1
|
Sonne-Holm E, Kjærgaard J, Bang LE, Køber L, Fosbøl E, Carlsen J, Winther-Jensen M. Educational differences in mortality but not in risk of recurrence following first-time pulmonary embolism: A Danish nationwide register-based study. Thromb Res 2022; 219:22-29. [PMID: 36088711 DOI: 10.1016/j.thromres.2022.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 08/11/2022] [Accepted: 09/05/2022] [Indexed: 11/16/2022]
Affiliation(s)
- Emilie Sonne-Holm
- Department of Cardiology, The Heart Centre, Copenhagen University Hospital Rigshospitalet, Denmark.
| | - Jesper Kjærgaard
- Department of Cardiology, The Heart Centre, Copenhagen University Hospital Rigshospitalet, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
| | - Lia E Bang
- Department of Cardiology, The Heart Centre, Copenhagen University Hospital Rigshospitalet, Denmark
| | - Lars Køber
- Department of Cardiology, The Heart Centre, Copenhagen University Hospital Rigshospitalet, Denmark
| | - Emil Fosbøl
- Department of Cardiology, The Heart Centre, Copenhagen University Hospital Rigshospitalet, Denmark
| | - Jørn Carlsen
- Department of Cardiology, The Heart Centre, Copenhagen University Hospital Rigshospitalet, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
| | - Matilde Winther-Jensen
- Department of Cardiology, The Heart Centre, Copenhagen University Hospital Rigshospitalet, Denmark; Department of Data, Biostatistics and Pharmacoepidemiology, Centre for Clinical Research and Prevention, Copenhagen University hospital Bispebjerg and Frederiksberg Hospital, Denmark
| |
Collapse
|
2
|
Sonne-Holm E, Kjærgaard J, Bang LE, Fosbøl E, Carlsen J, Winther-Jensen M. Pulmonary embolism: Age specific temporal trends in incidence and mortality in Denmark 1999-2018. Thromb Res 2021; 210:12-19. [PMID: 34959202 DOI: 10.1016/j.thromres.2021.12.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Revised: 11/30/2021] [Accepted: 12/13/2021] [Indexed: 01/22/2023]
Abstract
BACKGROUND Through the last two decades the prevention, diagnosis and treatment of pulmonary embolism (PE) has evolved along with demographic changes. The influence of these current transformations is important in the assessment of the future burden of PE. We aimed to describe age specific temporal trends in incidence of first-time PE and subsequent mortality. METHODS We identified patients ≥18 years of age with a first-time in-hospital diagnosis of PE in Danish national registers. By dividing patients into seven age groups (18-34, 35-44, 45-54, 55-65, 65-74, 75-84, >85 years), age specific incidence and 1-year mortality rates were calculated for four different calendar periods between 1999 and 2018. RESULTS From 1999 to 2018 65,478 patients with a first-time PE were identified. PE incidence per 100,000 person years increased during the study period in all age-groups (18-34 years: 10 to 18, 35-44 years: 18 to 35, 45-54: 26 to 63, 55-64 years: 42 to 123, 65-74 years: 92 to 229, 75-84 years: 166 to 383 and >85 years: 155 to 417), ptrend <0.0001 for all. During the study period 1-year mortality rate decreased from 4 to 2 per 10 person years in patients aged 65-74 years and this trend was found in all age groups (ptrend = 0.0001 for all). CONCLUSION Despite a decreasing mortality rate, incidence rate of PE increased in Denmark across all age groups from 1999 to 2018, reflecting improved sensitivity of diagnostic methods and changes in the burden of comorbid conditions, all together warranting a continuing need for early prevention of PE.
Collapse
Affiliation(s)
- Emilie Sonne-Holm
- Department of Cardiology, The Heart Centre, Copenhagen University Hospital Rigshospitalet, Denmark.
| | - Jesper Kjærgaard
- Department of Cardiology, The Heart Centre, Copenhagen University Hospital Rigshospitalet, Denmark
| | - Lia E Bang
- Department of Cardiology, The Heart Centre, Copenhagen University Hospital Rigshospitalet, Denmark
| | - Emil Fosbøl
- Department of Cardiology, The Heart Centre, Copenhagen University Hospital Rigshospitalet, Denmark
| | - Jørn Carlsen
- Department of Cardiology, The Heart Centre, Copenhagen University Hospital Rigshospitalet, Denmark
| | - Matilde Winther-Jensen
- Department of Cardiology, The Heart Centre, Copenhagen University Hospital Rigshospitalet, Denmark; Department of Data, Biostatistics and Epidemiology, Centre for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, Denmark
| |
Collapse
|
3
|
Loftus J, Chen Y, Alvir JMJ, Chi L, Dasgupta S, Gupta A, Wajnrajch MP. Suboptimal adherence to daily growth hormone in a US real-world study: an unmet need in the treatment of pediatric growth hormone deficiency. Curr Med Res Opin 2021; 37:2141-2150. [PMID: 34569388 DOI: 10.1080/03007995.2021.1982682] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To evaluate adherence to, and discontinuation of, somatropin treatment over 4 years in a US population-based study of children with pediatric growth hormone deficiency (pGHD). METHODS A retrospective cohort analysis of commercially insured patients ≥3 and <16 years, diagnosed with pGHD, newly treated with somatropin was conducted using Optum De-identified Clinformatics Data Mart. Index date was defined as the first prescription for somatropin between 01 July 2002 and 30 September 2019. Five non-exclusive patient cohorts were identified (>3, 12, 24, 36, and 48 months of post-index continuous enrollment). Suboptimal adherence was defined as medication possession ratio <80%. Discontinuation was defined as the date at which a gap of >60 days between somatropin fills first occurred. Cox proportional hazards regression was used to evaluate time to discontinuation. RESULTS In the 12-month cohort (n = 3091), mean age was 11.3 ± 2.9 years, 75.9% were male, 70.9% white, 9.4% Hispanic, 3.6% Asian, and 3.1% black. The proportion with suboptimal adherence at months 12 and 48 was 19.6% and 35.9%, respectively. Discontinuation occurred in 42.2% of patients. The rate of discontinuation (HR [95% CI]) was higher for age ≥10 (1.74 [1.53-1.98]), females (1.35 [1.21-1.50]), black and Hispanic race/ethnicity (1.50 [1.18-1.90] and 1.27 [1.09-1.49] compared to White) and obesity (1.69 [1.19-2.40]). CONCLUSION Suboptimal adherence increases with treatment duration, and risk of discontinuation is associated with age, female gender, black or Hispanic race/ethnicity, and obesity. Strategies that facilitate adherence among children at risk of discontinuation may improve clinical outcomes.
Collapse
Affiliation(s)
| | | | | | - Lei Chi
- Pfizer Inc, New York, NY, USA
| | | | | | - Michael P Wajnrajch
- Pfizer Inc, New York, NY, USA
- New York University Grossman School of Medicine, New York, NY, USA
| |
Collapse
|
4
|
Hong K, Sohn S, Choe YJ, Rhie K, Lee JK, Han MS, Chun BC, Choi EH. Waning Effectiveness of One-dose Universal Varicella Vaccination in Korea, 2011-2018: a Propensity Score Matched National Population Cohort. J Korean Med Sci 2021; 36:e222. [PMID: 34519184 PMCID: PMC8438188 DOI: 10.3346/jkms.2021.36.e222] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2021] [Accepted: 07/25/2021] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Despite high coverage (~98%) of universal varicella vaccination (UVV) in the Republic of Korea since 2005, reduction in the incidence rate of varicella is not obvious. The study aimed to evaluate the vaccine effectiveness (VE) of one-dose UVV by timeline and severity of the disease. METHODS All children born in Korea in 2011 were included for this retrospective cohort study that analyzed insurance claims data from 2011-2018 and the varicella vaccination records in the immunization registry. Adjusted hazard ratios by Cox proportional hazard models were used to estimate the VE through propensity score matching by the month of birth, sex, healthcare utilization rate, and region. RESULTS Of the total 421,070 newborns in the 2011 birth cohort, 13,360 were matched for age, sex, healthcare utilization rate, and region by the propensity score matching method. A total of 55,940 (13.29%) children were diagnosed with varicella, with the incidence rate 24.2 per 1000 person-year; 13.4% of vaccinated children and 10.4% of unvaccinated children. The VE of one-dose UVV against any varicella was 86.1% (95% confidence interval [CI], 81.4-89.5) during the first year after vaccination and 49.9% (95% CI, 43.3-55.7) during the 6-year follow-up period since vaccination, resulting in a 7.2% annual decrease of VE. The overall VE for severe varicella was 66.3%. The VE of two-dose compared to one-dose was 73.4% (95% CI, 72.2-74.6). CONCLUSION We found lower long-term VE in one-dose vaccination and waning of effectiveness over time. Longer follow ups of the vaccinated children as well as appropriately designed studies are needed to establish the optimal strategy in preventing varicella in Korea.
Collapse
Affiliation(s)
- Kwan Hong
- Department of Preventive Medicine, Korea University College of Medicine, Seoul, Korea
| | - Sangho Sohn
- Department of Preventive Medicine, Korea University College of Medicine, Seoul, Korea
| | - Young June Choe
- Department of Pediatrics, Korea University Anam Hospital, Seoul, Korea
| | - Kyuyol Rhie
- Department of Pediatrics, Incheon Sejong Hospital, Incheon, Korea
| | - Joon Kee Lee
- Department of Pediatrics, Chungbuk National University Hospital, Cheongju, Korea
| | - Mi Seon Han
- Department of Pediatrics, Seoul Metropolitan Government - Seoul National University Boramae Medical Center, Seoul, Korea
| | - Byung Chul Chun
- Department of Preventive Medicine, Korea University College of Medicine, Seoul, Korea
| | - Eun Hwa Choi
- Department of Pediatrics, Seoul National University Hospital, Seoul, Korea
- Department of Pediatrics, Seoul National University Hospital, Seoul, Korea.
| |
Collapse
|
5
|
Aker AM, Vigod SN, Dennis CL, Kaster T, Brown HK. The association between asthma and perinatal mental illness: a population-based cohort study. Int J Epidemiol 2021; 51:964-973. [PMID: 34379748 DOI: 10.1093/ije/dyab160] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Accepted: 07/15/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Asthma is a risk factor for mental illness, but few studies have explored this association around the time of pregnancy. We studied the association between asthma and perinatal mental illness and explored the modifying effects of social and medical complexities. METHODS In a population-based cohort of 846 155 women in Ontario, Canada, with a singleton live birth in 2005-2015 and no recent history of mental illness, modified Poisson regression models were constructed to examine the association between asthma diagnosed before pregnancy and perinatal mental illness, controlling for socio-demographics and medical history. We explored the modifying effects of social and medical complexities using relative excess risk due to interaction. Additional analyses examined the association between asthma and perinatal mental illness by timing and type of mental illness. RESULTS Women with asthma were more likely than those without asthma to have perinatal mental illness [adjusted relative risk (aRR) 1.14; 95% (confidence interval) CI: 1.13, 1.16]. Asthma was associated with increased risk of diagnosis of mental illness prenatally (aRR 1.11; 95% CI: 1.08, 1.13) and post-partum (aRR 1.17; 95% CI: 1.15, 1.19) and specifically diagnoses of mood and anxiety disorders (aRR 1.14; 95% CI: 1.13, 1.16), psychotic disorders (aRR 1.20; 95% CI: 1.10, 1.31) and substance- or alcohol-use disorders (aRR 1.24; 95% CI: 1.14, 1.36). There was no effect modification related to social or medical complexity for these outcomes. CONCLUSIONS Women with asthma predating pregnancy are at slightly increased risk of mental illness in pregnancy and post-partum. A multidisciplinary management strategy may be required to ensure timely identification and treatment.
