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Kohli DR, Desai M, Kennedy KF, Parasa S, Sharma P. Cholecystectomy for Biliary Gallstone Pancreatitis Is Often Not Performed During Index Hospitalization and Is Associated With Worse Outcomes. Clin Gastroenterol Hepatol 2022; 20:233-235.e1. [PMID: 33307183 DOI: 10.1016/j.cgh.2020.12.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Revised: 11/19/2020] [Accepted: 12/03/2020] [Indexed: 02/07/2023]
Abstract
Guidelines recommend that patients with mild gallstone pancreatitis (GSP) without necrosis or infection should undergo cholecystectomy during the index hospitalization before discharge.1,2 However, in routine clinical practice, cholecystectomy is often performed several weeks after hospital discharge, or not performed at all.3.
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Affiliation(s)
- Divyanshoo R Kohli
- Division of Gastroenterology and Hepatology, Kansas City VA Medical Center, Kansas City, Missouri.
| | - Madhav Desai
- Division of Gastroenterology and Hepatology, Kansas City VA Medical Center, Kansas City, Missouri
| | | | | | - Prateek Sharma
- Division of Gastroenterology and Hepatology, Kansas City VA Medical Center, Kansas City, Missouri
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2
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Johnson KM, Khakban A, Bryan S, Sin DD, Sadatsafavi M. Healthcare system encounters before COPD diagnosis: a registry-based longitudinal cohort study. Thorax 2019; 75:108-115. [PMID: 31704794 DOI: 10.1136/thoraxjnl-2019-213554] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Revised: 09/20/2019] [Accepted: 10/16/2019] [Indexed: 11/03/2022]
Abstract
BACKGROUND There is high interest in strategies for improving early detection of chronic obstructive pulmonary disease (COPD). These strategies often rely on opportunistic encounters between patients with undiagnosed COPD and the healthcare system; however, the frequency of these encounters is currently unknown. METHODS We used administrative health data for the province of British Columbia, Canada, from 1996 to 2015. We identified patients with COPD using a validated case definition, and assessed their visits to pharmacists, primary care and specialist physicians in the 5 years prior to the initial diagnosis of COPD. We used generalised linear models to compare the rate of outpatient visits between COPD and non-COPD comparator subjects matched on age, sex and socioeconomic status. RESULTS We assessed 112 635 COPD and non-COPD pairs (mean 68.6 years, 51.0% male). Patients with COPD interacted with pharmacists most frequently in the 5 years before diagnosis (mean 14.09, IQR 4-17 visits/year), followed by primary care (10.29, IQR 4-13 visits/year) and specialist (8.11, IQR 2-11 visits/year) physicians. In the 2 years prior to diagnosis, 72.1% of patients with COPD had a respiratory-related primary care visit that did not result in a COPD diagnosis. Compared with non-COPD subjects, patients with COPD had higher rates of primary care (rate ratio (RR) 1.40, 95% CI 1.39 to 1.41), specialist (RR 1.35, 95% CI 1.34 to 1.37) and pharmacist (RR 1.62, 95% CI 1.60 to 1.63) encounters. CONCLUSIONS Patients with COPD used higher rates of outpatient services before diagnosis than non-COPD subjects. Case detection technologies implemented in pharmacy or primary care settings have opportunities to diagnose COPD earlier.
