Prevalence and treatment of opioid use disorders among primary care patients in six health systems.

Background: The U.S. experienced nearly 48,000 opioid overdose deaths in 2017.

Involution of Breast Lobules, Mammographic Breast Density and Prognosis Among Tamoxifen-Treated Estrogen Receptor-Positive Breast Cancer Patients.

Mammographic breast density (MD) reflects breast fibroglandular content. Its decline following adjuvant tamoxifen treated, estrogen receptor (ER)-positive breast cancer has been associated with improved outcomes. Breast cancers arise from structures termed lobules, and lower MD is associated with increased age-related lobule involution.

Patterns of Health Care Utilization Before First Episode Psychosis in Racial and Ethnic Groups.

Objective: To compare patterns of health care utilization associated with first presentation of psychosis among different racial and ethnic groups of patients.

Design: The study was a retrospective observational design.

Setting: The study was conducted in five health care systems in the western United States.

Challenges in assessing population reach in a pragmatic trial.

Strategies and Opportunities to STOP Colon Cancer in Priority Populations (STOP CRC) was a pragmatic cluster-randomized trial conducted at federally qualified health centers and designed to "Reach" as many unscreened patients as possible by directly mailing them fecal screening tests. STOP CRC used an electronic health record registry to identify individuals' needing CRC screening and mail interventions to them. The registry was updated daily removing individuals completing CRC screening or those who no longer were clinic patients.

A Data Element-Function Conceptual Model for Data Quality Checks.

Introduction: In aggregate, existing data quality (DQ) checks are currently represented in heterogeneous formats, making it difficult to compare, categorize, and index checks. This study contributes a data element-function conceptual model to facilitate the categorization and indexing of DQ checks and explores the feasibility of leveraging natural language processing (NLP) for scalable acquisition of knowledge of common data elements and functions from DQ checks narratives.

Methods: The model defines a "data element", the primary focus of the check, and a "function", the qualitative or quantitative measure over a data element.

Assessing and Minimizing Re-identification Risk in Research Data Derived from Health Care Records.

Background: Sharing of research data derived from health system records supports the rigor and reproducibility of primary research and can accelerate research progress through secondary use. But public sharing of such data can create risk of re-identifying individuals, exposing sensitive health information.

Method: We describe a framework for assessing re-identification risk that includes: identifying data elements in a research dataset that overlap with external data sources, identifying small classes of records defined by unique combinations of those data elements, and considering the pattern of population overlap between the research dataset and an external source.

Preliminary evidence is promising, but challenges remain in providing service dogs to veterans: Commentary on preliminary efficacy of service dogs as a complementary treatment for posttraumatic stress disorder in military members and veterans (O'Haire & Rodriguez, 2018).

Objective: Veterans with posttraumatic stress disorder (PTSD) are interested in service dogs to manage or reduce symptoms. Until recently, evidence was anecdotal with few research studies documenting the feasibility or benefits of service dogs for veterans. In the past year, new studies have presented preliminary evidence on the benefits of service dogs.

Factors that hindered care seeking among people with a first diagnosis of psychosis.

Aim: Evidence-based treatment can improve psychosis outcomes, but service providers need to understand and address the reasons people experiencing first episode psychosis avoid or delay care seeking. The goal of this study was to identify reasons care seeking might be postponed, from the points of view of patients, caregivers and health care professionals in a large health care delivery system, in the United States, without an early psychosis intervention program.

Methods: About 22 patients who had received an initial psychosis diagnosis and 10 of their caregivers were interviewed about their experiences and pathways to care.

Patient perspectives on how living with a mental illness affects making and maintaining healthy lifestyle changes.

Objective: To understand the ways that mental health symptoms interfere with achieving health goals.

Methods: Individuals with mental illness diagnoses and varying levels of preventive service use were recruited from federally qualified health centers and an integrated health care delivery system and interviewed. Thematic analysis was used to characterize descriptions of how mental illness experiences influenced lifestyle change efforts.

Correlates of Benzodiazepine Use and Adverse Outcomes Among Patients with Chronic Pain Prescribed Long-term Opioid Therapy.

Objective: To examine the correlates and odds of receiving overlapping benzodiazepine and opioid prescriptions and whether co-prescription was associated with greater odds of falling or visiting the emergency department.

Design: Cross-sectional study.

Setting: A large private integrated health system and a Veterans Health Administration integrated health system.

The Effect of Age and Comorbidities on the Association Between the Medicare STAR Oral Antihyperglycemic Adherence Metric and Glycemic Control.

Background: The Medicare STAR program for Medicare Advantage Plans that include drug benefits provides monetary incentives for health plans to achieve good adherence to oral antihyperglycemic (OAH) agents but does not account for differential case mix that could affect the ability of health plans to achieve the required quality metrics.

