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Olson JE, Ryu E, Lyke KJ, Bielinski SJ, Winkler EM, Hathcock MA, Bublitz JT, Takahashi PY, Cerhan JR. Acceptability of Electronic Visits for Return of Research Results in the Mayo Clinic Biobank. Mayo Clin Proc Innov Qual Outcomes 2018; 2:352-358. [PMID: 30560237 PMCID: PMC6257882 DOI: 10.1016/j.mayocpiqo.2018.07.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Revised: 07/09/2018] [Accepted: 07/13/2018] [Indexed: 01/02/2023] Open
Abstract
Objective To understand patient characteristics related to acceptability of returning individual research results via various modalities, focusing on electronic visits (e-visits). Patients and Methods Twelve hundred participants from the Mayo Clinic Biobank were selected using a stratified random sampling approach based on sex, age, and education level. Mailed surveys ascertained return of results preferences for 2 disease vignettes (cystic fibrosis and hereditary breast cancer) and a pharmacogenomics vignette. The study was conducted from October 1, 2013, through March 31, 2014. Results In all, 685 patients (57%) responded, and 60% reported liking e-visits, although the option of receiving results in an office visit was liked most frequently. Multivariable logistic models showed that the odds of liking the use of e-visits for returning results for cystic fibrosis and hereditary breast cancer were higher among those with higher education and better genetic knowledge and among those not living in proximity to the Mayo Clinic (Rochester, Minnesota). Level of genetic knowledge was not considerably associated with accepting e-visits, whereas education level remained important. For all vignettes, those who are divorced were less likely to accept e-visits. Conclusion Researchers are faced with a difficult challenge of returning results with a method that is both acceptable to recipients and logistically feasible. This study implies that the use of e-visits may be a viable option for return of results to stratify the chasm between in-person genetic counseling and online portal receipt of results.
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Affiliation(s)
- Janet E. Olson
- Department of Health Sciences Research, Division of Epidemiology, Rochester, MN
- Correspondence: Address to Janet E. Olson, PhD, Department of Health Sciences Research, Mayo Clinic, 200 First St SW, Rochester, MN 55905.
| | - Euijung Ryu
- Department of Health Sciences Research, Division of Biomedical Statistics and Informatics, Rochester, MN
| | - Kelly J. Lyke
- Department of Health Sciences Research, Division of Epidemiology, Rochester, MN
| | | | | | - Matthew A. Hathcock
- Department of Health Sciences Research, Division of Biomedical Statistics and Informatics, Rochester, MN
| | - Joshua T. Bublitz
- Department of Health Sciences Research, Division of Biomedical Statistics and Informatics, Rochester, MN
| | - Paul Y. Takahashi
- Department of Medicine, Division of Primary Care Internal Medicine, Rochester, MN
| | - James R. Cerhan
- Department of Health Sciences Research, Division of Epidemiology, Rochester, MN
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52
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Affiliation(s)
- Janet E Olson
- Department of Health Sciences Research, Division of Epidemiology, Mayo Clinic, Rochester, MN.
| | - Paul Y Takahashi
- Department of Medicine, Division of Community Internal Medicine, Mayo Clinic, Rochester, MN
| | - Jennifer M St Sauver
- Department of Health Sciences Research, Division of Epidemiology, Mayo Clinic, Rochester, MN
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53
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Ryu E, Olson JE, Juhn YJ, Hathcock MA, Wi CI, Cerhan JR, Yost KJ, Takahashi PY. Association between an individual housing-based socioeconomic index and inconsistent self-reporting of health conditions: a prospective cohort study in the Mayo Clinic Biobank. BMJ Open 2018; 8:e020054. [PMID: 29764878 PMCID: PMC5961601 DOI: 10.1136/bmjopen-2017-020054] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
OBJECTIVE Using surveys to collect self-reported information on health and disease is commonly used in clinical practice and epidemiological research. However, the inconsistency of self-reported information collected longitudinally in repeated surveys is not well investigated. We aimed to investigate whether a socioeconomic status based on current housing characteristics, HOUsing-based SocioEconomic Status (HOUSES) index linking current address information to real estate property data, is associated with inconsistent self-reporting. STUDY SETTING AND PARTICIPANTS We performed a prospective cohort study using the Mayo Clinic Biobank (MCB) participants who resided in Olmsted County, Minnesota, USA, at the time of enrolment between 2009 and 2013, and were invited for a 4-year follow-up survey (n=11 717). PRIMARY AND SECONDARY OUTCOME MEASURES Using repeated survey data collected at the baseline and 4 years later, the primary outcome was the inconsistency in survey results when reporting prevalent diseases, defined by reporting to have 'ever' been diagnosed with a given disease in the baseline survey but reported 'never' in the follow-up survey. Secondary outcome was the response rate for the 4-year follow-up survey. RESULTS Among the MCB participants invited for the 4-year follow-up survey, 8508/11 717 (73%) responded to the survey. Forty-three per cent had at least one inconsistent self-reported disease. Lower HOUSES was associated with higher inconsistency rates, and the association remained significant after pertinent characteristics such as age and perceived general health (OR=1.46; 95% CI 1.17 to 1.84 for the lowest compared with the highest HOUSES decile). HOUSES was also associated with lower response rate for the follow-up survey (56% vs 77% for the lowest vs the highest HOUSES decile). CONCLUSION This study demonstrates the importance of using the HOUSES index that reflects current SES when using self-reporting through repeated surveys, as the HOUSES index at baseline survey was inversely associated with inconsistent self-report and the response rate for the follow-up survey.
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Affiliation(s)
- Euijung Ryu
- Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota, USA
| | - Janet E Olson
- Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota, USA
| | - Young J Juhn
- Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Matthew A Hathcock
- Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota, USA
| | - Chung-Il Wi
- Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - James R Cerhan
- Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota, USA
| | - Kathleen J Yost
- Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota, USA
| | - Paul Y Takahashi
- Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
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54
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Thorsteinsdottir B, Hickson LJ, Ramar P, Reinalda M, Krueger NW, Crowson CS, Rule AD, Takahashi PY, Chaudhry R, Tulledge-Scheitel SM, Tilburt JC, Williams AW, Albright RC, Meier SK, Shah ND. High rates of cancer screening among dialysis patients seen in primary care a cohort study. Prev Med Rep 2018; 10:176-183. [PMID: 29868364 PMCID: PMC5984226 DOI: 10.1016/j.pmedr.2018.03.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Revised: 02/09/2018] [Accepted: 03/09/2018] [Indexed: 11/22/2022] Open
Abstract
Routine preventive cancer screening is not recommended for patients with end-stage renal disease (ESRD)1 due to their limited life expectancy. The current extent of cancer screening in this population is unknown. Primary care (PC) reminder systems or performance incentives may encourage indiscriminate cancer screening. We compared rates of cancer screening in patients with ESRD, with and without PC visits. This is a retrospective cohort study using United States Renal Data System (USRDS) billing data and electronic medical record data. Patients aged ≥18 years starting dialysis from 2001 to 2008, Midwest regional dialysis network were categorized with or without a PC visit (defined as an office visit in family practice, internal medicine, pediatrics, geriatrics or preventive medicine during the first two years of dialysis). Cancer screening was based on Current Procedural Terminology codes in USRDS. We identified 2512 incident dialysis patients (60% men, median age 65y). Cancer screening rates were more frequent among those seen in PC: 38% vs 19% (P = 0.0002), for breast; 18% vs 10% (P = 0.047) for cervical; 13% versus 8% (P = 0.024) for prostate; and 18% vs 9% (P = 0.0002) for colon cancer. Multivariable analyses found that those with PC were more likely to be screened after adjusting for age, sex, and comorbidities. In our practice, cancer screening rates among chronic dialysis patients are lower than those previously reported for our general population (64% for breast cancer). However, a sizeable proportion of our ESRD population does receive cancer screening, especially those still seen in primary care. Dialysis patients have relatively high rates of cancer screening. Patients seen in primary care were more likely to get breast and colon ca screening. Half of women over age 65 received breast cancer screening within two years.