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Affiliation(s)
- Kate M Johnson
- Respiratory Evaluation Sciences Program, Collaboration for Outcomes Research and Evaluation, The University of British Columbia Faculty of Pharmaceutical Sciences, Vancouver, British Columbia, Canada
| | - Amir Khakban
- Respiratory Evaluation Sciences Program, Collaboration for Outcomes Research and Evaluation, The University of British Columbia Faculty of Pharmaceutical Sciences, Vancouver, British Columbia, Canada
| | - Stirling Bryan
- Centre for Clinical Epidemiology and Evaluation, Vancouver Coastal Health Research Institute, Vancouver, British Columbia, Canada
| | - Don D Sin
- University of British Columbia Centre for Heart Lung Innovation, St. Paul's Hospital, Vancouver, British Columbia, Canada.,Institute for Heart and Lung Health, The University of British Columbia Department of Medicine, Vancouver, British Columbia, Canada
| | - Mohsen Sadatsafavi
- Respiratory Evaluation Sciences Program, Collaboration for Outcomes Research and Evaluation, The University of British Columbia Faculty of Pharmaceutical Sciences, Vancouver, British Columbia, Canada.,Centre for Clinical Epidemiology and Evaluation, Vancouver Coastal Health Research Institute, Vancouver, British Columbia, Canada
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Shrestha SS, Zhang P, Hora IA, Gregg EW. Trajectory of Excess Medical Expenditures 10 Years Before and After Diabetes Diagnosis Among U.S. Adults Aged 25-64 Years, 2001-2013. Diabetes Care 2019; 42:62-68. [PMID: 30455325 PMCID: PMC6393199 DOI: 10.2337/dc17-2683] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Accepted: 10/12/2018] [Indexed: 02/03/2023]
Abstract
OBJECTIVE We assessed the excess medical expenditures for adults newly diagnosed with diabetes, for up to 10 years before and after diabetes diagnosis. RESEARCH DESIGN AND METHODS Using the 2001-2013 MarketScan data, we identified people with newly diagnosed diabetes among adults aged 25-64 years (diabetes cohort) and matched them with people who did not have diagnosed diabetes (control cohort) using 1:1 propensity score matching. We followed these two cohorts up to ±10 years from the index date, with annual matched cohort sizes ranging from 3,922 to 39,726 individuals. We estimated the yearly and cumulative excess medical expenditures of the diabetes cohorts before and after the diagnosis of diabetes. RESULTS The per capita annual total excess medical expenditure for the diabetes cohort was higher for the entire 10 years prior to their index date, ranging between $1,043 in year -10 and $4,492 in year -1. Excess expenditure spiked in year 1 ($8,109), declined in year 2, and then increased steadily, ranging from $4,261 to $6,162 in years 2-10. The cumulative excess expenditure for the diabetes cohort during the entire 20 years of follow-up was $69,177 ($18,732 before and $50,445 after diagnosis). CONCLUSIONS People diagnosed with diabetes had higher medical expenditures compared with their counterparts, not only after diagnosis but also up to 10 years prior to diagnosis. Managing risk factors for type 2 diabetes and cardiovascular disease before diagnosis, and for diabetes-related complications after diagnosis, could alleviate medical expenditure in people with diabetes.
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Affiliation(s)
- Sundar S Shrestha
- Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, GA
| | - Ping Zhang
- Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, GA
| | - Israel A Hora
- Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, GA
| | - Edward W Gregg
- Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, GA
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Tamas MJ, Khakharia A, Rothenberg RB, Phillips LS. Weight Trends in Veterans With and Without Diabetes, 2000 to 2014. Obesity (Silver Spring) 2018; 26:1949-1957. [PMID: 30417970 PMCID: PMC6284820 DOI: 10.1002/oby.22337] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2018] [Revised: 09/10/2018] [Accepted: 09/10/2018] [Indexed: 12/26/2022]
Abstract
OBJECTIVE The aim of this study was to assess weight trends and diabetes prevalence among US veterans. METHODS Information from the Veterans Affairs Informatics and Computing Infrastructure Corporate Data Warehouse was used to construct data sets that included demographic data, diabetes status, and weight observations for males and females. Secular and longitudinal trends in mean weight were analyzed. RESULTS A total of 4,527,865 patients born from 1915 to 1984 with weight data during 2000 to 2014 were included; 36.8% had diabetes. Mean weight at baseline was higher in men and women with diabetes (97 kg and 88 kg, respectively) than in men and women without diabetes (86 kg and 76 kg, respectively). Mean weight increased from 2000 to 2014 (P < 0.001) at rates of 0.36 kg/y in women without diabetes, 0.28 kg/y in men with diabetes, 0.25 kg/y in men without diabetes, and 0.22 kg/y in women with diabetes. Weight decreased in those born before 1940, was stable in those born between 1940 and 1949, and increased in those born since 1950. CONCLUSIONS Among contemporary veterans, women without diabetes are gaining weight more rapidly than women with diabetes or men. Younger veterans are gaining weight more rapidly than older veterans. Further efforts are needed to prevent weight gain in veterans, especially among women.
