Provider imaging practices and outcomes of advanced colorectal cancer.

Purpose: To explore the real-world utilization of computerized tomography (CT) in patients with advanced colorectal cancer (CRC) and the associated outcomes.

Methods: Using Optum's de-identified Clinformatics® Data Mart Database (2008-2016), we identified patients with CRC receiving combination of chemotherapies (fluoropyrimidines with either oxaliplatin or irinotecan, or capecitabine with either oxaliplatin or irinotecan) combined with bevacizumab as the initial treatment, and its starting date was registered as the index date. End of treatment was defined by the presence of a gap in therapy > 60 days or treatment switch.

Impact of Adding Pharmacists and Comprehensive Medication Management to a Medical Group's Transition of Care Services.

Objectives: Evaluate the impact of pharmacist-provided transition of care (TOC) services on hospital readmissions.

Methods: Starting March 2014, TOC services were provided to all hospitalized patients from an at-risk medical group. Data covering all inpatient and outpatient services and prescription drugs were retrieved for all adult patients discharged between January 2010 and December 2018.

Complications and hospital costs during hematopoietic stem cell transplantation for non-Hodgkin lymphoma in the United States.

While the initial hospitalization accounts for 75% of total healthcare costs during the first 100 days following hematopoietic stem cell transplantation (HSCT), there is a lack of studies evaluating the considerable variation in cost estimates. Using the National Inpatient Sample (NIS) database from 2012-2014, we identified 1832 adult non-Hodgkin lymphoma (NHL) patients who received autologous or allogeneic HSCT and examined complications as predictors of hospital cost. Complications occurred in >70% of patients, and the presence of one or more complications was associated with an increase in mean hospital costs of 46% in autologous HSCT and 81% in allogeneic HSCT.

Primary Prevention Using Cholesterol-Lowering Medications in Patients Meeting New Treatment Guidelines: A Retrospective Cohort Analysis.

Background: The American College of Cardiology and American Heart Association (ACC/AHA) issued new cholesterol treatment guidelines in 2013. Two of the groups designated for primary prevention were analyzed: patients with a low-density lipoprotein cholesterol (LDL-C) level ≥ 190 mg per dL and diabetic patients aged 40-75 years.

Objective: To estimate the effects of primary prevention as specified in the 2013 guidelines on cardiovascular event risk and cost.

Reduction of healthcare costs through a transitions-of-care program.

Purpose: Results of an evaluation of the impact of a pharmacy-based transitional care program on healthcare costs in a population of high-risk patients are reported.

Methods: A nonrandomized, observational cohort study was conducted to compare cost outcomes in a group of patients discharged from a single hospital who were referred to an ambulatory care pharmacy-based transitions-of-care (TOC) program and a control group of patients discharged from neighboring hospitals who received usual care; all patients were members of the same managed Medicaid plan. The intervention and control groups were matched by number of hospitalizations during the 180 days preceding the index admission and by index admission length of stay.

Budget Impact Analysis of a Pharmacist-Provided Transition of Care Program.

Background: Postdischarge medication management services have been shown to reduce the incidence of medication-related problems during the transition from inpatient to outpatient care. A pharmacist-run transition of care (TOC) program has been developed to reduce the unplanned readmissions of a high-risk managed Medicaid population after hospitalization.

Objective: To estimate the budget impact of adding an outpatient pharmacy-based TOC program to a medical benefit from the payer perspective.

Impact of a pharmacy-based transitional care program on hospital readmissions.

Objectives: Avoidable readmissions of patients discharged from hospitals are a major concern. This study evaluates the impact of pharmacist-provided postdischarge services on hospital readmissions for members of a US managed Medicaid health plan.

Study Design: Prospective cohort study.

A Retrospective Cohort Study of Acute Kidney Injury Risk Associated with Antipsychotics.

Background: A recent large database analysis raised concerns of potential acute kidney injury (AKI) risk associated with antipsychotics. However, whether individual atypical and typical antipsychotics are associated with differential AKI risks has not been investigated.