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Affiliation(s)
- Bjorg Thorsteinsdottir
- Division of Primary Care Internal Medicine, Department of Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, USA.,Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, 200 First Street SW, Rochester, MN, USA
| | - LaTonya J Hickson
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, USA.,Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, 200 First Street SW, Rochester, MN, USA
| | - Priya Ramar
- Division of Health Care Policy & Research, Mayo Clinic, 200 First Street SW, Rochester, MN, USA.,Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, 200 First Street SW, Rochester, MN, USA
| | - Megan Reinalda
- Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic, 200 First Street SW, Rochester, MN, USA.,Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, 200 First Street SW, Rochester, MN, USA
| | - Nicholas W Krueger
- Division of Health Care Policy & Research, Mayo Clinic, 200 First Street SW, Rochester, MN, USA.,Carnrite Group, 10330-DD Lake Rd, Houston, TX 77070, USA
| | - Cynthia S Crowson
- Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic, 200 First Street SW, Rochester, MN, USA.,Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, 200 First Street SW, Rochester, MN, USA
| | - Andrew D Rule
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, USA.,Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, 200 First Street SW, Rochester, MN, USA
| | - Paul Y Takahashi
- Division of Primary Care Internal Medicine, Department of Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, USA
| | - Rajeev Chaudhry
- Division of Primary Care Internal Medicine, Department of Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, USA
| | - Sidna M Tulledge-Scheitel
- Division of Primary Care Internal Medicine, Department of Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, USA
| | - Jon C Tilburt
- Division of General Internal Medicine, Department of Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, USA
| | - Amy W Williams
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, USA
| | - Robert C Albright
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, USA
| | - Sarah K Meier
- Division of Health Care Policy & Research, Mayo Clinic, 200 First Street SW, Rochester, MN, USA
| | - Nilay D Shah
- Division of Health Care Policy & Research, Mayo Clinic, 200 First Street SW, Rochester, MN, USA.,Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, 200 First Street SW, Rochester, MN, USA
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Abstract
The population of older adults residing in assisted living facilities (ALF) in the United States is growing, yet health data about this population is relatively sparse. We aimed to compare health outcomes of ALF residents with those of age- and sex-matched community dwelling adults in a retrospective cohort study of 808 older adults. Linear regression analyses were conducted to describe the relationship between ALF residency and our outcomes of hospitalizations within 1 year of the index date (earliest recorded date in the ALF), 30-day rehospitalization following index hospitalization, emergency department (ED) visits, and mortality at 1 year. Hospitalizations were significantly greater for ALF residents than for controls. The odds of death for ALF residents were approximately twice that of controls. Falls and ED visits were also significantly greater for ALF residents. The ALF population requires targeted geriatric and primary care models if we are to effectively meet the needs of this growing population.
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Affiliation(s)
- Mairead M Bartley
- Division of General Internal Medicine, Mayo Clinic, Rochester, Minnesota
| | - Stephanie M Quigg
- Division of Primary Care Internal Medicine, Mayo Clinic, Rochester, Minnesota
| | - Anupam Chandra
- Division of Primary Care Internal Medicine, Mayo Clinic, Rochester, Minnesota
| | - Paul Y Takahashi
- Division of Primary Care Internal Medicine, Mayo Clinic, Rochester, Minnesota
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56
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Roelfsema F, Yang RJ, Takahashi PY, Erickson D, Bowers CY, Veldhuis JD. Effects of Toremifene, a Selective Estrogen Receptor Modulator, on Spontaneous and Stimulated GH Secretion, IGF-I, and IGF-Binding Proteins in Healthy Elderly Subjects. J Endocr Soc 2017; 2:154-165. [PMID: 29383334 PMCID: PMC5789038 DOI: 10.1210/js.2017-00457] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2017] [Accepted: 12/21/2017] [Indexed: 11/19/2022] Open
Abstract
Context: Estrogens amplify spontaneous and stimulated growth hormone (GH) secretion, whereas they diminish GH-dependent insulin-like growth factor (IGF)-I in a dose-dependent manner. Selective estrogen receptor modulators (SERMs), including tamoxifen and toremifene, are widely adjunctively used in breast and prostate cancer. Although some endocrine effects of tamoxifen are known, few data are available for toremifene. Objective: To explore sex-dependent effects of toremifene on spontaneous 10-hour overnight GH secretion, followed by GH-releasing hormone–ghrelin stimulation. Additionally, effects on IGF-I, its binding proteins, and sex hormone–binding globulin (SHBG) were quantified. Participants and Design: Twenty men and 20 women, within an allowable age range of 50 to 80 years, volunteered for this double-blind, placebo-controlled prospective crossover study. Ten-minute blood sampling was done for 10 hours overnight and then for 2 hours after combined GH-releasing hormone–ghrelin injection. Main Outcome Measures: Pulsatile GH and stimulated GH secretion, and fasting levels of IGF-I, IGF-binding protein (IGFBP)1, IGFBP3, and SHBG. Results: Toremifene did not enhance pulsatile or stimulated GH secretion, but decreased IGF-I by 20% in men and women. IGFBP3 was unchanged, whereas while IGFBP1 and SHBG increased in both sexes to a similar extent. Conclusions: The expected rise in spontaneous and stimulated GH secretion under the diminished negative feedback restraint of powered IGF-I favors a central inhibitory antiestrogenic effect of toremifene. Estrogenic effects of toremifene on the liver were present, as evidenced by increased IGFBP1 and SHBG levels. Men and women responded to this SERM comparably.
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Affiliation(s)
- Ferdinand Roelfsema
- Department of Internal Medicine, Section of Endocrinology and Metabolism, Leiden University Medical Center, 2333 ZA Leiden, Netherlands
| | - Rebecca J Yang
- Endocrine Research Unit, Mayo School of Graduate Medical Education, Center for Translational Science Activities, Mayo Clinic, Rochester, Minnesota 55905
| | - Paul Y Takahashi
- Department of Primary Care Internal Medicine, Mayo Clinic, Rochester, Minnesota 55905
| | - Dana Erickson
- Department of Endocrinology, Mayo Clinic, Rochester, Minnesota 55905
| | - Cyril Y Bowers
- Department of Internal Medicine, Tulane University Health Sciences Center, New Orleans, Louisiana 70112
| | - Johannes D Veldhuis
- Endocrine Research Unit, Mayo School of Graduate Medical Education, Center for Translational Science Activities, Mayo Clinic, Rochester, Minnesota 55905
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57
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Borkenhagen LS, McCoy RG, Havyer RD, Peterson SM, Naessens JM, Takahashi PY. Symptoms Reported by Frail Elderly Adults Independently Predict 30-Day Hospital Readmission or Emergency Department Care. J Am Geriatr Soc 2017; 66:321-326. [PMID: 29231962 DOI: 10.1111/jgs.15221] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To assess the degree to which self-reported symptoms predict unplanned readmission or emergency department (ED) care within 30 days of high-risk, elderly adults enrolled in a posthospitalization care transition program (CTP). DESIGN Retrospective cohort study. SETTING Posthospitalization CTP at Mayo Clinic, Rochester, Minnesota, from January 1, 2013, through March 3, 2015. PARTICIPANTS Frail, elderly adults (N = 230; mean age 83.5 ± 8.3, 46.5% male). MEASUREMENTS Charlson Comorbidity Index (CCI) and self-reported symptoms, measured using the Edmonton Symptom Assessment System (ESAS), were ascertained upon CTP enrollment. RESULTS Mean CCI was 3.9 ± 2.3. Of 51 participants returning to the hospital within 30 days of discharge, 13 had ED visits, and 38 were readmitted. Age, sex, and CCI were not significantly different between returning and nonreturning participants, but returning participants were significantly more likely to report shortness of breath (P = .004), anxiety (P = .02), depression (P = .02), and drowsiness (P = .01). Overall ESAS score was also a significant predictor of hospital return (P = .01). CONCLUSION Four self-reported symptoms and overall ESAS score, but not CCI, ascertained after hospital discharge were strong predictors of hospital return within 30 days. Including symptoms in risk stratification of high-risk elderly adults may help target interventions and reduce readmissions.
