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Placzek H.,University of Massachusetts Medical School | Placzek H.,HealthCore Inc. | Madoff L.,University of Massachusetts Medical School
American Journal of Public Health | Year: 2014

Objectives: We linked hospital discharge and American Community Survey and US Census data to investigate 2009 H1N1 influenza (H1N1)-related outcomes by racial/ethnic groups and socioeconomic status (SES). Methods: We examined the population discharged from any acute care hospital in Massachusetts and calculated rates of intensive care unit (ICU) stay by racial/ethnic and SES groups between April 26 and September 30, 2009. We used logistic regression models to identify predictors of ICU stay. Results: Of 4874 H1N1-related hospitalizations, 526 (11%) were admitted to the ICU. Those in less affluent SES groups had lower risk of ICU stay than the most affluent SES group. Compared with Whites, Hispanics had significantly lower risk of 2009 H1N1-related ICU stay (odds ratio = 0.52; 95% confidence interval = 0.32, 0.86). Only 13% of Whites admitted to the ICU were in the lowest SES group, compared with 63% of Hispanics and 43% of Blacks. Conclusions: To our knowledge, this is the first statewide description of 2009 H1N1 influenza-related ICU stays according to racial/ethnic group and SES in the United States. Future work should investigate evidence related to social determinants of health among racial/ethnic groups to reduce disparities in relation to pandemic influenza.


Suaya J.A.,GlaxoSmithKlineVaccines | Eisenberg D.F.,HealthCore Inc. | Fang C.,HealthCore Inc. | Miller L.G.,University of California at Los Angeles
PLoS ONE | Year: 2013

Introduction:Skin and soft tissue infections (SSTIs) are common infections occurring in ambulatory and inpatient settings. The extent of complications associated with these infections by diabetes status is not well established.Methods:Using a very large repository database, we examined medical and pharmacy claims of individuals aged 0-64 between 2005 and 2010 enrolled in U.S. health plans. Diabetes, SSTIs, and SSTI-associated complications were identified by ICD-9 codes. SSTIs were stratified by clinical category and setting of initial diagnosis.Results:We identified 2,227,401 SSTI episodes, 10% of which occurred in diabetic individuals. Most SSTIs were initially diagnosed in ambulatory settings independent from diabetes status. Abscess/cellulitis was the more common SSTI group in diabetic and non-diabetic individuals (66% and 59%, respectively). There were differences in the frequencies of SSTI categories between diabetic and non-diabetic individuals (p<0.01). Among SSTIs diagnosed in ambulatory settings, the SSTI-associated complication rate was over five times higher in people with diabetes than in people without diabetes (4.9% vs. 0.8%, p<0.01) and SSTI-associated hospitalizations were 4.9% and 1.1% in patients with and without diabetes, respectively. Among SSTIs diagnosed in the inpatient setting, bacteremia/endocarditis/septicemia/sepsis was the most common associated complication occurring in 25% and 16% of SSTIs in patients with and without diabetes, respectively (p<0.01).Conclusions:Among persons with SSTIs, we found SSTI-associated complications were five times higher and SSTI-associated hospitalizations were four times higher, in patients with diabetes compared to those without diabetes. SSTI prevention efforts in individuals with diabetes may have significant impact on morbidity and healthcare resource utilization. © 2013 Suaya et al.


RIDGEFIELD, Conn. and WILMINGTON, Del., Nov. 14, 2016 /PRNewswire/ -- Boehringer Ingelheim Pharmaceuticals, Inc., Anthem, Inc. and HealthCore Inc. today announced the final results from the first phase of a three phase, large-scale research collaboration to generate real-world evidence to...


