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Theodore R. Levin - One of the best experts on this subject based on the ideXlab platform.
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diagnosis comorbidities and management of irritable bowel syndrome in patients in a large Health Maintenance Organization
Clinical Gastroenterology and Hepatology, 2012Co-Authors: Uri Ladabaum, Erin Boyd, Wei K Zhao, Ajitha Mannalithara, Annie Sharabidze, Gurkirpal Singh, Elaine Chung, Theodore R. LevinAbstract:Background & Aims Irritable bowel syndrome (IBS) imposes significant clinical and economic burdens. We aimed to characterize practice patterns for patients with IBS in a large Health Maintenance Organization, analyzing point of diagnosis, testing, comorbidities, and treatment. Methods Members of Kaiser Permanente Northern California who were diagnosed with IBS were matched to controls by age, sex, and period of enrollment. We compared rates of testing, comorbidities, and interventions. Results From 1995–2005, IBS was diagnosed in 141,295 patients (mean age, 46 years; standard deviation, 17 years; 74% female). Internists made 68% of diagnoses, gastroenterologists 13%, and others 19%. Lower endoscopy did not usually precede IBS diagnosis. Patients with IBS were more likely than controls to have blood, stool, endoscopic, and radiologic tests and to undergo abdominal or pelvic operations (odds ratios, 1.5–10.7; all P P Conclusions In a large, managed care cohort, most diagnoses of IBS were made by generalists, often without endoscopic evaluation. Patients with IBS had consistently higher rates of testing, chronic pain syndromes, psychiatric comorbidity, and operations than controls. Most patients with IBS were treated with psychiatric medications.
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A cost analysis of a Helicobacter pylori eradication strategy in a large Health Maintenance Organization
The American journal of gastroenterology, 1998Co-Authors: Theodore R. Levin, Julie A. Schmittdiel, James M. Henning, Kimberly Kunz, Curtis J. Henke, Christopher J. Colby, Joseph V. SelbyAbstract:A cost analysis of a Helicobacter pylori eradication strategy in a large Health Maintenance Organization
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costs of acid related disorders to a Health Maintenance Organization
The American Journal of Medicine, 1997Co-Authors: Julie A. Schmittdiel, Theodore R. Levin, James M. Henning, Kimberly Kunz, Curtis J. Henke, Christopher J. Colby, Joseph V. SelbyAbstract:Abstract BACKGROUND: Little is known about the economic impact of the acid-related disorders (ARDs), which include dyspepsia, gastritis, gastroesophageal reflux disease (GERD), and peptic ulcer disease (PUD), in managed care patient populations. OBJECTIVES: To describe the prevalence of medically attended ARDs, and their direct medical costs from the perspective of a large Health Maintenance Organization (HMO). METHODS: A total of 1,550 ARDs subjects (age ≥18 years), were randomly sampled from outpatient diagnosis and pharmacy databases of the Kaiser Permanente Medical Care Program of Northern California and verified by chart review. Five age- and gender-matched controls were identified per subject. One-year prevalence, excess annual costs, and initial 6-month costs for incident cases were estimated using the HMO cost accounting system. RESULTS: Total ARDs prevalence (5.8%) increases with advancing age. GERD is the most common ARD (2.9% overall prevalence). Annual per person attributable costs were $1,183, $471, and $431 respectively for PUD, GERD, and gastritis/dyspepsia. Excess inpatient costs for PUD explain its higher costs. Outpatient costs were somewhat higher for GERD ($279) than for PUD or gastritis/dyspepsia. Pharmacy costs were relatively low for each condition, in part because many patients were treated with generic cimetidine. Total annual HMO expenditures for ARDs were $59.4 million, with 40.6%, 36.8%, and 22.6% respectively for GERD, PUD, and gastritis/dyspepsia. CONCLUSIONS: Acid-related disorders, particularly GERD and PUD, contribute substantially to the direct costs of medical care in this managed care population.
Christine Cole Johnson - One of the best experts on this subject based on the ideXlab platform.
