The Permanente Medical Group

Walnut Creek, United States

The Permanente Medical Group

Walnut Creek, United States

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Kinney W.K.,The Permanente Medical Group | Huh W.K.,University of Alabama at Birmingham
Preventive Medicine | Year: 2017

The primary goal for many providers in the United States has been to deliver the level of protection against cervical cancer afforded by annual cervical cytology while improving screening test performance. Adoption of recent screening recommendations has been inconsistent and has created considerable consternation and confusion. This editorial addresses the perspective of U.S. patients and providers and how their preferences may run counter to current screening recommendations. © 2017 Elsevier Inc.


The Kaiser Permanente ERAS program, funded in part by the Betty & Gordon Moore Foundation, was designed and led by a multidisciplinary team of clinicians, performance improvement staff and patient education teams. The program focuses on improving pain management, mobility, nutrition and patient engagement. "In my 24 years as a surgeon, this has been the biggest change in our clinical practice," said co-author Efren Rosas, MD, surgeon champion for Kaiser Permanente's ERAS program. "For decades, surgeries were guided by commonly held principles including no food after midnight the night before surgery, strong opioids for pain management and bed rest for recovery. The elements of an ERAS program — alternative medications for pain control, avoiding prolonged fasting and encouraging walking — have been shown to reduce complications like blood clots, muscle atrophy, nausea, confusion, delirium and infection." Pain management involves opioid-sparing interventions using pain-relief alternatives including intravenous acetaminophen, non-steroidal anti-inflammatory medication, intravenous lidocaine and peripheral nerve blocks. Patients are also encouraged to begin walking within 12 hours of surgery and maintain a daily goal of walking at least 21 feet within the first three days of surgery. Efforts to reduce prolonged pre-surgical fasting include the use of a high-carbohydrate beverage within two to four hours before surgery. Post-operative nutrition is provided within 12 hours after surgery. To improve engagement in their care, an illustrated calendar is distributed to patients so they know what to expect from the night before surgery through hospital discharge. An informational video series also was designed to improve patient education and active involvement with recovery. Program implementation started in 2014 and was completed over the course of one year among two surgical populations — colorectal surgery and hip fracture repair. A total of 3,768 elective colorectal resection patients and 5,002 emergent hip fracture repair patients were included in the study, as were 5,556 comparison surgical patients for elective gastrointestinal surgery and 1,523 for other types of emergency orthopedic surgery. ERAS patients demonstrated significant gains after the implementation of the program. The rate of early ambulation increased 34 percent and 18 percent among colorectal and hip fracture patients, respectively. Similarly, the use of early nutrition increased 26 percent and 12 percent in colorectal and hip fracture patients, respectively. The total dose of opioids also decreased significantly in both groups. Hospital length of stay decreased significantly in both surgical groups, along with a one-third reduction in relative post-operative complication rates. "This study demonstrates the effectiveness of a systems-level approach to an enhanced recovery program implementation, even across widely divergent target populations," said senior author Stephen Parodi, MD, associate executive director of The Permanente Medical Group. "While prior studies have had limited ability to evaluate program implementation at scale in real-world settings, we were able to evaluate care patterns in over 16,000 surgical patients over a two-year period. We were able to demonstrate the feasibility of large-scale ERAS program implementation over a relatively short interval because of the collaboration of thousands of clinicians." About the Kaiser Permanente Division of Research The Kaiser Permanente Division of Research conducts, publishes and disseminates epidemiologic and health services research to improve the health and medical care of Kaiser Permanente members and society at large. It seeks to understand the determinants of illness and well-being, and to improve the quality and cost-effectiveness of health care. Currently, DOR's 550-plus staff is working on more than 350 epidemiological and health services research projects. For more information, visit www.dor.kaiser.org. Kaiser Permanente is committed to helping shape the future of health care. We are recognized as one of America's leading health care providers and not-for-profit health plans. Founded in 1945, Kaiser Permanente has a mission to provide high-quality, affordable health care services and to improve the health of our members and the communities we serve. We currently serve 11.8 members in eight states and the District of Columbia. Care for members and patients is focused on their total health and guided by their personal physicians, specialists and team of caregivers. Our expert and caring medical teams are empowered and supported by industry-leading technology advances and tools for health promotion, disease prevention, state-of-the-art care delivery and world-class chronic disease management. Kaiser Permanente is dedicated to care innovations, clinical research, health education and the support of community health. For more information, go to: www.kp.org/share. To view the original version on PR Newswire, visit:http://www.prnewswire.com/news-releases/enhanced-recovery-after-surgery-program-at-kaiser-permanente-significantly-improves-surgical-outcomes-300455074.html


