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.

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.

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.

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.

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).

Validation of New Care Coordination Quality Measures for Children with Medical Complexity.

Objectives: To validate new caregiver-reported quality measures assessing care coordination services for children with medical complexity (CMC).

Methods: A cross-sectional analysis of the associations between 20 newly developed Family Experiences with Coordination of Care (FECC) quality measures and 3 validation measures among 1209 caregivers who responded to a telephone or mailed survey from August to November 2013 in Minnesota and Washington. Validation measures included an access composite, a provider rating item, and a care coordination outcome measure, all derived from Consumer Assessments of Healthcare Providers and Systems (CAHPS) survey items.

Risk of Hepatitis B Virus Reactivation Among Patients Treated With Ledipasvir-Sofosbuvir for Hepatitis C Virus Infection.

Background: Direct acting antiviral (DAA) agents are the standard of care for treatment of hepatitis C virus (HCV)-infected individuals. Hepatitis B virus (HBV) reactivation during HCV treatment has been reported, the incidence and clinical outcome remains unclear. The aim of our study is to examine the risk of HBV reactivation in actively infected or previously exposed patients during or after HCV treatment with DAAs.

Development and Implementation of the Family Experiences With Coordination of Care Survey Quality Measures.

Objective: Ensuring high-quality care coordination for children with medical complexity (CMC) could yield significant health and economic benefits because they account for one-third of pediatric health care expenditures. The objective of this study was to develop and field test the Family Experiences with Coordination of Care (FECC) survey, which facilitates assessment of 20 new caregiver-reported quality measures for CMC.

Methods: We identified caregivers of Medicaid-insured CMC aged 0 to 17 years in Minnesota and Washington state, categorized by the Pediatric Medical Complexity Algorithm as having complex chronic disease.

Development and Testing of the ediatric espiratory llness asurement ystem (PRIMES) Quality Indicators.

Objectives: To develop and test quality indicators for assessing care in pediatric hospital settings for common respiratory illnesses.

Patients: A sample of 2796 children discharged from the emergency department or inpatient setting at 1 of the 3 participating hospitals with a primary diagnosis of asthma, bronchiolitis, croup, or community-acquired pneumonia (CAP) between January 1, 2010, and December 31, 2011.

Setting: Three tertiary care children's hospitals in the United States.

Quality Measures to Assess Care Transitions for Hospitalized Children.

Background: Transitions between sites of care are inherent to all hospitalizations, yet we lack pediatric-specific transitions-of-care quality measures. We describe the development and validation of new transitions-of-care quality measures obtained from medical record data.

Methods: After an evidence review, a multistakeholder panel prioritized quality measures by using the RAND/University of California, Los Angeles modified Delphi method.

Lower Patient Ratings of Physician Communication Are Associated With Unmet Need for Symptom Management in Patients With Lung and Colorectal Cancer.

Purpose: Little is known about factors associated with unmet needs for symptom management in patients with cancer.

Methods: Patients with a new diagnosis of lung and colorectal cancer from the diverse nationally representative Cancer Care Outcomes Research and Surveillance cohort completed a survey approximately 5 months after diagnosis (N = 5,422). We estimated the prevalence of unmet need for symptom management, defined as patients who report that they wanted help for at least one common symptom (pain, fatigue, depression, nausea/vomiting, cough, dyspnea, diarrhea) during the 4 weeks before the survey but did not receive it.

The Comparison of Matching Methods Using Different Measures of Balance: Benefits and Risks Exemplified within a Study to Evaluate the Effects of German Disease Management Programs on Long-Term Outcomes of Patients with Type 2 Diabetes.

Objective: To present a case study on how to compare various matching methods applying different measures of balance and to point out some pitfalls involved in relying on such measures.

Data Sources: Administrative claims data from a German statutory health insurance fund covering the years 2004-2008.

Study Design: We applied three different covariance balance diagnostics to a choice of 12 different matching methods used to evaluate the effectiveness of the German disease management program for type 2 diabetes (DMPDM2).