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Affiliation(s)
- Margery J. Tamas
- Institute for Medical and Nursing Education, Atlanta, Georgia, United States
| | | | | | - Lawrence S. Phillips
- Atlanta VA Medical Center, Decatur, Georgia, United States
- Emory University School of Medicine, Department of Medicine, Division of Endocrinology and Metabolism, Atlanta, Georgia, United States
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Rhee MK, Safo SE, Jackson SL, Xue W, Olson DE, Long Q, Barb D, Haw JS, Tomolo AM, Phillips LS. Inpatient Glucose Values: Determining the Nondiabetic Range and Use in Identifying Patients at High Risk for Diabetes. Am J Med 2018; 131:443.e11-443.e24. [PMID: 28993187 DOI: 10.1016/j.amjmed.2017.09.021] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2017] [Revised: 07/31/2017] [Accepted: 09/12/2017] [Indexed: 01/02/2023]
Abstract
BACKGROUND Many individuals with diabetes remain undiagnosed, leading to delays in treatment and higher risk for subsequent diabetes complications. Despite recommendations for diabetes screening in high-risk groups, the optimal approach is not known. We evaluated the utility of inpatient glucose levels as an opportunistic screening tool for identifying patients at high risk for diabetes. METHODS We retrospectively examined 462,421 patients in the US Department of Veterans Affairs healthcare system, hospitalized on medical/surgical services in 2000-2010, for ≥3 days, with ≥2 inpatient random plasma glucose (RPG) measurements. All had continuity of care: ≥1 primary care visit and ≥1 glucose measurement within 2 years before hospitalization and yearly for ≥3 years after discharge. Glucose levels during hospitalization and incidence of diabetes within 3 years after discharge in patients without diabetes were evaluated. RESULTS Patients had a mean age of 65.0 years, body mass index of 29.9 kg/m2, and were 96% male, 71% white, and 18% black. Pre-existing diabetes was present in 39.4%, 1.3% were diagnosed during hospitalization, 8.1% were diagnosed 5 years after discharge, and 51.3% were never diagnosed (NonDM). The NonDM group had the lowest mean hospital RPG value (112 mg/dL [6.2 mmol/L]). Having at least 2 RPG values >140 mg/dL (>7.8 mmol/L), the 95th percentile of NonDM hospital glucose, provided 81% specificity for identifying incident diabetes within 3 years after discharge. CONCLUSIONS Screening for diabetes could be considered in patients with at least 2 hospital glucose values at/above the 95th percentile of the nondiabetic range (141 mg/dL [7.8 mmol/L]).
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Affiliation(s)
- Mary K Rhee
- Medical Subspecialty/Endocrinology, Atlanta VA Medical Center, Decatur, Ga; Division of Endocrinology, Metabolism and Lipids, Department of Medicine, Emory University School of Medicine, Atlanta, Ga.