Objective: The current study compared the risks of AKI and known causes of AKI associated with a broad range of atypical and typical antipsychotics.

The Impact of Delayed Hepatitis C Viral Load Suppression on Patient Risk: Historical Evidence from the Veterans Administration.

Background: The high cost of new hepatitis C (HCV) treatments has resulted in "watchful waiting" strategies being developed to safely delay treatment, which will in turn delay viral load suppression (VLS).

Objective: To document if delayed VLS adversely impacted patient risk for adverse events and death.

Methods: 187,860 patients were selected from the Veterans Administration's (VA) clinical registry (CCR), a longitudinal compilation of electronic medical records (EMR) data for 1999-2010.

Comparative treatment effectiveness of direct acting antiviral regimens for hepatitis C: Data from the Veterans administration.

Background And Aims: Data addressing real world effectiveness of direct acting antiviral agents in hepatitis C infected patients are now emerging. This study compared the sustained virologic response rates achieved 12 weeks post-treatment in patients treated with three such agents by the Veterans Health Administration.

Methods: A retrospective cohort study was conducted using patients who terminated treatment by July 1, 2015.

Clozapine revisited: Impact of clozapine vs olanzapine on health care use by schizophrenia patients on Medicaid.

Background: Our purpose was to evaluate health care use and cost patterns for clozapine compared with olanzapine in the treatment of schizophrenia.

Methods: Health care outcomes were measured over a 1-year posttreatment period for episodes of antipsychotic therapy initiated between 1997 and 2002. Four episode categories were defined: restart after lapse in therapy, switch after break, switch without break, and augmentation.

The risk of long-term morbidity and mortality in patients with chronic hepatitis C: results from an analysis of data from a Department of Veterans Affairs Clinical Registry.

Importance: The impact of viral load suppression, genotype, race, and other factors on the risk of late-stage liver-related events in patients with hepatitis C (HCV) has been assessed previously using data from small observational cohorts or clinical trials. Data from large real-world practice samples are needed to improve risk factor estimates for late-stage liver events and death in HCV.

Objective: To describe the natural history of HCV in real-world clinical practice.

Primary nonadherence to medications in an integrated healthcare setting.

Objectives: To measure primary nonadherence (PNA) rates for 10 therapeutic drug groups and identify factors associated with PNA to chronic and acute medications.

Study Design: Retrospective cohort study.

Methods: New prescriptions written in an integrated healthcare system for study drugs were identified between December 1, 2009, and February 28, 2010.

Effect of exenatide, pen insulin, and vial insulin on patient outcomes: a retrospective database analysis of persistence and first-year costs in a commercially insured population.

Objective: We compared health care costs and medication persistence for patients with type 2 diabetes initiating treatment using exenatide, pen insulin, or vial insulin.

Methods: Commercial health plan data (2004-2008) were used to identify episodes of antidiabetic drug therapy, which were then classified according to treatment history: first observed treatment, restarting a previous therapy (90-day gap in all treatment), switching therapy, and augmentation therapy. Three time periods were defined for each episode: the month in which the episode was initiated (index month), 6 months before the index month (preindex period), and 12 months after the index month (postindex period).

Economic burden associated with patients diagnosed with hepatitis C.

Background: New therapies for Hepatitis C virus (HCV) are under development that will augment pegylated interferon-alpha plus ribavirin to improve patient outcomes. Data documenting the incremental economic and health burden of patients with HCV relative to those who are not infected with HCV will be required to evaluate the comparative effectiveness of these new therapies.

Objective: The objective of this study was to estimate the incremental impact of HCV infection on health care costs and risk of adverse health events.

Impact of drug treatment history on comparative effectiveness research in schizophrenia.

Objectives: Randomized clinical trials frequently attract volunteer patients who were either non-compliant or seeking to switch therapies. Patients on active therapies often undergo a washout period after which a single medication is initiated. Observational research has the potential to compare alternative treatments under a wider range of clinical situations if care is taken to document each patient's treatment history.