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Affiliation(s)
- Lynn S Borkenhagen
- Division of Primary Care Internal Medicine, Mayo Clinic, Rochester, Minnesota
| | - Rozalina G McCoy
- Division of Primary Care Internal Medicine, Mayo Clinic, Rochester, Minnesota.,Division of Health Care Policy & Research, Mayo Clinic, Rochester, Minnesota
| | - Rachel D Havyer
- Division of Primary Care Internal Medicine, Mayo Clinic, Rochester, Minnesota
| | - Stephanie M Peterson
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota
| | - James M Naessens
- Division of Health Care Policy & Research, Mayo Clinic, Rochester, Minnesota
| | - Paul Y Takahashi
- Division of Primary Care Internal Medicine, Mayo Clinic, Rochester, Minnesota
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58
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Hanson GJ, Borah BJ, Moriarty JP, Ransom JE, Naessens JM, Takahashi PY. Cost-Effectiveness of a Care Transitions Program in a Multimorbid Older Adult Cohort. J Am Geriatr Soc 2017; 66:297-301. [DOI: 10.1111/jgs.15203] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Gregory J. Hanson
- Division of Primary Care Internal Medicine; Mayo Clinic; Rochester Minnesota
| | - Bijan J. Borah
- Division of Health Care Policy and Research; Mayo Clinic; Rochester Minnesota
- Robert D. and Patricia E. Kern Center for Science of Health Care Delivery; Mayo Clinic; Rochester Minnesota
| | - James P. Moriarty
- Robert D. and Patricia E. Kern Center for Science of Health Care Delivery; Mayo Clinic; Rochester Minnesota
| | - Jeanine E. Ransom
- Division of Biomedical Statistics and Informatics; Mayo Clinic; Rochester Minnesota
| | - James M. Naessens
- Division of Health Care Policy and Research; Mayo Clinic; Rochester Minnesota
- Robert D. and Patricia E. Kern Center for Science of Health Care Delivery; Mayo Clinic; Rochester Minnesota
| | - Paul Y. Takahashi
- Division of Primary Care Internal Medicine; Mayo Clinic; Rochester Minnesota
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59
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Shapiro JS, McCoy RG, Takahashi PY, Thorsteinsdottir B, Peterson SM, Naessens JM, Rahman PA, Chandra A, Hanson GJ, Havyer RD, Chen CY, Borkenhagen LS. Medication Use Leading to Hospital Readmission in Frail Elders. J Nurse Pract 2017. [DOI: 10.1016/j.nurpra.2017.08.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Thorsteinsdottir B, Ramar P, Hickson LJ, Reinalda MS, Albright RC, Tilburt JC, Williams AW, Takahashi PY, Jeffery MM, Shah ND. Care of the dialysis patient: Primary provider involvement and resource utilization patterns - a cohort study. BMC Nephrol 2017; 18:322. [PMID: 29070040 PMCID: PMC5657054 DOI: 10.1186/s12882-017-0728-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2016] [Accepted: 09/29/2017] [Indexed: 01/21/2023] Open
Abstract
Background Efficient and safe delivery of care to dialysis patients is essential. Concerns have been raised regarding the ability of accountable care organizations to adequately serve this high-risk population. Little is known about primary care involvement in the care of dialysis patients. This study sought to describe the extent of primary care provider (PCP) involvement in the care of hemodialysis patients and the outcomes associated with that involvement. Methods In a retrospective cohort study, patients accessing a Midwestern dialysis network from 2001 to 2010 linked to United States Renal Database System and with >90 days follow up were identified (n = 2985). Outpatient visits were identified using Current Procedural Terminology (CPT)-4 codes, provider specialty, and grouped into quartiles-based on proportion of PCP visits per person-year (ppy). Top and bottom quartiles represented patients with high primary care (HPC) or low primary care (LPC), respectively. Patient characteristics and health care utilization were measured and compared across patient groups. Results Dialysis patients had an overall average of 4.5 PCP visits ppy, ranging from 0.6 in the LPC group to 6.9 in the HPC group. HPC patients were more likely female (43.4% vs. 35.3%), older (64.0 yrs. vs. 60.0 yrs), and with more comorbidities (Charlson 7.0 vs 6.0). HPC patients had higher utilization (hospitalizations 2.2 vs. 1.8 ppy; emergency department visits 1.6 vs 1.2 ppy) and worse survival (3.9 vs 4.3 yrs) and transplant rates (16.3 vs. 31.5). Conclusions PCPs are significantly involved in the care of hemodialysis patients. Patients with HPC are older, sicker, and utilize more resources than those managed primarily by nephrologists. After adjusting for confounders, there is no difference in outcomes between the groups. Further studies are needed to better understand whether there is causal impact of primary care involvement on patient survival. Electronic supplementary material The online version of this article (10.1186/s12882-017-0728-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Bjorg Thorsteinsdottir
- Division of Primary Care Internal Medicine, Department of Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA. .,Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, 55905, USA. .,Biomedical Ethics Research Program, Mayo Clinic, Rochester, MN, 55905, USA.
| | - Priya Ramar
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, 55905, USA
| | - LaTonya J Hickson
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, 55905, USA.,Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN, 55905, USA
| | - Megan S Reinalda
- Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic, Rochester, MN, 55905, USA
| | - Robert C Albright
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN, 55905, USA
| | - Jon C Tilburt
- Biomedical Ethics Research Program, Mayo Clinic, Rochester, MN, 55905, USA.,Division of General Internal Medicine, Department of Medicine, Mayo Clinic, Rochester, MN, 55905, USA
| | - Amy W Williams
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN, 55905, USA
| | - Paul Y Takahashi
- Division of Primary Care Internal Medicine, Department of Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Molly M Jeffery
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, 55905, USA
| | - Nilay D Shah
- Division of Health Care Policy and Research, Department of Health Sciences Research, Mayo Clinic, Rochester, MN, 55905, USA
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61
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Joven MH, Croghan IT, Quigg SM, Ebbert JO, Takahashi PY. Predictors of sedentary status in overweight and obese patients with multiple chronic conditions: a cohort study. Pragmat Obs Res 2017; 8:203-209. [PMID: 29042828 PMCID: PMC5633315 DOI: 10.2147/por.s139097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Purpose Walking may improve health in obese patients with multimorbidity. We aimed to identify predictors associated with achieving <5000 steps per day after 4 months. Patients and methods We conducted a cohort study of 125 adult patients with a body mass index >25 kg/m2 and ≥7 comorbidities. We evaluated potential predictors for <5000 steps per day using logistic regression and adjusting for age >65 years and sex. Results The mean (range) age was 63.6 (20.3–89.8) years. Daily step counts <5000 at baseline showed the highest risk of <5000 daily steps at 4 months (odds ratio [OR] 31.82, 95% confidence interval [CI]: 12.14–95.50). Other significant characteristics were physical quality of life (OR 6.21, 95% CI: 2.32–18.54), gait speed <1 m/s (OR 2.57, 95% CI: 1.18–5.71), age ≥65 years (OR 2.21, 95% CI: 1.05–4.77), waist circumference ≥102 cm (OR 2.48, 95% CI: 1.05–6.06), and body mass index ≥30 kg/m2 (OR 2.69, 95% CI: 1.20–6.26). Conclusion New models to increase walking may be required for higher-risk patients.
