Pre-Operative Predictors for Discharge to Post-Acute Care Facilities After Total Knee Arthroplasty.

Background: Joint replacement surgery is in increasing demand and is the most common inpatient surgery for Medicare beneficiaries. The venue for post-operative rehabilitation, including early outpatient therapy after surgery, influences recovery and quality of life. As part of a comprehensive total joint program at Kaiser Permanente Colorado, we developed and validated a predictive model to anticipate and plan the disposition for rehabilitation of our patients after total knee arthroplasty (TKA).

Development and Validation of a Model for Predicting Rehabilitation Care Location Among Patients Discharged Home After Total Knee Arthroplasty.

Background: Demand for joint replacement is increasing, with many patients receiving postsurgical physical therapy (PT) in non-inpatient settings. Clinicians need a reliable tool to guide decisions about the appropriate PT setting for patients discharged home after surgery. We developed and validated a model to predict PT location for patients in our health system discharged home after total knee arthroplasty.

Evaluation of care management intensity and bariatric surgical weight loss.

Objectives: To examine the effect of pre- and postoperative care management on weight loss following bariatric surgery.

Study Design: We conducted a retrospective cohort study supplemented by cross-sectional surveys across 9 bariatric surgery centers.

Methods: Based on the intensity of patient contact, care management intensity (CMI) was defined as high, moderate, or low for preoperative programs, and high or low for postoperative programs.

A pharmacist-led, American Heart Association Heart360 Web-enabled home blood pressure monitoring program.

Background: To determine whether a pharmacist-led, Heart360-enabled, home blood pressure monitoring (HBPM) intervention improves blood pressure (BP) control compared with usual care (UC).

Methods And Results: This randomized, controlled trial was conducted in 10 Kaiser Permanente Colorado clinics. Overall, 348 patients with BP above recommended levels were randomized to the HBPM (n=175) or UC (n=173) groups.

Blood pressure trajectories and associations with treatment intensification, medication adherence, and outcomes among newly diagnosed coronary artery disease patients.

Background: Blood pressure (BP) control among coronary artery disease patients remains suboptimal in clinical practice, potentially due to gaps in treatment intensification and medication adherence. However, longitudinal studies evaluating these relationships and outcomes are limited.

Methods And Results: We assessed BP trajectories among health maintenance organization patients with hypertension and incident coronary artery disease.

Association of longitudinal measures of hemoglobin and outcomes after hospitalization for heart failure.

Background: Cross-sectional assessments of hemoglobin (Hb) are associated with mortality in patients with heart failure (HF). Our objectives were to characterize patterns of change in Hb over time in patients with HF and to evaluate the relationship between longitudinal measures of Hb and adverse outcomes.

Methods: The study included 2,478 patients with a primary discharge diagnosis of HF from January 2001 to December 2006.

Missed opportunities for reperfusion therapy for ST-segment elevation myocardial infarction: results of the Emergency Department Quality in Myocardial Infarction (EDQMI) study.

Background: Although it is known that reperfusion therapy for ST-elevation myocardial infarction (STEMI) is underused, the reasons for the failure to provide this potentially life-saving treatment are not well described.

Methods: In a cohort of 2215 consecutive patients presenting with acute myocardial infarction to 5 emergency departments in Colorado and California between 2000 and 2002, patients with ischemic symptoms and ST-segment elevation on electrocardiogram without documented guideline-based contraindications to therapy were identified as eligible reperfusion candidates. Multivariable logistic models were constructed to identify factors associated with the failure to receive reperfusion.

Association of exercise capacity on treadmill with future cardiac events in patients referred for exercise testing.

Background: Little is known about the association between exercise capacity and nonfatal cardiac events in patients referred for exercise treadmill testing (ETT). Our objective was to determine the prognostic importance of exercise capacity for nonfatal cardiac events in a clinical population.

Methods: A cohort study was performed of 9191 patients referred for ETT.