A comprehensive Enhanced Recovery After Surgery program implemented in Kaiser Permanente's 20 Northern California medical centers involved nearly 9,000 surgical patients and resulted in a one-third relative reduction in postoperative complication rates and a 21 percent reduction in opioid prescribing rates. A study of the program, published today in JAMA Surgery, also showed decreased hospital mortality among colorectal resection patients and increased rates of home discharge over discharge to skilled nursing facilities among hip fracture patients. "Ensuring patient safety is essential in U.S. surgical care, where millions of inpatient procedures are performed annually and where perioperative complications are common and costly," said lead author Vincent Liu, MD, of the Kaiser Permanente Northern California Division of Research. "All-inclusive approaches to surgery like this ERAS program aim to reduce the stress of surgery, reduce complications and maximize the potential for recovery." The Kaiser Permanente ERAS program, funded in part by the Betty & Gordon Moore Foundation, was designed and led by a multidisciplinary team of clinicians, performance improvement staff and patient education teams. The program focuses on improving pain management, mobility, nutrition and patient engagement. "In my 24 years as a surgeon, this has been the biggest change in our clinical practice," said co-author Efren Rosas, MD, surgeon champion for Kaiser Permanente's ERAS program. "For decades, surgeries were guided by commonly held principles including no food after midnight the night before surgery, strong opioids for pain management and bed rest for recovery. The elements of an ERAS program -- alternative medications for pain control, avoiding prolonged fasting and encouraging walking -- have been shown to reduce complications like blood clots, muscle atrophy, nausea, confusion, delirium and infection." Pain management involves opioid-sparing interventions using pain-relief alternatives including intravenous acetaminophen, non-steroidal anti-inflammatory medication, intravenous lidocaine and peripheral nerve blocks. Patients are also encouraged to begin walking within 12 hours of surgery and maintain a daily goal of walking at least 21 feet within the first three days of surgery. Efforts to reduce prolonged pre-surgical fasting include the use of a high-carbohydrate beverage within two to four hours before surgery. Post-operative nutrition is provided within 12 hours after surgery. To improve engagement in their care, an illustrated calendar is distributed to patients so they know what to expect from the night before surgery through hospital discharge. An informational video series also was designed to improve patient education and active involvement with recovery. Program implementation started in 2014 and was completed over the course of one year among two surgical populations -- colorectal surgery and hip fracture repair. A total of 3,768 elective colorectal resection patients and 5,002 emergent hip fracture repair patients were included in the study, as were 5,556 comparison surgical patients for elective gastrointestinal surgery and 1,523 for other types of emergency orthopedic surgery. ERAS patients demonstrated significant gains after the implementation of the program. The rate of early ambulation increased 34 percent and 18 percent among colorectal and hip fracture patients, respectively. Similarly, the use of early nutrition increased 26 percent and 12 percent in colorectal and hip fracture patients, respectively. The total dose of opioids also decreased significantly in both groups. Hospital length of stay decreased significantly in both surgical groups, along with a one-third reduction in relative post-operative complication rates. "This study demonstrates the effectiveness of a systems-level approach to an enhanced recovery program implementation, even across widely divergent target populations," said senior author Stephen Parodi, MD, associate executive director of The Permanente Medical Group. "While prior studies have had limited ability to evaluate program implementation at scale in real-world settings, we were able to evaluate care patterns in over 16,000 surgical patients over a two-year period. We were able to demonstrate the feasibility of large-scale ERAS program implementation over a relatively short interval because of the collaboration of thousands of clinicians." The Kaiser Permanente Division of Research conducts, publishes and disseminates epidemiologic and health services research to improve the health and medical care of Kaiser Permanente members and society at large. It seeks to understand the determinants of illness and well-being, and to improve the quality and cost-effectiveness of health care. Currently, DOR's 550-plus staff is working on more than 350 epidemiological and health services research projects. For more information, visit http://www. . Kaiser Permanente is committed to helping shape the future of health care. We are recognized as one of America's leading health care providers and not-for-profit health plans. Founded in 1945, Kaiser Permanente has a mission to provide high-quality, affordable health care services and to improve the health of our members and the communities we serve. We currently serve more than 11.3 million members in eight states and the District of Columbia. Care for members and patients is focused on their total health and guided by their personal physicians, specialists and team of caregivers. Our expert and caring medical teams are empowered and supported by industry-leading technology advances and tools for health promotion, disease prevention, state-of-the-art care delivery and world-class chronic disease management. Kaiser Permanente is dedicated to care innovations, clinical research, health education and the support of community health. For more information, go to: http://www. .