Collapse
Affiliation(s)
- Amira M Aker
- Department of Health & Society, University of Toronto Scarborough, Toronto, Canada.,ICES, Toronto, Canada
| | - Simone N Vigod
- ICES, Toronto, Canada.,Women's College Research Institute, Women's College Hospital, Toronto, Canada.,Department of Psychiatry, University of Toronto, Toronto, Canada
| | - Cindy-Lee Dennis
- Department of Psychiatry, University of Toronto, Toronto, Canada.,Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada.,Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Canada
| | - Tyler Kaster
- ICES, Toronto, Canada.,Centre for Addiction & Mental Health, Toronto, Canada
| | - Hilary K Brown
- Department of Health & Society, University of Toronto Scarborough, Toronto, Canada.,ICES, Toronto, Canada.,Women's College Research Institute, Women's College Hospital, Toronto, Canada.,Department of Psychiatry, University of Toronto, Toronto, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| |
Collapse
|
6
|
San Giovanni CB, Ebeling M, Davis RA, Wagner CS, Basco WT. Sensitivity of Clinical Pediatric Obesity Diagnosis Documented in Electronic Health Records. Clin Pediatr (Phila) 2020; 59:1274-1281. [PMID: 32703004 DOI: 10.1177/0009922820941640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective. This study tested the sensitivity of obesity diagnosis in electronic health records (EHRs) using body mass index (BMI) classification and identified variables associated with obesity diagnosis. Methods. Eligible children aged 2 to 18 years had a calculable BMI in 2017 and had at least 1 visit in 2016 and 2017. Sensitivity of clinical obesity diagnosis compared with children's BMI percentile was calculated. Logistic regression was performed to determine variables associated with obesity diagnosis. Results. Analyses included 31 059 children with BMI at or above 95th percentile. Sensitivity of clinical obesity diagnosis was 35.81%. Clinical obesity diagnosis was more likely if the child had a well visit, had Medicaid insurance, was female, Hispanic or Black, had a chronic disease diagnosis, and saw a provider in a practice in an urban area or with academic affiliation. Conclusion. Sensitivity of clinical obesity diagnosis in EHR is low. Clinical obesity diagnosis is associated with nonmodifiable child-specific factors but also modifiable practice-specific factors.
Collapse
Affiliation(s)
| | - Myla Ebeling
- Medical University of South Carolina, Charleston, SC, USA
| | - Robert A Davis
- Medical University of South Carolina, Charleston, SC, USA
- American Medical Association, Greenville, SC, USA
| | | | | |
Collapse
|
7
|
Samadoulougou S, Idzerda L, Dault R, Lebel A, Cloutier A, Vanasse A. Validated methods for identifying individuals with obesity in health care administrative databases: A systematic review. Obes Sci Pract 2020; 6:677-693. [PMID: 33354346 PMCID: PMC7746972 DOI: 10.1002/osp4.450] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 06/24/2020] [Accepted: 07/18/2020] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Health care administrative databases are increasingly used for health studies and public health surveillance. Cases of individuals with obesity are selected using case-identification methods. However, the validity of these methods is fragmentary and particularly challenging for obesity case identification. OBJECTIVE The objectives of this systematic review are to (1) determine the case-identification methods used to identify individuals with obesity in health care administrative databases and (2) to summarize the validity of these case-identification methods when compared with a reference standard. METHODS A systematic literature search was conducted in six bibliographic databases for the period January 1980 to June 2019 for all studies evaluating obesity case-identification methods compared with a reference standard. RESULTS Seventeen articles met the inclusion criteria. International Classification of Diseases (ICD) codes were the only case-identification method utilized in selected articles. The performance of obesity-identification methods varied widely across studies, with positive predictive value ranging from 19% to 100% while sensitivity ranged from 3% to 92%. The sensitivity of these methods was usually low while the specificity was higher. CONCLUSION When obesity is reported in health care administrative databases, it is usually correctly reported; however, obesity tends to be highly underreported in databases. Therefore, case-identification methods to monitor the prevalence and incidence of obesity within health care administrative databases are not reliable. In contrast, the use of these methods remains relevant for the selection of individuals with obesity for cohort studies, particularly when identifying cohorts of individuals with severe obesity or cohorts where obesity is associated with comorbidities.
Collapse
Affiliation(s)
- Sékou Samadoulougou
- Centre for Research on Planning and Development (CRAD)Laval UniversityQuébecCanada
- Evaluation Platform on Obesity PreventionQuebec Heart and Lung Institute Research CenterQuébecCanada
| | - Leanne Idzerda
- Centre for Research on Planning and Development (CRAD)Laval UniversityQuébecCanada
- Evaluation Platform on Obesity PreventionQuebec Heart and Lung Institute Research CenterQuébecCanada
| | - Roxane Dault
- Research Group in Health Informatics (GRIIS)Université de SherbrookeSherbrookeCanada
| | - Alexandre Lebel
- Centre for Research on Planning and Development (CRAD)Laval UniversityQuébecCanada
- Evaluation Platform on Obesity PreventionQuebec Heart and Lung Institute Research CenterQuébecCanada
- Graduate School of Land Management and Regional Planning, Faculty of Planning, Architecture, Art and DesignLaval UniversityQuébecCanada
| | - Anne‐Marie Cloutier
- Research Group in Health Informatics (GRIIS)Université de SherbrookeSherbrookeCanada
| | - Alain Vanasse
- Département de médecine de famille et médecine d'urgence, Faculté de médecine et des sciences de la santéUniversité de SherbrookeSherbrookeCanada
- Centre de rechercheCIUSSS de l'Estrie‐CHUSSherbrookeCanada
| |
Collapse
|
8
|
Clemens KK, Reid JN, Shariff SZ, Welk B. Validity of Hospital Codes for Obesity in Ontario, Canada. Can J Diabetes 2020; 45:243-248.e4. [PMID: 33109445 DOI: 10.1016/j.jcjd.2020.08.106] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Accepted: 08/26/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Obesity has a significant impact on population health and health care. Administrative databases may be a useful tool to study obesity at a population level. In this work, we aimed to determine the validity of hospital codes for obesity in Ontario, Canada. METHODS Using linked health-care databases (ICES), we conducted a validation study in adults ≥18 years of age who had their height and weight recorded during a hospitalization in southwestern Ontario. We considered a body mass index ≥30 kg/m2 as our gold standard definition for obesity. We then examined the validity of 2 International Classification of Diseases---10th revision (ICD-10) coding algorithms for obesity (Algorithm 1, ICD-10 E66.X; and Algorithm 2, ICD-10 E65.X-68.X). As additional analyses, we examined the validity of algorithms in different obesity classes (i.e. obese classes 1, 2 and 3), and in patients with diagnosed diabetes and hypertension. RESULTS There were 34,588 patients included in our study (mean age, 62 years; 47% female). Algorithm 1 performed best, with a sensitivity, specificity, positive predictive value and negative predictive value of 8.8%, 99.8%, 95.4% and 65.1%, respectively. The sensitivity of this algorithm was highest in patients with obesity class 3 (27.4%) and in those with diagnosed diabetes. CONCLUSIONS Hospital codes for obesity have a high positive predictive value and specificity. These codes can be used to build and study cohorts of patients with obesity in administrative database studies. However, given their limited sensitivity, administrative codes provide inaccurate incidence and prevalence estimates.
Collapse
Affiliation(s)
- Kristin K Clemens
- Department of Medicine, Division of Endocrinology and Metabolism, Western University, London, Ontario, Canada; Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada; ICES, Ontario, Canada; Centre for Diabetes, Endocrinology and Metabolism, St. Joseph's Health Care London, London, Ontario, Canada; Lawson Health Research Institute, London, Ontario, Canada.
| | | | | | - Blayne Welk
- Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada; ICES, Ontario, Canada; Lawson Health Research Institute, London, Ontario, Canada; Division of Urology, Department of Surgery, Western University, London, Ontario, Canada
| |
Collapse
|
9
|
Mo L, Xie Z, Liu G, He Q, Mo Z, Wu Y, Wang W, Ding F, Liao Y, Hao L, Lu C, Sun J, Xu L, Zhang Y, Ghappar R, Peng H, Wei X, Xie J, Chen Y, Liang X. Feasibility of coding-based Charlson comorbidity index for hospitalized patients in China, a representative developing country. BMC Health Serv Res 2020; 20:432. [PMID: 32423399 PMCID: PMC7236530 DOI: 10.1186/s12913-020-05273-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2019] [Accepted: 04/29/2020] [Indexed: 12/21/2022] Open
Abstract
Background The Charlson Comorbidity Index (CCI) can be automatically calculated from the International Classification of Disease (ICD) code. However, the feasibility of this transformation has not been acknowledged, particularly in hospitals without a qualified ICD coding system. Here, we investigated the utility of coding-based CCI in China. Methods A multi-center, population-based, retrospective observational study was conducted, using a dataset incorporating 2,464,395 adult subjects from 15 hospitals. CCI was calculated using both ICD-10-based and diagnosis-based method, according to the transformation rule reported previously and to the literal description from discharge diagnosis, respectively. A κ coefficient of variation was used as a measure of agreement between the above two methods for each hospital. The discriminative abilities of the two methods were compared using the receiver-of-operating characteristic curve (ROC) for prediction of in-hospital mortality. Results Total agreement between the ICD-based and diagnosis-based CCI for each index ranged from 86.1 to 100%, with κ coefficients from 0.210 [95% confidence interval (CI) 0.208–0.212] to 0.932 (95% CI 0.924–0.940). None of the 19 indices of CCI had a κ coefficient > 0.75 in all the hospitals included for study. The area under the curve of ROC for in-hospital mortality of all 15 hospitals was significantly lower for ICD-based than diagnosis-based CCI [0.735 (0.732, 0.739) vs 0.760 (0.757, 0.764)], indicative of more limited discriminative ability of the ICD-based calculation. Conclusions CCI calculated using ICD-10 coding did not agree with diagnosis-based CCI. ICD-based CCI displayed diminished discrimination performance in terms of in-hospital mortality, indicating that this method is not promising for CCI scoring in China under the present circumstances.