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Affiliation(s)
- Mark H Joven
- Division of Primary Care Internal Medicine, Mayo Clinic, Rochester, Minnesota, MN, USA
| | - Ivana T Croghan
- Division of Primary Care Internal Medicine, Mayo Clinic, Rochester, Minnesota, MN, USA
| | - Stephanie M Quigg
- Division of Primary Care Internal Medicine, Mayo Clinic, Rochester, Minnesota, MN, USA
| | - Jon O Ebbert
- Division of Primary Care Internal Medicine, Mayo Clinic, Rochester, Minnesota, MN, USA
| | - Paul Y Takahashi
- Division of Primary Care Internal Medicine, Mayo Clinic, Rochester, Minnesota, MN, USA
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Costello M, Bartley MM, Joven MH, Takahashi PY, Tung EE. A Comparison of Emergency Medical Service Utilization in Assisted Living and Long-Term Care Facilities. ACTA ACUST UNITED AC 2017. [DOI: 10.25270/altc.2017.10.00002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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63
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St Sauver JL, Olson JE, Roger VL, Nicholson WT, Black JL, Takahashi PY, Caraballo PJ, Bell EJ, Jacobson DJ, Larson NB, Bielinski SJ. CYP2D6 phenotypes are associated with adverse outcomes related to opioid medications. Pharmgenomics Pers Med 2017. [PMID: 28769582 DOI: 10.2147/pgpm.s136341.] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Variation in the CYP2D6 gene may affect response to opioids in both poor and ultrarapid metabolizers, but data demonstrating such associations have been mixed, and the impact of variants on toxicity-related symptoms (e.g., nausea) is unclear. Therefore, we examined the association between CYP2D6 phenotype and poor pain control or other adverse symptoms related to the use of opioids in a sample of primary care patients. MATERIALS AND METHODS We identified all patients in the Mayo Clinic RIGHT Protocol who were prescribed an opioid medication between July 01, 2013 and June 30, 2015, and categorized patients into three phenotypes: poor, intermediate to extensive, or ultrarapid CYP2D6 metabolizers. We reviewed the electronic health record of these patients for indications of poor pain control or adverse symptoms related to medication use. Associations between phenotype and outcomes were assessed using Chi-square tests and logistic regression. RESULTS Overall, 257 (25% of RIGHT Protocol participants) patients received at least one opioid prescription; of these, 40 (15%) were poor metabolizers, 146 (57%) were intermediate to extensive metabolizers, and 71 (28%) were ultrarapid metabolizers. We removed patients that were prescribed a CYP2D6 inhibitor medication (n=38). After adjusting for age and sex, patients with a poor or ultrarapid phenotype were 2.7 times more likely to experience either poor pain control or an adverse symptom related to the prescription compared to patients with an intermediate to extensive phenotype (odds ratio: 2.68; 95% CI: 1.39, 5.17; p=0.003). CONCLUSION Our results suggest that >30% of patients with a poor or ultrarapid CYP2D6 phenotype may experience an adverse outcome after being prescribed codeine, tramadol, oxycodone, or hydrocodone. These medications are frequently prescribed for pain relief, and ~39% of the US population is expected to carry one of these phenotypes, suggesting that the population-level impact of these gene-drug interactions could be substantial.
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Affiliation(s)
- Jennifer L St Sauver
- Department of Health Sciences Research.,Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester
| | - Janet E Olson
- Department of Health Sciences Research.,Center for Individualized Medicine
| | - Veronique L Roger
- Department of Health Sciences Research.,Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester.,Department of Cardiovascular Diseases
| | | | - John L Black
- Center for Individualized Medicine.,Department of Laboratory Medicine and Pathology
| | - Paul Y Takahashi
- Department of Primary Care Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Pedro J Caraballo
- Department of Primary Care Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Elizabeth J Bell
- Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester
| | - Debra J Jacobson
- Department of Health Sciences Research.,Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester
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St Sauver JL, Olson JE, Roger VL, Nicholson WT, Black JL, Takahashi PY, Caraballo PJ, Bell EJ, Jacobson DJ, Larson NB, Bielinski SJ. CYP2D6 phenotypes are associated with adverse outcomes related to opioid medications. Pharmgenomics Pers Med 2017; 10:217-227. [PMID: 28769582 PMCID: PMC5533497 DOI: 10.2147/pgpm.s136341] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Background Variation in the CYP2D6 gene may affect response to opioids in both poor and ultrarapid metabolizers, but data demonstrating such associations have been mixed, and the impact of variants on toxicity-related symptoms (e.g., nausea) is unclear. Therefore, we examined the association between CYP2D6 phenotype and poor pain control or other adverse symptoms related to the use of opioids in a sample of primary care patients. Materials and methods We identified all patients in the Mayo Clinic RIGHT Protocol who were prescribed an opioid medication between July 01, 2013 and June 30, 2015, and categorized patients into three phenotypes: poor, intermediate to extensive, or ultrarapid CYP2D6 metabolizers. We reviewed the electronic health record of these patients for indications of poor pain control or adverse symptoms related to medication use. Associations between phenotype and outcomes were assessed using Chi-square tests and logistic regression. Results Overall, 257 (25% of RIGHT Protocol participants) patients received at least one opioid prescription; of these, 40 (15%) were poor metabolizers, 146 (57%) were intermediate to extensive metabolizers, and 71 (28%) were ultrarapid metabolizers. We removed patients that were prescribed a CYP2D6 inhibitor medication (n=38). After adjusting for age and sex, patients with a poor or ultrarapid phenotype were 2.7 times more likely to experience either poor pain control or an adverse symptom related to the prescription compared to patients with an intermediate to extensive phenotype (odds ratio: 2.68; 95% CI: 1.39, 5.17; p=0.003). Conclusion Our results suggest that >30% of patients with a poor or ultrarapid CYP2D6 phenotype may experience an adverse outcome after being prescribed codeine, tramadol, oxycodone, or hydrocodone. These medications are frequently prescribed for pain relief, and ~39% of the US population is expected to carry one of these phenotypes, suggesting that the population-level impact of these gene–drug interactions could be substantial.