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vitamin d and nonmelanoma skin cancer in a Health Maintenance Organization cohort
Archives of Dermatology, 2011Co-Authors: Melody J Eide, Dayna A Johnson, Gordon Jacobsen, Richard Krajenta, Sudhaker D Rao, Henry W Lim, Christine Cole JohnsonAbstract:Objective To examine the association of serum 25-hydroxyvitamin D (25-OHD) with the risk of nonmelanoma skin cancer (NMSC), defined as squamous cell carcinoma (SCC) and basal cell carcinoma (BCC). Design Cohort study. Setting Health Maintenance Organization. Patients The study included 3223 white Health Maintenance Organization patients who sought osteoporosis- or low-bone-density –related advice from 1997 to 2001. Interventions Vitamin D levels were ascertained at the time of the initial appointment, and a sufficient vitamin D level was defined as a baseline serum 25-OHD level greater than or equal to 30 ng/mL (to convert to nanomoles per liter, multiply by 2.496) and as a deficient vitamin D level less than 15 ng/mL. Main Outcome Measures The NMSC cases diagnosed between 1997 and 2009 were ascertained using claims data, considering first occurrence of specified disease outcome and complete person-years of follow-up since baseline. Charts were abstracted for histologic subtype and anatomical location. Results More patients were vitamin D insufficient (n = 2257) than sufficient (n = 966). There were 240 patients with NMSC: 49 had an SCC, 163 had a BCC, and 28 had both. Vitamin D levels greater than 15 ng/mL ( “not deficient level ”) were positively associated with NMSC (unadjusted odds ratio [OR], 1.7; 95% confidence interval [CI], 1.04-2.7), and this association was sustained after additional risk factors were adjusted for (adjusted OR, 1.8; 95% CI, 1.1-2.9). The 25-OHD levels were similarly positively associated, though statistically insignificant, with NMSC occurring on less UV-exposed anatomical locations (adjusted OR, 2.2; 95% CI, 0.7-7.0), whether for SCC (adjusted OR, 3.2; 95% CI, 0.4-24.0) or for BCC, although the risk estimate for BCC was lower (adjusted OR, 1.7; 95% CI, 0.5-5.8). Conclusions An increased baseline serum 25-OHD level was significantly associated with an increased NMSC risk. This association was positive, though nonsignificant on less UV-exposed body sites, and UV exposure remains a likely confounder. The complex and confounded relationship of vitamin D, UV, and NMSC makes classic epidemiological investigation difficult in the absence of carefully measured history of cumulative UV exposure.
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identification of patients with nonmelanoma skin cancer using Health Maintenance Organization claims data
American Journal of Epidemiology, 2010Co-Authors: Melody J Eide, Dayna A Johnson, Gordon Jacobsen, Richard Krajenta, Henry W Lim, Jordan Long, Maryam M Asgari, Christine Cole JohnsonAbstract:Cancer registries usually exclude nonmelanoma skin cancers (NMSC), despite the large population affected. Health Maintenance Organization (HMO) and Health system administrative databases could be used as sampling frames for ascertaining NMSC. NMSC patients diagnosed between January 1, 1988, and December 31, 2007, from such defined US populations were identified by using 3 algorithms: NMSC International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes, NMSC treatment Current Procedural Terminology (CPT) codes, or both codes. A subset of charts was reviewed to verify NMSC diagnosis, including all records from HMO-enrollee members in 2007. Positive predictive values for NMSC ascertainment were calculated. Analyses of data from 1988–2007 ascertained 11,742 NMSC patients. A random sample of 965 cases was selected for chart review, and NMSCs were validated in 47.0% of ICD-9-CM–identified patients, 73.4% of CPT-identified patients, and 94.9% identified with both codes. All charts from HMO–Health plan enrollees in 2007 were reviewed (n = 1,116). Cases of NMSC were confirmed in 96.5% of ICD-9-CM–identified patients, 98.3% of CPT-identified patients, and 98.7% identified with both codes. HMO administrative data can be used to ascertain NMSC with high positive predictive values with either ICD-9-CM or CPT code, but both codes may be necessary among non-HMO patient populations.
John A Merenich - One of the best experts on this subject based on the ideXlab platform.
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clinical pharmacy cardiac risk service for managing patients with coronary artery disease in a Health Maintenance Organization
American Journal of Health-system Pharmacy, 2007Co-Authors: Brian G Sandhoff, Leslie K Nies, Kari L Olson, James D Nash, Jon Rasmussen, John A MerenichAbstract:Purpose. A clinical pharmacy service for managing the treatment of coronary artery disease in a Health Maintenance Organization is described. Summary. Despite the proven benefits of aggressive risk factor modification for patients with coronary artery disease (CAD), there remains a treatment gap between consensus- and evidence-based recommendations and their application in patient care. In 1998, Kaiser Permanente of Colorado developed the Clinical Pharmacy Cardiac Risk Service (CPCRS) to focus on the long-term management of patients with CAD to improve clinical outcomes. The primary goals of the CPCRS are to increase the number of CAD patients on lipid-lowering therapy, manage medications shown to decrease the risk of future CAD-related events, assist in the monitoring and control of other diseases that increase cardiovascular risk, provide patient education and recommendations for nonpharmacologic therapy, and act as a CAD information resource for physicians and other Health care providers. Using an electronic medical record and tracking database, the service works in close collaboration with primary care physicians, cardiologists, cardiac rehabilitation nurses, and other Health care providers to reduce cardiac risk in the CAD population. Particular attention is given to dyslipidemia, blood pressure, diabetes mellitus, and tobacco cessation. Treatment with evidence-based regimens is initiated and adjusted as necessary. Over 11,000 patients are currently being followed by the CPCRS. Conclusion. A clinical pharmacy service in a large Health Maintenance Organization provides cardiac risk reduction for patients with CAD and helps close treatment gaps that may exist for these patients.
