Distinguishing between primary and secondary racial identification in analyses of health disparities of a multiracial population in Hawaii.

Objective: To examine the importance of distinguishing between primary and secondary racial identification in analyzing health disparities in a multiracial population.

Methods: A cross-sectional analysis of 2012 Hawaii Behavioral Risk Factor Surveillance System (H-BRFSS). As part of the survey, respondents were asked to identify all their races, and then which race they considered to be their primary race.

Racial/Ethnic Disparities in the Association Between Preeclampsia Risk Factors and Preeclampsia Among Women Residing in Hawaii.

Objective To assess differences in the rates of preeclampsia among a multiethnic population in Hawaii. Methods We performed a retrospective study on statewide inpatient data for delivery hospitalizations in Hawaii between January 1995 and December 2013. Multivariable logistic regression was used to assess the impact of maternal race/ethnicity on the rates of preeclampsia after adjusting for age, multiple gestation, multiparity, chronic hypertension, pregestational diabetes, obesity and smoking.

The Daniel K. Inouye College of Pharmacy Scripts: Prescription Drug Pricing.

Prescription drugs have reduced morbidity and mortality and improved the quality of life of millions of Americans. Yet, concerns over drug price increases loom. Drug spending has risen relatively slowly over the past decade because many of the most popular brand-name medicines lost patent protection.

Inpatient Hospitalization Costs: A Comparative Study of Micronesians, Native Hawaiians, Japanese, and Whites in Hawai'i.

Considerable interest exists in health care costs for the growing Micronesian population in the United States (US) due to their significant health care needs, poor average socioeconomic status, and unique immigration status, which impacts their access to public health care coverage. Using Hawai'i statewide impatient data from 2010 to 2012 for Micronesians, whites, Japanese, and Native Hawaiians (N = 162,152 hospitalizations), we compared inpatient hospital costs across racial/ethnic groups using multivariable models including age, gender, payer, residence location, and severity of illness (SOI). We also examined total inpatient hospital costs of Micronesians generally and for Medicaid specifically.

Hawaii state legislator views on e-cigarettes and likelihood of legislative action.

Objective: To examine perspectives on e-cigarette use and regulations in Hawaii through key informant interviews with state legislators.

Background: E-cigarette use is rapidly increasing, with sales in 2013 topping $1 billion in the United States, but e-cigarettes are still a largely unregulated industry. Although e-cigarettes are thought by most to be a healthier alternative to traditional cigarettes, long-term health effects are not yet known.

Length of Stay and Deaths in Diabetes-Related Preventable Hospitalizations Among Asian American, Pacific Islander, and White Older Adults on Medicare, Hawai'i, December 2006-December 2010.

Introduction: The objective of this study was to compare in-hospital deaths and length of stays for diabetes-related preventable hospitalizations (D-RPHs) in Hawai'i for Asian American, Pacific Islander, and white Medicare recipients aged 65 years or older.

Methods: We considered all hospitalizations of older (>65 years) Japanese, Chinese, Native Hawaiians, Filipinos, and whites living in Hawai'i with Medicare as the primary insurer from December 2006 through December 2010 (n = 127,079). We used International Classification of Diseases - 9th Revision (ICD-9) codes to identify D-RPHs as defined by the Agency for Healthcare Research and Quality.

Big data in pharmacy practice: current use, challenges, and the future.

Pharmacy informatics is defined as the use and integration of data, information, knowledge, technology, and automation in the medication-use process for the purpose of improving health outcomes. The term "big data" has been coined and is often defined in three V's: volume, velocity, and variety. This paper describes three major areas in which pharmacy utilizes big data, including: 1) informed decision making (clinical pathways and clinical practice guidelines); 2) improved care delivery in health care settings such as hospitals and community pharmacy practice settings; and 3) quality performance measurement for the Centers for Medicare and Medicaid and medication management activities such as tracking medication adherence and medication reconciliation.

Risk-Adjusted In-Hospital Mortality Models for Congestive Heart Failure and Acute Myocardial Infarction: Value of Clinical Laboratory Data and Race/Ethnicity.

Objective: To examine the impact of key laboratory and race/ethnicity data on the prediction of in-hospital mortality for congestive heart failure (CHF) and acute myocardial infarction (AMI).

