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Roebuck M.C.,University of Maryland Baltimore County | Feldstein J.I.,Center for Applied Value Analysis Inc. | McCarty C.A.,Essentia Institute of Rural Health | Grover L.L.,Wilmer Eye Institute
Archives of Ophthalmology | Year: 2012

Objective: To estimate annual per-patient health services utilization and costs of retinitis pigmentosa (RP) in the United States. Methods: A retrospective claims analysis of patients with RP (N=2990) and a 1:1 exactly matched cohort of non-RP patients was conducted using the MarketScan Commercial and Medicare Supplemental Databases. Individuals were continuously enrolled in a commercial health plan or employer-sponsored health insurance for at least 1 year. The following annual outcomes were analyzed using non-linear multivariate models: inpatient hospital admissions, inpatient hospital days, emergency department visits, outpatient physician visits, and prescription drug refills and inpatient and outpatientmedical, pharmacy, and total health care costs. Results: Patients with RP had 0.04 more hospital admissions (P < .001), 0.19 more inpatient hospital days (P < .02), 0.05 more emergency department visits (P < .01), 2.74 more outpatient visits (P < .001), and 2.18 additional prescription drug fills (P < .001) annually compared with their non-RP counterparts. Health care expenditures were significantly higher for patients with RP, who cost $894, $4855, and $452 more for inpatient, outpatient, and pharmacy services, respectively (P < .001). Overall health care costs were $7317 more per patient per year in the RP cohort, with expenditures varying considerably by age. Conclusions: Patients with RP consume substantially greater amounts of health services with significantly higher health care costs. Clinical Relevance: Treatments that slow, halt, or possibly restore RP-related vision loss may prove costeffective for payers and society.

Rasmussen L.V.,Biomedical Informatics Research Center | Peissig P.L.,Biomedical Informatics Research Center | McCarty C.A.,Essentia Institute of Rural Health | Starren J.,Biomedical Informatics Research Center | Starren J.,Northwestern University
Journal of the American Medical Informatics Association | Year: 2012

Background: Although the penetration of electronic health records is increasing rapidly, much of the historical medical record is only available in handwritten notes and forms, which require labor-intensive, human chart abstraction for some clinical research. The few previous studies on automated extraction of data from these handwritten notes have focused on monolithic, custom-developed recognition systems or third-party systems that require proprietary forms. Methods: We present an optical character recognition processing pipeline, which leverages the capabilities of existing third-party optical character recognition engines, and provides the flexibility offered by a modular custom-developed system. The system was configured and run on a selected set of form fields extracted from a corpus of handwritten ophthalmology forms. Observations: The processing pipeline allowed multiple configurations to be run, with the optimal configuration consisting of the Nuance and LEADTOOLS engines running in parallel with a positive predictive value of 94.6% and a sensitivity of 13.5%. Discussion: While limitations exist, preliminary experience from this project yielded insights on the generalizability and applicability of integrating multiple, inexpensive general-purpose third-party optical character recognition engines in a modular pipeline.

Gepner A.D.,University of Wisconsin - Madison | Haller I.V.,Essentia Institute of Rural Health | Krueger D.C.,University of Wisconsin - Madison | Korcarz C.E.,University of Wisconsin - Madison | And 2 more authors.
Atherosclerosis | Year: 2015

Objective: It is unclear if vitamin D supplementation improves central blood pressure or arterial stiffness in Native American (NA) women. Methods: Healthy postmenopausal NA women were randomized to receive 400 IU or 2500 IU of vitamin D for 6 months. Central systolic blood pressure (cSBP), central pulse pressure (cPP) and aortic augmentation index (AIx) were estimated by tonometry at baseline and after 6 months. Results: Study volunteers (n=98) were 61 (7.3) years old. 25(OH)D was 26.4 (11.0) ng/mL. 25(OH)D was similar between the two treatment groups (p=0.291), as were baseline cSBP, cPP, and CVD risk factors (all p>0.1). Treatment with 2500 IU of daily vitamin D3 did not affect cSBP, cPP, or AIx (all p>0.1) compared to 400 IU daily. Conclusions: Despite low serum 25(OH)D at baseline, 6 months of vitamin D supplementation did not improve central blood pressure parameters or arterial stiffness in NA women. Clinical trials. gov identifier: NCT01490333. © 2015 Elsevier Ireland Ltd.