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Affiliation(s)
- Jennifer L St Sauver
- Department of Health Sciences Research.,Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester
| | - Janet E Olson
- Department of Health Sciences Research.,Center for Individualized Medicine
| | - Veronique L Roger
- Department of Health Sciences Research.,Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester.,Department of Cardiovascular Diseases
| | | | - John L Black
- Center for Individualized Medicine.,Department of Laboratory Medicine and Pathology
| | - Paul Y Takahashi
- Department of Primary Care Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Pedro J Caraballo
- Department of Primary Care Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Elizabeth J Bell
- Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester
| | - Debra J Jacobson
- Department of Health Sciences Research.,Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester
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Roelfsema F, Aoun P, Takahashi PY, Erickson D, Yang R, Veldhuis JD. Regulation of Pulsatile and Entropic ACTH Secretion Under Fixed Exogenous Secretagogue Clamps. J Clin Endocrinol Metab 2017; 102:2611-2619. [PMID: 28368521 PMCID: PMC5505204 DOI: 10.1210/jc.2017-00115] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2017] [Accepted: 03/22/2017] [Indexed: 11/19/2022]
Abstract
BACKGROUND Adrenocorticotropic hormone (ACTH) secretion is controlled by unobservable hypothalamic corticotropin-releasing hormone (CRH) and arginine vasopressin (AVP) pulses. Clamping exogenous CRH or AVP input could allow indirect quantification of the impact of the endogenous heterotypic hormone. METHODS We conducted a randomized, double-blind, placebo-controlled, crossover study in 28 healthy adults (16 men). Volunteers underwent a sex-steroid clamp and a cortisol clamp. ACTH was measured over 10 hours by 10-minute sampling during each of four randomized intravenous (IV) secretagogue clamps (i.e., continuous IV CRH, AVP, both peptides, or saline). Desensitization was tested by bolus injection of the noninfused peptide. RESULTS Mean ± standard error of the mean 10-hour ACTH concentrations (ng/L) in the sex-combined analysis were: saline, 32 ± 4.6; AVP, 29 ± 4.6; CRH, 67 ± 6.2; and CRH-AVP, 67 ± 8.8 (any CRH vs AVP or saline, P < 0.0001). CRH and AVP increased approximate entropy (relative randomness) of ACTH release (P < 0.0001). Bolus AVP injection after CRH infusion yielded a 2.5-hour ACTH concentration of 46 ± 4.3, exceeding that seen after bolus CRH or saline injection (26 ± 3.3 and 24 ± 3.6, respectively; P = 0.002 and 0.001). Sex hormone clamps did not influence ACTH levels. CONCLUSIONS A CRH, but not AVP, clamp yields sustained pulsatile ACTH secretion with high ACTH secretory-burst mass and randomness. After 10-hour CRH infusion, bolus AVP but not CRH, evoked marked ACTH release, likely caused by heterotypic sensitization of corticotropes by CRH. Similar interactions might underlie chronic stress states.
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Affiliation(s)
- Ferdinand Roelfsema
- Department of Endocrinology and Metabolism, Leiden University Medical Center, 2333ZA Leiden, The Netherlands
| | - Paul Aoun
- Endocrine Research Unit, Mayo School of Graduate Medical Education, Center for Translational Science Activities, Mayo Clinic, Rochester, Minnesota 55902
| | - Paul Y. Takahashi
- Primary Care Internal Medicine, Mayo Clinic, Rochester, Minnesota 55902
| | - Dana Erickson
- Endocrine Research Unit, Mayo School of Graduate Medical Education, Center for Translational Science Activities, Mayo Clinic, Rochester, Minnesota 55902
| | - Rebecca Yang
- Endocrine Research Unit, Mayo School of Graduate Medical Education, Center for Translational Science Activities, Mayo Clinic, Rochester, Minnesota 55902
| | - Johannes D. Veldhuis
- Endocrine Research Unit, Mayo School of Graduate Medical Education, Center for Translational Science Activities, Mayo Clinic, Rochester, Minnesota 55902
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Roelfsema F, Yang RJ, Olson TP, Joyner MJ, Takahashi PY, Veldhuis JD. Enhanced Coupling Within Gonadotropic and Adrenocorticotropic Axes by Moderate Exercise in Healthy Men. J Clin Endocrinol Metab 2017; 102:2482-2490. [PMID: 28453740 PMCID: PMC5505190 DOI: 10.1210/jc.2017-00036] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2017] [Accepted: 04/17/2017] [Indexed: 11/19/2022]
Abstract
CONTEXT Exercise elicits incompletely defined adaptations of metabolic and endocrine milieu, including the gonadotropic and corticotropic axes. OBJECTIVE To quantify the impact of acute exercise on coordinate luteinizing hormone (LH) and testosterone (T) and adrenocorticotropic hormone (ACTH) and cortisol secretion in healthy men in relation to age. PARTICIPANTS AND DESIGN Prospectively randomized, within-subject crossover study in 23 men aged 19 to 77 years old. Subjects underwent rest and 30 minutes of mixed exercise at 65% of maximal aerobic capacity with 10-minute blood sampling between 7:00 am and 1:00 pm, 2 weeks apart. MAIN OUTCOME MEASURES Incremental changes in LH, T, ACTH, and cortisol concentrations, the feedforward and feedback strength between exercise and rest, quantified by approximate entropy (ApEn), and bihormonal synchrony, quantitated by cross-ApEn. RESULTS Mean hourly exercise-minus-rest LH and ACTH increments increased from -0.055 ± 0.187 to 0.755 ± 0.245 IU/L (P = 0.003) and from 2.9 ± 2.2 to 71.2 ± 16.1 ng/L (P < 0.0001), respectively, during exercise. T and cortisol increments increased concurrently from -9.6 ± 16.7 to 47.6 ± 17.1 ng/dL (P < 0.0001) and 0.45 ± 0.76 to 7.27 ± 0.64 µg/dL (P < 0.0001), respectively. During exercise, feedforward and feedback LH-T and ACTH-cortisol cross-ApEn decreased markedly quantifying enhanced hormonal coupling. CONCLUSIONS Acute moderate mixed exercise in healthy men rapidly enhances feedforward LH-T and ACTH-cortisol coordination and reciprocal feedback within the gonadotropic and corticotropic axes. In principle, enhancement of both LH-T and ACTH-cortisol secretory synchrony by exercise could reflect augmented coupling between brain-testicular and brain-adrenal neural outflow.
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Affiliation(s)
- Ferdinand Roelfsema
- Department of Endocrinology and Metabolism, Leiden University Medical Center, 2333ZA Leiden, The Netherlands
| | - Rebecca J. Yang
- Endocrine Research Unit, Mayo School of Graduate Medical Education, Center for Translational Science Activities, Mayo Clinic, Rochester, Minnesota 55905
| | - Thomas P. Olson
- Department of Cardiovascular Research, Mayo Clinic, Rochester, Minnesota 55905
| | - Michael J. Joyner
- Department of Anesthesia Research, Department of Physiology and Biomedical Engineering, and Department of Molecular Pharmacology and Experimental Therapeutics, Mayo Clinic, Rochester, Minnesota 55905
| | - Paul Y. Takahashi
- Department of Primary Care Internal Medicine, Mayo Clinic, Rochester, Minnesota 55905
| | - Johannes D. Veldhuis
- Endocrine Research Unit, Mayo School of Graduate Medical Education, Center for Translational Science Activities, Mayo Clinic, Rochester, Minnesota 55905
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Ryu E, Juhn YJ, Wheeler PH, Hathcock MA, Wi CI, Olson JE, Cerhan JR, Takahashi PY. Individual housing-based socioeconomic status predicts risk of accidental falls among adults. Ann Epidemiol 2017. [PMID: 28648550 DOI: 10.1016/j.annepidem.2017.05.019] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
PURPOSE Accidental falls are a major public health concern among people of all ages. Little is known about whether an individual-level housing-based socioeconomic status measure is associated with the risk of accidental falls. METHODS Among 12,286 Mayo Clinic Biobank participants residing in Olmsted County, Minnesota, subjects who experienced accidental falls between the biobank enrollment and September 2014 were identified using ICD-9 codes evaluated at emergency departments. HOUSES (HOUsing-based Index of SocioEconomic Status), a socioeconomic status measure based on individual housing features, was also calculated. Cox regression models were utilized to assess the association of the HOUSES (in quartiles) with accidental fall risk. RESULTS Seven hundred eleven (5.8%) participants had at least one emergency room visit due to an accidental fall during the study period. Subjects with higher HOUSES were less likely to experience falls in a dose-response manner (hazard ratio: 0.58; 95% confidence interval: 0.44-0.76 for comparing the highest to the lowest quartile). In addition, the HOUSES was positively associated with better health behaviors, social support, and functional status. CONCLUSIONS The HOUSES is inversely associated with accidental fall risk requiring emergency care in a dose-response manner. The HOUSES may capture falls-related risk factors through housing features and socioeconomic status-related psychosocial factors.
