Automated phone and mail population outreach to promote colorectal cancer screening.

Objectives: To evaluate a population outreach program to promote screening for colorectal cancer (CRC) among average-risk insured men and women.

Study Design: In 2008, 58,440 Kaiser Permanente Colorado members unscreened for CRC received an interactive voice response (IVR) call followed by mailed fecal immunochemical test (FIT), or colonoscopy if requested. We used a quasi-experimental design with staged implementation, in which a random subset of eligible members was selected each week to receive the intervention.

Seasonal influenza vaccination status among children with laboratory evidence of pandemic H1N1 infection.

Background: The 2009 pandemic H1N1 influenza virus emerged in March 2009 and spread rapidly, causing many thousands of deaths worldwide. A case-control study of 60 Mexican adults with H1N1 suggested that the seasonal influenza vaccine protected against H1N1 infection (odds ratio [OR], 0.27; 95% confidence interval [CI], 0.

Parental refusal of varicella vaccination and the associated risk of varicella infection in children.

Objective: To quantify both the individual-level and attributable risk of varicella infection requiring medical care in children whose parents refuse varicella immunizations.

Design: Matched case-control study with conditional logistic regression analysis.

Setting: Kaiser Permanente of Colorado (KPCO) health plan between 1998 and 2008.

Parental refusal of pertussis vaccination is associated with an increased risk of pertussis infection in children.

Objective: The objective of this study was to determine if children who contracted pertussis infection were more likely to have parents who refused pertussis vaccinations than a similar group of children who did not develop pertussis infection.

Methods: We conducted a case-control study of children enrolled in the Kaiser Permanente of Colorado health plan between 1996 and 2007. Each pertussis case was matched to 4 randomly selected controls.

Long-term results of a smoking reduction program.

Introduction: There have been few comprehensive evaluations of smoking reduction, especially in health care delivery systems, and little is known about its cost, maintenance of reduced smoking, or robustness across patient subgroups.

Methods: A generally representative sample of 320 adult smokers from an HMO scheduled for outpatient surgery or a diagnostic procedure was randomized to enhanced usual care or a theory-based smoking reduction intervention that combined telephone counseling and tailored newsletters. Outcomes included cigarettes smoked, carbon monoxide levels, and costs.

Risk of immune thrombocytopenic purpura after measles-mumps-rubella immunization in children.

Background: The measles-mumps-rubella vaccine has been associated with immune thrombocytopenia purpura in 2 small studies.

Methods: By using the Vaccine Safety Datalink, we identified measles-mumps-rubella-vaccinated children aged 1 to 18. A case of immune thrombocytopenia purpura was defined as a patient with a platelet count of < or = 50,000/microL with clinical bleeding and normal red and white blood cell indices.

A population-based, multisite cohort study of the predictors of chronic idiopathic thrombocytopenic purpura in children.

Objective: The objective of this study was to identify risk factors for developing chronic idiopathic thrombocytopenic purpura in a cohort of pediatric patients with idiopathic thrombocytopenic purpura.

Methods: We conducted a retrospective cohort analysis of 259 children who were diagnosed with idiopathic thrombocytopenic purpura between 1991 and 2000 at 1 of 8 managed care organizations that comprise the Vaccine Safety Datalink. We reviewed the charts of 595 potential patients with idiopathic thrombocytopenic purpura from the 8 Vaccine Safety Datalink sites and excluded patients with known causes of thrombocytopenia.

Surveillance for invasive pneumococcal disease during 2000-2005 in a population of children who received 7-valent pneumococcal conjugate vaccine.

Objectives: To assess the incidence of invasive pneumococcal disease (IPD) in all children younger than 5 years of age in the Northern California Kaiser Permanente (NCKP) health care system during a 5-year surveillance period (2000-2005) after the introduction in April 2000 of routine use of 7-valent pneumococcal conjugate vaccine (PCV7).

Methods: This was a laboratory-based surveillance study of all children younger than 5 years of age in the NCKP health care system from April 2000 to March 2005. The comparison group was all children younger than 5 years of age in the NCKP health care system from April 1996 to March 2000.

Impact of maternal influenza vaccination during pregnancy on the incidence of acute respiratory illness visits among infants.

Objective: To determine whether influenza vaccination of pregnant women prevents visits for respiratory illness in their infants born during the influenza season.

Design: Retrospective matched cohort study.

Setting: Four managed care organizations in the United States.

Variation in hepatitis B immunization coverage rates associated with provider practices after the temporary suspension of the birth dose.

Background: In 1999, the American Academy of Pediatrics and U.S. Public Health Service recommended suspending the birth dose of hepatitis B vaccine due to concerns about potential mercury exposure.

Safety of trivalent inactivated influenza vaccine in children 6 to 23 months old.

Context: Beginning with the winter season of 2004-2005, influenza vaccination has been recommended for all children 6 to 23 months old in the United States. However, its safety in young children has not been adequately studied in large populations.

Objective: To screen for medically attended events in the clinic, emergency department, or hospital after administration of trivalent inactivated influenza vaccine in children 6 to 23 months old.

Four different study designs to evaluate vaccine safety were equally validated with contrasting limitations.

