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Maximous M, Webster J, Hsu JWY, Chung J, Chock B. The Impact of Primary Care Practitioner Intervention as an Adjunct to a Diabetes Case Management System. Perm J 2023:1-6. [PMID: 37057344 DOI: 10.7812/tpp/22.088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/15/2023]
Abstract
Objective The objective of this study was to assess whether additional primary care practitioner (PCP) contacts beyond the intake visit are associated with reduced hemoglobin A1c in patients with type 2 diabetes actively engaged in the Kaiser Permanente case management system. Methods This retrospective cohort study using the Kaiser Permanente electronic health record explored the effect of enhanced PCP contact among adult patients with type 2 diabetes actively working with diabetes case managers (defined as ≥ 4 case manager contacts during the study period). Results A total of 837 patients met the inclusion and exclusion criteria. On average, patients with the highest PCP contact, < 7 contacts, had Ac levels 0.53 lower than those in the lowest PCP contact quartile, < 3 contacts (p = 0.0007). A1c decreased an average of 0.20 when the PCP contact quartile was one quartile higher (p = 0.0004). Holding the baseline A1c constant, the A1c decreased an average of 0.15 when the PCP contact quartile was one quartile higher (p = 0.0024). A1c change was significantly correlated with baseline A1c; A1c decreased by 0.64 more as the baseline A1c level increased by 1 (p < 0.0001). Additionally, the A1c level decreased by 0.02 more when patient age increased by 1 (p < 0.0001). Metformin use was associated with a decrease of A1c by 0.40 (p = 0.0057), whereas insulin use was associated with an increase of A1c by 0.29 (p = 0.0280). Conclusion In summary, a significant reduction was observed in A1c in patients with increased PCP contacts. This effect was seen in patients already receiving recommended case manager support.
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Affiliation(s)
- Mina Maximous
- Department of Endocrinology, Kaiser Permanente San Bernardino County Service Area, Fontana, CA, USA
| | - John Webster
- Department of Endocrinology, Kaiser Permanente San Bernardino County Service Area, Fontana, CA, USA
| | - Jin-Wen Y Hsu
- Department of Research and Evaluation, Kaiser Permanente Pasadena, Pasadena, CA, USA
| | - Joanie Chung
- Department of Research and Evaluation, Kaiser Permanente Pasadena, Pasadena, CA, USA
| | - Brandon Chock
- Department of Endocrinology, Kaiser Permanente San Bernardino County Service Area, Fontana, CA, USA
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Wong K, Bruxvoort K, Slezak J, Hsu JWY, Reynolds K, Sy LS, Jacobsen SJ. Hepatitis B vaccine and risk of acute myocardial infarction among individuals with diabetes mellitus. Pharmacoepidemiol Drug Saf 2021; 30:1441-1446. [PMID: 34245081 DOI: 10.1002/pds.5327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 05/10/2021] [Accepted: 07/07/2021] [Indexed: 11/05/2022]
Abstract
PURPOSE A pre-licensure clinical trial of a two-dose cytosine phosphoguanine adjuvanted hepatitis B vaccine (HEPLISAV-B® [Dynavax, USA]; HepB-CpG vaccine) found an unanticipated numerical imbalance in acute myocardial infarction (AMI) compared to recipients of a three-dose aluminum adjuvanted hepatitis B vaccine (ENGERIX-B® [GlaxoSmithKline, Belgium]; HepB-alum vaccine). A post-licensure study was required to compare AMI rates among recipients of HepB-CpG vaccine and HepB-alum vaccine. Individuals with diabetes mellitus (DM), who are at higher risk of AMI, comprise more than half of the post-licensure study cohort. To inform the ongoing post-licensure study, we examined the association between AMI and receipt of HepB-alum vaccine in individuals with DM. METHODS We conducted a case-control study nested in a cohort of individuals with DM ages ≥40 years at Kaiser Permanente Southern California using electronic health records. AMI cases from 2012 to 2017 were identified by principal discharge diagnosis and matched 1:1 with randomly selected controls. The adjusted odds ratio (aOR) for receipt of ≥1 HepB-alum vaccine dose was compared for AMI cases and controls using conditional logistic regression. We subsequently performed the same matched case-control analysis stratified by year. RESULTS Of 8138 matched case-control pairs, 17.4% of cases and 15.0% of controls received HepB-alum vaccine. The aOR of HepB-alum vaccination comparing cases and controls was 0.97 (95% confidence interval 0.87-1.08). Similarly, there was no significant association between HepB-alum vaccine and AMI in any of the study years. CONCLUSIONS HepB-alum vaccination was not associated with AMI in individuals with DM. This finding will provide contextual insight for the ongoing post-licensure study of HepB-CpG vaccine.