Collapse
Affiliation(s)
- Liyi Mo
- Division of Nephrology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, No.106 Zhongshan Road 2, Guangzhou, 510080, Guangdong, China.,Department of Nephrology, Dongguan People's Hospital, Dongguan, 523018, China
| | - Zhen Xie
- Department of Dermatology, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, Chengdu, 610072, China
| | - Guohui Liu
- Department of Nephrology, Dongguan People's Hospital, Dongguan, 523018, China
| | - Qiang He
- Department of Nephrology, Zhejiang Provincial People's Hospital (People's Hospital of Hangzhou Medical College), Hangzhou, 310014, China
| | - Zhiming Mo
- Division of Nephrology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, No.106 Zhongshan Road 2, Guangzhou, 510080, Guangdong, China
| | - Yanhua Wu
- Division of Nephrology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, No.106 Zhongshan Road 2, Guangzhou, 510080, Guangdong, China
| | - Wenji Wang
- Division of Nephrology, Shanghai Ninth People's Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, 200030, China
| | - Feng Ding
- Division of Nephrology, Shanghai Ninth People's Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, 200030, China
| | - Yuanjiang Liao
- Department of Nephrology, Chongqing Ninth People's Hospital, Chongqing, 400700, China
| | - Li Hao
- Department of Nephrology, Second Hospital of Anhui Medical University, Hefei, 230601, China
| | - Chen Lu
- Department of Nephrology, People's Hospital of Xinjiang Uygur Autonomous Region, Urumqi, 830001, China
| | - Jin Sun
- Department of Nephrology, Second Hospital of Jilin University, Changchun, 130022, China
| | - Libin Xu
- Department of Nephrology, Inner Mongolia People's Hospital, Hohhot, 010017, China
| | - Yusheng Zhang
- Second Division of Internal Medicine, Wuhua People's Hospital, Meizhou, 514400, China
| | - Rizwangul Ghappar
- Department of Nephrology, First People's Hospital of Kashgar, Kashgar, 844000, China
| | - Hongwei Peng
- People's Hospital of Wanning & The First Affiliated Hospital of Chongqing Medical Univesity, Wanning, 571500, China
| | - Xiaohong Wei
- Department of Nephrology, Chongzuo People's Hospital, Chongzuo, 844000, China
| | - Jinglie Xie
- Division of Nephrology, Guangdong Lufeng People's Hospital, Lufeng, 516500, China
| | - Yuanhan Chen
- Division of Nephrology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, No.106 Zhongshan Road 2, Guangzhou, 510080, Guangdong, China.
| | - Xinling Liang
- Division of Nephrology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, No.106 Zhongshan Road 2, Guangzhou, 510080, Guangdong, China.
| | | |
Collapse
|
10
|
Daly S, Nguyen TQ, Gabbe BJ, Braaf S, Simpson P, Ekegren CL. Agreement between medical record and administrative coding of common comorbidities in orthopaedic trauma patients. Injury 2019; 50:1277-1283. [PMID: 31109684 DOI: 10.1016/j.injury.2019.05.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Revised: 05/06/2019] [Accepted: 05/07/2019] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To i) quantify the agreement between comorbidities documented within medical records and an orthopaedic trauma dataset; and ii) compare agreement between these sources before and after the introduction of new comorbidity coding rules in Australian hospitals. STUDY DESIGN AND SETTING A random sample of adult (≥ 16 years) orthopaedic trauma patients (n = 400) were extracted from the Victorian Orthopaedic Trauma Outcomes Registry (VOTOR). Diagnoses of obesity, arthritis, diabetes and cardiac conditions documented within patients' medical records were compared to ICD-10-AM comorbidity codes (provided by hospitals) for the same admission. Agreement was calculated (Cohen's kappa) before and after the introduction of new coding rules. RESULTS All comorbidities had the same or higher prevalence in medical record data compared to coded data. Kappa values ranged from <0.001 (poor agreement) for coronary artery disease to 0.94 (excellent agreement) for type 2 diabetes. There was improvement in agreement between sources for most conditions following the introduction of new coding rules. CONCLUSION There has been improvement in the coding of certain comorbidities since the introduction of new coding rules, suggesting that, since 2015, administrative data has improved capacity to capture patients' comorbidity profiles. Consideration must be taken when using the ICD-10-AM data due to its limitations.
Collapse
Affiliation(s)
- Stuart Daly
- School of Medicine, Monash University, Melbourne, VIC, Australia
| | - Tu Q Nguyen
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Belinda J Gabbe
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia; Health Data Research, UK
| | - Sandra Braaf
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Pamela Simpson
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Christina L Ekegren
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia.
| |
Collapse
|
11
|
A National Population-based Study of Adults With Coronary Artery Disease and Coarctation of the Aorta. Am J Cardiol 2018; 122:2120-2124. [PMID: 30318418 DOI: 10.1016/j.amjcard.2018.08.051] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Revised: 08/28/2018] [Accepted: 08/30/2018] [Indexed: 11/23/2022]
Abstract
Adults with repaired coarctation of the aorta (CoA) suffer reduced long-term survival compared with the general population, in part due to coronary artery disease (CAD). There is conflicting evidence as to whether or not CoA is an independent risk factor for CAD. The primary aim was to determine if CoA is independently associated with premature myocardial infarction (MI) in the contemporary era. The secondary aim was to determine if CoA is independently associated with early coronary intervention. In a cross-sectional study using the National Inpatient Sample database from 2005 to 2014, we compared the age at MI and the age at coronary intervention (coronary artery bypass grafting or percutaneous coronary intervention, in the absence of MI diagnosis) in patients with and without CoA using weighted linear regression. Among 5,472,416 observations with a primary diagnosis of MI, 174 had a diagnosis of CoA. Patients with CoA had MI 7.2 years younger than those without CoA, after adjusting for potential confounders (95% CI -11.3, -3.1, p = 0.001). Among 3,631,718 patients without a diagnosis of MI who underwent coronary artery bypass grafting or percutaneous coronary intervention, 279 had a diagnosis of CoA. Patients with CoA who underwent coronary intervention were 15.6 years younger than those without CoA, after adjusting for potential confounders (95% CI -18.3, -12.9, p < 0.001). In conclusion, patients with CoA have MI at a slightly younger age and undergo coronary intervention at a significantly younger age than those without CoA in the contemporary era. Our findings support continued close surveillance for and treatment of modifiable risk factors for CAD.
Collapse
|
12
|
Morais A, Kelly J, Bost JE, Vaidya SS. Characteristics of Correctly Identified Pediatric Obesity and Overweight Status and Management in an Academic General Pediatric Clinic. Clin Pediatr (Phila) 2018. [PMID: 29514514 DOI: 10.1177/0009922818761891] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This study identified and characterized the rates of documentation and guideline-based management of overweight and obese children within an academic pediatric clinic through a retrospective electronic medical record review of 7422 well-child visits in 2016. Diagnosis and treatment were analyzed by patient's weight diagnosis, sex, age, and provider training level. The percentages of correctly identified severely obese (90.2%), obese (77.0%), and overweight (42.0%) children were much higher than in previous retrospective chart reviews; however, less than 30% of children were referred for more intensive weight management to a dietitian or pediatric obesity weight management program. Increased provider training level was associated with a lower adherence to pediatric obesity guidelines. Strategic modifications to electronic medical records that automatically offer body mass index-associated weight diagnoses with a link to treatment pathways and resources are needed to facilitate improved compliance with current pediatric obesity guidelines in the primary care setting.
Collapse
Affiliation(s)
- Ana Morais
- 1 George Washington University, Washington, DC, USA
| | - Joseph Kelly
- 2 Children's National Health System, Washington, DC, USA
| | - James E Bost
- 2 Children's National Health System, Washington, DC, USA
| | | |
Collapse
|
13
|
Pickard SS, Gauvreau K, Gurvitz M, Gagne JJ, Opotowsky AR, Jenkins KJ, Prakash A. Stroke in Adults With Coarctation of the Aorta: A National Population-Based Study. J Am Heart Assoc 2018; 7:e009072. [PMID: 29858370 PMCID: PMC6015389 DOI: 10.1161/jaha.118.009072] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Accepted: 04/12/2018] [Indexed: 11/16/2022]
Abstract
BACKGROUND Adults with repaired coarctation of the aorta (CoA) have reduced long-term survival compared with the general population. This study aimed to determine whether CoA is independently associated with premature ischemic and hemorrhagic stroke in the contemporary era. METHODS AND RESULTS This was a cross-sectional study utilizing the National Inpatient Sample database from 2005 to 2014. We hypothesized that patients with CoA are hospitalized with ischemic and hemorrhagic stroke at a younger age compared with the general population. To test this hypothesis, we compared the age at stroke in patients with and without a diagnosis of CoA using simple and multivariable weighted linear regression. Among 4 894 582 stroke discharges, 207 had a diagnosis of CoA. Patients with CoA had strokes at significantly younger age compared with patients without CoA: 18.9 years younger for all-cause stroke (P<0.001), 15.9 years younger for ischemic stroke (P<0.001), and 28.5 years younger for hemorrhagic stroke (P<0.001), after adjusting for potential confounders. There was no significant difference in the proportion of ischemic strokes between those with and without CoA (79.2% versus 83.0%, P=0.50). However, CoA patients had a higher proportion of subarachnoid hemorrhage (11.8% versus 4.8%, P=0.039) than those without CoA. Among patients who had a hemorrhagic stroke, the prevalence of unruptured intracranial aneurysms was higher in patients with CoA compared with those without CoA (23.3% versus 2.5%, P=0.002). CONCLUSIONS Patients with CoA have both ischemic and hemorrhagic strokes at significantly younger ages compared with the general population.
Collapse
Affiliation(s)
- Sarah S Pickard
- Department of Cardiology, Boston Children's Hospital, Boston, MA
- Department of Pediatrics, Harvard Medical School, Boston, MA
| | - Kimberlee Gauvreau
- Department of Cardiology, Boston Children's Hospital, Boston, MA
- Department of Pediatrics, Harvard Medical School, Boston, MA
| | - Michelle Gurvitz
- Department of Cardiology, Boston Children's Hospital, Boston, MA
- Department of Pediatrics, Harvard Medical School, Boston, MA
| | - Joshua J Gagne
- Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women's Hospital and Harvard Medical School, Boston, MA
- Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA
| | - Alexander R Opotowsky
- Department of Cardiology, Boston Children's Hospital, Boston, MA
- Department of Pediatrics, Harvard Medical School, Boston, MA
- Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA
| | - Kathy J Jenkins
- Department of Cardiology, Boston Children's Hospital, Boston, MA
- Department of Pediatrics, Harvard Medical School, Boston, MA
| | - Ashwin Prakash
- Department of Cardiology, Boston Children's Hospital, Boston, MA
- Department of Pediatrics, Harvard Medical School, Boston, MA
| |
Collapse
|
14
|
Cygan H, Reed M, Lui K, Mullen M. The Chronic Care Model to Improve Management of Childhood Obesity. Clin Pediatr (Phila) 2018; 57:727-732. [PMID: 29019281 DOI: 10.1177/0009922817734357] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
One-third of children in the United States are overweight or obese. Comorbidities continue into adulthood if a healthy weight is not established. While expert guidelines for management of this condition are recognized, provider adherence to guidelines is lacking. The purpose of this quality improvement project was to evaluate the effectiveness of the chronic care model (CCM) on improving primary care provider identification, prevention, and management of childhood overweight and obesity. A pre- and postintervention chart audit was completed to evaluate documentation of 20 assessment measures included in expert guidelines. A chi-square analysis was conducted to assess differences. Statistically significant improvements were found in documentation of parental obesity, family medical history, sleep assessment, endocrine assessment, and weight classification as a diagnosis. Use of the CCM had a positive impact on provider adherence to expert guidelines. Furthermore, not all aspects of the CCM must be used to see statistically significant improvements.
Collapse
|
15
|
Foy AJ, Mandrola J, Liu G, Naccarelli GV. Relation of Obesity to New-Onset Atrial Fibrillation and Atrial Flutter in Adults. Am J Cardiol 2018; 121:1072-1075. [PMID: 29501206 DOI: 10.1016/j.amjcard.2018.01.019] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2017] [Revised: 01/12/2018] [Accepted: 01/17/2018] [Indexed: 11/15/2022]
Abstract
Prospective cohort studies involving older adults report an association of obesity and new-onset atrial fibrillation and atrial flutter. To assess this relation, we performed a longitudinal cohort study from January 1, 2006 to December 31, 2013, using a national claims database that tracks all inpatient, outpatient, and pharmacy claims data. The primary end point of new-onset atrial fibrillation was compared between obese and nonobese cohorts. We used logistic regression to determine the strength of association between obesity and new-onset atrial fibrillation controlling for age, gender, hypertension, and diabetes. Overall, 67,278 subjects were included in the cohort, divided evenly between those with and without a diagnosis of obesity. Obese subjects were significantly more likely to have hypertension (29.5% vs 14.6%) and diabetes (12.7% vs 5.2%) at study onset. Over 8 years of follow-up, we recorded a new diagnosis of atrial fibrillation in 1,511 (2.2%) subjects. Obesity was strongly associated with a new diagnosis of atrial fibrillation after controlling for age, gender, hypertension, and diabetes (odds ratio 1.4, 95% confidence interval 1.3 to 1.6). In conclusion, this information contributes to the growing evidence supporting the causal relation between obesity and atrial fibrillation, and emphasizes the need of addressing obesity as part of our therapeutic strategy to prevent atrial fibrillation.