News Article | February 17, 2017
Site: www.businesswire.com

WILMINGTON, Del. & CLEVELAND--(BUSINESS WIRE)--HealthCore Inc. and LiveHealth Online today announced the results of a new study sponsored by Anthem, Inc. and published in the Journal of Medical Internet Research (Vol 19, No 2 (2017): February). The results found that LiveHealth Online virtual video visits with doctors resolve medical issues for minor ailments, such as sinus infections, pink eye and ear ache, just as well as face-to-face visits with a healthcare provider. The study is the first to broadly explore the quality of virtual video visits. “Based on our review of published literature and anecdotal experiences, people have questioned whether doctors practicing virtually can appropriately treat illnesses in the absence of physical interaction with their patients,” said Andrea DeVries, senior author of the study and staff vice president of research at HealthCore. “This study demonstrates that they can when treating several minor ailments among people who do not have chronic conditions.” Researchers examined claims submitted by consumers who have a covered telehealth benefit for visits using LiveHealth Online. They looked at 11 of the most common telehealth diagnoses and discovered that most patients had similar numbers of follow-up visits as those who saw a provider at an urgent health care clinic, retail health clinic, emergency department or doctor’s office for the same types of ailments. Also, patients who had video visits with doctors via LiveHealth Online had fewer hospitalizations and emergency department visits within a three–week period after their telehealth visit than those who saw providers in a urgent care clinic, emergency department or doctor’s office. “By using follow-up visits as a proxy for misdiagnoses or treatment failures, we can tell consumers are getting resolution to their health concerns through video visits because they are not then going on to have face-to-face visits with other providers,” said John Jesser, president of LiveHealth Online. “The outcome of this research is a great step in boosting confidence among consumers that a telehealth visit using LiveHealth Online is an effective way to manage a minor health issue when they cannot get to their regular doctor.” The study analyzed insurance claims data with service dates between January 1, 2014 and May 11, 2015 on the following conditions over a three-week period beginning with the claim for the first visit: sinusitis, upper respiratory infections, urinary tract infections, pink eye, bronchitis, sore throat, influenza, cough, dermatitis, nausea/vomiting/diarrhea and ear ache. Approximately 4,600 virtual visits using LiveHealth Online were examined in addition to 55,310 visits to in person locations at urgent care clinics, retail health clinics, emergency departments or doctor’s offices. LiveHealth® Online is a leading telehealth tool providing consumers with convenient access to U.S.-based board-certified doctors and licensed therapists via live video chat on their smartphone, tablet or computer with a webcam. Healthcare providers using LiveHealth® Online can diagnose, treat and write a prescription. Since its launch in 2013, hundreds of thousands of consumers have signed up for and had video visits using LiveHealth Online with registrations and usage growing daily. LiveHealth® Online is the trade name of Health Management Corporation. For more information, visit LiveHealthOnline.com. HealthCore Inc., www.healthcore.com, uses real world data, including claims information, to provide clinical and other scientific expertise and research services to the pharmaceutical, biotechnology and device industries, in the conduct of industry-sponsored safety, health economic outcomes, comparative effectiveness, epidemiological and late stage research projects. HealthCore’s capabilities include retrospective database design and analysis, prospective observational research design and analysis, safety and epidemiologic research services, post authorization safety study (PASS), health services research, patient and/or provider survey development and implementation, and general research consultation.


Palli S.R.,HealthCore Inc. | Kamble P.S.,University of Houston | Chen H.,University of Houston | Aparasu R.R.,University of Houston
Journal of Child and Adolescent Psychopharmacology | Year: 2012

Objective: To examine the persistence of three newly initiated stimulant preparations among Medicaid children and adolescents with attention-deficit/ hyperactivity disorder (ADHD) diagnosis. Methods: A retrospective longitudinal claims analysis was conducted by using Medicaid analytical eXtract data of four states. The study focused on patients between 6 and 19 years of age with ADHD diagnosis and a stimulant prescription from January 2003 to December 2005. Stimulants were grouped into short-acting stimulants (SAS), intermediate-acting stimulants (IAS), and long-acting stimulants (LAS). Persistence was measured by totaling the number of days the patient remained on the index stimulant therapy from the index prescription date provided the refill gap between two consecutive stimulant claims was no more than 30 days. All the stimulant recipients were uniformly followed for 1 year (365 days). Survival time ratios (STR) were calculated by using accelerated failure time models to examine variation in index stimulant persistence for each stimulant class. Results: Among the 46,135 patients with ADHD continuously followed for 1 year, 8,260 were SAS users, 4,314 were IAS users, and 33,561 were LAS users. Children who received IAS medications had 4% shorter persistence (STR, 0.96 [95% confidence interval [CI], 0.93-0.98]) when compared with those who received SAS medications, whereas those who received index LAS medications had 29% longer persistence (STR, 1.29 [95% CI, 1.27-1.32]). Multivariate accelerated failure time models revealed that Blacks and Hispanics had consistently lower persistence than their counterparts. Foster care was positively associated with index stimulant persistence in the three stimulant types. Further, addition of another stimulant and other psychotropic medications significantly improved persistence of index stimulant in all three stimulant classes. Conclusions: LAS had comparatively longer persistence than other stimulants. An understanding of demographic and clinical characteristics that influence treatment continuation can help improve stimulant persistence rates in ADHD. © 2012 Mary Ann Liebert, Inc.