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Affiliation(s)
- Euijung Ryu
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN
| | - Young J Juhn
- Asthma Epidemiology Research Unit and Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN
| | - Philip H Wheeler
- Asthma Epidemiology Research Unit and Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN
| | | | - Chung-Il Wi
- Asthma Epidemiology Research Unit and Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN
| | - Janet E Olson
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN
| | - James R Cerhan
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN
| | - Paul Y Takahashi
- Division of Primary Care Internal Medicine, Mayo Clinic, Rochester, MN.
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Takahashi PY, Ryu E, Pathak J, Jenkins GD, Batzler A, Hathcock MA, Black JL, Olson JE, Cerhan JR, Bielinski SJ. Increased risk of hospitalization for ultrarapid metabolizers of cytochrome P450 2D6. Pharmgenomics Pers Med 2017; 10:39-47. [PMID: 28243137 PMCID: PMC5317339 DOI: 10.2147/pgpm.s114211] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
Background Cytochrome P450 2D6 (CYP2D6) is responsible for the metabolism of clinically used drugs and other environmental exposures, but it is unclear whether the CYP2D6 phenotype is associated with adverse health outcomes. The aim was to determine the association of CYP2D6 phenotype with the risk of hospitalization or an emergency department (ED) visit among a group of primary care patients. Methods In this study, 929 adult patients underwent CYP2D6 testing. The primary outcome was risk of hospitalization or an ED visit from January 2005 through September 2014. CYP2D6 genotypes were interpreted as 1 of 7 clinical phenotypes, from ultrarapid to poor metabolizer, and patients with the extensive metabolizer phenotype were used as the reference group. The hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated for finding the association of CYP2D6 phenotypes with the risk of hospitalization or an ED visit by using Cox proportional hazard models and adjusting for age and sex. Results The median age was 49 years (interquartile range, 46–52 years); 74% of patients had 3 or fewer chronic conditions, 285 had at least 1 hospitalization, and 496 had at least 1 ED visit. The risk of hospitalization was higher among patients who were ultrarapid metabolizers compared to extensive metabolizers (47% vs 30%; HR, 1.69; 95% CI, 1.11–2.57), as was the risk of an ED visit (62% vs 49%; HR, 1.50; 95% CI, 1.05–2.14). For poor metabolizers compared to extensive metabolizers, there was no difference in the risk of hospitalization (HR, 0.95; 95% CI, 0.58–1.56), but there was an increase in the risk of an ED visit (HR, 1.38; 95% CI, 0.96–1.98) (the difference was not statistically significant). Conclusion We found an increased risk of hospitalization or an ED visit among ultrarapid compared to extensive CYP2D6 metabolizers. Further research identifying the mechanisms of the association and ultimate clinical utility is warranted.
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Affiliation(s)
- Paul Y Takahashi
- Division of Primary Care Internal Medicine, Department of Medicine
| | | | | | | | | | | | - John Logan Black
- Division of Clinical Biochemistry and Immunology, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
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St Sauver JL, Bielinski SJ, Olson JE, Bell EJ, Mc Gree ME, Jacobson DJ, McCormick JB, Caraballo PJ, Takahashi PY, Roger VL, Rohrer Vitek CR. Integrating Pharmacogenomics into Clinical Practice: Promise vs Reality. Am J Med 2016; 129:1093-1099.e1. [PMID: 27155109 PMCID: PMC5600492 DOI: 10.1016/j.amjmed.2016.04.009] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2016] [Revised: 03/30/2016] [Accepted: 04/05/2016] [Indexed: 01/10/2023]
Abstract
BACKGROUND Limited information is available regarding primary care clinicians' response to pharmacogenomic clinical decision support (PGx-CDS) alerts integrated in the electronic health record. METHODS In February 2015, 159 clinicians in the Mayo Clinic primary care practice were sent e-mail surveys to understand their perspectives on the implementation and use of pharmacogenomic testing in their clinical practice. Surveys assessed how the clinicians felt about pharmacogenomics and whether they thought electronic PGx-CDS alerts were useful. Information was abstracted on the number of CDS alerts the clinicians received between October 2013 and the date their survey was returned. CDS alerts were grouped into 2 categories: the alert recommended caution using the prescription, or the alert recommended an alternate prescription. Finally, data were abstracted regarding whether the clinician changed their prescription in response to the alert recommendation. RESULTS The survey response rate was 57% (n = 90). Overall, 52% of the clinicians did not expect to use or did not know whether they would use pharmacogenomic information in their future prescribing practices. Additionally, 53% of the clinicians felt that the alerts were confusing, irritating, frustrating, or that it was difficult to find additional information. Finally, only 30% of the clinicians that received a CDS alert changed their prescription to an alternative medication. CONCLUSIONS Our results suggest a lack of clinician comfort with integration of pharmacogenomic data into primary care. Further efforts to refine PGx-CDS alerts to make them as useful and user-friendly as possible are needed to improve clinician satisfaction with these new tools.
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Affiliation(s)
- Jennifer L St Sauver
- Division of Epidemiology, Department of Health Sciences Research, Mayo Clinic, Rochester, Minn.
| | - Suzette J Bielinski
- Division of Epidemiology, Department of Health Sciences Research, Mayo Clinic, Rochester, Minn
| | - Janet E Olson
- Division of Epidemiology, Department of Health Sciences Research, Mayo Clinic, Rochester, Minn
| | - Elizabeth J Bell
- Division of Epidemiology, Department of Health Sciences Research, Mayo Clinic, Rochester, Minn
| | - Michaela E Mc Gree
- Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic, Rochester, Minn
| | - Debra J Jacobson
- Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic, Rochester, Minn
| | - Jennifer B McCormick
- Division of Health Care Policy and Research, Department of Health Sciences Research, Mayo Clinic, Rochester, Minn
| | - Pedro J Caraballo
- Department of General Internal Medicine, Mayo Clinic, Rochester, Minn
| | - Paul Y Takahashi
- Department of Primary Care Internal Medicine, Mayo Clinic, Rochester, Minn
| | - Veronique L Roger
- Division of Cardiovascular Diseases, Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minn
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Takahashi PY, Quigg SM, Croghan IT, Schroeder DR, Ebbert JO. Effect of pedometer use and goal setting on walking and functional status in overweight adults with multimorbidity: a crossover clinical trial. Clin Interv Aging 2016; 11:1099-106. [PMID: 27621602 PMCID: PMC5012619 DOI: 10.2147/cia.s107626] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Walking can improve functional status, and a pedometer and goal setting can increase walking and, potentially, gait speed. The efficacy of pedometer use and goal setting for increasing step counts among overweight and obese adults with multiple comorbid conditions has not been evaluated. METHODS We recruited and randomly assigned obese or overweight adults with multimorbidity to immediate pedometer use with goal setting or delayed pedometer use, using a crossover design. The primary outcome of interest was step count, with secondary outcomes of gait speed and grip strength, with comparison between the intervention and delayed pedometer groups. RESULTS Mean (standard deviation [SD]) age of the 130 participants was 63.4 (15.0) years. At 2 months, mean (SD) steps for the immediate pedometer use group (n=64) was 5,337 (3,096), compared with 4,446 (2,422) steps in the delayed pedometer group (n=66) (P=0.08). Within-group step count increased nonsignificantly, by 179 steps in the immediate pedometer group and 212 steps in the delayed pedometer group after 2 months of intervention, with no significant difference between the groups. Gait speed significantly increased by 0.08 m/s (P<0.05) and grip strength significantly increased by 1.6 kg (P<0.05) in the immediate pedometer group. CONCLUSION Pedometer use and goal setting did not significantly increase step count among overweight and obese adults with multimorbidity. The absolute step count was lower than many reported averages. Gait speed and grip strength increased with immediate pedometer use. The use of pedometers and goal setting may have an attenuated response in this population.