Collapse
Affiliation(s)
- Andrew J Foy
- Division of Cardiology, Penn State Heart and Vascular Institute, Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania; Department of Public Health Sciences, Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania.
| | - John Mandrola
- Cardiology Group, Baptist Health Louisville, Louisville, Kentucky
| | - Guodong Liu
- Department of Public Health Sciences, Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania
| | - Gerald V Naccarelli
- Division of Cardiology, Penn State Heart and Vascular Institute, Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania
| |
Collapse
|
16
|
Rhee KE, Kessl S, Lindback S, Littman M, El-Kareh RE. Provider views on childhood obesity management in primary care settings: a mixed methods analysis. BMC Health Serv Res 2018; 18:55. [PMID: 29378579 PMCID: PMC5789606 DOI: 10.1186/s12913-018-2870-y] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2017] [Accepted: 01/21/2018] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Pediatric providers are key players in the treatment of childhood obesity, yet rates of obesity management in the primary care setting are low. The goal of this study was to examine the views of pediatric providers on conducting obesity management in the primary care setting, and identify potential resources and care models that could facilitate delivery of this care. METHODS A mixed methods approach was utilized. Four focus groups were conducted with providers from a large pediatric network in San Diego County. Based on a priori and emerging themes, a questionnaire was developed and administered to the larger group of providers in this network. RESULTS Barriers to conducting obesity management fell into four categories: provider-level/individual (e.g., lack of knowledge and confidence), practice-based/systems-level (e.g., lack of time and resources), parent-level (e.g., poor motivation and follow-up), and environmental (e.g., lack of access to resources). Solutions centered around implementing a team approach to care (with case managers and health coaches) and electronic medical record changes to include best practice guidelines, increased ease of documentation, and delivery of standardized handouts/resources. Survey results revealed only 23.8% of providers wanted to conduct behavioral management of obesity. The most requested support was the introduction of a health educator in the office to deliver a brief behavioral intervention. CONCLUSION While providers recognize the importance of addressing weight during a well-child visit, they do not want to conduct obesity management on their own. Future efforts to improve health outcomes for pediatric obesity should consider implementing a collaborative care approach.
Collapse
Affiliation(s)
- Kyung E. Rhee
- Department of Pediatrics, University of California, San Diego, 9500 Gilman Drive, MC 0874, La Jolla, CA 92093 USA
| | - Stephanie Kessl
- Department of Pediatrics, University of California, San Diego, 9500 Gilman Drive, MC 0874, La Jolla, CA 92093 USA
| | - Sarah Lindback
- Department of Pediatrics, University of California, San Diego, 9500 Gilman Drive, MC 0874, La Jolla, CA 92093 USA
- Children’s Primary Care Medical Group, San Diego, CA USA
| | | | - Robert E. El-Kareh
- University of California, San Diego, Departments of Biomedical Informatics and Medicine, La Jolla, CA USA
| |
Collapse
|
17
|
Lebenbaum M, Espin-Garcia O, Li Y, Rosella LC. Development and validation of a population based risk algorithm for obesity: The Obesity Population Risk Tool (OPoRT). PLoS One 2018; 13:e0191169. [PMID: 29346391 PMCID: PMC5773177 DOI: 10.1371/journal.pone.0191169] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2017] [Accepted: 12/01/2017] [Indexed: 11/18/2022] Open
Abstract
Background Given the dramatic rise in the prevalence of obesity, greater focus on prevention is necessary. We sought to develop and validate a population risk tool for obesity to inform prevention efforts. Methods We developed the Obesity Population Risk Tool (OPoRT) using the longitudinal National Population Health Survey and sex-specific Generalized Estimating Equations to predict the 10-year risk of obesity among adults 18 and older. The model was validated using a bootstrap approach accounting for the survey design. Model performance was measured by the Brier statistic, discrimination was measured by the C-statistic, and calibration was assessed using the Hosmer-Lemeshow Goodness of Fit Chi Square (HL χ2). Results Predictive factors included baseline body mass index, age, time and their interactions, smoking status, living arrangements, education, alcohol consumption, physical activity, and ethnicity. OPoRT showed good performance for males and females (Brier 0.118 and 0.095, respectively), excellent discrimination (C statistic ≥ 0.89) and achieved calibration (HL χ2 <20). Conclusion OPoRT is a valid and reliable algorithm that can be applied to routinely collected survey data to estimate the risk of obesity and identify groups at increased risk of obesity. These results can guide prevention efforts aimed at reducing the population burden of obesity.
Collapse
Affiliation(s)
- Michael Lebenbaum
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
| | - Osvaldo Espin-Garcia
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Yi Li
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Public Health Ontario, Toronto, Ontario, Canada
| | - Laura C. Rosella
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
- Public Health Ontario, Toronto, Ontario, Canada
- * E-mail:
| |
Collapse
|
18
|
Yang S, Lix LM, Yan L, Hinds AM, Leslie WD. International Classification of Diseases (ICD)-coded obesity predicts risk of incident osteoporotic fracture. PLoS One 2017; 12:e0189168. [PMID: 29216254 PMCID: PMC5720696 DOI: 10.1371/journal.pone.0189168] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2017] [Accepted: 11/20/2017] [Indexed: 11/25/2022] Open
Abstract
International Classification of Diseases (ICD) codes have been used to ascertain individuals who are obese. There has been limited research about the predictive value of ICD-coded obesity for major chronic conditions at the population level. We tested the utility of ICD-coded obesity versus measured obesity for predicting incident major osteoporotic fracture (MOF), after adjusting for covariates (i.e., age and sex). In this historical cohort study (2001–2015), we selected 61,854 individuals aged 50 years and older from the Manitoba Bone Mineral Density Database, Canada. Body mass index (BMI) ≥30 kg/m2 was used to define measured obesity. Hospital and physician ICD codes were used to ascertain ICD-coded obesity and incident MOF. Average cohort age was 66.3 years and 90.3% were female. The sensitivity, specificity and positive predictive value for ICD-coded obesity using measured obesity as the reference were 0.11 (95% confidence interval [CI]: 0.10, 0.11), 0.99 (95% CI: 0.99, 0.99) and 0.79 (95% CI: 0.77, 0.81), respectively. ICD-coded obesity (adjusted hazard ratio [HR] 0.83; 95% CI: 0.70, 0.99) and measured obesity (adjusted HR 0.83; 95% CI: 0.78, 0.88) were associated with decreased MOF risk. Although the area under the receiver operating characteristic curve (AUROC) estimates for incident MOF were not significantly different for ICD-coded obesity versus measured obesity (0.648 for ICD-coded obesity versus 0.650 for measured obesity; P = 0.056 for AUROC difference), the category-free net reclassification index for ICD-coded obesity versus measured obesity was -0.08 (95% CI: -0.11, -0.06) for predicting incident MOF. ICD-coded obesity predicted incident MOF, though it had low sensitivity and reclassified MOF risk slightly less well than measured obesity.
Collapse
Affiliation(s)
- Shuman Yang
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Changchun, Jilin, China
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
- Department of Internal Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
- * E-mail:
| | - Lisa M. Lix
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Lin Yan
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Aynslie M. Hinds
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - William D. Leslie
- Department of Internal Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| |
Collapse
|
19
|
Wei YJ, Liu X, Rao N, McPherson M, Jones MB, Bussing R, Winterstein AG. Physical Health Outcomes in Preschoolers with Prior Authorization for Antipsychotics. J Child Adolesc Psychopharmacol 2017; 27:833-839. [PMID: 28708433 PMCID: PMC5824663 DOI: 10.1089/cap.2017.0006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
OBJECTIVE To examine incidence of adverse health outcomes and associated factors among preschoolers (under age 6) who received antipsychotic treatment through the Florida Medicaid Prior Authorization (PA) program. METHODS Using Florida's PA registry linked to the state's Medicaid claims data, we ascertained incident outcomes during PA-approved antipsychotic use between April 2008 and September 2015 (7.5 years). Six outcomes associated with use of antipsychotics included: diabetes, obesity, hyperlipidemia, hyperprolactinemia, cardiovascular disease (CVD) (including hypertension, ventricular arrhythmia, and other CVDs), and extrapyramidal symptoms (EPS) (including dystonia, akathisia, parkinsonism, and tardive dyskinesia). Outcome-specific incidences were stratified by short-term (≤1 year) and long-term (>1-7 years) antipsychotic use. We used multivariate modified Poisson regressions to determine factors associated with these outcomes among preschoolers. RESULTS The overall crude incidence during PA-approved antipsychotic use was highest for EPS and obesity (57 and 19 cases/1000 children-years, respectively). The rate of these two outcomes differed by duration of antipsychotic use. We observed a higher obesity (23.8 vs. 9.6, p < 0.001) and dystonia incidence (7.2 vs. 2.5, p < 0.05), but lower akathisia incidence (44.4 vs. 60.6, p < 0.05) among long-term antipsychotic users compared with short-term users. Five outcomes-ventricular arrhythmia, other cardiovascular side effects, hyperprolactinemia, parkinsonism, and tardive dyskinesia-occurred rarely (<2.0/1000 children-years). Preschoolers who were younger at baseline (≤2 years old vs. 4-5 years old) and Black (vs. White) were at a higher risk of EPS. CONCLUSION Risk for EPS and obesity deserves clinical attention during antipsychotic treatment among preschoolers. Controlled studies that allow interpretation of these incidence rates in the context of background risk and that formally quantify the incremental risk associated with antipsychotic initiation during early childhood are needed.
Collapse
Affiliation(s)
- Yu-Jung Wei
- Department of Pharmaceutical Outcomes and Policy, University of Florida College of Pharmacy, Gainesville, Florida
| | - Xinyue Liu
- Department of Pharmaceutical Outcomes and Policy, University of Florida College of Pharmacy, Gainesville, Florida
| | - Nikhil Rao
- Department of Psychiatry, University of Florida College of Medicine, Gainesville, Florida
| | - Marie McPherson
- Florida Mental Health Institute, University of South Florida, Tampa, Florida
| | - Mary Beth Jones
- Florida Agency for Health Care Administration, Tallahassee, Florida
| | - Regina Bussing
- Department of Psychiatry, University of Florida College of Medicine, Gainesville, Florida
| | - Almut G. Winterstein
- Department of Pharmaceutical Outcomes and Policy, University of Florida College of Pharmacy, Gainesville, Florida.,Department of Epidemiology, University of Florida Colleges of Medicine and Public Health & Health Professions, Florida
| |
Collapse
|
20
|
Bush RA, Connelly CD, Pérez A, Barlow H, Chiang GJ. Extracting autism spectrum disorder data from the electronic health record. Appl Clin Inform 2017; 8:731-741. [PMID: 28925416 DOI: 10.4338/aci-2017-02-ra-0029] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Accepted: 05/07/2017] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Little is known about the health care utilization patterns of individuals with pediatric autism spectrum disorder (ASD). OBJECTIVES Electronic health record (EHR) data provide an opportunity to study medical utilization and track outcomes among children with ASD. Methods: Using a pediatric, tertiary, academic hospital's Epic EHR, search queries were built to identify individuals aged 2-18 with International Classification of Diseases, Ninth Revision (ICD-9) codes, 299.00, 299.10, and 299.80 in their records. Codes were entered in the EHR using four different workflows: (1) during an ambulatory visit, (2) abstracted by Health Information Management (HIM) for an encounter, (3) recorded on the patient problem list, or (4) added as a chief complaint during an Emergency Department visit. Once individuals were identified, demographics, scheduling, procedures, and prescribed medications were extracted for all patient-related encounters for the period October 2010 through September 2012. RESULTS There were 100,000 encounters for more than 4,800 unique individuals. Individuals were most frequently identified with an HIM abstracted code (82.6%) and least likely to be identified by a chief complaint (45.8%). Categorical frequency for reported race (2 = 816.5, p < 0.001); payor type (2 = 354.1, p < 0.001); encounter type (2 = 1497.0, p < 0.001); and department (2 = 3722.8, p < 0.001) differed by search query. Challenges encountered included, locating available discrete data elements and missing data. CONCLUSIONS This study identifies challenges inherent in designing inclusive algorithms for identifying individuals with ASD and demonstrates the utility of employing multiple extractions to improve the completeness and quality of EHR data when conducting research.