Patorno E.,Brigham and Women's Hospital | Bohn R.L.,Brigham and Women's Hospital | Bohn R.L.,HealthCore Inc. | Wahl P.M.,HealthCore Inc. | And 4 more authors.
JAMA - Journal of the American Medical Association | Year: 2010

Context: In 2008, the US Food and Drug Administration mandated warning labeling for anticonvulsant medications regarding the increased risk of suicidal thoughts and behaviors. The decision was based on a meta-analysis not sufficiently large to investigate individual drugs. Objective: To evaluate the risk of suicidal acts and combined suicidal acts or violent death associated with individual anticonvulsants. Design: A cohort study of the risk of suicidal acts and combined suicidal acts or violent death in patients beginning use of anticonvulsant medications compared with patients initiating a reference anticonvulsant drug. Setting and Patients: Patients 15 years and older from the HealthCore Integrated Research Database (HIRD) who began taking an anticonvulsant between July 2001 and December 2006. Main Outcome Measures: Cox proportional hazards models and propensity score - matched analyses were used to evaluate risk of attempted or completed suicide and combined suicidal acts or violent death, controlling for psychiatric comorbidities and other risk factors, among individual anticonvulsants compared with topiramate and secondarily carbamazepine. Results: The study identified 26 completed suicides, 801 attempted suicides, and 41 violent deaths in 297 620 new episodes of treatment with an anticonvulsant (overall median follow-up, 60 days). The incidence of the composite outcomes of completed suicides, attempted suicides, and violent deaths for anticonvulsants used in at least 100 treatment episodes ranged from 6.2 per 1000 person-years for primidone to 34.3 per 1000 person-years for oxcarbazepine. The risk of suicidal acts was increased for gabapentin (hazard ratio [HR], 1.42; 95% confidence interval [CI], 1.11-1.80), lamotrigine (HR, 1.84; 95% CI, 1.43-2.37), oxcarbazepine (HR, 2.07; 95% CI, 1.52-2.80), tiagabine (HR, 2.41; 95% CI, 1.65-3.52), and valproate (HR, 1.65; 95% CI, 1.25-2.19), compared with topiramate. The analyses including violent death produced similar results. Gabapentin users had increased risk in subgroups of younger and older patients, patients with mood disorders, and patients with epilepsy or seizure when compared with carbamazepine. Conclusion: This exploratory analysis suggests that the use of gabapentin, lamotrigine, oxcarbazepine, and tiagabine, compared with the use of topiramate, may be associated with an increased risk of suicidal acts or violent deaths. ©2010 American Medical Association. All rights reserved.


Grabner M.,HealthCore Inc.
Obesity Facts | Year: 2012

Objective:This study is a descriptive investigation of trends in BMI in the USA over time, across race/ethnicity, gender, and socioeconomic status (SES) groups, and across different datasets. Methods: The study analyzes micro-level data from three widely used cross-sectional US health datasets: the National Health and Nutrition Examination Survey (NHANES), the National Health Interview Survey (NHIS), and the Behavioral Risk Factor Surveillance System (BRFSS), from the 1970s to 2008. Consistent race/ethnicity and SES groups are constructed for all datasets. SES is measured by education and income. Focusing on adults aged 20-74 years, the study estimates BMI time trends, distributional shifts, and incremental associations (gradients) with SES. Results: SES-BMI gradients are consistently larger for women than for men, differ across race/ethnicity groups, and are similar across datasets. Trends in mean BMI are comparable across White, Black and Hispanic males, while Hispanic females range between White and Black females. Self-reported BMI in the NHANES differs markedly from self-reports in the NHIS and BRFSS. Conclusion: The NHANES, NHIS, and BRFSS provide similar evidence regarding BMI trends over time and across race/ethnicity, gender, and SES groups. Racial disparities in BMI remain after adjusting for SES and should be studied further. Copyright © 2012 S. Karger GmbH, Freiburg.