Patient sex and quality of ED care for patients with myocardial infarction.

Objective: The aim of the study was to assess the quality of care between male and female emergency department (ED) patients with acute myocardial infarction (AMI).

Methods: A 2-year retrospective cohort study of 2215 patients with AMI presenting immediately to 5 EDs from July 1, 2000, through June 30, 2002 was conducted. Data on patient characteristics, clinical presentation, and ED processes of care were obtained from chart and electrocardiogram reviews.

Chest pain on exercise treadmill test predicts future cardiac hospitalizations.

Background: Patients often have chest pain during exercise treadmill testing (ETT). However, the evidence supporting chest pain as an independent adverse prognostic factor during ETT has been inconsistent. The objective of this study was to determine the importance of chest pain during ETT in predicting future nonfatal cardiac hospitalizations.

Implications of the failure to identify high-risk electrocardiogram findings for the quality of care of patients with acute myocardial infarction: results of the Emergency Department Quality in Myocardial Infarction (EDQMI) study.

Background: The impact of misinterpretation of the ECG in patients with acute myocardial infarction (AMI) in the emergency department (ED) setting is not well known. Our goal was to assess the prevalence of the failure to identify high-risk ECG findings in ED patients with AMI and to determine whether this failure is associated with lower-quality care.

Methods And Results: In a retrospective cohort study of consecutive patients presenting to 5 EDs in California and Colorado from July 1, 2000, through June 30, 2002, with confirmed AMI (n=1684), we determined the frequency of the failure by the treating provider to identify significant ST-segment depressions, ST-segment elevations, or T-wave inversions on the presenting ECG.

Randomized trial to improve laboratory safety monitoring of ongoing drug therapy in ambulatory patients.

Study Objective: To determine whether an electronic tool effectively increases the percentage of patients receiving laboratory monitoring during ongoing drug therapy.

Design: Randomized trial.

Setting: Outpatient medical offices of a group model health maintenance organization.

Laboratory monitoring of drugs at initiation of therapy in ambulatory care.

Background And Objectives: Product labeling and published guidelines reflect the importance of monitoring laboratory parameters for drugs with a risk of organ system toxicity or electrolyte imbalance. Limited information exists about adherence to laboratory monitoring recommendations. The objective of this study was to describe laboratory monitoring among ambulatory patients dispensed medications for which laboratory testing is recommended at therapy initiation.

Older emergency department patients with acute myocardial infarction receive lower quality of care than younger patients.

Study Objective: We assessed the independent relationship between age and the quality of medical care provided to patients presenting to the emergency department (ED) with acute myocardial infarction.

Methods: We conducted a 2-year retrospective cohort study of 2,216 acute myocardial infarction patients presenting urgently to 5 EDs in Colorado and California from July 1, 2000, through June 30, 2002. Data on patient characteristics, clinical presentation, and ED processes of care were obtained from the ED record and ECG review.

Adherence to CDC STD guideline recommendations for the treatment of Chlamydia trachomatis infection in two managed care organizations.

Background: The extent of adherence to the Centers for Disease Control and Prevention (CDC) STD guidelines by clinicians practicing in managed care settings is unknown. GOAL The goal was to assess adherence to the CDC guideline recommendations for the treatment of genital chlamydial infection, by clinicians at two group model managed care organizations.

Design: Retrospective cohort study of men and women with laboratory-confirmed chlamydial infection.

Work-related exacerbation of asthma.

Adults with asthma who had been enrolled in an HMO for at least a year were requested to complete a questionnaire about their health status. Approximately 25% of the 1,461 participants responded positively to "Does your current work environment make your asthma worse?" and were classified as having workplace exacerbation of asthma. Those with workplace exacerbation were more likely to have never attended college, be current or former smokers, have a history of other respiratory diseases, have missed work or usual activities at least one day in the past for weeks, and report their asthma was moderate, severe, or very severe.