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Affiliation(s)
- Katherine Wong
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California, USA
| | - Katia Bruxvoort
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California, USA
| | - Jeff Slezak
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California, USA
| | - Jin-Wen Y Hsu
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California, USA
| | - Kristi Reynolds
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California, USA
| | - Lina S Sy
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California, USA
| | - Steven J Jacobsen
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California, USA
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Haghverdian JC, Hsu JWY, Harness NG. Complications of Corrective Osteotomies for Extra-Articular Distal Radius Malunion. J Hand Surg Am 2019; 44:987.e1-987.e9. [PMID: 30733100 DOI: 10.1016/j.jhsa.2018.12.013] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2017] [Revised: 11/06/2018] [Accepted: 12/10/2018] [Indexed: 02/02/2023]
Abstract
PURPOSE Osteotomy of the distal radius for a fracture malunion is a challenging procedure. The purpose of this study was to review a series of osteotomies to determine the type and risk of complications. METHODS A retrospective cohort study was performed, including all Kaiser Permanente Southern California patients who were aged 18 years or older between January 1, 2007, and September 25, 2015, and underwent osteotomy for an extra-articular distal radius fracture malunion. Charts were reviewed for demographic data, comorbidities, osteotomy type (hinged vs distraction), implant, and bone graft type. Complications including infection, nonunion, loss of reduction, implant failure, nerve injury, tendon injury, and complex regional pain syndrome were recorded. RESULTS There were 60 patients who underwent extra-articular osteotomy of the distal radius for malunion during the study period. The mean age was 54 years (range, 21-83 years). There were 24 distraction-type (intervening bone graft) and 36 hinge-type (volar cortical contact maintained) osteotomies. Twenty-five of 60 patients had complications related to the procedure requiring 13 subsequent procedures. There were 7 nonunions and 3 cases of delayed healing at the osteotomy site. One extensor carpi radialis longus tendon laceration resulted from the use of an osteotome. There were 3 delayed extensor pollicis longus (EPL) tendon ruptures after surgery. The distraction-type osteotomy was associated with a greater risk of major complications including nonunion and delayed union. CONCLUSIONS A complication rate of nearly 50% was observed in distal radius osteotomies. Surgeons should be aware of the risk of injury to, or delayed rupture of the EPL tendon associated with these procedures. The risk of nonunion or delayed union is higher in distraction-type compared with hinge-type osteotomies. Low surgeon volume with this procedure may be a contributing factor to the high rate of complications. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic IV.
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Affiliation(s)
- Justin C Haghverdian
- Department of Orthopaedic Surgery, University of California, Irvine Medical Center, Orange, CA
| | - Jin-Wen Y Hsu
- Department of Research & Evaluation, Southern California Permanente Medical Group, Pasadena, CA
| | - Neil G Harness
- Department of Orthopaedic Surgery, Southern California Permanente Medical Group, Anaheim, CA.
