Entity

Time filter

Source Type

Cambridge, MA, United States

Berz J.P.B.,Boston University | Singer M.R.,Boston University | Guo X.,Outcome science Inc. | Daniels S.R.,University of Colorado at Denver | Moore L.L.,Boston University
Archives of Pediatrics and Adolescent Medicine | Year: 2011

Objective: To study the effects of selected dietary patterns, particularly a DASH (Dietary Approach to Stop Hypertension) eating pattern, on body mass index (BMI) throughout adolescence. Design: Prospective National Growth and Health Study. Setting: Washington, DC; Cincinnati, Ohio; and Berkeley, California. Participants: A total of 2327 girls with 10 annual visits starting at age 9 years. Main Exposures: Individual DASH-related food groups and a modified DASH adherence score. Main Outcome Measure: The BMI value from measured yearly height and weight over 10 years. Results: Longitudinal mixed modeling methods were used to assess the effects of individual DASH food groups and a DASH adherence score on BMI during 10 years of follow-up, adjusting for race, height, socioeconomic status, television viewing and video game playing hours, physical activity level, and total energy intake. Girls in the highest vs lowest quintile of the DASH score had an adjusted mean BMI of 24.4 vs 26.3 (calculated as weight in kilograms divided by height in meters squared) (P<.05). The strongest individual food group predictors of BMI were total fruit (mean BMI, 26.0 vs 23.6 for <1 vs ≥2 servings per day; P<.001) and low-fat dairy (mean BMI, 25.7 vs 23.2 for <1 vs ≥2 servings per day; P<.001). Whole grain consumption was more weakly but beneficially associated with BMI. Conclusions: Adolescent girls whose diet more closely resembled the DASH eating pattern had smaller gains in BMI over 10 years. Such an eating pattern may help prevent excess weight gain during adolescence. ©2011 American Medical Association. All rights reserved. Source


Li Q.,Harvard University | Glynn R.J.,Brigham and Womens Hospital | Dreyer N.A.,Outcome science Inc. | Liu J.,Brigham and Womens Hospital | And 2 more authors.
Pharmacoepidemiology and Drug Safety | Year: 2011

Purpose: Ejection fraction (EF) is crucial information when studying the use and effectiveness of therapies in patients with heart failure (HF) and myocardial infarction (MI). We aimed to assess the validity of claims data-based definitions of systolic dysfunction (SD). Methods: We identified 1072 patients with EF recorded for an HF/MI hospitalization in Medicare linked with pharmacy data and national HF/MI registries in 1999-2006. Thirteen claims-based definitions for SD were developed using a single or combination of ICD-9 diagnosis codes and cardiovascular medications use. We calculated sensitivity, specificity, and positive predictive values (PPVs) using recorded EFs as the gold standard. Results: Using an EF cutoff of 45%, the definitions based on digoxin use and no atrial fibrillation or flutter had the highest PPVs (76% to 84%) and specificity (>97%) but low sensitivity (6%-14%). As we varied the EF cutoff between 50% and 25%, the specificity decreased by 3%, but the PPVs decreased by 52%. We observed potential differences in the PPVs by patients' characteristics. In a hypothetical study assessing implantable defibrillator effectiveness, using our definition to identify patients with SD would underestimate the effectiveness by 3% to 24%. In another hypothetical study comparing two classes of angiotensin system blockers where SD was considered confounding, our definition introduced ~43% misclassification bias. Conclusions: Claims-based definitions for SD had excellent specificity and good PPV but low sensitivity. The definitions with good PPV could be used for cohort identification or confounding adjustment by restriction and would result in relatively small misclassification bias albeit limited generalizability. © 2011 John Wiley & Sons, Ltd. Source


Trademark
OUTCOME science INC. | Date: 2011-02-22

Computer software for use in collecting and reporting medical data relating to patient medical conditions in the area of patient registries, quality improvement programs and outcomes research; computer software for use in conducting patient registries, post-approval marketing studies, observational studies, electronic data capture services for patient registries, post-approval marketing studies, and quality improvement programs in the healthcare, biopharmaceutical, and medical device and diagnostic industries. Computer services, namely, providing temporary use of on-line non-downloadable computer software used for collecting, analyzing and reporting medical data relating to patient medical conditions in the area of patient registries, quality improvement programs and outcomes research; providing information regarding networks of clinicians collecting clinical data; providing temporary use of non-downloadable web-based software for use in collecting, analyzing and reporting medical data relating to patient medical conditions in the area of patient registries, quality improvement programs and outcomes research; providing temporary use of non-downloadable web-based software for use in conducting patient registries, post-approval marketing studies, observational studies, electronic data capture services for post-approval marketing studies, and quality improvement programs in the healthcare, biopharmaceutical, and medical device and diagnostic industries; providing temporary use of non-downloadable web-based electronic data capture and management systems consisting of computer software for electronic data capture, analysis and management. providing temporary use of non-downloadable web-based clinical data management systems consisting of computer software for use in collecting, analyzing and reporting medical data relating to patient medical conditions in the area of patient registries, quality improvement programs and outcomes research and for use in conducting patient registries, post-approval marketing studies, electronic data capture services for post-approval marketing studies, and quality improvement programs in the healthcare, biopharmaceutical, and medical device and diagnostic industries; providing an online interactive computer database in the field of scientific affairs used in the fields of healthcare, biopharmaceutical, and medical device and diagnostic industries. Providing an interactive database featuring healthcare information. Providing an online interactive computer database in the field of regulatory affairs used in the fields of healthcare, biopharmaceutical, and medical device and diagnostic industries.


