Comparing the clinical and cost-effectiveness of remote (telehealth and online) cognitive behavioral therapy-based treatments for high-impact chronic pain relative to usual care: study protocol for the RESOLVE multisite randomized control trial.

Background: Cognitive behavioral therapy for chronic pain (CBT-CP) is an effective but underused treatment for high-impact chronic pain. Increased access to CBT-CP services for pain is of critical public health importance, particularly for rural and medically underserved populations who have limited access due to these services being concentrated in urban and high income areas. Making CBT-CP widely available and more affordable could reduce barriers to CBT-CP use.

Sexually Transmitted Infection Testing, Prevalence, and Treatment Among Individuals Receiving HIV Preexposure Prophylaxis Within an Integrated Healthcare Delivery System.

Background: Initial and follow-up sexually transmitted infection (STI) and human immunodeficiency virus (HIV) testing are recommended when taking HIV preexposure prophylaxis (PrEP). We assessed STI services before and after PrEP initiation among persons 18 years or older.

Methods: We conducted this retrospective cohort study at a US integrated healthcare delivery system.

Predicting risk of multiple levels of recurrence and progression after initial diagnosis of nonmuscle-invasive bladder cancer in a multisite, community-based cohort.

Background: Nonmuscle-invasive bladder cancer (NMIBC) has heterogeneous recurrence and progression outcomes. Available risk calculators estimate recurrence and progression but do not predict the recurrence stage or grade, which may influence downstream treatment. The objective of this study was to predict risk-stratified NMIBC recurrence and progression based on recurrence tumor classification and grade.

Long-Term Patterns of Oral Anticancer Agent Adoption, Duration, and Switching in Patients With CML.

Background: Oral tyrosine kinase inhibitors (TKIs) have been the standard of care for chronic myeloid leukemia (CML) since 2001. However, few studies have evaluated changes in the treatment landscape of CML over time. This study assessed the long-term treatment patterns of oral anticancer therapies among patients with CML.

Medical Care Costs Associated With Cancer in Integrated Delivery Systems.

The high economic burden of cancer is projected to continue growing. Cost-of-care estimates are key inputs for comparative effectiveness and economic analyses that aim to inform policies associated with cancer care. Existing estimates are based largely on SEER-Medicare data in the elderly, leaving a knowledge gap regarding costs for patients aged <65 years.

Preventive care receipt and office visit use among breast and colorectal cancer survivors relative to age- and gender-matched cancer-free controls.

Purpose: We compare breast and colorectal cancer survivors' annual receipt of preventive care and office visits to that of age- and gender-matched cancer-free controls.

Methods: Automated data, including tumor registries, were used to identify insured individuals aged 50+ at the time of breast or colorectal cancer diagnosis between 2000 and 2008 as well as cancer-free controls receiving care from four integrated delivery systems. Those with metastatic or un-staged disease, or a prior cancer diagnosis were excluded.

A standardized relative resource cost model for medical care: application to cancer control programs.

Medicare data represent 75% of aged and permanently disabled Medicare beneficiaries enrolled in the fee-for-service (FFS) indemnity option, but the data omit 25% of beneficiaries enrolled in Medicare Advantage health maintenance organizations (HMOs). Little research has examined how longitudinal patterns of utilization differ between HMOs and FFS. The Burden of Cancer Study developed and implemented an algorithm to assign standardized relative costs to HMO and Medicare FFS data consistently across time and place.

The challenge of conducting comparative effectiveness research in cancer: the impact of a fragmented U.S. health-care system.

Comparative effectiveness research (CER) can make important contributions to the transformation of US health care by filling gaps left by tightly controlled clinical trials. However, without comprehensive and comparable data that reflect the diversity of the US health-care system, CER's value will be diminished. We document the limits of observational CER by examining the age at diagnosis, disease stage, and select measures of health-care use among individuals diagnosed with incident cancer aged 65 or older from four large health maintenance organizations (HMOs) relative to seniors identified through the linked Surveillance, Epidemiology, and End Results (SEER)-Medicare data for the period 1999-2007.