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evaluation of cases of severe statin related transaminitis within a large Health Maintenance Organization
The American Journal of Medicine, 2005Co-Authors: Brian G Sandhoff, Kari L Olson, John A Merenich, Evguenia C Charles, David L McclureAbstract:Abstract Purpose To describe the rate, potential causes, symptoms, time to onset, and time to resolution of severe transaminitis associated with increased 3-hydroxy-3-methylglutaryl coenzyme reductase inhibitor ("statin") usage in a large group model Health Maintenance Organization. Subjects and methods Health plan members 18 years of age and older, not receiving chemotherapy, who had received at least 1 statin prescription between January 1, 1997, and December 31, 2001 were eligible. All eligible patients with an alanine aminotransferase greater than 10 times the upper limit of normal at any time during the study period were identified using computerized laboratory records. Medical records were subsequently reviewed in order to determine whether the elevation was attributable to statin therapy. Results Alanine aminotransferase had never been measured in 2334 of 25334 (9%) of eligible patients. In the remaining 23000 patients, 62 (0.3%) were identified with an alanine aminotransferase greater than 10 times the upper limit of normal during the 5-year study period. Of these, 17 (0.1% of 23000 patients) had severe transaminitis deemed directly attributable to statin use. All except 4 of these 17 cases were associated with drug interactions. In 16 cases, transaminitis resolved upon statin discontinuation. Conclusions In the observed study sample, statin-related severe transaminitis occurred infrequently. These findings support less frequent liver enzyme monitoring for most patients on statins. Continued monitoring remains warranted for patients on concomitant medications or those with comorbid conditions.
Melody J Eide - One of the best experts on this subject based on the ideXlab platform.
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vitamin d and nonmelanoma skin cancer in a Health Maintenance Organization cohort
Archives of Dermatology, 2011Co-Authors: Melody J Eide, Dayna A Johnson, Gordon Jacobsen, Richard Krajenta, Sudhaker D Rao, Henry W Lim, Christine Cole JohnsonAbstract:Objective To examine the association of serum 25-hydroxyvitamin D (25-OHD) with the risk of nonmelanoma skin cancer (NMSC), defined as squamous cell carcinoma (SCC) and basal cell carcinoma (BCC). Design Cohort study. Setting Health Maintenance Organization. Patients The study included 3223 white Health Maintenance Organization patients who sought osteoporosis- or low-bone-density –related advice from 1997 to 2001. Interventions Vitamin D levels were ascertained at the time of the initial appointment, and a sufficient vitamin D level was defined as a baseline serum 25-OHD level greater than or equal to 30 ng/mL (to convert to nanomoles per liter, multiply by 2.496) and as a deficient vitamin D level less than 15 ng/mL. Main Outcome Measures The NMSC cases diagnosed between 1997 and 2009 were ascertained using claims data, considering first occurrence of specified disease outcome and complete person-years of follow-up since baseline. Charts were abstracted for histologic subtype and anatomical location. Results More patients were vitamin D insufficient (n = 2257) than sufficient (n = 966). There were 240 patients with NMSC: 49 had an SCC, 163 had a BCC, and 28 had both. Vitamin D levels greater than 15 ng/mL ( “not deficient level ”) were positively associated with NMSC (unadjusted odds ratio [OR], 1.7; 95% confidence interval [CI], 1.04-2.7), and this association was sustained after additional risk factors were adjusted for (adjusted OR, 1.8; 95% CI, 1.1-2.9). The 25-OHD levels were similarly positively associated, though statistically insignificant, with NMSC occurring on less UV-exposed anatomical locations (adjusted OR, 2.2; 95% CI, 0.7-7.0), whether for SCC (adjusted OR, 3.2; 95% CI, 0.4-24.0) or for BCC, although the risk estimate for BCC was lower (adjusted OR, 1.7; 95% CI, 0.5-5.8). Conclusions An increased baseline serum 25-OHD level was significantly associated with an increased NMSC risk. This association was positive, though nonsignificant on less UV-exposed body sites, and UV exposure remains a likely confounder. The complex and confounded relationship of vitamin D, UV, and NMSC makes classic epidemiological investigation difficult in the absence of carefully measured history of cumulative UV exposure.
