidalgo, Mexico
- Research Centre in Medical and Biological Sciences, School of Medicine and Surgery, Autonomous University “Benito Juarez” of Oaxaca, Oaxaca, Mexico
| | | | - Eduardo Pérez-Campos
- Research Centre in Medical and Biological Sciences, School of Medicine and Surgery, Autonomous University “Benito Juarez” of Oaxaca, Oaxaca, Mexico
- Biochemistry Unit ITO-UNAM, Oaxaca, Mexico
| | - Pedro Hernández-Cruz
- Research Centre in Medical and Biological Sciences, School of Medicine and Surgery, Autonomous University “Benito Juarez” of Oaxaca, Oaxaca, Mexico
- Biochemistry Unit ITO-UNAM, Oaxaca, Mexico
| | - Leticia Avila-Burgos
- Health Systems Research Centre, National Institute of Public Health, Cuernavaca, Morelos, Mexico
| | - Martha Mendoza-Rodríguez
- Academic Area of Dentistry of Health Sciences Institute, Autonomous University of Hidalgo State, Pachuca, Hidalgo, Mexico
| | - Gerardo Maupomé
- Indiana University/Purdue University at Indianapolis, School of Dentistry, Indianapolis, IN, U.S.A
- The Regenstrief Institute, Inc. Indianapolis, Indiana, IN, U.S.A
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Raebel MA, Ellis JL, Schroeder EB, Xu S, O'Connor PJ, Segal JB, Butler MG, Schmittdiel JA, Kirchner HL, Goodrich GK, Lawrence JM, Nichols GA, Newton KM, Pathak RD, Steiner JF. Intensification of antihyperglycemic therapy among patients with incident diabetes: a Surveillance Prevention and Management of Diabetes Mellitus (SUPREME-DM) study. Pharmacoepidemiol Drug Saf 2014; 23:699-710. [DOI: 10.1002/pds.3610] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2013] [Revised: 01/23/2014] [Accepted: 02/16/2014] [Indexed: 01/17/2023]
Affiliation(s)
- Marsha A. Raebel
- Kaiser Permanente Colorado Institute for Health Research; Denver CO USA
- University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences; Aurora CO USA
| | - Jennifer L. Ellis
- Kaiser Permanente Colorado Institute for Health Research; Denver CO USA
| | - Emily B. Schroeder
- Kaiser Permanente Colorado Institute for Health Research; Denver CO USA
- University of Colorado School of Medicine; Aurora CO USA
| | - Stanley Xu
- Kaiser Permanente Colorado Institute for Health Research; Denver CO USA
| | | | | | - Melissa G. Butler
- Center for Health Research Southeast; Kaiser Permanente Georgia; Atlanta GA USA
| | | | | | - Glenn K. Goodrich
- Kaiser Permanente Colorado Institute for Health Research; Denver CO USA
| | - Jean M. Lawrence
- Department of Research and Evaluation; Kaiser Permanente Southern California; Pasadena CA USA
| | | | | | - Ram D. Pathak
- Marshfield Clinic Research Foundation; Marshfield WI USA
| | - John F. Steiner
- Kaiser Permanente Colorado Institute for Health Research; Denver CO USA
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Brett T, Arnold-Reed DE, Popescu A, Soliman B, Bulsara MK, Fine H, Bovell G, Moorhead RG. Multimorbidity in patients attending 2 Australian primary care practices. Ann Fam Med 2013; 11:535-42. [PMID: 24218377 PMCID: PMC3823724 DOI: 10.1370/afm.1570] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
PURPOSE Multiple chronic conditions in a single patient can be a challenging health burden. We aimed to examine patterns and prevalence of multimorbidity among patients attending 2 large Australian primary care practices and to estimate disease severity burden using the Cumulative Illness Rating Scale (CIRS). METHODS Using published CIRS guidelines and a disease severity index calculated for each individual, we extracted data from the medical records of all 7,247 patients (58.5% female) seen over 6 months in 2008 who were rated for chronic conditions across 14 anatomical domains. RESULTS Fifty-two percent of patients had multimorbidity in 2 or more CIRS domains, ranging from 20.6% if younger than 25 years, 43.7% if aged 25 to 44 years, 75.5% if aged 45 to 64 years, 87.5% if aged 65 to 74 years, and 97.1% if aged 75 years and older. Using a cutoff of 3 or more CIRS domains, 34.5% had multimorbidity ranging from 4.8% if younger than 25 years, 22.3% if aged 25 to 44 years, 56.1% if aged 45 to 64 years, 74.6% if aged 65 to 74 years, and 92.0% if aged 75 years and older. Musculoskeletal, singularly or in combination with others, was the commonest morbidity domain. The moderate severity index category increased with increasing age. CONCLUSIONS Multimorbidity is a significant problem in men and women across all age-groups, and the moderate severity index increases with age. The musculoskeletal domain was most commonly affected. Mild and moderate severity index categories may underrepresent disease burden. Severity burden assessment in the primary care setting needs to take into account the severity index, as well as levels of domain severity within the index categories.