Insulin pens may help patients reach glycated hemoglobin (HbA1c) target levels, but a substantial proportion of patients continue to use insulin vials/syringes. The objective of the current study was to evaluate real-world clinical and economic outcomes of patients with type 2 diabetes mellitus (T2DM) initiating insulin glargine via pen delivery (pen) or vial/syringe (vial) within a large managed-care population in the United States. This retrospective administrative claims study used data on adult, insulin-naïve patients with T2DM treated with ≥ 1 oral antidiabetic or glucagon-like peptide-1 receptor agonist at baseline. The index date was the earliest pen or vial prescription date. Propensity score matching (1:1) of patients in the pen and vial cohorts was used when comparing 1-year outcomes, including treatment persistence and adherence, HbA1c levels, hypoglycemia rates, and all-cause and diabetes-related health care costs (computed as paid amounts on claims). Patients in the matched cohorts (n = 733 per cohort) were well balanced with regard to demographics (mean age 52 years; 43% women), clinical measures (mean HbA1c level, 9.4%; mean Quan-Modified Charlson Comorbidity Index score, 0.9), and health care utilization at baseline. Following initiation of insulin glargine, pen patients were more persistent (60.6% vs 50.1%; P < 0.001) and adherent (medication possession ratio, 0.73 vs 0.57; P < 0.001), with lower HbA1c levels during follow-up (mean adjusted change, -1.05 vs -0.73; P < 0.001), compared with vial patients. Hypoglycemic events occurred at similar rates across pen and vial cohorts (3.8% vs 5.2%, respectively; P = 0.21). Study drug costs were higher among pen users ($1164 vs $762, respectively; P < 0.001), but this did not translate into higher total all-cause or diabetes-related costs. For patients with diabetes newly initiating insulin glargine, using an insulin pen device was associated with increased therapy persistence and adherence, and lower HbA1c levels relative to vial/syringe, without increasing total all-cause or diabetes-related costs.


Devries A.,HealthCore Inc. | Li C.-H.,HealthCore Inc. | Oza M.,WellPoint Inc.
Medical Care | Year: 2013

Background: This administrative claims analysis evaluated the impact of a health plan-sponsored Emergency Room Utilization Management Initiative (ERUMI), which combined increased patient copays for ED visits with educational outreach to reduce inappropriate ED use and encourage use of retail health clinics (RHCs) and other alternative treatment sites among a commercially insured population. Methods: Emergency department (ED) utilization rates for select acute but nonurgent conditions that could be treated appropriately in an RHC were compared for members of an employer group with (intervention group) and without (comparators) ERUMI. Utilization was compared for baseline period (January-June 2009) and ERUMI implementation period (January-June 2010). Results: A total of 56,896 members (14,224 intervention, 42,672 matched comparators) were included. ED utilization for conditions that could be treated appropriately by RHCs decreased by 10.39 visits/1000 members in the intervention group versus 6.29 visits in comparators. RHC visits rose for both the groups, with a greater increase in the intervention group (22.61 visits/1000 members, P<0.001) versus comparison (1.64/1000, P=0.064). After ERUMI implementation, intervention group members were nearly 5 times more likely than comparators to choose RHCs over ED for nonurgent care. Conclusions: The health plan-sponsored ERUMI program, consisting of both financial and educational components, decreased nonurgent ED utilization while increasing the use of alternative treatment sites. © 2012 by Lippincott Williams & Wilkins.


This study examines the impact of disenrolling from Medicaid/State Children's Health Insurance Programs (SCHIP) on health care utilization and expenditures among children using the 1996-2005 Medical Expenditure Panel Survey data. Changes in expenditures and utilization upon Medicaid/SCHIP disenrollment were examined for two disenrollment groups, children who became uninsured and those who transitioned to private insurance; relative to a control group, those continuously enrolled in Medicaid/SCHIP during the study period. In multivariate analysis, a modified two-part model and difference-in-difference analytic approach were used. The dependent variables were changes in total expenditures and changes in utilization (i.e., well-child visits, physician visits, emergency room visits, hospitalizations, and prescription drug use) from pre- to post-disenrollment round. This study found that losing Medicaid/SCHIP coverage is associated with decreased preventive care utilization among children, regardless of the insurance status post-disenrollment. In addition, children who become uninsured following Medicaid/SCHIP disenrollment may also experience reductions in physician visits and prescription drug use.

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