Fonarow G.C.,University of California at Los Angeles | Albert N.M.,Cleveland Clinic | Curtis A.B.,University of South Florida | Gattis Stough W.,Duke University | And 9 more authors.
Circulation | Year: 2010

Background: A treatment gap exists between heart failure (HF) guidelines and the clinical care of patients. The Registry to Improve the Use of Evidence-Based Heart Failure Therapies in the Outpatient Setting (IMPROVE HF) prospectively tested a multidimensional practice-specific performance improvement intervention on the use of guideline-recommended therapies for HF in outpatient cardiology practices. Methods and Results: Performance data were collected in a random sample of HF patients from 167 US outpatient cardiology practices at baseline, longitudinally after intervention at 12 and 24 months, and in single-point-in-time patient cohorts at 6 and 18 months. Participants included 34 810 patients with reduced left ventricular ejection fraction (≤35%) and chronic HF or previous myocardial infarction. To quantify guideline adherence, 7 quality measures were assessed. Interventions included clinical decision support tools, structured improvement strategies, and chart audits with feedback. The performance improvement intervention resulted in significant improvements in 5 of 7 quality measures at the 24-month assessment compared with baseline: β-blocker (92.2% versus 86.0%, +6.2%), aldosterone antagonist (60.3% versus 34.5%, +25.1%), cardiac resynchronization therapy (66.3% versus 37.2%, +29.9%), implantable cardioverter-defibrillator (77.5% versus 50.1%, +27.4%), and HF education (72.1% versus 59.5%, +12.6%) (each P<0.001). There were no statistically significant improvements in angiotensin-converting enzyme inhibitor/angiotensin receptor blocker use or anticoagulation for atrial fibrillation. Sensitivity analyses at the patient level and limited to patients with both baseline and 24-month quality measure data yielded similar results. Improvements in the single-point-in-time cohorts were smaller, and there were no concurrent control practices. Conclusions: The Registry to Improve the Use of Evidence-Based Heart Failure Therapies in the Outpatient Setting, a defined and scalable practice-specific performance improvement intervention, was associated with substantial improvements in the use of guideline-recommended therapies in eligible patients with HF in outpatient cardiology practices. © 2010 American Heart Association, Inc. Source


Albert N.M.,Cleveland Clinic | Fonarow G.C.,University of California at Los Angeles | Yancy C.W.,Baylor University | Curtis A.B.,University of South Florida | And 9 more authors.
American Heart Journal | Year: 2010

Background: National guidelines recommend heart failure (HF) disease management programs to facilitate adherence to evidence-based practices. This study examined the influence of dedicated HF clinics on delivery of guideline-recommended therapies for cardiology practice outpatients with HF and reduced left ventricular ejection fraction. Methods: IMPROVE HF, a prospective cohort study, enrolled 167 cardiology practices to characterize outpatient management of 15,381 patients with chronic systolic HF. Adherence to guideline-recommended HF therapies was recorded, and the presence of a dedicated HF clinic was assessed by survey. Multivariate models identified contributions to delivery of guideline-recommended HF therapies. Results: Of practices, 41.3% had a dedicated HF clinic. Practices with a dedicated HF clinic had greater adherence to 3 of 7 guideline-recommended HF therapy measures: angiotensin-converting enzyme inhibitor/angiotensin receptor blocker (P = .02), β-blocker (P = .025), and HF education (P = .009). After adjustment, use of a dedicated HF clinic was associated with greater conformity in 2 of 7 measures: cardiac resynchronization therapy (P = .036) and HF education (P = .005) but not angiotensin-converting enzyme inhibitor/angiotensin receptor blocker, β-blocker, aldosterone antagonist, implantable cardioverter-defibrillator therapy, and anticoagulation for atrial fibrillation. Conclusions: Use of dedicated HF clinics varied in cardiology outpatient practices and was associated with greater use of cardiac resynchronization therapy and HF education but not other guideline-recommended therapies. © 2010 Mosby, Inc. All rights reserved. Source

Discover hidden collaborations