The International Association of HealthCare Professionals is pleased to welcome Aboaba A. Afilaka Jr., MD, MS, MBBS, Occupational Medicine Physician to their prestigious organization with his upcoming publication in The Leading Physicians of the World. Dr. Afilaka is a highly trained and qualified occupational medicine physician with an extensive expertise in preventive medicine. Holding over three decades of experience in his field, Dr. Afilaka is currently serving patients within Kaiser Permanente, The Permanente Medical Group, and the Stockton Medical Offices – Occupational Health Center in Stockton, California. A highly active physician, he conducts research on various topics such as musculoskeletal disorders, smoking cessation, toxicity, and asbestos related diseases. Dr. Afilaka’s career in medicine began after gaining his Bachelor of Medicine, Bachelor of Surgery Degree from the University of Nigeria, College of Medicine. Upon relocating to the United States, he completed an internship at Monmouth Medical Center in New Jersey. He then served his Occupational Medicine residency at Mount Sinai School of Medicine and Mount Sinai Hospital in New York City, before undertaking his Internal Medicine residency at Lincoln Medical and Mental Health Center in Bronx, New York. To keep up to date with the latest advances in his field, Dr. Afilaka remains a distinguished member of the American Medical Association and the New York Occupational Medicine Academy. He obtained board certification in Occupational Medicine by the American Board of Preventive Medicine. For his hard work and dedication to his speciality, Dr. Afilaka is a published author and the recipient of the Center for Multicultural and Community Affairs Award for Research. He credits his success to compassion, which allowed him to deliver the best possible patient care throughout his entire career. Dr. Afilaka has said about his work, “I believe that medical and surgical specialties seek curative outcomes; being an Occupational Medicine physician allows me to care for and educate members about injury prevention and to promote awareness of their work environment so they can work safely and effectively for themselves, co-workers, and the employer.” In his free time, Dr. Afilaka enjoys reading, as well as spending time outdoors biking, and hiking. Learn more about Dr. Afilaka here: https://mydoctor.kaiserpermanente.org/ncal/provider/aboabaafilaka#tab and be sure to read his upcoming publication in The Leading Physicians of the World. FindaTopDoc.com is a hub for all things medicine, featuring detailed descriptions of medical professionals across all areas of expertise, and information on thousands of healthcare topics.  Each month, millions of patients use FindaTopDoc to find a doctor nearby and instantly book an appointment online or create a review.  FindaTopDoc.com features each doctor’s full professional biography highlighting their achievements, experience, patient reviews and areas of expertise.  A leading provider of valuable health information that helps empower patient and doctor alike, FindaTopDoc enables readers to live a happier and healthier life.  For more information about FindaTopDoc, visit http://www.findatopdoc.com