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identification of patients with nonmelanoma skin cancer using Health Maintenance Organization claims data
American Journal of Epidemiology, 2010Co-Authors: Melody J Eide, Dayna A Johnson, Gordon Jacobsen, Richard Krajenta, Henry W Lim, Jordan Long, Maryam M Asgari, Christine Cole JohnsonAbstract:Cancer registries usually exclude nonmelanoma skin cancers (NMSC), despite the large population affected. Health Maintenance Organization (HMO) and Health system administrative databases could be used as sampling frames for ascertaining NMSC. NMSC patients diagnosed between January 1, 1988, and December 31, 2007, from such defined US populations were identified by using 3 algorithms: NMSC International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes, NMSC treatment Current Procedural Terminology (CPT) codes, or both codes. A subset of charts was reviewed to verify NMSC diagnosis, including all records from HMO-enrollee members in 2007. Positive predictive values for NMSC ascertainment were calculated. Analyses of data from 1988–2007 ascertained 11,742 NMSC patients. A random sample of 965 cases was selected for chart review, and NMSCs were validated in 47.0% of ICD-9-CM–identified patients, 73.4% of CPT-identified patients, and 94.9% identified with both codes. All charts from HMO–Health plan enrollees in 2007 were reviewed (n = 1,116). Cases of NMSC were confirmed in 96.5% of ICD-9-CM–identified patients, 98.3% of CPT-identified patients, and 98.7% identified with both codes. HMO administrative data can be used to ascertain NMSC with high positive predictive values with either ICD-9-CM or CPT code, but both codes may be necessary among non-HMO patient populations.
Lynn Ackerson - One of the best experts on this subject based on the ideXlab platform.
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patterns of cigarette smoking and alcohol use among lesbians and bisexual women enrolled in a large Health Maintenance Organization
American Journal of Public Health, 2001Co-Authors: Elisabeth P Gruskin, Nancy P Gordon, Stacey L Hart, Lynn AckersonAbstract:Objectives. This study compared the prevalence of cigarette smoking and alcohol use among lesbians and bisexual women with that among heterosexual women. Methods. Logistic regression models were created with data from an extensive member Health survey at a large Health Maintenance Organization. Sexual orientation was the primary predictor, and alcohol consumption and cigarette smoking were outcomes. Results. Lesbians and bisexual women younger than 50 years were more likely than heterosexual women to smoke cigarettes and drink heavily. Lesbians and bisexual women aged 20 to 34 reported higher weekly alcohol consumption and less abstinence compared with heterosexual women and older lesbians and bisexual women. Conclusions. Lesbians and bisexual women aged 20 to 34 years are at risk for alcohol use and cigarette smoking. (Am J Public Health. 2001;91: 976‐979)
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the effect of patient and provider reminders on mammography and papanicolaou smear screening in a large Health Maintenance Organization
JAMA Internal Medicine, 1997Co-Authors: Carol P Somkin, Robert A Hiatt, Leo B Hurley, Elisabeth P Gruskin, Lynn Ackerson, Pamela LarsonAbstract:Background: We evaluated the effectiveness of 2 reminder interventions to increase the use of screening mammograms and Papanicolaou (Pap) smears among female members of a large Health Maintenance Organization. Methods: Seven thousand seventy-seven female Health Maintenance Organization members (aged 50-74 years with no prior mammogram in the previous 30 months or aged 20-64 years with no prior Pap smear in the previous 36 months) were randomized to receive one of the following: a letter inviting them to make an appointment for a mammogram or a Pap smear; in addition to the letter, a reminder manually placed in the patient's medical chart alerting providers of that member's need for screening; or their usual care. Results: Compared with women who did not receive the reminder letter, women who did receive the letter were more likely to obtain mammograms (16.0% vs 25.5%, respectively;P Conclusions: We recommend the use of patient reminder letters as a first step in a mammography or Pap smear screening outreach program. Further research is needed to evaluate a cost-effective provider reminder system and additional outreach strategies directed to women who do not use Health care services. Arch Intern Med. 1997;157:1658-1664
