219 results match your criteria: "The Center for Health Research[Affiliation]"

Article Synopsis
  • - The 9-valent human papillomavirus (9vHPV) vaccine is suggested for individuals up to 26 years old, and for women up to 45, but research on its effects during pregnancy is scarce.
  • - This study examined the links between 9vHPV vaccine exposure during pregnancy or around pregnancy and various outcomes such as spontaneous abortion, preterm birth, small-for-gestational age births, and major structural birth defects.
  • - Data were collected from a cohort of pregnancies involving girls and women aged 12 to 28, analyzing outcomes between different vaccination timing windows and comparing them with those who received other HPV vaccines.
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Objective: To evaluate the association between provider religion and religiosity and consensus about end-of-life care and explore if geographical and institutional factors contribute to variability in practice.

Methods: Using a modified Delphi method 22 end-of-life issues consisting of 35 definitions and 46 statements were evaluated in 32 countries in North America, South America, Eastern Europe, Western Europe, Asia, Australia and South Africa. A multidisciplinary, expert group from specialties treating patients at the end-of-life within each participating institution assessed the association between 7 key statements and geography, religion, religiosity and institutional factors likely influencing the development of consensus.

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A Pragmatic, Randomized Clinical Trial of Gestational Diabetes Screening.

N Engl J Med

March 2021

From the Center for Health Research, Kaiser Permanente Northwest (T.A.H., K.L.P., K.K.V., J.V.M.), and the Division of Perinatology, Department of Obstetrics and Gynecology, Northwest Permanente, Kaiser Permanente (S.L.L.), Portland, Oregon; and the Center for Integrated Health Care Research (T.A.H., C.E.S.O.) and the Division of Perinatology, Department of Obstetrics and Gynecology (K.K.O.), Hawaii Permanente Medical Group (K.L.P., K.K.O.), Kaiser Permanente Hawaii, Honolulu.

Background: Gestational diabetes mellitus is common and is associated with an increased risk of adverse maternal and perinatal outcomes. Although experts recommend universal screening for gestational diabetes, consensus is lacking about which of two recommended screening approaches should be used.

Methods: We performed a pragmatic, randomized trial comparing one-step screening (i.

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Diagnosis of chronic obstructive pulmonary disease (COPD) relies on abnormal spirometry. However, spirometry may underestimate the effects of smoking, missing smokers with respiratory disease who have minimal or no airflow obstruction. To develop a multidimensional definition of a lung-related "resilient smoker" that is useful in research studies and then identify a resilient smoker subgroup in the SPIROMICS (SubPopulations and InteRmediate Outcome Measures In COPD Study) cohort using this definition.

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Using electronic health records, we found that hepatitis C virus (HCV) reporting on death certificates of 2901 HCV-infected decedents from 4 US healthcare organizations during 2011-2017 was documented in only 50% of decedents with hepatocellular carcinoma and less than half with decompensated cirrhosis. National figures likely underestimate the US HCV mortality burden.

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Background: Colorectal cancer (CRC) is the 3rd leading cancer killer among men and women in the US. The Strategies and Opportunities to STOP Colon Cancer in Priority Populations (STOP CRC) project aimed to increase CRC screening among patients in Federally Qualified Health Centers (FQHCs) through a mailed fecal immunochemical test (FIT) outreach program. However, rates of completion of the follow-up colonoscopy following an abnormal FIT remain low.

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Objectives: In a previous project aimed at informing patient-centered care for people with multiple chronic conditions, we performed highly stratified quantitative benefit-harm assessments for 2 top priority questions. In this current work, our goal was to describe the process and approaches we developed and to qualitatively glean important elements from it that address patient-centered care.

Methods: We engaged patients, caregivers, clinicians, and guideline developers as stakeholder representatives throughout the process of the quantitative benefit-harm assessment and investigated whether the benefit-harm balance differed based on patient preferences and characteristics (stratification).

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Little is known about the association between health insurance literacy and financial hardship among cancer survivors. Using the 2016 Medical Expenditure Panel Survey Experiences with Cancer self-administered questionnaire, we evaluated the associations between health insurance literacy and medical financial hardship and nonmedical financial sacrifices among adult cancer survivors in the United States. Of the survivors, 18.