Data Sources: Hawaii adult hospitalizations database between 2009 and 2011, linked to laboratory database.

Study Design: Cross-sectional design was employed to develop risk-adjusted in-hospital mortality models among patients with CHF (n = 5,718) and AMI (n = 5,703).

Medicare reimbursement to ophthalmologists: a comparison of Hawai'i to other states.

When Medicare publically released data on payments made to specific physicians in April of 2014, it quickly became apparent that a large portion of 2012 Medicare reimbursements went to ophthalmologists. Part of the reason for this unusually high level of reimbursement was thought to be the cost of injectable drugs such as ranibizumab (brand name Lucentis). This study was designed to compare Hawai'i ophthalmologists' Medicare reimbursements with those of other states.

Factors affecting medication adherence trajectories for patients with heart failure.

Objectives: To examine the relationship between patient characteristics and medication adherence trajectories for patients with congestive heart failure (CHF).

Study Design: Historical prospective study.

Methods: We conducted a secondary analysis of data assembled for the Practice Variation and Care Outcomes (PRAVCO) study, which examined patterns of cardiovascular care.

Cost Burden of Potentially Preventable Hospitalizations for Cardiovascular Disease and Diabetes for Asian Americans, Pacific Islanders, and Whites in Hawai'i.

We compared the cost burdens of potentially preventable hospitalizations for cardiovascular disease and diabetes for Asian Americans, Pacific Islanders, and Whites using Hawai'i statewide 2007-2012 inpatient data. The cost burden of the 27,894 preventable hospitalizations over six years (total cost: over $353 million) fell heavily on Native Hawaiians who had the largest proportion (23%) of all preventable hospitalizations and the highest unadjusted average costs (median: $9,117) for these hospitalizations. Diabetes-related amputations (median cost: $20,167) were the most expensive of the seven preventable hospitalization types.

Disparities in medication therapy in patients with heart failure across the State of Hawai'i.

The purpose of this study is to evaluate if heart failure patients in Hawai'i are receiving recommended standard therapy of a select beta-blocker in combination with an ACE inhibitor (ACEI) or angiotensin receptor blocker (ARB), and to determine if a gap in quality of care exists between the different regions within the state. A retrospective claims-based analysis of all adult patients (age > 18 years of age) with CHF who were enrolled in a large health plan in Hawai'i was performed (n = 24,149). Data collected included the presence of pharmaceutical claims for ACEI, ARBs and select β-blockers, region of residence, gender, and age.

The excess cost of interisland transfer of intracerebral hemorrhage patients.

Background: Currently, intracerebral hemorrhage (ICH) patients from neighbor islands are air transported to a higher-level facility on Oahu with neuroscience expertise. However, the majority of them do not receive subspecialized neurosurgical procedures (SNP) upon transfer. Hence, their transfer may potentially be considered as excess cost.

Disparities in diabetes-related preventable hospitalizations among working-age Native Hawaiians and Asians in Hawai'i.

Elderly (65+) Native Hawaiian, Filipino, and Japanese men and Filipino women have a higher risk of diabetes-related potentially preventable hospitalizations than Whites even when demographic factors and the higher diabetes prevalence in these populations is considered. The study objective was to determine if similar disparities are seen among the non-elderly (< 65). We used discharge data for all non-maternity hospitalizations by working-age adults (18-64 years) in Hawai'i from December 2006 to December 2010.

Significance of HbA1c and its measurement in the diagnosis of diabetes mellitus: US experience.

The 2014 American Diabetes Association guidelines denote four means of diagnosing diabetes. The first of these is a glycosylated hemoglobin (HbA1c) >6.5%.

Failure to reach target glycated a1c levels among patients with diabetes who are adherent to their antidiabetic medication.

The objectives of this study were to describe patient characteristics and types of medications taken by those with poor glycemic control (A1c>7%) despite being adherent to antidiabetic medications. This is a retrospective analysis of administrative data from adult patients with diabetes enrolled in a large health plan in Hawaii (n=21,267 observations for 11,013 individuals) and adherent to their antidiabetic medications. Multivariable logistic regressions were estimated to determine characteristics and types of medications associated with poor glycemic control.

A descriptive study of Marshallese and Chuukese patients with diabetes in Hawai'i.