Okere A.N.,Ferris State University | Renier C.M.,Essentia Institute of Rural Health | Tomsche J.J.,St Marys Medical Center
Journal of Managed Care Pharmacy | Year: 2015

BACKGROUND: The implementation of the Patient Protection and Affordable Care Act is anticipated to increase the frequency of emergency department (ED) visits. Therefore, there is a critical need to improve the quality of care transitions among ED patients from ED to outpatient services. OBJECTIVE: To evaluate the effect of systematic implementation of a pharmacistled patient-centered approach to medication therapy management and reconciliation service (MRS) in the ED on patient utilization of available health care services. METHODS: A single institution prospective randomized cohort study with 90-day postvisit observation randomized patients into 2 groups: (1) medication therapy management reconciliation service following a patient-centered approach (MRS) or (2) usual care provided by the institution (non-MRS). To align patient enrollment with availability of other primary care services, subjects were enrolled during weekday daytime hours. Data for the 90 days before and after the index ED visit were matched in all analyses. Generalized estimating equations evaluated any primary care (PC), urgent care (UC), and ED visits during the 90 days post-index ED visit, adjusted by age and sex and weighted by survival time. Generalized linear models evaluated the average number of ED visits during that period, adjusted by age and sex and weighted by survival time. Data were analyzed for all adult patients (ADLTS), aged ≥ 18 years, and the subpopulation taking 1 or more prescribed daily medication at the time of the index ED visit (ADLTS1+)-the patients expected to receive greatest benefit from an MRS program. RESULTS: ADLTS MRS patients were 1.9 more likely than non-MRS patients to visit their PC providers (mean difference 0.15, P < 0.001). Similarly, ADLTS1+ MRS patients were 1.5 times more likely to visit their PC providers (mean difference 0.10, P = 0.026). Although ADLT MRS patients were less likely to visit the UC, this was not significant. However, ADLTS1+ MRS patients were significantly less likely than non-MRS patients (OR = 0.5, 95% CI = 0.3-0.9) to visit the UC. No significant difference was seen in ED visits. CONCLUSIONS: The implementation of a patient-centered approach to medication therapy management and reconciliation improved the odds of patients visiting their PC providers, a positive first step in transitioning patients toward an appropriate use of PC services. © 2015, Academy of Managed Care Pharmacy.

Olson M.E.,Childrens Hospitals and Clinics of Minnesota | Diekema D.,Treuman Katz Center for Pediatric Bioethics | Diekema D.,University of Washington | Elliott B.A.,University of Minnesota | Renier C.M.,Essentia Institute of Rural Health
Pediatrics | Year: 2010

OBJECTIVES: The goal was to investigate the relationships of income and income inequality with neonatal and infant health outcomes in the United States. METHODS: The 2000-2004 state data were extracted from the Kids Count Data Center. Health indicators included proportion of preterm births (PTBs), proportion of infants with low birth weight (LBW), proportion of infants with very low birth weight (VLBW), and infant mortality rate (IMR). Income was evaluated on the basis of median family income and proportion of federal poverty levels; income inequality was measured by using the Gini coefficient. Pearson correlations evaluated associations between the proportion of children living in poverty and the health indicators. Linear regression evaluated predictive relationships between median household income, proportion of children living in poverty, and income inequality for the 4 health indicators. RESULTS: Median family income was negatively correlated with all birth outcomes (PTB, r=-0.481; LBW, r=-0.295; VLBW, r=-0.133; IMR, r = -0.432), and the Gini coefficient was positively correlated (PTB, r = 0.339; LBW, r = 0.398; VLBW, r = 0.460; IMR, r = 0.114). The Gini coefficient explained a significant proportion of the variance in rate for each outcome in linear regression models with median family income. Among children living in poverty, the role of income decreased as the degree of poverty decreased, whereas the role of income inequality increased. CONCLUSIONS: Both income and income inequality affect infant health outcomes in the United States. The health of the poorest infants was affected more by absolute wealth than relative wealth. Copyright © 2010 by the American Academy of Pediatrics.

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