Appointment reminders by text message in a safety net health care system: a pragmatic investigation.

Introduction: Short Message Service (SMS) appointment reminders may provide a wide-reaching, low cost approach to reducing operational inefficiencies and improving access to care. Previous studies indicate this modality may improve attendance rates, yet there is a need for large-scale, pragmatic studies that include unintended consequences and operational costs.

Methods: This pragmatic investigation was a before-after analysis that compared visit attendance outcomes among patients who opted into SMS appointment reminders with outcomes among those who declined over an 18-month evaluation period from March 25, 2013, to September 30, 2014.

The impact of tailored intervention services on charges and mortality for adult super-utilizers.

Background: Interventions designed to improve care and reduce costs for patients with the highest rates of hospital utilization (super-utilizers) continue to proliferate, despite conflicting evidence of cost savings.

Methods: We evaluated a practice transformation intervention that implemented team-based care and risk-stratification to match specific primary care resources based on need. This included an intensive outpatient clinic for super-utilizers.

Identifying Subgroups of Adult Superutilizers in an Urban Safety-Net System Using Latent Class Analysis: Implications for Clinical Practice.

Background: Patients with repeated hospitalizations represent a group with potentially avoidable utilization. Recent publications have begun to highlight the heterogeneity of this group. Latent class analysis provides a novel methodological approach to utilizing administrative data to identify clinically meaningful subgroups of patients to inform tailored intervention efforts.

Augmenting Predictive Modeling Tools with Clinical Insights for Care Coordination Program Design and Implementation.

Context: The Center for Medicare and Medicaid Innovation (CMMI) awarded Denver Health's (DH) integrated, safety net health care system $19.8 million to implement a "population health" approach into the delivery of primary care. This major practice transformation builds on the Patient Centered Medical Home (PCMH) and Wagner's Chronic Care Model (CCM) to achieve the "Triple Aim": improved health for populations, care to individuals, and lower per capita costs.

For many patients who use large amounts of health care services, the need is intense yet temporary.

Patients who accumulate multiple emergency department visits and hospital admissions, known as super-utilizers, have become the focus of policy initiatives aimed at preventing such costly use of the health care system through less expensive community- and primary care-based interventions. We conducted cross-sectional and longitudinal analyses of 4,774 publicly insured or uninsured super-utilizers in an urban safety-net integrated delivery system for the period May 1, 2011-April 30, 2013. Our analysis found that consistently 3 percent of adult patients met super-utilizer criteria and accounted for 30 percent of adult charges.

Access and care issues in urban urgent care clinic patients.

Background: Although primary care should be the cornerstone of medical practice, inappropriate use of urgent care for non-urgent patients is a growing problem that has significant economic and healthcare consequences. The characteristics of patients who choose the urgent care setting, as well as the reasoning behind their decisions, is not well established. The purpose of this study was to determine the motivation behind, and characteristics of, adult patients who choose to access health care in our urgent care clinic.

Off-site percutaneous coronary intervention reduces hospital length of stay in vulnerable patients with acute myocardial infarction.

Primary percutaneious coronary intervention (PCI) is rapidly becoming the preferred therapy for acute ST-segment elevation myocardial infarction (AMI) because of a lower mortality rate and decreased hospital length of stay (LOS) compared with thrombolysis. However, generalizability of these findings beyond randomized trials involving specialized centers has not been well described. Many urban county hospitals care for disadvantaged patients and lack on-site PCI capabilities.

Impact of prescription size on statin adherence and cholesterol levels.

Background: Therapy with 3-Hydroxy-3-methylglutaryl Co-enzyme A reductase inhibitors (statins) improve outcomes in a broad spectrum of patients with hyperlipidemia. However, effective therapy requires ongoing medication adherence; restrictive pharmacy policies may represent a barrier to successful adherence, particularly among vulnerable patients. In this study we sought to assess the relationship between the quantity of statin dispensed by the pharmacy with patient adherence and total cholesterol.

Papanicolaou screening in an urgent care setting.

Objective: This study was undertaken to determine the efficacy of Papanicolaou (Pap) screening in an urgent care setting, and to compare the rates of cervical intraepithelial neoplasia (CIN), and follow-up in patients with and without established primary care.

Study Design: All patients presenting with a complaint warranting pelvic examination between December 2000 and September 2001 underwent Pap screening. All patients were scheduled an appointment or follow-up visit when an abnormal Pap test was found.

Sudden Infant Death Syndrome and prenatal maternal smoking: rising attributed risk in the Back to Sleep era.

Background: Parental smoking and prone sleep positioning are recognized causal features of Sudden Infant Death. This study quantifies the relationship between prenatal smoking and infant death over the time period of the Back to Sleep campaign in the United States, which encouraged parents to use a supine sleeping position for infants.

Methods: This retrospective cohort study utilized the Colorado Birth Registry.

Conventional and molecular epidemiology of trimethoprim-sulfamethoxazole resistance among urinary Escherichia coli isolates.

Background: Antibiotic resistance is increasing in Escherichia coli, the most common cause of urinary tract infections, but its epidemiology has not been well described. We evaluated the epidemiology of trimethoprim-sulfamethoxazole-resistant E. coli in a large, public health care system in Denver, Colorado.

Optimizing antibiotic prescribing for acute respiratory tract infections in an urban urgent care clinic.

Objective: To decrease unnecessary antibiotic use for acute respiratory tract infections in adults in a point-of-service health care setting.

Design: Prospective, nonrandomized controlled trial.

Setting: An urban urgent care clinic associated with the major indigent care hospital in Denver, Colorado between October 2000 and April 2001.

Effect of Spanish interpretation method on patient satisfaction in an urban walk-in clinic.

Objective: To examine the effect of Spanish interpretation method on satisfaction with care.

Design: Self-administered post-visit questionnaire.

Setting: Urban, university-affiliated walk-in clinic.