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Reynolds K, Mues KE, Harrison TN, Qian L, Chen S, Hsu JWY, Philip KJ, Monda KL, Reading SR, Brar SS. Trends in statin utilization among adults with severe peripheral artery disease including critical limb ischemia in an integrated healthcare delivery system. Vasc Med 2019; 25:3-12. [PMID: 31512991 DOI: 10.1177/1358863x19871100] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Evidence suggests that statin therapy in patients with peripheral artery disease (PAD) is beneficial yet use remains suboptimal. We examined trends in statin use, intensity, and discontinuation among adults aged ⩾ 40 years with incident severe PAD and a subset with critical limb ischemia (CLI) between 2002 and 2015 within an integrated healthcare delivery system. Discontinuation of statin therapy was defined as the first 90-day gap in treatment within 1 year following PAD diagnosis. We identified 11,059 patients with incident severe PAD: 31.1% (n = 3442) with CLI and 68.9% (n = 7617) without CLI. Mean (SD) age was 68.6 (11.3) years, 60.5% were male, 54.2% white, 23.2% Hispanic, and 16.2% black. Statin use in the year before diagnosis increased from 50.4% in 2002 to 66.0% in 2015 (CLI: 43.7% to 68.0%; without CLI: 53.1% to 64.2%, respectively). The proportion of patients on high-intensity statins increased from 7.3% in 2002 to 41.9% in 2015 (CLI: 7.2% to 39.4%; without CLI: 7.4% to 44.2%, respectively). Of the 40.5% (n = 4481) who were not on a statin in the year before diagnosis, 13.5% (n = 607) newly initiated therapy within 1 month (CLI: 10.1% (n = 150); without CLI: 15.3% (n = 457)). Following diagnosis, 12.5% (n = 660) discontinued statin therapy within 1 year (CLI: 15.5% (n = 202); without CLI: 11.5% (n = 458)). Although use of statins increased from 2002 to 2015, a substantial proportion of the overall PAD and CLI subpopulation remained untreated with statins, representing a significant treatment gap in a population at high risk for cardiovascular events and adverse limb outcomes.
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Affiliation(s)
- Kristi Reynolds
- Kaiser Permanente Southern California, Department of Research & Evaluation, Pasadena, CA, USA
| | | | - Teresa N Harrison
- Kaiser Permanente Southern California, Department of Research & Evaluation, Pasadena, CA, USA
| | - Lei Qian
- Kaiser Permanente Southern California, Department of Research & Evaluation, Pasadena, CA, USA
| | - Songyue Chen
- Kaiser Permanente Southern California, Department of Research & Evaluation, Pasadena, CA, USA
| | - Jin-Wen Y Hsu
- Kaiser Permanente Southern California, Department of Research & Evaluation, Pasadena, CA, USA
| | | | | | - Stephanie R Reading
- Kaiser Permanente Southern California, Department of Research & Evaluation, Pasadena, CA, USA.,Amgen Inc., Thousand Oaks, CA, USA
| | - Somjot S Brar
- Kaiser Permanente Los Angeles Medical Center, Los Angeles, CA, USA
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Harrison TN, Hsu JWY, Rosenson RS, Levitan EB, Muntner P, Cheetham TC, Wei R, Scott RD, Reynolds K. Unmet Patient Need in Statin Intolerance: the Clinical Characteristics and Management. Cardiovasc Drugs Ther 2019; 32:29-36. [PMID: 29417422 DOI: 10.1007/s10557-018-6775-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
PURPOSE A substantial percentage of patients report intolerance or side effects of statin treatment leading to treatment changes or discontinuation. The purpose of this study was to examine statin therapy changes and subsequent effects on low-density lipoprotein cholesterol (LDL-C) among patients with statin intolerance (SI). METHODS We identified 45,037 adults from Kaiser Permanente Southern California with SI documented between 2006 and 2012. Changes in statin therapy in the year before and after the SI index date were examined. We categorized patients into those who initiated statin therapy, discontinued, up-titrated, down-titrated, or did not switch therapy. We calculated the percentage change in LDL-C from the year before to the year after SI, and the percentage of patients attaining LDL-C < 100 and < 70 mg/dL. RESULTS In the year prior to the SI date, 77.8% of patients filled a statin prescription. Following SI, 44.6% had no treatment change, 25.5% discontinued, and 30.0% altered their statin therapy. Of those who altered statin therapy, 52.6% down-titrated and 17.2% up-titrated their dose. Rhabdomyolysis was documented in < 1% of the cohort. The largest changes in LDL-C were experienced by patients who were on a high-intensity statin then discontinued treatment (35.6% increase) and those who initiated a high-intensity statin (25.5% decrease). The proportion of patients achieving LDL-C < 100 mg/dL and LDL-C < 70 mg/dL was the lowest among those who discontinued therapy. CONCLUSIONS Although adjustments to the statin dosage may be appropriate upon documentation of SI, many of these patients will have high LDL-C. Strategies for LDL-C reduction in patients with SI may be necessary.