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Affiliation(s)
- Tom Brett
- General Practice and Primary Health Care Research, School of Medicine, The University of Notre Dame Australia, Fremantle, Western Australia
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Hersh WR, Weiner MG, Embi PJ, Logan JR, Payne PR, Bernstam EV, Lehmann HP, Hripcsak G, Hartzog TH, Cimino JJ, Saltz JH. Caveats for the use of operational electronic health record data in comparative effectiveness research. Med Care 2013; 51:S30-7. [PMID: 23774517 PMCID: PMC3748381 DOI: 10.1097/mlr.0b013e31829b1dbd] [Citation(s) in RCA: 338] [Impact Index Per Article: 30.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
The growing amount of data in operational electronic health record systems provides unprecedented opportunity for its reuse for many tasks, including comparative effectiveness research. However, there are many caveats to the use of such data. Electronic health record data from clinical settings may be inaccurate, incomplete, transformed in ways that undermine their meaning, unrecoverable for research, of unknown provenance, of insufficient granularity, and incompatible with research protocols. However, the quantity and real-world nature of these data provide impetus for their use, and we develop a list of caveats to inform would-be users of such data as well as provide an informatics roadmap that aims to insure this opportunity to augment comparative effectiveness research can be best leveraged.
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Thompson RT, Bennett WE, Finnell SME, Downs SM, Carroll AE. Increased length of stay and costs associated with weekend admissions for failure to thrive. Pediatrics 2013; 131:e805-10. [PMID: 23439903 DOI: 10.1542/peds.2012-2015] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE To evaluate whether admission day of the week affects the length of stay (LOS) and health care costs for failure to thrive (FTT) admissions. METHODS Administrative data were obtained for all children aged <2 years (N = 23 332) with a primary admission diagnosis of FTT from 2003-2011 from 42 freestanding US hospitals. Demographic characteristics, day of admission, LOS, costs per stay, number of discharge diagnoses, primary discharge diagnoses, primary procedure code, number of radiologic and laboratory units billed during admission were obtained for each admission. Linear regression and zero-truncated Poisson regression were used for analysis. RESULTS Weekend admission was significantly correlated with increased LOS and increased average cost (P < .002). This finding was also true for children with both admission and discharge diagnoses of FTT (P < .001). The number of procedures for children admitted on the weekend was not significantly different compared with children admitted on the weekdays (incident rate ratio [IRR]:1.04 [95% confidence interval (CI): 0.99-1.09]). However, weekend admissions did have more radiologic studies (IRR: 1.13 [95% CI: 1.10-1.16]) and laboratory tests (IRR: 1.39 [95% CI: 1.38-1.40]) performed. If one-half of weekend admissions in 2010 with both admission and discharge diagnoses of FTT were converted to Monday admissions, total savings in health care dollars for 2010 would be $534, 145. CONCLUSIONS Scheduled FTT admissions on weekends increased LOS and health care costs compared with weekday admissions of similar levels of complexity. Reduction in planned weekend admissions for FTT could significantly reduce health care costs.
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Affiliation(s)
- Rachel T Thompson
- Children's Health Services Research, Section of Children’s Health Services Research, Clinical Utilization and Resource Efficiency (CURE) Group, Indiana University School of Medicine, Indianapolis, IN 46202, USA.
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Prinja S, Jeet G, Kumar R. Validity of self-reported morbidity. Indian J Med Res 2012; 136:722-4. [PMID: 23287117 PMCID: PMC3573591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Affiliation(s)
- Shankar Prinja
- School of Public Health, Postgraduate Institute of Medical Education & Research, Chandigarh 160 012, India
| | - Gursimer Jeet
- School of Public Health, Postgraduate Institute of Medical Education & Research, Chandigarh 160 012, India
| | - Rajesh Kumar
- School of Public Health, Postgraduate Institute of Medical Education & Research, Chandigarh 160 012, India,For correspondence:
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Affiliation(s)
- Richard A. Goodman
- National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
- Division of Geriatric Medicine and Gerontology, Emory University School of Medicine, Atlanta, Georgia
- Office of the Assistant Secretary for Health, US Department of Health and Human Services, Washington, DC
- CORRESPONDING AUTHOR: Richard A. Goodman, MD, Centers for Disease Control and Prevention, Mailstop K45, 4770 Buford Highway NE, Atlanta, GA 30341,
| | - Anand K. Parekh
- Office of the Assistant Secretary for Health, US Department of Health and Human Services, Washington, DC
| | - Howard K. Koh
- Office of the Assistant Secretary for Health, US Department of Health and Human Services, Washington, DC
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