Objective: We conducted a simulation study to empirically compare four study designs [cohort, case-control, risk-interval, self-controlled case series (SCCS)] used to assess vaccine safety.

Study Design And Methods: Using Vaccine Safety Datalink data (a Centers for Disease Control and Prevention-funded project), we simulated 250 case sets of an acute illness within a cohort of vaccinated and unvaccinated children. We constructed the other three study designs from the cohort at three different incident rate ratios (IRRs, 2.

Association between higher cumulative doses of recombinant erythropoietin and risk for retinopathy of prematurity.

Background: Retinopathy of prematurity is a complication of premature birth that varies in its severity. The incidence and severity of retinopathy of prematurity at our perinatal center in a regional referral hospital changed substantially during 1995 to 1998 and presented us with an opportunity to examine whether there was a protective effect on risk of retinopathy associated with exposure to recombinant erythropoietin.

Methods: We undertook a retrospective cohort study.

Impact of the introduction of pneumococcal conjugate vaccine on immunization coverage among infants.

Background: The introduction of pneumococcal conjugate vaccine (PCV) to the U.S. recommended childhood immunization schedule in the year 2000 added three injections to the number of vaccinations a child is expected to receive during the first year of life.

Relationship between tobacco control policies and the delivery of smoking cessation services in nonprofit HMOs.

Background: This project examined tobacco policies and delivery of cessation services in nonprofit HMOs that collectively provide comprehensive medical care to more than 8 million members.

Methods: Three annual surveys with health plan managers showed that all of these health plans had written tobacco control guidelines that became more comprehensive over the span of this study. We also surveyed a random sample of 4207 current smokers who had attended a primary care visit in the past year (399-528 at each of nine health plans).

Effectiveness of the 2003-2004 influenza vaccine among children 6 months to 8 years of age, with 1 vs 2 doses.

Objective: To evaluate the effectiveness of 1 and 2 doses of the 2003-2004 influenza vaccine in preventing medically attended influenza-like illness (ILI) among children 6 to 23 months and 6 months to 8 years of age.

Design And Methods: Outpatient and emergency department visits and immunization records were used to conduct a retrospective cohort study among children 6 months to 8 years of age. ILI and pneumonia and influenza (P&I) outcomes were defined on the basis of International Classification of Diseases, Ninth Revision, codes.

Do behavioral smoking reduction approaches reach more or different smokers? Two studies; similar answers.

There is a need for innovative approaches capable of reaching smokers who would not otherwise participate in efforts to modify their smoking. This paper reports on two studies to determine whether a smoking reduction intervention would appeal to additional or different types of smokers than do cessation interventions. Study 1 attempted to contact 160 HMO smokers scheduled for outpatient surgeries.

Effect of the frequency of delivery of reminders and an influenza tool kit on increasing influenza vaccination rates among adults with high-risk conditions.

Objective: To evaluate the incremental effect of a second client reminder postcard or an influenza tool kit targeted toward employers on increasing influenza vaccination rates among adults age < 65 years at high risk for complications from influenza illness.

Methods: In this demonstration study, enrollees of 3 managed care organizations (n = 8881) were randomized at the employer level into 4 arms: 1 postcard, 2 postcards, 1 postcard + tool kit, and 2 postcards + tool kit. The postcards and tool kits were mailed during the fall of 2001, and their effect on influenza vaccination rates was assessed through a survey.

Safety of the trivalent inactivated influenza vaccine among children: a population-based study.

Background: To our knowledge, there are no published population-based studies on the safety of the inactivated trivalent influenza vaccine among children.

Objective: To screen a large population of children for evidence of increased medical visits in the 2 weeks after influenza vaccination compared with 2 control periods. Secondary analyses included shorter risk periods and restricted age categories.

Effectiveness of influenza vaccine during pregnancy in preventing hospitalizations and outpatient visits for respiratory illness in pregnant women and their infants.

The Advisory Committee on Immunization Practices of the Centers for Disease Control and Prevention recommends influenza vaccination for women who will be in the second or third trimester of pregnancy during the influenza season. We analyzed hospital admissions with principal diagnoses of influenza or pneumonia and influenza-like illness (ILI) outpatient visits to study the effectiveness of influenza vaccine during pregnancy in protecting women and infants from influenza-related morbidity. Estimates of influenza vaccine effectiveness across five flu seasons (Fall 1997 to Spring 2002) were calculated using Cox proportional hazards models for women and infant study populations in Kaiser Permanente Northern California.

Effectiveness of an asthma management program for pediatric members of a large health maintenance organization.

Objective: To assess the impact of an asthma management program on the dispensing of inhaled corticosteroids, hospitalizations, and emergency department (ED) visits on children, adolescents, and young adults.

Design: We used medical record and pharmacy data for the 18 months after initiation of a pilot asthma management program. Two intervention offices were matched with 2 control offices on pediatric volume, number of pediatricians or family practitioners, and specialist availability.

Tobacco-control policies in 11 leading managed care organizations: progress and challenges.

Context: Although evidence-based national guidelines for tobacco-dependence treatment have been available since 1996, translating these guidelines into clinical practice is challenging.

Practice Pattern Examined: Policies regarding tobacco-dependence treatment (e.g.