Collapse
Affiliation(s)
- Ruth A Bush
- Ruth A. Bush PhD, MPH, Hahn School of Nursing and Health Science, Beyster Institute for Nursing Research, University of San Diego, San Diego, USA,
| | | | | | | | | |
Collapse
|
21
|
Christiansen MN, Køber L, Weeke P, Vasan RS, Jeppesen JL, Smith JG, Gislason GH, Torp-Pedersen C, Andersson C. Age-Specific Trends in Incidence, Mortality, and Comorbidities of Heart Failure in Denmark, 1995 to 2012. Circulation 2017; 135:1214-1223. [DOI: 10.1161/circulationaha.116.025941] [Citation(s) in RCA: 137] [Impact Index Per Article: 19.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2016] [Accepted: 01/26/2017] [Indexed: 02/06/2023]
Abstract
Background:
The cumulative burden and importance of cardiovascular risk factors have changed over the past decades. Specifically, obesity rates have increased among younger people, whereas cardiovascular health has improved in the elderly. Little is known regarding how these changes have impacted the incidence and the mortality rates of heart failure. Therefore, we aimed to investigate the age-specific trends in the incidence and 1-year mortality rates following a first-time diagnosis of heart failure in Denmark between 1995 and 2012.
Methods:
We included all Danish individuals >18 years of age with a first-time in-hospital diagnosis of heart failure. Data were collected from 3 nationwide Danish registries. Annual incidence rates of heart failure and 1-year standardized mortality rates were calculated under the assumption of a Poisson distribution.
Results:
We identified 210 430 individuals with a first-time diagnosis of heart failure between 1995 and 2012; the annual incidence rates per 10 000 person-years declined among older individuals (rates in 1995 versus 2012: 164 versus 115 in individuals >74 years, 63 versus 35 in individuals 65–74 years, and 20 versus 17 in individuals 55–64 years;
P
<0.0001 for all) but increased among the younger (0.4 versus 0.7 in individuals 18–34 years, 1.3 versus 2.0 in individuals 35–44 years, and 5.0 versus 6.4 in individuals 45–54 years;
P
<0.0001 for all). The proportion of patients with incident heart failure ≤50 years of age doubled from 3% in 1995 to 6% in 2012 (
P
<0.0001). Sex- and age-adjusted incidence rate ratios for 2012 versus 1996 were 0.69 (95% confidence interval, 0.67–0.71;
P
<0.0001) among people >50 years of age, and 1.52 (95% confidence interval, 1.33–1.73;
P
<0.0001) among individuals ≤50 years of age; it remained essentially unchanged on additional adjustment for diabetes mellitus, ischemic heart disease, and hypertension. Standardized 1-year mortality rates declined for middle-aged patients with heart failure but remained constant for younger (<45 years) and elderly (≥65 years) patients. The prevalence of comorbidities (including diabetes mellitus, hypertension, and atrial fibrillation) increased, especially in younger patients with heart failure.
Conclusions:
Over the past 2 decades, the incidence of heart failure in Denmark declined among older individuals (>50 years), but increased among younger (≤50 years) individuals. These observations may portend a rising burden of heart failure in the community.
Collapse
Affiliation(s)
- Mia N. Christiansen
- From Department of Cardiology, The Heart Centre, Rigshospitalet, University of Copenhagen, Denmark (M.N.C., L.K.); Department of Cardiology, The Cardiovascular Research Centre, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup, Denmark (P.W., G.H.G.); Sections of Preventive Medicine and Cardiology, Departments of Medicine and Epidemiology, Boston University Schools of Medicine and Public Health, MA (R.S.V.); Department of Internal Medicine, Section of Cardiology, Amager Hvidovre
| | - Lars Køber
- From Department of Cardiology, The Heart Centre, Rigshospitalet, University of Copenhagen, Denmark (M.N.C., L.K.); Department of Cardiology, The Cardiovascular Research Centre, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup, Denmark (P.W., G.H.G.); Sections of Preventive Medicine and Cardiology, Departments of Medicine and Epidemiology, Boston University Schools of Medicine and Public Health, MA (R.S.V.); Department of Internal Medicine, Section of Cardiology, Amager Hvidovre
| | - Peter Weeke
- From Department of Cardiology, The Heart Centre, Rigshospitalet, University of Copenhagen, Denmark (M.N.C., L.K.); Department of Cardiology, The Cardiovascular Research Centre, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup, Denmark (P.W., G.H.G.); Sections of Preventive Medicine and Cardiology, Departments of Medicine and Epidemiology, Boston University Schools of Medicine and Public Health, MA (R.S.V.); Department of Internal Medicine, Section of Cardiology, Amager Hvidovre
| | - Ramachandran S. Vasan
- From Department of Cardiology, The Heart Centre, Rigshospitalet, University of Copenhagen, Denmark (M.N.C., L.K.); Department of Cardiology, The Cardiovascular Research Centre, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup, Denmark (P.W., G.H.G.); Sections of Preventive Medicine and Cardiology, Departments of Medicine and Epidemiology, Boston University Schools of Medicine and Public Health, MA (R.S.V.); Department of Internal Medicine, Section of Cardiology, Amager Hvidovre
| | - Jørgen L. Jeppesen
- From Department of Cardiology, The Heart Centre, Rigshospitalet, University of Copenhagen, Denmark (M.N.C., L.K.); Department of Cardiology, The Cardiovascular Research Centre, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup, Denmark (P.W., G.H.G.); Sections of Preventive Medicine and Cardiology, Departments of Medicine and Epidemiology, Boston University Schools of Medicine and Public Health, MA (R.S.V.); Department of Internal Medicine, Section of Cardiology, Amager Hvidovre
| | - J. Gustav Smith
- From Department of Cardiology, The Heart Centre, Rigshospitalet, University of Copenhagen, Denmark (M.N.C., L.K.); Department of Cardiology, The Cardiovascular Research Centre, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup, Denmark (P.W., G.H.G.); Sections of Preventive Medicine and Cardiology, Departments of Medicine and Epidemiology, Boston University Schools of Medicine and Public Health, MA (R.S.V.); Department of Internal Medicine, Section of Cardiology, Amager Hvidovre
| | - Gunnar H. Gislason
- From Department of Cardiology, The Heart Centre, Rigshospitalet, University of Copenhagen, Denmark (M.N.C., L.K.); Department of Cardiology, The Cardiovascular Research Centre, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup, Denmark (P.W., G.H.G.); Sections of Preventive Medicine and Cardiology, Departments of Medicine and Epidemiology, Boston University Schools of Medicine and Public Health, MA (R.S.V.); Department of Internal Medicine, Section of Cardiology, Amager Hvidovre
| | - Christian Torp-Pedersen
- From Department of Cardiology, The Heart Centre, Rigshospitalet, University of Copenhagen, Denmark (M.N.C., L.K.); Department of Cardiology, The Cardiovascular Research Centre, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup, Denmark (P.W., G.H.G.); Sections of Preventive Medicine and Cardiology, Departments of Medicine and Epidemiology, Boston University Schools of Medicine and Public Health, MA (R.S.V.); Department of Internal Medicine, Section of Cardiology, Amager Hvidovre
| | - Charlotte Andersson
- From Department of Cardiology, The Heart Centre, Rigshospitalet, University of Copenhagen, Denmark (M.N.C., L.K.); Department of Cardiology, The Cardiovascular Research Centre, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup, Denmark (P.W., G.H.G.); Sections of Preventive Medicine and Cardiology, Departments of Medicine and Epidemiology, Boston University Schools of Medicine and Public Health, MA (R.S.V.); Department of Internal Medicine, Section of Cardiology, Amager Hvidovre
| |
Collapse
|
22
|
Gentile N, Cristiani V, Lynch BA, Wilson PM, Weaver AL, Rutten LJ, Jacobson DJ, Chaudhry R, Sriram S, Kumar S. The effect of an automated point of care tool on diagnosis and management of childhood obesity in primary care. J Eval Clin Pract 2016; 22:958-964. [PMID: 27282887 DOI: 10.1111/jep.12572] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2016] [Accepted: 04/29/2016] [Indexed: 01/16/2023]
Abstract
BACKGROUND Childhood obesity is underdiagnosed in primary care practices. Our study aimed to compare rates of documentation of diagnosis of obesity and counselling for nutrition and physical activity at an academic primary care practice prior to and following implementation of a body mass index (BMI)-based electronic point of care clinical reminder tool. METHODS We performed a retrospective record review of children aged 2-18 years undergoing well child visits during any of three calendar years (2009, 2011 and 2013). The electronic clinical reminder tool was implemented in September 2010. Records of children with BMI > 95th percentile were electronically searched for terms of documentation of diagnosis of obesity and nutrition and physical activity counselling. Multivariable logistic regression models were used to adjust for potential patient and provider confounders. RESULTS Among those with BMI ≥ 95th percentile, there was a statistically significant increase in documentation of diagnosis of obesity (45.5% in 2009 vs. 52.4% in 2011; P < 0.001; adjusted odds ratio 1.36; 95% CI 1.13-1.65) and in counselling for physical activity and nutrition (66.8% in 2009 vs. 75.2% in 2011; P < 0.001; adjusted odds ratio 1.33; 95% CI 1.06-1.66) following implementation of the tool. Compared with 2011, there was no statistically significant increase in documentation of obesity (50.4%) or nutrition and physical activity counselling (77.9%) in 2013. CONCLUSIONS The implementation of a point of care clinical reminder tool was associated with improvement in documentation of diagnosis of obesity and counselling for nutrition and physical activity. Further studies are needed to determine the impact of these automated tools on weight outcomes in children.