When does an episode of care for cancer begin?

Background: Little is known about the medical care resources devoted to diagnosing and treating cancer-related symptoms before a definitive cancer diagnosis. Previous research using SEER-Medicare data to measure incremental costs and utilization associated with cancer started with the date of diagnosis. We hypothesized that health care use increases before diagnosis of a new primary cancer.

Effectiveness of care coordination and health counseling in advancing illness.

Objective: To evaluate the Advanced Illness Coordinated Care Program (hereafter AICCP) for effects on health delivery among patients and caregivers, quality of life, advance planning, and health service utilization.

Study Design: Prospective trial involving 532 patients and 185 caregivers. AICCP consisted of care coordination, health counseling, and education delivered in cooperation with physicians.

Case-control study of medical comorbidities in women with interstitial cystitis.

Purpose: We used physician assigned diagnoses in an electronic medical record to assess comorbidities associated with interstitial cystitis.

Materials And Methods: A computer search of the administrative database at Kaiser Permanente Northwest, Portland, Oregon was performed for May 1, 1998 to April 30, 2003. All women with a medical record diagnosis of interstitial cystitis (ICD-9 code 595.

Costs of interstitial cystitis in a managed care population.

Objectives: To assess the direct medical costs, medication, and procedure use associated with interstitial cystitis (IC) in women in the Kaiser Permanente Northwest (KPNW) managed care population.

Methods: The KPNW electronic medical record was used to identify women diagnosed with IC (n = 239). Each of these patients was matched with three controls according to age and duration in the health plan.

Incidence and clinical characteristics of interstitial cystitis in the community.

We utilized physician-coded diagnoses and chart reviews to estimate the incidence of interstitial cystitis (IC) in women. A computer search of the Kaiser Permanente database was performed to identify newly coded diagnoses of IC (ICD-9 code 595.1) between May 2002 and May 2005.

Prevalence of and risk factors for prostatitis: population based assessment using physician assigned diagnoses.

Purpose: Previous studies to assess risk factors for prostatitis used patient self-reported data and, therefore, they were subject to recall bias. We 1) used coded physician diagnoses to calculate the prevalence of prostatitis and 2) compared these patients with matched controls to identify medical conditions that are associated with prostatitis. Subjects were male enrollees in the Kaiser Permanente Northwest, Portland, Oregon health maintenance organization.

Overlap of voiding symptoms, storage symptoms and pain in men and women.

Purpose: We quantified the degree of symptomatic overlap in individuals who reported urological symptoms and compared these patterns between men and women.

Materials And Methods: A questionnaire was mailed to a random sample of the Kaiser Permanente Northwest membership with no medical record evidence of pelvic malignancy or neurological disease. The questionnaire included the International Prostate Symptom Scale, Interstitial Cystitis Symptom Index and Problem Index, and National Institutes of Health Chronic Prostatitis Symptom Index.

Cost-effectiveness of echocardiography to identify intracardiac thrombus among patients with first stroke or transient ischemic attack.

Background And Purpose: Echocardiography to select stroke patients for targeted treatments, such as anticoagulation (AC), to reduce recurrent stroke risk is controversial. The authors' objective was to evaluate the cost-effectiveness of imaging strategies that use transthoracic (TTE) and transesophageal (TEE) echocardiography for identifying intracardiac thrombus in new stroke patients.

Methods: Model-based cost-effectiveness analysis of 7 echocardiographic imaging strategies and 2 nontesting strategies with model parameters based on systematic evidence review related to effectiveness of echocardiography in newly diagnosed ischemic stroke patients (white males aged 65 years in base case).

Prevalence of prostatitis-like symptoms in a managed care population.

Purpose: We calculated the prevalence of symptoms typically associated with chronic prostatitis/chronic pelvic pain syndrome in men in a managed care population in the Pacific Northwest.

