Intersectional Analysis of Social Risk and Need Among a Large Representative Sample of Adults From an Integrated Health System in the U.S.

Introduction: Social health is increasingly a focus of healthcare systems. Representative and intersectional analyses of individuals' social risks such as food, housing, transportation, and financial insecurity and their interest in receiving assistance from the healthcare system (social needs) can provide healthcare organizations with more nuanced estimates that can lead to more effective interventions.

Methods: The authors conducted cross-sectional survey of a representative sample of 43,936 Kaiser Permanente members in December 2019-September 2020.

Hospital Readmissions by Variation in Engagement in the Health Care Hotspotting Trial: A Secondary Analysis of a Randomized Clinical Trial.

Importance: Variability in intervention participation within care management programs can complicate standard analysis strategies.

Objective: To evaluate whether care management was associated with reduced hospital readmissions among individuals with higher participation probabilities.

Design, Setting, And Participants: A total of 800 hospitalized patients aged 18 years and older were randomized as part of the Health Care Hotspotting randomized clinical trial, which was conducted in Camden, New Jersey, from June 2014 to September 2017.

High-dose corticosteroids in patients hospitalized for COVID-19 pneumonia: an observational study of comparative effectiveness.

Objectives: To assess whether high- compared with low-dose corticosteroids started upon hospitalization reduce mortality in patients with severe COVID-19 pneumonia or in subgroups stratified by severity of respiratory impairment on admission.

Methods: We conducted a retrospective cohort study of patients with confirmed SARS-CoV-2 infection who required oxygen supplementation upon hospitalization between March 1 and December 31, 2020. In-hospital death was analyzed using logistic regression with inverse probability of treatment weighting of receiving low- or high-dose corticosteroid (dexamethasone 6-10 mg daily or >10-20 mg daily or other corticosteroid equivalents).

Anakinra or high-dose corticosteroids in COVID-19 pneumonia patients who deteriorate on low-dose dexamethasone: an observational study of comparative effectiveness.

Objectives: To assess whether escalating to high-dose corticosteroids or anakinra compared with continuing low-dose corticosteroids reduced mortality in patients with severe COVID-19 whose respiratory function deteriorated while receiving dexamethasone 6 mg daily.

Methods: We conducted a retrospective cohort study between March 1 to December 31, 2020, of hospitalized patients with confirmed COVID-19 pneumonia. In-hospital death was analyzed using logistic regression with inverse probability of treatment weighting of receiving anakinra, high-dose corticosteroid (dexamethasone >10 mg daily), or remaining on low-dose corticosteroids on the day of first respiratory deterioration.

The intensity of anticoagulant dosing in hospitalized patients with COVID-19: An observational, comparative effectiveness study.

Background: The question of anticoagulant dosing in hospitalized patients with coronavirus disease-2019 (COVID-19) is unresolved, with randomized trials showing mixed results and heterogeneity of treatment effects for in-hospital death.

Objective: To examine the association between the intensity of anticoagulation and clinical outcomes in hospitalized patients with COVID-19.

Design, Setting And Participants: Retrospective cohort study of patients with COVID-19 and respiratory impairment who were hospitalized between 3/1/2020-12/31/2020 in two Kaiser Permanente regions.

Addressing unmeasured confounding bias with a prior knowledge guided approach: coronary artery bypass grafting (CABG) versus percutaneous coronary intervention (PCI) in patients with stable ischemic heart disease.

Unlabelled: Unmeasured confounding undermines the validity of observational studies. Although randomized clinical trials (RCTs) are considered the "gold standard" of study types, we often observe divergent findings between RCTs and empirical settings. We present the "L-table", a simulation-based, prior knowledge (e.

The distillation method: A novel approach for analyzing randomized trials when exposure to the intervention is diluted.

Objective: To introduce a novel analytical approach for randomized controlled trials that are underpowered because of low participant enrollment or engagement.