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Goals: To determine the proportion and characteristics of adults with hepatitis C at health care organizations in 4 US states who initiated direct-acting antivirals (DAAs).

Background: There are almost no data to assess the penetrance of treatment of the hepatitis C population in general US health care settings.

Study: We conducted a prospective observational study using electronic clinical, pharmacy, and mortality data to determine the fraction of patients who initiated DAAs between January 2014 and December 2017, by start date and regimen.

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A Narrative Review and Proposed Framework for Using Health System Data with Systematic Reviews to Support Decision-making.

J Gen Intern Med

June 2020

Veterans Health Administration Health Services Research Department Evidence Synthesis Program, Portland, OR, USA.

Systematic reviews are a necessary, but often insufficient, source of information to address the decision-making needs of health systems. In this paper, we address when and how the use of health system data might make systematic reviews more useful to decision-makers. We describe the different ways in which health system data can be used with systematic reviews, identify scenarios in which the addition of health system data may be most helpful (i.

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Worry About Daily Financial Needs and Food Insecurity Among Cancer Survivors in the United States.

J Natl Compr Canc Netw

March 2020

Surveillance and Health Services Research Program, American Cancer Society, Atlanta, Georgia.

Background: A cancer diagnosis can impose substantial medical financial burden on individuals and may limit their ability to work. However, less is known about worry for nonmedical financial needs and food insecurity among cancer survivors.

Methods: The National Health Interview Survey (2013-2017) was used to identify cancer survivors (age 18-39 years, n=771; age 40-64 years, n=4,269; age ≥65 years, n=7,101) and individuals without a cancer history (age 18-39 years, n=53,262; age 40-64 years, n=60,141; age ≥65 years, n=30,261).

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Telehealth Interventions to Improve Obstetric and Gynecologic Health Outcomes: A Systematic Review.

Obstet Gynecol

February 2020

Departments of Obstetrics and Gynecology, George Washington University, Washington, DC, the University of Pennsylvania, Philadelphia, Pennsylvania, the Mayo Clinic, Rochester, Minnesota, the Uniformed Services University of the Health Sciences, Bethesda, Maryland, and the University of Arkansas for Medical Sciences, Little Rock, Arkansas; the Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco, San Francisco, California; the Center for Health Research, Kaiser Permanente, Northwest, Portland, Oregon; and the American College of Obstetricians and Gynecologists, Washington, District of Columbia.

Objective: To systematically review the effectiveness of telehealth interventions for improving obstetric and gynecologic health outcomes.

Data Sources: We conducted a comprehensive search for primary literature in ClinicalTrials.gov, Cochrane Library, Cochrane Collaboration Registry of Controlled Trials, EMBASE, PubMed, and MEDLINE.

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Background: Studies in countries with high human papillomavirus (HPV) vaccination coverage have demonstrated marked reductions in anogenital wart (AGW) incidence. Our goal was to assess the impact of HPV vaccination in a population with suboptimal coverage by comparing AGW incidence trends in the years before and after vaccine introduction.

Methods: We conducted a retrospective analysis of AGW incidence trends using an ecologic study design among 11- through 39-year-olds enrolled at Kaiser Permanente Northwest.

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Background: Older people with hypertension and multiple chronic conditions (MCC) receive complex treatments and face challenging trade-offs. Patients' preferences for different health outcomes can impact multiple treatment decisions. Since evidence about outcome preferences is especially scarce among people with MCC our aim was to elicit preferences of people with MCC for outcomes related to hypertension, and to determine how these outcomes should be weighed when benefits and harms are assessed for patient-centered clinical practice guidelines and health economic assessments.

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Objective: For patients with head and neck squamous cell carcinoma (HNSCC), delays in the initiation of radiotherapy (RT) have been closely associated with worse outcomes. We sought to investigate whether RT modality (proton vs. photon) is associated with differences in the time to initiation of RT.

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Colorectal cancer screening (CRC) rates are low, particularly among individuals with low socioeconomic status. Organized CRC screening programs have demonstrated success in increasing screening rates. Little is known about provider attitudes, beliefs, and practices related to CRC screening or how they are influenced by an organized CRC screening program.