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Affiliation(s)
| | | | | | - Darrell R Schroeder
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, USA
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Sterner RM, Takahashi PY, Yu Ballard AC. Active Vaccines for Alzheimer Disease Treatment. J Am Med Dir Assoc 2016; 17:862.e11-5. [PMID: 27461865 DOI: 10.1016/j.jamda.2016.06.009] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2016] [Revised: 06/07/2016] [Accepted: 06/08/2016] [Indexed: 01/03/2023]
Abstract
INTRODUCTION Vaccination against peptides specific to Alzheimer disease may generate an immune response that could help inhibit disease and symptom progression. METHODS PubMed and Scopus were searched for clinical trial articles, review articles, and preclinical studies relevant to the field of active Alzheimer disease vaccines and raw searches yielded articles ranging from 2016 to 1973. ClinicalTrials.gov was searched for active Alzheimer disease vaccine trials. Manual research and cross-referencing from reviews and original articles was performed. RESULTS First generation Aβ42 phase 2a trial in patients with mild to moderate Alzheimer disease resulted in cases of meningoencephalitis in 6% of patients, so next generation vaccines are working to target more specific epitopes to induce a more controlled immune response. Difficulty in developing these vaccines resides in striking a balance between providing a vaccine that induces enough of an immune response to actually clear protein sustainably but not so much of a response that results in excess immune activation and possibly adverse effects such as meningoencephalitis. CONCLUSIONS Although much work still needs to be done in the field to make this a practical possibility, the enticing allure of being able to treat or even prevent the extraordinarily impactful disease that is Alzheimer disease makes the idea of active vaccination for Alzheimer disease very appealing and something worth striving toward.
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Takahashi PY, Heien HC, Sangaralingham LR, Shah ND, Naessens JM. Enhanced risk prediction model for emergency department use and hospitalizations in patients in a primary care medical home. Am J Manag Care 2016; 22:475-483. [PMID: 27442203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
OBJECTIVES With the advent of healthcare payment reform, identifying high-risk populations has become more important to providers. Existing risk-prediction models often focus on chronic conditions. This study sought to better understand other factors to improve identification of the highest risk population. STUDY DESIGN A retrospective cohort study of a paneled primary care population utilizing 2010 data to calibrate a risk prediction model of hospital and emergency department (ED) use in 2011. METHODS Data were randomly split into development and validation data sets. We compared the enhanced model containing the additional risk predictors with the Minnesota medical tiering model. The study was conducted in the primary care practice of an integrated delivery system at an academic medical center in Rochester, Minnesota. The study focus was primary care medical home patients in 2010 and 2011 (n = 84,752), with the primary outcome of subsequent hospitalization or ED visit. A total of 42,384 individuals derived the enhanced risk-prediction model and 42,368 individuals validated the model. Predictors included Adjusted Clinical Groups-based Minnesota medical tiering, patient demographics, insurance status, and prior year healthcare utilization. Additional variables included specific mental and medical conditions, use of high-risk medications, and body mass index. RESULTS The area under the curve in the enhanced model was 0.705 (95% CI, 0.698-0.712) compared with 0.662 (95% CI, 0.656-0.669) in the Minnesota medical tiering-only model. New high-risk patients in the enhanced model were more likely to have lack of health insurance, presence of Medicaid, diagnosed depression, and prior ED utilization. CONCLUSIONS An enhanced model including additional healthcare-related factors improved the prediction of risk of hospitalization or ED visit.
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Haag JD, Davis AZ, Hoel RW, Armon JJ, Odell LJ, Dierkhising RA, Takahashi PY. Impact of Pharmacist-Provided Medication Therapy Management on Healthcare Quality and Utilization in Recently Discharged Elderly Patients. Am Health Drug Benefits 2016; 9:259-268. [PMID: 27625743 PMCID: PMC5007055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 09/16/2015] [Accepted: 05/10/2016] [Indexed: 06/06/2023]
Abstract
BACKGROUND The optimization of medication use during care transitions represents an opportunity to improve overall health-related outcomes. The utilization of clinical pharmacists during care transitions has demonstrated benefit, although the optimal method of integration during the care transition process remains unclear. OBJECTIVE To evaluate the impact of pharmacist-provided telephonic medication therapy management (MTM) on care quality in a care transitions program (CTP) for high-risk older adults. METHODS This prospective, randomized, controlled study was conducted from December 8, 2011, through October 25, 2012, in a primary care work group at a tertiary care academic medical center in the midwestern United States. High-risk elderly (aged ≥60 years) patients were randomized to a pharmacist-provided MTM program via telephone or to usual care within an existing outpatient CTP. The primary outcome was the quality of medication prescribing and utilization based on the Screening Tool to Alert Doctors to the Right Treatment (START) and the Screening Tool of Older Persons' Prescriptions (STOPP) scores. The secondary outcomes were medication utilization using a modified version of the Medication Appropriateness Index, hospital resource utilization within 30 days of discharge, and drug therapy problems. RESULTS Of 222 eligible high-risk patients, 25 were included in the study and were randomized to the pharmacist MTM intervention (N = 13) or to usual care (N = 12). No significant differences were found between the 2 groups in medications meeting the STOPP or START criteria. At 30-day follow-up, no significant differences were found between the 2 cohorts in medication utilization quality indicators or in hospital utilization. At 30-day follow-up, 3 (13.6%) patients had an emergency department visit or a hospital readmission since discharge. In all, 22 patients completed the study. Medication underuse was common, with 20 START criteria absent medications evident for all 25 patients at baseline, representing 15 (60%) patients with ≥1 missing medications. Overall, 55 drug therapy problems were identified at baseline, 24 (43.6%) of which remained unresolved at 30-day follow-up. CONCLUSION The use of a pharmacist-provided MTM program did not achieve a significant difference compared with usual care in an existing CTP; however, the findings demonstrated frequent utilization of inappropriate medications as well as medication underuse, and many drug therapy problems remained unresolved. The small size of the study may have limited the ability to detect a difference between the intervention and usual care groups.