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Affiliation(s)
- Teresa N Harrison
- Department of Research and Evaluation, Kaiser Permanente Southern California, 100 S. Los Robles, 2nd Floor, Pasadena, CA, 91101, USA
| | - Jin-Wen Y Hsu
- Department of Research and Evaluation, Kaiser Permanente Southern California, 100 S. Los Robles, 2nd Floor, Pasadena, CA, 91101, USA
| | - Robert S Rosenson
- Icahn School of Medicine at Mount Sinai, Mount Sinai Heart, New York, NY, USA
| | - Emily B Levitan
- School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Paul Muntner
- School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA
| | | | - Rong Wei
- Department of Research and Evaluation, Kaiser Permanente Southern California, 100 S. Los Robles, 2nd Floor, Pasadena, CA, 91101, USA
| | - Ronald D Scott
- West Los Angeles Medical Center, Kaiser Permanente Southern California, Los Angeles, CA, USA
| | - Kristi Reynolds
- Department of Research and Evaluation, Kaiser Permanente Southern California, 100 S. Los Robles, 2nd Floor, Pasadena, CA, 91101, USA.
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Grant DSL, Scott RD, Harrison TN, Cheetham TC, Chang SC, Hsu JWY, Wei R, Boklage SH, Romo-LeTourneau V, Reynolds K. Trends in Lipid Screening Among Adults in an Integrated Health Care Delivery System, 2009-2015. J Manag Care Spec Pharm 2018; 24:1090-1101. [PMID: 30063170 PMCID: PMC10397736 DOI: 10.18553/jmcp.2018.18100] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Lipid screening determines eligibility for statins and other cardiovascular risk reduction interventions. OBJECTIVE To examine trends in lipid screening among adults aged ≥20 years in a large, multiethnic, integrated health care delivery system in southern California. METHODS Temporal trends in lipid screening were examined from 2009 to 2015 with an index date of September 30 of each year. Lipid screening was defined as the proportion of eligible members each year who (a) had ever been screened among those aged 20-39 years and (b) had been screened in the previous 6 years for those aged ≥ 40 years. Trends were analyzed by age, gender, and the presence of atherosclerotic cardiovascular disease (ASCVD) or diabetes without ASCVD status. RESULTS More than 2 million individuals were included each year: 5%-6% had ASCVD (includes those with diabetes), 7%-8% had diabetes without ASCVD, and 87% had neither condition. Among the entire population, lipid screening increased from 79.8% in 2009 to 82.6% in 2015 (P < 0.0001). Among those with ASCVD or diabetes, lipid screening was 99% across all years. Among those without ASCVD or DM, screening increased from 76.9% in 2009 to 80.0% in 2015 (P < 0.0001), with higher screening among women compared with men and lower screening among individuals younger than 55 years. CONCLUSIONS Consistently high rates of lipid screening were observed among individuals with ASCVD or diabetes. In individuals without these conditions, screening increased over time. However, there is room to further increase screening rates in adults younger than 55 years. DISCLOSURES This manuscript and research work was supported by a contractual agreement between the Southern California Permanente Medical Group and Regeneron Pharmaceuticals and Sanofi U.S. Researchers from Regeneron and Sanofi collaborated on the study design, interpretation of data, and writing of the manuscript. Ling Grant, Harrison, Chang, Hsu, Cheetham, Wei, and Reynolds are employed by Kaiser Permanente Southern California. Scott is employed by Southern California Permanente Medical Group. Boklage is employed by Regeneron, and Romo-LeTourneau is employed by Sanofi. Preliminary results from this study were presented at the American Heart Association Scientific Sessions; November 12-16, 2016; New Orleans, LA.
