Effectiveness of direct patient outreach with a narrative naloxone and overdose prevention video to patients prescribed long-term opioid therapy in the USA: the Naloxone Navigator randomised clinical trial.

Introduction: Public health efforts to reduce opioid overdose fatalities include educating people at risk and expanding access to naloxone, a medication that reverses opioid-induced respiratory depression. People receiving long-term opioid therapy (LTOT) are at increased risk for overdose, yet naloxone uptake in this population remains low. The objective of this study was to determine if a targeted, digital health intervention changed patient risk behavior, increased naloxone uptake, and increased knowledge about opioid overdose prevention and naloxone.

The impact of timing of initiating invasive mechanical ventilation in COVID-19-related respiratory failure.

Purpose: Optimal timing of initiating invasive mechanical ventilation (IMV) in coronavirus disease 2019 (COVID-19)-related respiratory failure is unclear. We hypothesized that a strategy of IMV as opposed to continuing high flow oxygen or non-invasive mechanical ventilation each day after reaching a high FiO2 threshold would be associated with worse in-hospital mortality.

Methods: Using data from Kaiser Permanente Northern/Southern California's 36 medical centers, we identified patients with COVID-19-related acute respiratory failure who reached ≥80% FiO2 on high flow nasal cannula or non-invasive ventilation.

Naloxone Co-Dispensing with Opioids: a Cluster Randomized Pragmatic Trial.

Background: Although naloxone prevents opioid overdose deaths, few patients prescribed opioids receive naloxone, limiting its effectiveness in real-world settings. Barriers to naloxone prescribing include concerns that naloxone could increase risk behavior and limited time to provide necessary patient education.

Objective: To determine whether pharmacy-based naloxone co-dispensing affected opioid risk behavior.

The Association between Opioid Discontinuation and Heroin Use: A Nested Case-Control Study.

Background: Opioid prescribing guidelines recommend reducing or discontinuing opioids for chronic pain if harms of opioid treatment outweigh benefits. As opioid discontinuation becomes more prevalent, it is important to understand whether opioid discontinuation is associated with heroin use. In this study, we sought to assess the association between opioid discontinuation and heroin use documented in the medical record.

Adults With Asthma Experience No Increase in Asthma-related Exacerbations When Digital Communication Technology Tools Are Employed to Offset Provider Workload: A Pragmatic Randomized Trial.

Background: Challenges to health care efficiency are increasingly addressed with the help of digital communication technology tools (DCTs).

Objective: The objective of this study was to test whether DCT, compared with Usual Care, can reduce health care clinician burden without increasing asthma-related exacerbations among patients with asthma in a large integrated health care system.

Research Design: The (Breathewell) program was a pragmatic, randomized trial at (Kaiser Permanente Colorado), where asthma nurses screen patients for poor symptom control when beta2-agonist refill requests came within 60 days of previous fill or in the absence of a controller medication fill within 4 months (beta2-agonist overfill).

Order of Live and Inactivated Vaccines and Risk of Non-vaccine-targeted Infections in US Children 11-23 Months of Age.

Background: Some findings from observational studies have suggested that recent receipt of live vaccines may be associated with decreased non-vaccine-targeted infection risk and mortality. Our objective was to estimate risk of non-vaccine-targeted infections based on most recent vaccine type (live vaccines only, inactivated vaccines only or both concurrently) received in US children 11-23 months of age.

Methods: We conducted a retrospective cohort study within the Vaccine Safety Datalink.

A primer on quantitative bias analysis with positive predictive values in research using electronic health data.

Objective: In health informatics, there have been concerns with reuse of electronic health data for research, including potential bias from incorrect or incomplete outcome ascertainment. In this tutorial, we provide a concise review of predictive value-based quantitative bias analysis (QBA), which comprises epidemiologic methods that use estimates of data quality accuracy to quantify the bias caused by outcome misclassification.

Target Audience: Health informaticians and investigators reusing large, electronic health data sources for research.

Association Between Opioid Dose Variability and Opioid Overdose Among Adults Prescribed Long-term Opioid Therapy.

Importance: Attempts to discontinue opioid therapy to reduce the risk of overdose and adhere to prescribing guidelines may lead patients to be exposed to variability in opioid dosing. Such dose variability may increase the risk of opioid overdose even if therapy discontinuation is associated with a reduction in risk.

Objective: To examine the association between opioid dose variability and opioid overdose.

Optimizing number and timing of appointment reminders: a randomized trial.

Objectives: To compare missed appointment rates for patients receiving a single reminder either 3 days prior to a primary care visit, 1 day prior to the visit, or both 3 days and 1 day prior to the visit.

Study Design: Three-armed randomized controlled trial.

Methods: Text messages or interactive voice response calls were sent to patients with appointments at 25 primary care clinics in an integrated delivery system.

Bias from outcome misclassification in immunization schedule safety research.

Purpose: The Institute of Medicine recommended conducting observational studies of childhood immunization schedule safety. Such studies could be biased by outcome misclassification, leading to incorrect inferences. Using simulations, we evaluated (1) outcome positive predictive values (PPVs) as indicators of bias of an exposure-outcome association, and (2) quantitative bias analyses (QBA) for bias correction.

Predicting the 6-month risk of severe hypoglycemia among adults with diabetes: Development and external validation of a prediction model.

Aims: To develop and externally validate a prediction model for the 6-month risk of a severe hypoglycemic event among individuals with pharmacologically treated diabetes.