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Background: Colorectal cancer screening uptake is low, particularly among individuals enrolled in Medicaid. To the authors' knowledge, little is known regarding the effectiveness of direct-to-member outreach by Medicaid health insurance plans to raise colorectal cancer screening use, nor how best to deliver such outreach.

Methods: BeneFIT is a hybrid implementation-effectiveness study of 2 program models that health plans developed for a mailed fecal immunochemical test (FIT) intervention.

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Background: Globally, tuberculosis (TB) remains a serious cause of morbidity and mortality for children. Mozambique is 1 of 30 high TB and TB/HIV burden countries. This study aimed to assess treatment outcomes of childhood TB in Chókwè District, Mozambique.

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Objective: Recent studies suggest that a systolic blood pressure (SBP) target of 120 mm Hg is appropriate for people with hypertension, but this is debated particularly in people with multiple chronic conditions (MCC). We aimed to quantitatively determine whether benefits of a lower SBP target justify increased risks of harm in people with MCC, considering patient-valued outcomes and their relative importance.

Design: Highly stratified quantitative benefit-harm assessment based on various input data identified as the most valid and applicable from a systematic review of evidence and based on weights from a patient preference survey.

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Small pulmonary nodules are most often managed by surveillance imaging with computed tomography (CT) of the chest, but the optimal frequency and duration of surveillance are unknown. The Watch the Spot Trial is a multicenter, pragmatic, comparative-effectiveness trial with cluster randomization by hospital or health system that compares more- versus less-intensive strategies for active surveillance of small pulmonary nodules. The study plans to enroll approximately 35,200 patients with a small pulmonary nodule that is newly detected on chest CT imaging, either incidentally or by screening.

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Agreement With Consensus Statements on End-of-Life Care: A Description of Variability at the Level of the Provider, Hospital, and Country.

Crit Care Med

October 2019

Department of Anesthesiology, Critical Care and Pain Medicine, Hadassah Medical Center, Hebrew University of Jerusalem, Faculty of Medicine, Jerusalem, Israel.

Objectives: To develop an enhanced understanding of factors that influence providers' views about end-of-life care, we examined the contributions of provider, hospital, and country to variability in agreement with consensus statements about end-of-life care.

Design And Setting: Data were drawn from a survey of providers' views on principles of end-of-life care obtained during the consensus process for the Worldwide End-of-Life Practice for Patients in ICUs study.

Subjects: Participants in Worldwide End-of-Life Practice for Patients in ICUs included physicians, nurses, and other providers.

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Objectives: To evaluate the relationship between cancer history and cost-related medication nonadherence (CRN) as well as cost-coping strategies, by health insurance coverage.

Methods: We used the 2013 to 2016 National Health Interview Survey to identify adults aged 18 to 64 years with (n = 3599) and without (n = 56 909) a cancer history. Cost-related changes in medication use included (1) CRN, measured as skipping, taking less, or delaying medication because of cost, and (2) cost-coping strategies, measured as requesting lower cost medication or using alternative therapies to save money.

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Developing Patient-Refined Messaging for a Mailed Colorectal Cancer Screening Program in a Latino-Based Community Health Center.

J Am Board Fam Med

June 2020

From the Center for Health Research, Kaiser Permanente Northwest, Portland, OR (JHT, JSR, SLR, GDC); Oregon Rural Practice-based Research Network, Oregon Health & Science University, Portland (MMD, LM); AltaMed Health Services, Los Angeles, CA (MLC, BMY, MC).

Introduction: Colon cancer is the second leading cause of cancer death in the United States, and screening rates are disproportionately low among Latinos. One factor thought to contribute to the low screening rate is the difficulty Latinos encounter in understanding health information, and therefore in taking appropriate health action. Therefore, we used Boot Camp Translation (BCT), a patient engagement approach, to engage Latino stakeholders (ie, patients, clinic staff) in refining the messages and format of colon cancer screening reminders for a clinic-based direct mail fecal immunochemical testing (FIT) program.

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