The agenda is now available for the 9th Annual mHealth + Telehealth World from July 24-25, 2017 located in Boston. Boston, MA, April 19, 2017 --( Meet the Featured Keynote Speaker: Robert Pearl, MD, Executive Director, Chief Executive Officer, The Permanente Medical Group; President, Chief Executive Officer, Mid-Atlantic Permanente Medical Group; Author, Mistreated: Why We Think We’re Getting Good Health Care-And Why We’re Usually Wrong As part of the keynote session, how to “Build a Fully Integrated, Technology-Enabled, Physician-Led Connected Care Program,” learn how to: · Bring together mHealth, telehealth, and other technologies to create a comprehensive connected care program · Gain insights into a variety of technologies and weigh the hype versus the potential · Discuss the challenges and opportunities associated with the transition from 20th to 21st century technology If you are interested in learning more or would like to register for the upcoming 9th Annual mHealth + Telehealth World from July 24 - 25, 2017, please visit https://goo.gl/4R4E3c for details. The summit is located in Boston, MA at the Seaport Hotel. Registration is open. Boston, MA, April 19, 2017 --( PR.com )-- Join mHealth + Telehealth World 2017 to learn strategies to expand digital health capabilities and understand the impact connected health will have on the future of health care. This Summit is a must attend for health care executives interested in learning how to most efficiently utilize mHealth, Telehealth, and remote patient monitoring technologies to engage consumers, improve outcomes, and lower costs.Meet the Featured Keynote Speaker:Robert Pearl, MD, Executive Director, Chief Executive Officer, The Permanente Medical Group; President, Chief Executive Officer, Mid-Atlantic Permanente Medical Group; Author, Mistreated: Why We Think We’re Getting Good Health Care-And Why We’re Usually WrongAs part of the keynote session, how to “Build a Fully Integrated, Technology-Enabled, Physician-Led Connected Care Program,” learn how to:· Bring together mHealth, telehealth, and other technologies to create a comprehensive connected care program· Gain insights into a variety of technologies and weigh the hype versus the potential· Discuss the challenges and opportunities associated with the transition from 20th to 21st century technologyIf you are interested in learning more or would like to register for the upcoming 9th Annual mHealth + Telehealth World from July 24 - 25, 2017, please visit https://goo.gl/4R4E3c for details. The summit is located in Boston, MA at the Seaport Hotel. Registration is open. Click here to view the list of recent Press Releases from World Congress


WASHINGTON--(BUSINESS WIRE)--Costs for health care in the U.S. are unsustainable, threatening the economic health of the nation, yet hundreds of thousands of Americans die each year unnecessarily because of a combination of medical errors, failures in prevention and health care disparities. The American health care system is broken; an inefficient care delivery structure, outdated technology, and profound misalignment of incentives result in millions of patients being mistreated. This dire prognosis – and the treatment required to resuscitate American health care – is the message in the new book, “Mistreated: Why We Think We Are Getting Good Healthcare and Why We Are Usually Wrong,” by Robert Pearl, M.D., Chairman of the Council of Accountable Physician Practices (CAPP), a coalition of America’s high-performing medical groups and health systems, and CEO of The Permanente Medical Group, Kaiser Permanente. Dr. Pearl’s warning and solutions were shared in two keynotes at the 14th Annual World Health Care Congress in Washington D.C., May 1 – 3. “The real crisis today isn’t around how we structure coverage or even if it is paid through businesses or the government; it is the critical need to reform our entire health care delivery system,” said Pearl. “If we reward health care providers for value instead of volume, and leverage digital technology and video to connect the health care team and patients, we can actually deliver better quality care and a lower cost. “The medical groups in CAPP have demonstrated what is possible in terms of quality, convenience, technology, and cost, and how innovation improves patient outcomes. But if we as a nation do not embrace these changes more broadly, then we will experience either a huge disruption through global competition, or a slide into a two-tier system in which most Americans will get second class health care.” “Mistreated: Why We Think We Are Getting Good Healthcare and Why We Are Usually Wrong,” released May 2, is dedicated to Dr. Pearl’s father who died due in part to medical error and failures in communication. In the book, Dr. Pearl explains how these medical errors can be eliminated through care coordination, technology and aligned incentives. Using psychological research, behavioral economics and the most recent brain scanning findings, he shows how our brains lead us to form incorrect perceptions about the health care we receive. He emphasizes the power of context, and how through integration, prepayment, information technology, and physician leadership, superior outcomes can be achieved. Citing the unlikelihood of the legacy players in health care to make these types of sweeping changes, Pearl turns to patients to become a driving force for transformation. “Mistreated” was written for the patient in all of us,” Pearl noted. “If we can change some of the erroneous beliefs we all have, we can make real change.” Dr. Pearl is donating all profits from the book to increase access to health care for people who today can't obtain it. For more information, please visit his website: http://robertpearlmd.com/. To learn more about physician leadership in the work to achieve accountable care, and to receive updates on key health care issues, follow CAPP on Twitter at: @accountableDOCS. About the Council of Accountable Physician Practices: The Council of Accountable Physician Practices (CAPP), an affiliate of the AMGA Foundation, is a coalition of visionary medical group and health system leaders. We believe that physicians working together, backed by integrated services, systems and data and technology, can best shape and guide the way care is delivered so that the welfare of the patient is always the primary focus. For more information, contact CAPP at Accountablecaredoctors.org.