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Affiliation(s)
- Deborah S Ling Grant
- 1 Kaiser Permanente Southern California, Department of Research & Evaluation, Pasadena
| | - Ronald D Scott
- 2 Southern California Permanente Medical Group, Los Angeles
| | - Teresa N Harrison
- 1 Kaiser Permanente Southern California, Department of Research & Evaluation, Pasadena
| | - T Craig Cheetham
- 3 Kaiser Permanente Southern California, Department of Research & Evaluation, Pasadena, and Western University College of Pharmacy, Pomona, California
| | - Shen-Chih Chang
- 1 Kaiser Permanente Southern California, Department of Research & Evaluation, Pasadena
| | - Jin-Wen Y Hsu
- 1 Kaiser Permanente Southern California, Department of Research & Evaluation, Pasadena
| | - Rong Wei
- 1 Kaiser Permanente Southern California, Department of Research & Evaluation, Pasadena
| | | | | | - Kristi Reynolds
- 1 Kaiser Permanente Southern California, Department of Research & Evaluation, Pasadena
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Reynolds K, Cheetham TC, Chang SC, Hsu JWY, Wei R, Ling-Grant DS, Harrison T, Boklage SH, Romo-LeTourneau V, Scott R. TRENDS IN STATIN USE AMONG ADULTS IN AN INTEGRATED HEALTH CARE DELIVERY SYSTEM: IMPACT OF THE 2013 GUIDELINE ON THE TREATMENT OF BLOOD CHOLESTEROL. J Am Coll Cardiol 2017. [DOI: 10.1016/s0735-1097(17)35083-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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8
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Reading SR, Porter KR, Hsu JWY, Wallner LP, Loo RK, Jacobsen SJ. Racial and Ethnic Variation in Time to Prostate Biopsy After an Elevated Screening Level of Serum Prostate-specific Antigen. Urology 2016; 96:121-127. [PMID: 27316374 DOI: 10.1016/j.urology.2016.06.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2016] [Revised: 06/06/2016] [Accepted: 06/08/2016] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To examine the racial and ethnic variation in time to prostate biopsy after an elevated screening level of serum prostate-specific antigen (PSA). METHODS Male members of the Kaiser Permanente of Southern California health plan, 45 years of age or older, with no history of prostate cancer or a prostate biopsy, and at least 1 elevated screening level of serum PSA between January 1, 1998 and December 31, 2007 were retrospectively identified (n = 59,506). All participants were passively followed via electronic health records until their time of prostate biopsy, death, membership disenrollment, or study conclusion (December 31, 2014), whichever was the initial event. Proportional hazard regression analyses were used to estimate the association between time from an elevated screening level of serum PSA to prostate biopsy, adjusting for age, benign prostatic hyperplasia, prostatitis, type 2 diabetes mellitus, hypertension, and Charlson Comorbidity Index score. RESULTS Median time until biopsy was 0.6 years (214 days), with approximately 41% of participants receiving a prostate biopsy within the study period. Results from the fully adjusted analysis indicated that the non-Hispanic Asian or Pacific Islanders (hazard ratio: 1.10, 95% confidence interval: [1.04, 1.15]) and the non-Hispanic blacks (hazard ratio: 1.04, 95% confidence interval: [1.00, 1.08]) had a slightly shorter time to prostate biopsy after an elevated screening level of serum PSA compared to the non-Hispanic whites. CONCLUSION These data suggest that, within an integrated healthcare organization, minimal differences exist between racial and ethnic subgroups in their time to prostate biopsy after an elevated screening level of serum PSA.