Collapse
Affiliation(s)
- Natalie Gentile
- Department of Family Medicine, Mayo Clinic, Rochester, MN, USA
| | - Valeria Cristiani
- Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN, USA
| | - Brian A Lynch
- Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN, USA
| | - Patrick M Wilson
- Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA
| | - Amy L Weaver
- Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA
| | - Lila J Rutten
- Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA
| | - Debra J Jacobson
- Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA
| | - Rajeev Chaudhry
- Division of Primary Care Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Swetha Sriram
- Division of Pediatric Endocrinology and Metabolism, Mayo Clinic, Rochester, MN, USA
| | - Seema Kumar
- Division of Pediatric Endocrinology and Metabolism, Mayo Clinic, Rochester, MN, USA
| |
Collapse
|
23
|
Suboptimal Clinical Documentation in Young Children with Severe Obesity at Tertiary Care Centers. Int J Pediatr 2016; 2016:4068582. [PMID: 27698673 PMCID: PMC5028875 DOI: 10.1155/2016/4068582] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2016] [Revised: 08/04/2016] [Accepted: 08/08/2016] [Indexed: 12/13/2022] Open
Abstract
Background and Objectives. The prevalence of severe obesity in children has doubled in the past decade. The objective of this study is to identify the clinical documentation of obesity in young children with a BMI ≥ 99th percentile at two large tertiary care pediatric hospitals. Methods. We used a standardized algorithm utilizing data from electronic health records to identify children with severe early onset obesity (BMI ≥ 99th percentile at age <6 years). We extracted descriptive terms and ICD-9 codes to evaluate documentation of obesity at Boston Children's Hospital and Cincinnati Children's Hospital and Medical Center between 2007 and 2014. Results. A total of 9887 visit records of 2588 children with severe early onset obesity were identified. Based on predefined criteria for documentation of obesity, 21.5% of children (13.5% of visits) had positive documentation, which varied by institution. Documentation in children first seen under 2 years of age was lower than in older children (15% versus 26%). Documentation was significantly higher in girls (29% versus 17%, p < 0.001), African American children (27% versus 19% in whites, p < 0.001), and the obesity focused specialty clinics (70% versus 15% in primary care and 9% in other subspecialty clinics, p < 0.001). Conclusions. There is significant opportunity for improvement in documentation of obesity in young children, even years after the 2007 AAP guidelines for management of obesity.
Collapse
|
24
|
Ng DB, McCart M, Klein C, Campbell C, Schoenhaus R, Berner T. Evaluating Outcomes in Patients with Overactive Bladder within an Integrated Healthcare Delivery System Using a Treatment Patterns Analyzer. AMERICAN HEALTH & DRUG BENEFITS 2016; 9:343-353. [PMID: 27924187 PMCID: PMC5123653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 01/11/2016] [Accepted: 06/03/2016] [Indexed: 06/06/2023]
Abstract
BACKGROUND Overactive bladder (OAB) is a relatively common disease that has been linked to a variety of comorbidities, reductions in quality of life, and increased healthcare costs. Antimuscarinic agents are the standard of care among pharmacologic treatments for OAB, but these drugs are linked to high levels of anticholinergic burden, especially in the elderly. OBJECTIVE To demonstrate how efficient data analysis can be used to identify gaps in care as a result of improvement strategies for OAB within an integrated healthcare delivery system setting. METHODS We developed an OAB treatment patterns analyzer, a clinical outcomes software analysis program, to identify gaps in care, high anticholinergic burden, and potential quality improvement initiatives. Deidentified pharmacy and medical claims data from an integrated delivery network were imported into the OAB treatment patterns analyzer. Patients with a diagnosis of OAB who were continuously enrolled in the network between January 1, 2009, and December 31, 2013, were identified and were imported into the analyzer. The analyzer used National Drug Code; International Classification of Diseases, Ninth Edition, Clinical Modification; Current Procedural Terminology; and UB-92 codes to measure treatment patterns, comorbid conditions, anticholinergic burden, concomitant use with anticholinesterases, costs, and healthcare resource utilization. RESULTS Of 157,710 members in the integrated delivery network population, 7309 patients met the study eligibility criteria. Of patients taking medications for OAB, 85% were nonadherent and 73% discontinued treatment within 1 year. Among 1147 patients in the integrated healthcare delivery system who were using medications for OAB, 39 (3.4%) patients were concomitantly taking anticholinesterase drugs and an antimuscarinic agent. The per-month plan-paid cost per member was $318.67. Of all the patients with OAB within the population, the rates of all-cause office visits, emergency department visits, and hospitalizations were 81%, 6%, and 4%, respectively. The rate of clinically relevant anticholinergic burden was 16%, with higher rates among patients with dementia who were also receiving a branded (20%) or generic (24%) antimuscarinic drug. CONCLUSION In patients using medications for the treatment of OAB, the rates of medication persistence and adherence were poor. Antimuscarinic medications may place certain patient populations at risk for increased anticholinergic burden. Data included in the analyzer can be used to implement member-specific strategies to prevent poor outcomes and reduce associated healthcare costs and utilization.
Collapse
Affiliation(s)
- Daniel B Ng
- Associate Director, Health Economics and Clinical Outcomes Research, Astellas Pharma Global Development, Northbrook, IL
| | - Melissa McCart
- Assistant Director, Global Health Economics and Outcomes Research, Xcenda, Palm Harbor, FL
| | | | - Chelsey Campbell
- Assistant Director, Global Health Economics and Outcomes Research, Xcenda
| | | | - Todd Berner
- Director, Health Economics and Clinical Outcomes Research, Astellas Scientific and Medical Affairs, Northbrook, IL
| |
Collapse
|
25
|
Reed M, Cygan H, Lui K, Mullen M. Identification, Prevention, and Management of Childhood Overweight and Obesity in a Pediatric Primary Care Center. Clin Pediatr (Phila) 2016; 55:860-6. [PMID: 26581352 DOI: 10.1177/0009922815614350] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Background In the United States, overweight/obesity among youth has reached epidemic proportions. The purpose of this project was to (1) examine primary care provider adherence to American Academy of Pediatrics guidelines; (2) compare adherence based on patients' weight classification, age, race, and gender; and (3) identify areas for improvement in health care delivery. Methods A retrospective chart audit and feedback quality improvement project was conducted with a stratified random sample of 175 charts of 6- to 19-year-olds seen for well-child visits. Frequencies of provider adherence were reported. χ(2) Analyses of weight classification, age, race, or gender influence on adherence was calculated. Results After discussion with the primary care providers, 5 areas were identified as priorities for change (diagnosis based on BMI, parental history of obesity, sleep assessment, endocrine assessment, and attendance of patients at the follow-up visit). Conclusion Cost-efficient, feasible strategies to improve provider adherence to recommendations for identification, prevention and management of childhood overweight and obesity were identified.
Collapse
|
26
|
Aragona E, El-Magbri E, Wang J, Scheckelhoff T, Scheckelhoff T, Hyacinthe A, Nair S, Khan A, Nino G, Pillai DK. Impact of Obesity on Clinical Outcomes in Urban Children Hospitalized for Status Asthmaticus. Hosp Pediatr 2016; 6:211-8. [PMID: 27012614 DOI: 10.1542/hpeds.2015-0094] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
BACKGROUND AND OBJECTIVE The prevalence of both childhood asthma and obesity remain at historically high levels and disproportionately affect urban children. Asthma is a common and costly cause for pediatric hospitalization. Our objective was to determine the effect of obesity on outcomes among urban children hospitalized with status asthmaticus. METHODS A retrospective cohort study was performed by using billing system data and chart review to evaluate urban children admitted for asthma. Demographics, asthma severity, reported comorbidities, and outcomes were assessed. Obesity was defined by BMI percentile (lean<85%, overweight 85%-95%, obese≥95%). Outcomes were length of stay, hospitalization charges, ICU stay, repeat admissions, and subsequent emergency department (ED) visits. Bivariate analysis assessed for differences between overweight/obese and lean children. Multivariable regression assessed the relationship between overweight status and primary outcomes while controlling for other variables. Post hoc age-stratified analysis was also performed. RESULTS The study included 333 subjects; 38% were overweight/obese. Overweight/obese children admitted with asthma were more likely than lean children to have subsequent ED visits (odds ratio 1.6, 95% confidence interval 1.0-2.6). When stratified by age, overweight/obese preschool-age children (<5 years) were >2 times as likely to have repeat ED visits than lean preschool-age children (odds ratio 2.3, 95% confidence interval 1.0-5.6). There were no differences in the other outcomes between overweight/obese and lean individuals within the entire cohort or within other age groups.
Collapse
Affiliation(s)
- Elena Aragona
- Pediatric Hospital Medicine, Tufts Floating Hospital for Children, Boston, Massachusetts;
| | | | | | | | | | | | - Suja Nair
- Pediatric Pulmonology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Amina Khan
- Pediatric Hospital Medicine, Tufts Floating Hospital for Children, Boston, Massachusetts
| | | | | |
Collapse
|
27
|
Maley N, Gebremariam A, Odetola F, Singer K. Influence of Obesity Diagnosis With Organ Dysfunction, Mortality, and Resource Use Among Children Hospitalized With Infection in the United States. J Intensive Care Med 2016; 32:339-345. [PMID: 26880005 DOI: 10.1177/0885066616631325] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Sepsis induces inflammation in response to infection and is a major cause of mortality and hospitalization in children. Obesity induces chronic inflammation leading to many clinical manifestations. Our understanding of the impact of obesity on diseases, such as infection and sepsis, is limited. The objective of this study was to evaluate the association of obesity with organ dysfunction, mortality, duration, and charges during among US children hospitalized with infection. METHODS Retrospective study of hospitalizations in children with infection aged 0 to 20 years, using the 2009 Kids' Inpatient Database. RESULTS Of 3.4 million hospitalizations, 357 701 were for infection, 5685 of which were reported as obese children. Obese patients had higher rates of organ dysfunction (7.35% vs 5.5%, P < .01), longer hospital stays (4.1 vs 3.5 days, P < .001), and accrued higher charges (US$29 019 vs US$21 200, P < .001). In multivariable analysis, mortality did not differ by obesity status (odds ratio: 0.56, 95% confidence interval: 0.23-1.34), however severity of illness modified the association between obesity status and the other outcomes. CONCLUSIONS While there was no difference in in-hospital mortality by obesity diagnosis, variation in organ dysfunction, hospital stay, and hospital charges according to obesity status was mediated by illness severity. Findings from this study have significant implications for targeted approaches to mitigate the burden of obesity on infection and sepsis.
Collapse
Affiliation(s)
- Nidhi Maley
- 1 Department of Pediatrics and Communicable Diseases, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Achamyeleh Gebremariam
- 1 Department of Pediatrics and Communicable Diseases, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Folafoluwa Odetola
- 1 Department of Pediatrics and Communicable Diseases, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Kanakadurga Singer
- 1 Department of Pediatrics and Communicable Diseases, University of Michigan Medical School, Ann Arbor, MI, USA
| |
Collapse
|
28
|
ICD-9 diagnosis codes have poor sensitivity for identification of preexisting comorbidities in traumatic fracture patients: A study of the National Trauma Data Bank. J Trauma Acute Care Surg 2015; 79:622-30. [PMID: 26402537 DOI: 10.1097/ta.0000000000000805] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND The use of large national databases for clinical research has increased recently in the field of trauma care as they allow study of rare events without the logistical difficulties of a prospective study. However, many of these databases use administrative billing codes, such as International Classification of Disease-9th Rev. (ICD-9) codes, to identify preexisting patient comorbidities. While the accuracy of these billing codes for research purposes has previously been called into question, this has not been studied in a trauma population. METHODS All patients with proximal tibia fractures in the 2011 and 2012 American College of Surgeons' National Trauma Data Bank were reviewed. Rates of 12 individual comorbidities in this population were computed using both ICD-9 diagnosis codes and also National Trauma Data Bank chart-abstracted variables. The sensitivity was computed for ICD-9 coding of each comorbidity taking chart-abstracted data elements as criterion standard. With the use of multivariate logistic regression, controlling for age and Injury Severity Score (ISS), the odds ratio for mortality was computed for each comorbidity, using both ICD-9 diagnoses and chart-abstracted diagnoses. RESULTS A total of 32,441 patients with proximal tibia fractures were identified. The sensitivities of ICD-9 billing codes for the comorbidities analyzed ranged from 18.8% for previous myocardial infarction to 2.4% for alcoholism. In individual multivariate analyses of each comorbidity, there was a change in the statistical significance of the odds ratio for mortality for 6 of 12 comorbidities analyzed. CONCLUSION Researchers and those evaluating research in the field of trauma should carefully consider the accuracy of data elements in future studies, especially ICD-9-coded comorbidity diagnoses.
