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Salt Lake City, UT, United States

LaFleur J.,University of Utah | DuVall S.L.,University of Utah | Willson T.,University of Utah | Ginter T.,VA Salt Lake City Heath Care System | And 10 more authors.
Bone | Year: 2015

Adherence and persistence with bisphosphonates are frequently poor, and stopping, restarting, or switching bisphosphonates is common. We evaluated bisphosphonate change behaviors (switching, discontinuing, or reinitiating) over time, as well as fractures and costs, among a large, national cohort of postmenopausal veterans. Methods: Female veterans aged 50. + treated with bisphosphonates during 2003-2011 were identified in Veterans Health Administration (VHA) datasets. Bisphosphonate change behaviors were characterized using pharmacy refill records. Patients' baseline disease severity was characterized based on age, T-score, and prior fracture. Cox Proportional Hazard analysis was used to evaluate characteristics associated with discontinuation and the relationship between change behaviors and fracture outcomes. Generalized estimating equations were used to evaluate the relationship between change behaviors and cost outcomes. Results: A total of 35,650 patients met eligibility criteria. Over 6800 patients (19.1%) were non-switchers. The remaining patients were in the change cohort; at least half displayed more than one change behavior over time. A strong, significant predictor of discontinuation was ≥. 5 healthcare visits in the prior year (11-23% more likely to discontinue), and discontinuation risk decreased with increasing age. No change behaviors were associated with increased fracture risk. Total costs were significantly higher in patients with change behaviors (4.7-19.7% higher). Change-behavior patients mostly had significantly lower osteoporosis-related costs than non-switchers (22%-118% lower). Conclusions: Most bisphosphonate patients discontinue treatment at some point, which did not significantly increase the risk of fracture in this majority non-high risk population. Bisphosphonate change behaviors were associated with significantly lower osteoporosis costs, but significantly higher total costs. © 2015 Elsevier Inc.

Forbush T.B.,VA Salt Lake City Heath Care System | Forbush T.B.,University of Utah | Shen S.,VA Salt Lake City Heath Care System | Shen S.,University of Utah | And 4 more authors.
Studies in Health Technology and Informatics | Year: 2013

Human annotation and chart review is an important process in biomedical informatics research, but which humans are best suited for the job? Domain expertise, such as medical or linguistic knowledge is desirable, but other factors may be equally important. The University of Utah has a group of 20+ reviewers with backgrounds in medicine and linguistics, and 10 key traits have surfaced in those best able to annotate quickly and with high quality. To identify reviewers with these key traits, we created a hiring process that includes interviewing candidates, testing their medical and linguistic knowledge, and having them complete an annotation exercise on realistic medical text. Each step is designed to assess the key traits and allow the investigator to choose the skill set required for each project. © 2013 IMIA and IOS Press.

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