Data Sources: Reanalysis of data for 805 patients randomized as part of a pilot complex care intervention in 2015-2016 in a large delivery system. In the pilot randomized trial, only 64.

Opioid and Naloxone Prescribing Following Insertion of Prompts in the Electronic Health Record to Encourage Compliance With California State Opioid Law.

Importance: Opioid addiction or dependency is a serious crisis in the US that affects public health as well as social and economic welfare. The State of California passed Assembly Bill (AB) 2760 in 2018 that mandates the coprescription of naloxone and opioids for patients with a high overdose risk.

Objective: To assess whether the AB 2760-based electronic prompts were associated with increased naloxone orders for opioid users and reduced opioid prescribing when integrated into the practitioner workflow.

Population-Based Incidence of New Ampicillin, Cephalexin, Cefaclor, and Sulfonamide Antibiotic "Allergies" in Exposed Individuals with and without Preexisting Ampicillin, Cephalexin, or Cefaclor "Allergies".

Background: There is a theoretical concern, unconfirmed by population-based challenge data, that clinically significant, immunologically mediated hypersensitivity occurs among β-lactams sharing side chains.

Objective: To determine the population-based allergy incidence associated with the use of β-lactams sharing exact R1 side chains (ampicillin, cephalexin, and cefaclor [ACC]), with or without a current ACC allergy or a sulfonamide antibiotic allergy for comparison.

Methods: All courses of ACC and trimethoprim-sulfamethoxazole used by any Kaiser Permanente California members in 2017 and 2018, with follow-up through January 2019, were identified along with their preexisting antibiotic allergy status and all new antibiotic-specific allergies reported within 30 days of course initiation.

The Effectiveness of Neuromuscular Warmups for Lower Extremity Injury Prevention in Basketball: A Systematic Review.

Background: Neuromuscular warmups have gained increasing attention as a means of preventing sports-related injuries, but data on effectiveness in basketball are sparse. The objective of this systematic review was to evaluate evidence of the effectiveness of neuromuscular warmup-based strategies for preventing lower extremity injuries among basketball athletes.

Methods: PubMed and Cochrane Library databases were searched in February 2019.

Defining Complex Patient Populations: Implications for Population Size, Composition, Utilization, and Costs.

Background: Interventions to support patients with complex needs have proliferated in recent years, but the question of how to identify patients with complex needs has received relatively little attention. There are innumerable ways to structure inclusion and exclusion criteria for complex care interventions, and little is known about the implications of choices made in designing patient selection criteria.

Objective: To provide insights into the design of patient selection criteria for interventions, by implementing criteria sets within a large health plan member population and comparing the characteristics of the resulting complex patient cohorts.

High School Basketball Coach and Player Perspectives on Warm-Up Routines and Lower Extremity Injuries.

Background: While participation in sports-related activities results in improved health outcomes, high school athletes are at risk for lower extremity injuries, especially ankle, knee, and thigh injuries. Efforts to promote the adoption and implementation of evidence-driven approaches to reduce injury risk among school-aged athletes are needed. However, there is limited research regarding the perceived barriers, facilitators, and adherence factors that may influence the successful implementation of effective warm-up routines among this population.

Identifying Populations with Complex Needs: Variation in Approaches Used to Select Complex Patient Populations.

Interventions to support patients with complex needs are proliferating. However, little attention has been paid to methods for identifying complex patients. This study aims to summarize approaches used to define populations with complex needs in practice, by cataloging specific population criteria and organizing them into a taxonomy.

Predictors of Hyperkalemia and Hypokalemia in Individuals with Diabetes: a Classification and Regression Tree Analysis.

Background: Both hyperkalemia and hypokalemia can lead to cardiac arrhythmias and are associated with increased mortality. Information on the predictors of potassium in individuals with diabetes in routine clinical practice is lacking.

Objective: To identify predictors of hyperkalemia and hypokalemia in adults with diabetes.

