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Crudu V.,00 N Academy Ave | Blankenship J.,00 N Academy Ave | Berger P.,Geisinger Center for Health Research | Scott T.,00 N Academy Ave | Skelding K.,00 N Academy Ave
Catheterization and Cardiovascular Interventions | Year: 2011

Objectives: The primary objective was to compare the NCDR rate of four access site related complications (arteriovenous fistula, pseudoaneurysm, retroperitoneal bleed, and blood transfusion) with that obtained independently within a Quality Improvement (QI) Database. The secondary objective was to determine the in-hospital mortality related to these complications. Background: NCDR is the most comprehensive database of post-PCI patients and a method by which hospitals are compared for quality of care and outcomes. The collected data include in-hospital events only, therefore reporting for same day and/or early discharges may fail to capture adverse events. We hypothesized that the actual rate of complications post-PCI may be higher than the rate reported in NCDR. Methods: Adverse events following PCIs were collected in a QI database. We compared the rate of four abovementioned complications between NCDR and our QI database for the time period between January 1, 2005 and December 31, 2008. Results: A total of 3,940 PCIs were performed on 3,430 patients in the four-year interval. The incidence of the combined endpoint of the four adverse events was 4.1% (161 events) in NCDR, vs. 4.7% (186 events) in QI database, a 13% higher yield. There was significantly higher in-hospital mortality in the complication group with regards to both all cause (4.7% vs. 1.1%, P < 0.0001) and cardiovascular mortality (2.7% vs. 1%, P = 0.046). Conclusions: Access site related complications occurred 13% more than what was reported in NCDR and were associated with a greater than fourfold increase in in-hospital mortality. © 2011 Wiley-Liss, Inc.

Snyder S.R.,Geisinger Center for Health Research | Mitropoulou C.,Erasmus Medical Center | Patrinos G.P.,University of Patras | Williams M.S.,00 N Academy Avenue
Public Health Genomics | Year: 2014

Evidence of the value of pharmacogenomic testing is needed to inform policymakers and clinicians for decision making related to adoption and coverage, and to facilitate prioritization for research and development. Pharmacogenomics has an important role in creating a more efficient healthcare system, and this article addresses how economic evaluation can strategically target evidence gaps for public health priorities with examples from pharmacogenomic medicine. This article begins with a review of the need for and use of economic evaluations in value-based decision making for pharmacogenomic testing. Three important gaps are described with examples demonstrating how they can be addressed: (1) projected impact of hypothetical new technology, (2) pre-implementation assessment of a specific technology, and (3) post-implementation assessment from relevant analytical stakeholder perspectives. Additional needs, challenges and approaches specific to pharmacogenomic economic evaluation in the developing world are also identified. These pragmatic approaches can provide much needed evidence to support real-world value-based decision making for pharmacogenomic-based screening and treatment strategies. © 2014 S. Karger AG, Basel.

Schoenthaler A.M.,New York University | Schwartz B.S.,Johns Hopkins University | Wood C.,Geisinger Center for Health Research | Stewart W.F.,Geisinger Center for Health Research
Diabetes Educator | Year: 2012

Purpose: The purpose of this study was to examine the influence of patient and physician psychosocial, sociodemographic, and disease-related factors on diabetes medication adherence. These factors were also examined as effect modifiers of the association between quality of the patient-physician relationship and medication adherence. Methods: Data were collected from 41 Geisinger Clinic primary care physicians and 608 of their patients with type 2 diabetes. Adherence to oral hypoglycemic medications was calculated using a medication possession ratio based on physician orders in electronic health records (MPR EHR). MPR EHR was defined as the proportion of total time in the 2 years prior to study enrollment that the patient was in possession of oral hypoglycemic medications. Linear regression was used to examine the influence of patient- and physician-level factors on adherence. Effect modification of the patient-physician relationship-adherence association was evaluated by adding the main effects of the individual-level factors and their cross-products to the models. Results: In adjusted analyses, satisfaction with the physician's patient education skills, patient beliefs about the need for their medications, and lower diabetes-related knowledge were associated with better adherence to oral hypoglycemic medications. Shorter duration of time with diabetes and taking only oral hypoglycemic medications were also associated with better adherence. Finally, the association between shared decision making and medication adherence was significantly modified by patients' level of social support. Conclusions: This study identified several patient-, physician-, and disease-related factors that should be targeted to maximize the potential for developing tailored adherence-enhancing interventions within the context of a collaborative patient-physician relationship. © 2012 The Author(s).

Prevots D.R.,National Institute of Allergy and Infectious Diseases | Shaw P.A.,National Institute of Allergy and Infectious Diseases | Strickland D.,Kaiser Permanente | Jackson L.A.,Group Health Research Institute | And 7 more authors.
American Journal of Respiratory and Critical Care Medicine | Year: 2010

Rationale: Single-site clinic-based studies suggest an increasing prevalence of pulmonary nontuberculous mycobacteria (NTM) disease, but systematic data are lacking. Objectives: To describe prevalence and trends for NTM lung disease at four geographically diverse integrated heath care delivery systems in the United States. Methods: We abstracted mycobacterial culture results from electronic laboratory databases and linked to other datasets containing clinical and demographic information. Possible cases were defined as a single positive NTM pulmonary isolate, and definite cases were defined as two positive sputum cultures, or one positive culture from a bronchoalveolar lavage or lung biopsy. Annual prevalence was calculated using United States census data; average annual prevalence is presented for 2004-2006. Poisson regression models were used to estimate the annual percent change in prevalence. Measurements and Main Results: A total of 28,697 samples from 7,940 patients were included in the analysis. Of these, 3,988 (50%) were defined as possible cases, and 1,865 (47%) of these were defined as definite cases. Average annual (2004-2006) site-specific prevalence ranged from 1.4 to 6.6 per 100,000. Prevalence was 1.l- to 1.6-fold higher among women relative to men across sites. The prevalence of NTM lung disease was increasing significantly at the two sites where trends were studied, by 2.6% per year among women and 2.9% per year among men. Among persons aged greater than or equal to 60 years, annual prevalence increased from 19.6 per 100,000 during 1994-1996 to 26.7 per 100,000 during 2004-2006. Conclusions: The epidemiology of nontuberculous mycobacterial lung disease is changing, with a predominance of women and increasing prevalence at the sites studied.

Roy J.,University of Pennsylvania | Stewart W.F.,Geisinger Center for Health Research
American Journal of Epidemiology | Year: 2011

Knowledge about remission rates can affect treatment decisions and facilitate etiologic discoveries. However, little is known about remission of many chronic episodic disorders, including migraine. This is partly due to the fact that medical records do not fully capture the history of these conditions, since patients might stop seeking care once they no longer have symptoms. For these disorders, remission rates would typically be obtained from prospective observational studies. Prospective studies of remission for chronic episodic conditions are rarely conducted, however, and suffer from many analytical challenges, such as outcome-dependent dropout. Here the authors propose an alternative approach that is appropriate for use with cross-sectional survey data in which reported age of onset was recorded. The authors estimated migraine remission rates using data from a 2004 national survey. They took a Bayesian approach and modeled sex- and age-specific remission rates as a function of incidence and prevalence. The authors found that remission rates were an increasing function of age and were similar for men and women. Follow-up survey data from migraine cases (2005) were used to validate the methods. The remission curves estimated from the validation data were very similar to the ones from the cross-sectional data. © 2011 The Author.

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