Dillon M.T.,The Permanente Medical Group | Inacio M.C.S.,Kaiser Permanente | Burke M.F.,Kaiser Permanente | Navarro R.A.,Southern California Permanente Medical Group | Yian E.H.,Southern California Permanente Medical Group
Journal of Shoulder and Elbow Surgery | Year: 2013

Background: While shoulder arthroplasty is a well established treatment for a variety of conditions about the shoulder, the results of shoulder replacement in younger patients are not as predictable. The purpose of this study is to examine the indications for shoulder arthroplasty in patients 59 years old and younger, and to analyze revision rates between younger and older patients. Methods: This is a retrospective cohort study of shoulder arthroplasties performed within a statewide integrated healthcare system between 2005 and 2010. Patients were stratified into 2 groups based on age at time of index replacement procedure: younger patients (≤59 years) and older patients (>59 years). Results: There were 2981 primary arthroplasties followed for a median time of 2.2 years (interquartile range, 1.0-3.8), 90 (3.0%) of which required revisions. After adjusting for procedure type and diagnosis, younger patients had a two times higher risk (95% CI 1.2-3.5, P = .007) of revision than older patients. When looking at the risk of revision in younger and older patients separately, the risk of revision in hemiarthroplasty (RR = 4.5 vs RR = 1.7) and reverse total shoulder arthroplasty (RR = 33.6 vs RR = 3.0) compared to total shoulder arthroplasty were higher in younger patients compared to older patients. Conclusion: This study suggests patients 59 years and younger have an increased risk of revision at early follow-up. The higher risk of revision in younger patients receiving hemiarthroplasty may support the use of total shoulder arthroplasty in patients 59 years of age and younger. © 2013 Journal of Shoulder and Elbow Surgery Board of Trustees.


Sagray B.A.,The Permanente Medical Group | Steinberg J.S.,Georgetown University
Clinics in Podiatric Medicine and Surgery | Year: 2014

Treatment of the patient with a diabetic foot infection and underlying osteomyelitis is currently an evolving process, often complicated by neuropathy, peripheral vascular disease, and renal insufficiency. Understanding which patients require hospitalization, intravenous antibiotic therapy, and urgent operative intervention may ultimately prevent the spread of infection or major limb amputation. The treating surgeon should focus on accurate and early diagnosis, proper antibiosis, and appropriate surgical debridement to eradicate infection while preserving function with a plantar-grade foot. © 2014 Elsevier Inc.


Dillon M.T.,The Permanente Medical Group
American journal of orthopedics (Belle Mead, N.J.) | Year: 2010

In the study reported here, we sought to determine the interobserver reliability and the intraobserver reproductibility of the Mason classification. We also evaluated the effect of having an external rotation oblique view on agreement in radiographic readings. Four readers reviewed 50 radial head fracture radiographs approximately 2 months apart. Half the radiographs had an anteroposterior view and a lateral view; the other half had an additional external rotation oblique view. There was a trend toward improved interobserver agreement in the 3-view radiographs. Three of the 4 readers demonstrated substantial intraobserver reproducibility, which was noted to be higher when 3 views were available.


Dillon M.T.,The Permanente Medical Group
Journal of surgical orthopaedic advances | Year: 2011

Heterotopic ossification is rarely encountered following repair of a distal biceps tendon by an anterior approach. Although much less common than with a classic two-incision approach, a review of the literature demonstrates that heterotopic ossification may still occur following anterior single incision techniques. We describe only the second reported case to our knowledge of symptomatic heterotopic ossification following repair of a distal biceps tendon rupture with an EndoButton.

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