Collapse
|
29
|
Kuhle S, Doucette R, Piccinini-Vallis H, Kirk SFL. Successful childhood obesity management in primary care in Canada: what are the odds? PeerJ 2015; 3:e1327. [PMID: 26623175 PMCID: PMC4662587 DOI: 10.7717/peerj.1327] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2015] [Accepted: 09/24/2015] [Indexed: 12/11/2022] Open
Abstract
Background. The management of a child presenting with obesity in a primary care setting can be viewed as a multi-step behavioral process with many perceived and actual barriers for families and primary care providers. In order to achieve the goal of behavior change and, ultimately, clinically meaningful weight management outcomes in a child who is considered obese, all steps in this process should ideally be completed. We sought to review the evidence for completing each step, and to estimate the population effect of secondary prevention of childhood obesity in Canada. Methods. Data from the 2009/2010 Canadian Community Health Survey and from a review of the literature were used to estimate the probabilities for completion of each step. A flow chart based on these probabilities was used to determine the proportion of children with obesity that would undergo and achieve clinically meaningful weight management outcomes each year in Canada. Results. We estimated that the probability of a child in Canada who presents with obesity achieving clinically meaningful weight management outcomes through secondary prevention in primary care is around 0.6% per year, with a range from 0.01% to 7.2% per year. The lack of accessible and effective weight management programs appeared to be the most important bottleneck in the process. Conclusions. In order to make progress towards supporting effective pediatric obesity management, efforts should focus on population-based primary prevention and a systems approach to change our obesogenic society, alongside the allocation of resources toward weight management approaches that are comprehensively offered, equitably distributed and robustly evaluated.
Collapse
Affiliation(s)
- Stefan Kuhle
- Perinatal Epidemiology Research Unit, Departments of Obstetrics & Gynaecology and Pediatrics, Dalhousie University , Halifax, Nova Scotia , Canada
| | - Rachel Doucette
- Perinatal Epidemiology Research Unit, Departments of Obstetrics & Gynaecology and Pediatrics, Dalhousie University , Halifax, Nova Scotia , Canada ; Department of Family Medicine, Dalhousie University , Halifax, Nova Scotia , Canada
| | | | - Sara F L Kirk
- School of Health and Human Performance, Dalhousie University and the IWK Health Centre , Halifax, Nova Scotia , Canada
| |
Collapse
|
30
|
Bettenhausen J, Puls H, Queen MA, Peacock C, Burrus S, Miller C, Daly A, Colvin JD. Childhood obesity and in-hospital asthma resource utilization. J Hosp Med 2015; 10:160-4. [PMID: 25449960 DOI: 10.1002/jhm.2296] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2014] [Revised: 10/27/2014] [Accepted: 11/14/2014] [Indexed: 11/12/2022]
Abstract
OBJECTIVE To examine the relationship between pediatric obesity and inpatient length of stay (LOS), resource utilization, readmission rates, and total billed charges for in-hospital status asthmaticus. DESIGN/METHODS We conducted a cross-sectional study of patients 5 to 17 years old hospitalized with status asthmaticus to 1 free-standing children's hospital system over 12 months. Only hospitalized patients initially treated in the hospital's emergency department were included to ensure all therapies/charges were examined. Patients with complex chronic conditions, pneumonia, or lacking recorded body mass index (BMI) were excluded. The primary exposure was BMI percentile for age. The primary outcome was LOS (in hours). Secondary outcomes were 90-day readmission rate, billed charges, and resource utilization: number of albuterol treatments, chest radiographs, intravenous fluids, intravenous or intramuscular steroids, and intensive care unit admission. Bivariate, adjusted Poisson and logistic regression model analyses were performed. RESULTS Five hundred eighteen patients met inclusion criteria. Most had a normal BMI (59.7%); 36.7% were overweight or obese. LOS, readmissions, and resource utilization outcomes were not associated with BMI category on bivariate analyses. After adjustment for demographic/clinical characteristics, LOS decreased by 2% for each decile increase in BMI percentile for age. BMI percentile for age was not associated with billed charges, readmissions, or other measures of resource utilization. CONCLUSIONS Although BMI decile for age is inversely associated with LOS for in-hospital pediatric status asthmaticus, the effect likely is not clinically meaningful.
Collapse
Affiliation(s)
- Jessica Bettenhausen
- Department of Pediatrics, Children's Mercy Hospitals and Clinics, University of Missouri-Kansas City School of Medicine, Kansas City, Missouri
| | | | | | | | | | | | | | | |
Collapse
|
31
|
Golinvaux NS, Bohl DD, Basques BA, Fu MC, Gardner EC, Grauer JN. Limitations of administrative databases in spine research: a study in obesity. Spine J 2014; 14:2923-8. [PMID: 24780248 DOI: 10.1016/j.spinee.2014.04.025] [Citation(s) in RCA: 101] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2014] [Accepted: 04/18/2014] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT The use of national inpatient databases for spine surgery research has been increasing. Unfortunately, without firsthand knowledge of each specific database, it can be difficult to judge the validity of such studies. Large databases that rely on administrative data, such as International Classification of Diseases, Ninth Revision (ICD-9) codes, may misrepresent patient information and could thus affect the results of studies that use these data. PURPOSE The present study uses obesity, an easily quantified and objective variable, as an example comorbidity to assess the accuracy of ICD-9 codes in the setting of their continued use in spine database studies. STUDY DESIGN/SETTING A cross-sectional study at a large academic medical center. PATIENT SAMPLE All patients spending at least one night in the hospital as an inpatient between April 1, 2013 and April 16, 2013. Obstetrics and gynecology, psychiatry, and pediatric patients were excluded. OUTCOME MEASURES Proportion of patients for whom ICD-9 obesity diagnosis codes assigned at hospital discharge match chart-documented body mass index (BMI). METHODS The medical record was reviewed for each patient, and obesity ICD-9 codes were directly compared with documented BMI. RESULTS The study included 2,075 patients. Of 573 "obese" patients (calculated BMI 30-39.9), only 109 received the correct code (278.00), giving this ICD-9 code a sensitivity of 0.19. Of 174 "morbidly obese" patients (calculated BMI >40), only 84 received the correct code (278.01), giving this ICD-9 code a sensitivity of 0.48. CONCLUSIONS Using obesity as an example, this study highlights the potential errors inherent to using ICD-9-coded databases for spine surgery research. Should a study based on such data use "obesity" as a variable in any analyses, the reader should interpret these results with caution. We further suggest that obesity is likely not the only comorbidity to which these results apply. As database research continues to represent an increasing proportion of publications in the field of spine surgery, it is important to realize that study outcomes can be skewed by data accuracy, and, thus, should not be blindly accepted simply by virtue of large sample sizes.
Collapse
Affiliation(s)
- Nicholas S Golinvaux
- Department of Orthopaedics and Rehabilitation, Yale University School of Medicine, PO Box 208071, 800 Howard Ave., New Haven, CT 06519, USA
| | - Daniel D Bohl
- Department of Orthopaedics and Rehabilitation, Yale University School of Medicine, PO Box 208071, 800 Howard Ave., New Haven, CT 06519, USA
| | - Bryce A Basques
- Department of Orthopaedics and Rehabilitation, Yale University School of Medicine, PO Box 208071, 800 Howard Ave., New Haven, CT 06519, USA
| | - Michael C Fu
- Department of Orthopaedics and Rehabilitation, Yale University School of Medicine, PO Box 208071, 800 Howard Ave., New Haven, CT 06519, USA
| | - Elizabeth C Gardner
- Department of Orthopaedics and Rehabilitation, Yale University School of Medicine, PO Box 208071, 800 Howard Ave., New Haven, CT 06519, USA
| | - Jonathan N Grauer
- Department of Orthopaedics and Rehabilitation, Yale University School of Medicine, PO Box 208071, 800 Howard Ave., New Haven, CT 06519, USA.
| |
Collapse
|
32
|
Administrative database concerns: accuracy of International Classification of Diseases, Ninth Revision coding is poor for preoperative anemia in patients undergoing spinal fusion. Spine (Phila Pa 1976) 2014; 39:2019-23. [PMID: 25202941 DOI: 10.1097/brs.0000000000000598] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Cross-sectional study. OBJECTIVE To objectively evaluate the ability of International Classification of Diseases, Ninth Revision (ICD-9) codes, which are used as the foundation for administratively coded national databases, to identify preoperative anemia in patients undergoing spinal fusion. SUMMARY OF BACKGROUND DATA National database research in spine surgery continues to rise. However, the validity of studies based on administratively coded data, such as the Nationwide Inpatient Sample, are dependent on the accuracy of ICD-9 coding. Such coding has previously been found to have poor sensitivity to conditions such as obesity and infection. METHODS A cross-sectional study was performed at an academic medical center. Hospital-reported anemia ICD-9 codes (those used for administratively coded databases) were directly compared with the chart-documented preoperative hematocrits (true laboratory values). A patient was deemed to have preoperative anemia if the preoperative hematocrit was less than the lower end of the normal range (36.0% for females and 41.0% for males). RESULTS The study included 260 patients. Of these, 37 patients (14.2%) were anemic; however, only 10 patients (3.8%) received an "anemia" ICD-9 code. Of the 10 patients coded as anemic, 7 were anemic by definition, whereas 3 were not, and thus were miscoded. This equates to an ICD-9 code sensitivity of 0.19, with a specificity of 0.99, and positive and negative predictive values of 0.70 and 0.88, respectively. CONCLUSION This study uses preoperative anemia to demonstrate the potential inaccuracies of ICD-9 coding. These results have implications for publications using databases that are compiled from ICD-9 coding data. Furthermore, the findings of the current investigation raise concerns regarding the accuracy of additional comorbidities. Although administrative databases are powerful resources that provide large sample sizes, it is crucial that we further consider the quality of the data source relative to its intended purpose.
Collapse
|
33
|
Lloyd JT, Blackwell SA, Wei II, Howell BL, Shrank WH. Validity of a Claims-Based Diagnosis of Obesity Among Medicare Beneficiaries. Eval Health Prof 2014; 38:508-17. [PMID: 25380698 DOI: 10.1177/0163278714553661] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Population-level data on obesity are difficult to obtain. Claims-based data sets are useful for studying public health at a population level but lack physical measurements. The objective of this study was to determine the validity of a claims-based measure of obesity compared to obesity diagnosed with clinical data as well as the validity among older adults who suffer from chronic disease. This study used data from the National Health and Nutrition Examination Survey 1999-2004 for adults aged ≥ 65 successfully linked to 1999-2007 Medicare claims (N = 3,554). Sensitivity, specificity, positive and negative predictive values, κ statistics as well as logistic regression analyses were computed for the claims-based diagnosis of obesity versus obesity diagnosed with body mass index. The claims-based diagnosis of obesity underestimates the true prevalence in the older Medicare population with a low sensitivity (18.4%). However, this method has a high specificity (97.3%) and is accurate when it is present. Sensitivity was improved when comparing the claim-based diagnosis to Class II obesity (34.2%) and when used in combination with chronic conditions such as diabetes, congestive heart failure, chronic obstructive pulmonary disease, or depression. Understanding the validity of a claims-based obesity diagnosis could aid researchers in understanding the feasibility of conducting research on obesity using claims data.