Diabetes is a growing epidemic in the United States with significant racial and ethnic health disparities among minorities. In Pacific Islanders, diabetes ranks as the fifth leading cause of death, higher than the national average. Despite this, little is known about diabetes in this population, and even less so in subpopulations such as Micronesians.

Drug take back in Hawai'i: partnership between the University of Hawai'i Hilo College of Pharmacy and the Narcotics Enforcement Division.

Unused/unwanted medications in households and patient care facilities expose vulnerable populations, including children, elders, and pets, to potential harm through inadvertent ingestion, as well as the potential for theft and assault. Hawai'i Administrative Rules prohibit the return of any prescription medications to retail pharmacies after dispensing. The Hawai'i Narcotics Enforcement Division (NED) partnered with the University of Hawai'i at Hilo Daniel K.

Interventions to increase medication adherence in African-American and Latino populations: a literature review.

The objective of this systematic review was to investigate the effectiveness of interventions to improve medication adherence in ethnic minority populations. A literature search from January 2000 to August 2012 was conducted through PubMed/Medline, Web of Science, The Cochrane Library, and Google Scholar. Search terms used included: medication (MeSH), adherence, medication adherence (MeSH), compliance (MeSH), persistence, race, ethnicity, ethnic groups (MeSH), minority, African-American, Hispanic, Latino, Asian, Pacific Islander, and intervention.

Adjustments to diabetes medications in response to increases in hemoglobin a1c: an epidemiologic study.

Objective: The primary objective was to assess associations between increases in glycated hemoglobin (HbA1c) levels and medication adjustments among patients with diabetes. A secondary objective was to measure the effect of adjustments on subsequent HbA1c levels.

Methods: A retrospective analysis of administrative data from a large health insurer in Hawaii of 7654 patients with diabetes mellitus type II, HbA1c levels greater than 7%, and who were taking oral diabetic medications.

Using quantile regression to assess disparities in medication adherence.

Objective: To examine racial/ethnic disparities in medication adherence between Asian and Pacific Islander Americans and Whites.

Methods: This retrospective data analysis included diabetes patients enrolled in a health plan in Hawaii (N = 43,445). For anti-diabetic, lipid-lowering, and anti-hypertensive medications, quantile regression was estimated at 25(th), 50(th), and 75(th) quantiles to examine the association with race and ethnicity, controlling for other patient characteristics.

Comparison of potentially preventable hospitalizations related to diabetes among Native Hawaiian, Chinese, Filipino, and Japanese elderly compared with whites, Hawai'i, December 2006-December 2010.

Introduction: Approximately 25% of individuals aged 65 years or older in the United States have diabetes mellitus. Diabetes rates in this age group are higher for Asian American and Pacific Islanders (AA/PI) than for whites. We examined racial/ethnic differences in diabetes-related potentially preventable hospitalizations (DRPH) among people aged 65 years or older for Japanese, Chinese, Filipinos, Native Hawaiians, and whites.

Factors Affecting Sustained Medication Adherence and Its Impact on Health Care Utilization in Patients with Diabetes.

Objective: To identify factors associated with years of medication adherence and to examine the relationship between years of adherence and health care utilization.

Methods: This retrospective analysis used administrative data from adult patients with diabetes enrolled in health plan in Hawaii for four years (n= 23,450 patients). Ordered logistic regression was used to examine factors related to years of medication adherence for three types of medications (anti-diabetic, antihypertensive, lipid-lowering).

Factors associated with poor glycemic control or wide glycemic variability among diabetes patients in Hawaii, 2006-2009.

Introduction: Although glycemic control is known to reduce complications associated with diabetes, it is an elusive goal for many patients with diabetes. The objective of this study was to identify factors associated with sustained poor glycemic control, some glycemic variability, and wide glycemic variability among diabetes patients over 3 years.

Methods: This retrospective study was conducted among 2,970 diabetes patients with poor glycemic control (hemoglobin A1c [HbA1c] >9%) who were enrolled in a health plan in Hawaii in 2006.

The relationship of hospital quality and cost per case in Hawaii.

One of the leading questions of our time is whether high-quality care leads to lower health care costs. Using data from Hawaii hospitals, this paper addresses the relationship of overall cost per case to a composite measure of the quality of inpatient care and a 30-day readmission rate. We found that low-cost hospitals tend to have the highest quality but the worst readmission performance.