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Affiliation(s)
- Stephanie R Reading
- Department of Research and Evaluation, Kaiser Permanente of Southern California, Pasadena, CA
| | - Kimberly R Porter
- Department of Research and Evaluation, Kaiser Permanente of Southern California, Pasadena, CA
| | - Jin-Wen Y Hsu
- Department of Research and Evaluation, Kaiser Permanente of Southern California, Pasadena, CA
| | - Lauren P Wallner
- Department of Medicine and Epidemiology, University of Michigan, Ann Arbor, MI
| | - Ronald K Loo
- Department of Urology, Kaiser Permanente of Southern California, Los Angeles, CA
| | - Steven J Jacobsen
- Department of Research and Evaluation, Kaiser Permanente of Southern California, Pasadena, CA.
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9
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Wallner LP, Hsu JWY, Loo RK, Palmer-Toy DE, Schottinger JE, Jacobsen SJ. Trends in Prostate-specific Antigen Screening, Prostate Biopsies, Urology Visits, and Prostate Cancer Treatments From 2000 to 2012. Urology 2015; 86:498-505. [DOI: 10.1016/j.urology.2015.04.063] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2015] [Revised: 03/18/2015] [Accepted: 04/02/2015] [Indexed: 11/28/2022]
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Reynolds K, Harrison TN, Hsu JWY, Levitan E, Muntner P, Cheetham TC, Wei R, Scott RD, Taylor B. UNMET PATIENT NEED IN STATIN INTOLERANCE: THE EPIDEMIOLOGY, CLINICAL CHARACTERISTICS, AND MANAGEMENT. J Am Coll Cardiol 2015. [DOI: 10.1016/s0735-1097(15)61445-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Porter KR, Chao C, Quinn VP, Hsu JWY, Jacobsen SJ. Variability in date of prostate cancer diagnosis: a comparison of cancer registry, pathology report, and electronic health data sources. Ann Epidemiol 2014; 24:855-60. [PMID: 25282324 DOI: 10.1016/j.annepidem.2014.09.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2014] [Revised: 09/04/2014] [Accepted: 09/10/2014] [Indexed: 11/17/2022]
Abstract
PURPOSE The date of cancer diagnosis is a critical data element for clinical care and research. Because this date can be abstracted from various data sources, its comparability from source to source is unclear. This study compared the date of diagnosis from multiple sources within the same population of prostate cancer patients. METHODS We linked cancer registry, pathology report, and electronic health data sources from the Kaiser Permanente Southern California health data systems for a cohort of 22,666 members diagnosed with prostate cancer between 2000 and 2010. The magnitude and direction of the differences in date of diagnosis were assessed for each date pairwise comparison. We reviewed 454 medical records to determine reasons for date discrepancies. RESULTS Among the date pairwise comparisons, differences in date of diagnosis spanned from 9.6 years earlier to 10 years later than each other. However, the overall median difference ranged from 1 to 16 days, thus suggesting that the vast majority of the date differences were small. Chart review results identified major categories of date discrepancies. CONCLUSIONS These data demonstrate variability in date of diagnosis across these data sources. This variability may have implications for epidemiologic estimates or patient identification in research studies using different data sources.
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Affiliation(s)
- Kimberly R Porter
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA.