Collapse
Affiliation(s)
- Jennifer T Lloyd
- Research and Rapid-Cycle Evaluation Group, Center for Medicare & Medicaid Innovation, Centers for Medicare & Medicaid Services, Baltimore, MD, USA
| | - Steve A Blackwell
- Research and Rapid-Cycle Evaluation Group, Center for Medicare & Medicaid Innovation, Centers for Medicare & Medicaid Services, Baltimore, MD, USA
| | - Iris I Wei
- Research and Rapid-Cycle Evaluation Group, Center for Medicare & Medicaid Innovation, Centers for Medicare & Medicaid Services, Baltimore, MD, USA
| | - Benjamin L Howell
- Research and Rapid-Cycle Evaluation Group, Center for Medicare & Medicaid Innovation, Centers for Medicare & Medicaid Services, Baltimore, MD, USA
| | | |
Collapse
|
34
|
Cygan HR, Baldwin K, Chehab LG, Rodriguez NA, Zenk SN. Six to success: improving primary care management of pediatric overweight and obesity. J Pediatr Health Care 2014; 28:429-37. [PMID: 24725517 DOI: 10.1016/j.pedhc.2014.02.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2013] [Revised: 01/29/2014] [Accepted: 02/05/2014] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Despite the existence of established guidelines addressing pediatric obesity, many primary care providers fail to successfully implement recommendations. This study measured the impact of Six to Success, a weight management program based on the Chronic Care Model, on primary care provider adherence to pediatric weight management guidelines. METHOD We used comprehensive pre- and postimplementation chart audits (N = 396) to conduct a quality improvement study at a hospital-based pediatric outpatient clinic. Charts of patients with a body mass index percentile at or above the 85th percentile (preimplementation, n = 90; postimplementation, n = 97) were audited for 23 identification, assessment, and prevention measures recommended in the care of the pediatric overweight/obese patient. RESULTS Statistically significant improvements to clinical guideline adherence were found in the following areas: correct diagnosis, physical examination, lifestyle assessment, use of motivational interviewing, and prevention strategies. DISCUSSION These findings suggest that Six to Success can be an effective method of improving primary care provider adherence to established pediatric weight management guidelines.
Collapse
|
35
|
Shiff NJ, Jama S, Boden C, Lix LM. Validation of administrative health data for the pediatric population: a scoping review. BMC Health Serv Res 2014; 14:236. [PMID: 24885035 PMCID: PMC4057929 DOI: 10.1186/1472-6963-14-236] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2013] [Accepted: 05/15/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The purpose of this research was to perform a scoping review of published literature on the validity of administrative health data for ascertaining health conditions in the pediatric population (≤20 years). METHODS A comprehensive search of OVID Medline (1946 - present), CINAHL (1937 - present) and EMBASE (1947 - present) was conducted. Characteristics of validation studies that were abstracted included the study population, health condition, topic of the validation (e.g., single diagnosis code versus case-finding algorithm), administrative and validation data sources. Inter-rater agreement was measured using Cohen's κ. Extracted data were analyzed using descriptive statistics. RESULTS A total of 37 articles met the study inclusion criteria. Cohen's κ for study inclusion/exclusion and data abstraction was 0.88 and 0.97, respectively. Most studies validated administrative data from the USA (43.2%) and Canada (24.3%), and focused on inpatient records (67.6%). Case-finding algorithms (56.7%) were more frequently validated than diagnoses codes alone (37.8%). Five conditions were validated in more than one study: diabetes mellitus, inflammatory bowel disease, asthma, rotavirus infection, and tuberculosis. CONCLUSIONS This scoping review identified a number of gaps in the validation of administrative health data for pediatric populations, including limited investigation of outpatient populations and older pediatric age groups.
Collapse
Affiliation(s)
- Natalie J Shiff
- Department of Pediatrics, College of Medicine, University of Saskatchewan, 103 Hospital Drive, SK S7N 0W8, Saskatoon, Canada
| | - Sadia Jama
- Department of Community Health and Epidemiology, College of Medicine, University of Saskatchewan, 103 Hospital Drive, SK S7N 0W8, Saskatoon, Canada
| | - Catherine Boden
- University Library, University of Saskatchewan, Room 1441, Leslie and Irene Dube Health Sciences Library, 104 Clinic Place, SK S7N 5E5, Saskatoon, Canada
| | - Lisa M Lix
- Department of Community Health Sciences, S113-750 Bannatyne Avenue, University of Manitoba, MB R3E 0W3, Winnipeg, Canada
| |
Collapse
|
36
|
Wright DR, Prosser LA. The impact of overweight and obesity on pediatric medical expenditures. APPLIED HEALTH ECONOMICS AND HEALTH POLICY 2014; 12:139-150. [PMID: 24652198 DOI: 10.1007/s40258-014-0088-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
BACKGROUND Published studies do not consistently find overweight and obesity to be associated with higher medical expenditures for US children. Previous analyses use varying samples and methods, making results difficult to compare. OBJECTIVE To examine whether methodological choices or temporal trends are driving differences in estimates of the association between weight and pediatric medical expenditures. METHODS We analyzed the medical expenditures and use of 6- to 17-year-old individuals in the 2006-2010 US Medical Expenditure Panel Surveys. The impact of overweight and obesity on annual medical expenditures and use was assessed, controlling for age, income, race, sex, geographic region, urban/rural residency, insurance status, and survey year. A two-part regression model, in which part one estimated the likelihood of incurring any expenditure and part two estimated non-zero expenditures, was used to predict total expenditures. Expenditures were inflated to 2012 dollars using the medical care component of the Consumer Price Index. Poisson and logistic regression models were used to predict differences in healthcare use between normal weight, overweight, and obese youth. RESULTS We found that overweight and obese youth have higher, but not significantly higher medical expenditures than normal weight youth. Conclusions were robust to various methodological assumptions. We found that obese adolescents have a higher use of prescriptions drugs and healthcare visits compared with normal weight youth (0.04-1.3 visits), but differences in use only translated into marginally higher expenditures. CONCLUSIONS These findings may reflect new trends in healthcare use among obese youth. Future research should assess whether services are being underused by obese youth and the impact of persistent obesity on long-term medical expenditures.
Collapse
Affiliation(s)
- Davene R Wright
- Department of Pediatrics, University of Washington, Seattle, WA, USA,
| | | |
Collapse
|
37
|
Walsh CO, Milliren CE, Feldman HA, Taveras EM. Sensitivity and specificity of obesity diagnosis in pediatric ambulatory care in the United States. Clin Pediatr (Phila) 2013; 52:829-35. [PMID: 23676286 DOI: 10.1177/0009922813488648] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
OBJECTIVE We examined the sensitivity and specificity of an obesity diagnosis in a nationally representative sample of pediatric outpatient visits. METHODS We used the 2005 to 2009 National Ambulatory Medical Care and National Hospital Ambulatory Medical Care surveys. We included visits with children 2 to 18 years, yielding a sample of 48 145 database visits. We determined 3 methods of identifying obesity: documented body mass index (BMI) ≥95th percentile; International Classification of Diseases, Ninth Revision (ICD-9) code; and positive answer to the question, "Does the patient now have obesity?" Using BMI as the gold standard, we calculated the sensitivity and specificity of a clinical obesity diagnosis. RESULTS Among the 19.5% of children who were obese by BMI, 7.0% had an ICD-9 code and 15.2% had a positive response to questioning. The sensitivity of an obesity diagnosis was 15.4%, and the specificity was 99.2%. CONCLUSIONS The sensitivity of the obesity diagnosis in pediatric ambulatory visits is low. Efforts are needed to increase identification of obese children.
Collapse
Affiliation(s)
- Carolyn O Walsh
- Boston Medical Center/Boston Children's Hospital, Boston, MA, USA
| | | | | | | |
Collapse
|
38
|
Buckley CM, Kearney PM, Ali F, Bhuachalla CN, Casey C, Roberts G, Perry IJ, Bradley CP. Concordance studies between hospital discharge data and medical records for the recording of lower extremity amputation and diabetes in the Republic of Ireland. BMC Res Notes 2013; 6:148. [PMID: 23587134 PMCID: PMC3640954 DOI: 10.1186/1756-0500-6-148] [Citation(s) in RCA: 8] [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: 12/26/2012] [Accepted: 03/08/2013] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Hospital discharge data have been used to study trends in Lower Extremity Amputation (LEA) rates in people with and without diabetes. The aim of this study was to assess the reliability of routine hospital discharge data in the Republic of Ireland (RoI) for this purpose by determining the level of agreement between hospital discharge data and medical records for both the occurrence of LEA and diagnosis of diabetes. METHODS Two concordance studies between hospital discharge data (HIPE) and medical records were performed. To determine the level of agreement for LEA occurrence, HIPE records were compared to theatre logbooks in 9 hospitals utilising HIPE over a two-year period in a defined study area. To determine the level of agreement for diabetes diagnosis, HIPE records were compared to laboratory records in each of the 4 largest hospitals utilising HIPE over a one week period in the same study area. The proportions of positive and negative agreement and Cohen's kappa statistic of agreement were calculated. RESULTS During a two-year study period in 9 hospitals, 216 LEAs were recorded in both data sources. Sixteen LEAs were recorded in medical records alone and 25 LEAs were recorded in hospital discharge records alone. The proportion of positive agreement was 0.91 (95% CI 0.88-0.94), the proportion of negative agreement was 0.99 (95% CI 0.98-0.99) and the kappa statistic was 0.91 (95% CI 0.88-0.94). During a one-week study period in 4 hospitals, 49 patients with diabetes and 716 patients without diabetes were recorded in both data sources. Eighteen patients had diabetes in medical records alone and 2 patients had diabetes in hospital discharge records alone. The proportion of positive agreement was 0.83 (95% CI 0.76-0.9), the proportion of negative agreement was 0.99 (95% CI 0.98-0.99) and the kappa statistic was 0.82 (95% CI 0.75-0.89). CONCLUSIONS This study detected high levels of agreement between hospital discharge data and medical records for LEA and diabetes in a defined study area. Based on these findings, we suggest that HIPE is sufficiently reliable to monitor trends in LEAs in people with and without diabetes in the RoI.
Collapse
Affiliation(s)
- Claire M Buckley
- Department of General Practice, University College Cork, Room 2.57, Western Gateway Building, Cork, Ireland
| | - Patricia M Kearney
- Department of Epidemiology & Public Health, University College Cork, Cork, Ireland
| | - Fawzi Ali
- Department of Medicine and Metabolism, Waterford Institute of Technology, Waterford, Ireland
| | | | - Caoimhe Casey
- Department of General Practice, University College Cork, Room 2.57, Western Gateway Building, Cork, Ireland
| | - Graham Roberts
- Department of Medicine and Metabolism, Waterford Institute of Technology, Waterford, Ireland
| | - Ivan J Perry
- Department of Epidemiology & Public Health, University College Cork, Cork, Ireland
| | - Colin P Bradley
- Department of General Practice, University College Cork, Room 2.57, Western Gateway Building, Cork, Ireland
| |
Collapse
|
39
|
Sung KS, Yoon YM, Kim EJ. Meta-analysis of the Effects of Obesity Management Program for Children. CHILD HEALTH NURSING RESEARCH 2013. [DOI: 10.4094/chnr.2013.19.4.262] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- Kyung-Suk Sung
- Department of Nursing, Gangneung-Wonju National University, Wonju, Korea
| | - Young-Mi Yoon
- Department of Nursing, Seoil University, Seoul, Korea
| | - Eun-Joo Kim
- Department of Nursing, Sangji University, Wonju, Korea
| |
Collapse
|
40
|
Sánchez-Muñoz LA. Nutritional status, heart failure and minimum basic data set. Rev Esp Cardiol 2012; 65:583; author reply 584. [PMID: 22385983 DOI: 10.1016/j.recesp.2012.01.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2012] [Accepted: 01/20/2012] [Indexed: 12/25/2022]
|