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Boise, ID, United States

Martin B.I.,Dartmouth Hitchcock Medical Center | Gerkovich M.M.,University of Missouri - Kansas City | Deyo R.A.,Oregon Health And Science University | Deyo R.A.,Kaiser Permanente | And 5 more authors.
Medical Care | Year: 2012

BACKGROUND: Health care costs associated with use of complementary and alternative medicine (CAM) by patients with spine problems have not been studied in a national sample. OBJECTIVES: To estimate the total and spine-specific medical expenditures among CAM and non-CAM users with spine problems. RESEARCH DESIGN: Analysis of the 2002-2008 Medical Expenditure Panel Survey. SUBJECTS: Adults (above 17 y) with self-reported neck and back problems who did or did not use CAM services. MEASURES: Survey-weighted generalized linear regression and propensity matching to examine expenditure differences between CAM users and non-CAM users while controlling for patient, socioeconomic, and health characteristics. RESULTS: A total of 12,036 respondents with spine problems were included, including 4306 (35.8%) CAM users (40.8% in weighted sample). CAM users had significantly better self-reported health, education, and comorbidity compared with non-CAM users. Adjusted annual medical costs among CAM users was $424 lower (95% confidence interval: $240, $609; P<0.001) for spine-related costs, and $796 lower (95% confidence interval: $121, $1470; P=0.021) for total health care cost than among non-CAM users. Average expenditure for CAM users, based on propensity matching, was $526 lower for spine-specific costs (P<0.001) and $298 lower for total health costs (P=0.403). Expenditure differences were primarily due to lower inpatient expenditures among CAM users. CONCLUSIONS: CAM users did not add to the overall medical spending in a nationally representative sample with neck and back problems. As the causal associations remain unclear in these cross-sectional data, future research exploring these cost differences might benefit from research designs that minimize confounding. Copyright © 2012 by Lippincott Williams & Wilkins. Source

Lind B.K.,Saint Lukes Health System | Gerkovich M.M.,University of Missouri - Kansas City | Cherkin D.C.,Group Health Research Institute | Deyo R.A.,Oregon Health And Science University | And 2 more authors.
Journal of Alternative and Complementary Medicine | Year: 2013

Objectives: Complementary and alternative medicine (CAM) providers are becoming more integrated into the United States health care system. Because patients self-select CAM use, risk adjustment is needed to make the groups more comparable when analyzing utilization. This study examined how the choice of risk adjustment method affects assessment of CAM use on overall health care utilization. Design and subjects: Insurance claims data for 2000-2003 from Washington State, which mandates coverage of CAM providers, were analyzed. Three (3) risk adjustment methods were compared in patients with musculoskeletal conditions: Adjusted Clinical Groups (ACG), Diagnostic Cost Groups (DCG), and the Charlson Index. Relative Value Units (RVUs) were used as a proxy for expenditures. Two (2) sets of median regression models were created: prospective, which used risk adjustments from the previous year to predict RVU in the subsequent year, and concurrent, which used risk adjustment measures to predict RVU in the same year. Results: The sample included 92,474 claimants. Prospective models showed little difference in the effect of CAM use on RVU among the three risk adjustment methods, and all models had low predictive power (R2 ≤0.05). In the concurrent models, coefficients were similar in direction and magnitude for all risk adjustment methods, but in some models the predicted effect of CAM use on RVU differed by as much as double between methods. Results of DCG and ACG models were similar and were stronger than Charlson models. Conclusions: Choice of risk adjustment method may have a modest effect on the outcome of interest. © Copyright 2013, Mary Ann Liebert, Inc. 2013. Source

Jaschke K.,Saint Lukes Hospital of Kansas City | Brown D.,Saint Lukes Hospital of Kansas City | Clark A.,Saint Lukes Hospital of Kansas City | Doull S.,Saint Lukes Hospital of Kansas City | And 10 more authors.
American Journal of Critical Care | Year: 2014

Background Measurement of mixed venous oxygen saturation helps determine whether cardiac output and oxygen delivery are sufficient for metabolic needs. As recommended by the American Association of Critical-Care Nurses guideline, blood samples for determining mixed venous oxygen saturation are obtained by slowly, in 1 to 2 minutes, withdrawing 1.5mL of blood from the distal port of the pulmonary artery catheter. In theory, the negative force of rapid withdrawal could pull oxygenated blood from the pulmonary capillary bed, causing falsely elevated saturation values. Objective To determine if the speed of withdrawal affects oxygen content in blood samples used to measure mixed venous oxygen saturation. Methods The sample consisted of heart failure patients with pulmonary artery catheters admitted to a cardiac intensive care unit. A prospective, randomized, 2 × 2 crossover design was used to compare mixed venous oxygen saturation in blood samples obtained quickly or slowly. A total of 50 sets of saturation values were analyzed. Each set included 1 blood sample obtained slowly, in 1 to 2 minutes, and 1 obtained rapidly, in 5seconds. Results The mean difference in saturation values between the fast and the slow groups was -0.3 (CI, -1.5 to 0.8; P = .55), indicating that no meaningful systematic bias is attributable to fast withdrawal of blood. Conclusions Rapid blood sampling does not falsely elevate measurements of mixed venous oxygen saturation. ©2014 American Association of Critical-Care Nurses. Source

Ahmed A.H.,Saint Lukes Health System | Ahmed A.H.,University of Missouri - Kansas City
Hospital Medicine Clinics | Year: 2014

Severe, moderate, and mild hospital-acquired anemia (HAA) is prevalent in the intensive care unit as well as on the wards. Patients who are anemic before admission are at risk of worsening anemia during hospitalization. Causes of HAA include blood draws, erythropoietin (EPO) suppression, and downregulation of iron. HAA recognition and treatment affect patient outcomes. Prevention and management of HAA demand a team approach and a culture that supports recognition and reduction of unnecessary laboratory testing and procedures. Pharmacologic treatment is evolving, and evidence-based use of intravenous iron and EPO may have a role in supporting erythropoiesis to help prevent transfusion. © 2014 Elsevier Inc. Source

Murillo H.,Sutter Medical Group | Restrepo C.S.,University of Texas Health Science Center at San Antonio | Marmol-Velez J.A.,University of Texas Health Science Center at San Antonio | Vargas D.,Aurora University | And 4 more authors.
Radiographics | Year: 2016

Myriad infectious organisms can infect the endocardium, myocardium, and pericardium, including bacteria, fungi, parasites, and viruses. Significant cardiac infections are rare in the general population but are associated with high morbidity and mortality as well as increased risk in certain populations, such as the elderly, those undergoing cardiac instrumentation, and intravenous drug abusers. Diagnostic imaging of cardiac infections plays an important role despite its variable sensitivity and specificity, which are due in part to the nonspecific manifestations of the central inflammatory process of infection and the time of onset with respect to the time of imaging. The primary imaging modality remains echocardiography. However, cardiac computed tomography and magnetic resonance (MR) imaging have emerged as the modalities of choice wherever available, especially for diagnosis of complex infectious complications including abscesses, infected prosthetic material, central lines and instruments, and the cryptic manifestations of viral and parasitic diseases. MR imaging can provide functional, morphologic, and prognostic value in a single examination by allowing characterization of inflammatory changes from the acute to chronic stages, including edema and the patterns and extent of delayed gadolinium enhancement. We review the heterogeneous and diverse group of cardiac infections based on their site of primary cardiac involvement with emphasis on their cross-sectional imaging manifestations. © RSNA, 2016. Source

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