Assessing the Safety of Direct-Acting Antiviral Agents for Hepatitis C.

Importance: Recent reports based on the US Food and Drug Administration's voluntary Adverse Events Reporting System raised questions about the safety of direct-acting antivirals (DAAs) for treatment of the hepatitis C virus (HCV).

Objective: To assess the rates of adverse events in patients with HCV infection exposed to DAAs compared with those not exposed.

Design, Setting, And Participants: A retrospective cohort study calculated unadjusted adverse event rates for exposed vs unexposed time, using claims and clinical data from 3 health systems between January 1, 2012, and December 31, 2017.

Timely Outpatient Follow-up Is Associated with Fewer Hospital Readmissions among Patients with Behavioral Health Conditions.

Background: Hospital readmissions contribute to high health care costs and are an indicator of poor performance. Reducing readmissions through reconnecting patients to primary care after hospitalization is a solution that is particularly relevant to complex patients with behavioral health conditions. We therefore aimed to examine the rate of follow-up visits among patients with behavioral health conditions and to assess the impact of this visit on the subsequent rate of readmission.

Imputation of race/ethnicity to enable measurement of HEDIS performance by race/ethnicity.

Objective: To improve an existing method, Medicare Bayesian Improved Surname Geocoding (MBISG) 1.0 that augments the Centers for Medicare & Medicaid Services' (CMS) administrative measure of race/ethnicity with surname and geographic data to estimate race/ethnicity.

Data Sources/study Setting: Data from 284 627 respondents to the 2014 Medicare CAHPS survey.

Advancing the Science of Healthcare Service Delivery: The NHLBI Corporate Healthcare Leaders' Panel.

There is a growing gap between available science and evidence and the ability of service providers to deliver high-quality care in a cost-effective way to the entire population. We believe that the chasm between knowledge and action is due to a lack of concerted effort among all organizations that deliver health care services across the life span of patients. Broad participation is needed and necessitates a far more explicit and concerted public-private partnership focused on large-scale transformation.

Segmentation of High-Cost Adults in an Integrated Healthcare System Based on Empirical Clustering of Acute and Chronic Conditions.

Background: High-cost patients are a frequent focus of improvement projects based on primary care and other settings. Efforts to characterize high-cost, high-need patients are needed to inform care planning, but such efforts often rely on a priori assumptions, masking underlying complexities of a heterogenous population.

Objective: To define recognizable subgroups of patients among high-cost adults based on clinical conditions, and describe their survival and future spending.

Quality of Care for Children With Medical Complexity: An Analysis of Continuity of Care as a Potential Quality Indicator.

Objective: To examine the relationship between continuity of care for children with medical complexity (CMC) and emergency department (ED) utilization, care coordination quality, and family effects related to care coordination.

Methods: We measured ED utilization and primary care continuity with the Bice-Boxerman continuity of care index for 1477 CMC using administrative data from Minnesota and Washington state Medicaid agencies. For a subset of 186 of these CMC a caregiver survey was used to measure care coordination quality (using items adapted from the Consumer Assessment of Healthcare Providers and System Adult Health Plan Survey) and family impact (using items adapted from the National Survey of Children with Special Health Care Needs).

Add-On Antihypertensive Medications to Angiotensin-Aldosterone System Blockers in Diabetes: A Comparative Effectiveness Study.

Background And Objectives: In individuals with diabetes, the comparative effectiveness of add-on antihypertensive medications added to an angiotensin-converting enzyme inhibitor or angiotensin II receptor blocker on the risk of significant kidney events is unknown.

Design, Setting Participants, & Measurements: We used an observational, multicenter cohort of 21,897 individuals with diabetes to compare individuals who added -blockers, dihydropyridine calcium channel blockers, loop diuretics, or thiazide diuretics to angiotensin-converting enzyme inhibitors or angiotensin II receptor blockers. We examined the hazard of significant kidney events, cardiovascular events, and death using Cox proportional hazard models with propensity score weighting.