| | - Sandra E Safo
- Medical Subspecialty/Endocrinology, Atlanta VA Medical Center, Decatur, Ga; Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, Ga
| | - Sandra L Jackson
- Medical Subspecialty/Endocrinology, Atlanta VA Medical Center, Decatur, Ga; Nutrition and Health Sciences, Graduate Division of Biological and Biomedical Sciences, Emory University, Atlanta, Ga; Division of Heart Disease and Stroke Prevention, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Ga
| | - Wenqiong Xue
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, Ga; Boehringer Ingelheim Pharmaceuticals, Inc., Ridgefield, Conn
| | - Darin E Olson
- Medical Subspecialty/Endocrinology, Atlanta VA Medical Center, Decatur, Ga; Division of Endocrinology, Metabolism and Lipids, Department of Medicine, Emory University School of Medicine, Atlanta, Ga
| | - Qi Long
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, Ga; Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Diana Barb
- Division of Endocrinology, Metabolism and Lipids, Department of Medicine, Emory University School of Medicine, Atlanta, Ga; Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, University of Florida College of Medicine, Gainesville
| | - J Sonya Haw
- Division of Endocrinology, Metabolism and Lipids, Department of Medicine, Emory University School of Medicine, Atlanta, Ga
| | - Anne M Tomolo
- Medical Subspecialty/Endocrinology, Atlanta VA Medical Center, Decatur, Ga; Division of General Internal Medicine and Geriatrics, Department of Medicine, Emory University School of Medicine, Atlanta, Ga
| | - Lawrence S Phillips
- Medical Subspecialty/Endocrinology, Atlanta VA Medical Center, Decatur, Ga; Division of Endocrinology, Metabolism and Lipids, Department of Medicine, Emory University School of Medicine, Atlanta, Ga
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Jackson SL, Safo SE, Staimez LR, Olson DE, Narayan KMV, Long Q, Lipscomb J, Rhee MK, Wilson PWF, Tomolo AM, Phillips LS. Glucose challenge test screening for prediabetes and early diabetes. Diabet Med 2017; 34:716-724. [PMID: 27727467 PMCID: PMC5388592 DOI: 10.1111/dme.13270] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2016] [Revised: 08/15/2016] [Accepted: 10/06/2016] [Indexed: 12/29/2022]
Abstract
AIMS To test the hypothesis that a 50-g oral glucose challenge test with 1-h glucose measurement would have superior performance compared with other opportunistic screening methods. METHODS In this prospective study in a Veterans Health Administration primary care clinic, the following test performances, measured by area under receiver-operating characteristic curves, were compared: 50-g oral glucose challenge test; random glucose; and HbA1c level, using a 75-g oral glucose tolerance test as the 'gold standard'. RESULTS The study population was comprised of 1535 people (mean age 56 years, BMI 30.3 kg/m2 , 94% men, 74% black). By oral glucose tolerance test criteria, diabetes was present in 10% and high-risk prediabetes was present in 22% of participants. The plasma glucose challenge test provided area under receiver-operating characteristic curves of 0.85 (95% CI 0.78-0.91) to detect diabetes and 0.76 (95% CI 0.72-0.80) to detect high-risk dysglycaemia (diabetes or high-risk prediabetes), while area under receiver-operating characteristic curves for the capillary glucose challenge test were 0.82 (95% CI 0.75-0.89) and 0.73 (95% CI 0.69-0.77) for diabetes and high-risk dysglycaemia, respectively. Random glucose performed less well [plasma: 0.76 (95% CI 0.69-0.82) and 0.66 (95% CI 0.62-0.71), respectively; capillary: 0.72 (95% CI 0.65-0.80) and 0.64 (95% CI 0.59-0.68), respectively], and HbA1c performed even less well [0.67 (95% CI 0.57-0.76) and 0.63 (95% CI 0.58-0.68), respectively]. The cost of identifying one case of high-risk dysglycaemia with a plasma glucose challenge test would be $42 from a Veterans Health Administration perspective, and $55 from a US Medicare perspective. CONCLUSIONS Glucose challenge test screening, followed, if abnormal, by an oral glucose tolerance test, would be convenient and more accurate than other opportunistic tests. Use of glucose challenge test screening could improve management by permitting earlier therapy.
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Affiliation(s)
- S L Jackson
- Atlanta VA Medical Center, Decatur, GA, USA
- Nutrition and Health Sciences, Graduate Division of Biological and Biomedical Sciences, Emory University, Atlanta, GA, USA
| | - S E Safo
- Atlanta VA Medical Center, Decatur, GA, USA
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - L R Staimez
- Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - D E Olson
- Atlanta VA Medical Center, Decatur, GA, USA
- Division of Endocrinology and Metabolism, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - K M V Narayan
- Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Q Long
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - J Lipscomb
- Department of Health Policy and Management, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - M K Rhee
- Atlanta VA Medical Center, Decatur, GA, USA
- Division of Endocrinology and Metabolism, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | | | - A M Tomolo
- Atlanta VA Medical Center, Decatur, GA, USA
- Division of General Medicine, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - L S Phillips
- Atlanta VA Medical Center, Decatur, GA, USA
- Division of Endocrinology and Metabolism, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
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