Materials And Methods: A questionnaire mailing to 5,000 male enrollees 25 to 80 years old in the Kaiser Permanente Northwest (Portland, Oregon) health plan was performed. The questionnaires included screening questions about the presence, duration and severity of pelvic pain, and the National Institutes of Health Chronic Prostatitis Symptom Index.

Incidence and clinical characteristics of National Institutes of Health type III prostatitis in the community.

Purpose: Few population-based epidemiological studies of prostatitis have been performed. We used coded physician diagnoses and subsequent chart reviews to estimate the incidence and clinical characteristics of physician diagnosed National Institutes of Health (NIH) type III prostatitis.

Materials And Methods: Computer searches of the Kaiser Permanente Northwest (Portland, Oregon) database were performed on the 2-year interval May 2002 to May 2004 to identify new diagnoses of chronic prostatitis (International Classification of Diseases, 9th Revision code 601.

Prevalence of interstitial cystitis symptoms in a managed care population.

Purpose: We calculated the prevalence of symptoms typically associated with interstitial cystitis (IC) in men and women in a managed care population in the Pacific Northwest.

Materials And Methods: International Classification of Diseases-9 based queries of the Kaiser Permanente Northwest, Portland, Oregon database were used to identify subjects with IC exclusion criteria, who were excluded from further analysis. A total of 10,000 questionnaires, including 5,000 for women and 5,000 for men, were mailed to subjects with codes indicating bladder symptoms and to those with none of the codes.

Prevalence and incidence of interstitial cystitis in a managed care population.

Purpose: We calculated the prevalence and incidence of physician diagnosed interstitial cystitis (IC) in men and women in a managed care population in the Pacific Northwest.

Materials And Methods: A computer search of the Kaiser Permanente Northwest (Portland, Oregon) database was performed for January 1998 to May 2002. The prevalence of IC in patients 25 to 80 years old was calculated using the 4 definitions of 1) patients assigned a diagnosis of IC, 2) patients assigned a diagnosis of IC without any of the consensus IC exclusion criteria, 3) patients who had also had undergone cystoscopy and 4) patients who had specifically undergone cystoscopy with hydrodistention for IC.

Using risk-adjustment models to identify high-cost risks.

Background: We examine the ability of various publicly available risk models to identify high-cost individuals and enrollee groups using multi-HMO administrative data.

Methods: Five risk-adjustment models (the Global Risk-Adjustment Model [GRAM], Diagnostic Cost Groups [DCGs], Adjusted Clinical Groups [ACGs], RxRisk, and Prior-expense) were estimated on a multi-HMO administrative data set of 1.5 million individual-level observations for 1995-1996.

Risk adjustment using automated ambulatory pharmacy data: the RxRisk model.

Objectives: Develop and estimate the RxRisk model, a risk assessment instrument that uses automated ambulatory pharmacy data to identify chronic conditions and predict future health care cost. The RxRisk model's performance in predicting cost is compared with a demographic-only model, the Ambulatory Clinical Groups (ACG), and Hierarchical Coexisting Conditions (HCC) ICD-9-CM diagnosis-based risk assessment instruments. Each model's power to forecast health care resource use is assessed.

Pooling multisite administrative data for economic analysis.

Economic evaluations, such as cost-offset analyses, are receiving increased attention by US health insurers and payers. Administrative data collected by health maintenance organizations (HMOs) are considered an efficient source of utilization and cost measures for multisite economic analyses that increase external validity. However, pooling administrative data are problematic because HMO data sources reflect differences in systems of care, costing and coding.

Issues in pooling administrative data for economic evaluation.

Managed care, in particular the health maintenance organization (HMO), now dominates US healthcare delivery, and economic evaluation is receiving increasing attention as a management tool that can be tailored to its perceived business needs. This encourages use of HMO administrative data as an efficient source of resource utilization and cost measures. Use of administrative data coincides with growing research interest in multisite analyses that increase external validity.