Methods: The development cohort consisted of 31,674 Kaiser Permanente Colorado members with pharmacologically treated diabetes (2007-2015). The validation cohorts consisted of 38,764 Kaiser Permanente Northwest members and 12,035 HealthPartners members.

Reducing Missed Primary Care Appointments in a Learning Health System: Two Randomized Trials and Validation of a Predictive Model.

Background: Collaborations between clinical/operational leaders and researchers are advocated to develop "learning health systems," but few practical examples are reported.

Objectives: To describe collaborative efforts to reduce missed appointments through an interactive voice response and text message (IVR-T) intervention, and to develop and validate a prediction model to identify individuals at high risk of missing appointments.

Research Subjects And Design: Random assignment of 8804 adults with primary care appointments to a single IVR-T reminder or no reminder at an index clinic (IC) and 7497 at a replication clinic (RC) in an integrated health system in Denver, CO.

Automating assessment of lifestyle counseling in electronic health records.

Background: Numerous population-based surveys indicate that overweight and obese patients can benefit from lifestyle counseling during routine clinical care.

Purpose: To determine if natural language processing (NLP) could be applied to information in the electronic health record (EHR) to automatically assess delivery of weight management-related counseling in clinical healthcare encounters.

Methods: The MediClass system with NLP capabilities was used to identify weight-management counseling in EHRs.

Geographic variation in cardiovascular procedure use among Medicare fee-for-service vs Medicare Advantage beneficiaries.

Importance: Little is known about how different financial incentives between Medicare Advantage and Medicare fee-for-service (FFS) reimbursement structures influence use of cardiovascular procedures.

Objective: To compare regional cardiovascular procedure rates between Medicare Advantage and Medicare FFS beneficiaries.

Design, Setting, And Participants: Cross-sectional study of Medicare beneficiaries older than 65 years between 2003-2007 comparing rates of coronary angiography, percutaneous coronary intervention (PCI), and coronary artery bypass graft (CABG) surgery across 32 hospital referral regions in 12 states.

Interventional radiologic treatment of hepatocellular carcinoma-a cost analysis from the payer perspective.

Purpose: To determine whether there is a cost advantage for one of the three commonly performed interventional radiology (IR) procedures (chemoembolization, selective internal radiation therapy [SIRT], radiofrequency ablation [RFA]) in the treatment of hepatocellular carcinoma (HCC).

Materials And Methods: A cost analysis from the payer perspective was performed. Primary data were collected from a university hospital, and sensitivity testing was done by comparing coding information obtained at two other tertiary care medical facilities.

Trivalent inactivated influenza vaccine is not associated with sickle cell crises in children.

Background And Objectives: Children with sickle cell disease are considered at high risk for complications from influenza infection and are recommended to receive annual influenza vaccination. However, data on the safety of influenza vaccination in children with sickle cell anemia are sparse.

Methods: Using a retrospective cohort of children aged 6 months to 17 years in 8 managed care organizations that comprise the Vaccine Safety Datalink and who had a diagnosis of sickle cell anemia from 1999 to 2006, we conducted matched case-control and self-controlled case series studies to examine the association of trivalent inactivated influenza vaccination with hospitalization for sickle cell crisis in the 2 weeks after vaccination.

Characteristics of patients with primary non-adherence to medications for hypertension, diabetes, and lipid disorders.

Background: Information comparing characteristics of patients who do and do not pick up their prescriptions is sparse, in part because adherence measured using pharmacy claims databases does not include information on patients who never pick up their first prescription, that is, patients with primary non-adherence. Electronic health record medication order entry enhances the potential to identify patients with primary non-adherence, and in organizations with medication order entry and pharmacy information systems, orders can be linked to dispensings to identify primarily non-adherent patients.

Objective: This study aims to use database information from an integrated system to compare patient, prescriber, and payment characteristics of patients with primary non-adherence and patients with ongoing dispensings of newly initiated medications for hypertension, diabetes, and/or hyperlipidemia.

Safety of trivalent inactivated influenza vaccine in children aged 24 to 59 months in the vaccine safety datalink.

Objectives: To evaluate the safety of trivalent inactivated influenza vaccine (TIV) in children aged 24 to 59 months and to evaluate the risk of medically attended events (MAEs) in a subcohort of children who had multiple annual doses of TIV over their lifetimes.

Design: Self-controlled screening study.

Setting: Seven US managed care organizations from October 1, 2002, to March 31, 2006.

Gender differences in hospitalization after emergency room visits for depressive symptoms.

Background: Depressed women have greater than three times the odds of hospitalization as clinically comparable men. The objective of this study is to understand if these gender differences emerge in admissions decisions after depressed individuals' arrival at the emergency room (ER).

Methods: We used multivariate logistic regression to examine gender differences in hospitalization after 6266 ER visits for depressive symptoms in the nationally representative 1998-2007 National Hospital Ambulatory Care Medical Survey.

Building a multiple modality, theory-based physical activity intervention: The development of CardiACTION!

OBJECTIVES: Despite the widely acknowledged benefits of regular physical activity (PA), specific goals for increased population levels of PA, and strongly recommended strategies to promote PA, there is no evidence suggesting that the prevalence of PA is improving. If PA intervention research is to be improved, theory should be used as the basis for intervention development, participant context or environment should be considered in the process, and intervention characteristics that will heighten the likelihood of translation into practice should be implemented (e.g.