| | - Chun Chao
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA
| | - Virginia P Quinn
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA
| | - Jin-Wen Y Hsu
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA
| | - Steven J Jacobsen
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA
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12
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Londoño DC, Wuerstle MC, Thomas AA, Salazar LE, Hsu JWY, Danial T, Chien GW. Accuracy and implications of percutaneous renal biopsy in the management of renal masses. Perm J 2014; 17:4-7. [PMID: 24355883 DOI: 10.7812/tpp/12-110] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Percutaneous renal biopsy in patients with renal masses is increasing. We investigated the accuracy of percutaneous renal mass biopsy results in patients undergoing evaluation of solid renal masses. METHODS A retrospective review was performed of patients in the Kaiser Permanente Southern California Region who underwent computed tomography or ultrasound-guided percutaneous renal biopsy of a solid renal mass between January 2005 and December 2009. Patients were stratified by size of mass (≤ 4 cm vs > 4 cm). Initial biopsy results were correlated with final pathology specimens after extirpation. RESULTS Medical records of 126 patients (129 renal units with 132 biopsies) were reviewed. Initial diagnostic biopsies revealed 87 (66%) malignant, 38 (29%) benign, and 7 (5%) nondiagnostic lesions. Sixty-three patients (50%) ultimately underwent extirpative surgery (23 partial and 40 radical nephrectomies). Of these patients, the diagnostic accuracy of the initial percutaneous renal mass biopsy was 76%, with an overall sensitivity and specificity of 75.4% and 100%, respectively. The biopsy concordance to final histologic tumor subtype was 93%. Larger tumor size (odds ratio [OR], 2.20; 95% confidence interval [CI], 0.55 to 8.88) and increasing number of biopsies (OR, 2.50; 95% CI, 0.59 to 10.69) were associated with increasing accuracy of a biopsy result to predict cancer; however, these associations were not statistically significant. CONCLUSION Percutaneous renal mass biopsy is diagnostically accurate and has good sensitivity, specificity, and concordance with final pathologic renal cell carcinoma subtype. This diagnostic modality can assist in management of select renal masses as treatment options are expanding.
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Affiliation(s)
- Diana C Londoño
- Urology Resident at the Sunset Medical Center in Los Angeles, CA. E-mail:
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Wallner LP, Frencher SK, Hsu JWY, Chao CR, Nichol MB, Loo RK, Jacobsen SJ. Changes in serum prostate-specific antigen levels and the identification of prostate cancer in a large managed care population. BJU Int 2013; 111:1245-52. [DOI: 10.1111/j.1464-410x.2012.11651.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Lauren P. Wallner
- Department of Research and Evaluation; Kaiser Permanente Southern California; Pasadena; USA
| | | | - Jin-Wen Y. Hsu
- Department of Research and Evaluation; Kaiser Permanente Southern California; Pasadena; USA
| | - Chun R. Chao
- Department of Research and Evaluation; Kaiser Permanente Southern California; Pasadena; USA
| | - Michael B. Nichol
- School of Pharmacy; University of Southern California; Los Angeles; USA
| | - Ronald K. Loo
- Department of Urology; Southern California Permanente Medical Group; Downey; CA; USA
| | - Steven J. Jacobsen
- Department of Research and Evaluation; Kaiser Permanente Southern California; Pasadena; USA
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Reynolds K, Viswanathan HN, O'Malley CD, Muntner P, Harrison TN, Cheetham TC, Hsu JWY, Gold DT, Silverman S, Grauer A, Morisky DE. Psychometric properties of the Osteoporosis-specific Morisky Medication Adherence Scale in postmenopausal women with osteoporosis newly treated with bisphosphonates. Ann Pharmacother 2012; 46:659-70. [PMID: 22510666 DOI: 10.1345/aph.1q652] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Poor adherence to oral osteoporosis medications is common. Strategies for improving adherence begin with identification of the problem. The 8-item Morisky Medication Adherence Scale for self-reported adherence to antihypertensive medications was modified for assessing adherence to oral osteoporosis medications. An evaluation of the measurement properties of the Osteoporosis-Specific Morisky Medication Adherence Scale (OS-MMAS) was needed. OBJECTIVE To examine the psychometric properties of the OS-MMAS in women with postmenopausal osteoporosis. METHODS Five hundred women aged 55 years and older with osteoporosis who were newly prescribed daily or weekly oral bisphosphonates between May 15, 2010, and August 15, 2010, were randomly selected from Kaiser Permanente Southern California, a large integrated health care delivery system, and mailed a self-administered survey that included the 8-item OS-MMAS, Self-Efficacy for Appropriate Medication Use Scale (SEAMS), Beliefs about Medicines Questionnaire (BMQ), Treatment Satisfaction Questionnaire for Medication (TSQM), Gastrointestinal Symptom Rating Scale (GSRS), and 12-item Short-Form Health Survey (SF-12v2). OS-MMAS scores can range from 0 to 8, with higher scores indicating better medication adherence. Internal consistency reliability was evaluated using Cronbach α coefficient. Test-retest reliability was assessed using intraclass correlation coefficients (ICCs) in a subset of 102 participants. Construct validity was assessed using confirmatory factor analysis and correlations between OS-MMAS and related measures. RESULTS Of 197 participants, 150 reported that they were still taking their bisphosphonate at the time of the survey and completed the OS-MMAS. Overall, 30.7%, 32.7%, and 36.7% had low, medium, and high OS-MMAS scores (<6, 6 to <8, and 8, respectively). Cronbach α was 0.82 and the ICC was 0.77. Convergent validity was supported by significant correlations with SEAMS, BMQ necessity, and TSQM scores. In confirmatory factor analysis, a single-factor scale was supported. CONCLUSIONS The OS-MMAS showed strong psychometric properties with good reliability and construct validity and may provide a valuable assessment of self-reported medication adherence in women newly prescribed oral osteoporosis medications.