Objective: To determine whether OAH adherence varies by age and comorbidities among patients aged 65 years or older and the extent to which adherence affects glycemic control across age and comorbidity strata.

Methods: We studied 54,480 patients with diabetes aged > 65 years from the Colorado, Northwest, and Northern California regions of Kaiser Permanente who received OAH agents but not insulin in 2010.

Mind the Gap: Putting Evidence into Practice in the Era of Learning Health Systems.

Due to the increasing amount of available published evidence and the continual need to apply and update evidence in practice, we propose a shift in the way evidence generated by learning health systems can be integrated into more traditional evidence reviews. This paper discusses two main mechanisms to close the evidence-to-practice gap: (1) integrating Learning Health System (LHS) results with existing systematic review evidence and (2) providing this combined evidence in a standardized, computable data format. We believe these efforts will better inform practice, thereby improving individual and population health.

Building Meaningful Patient Engagement in Research: Case Study From ADVANCE Clinical Data Research Network.

Background: Strategies to engage patients to improve and enhance research and clinical care are increasingly being implemented in the United States, yet little is known about best practices for or the impacts of meaningful patient engagement.

Objective: We describe and reflect on our patient stakeholder groups, engagement framework, experiences, and lessons learned in engaging patients in research, from generating proposal ideas to disseminating findings.

Setting: The ADVANCE (Accelerating Data Value Across a National Community Health Center Network) clinical data research network is the nation's largest clinical dataset on the safety net, with outpatient clinical data from 122 health systems (1109 clinics) in 23 states.

Electronic health record tools to assist with children's insurance coverage: a mixed methods study.

Background: Children with health insurance have increased access to healthcare and receive higher quality care. However, despite recent initiatives expanding children's coverage, many remain uninsured. New technologies present opportunities for helping clinics provide enrollment support for patients.

Prevalence and Correlates of Low Pain Interference Among Patients With High Pain Intensity Who Are Prescribed Long-Term Opioid Therapy.

Unlabelled: The pain experience may vary greatly among individuals reporting equally high levels of pain. We sought to examine the demographic and clinical characteristics associated with pain interference in patients with high pain intensity. Among patients with chronic musculoskeletal pain who were prescribed long-term opioid therapy and who were recruited from 2 health care systems, we identified a subset who reported high pain intensity (n = 189).

Benefits and challenges of using service dogs for veterans with posttraumatic stress disorder.

Objective: Veterans with posttraumatic stress disorder (PTSD) are increasingly seeking service dogs to help them manage trauma-related symptoms, yet literature describing service dog use in this population is scant. The goal of this study was to document the benefits and challenges experienced by veterans with service dogs trained to assist with PTSD-related needs.

Method: Participants were veterans (N = 41) with service dogs, and their caregivers (n = 8), recruited through community-based service dog training agencies.

Correlates of Use and Perceived Effectiveness of Non-pharmacologic Strategies for Chronic Pain Among Patients Prescribed Long-term Opioid Therapy.

Objective: Non-pharmacologic treatments (NPTs) are recommended for chronic pain. Information is limited on patient use or perceptions of NPTs. We examined the frequency and correlates of use and self-rated helpfulness of NPTs for chronic pain among patients who are prescribed long-term opioid therapy (LTOT).

Patient and System Characteristics Associated with Performance on the HEDIS Measures of Alcohol and Other Drug Treatment Initiation and Engagement.

Objectives: Understand patient and system characteristics associated with performance on the Healthcare Effectiveness Data and Information Set (HEDIS) Alcohol and Other Drug (AOD) Initiation and Engagement of Treatment (IET) measures.

Methods: This mixed-methods study linked patient and health system data from four Kaiser Permanente regions to HEDIS performance measure data for 44,320 commercially or Medicare-insured adults with HEDIS-eligible AOD diagnoses in 2012. Characteristics associated with IET were examined using multilevel logistic regression models.

Long-term Outcomes Associated With Implantable Cardioverter Defibrillator in Adults With Chronic Kidney Disease.

Importance: Chronic kidney disease (CKD) is common in adults with heart failure and is associated with an increased risk of sudden cardiac death. Randomized trials of participants without CKD have demonstrated that implantable cardioverter defibrillators (ICDs) decrease the risk of arrhythmic death in selected patients with reduced left ventricular ejection fraction (LVEF) heart failure. However, whether ICDs improve clinical outcomes in patients with CKD is not well elucidated.

Mortality Rates After the First Diagnosis of Psychotic Disorder in Adolescents and Young Adults.

Importance: Individuals with psychotic disorders have increased mortality, and recent research suggests a marked increase shortly after diagnosis.

Objective: To use population-based data to examine overall and cause-specific mortality after first diagnosis of a psychotic disorder.

Design, Setting, And Participants: This cohort study used records from 5 integrated health systems that serve more than 8 million members in 5 states.