The impact of the iPLEDGE program on isotretinoin fetal exposure in an integrated health care system.

Background: Preventing fetal exposure to isotretinoin is widely acknowledged as an important safety issue. The iPLEDGE program is the latest in a series of Food and Drug Administration-mandated risk management programs designed to prevent pregnancies in female patients of childbearing potential (FCBP) taking isotretinoin.

Objective: We sought to evaluate the effect of iPLEDGE relative to the prior risk management program (system to manage Accutane-related teratogenicity [SMART]) on the risk of isotretinoin fetal exposure in FCBP in a managed care setting.

The impact of clinical pharmacy services integrated into medical homes on diabetes-related clinical outcomes.

Background: Pharmacist services have expanded in the US health-care system from traditional roles to include comprehensive clinical services, but many studies lack comparison groups to evaluate outcomes of these clinical services.

Objective: To evaluate the clinical outcomes of uninsured or underinsured patients with type 2 diabetes who received care from pharmacists in local "safety net" clinic medical homes compared to outcomes of patients from clinics receiving usual care without the services of clinical pharmacists.

Methods: Pharmacists provided comprehensive pharmacy services in safety net clinic medical homes for uninsured patients in a major urban city.

Applying comparative effectiveness research methods in bipolar disorders.

Background: Randomized clinical trials [RCT] are the Gold Standard of medical evidence. However, observational comparative effectiveness research [CER] based on real-world data is receiving national attention. This paper demonstrates how observational CER can fill important gaps in clinical knowledge left behind by RCT approaches.

A1C and cardiovascular outcomes in type 2 diabetes: a nested case-control study.

Objective: Type 2 diabetes is associated with increased cardiovascular risk. The role of aggressive glycemic control in preventing cardiovascular events is unclear. A nested case-control study design was used to evaluate the association between average A1C and cardiovascular outcomes.

Duration of antipsychotic drug therapy in real-world practice: a comparison with CATIE trial results.

Background: Duration of drug therapy is a key measure of drug effectiveness in schizophrenia. The Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE) trial found that only olanzapine achieved a longer time to all-cause-discontinuation (TTAD) than a standard therapy comparator. This study compares the TTAD achieved when using alternative antipsychotics to treat patients with schizophrenia in real-world practice settings.

Classifying patients by antipsychotic adherence patterns using latent class analysis: characteristics of nonadherent groups in the California Medicaid (Medi-Cal) program.

Objectives: This study identifies latent classes defined by varying degrees of adherence to antipsychotic drug therapy and examines the sociodemographic, clinical, and resource utilization correlates associated with membership in each adherence class.

Data And Methods: Patient-level data were drawn from the 1994 to 2003, 100%-sample California Medicaid fee-for-service paid claims data for patients with schizophrenia (N = 36,195). The date of the first antipsychotic medication filled after January 1, 1999 was then used to divide each patient's data into a 6-month preindex (baseline) and a 12-month postindex (follow-up) period.

The impact of atypical antipsychotic medications on the use of health care by patients with schizophrenia.

Objective: Using data in real-world clinical practice, this study aims to compare the health-care use patterns of patients with schizophrenia who use oral antipsychotics.

Methods: A total of 219,504 episodes of antipsychotic drug therapy initiated during the period from 2000 to 2002 were identified using data from the California Medicaid program. Four types of episodes were analyzed based on the patient's drug use history as far back as 1994: restarting therapy after a break in therapy using the same drug used in the preceding episode; switching therapy after a break in treatment using a different medication; switching therapy without a break in therapy; and augmentation.

The impact of unrecognized bipolar disorders among patients treated for depression with antidepressants in the fee-for-services California Medicaid (Medi-Cal) program: a 6-year retrospective analysis.

Introduction: The cost of unrecognized bipolar disorders over time is unknown.

Methods: Ten years of data from the California Medicaid program were used to identify depressed patients initiating new episodes of antidepressant therapy and with 6+ years of post-treatment data. Recognized bipolar (RBP) patients received a BP diagnosis or used mood stabilizers in the pre-index period.