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Affiliation(s)
- Kristi Reynolds
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA.
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Wong E, Scott LM, Briseno JR, Crawford CL, Hsu JWY. Determining critical incident nursing interventions for the critical care setting: a pilot study. ACTA ACUST UNITED AC 2009; 20:110-21. [PMID: 19659841 DOI: 10.1111/j.1744-618x.2009.01123.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
PURPOSE The purpose of this research survey was to determine which Adult Critical Care Core Nursing Interventions (ACCCNIs) in the Nursing Interventions Classification constitutes a critical incident nursing intervention (CINI). A CINI is defined as any indirect or direct care registered nurse (RN)-initiated treatment performed in response to a life-threatening nursing diagnosis. METHODS A list of ACCCNIs were sent to 50 critical care RNs in two survey rounds. Responses >80% for each ACCCNI was determined to be a CINI. FINDINGS Forty-one ACCCNIs were determined to be CINIs. CONCLUSIONS It is recommended that CINIs be included as a separate Nursing Intervention Classification category to reflect current nursing practice. IMPLICATIONS FOR NURSING PRACTICE CINIs can enhance RN competency, education, and vigilance, thereby preventing or decreasing the number of deaths that occur from critical incidents.
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Brar SS, Khan SS, Sandhu GK, Jorgensen MB, Parikh N, Hsu JWY, Shen AYJ. Incidence, mortality, and racial differences in peripartum cardiomyopathy. Am J Cardiol 2007; 100:302-4. [PMID: 17631087 DOI: 10.1016/j.amjcard.2007.02.092] [Citation(s) in RCA: 201] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2006] [Revised: 02/17/2007] [Accepted: 02/17/2007] [Indexed: 10/23/2022]
Abstract
There are no large population-based studies on the incidence and prognosis of peripartum cardiomyopathy (PC). Between 1996 and 2005, there were 241,497 deliveries within the Southern California Kaiser healthcare system. Among these, we identified 60 cases of PC by searching for an International Classification of Diseases, Ninth Edition diagnosis of heart failure (HF) and detailed chart review. PC was confirmed if all of the following criteria were satisfied: (1) left ventricular ejection fraction <0.50, (2) met the Framingham criteria for HF, (3) new symptoms of HF or initial echocardiographic diagnosis of left ventricular dysfunction occurred in the month before or in the 5 months after delivery, and (4) no alternative cause of HF could be identified. The overall incidence of PC was 1 in 4,025 deliveries. The incidence in whites, African-Americans, Hispanics, and Asians was 1 of 4,075, 1 of 1,421, 1 of 9,861, and 1 of 2,675 deliveries, respectively. The incidence of PC was greatest in African-Americans, which was 2.9-fold higher compared with whites (p = 0.03) and 7-fold that of Hispanics (p <0.001). With a mean follow-up of 4.7 years, the freedom from all-cause death was 96.7% by the Kaplan-Meier method. In conclusion, this large population-based study highlights important racial differences in the incidence of PC. We observed the lowest incidence of PC in Hispanics and the highest in African-Americans. Our findings also suggest that the current mortality associated with PC may be less than reported in older series, perhaps because of the high utilization of modern HF therapy.
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