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Affiliation(s)
- Jordan D Haag
- Clinical Pharmacist, Department of Pharmacy, Mayo Clinic in Rochester, MN
| | - Amanda Z Davis
- Clinical Pharmacist, Department of Pharmacy, Mayo Clinic in Rochester, MN
| | - Robert W Hoel
- Clinical Pharmacist, Department of Pharmacy, Mayo Clinic in Rochester, MN
| | - Jeffrey J Armon
- Clinical Pharmacist, Department of Pharmacy, Mayo Clinic in Rochester, MN
| | - Laura J Odell
- Clinical Pharmacist, Department of Pharmacy, Mayo Clinic in Rochester, MN
| | - Ross A Dierkhising
- Statistician, Division of Biomedical Statistics and Informatics, Mayo Clinic in Rochester, MN
| | - Paul Y Takahashi
- Consultant, Division of Primary Care Internal Medicine, Mayo Clinic in Rochester, MN
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Biehl M, Takahashi PY, Cha SS, Chaudhry R, Gajic O, Thorsteinsdottir B. Prediction of critical illness in elderly outpatients using elder risk assessment: a population-based study. Clin Interv Aging 2016; 11:829-34. [PMID: 27382266 PMCID: PMC4920232 DOI: 10.2147/cia.s99419] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Rationale Identifying patients at high risk of critical illness is necessary for the development and testing of strategies to prevent critical illness. The aim of this study was to determine the relationship between high elder risk assessment (ERA) score and critical illness requiring intensive care and to see if the ERA can be used as a prediction tool to identify elderly patients at the primary care visit who are at high risk of critical illness. Methods A population-based historical cohort study was conducted in elderly patients (age >65 years) identified at the time of primary care visit in Rochester, MN, USA. Predictors including age, previous hospital days, and comorbid health conditions were identified from routine administrative data available in the electronic medical record. The main outcome was critical illness, defined as sepsis, need for mechanical ventilation, or death within 2 years of initial visit. Patients with an ERA score of 16 were considered to be at high risk. The discrimination of the ERA score was assessed using area under the receiver operating characteristic curve. Results Of the 13,457 eligible patients, 9,872 gave consent for medical record review and had full information on intensive care unit utilization. The mean age was 75.8 years (standard deviation ±7.6 years), and 58% were female, 94% were Caucasian, 62% were married, and 13% were living in nursing homes. In the overall group, 417 patients (4.2%) suffered from critical illness. In the 1,134 patients with ERA >16, 154 (14%) suffered from critical illness. An ERA score ≥16 predicted critical illness (odds ratio 6.35; 95% confidence interval 3.51–11.48). The area under the receiver operating characteristic curve was 0.75, which indicated good discrimination. Conclusion A simple model based on easily obtainable administrative data predicted critical illness in the next 2 years in elderly outpatients with up to 14% of the highest risk population suffering from critical illness. This model can facilitate efficient enrollment of patients into clinical programs such as care transition programs and studies aimed at the prevention of critical illness. It also can serve as a reminder to initiate advance care planning for high-risk elderly patients. External validation of this tool in different populations may enhance its generalizability.
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Affiliation(s)
- Michelle Biehl
- Division of Pulmonary and Critical Care Medicine, Department of Medicine
| | | | - Stephen S Cha
- Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | | | - Ognjen Gajic
- Division of Pulmonary and Critical Care Medicine, Department of Medicine
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Pike MM, Decker PA, Larson NB, St Sauver JL, Takahashi PY, Roger VL, Rocca WA, Miller VM, Olson JE, Pathak J, Bielinski SJ. Improvement in Cardiovascular Risk Prediction with Electronic Health Records. J Cardiovasc Transl Res 2016; 9:214-222. [PMID: 26960568 DOI: 10.1007/s12265-016-9687-z] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2016] [Accepted: 02/29/2016] [Indexed: 12/20/2022]
Abstract
The aim of this study was to compare the QRISKII, an electronic health data-based risk score, to the Framingham Risk Score (FRS) and atherosclerotic cardiovascular disease (ASCVD) score. Risk estimates were calculated for a cohort of 8783 patients, and the patients were followed up from November 29, 2012, through June 1, 2015, for a cardiovascular disease (CVD) event. During follow-up, 246 men and 247 women had a CVD event. Cohen's kappa statistic for the comparison of the QRISKII and FRS was 0.22 for men and 0.23 for women, with the QRISKII classifying more patients in the higher-risk groups. The QRISKII and ASCVD were more similar with kappa statistics of 0.49 for men and 0.51 for women. The QRISKII shows increased discrimination with area under the curve (AUC) statistics of 0.65 and 0.71, respectively, compared to the FRS (0.59 and 0.66) and ASCVD (0.63 and 0.69). These results demonstrate that incorporating additional data from the electronic health record (EHR) may improve CVD risk stratification.
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Affiliation(s)
- Mindy M Pike
- Department of Health Sciences Research, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Paul A Decker
- Department of Health Sciences Research, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Nicholas B Larson
- Department of Health Sciences Research, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Jennifer L St Sauver
- Department of Health Sciences Research, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA
| | | | - Véronique L Roger
- Department of Health Sciences Research, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
- Division of Cardiovascular Diseases in the Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Walter A Rocca
- Department of Health Sciences Research, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
- Department of Neurology, Mayo Clinic, Rochester, MN, USA
| | - Virginia M Miller
- Department of Surgery, Mayo Clinic, Rochester, MN, USA
- Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, MN, USA
| | - Janet E Olson
- Department of Health Sciences Research, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Jyotishman Pathak
- Department of Healthcare Policy and Research, Weill Cornell Medical College, New York, NY, USA
| | - Suzette J Bielinski
- Department of Health Sciences Research, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
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Takahashi PY, Naessens JM, Peterson SM, Rahman PA, Shah ND, Finnie DM, Weymiller AJ, Thorsteinsdottir B, Hanson GJ. Short-term and long-term effectiveness of a post-hospital care transitions program in an older, medically complex population. Healthcare (Basel) 2016; 4:30-5. [DOI: 10.1016/j.hjdsi.2015.06.006] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2015] [Revised: 06/19/2015] [Accepted: 06/27/2015] [Indexed: 01/17/2023] Open
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Chen CY, Thorsteinsdottir B, Cha SS, Hanson GJ, Peterson SM, Rahman PA, Naessens JM, Takahashi PY. Health care outcomes and advance care planning in older adults who receive home-based palliative care: a pilot cohort study. J Palliat Med 2015; 18:38-44. [PMID: 25375663 DOI: 10.1089/jpm.2014.0150] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Approximately 20% of seniors live with five or more chronic medical illnesses. Terminal stages of their lives are often characterized by repeated burdensome hospitalizations and advance care directives are insufficiently addressed. This study reports on the preliminary results of a Palliative Care Homebound Program (PCHP) at the Mayo Clinic in Rochester, Minnesota to service these vulnerable populations. OBJECTIVE The study objective was to evaluate inpatient hospital utilization and the adequacy of advance care planning in patients who receive home-based palliative care. METHODS This is a retrospective pilot cohort study of patients enrolled in the PCHP between September 2012 and March 2013. Two control patients were matched to each intervention patient by propensity scoring methods that factor in risk and prognosis. Primary outcomes were six-month hospital utilization including ER visits. Secondary outcomes evaluated advance care directive completion and overall mortality. RESULTS Patients enrolled in the PCHP group (n = 54) were matched to 108 controls with an average age of 87 years. Ninety-two percent of controls and 33% of PCHP patients were admitted to the hospital at least once. The average number of hospital admissions was 1.36 per patient for controls versus 0.35 in the PCHP (p < 0.001). Total hospital days were reduced by 5.13 days. There was no difference between rates of ER visits. Advanced care directive were completed more often in the intervention group (98%) as compared to controls (31%), with p < 0.001. Goals of care discussions were held at least once for all patients in the PCHP group, compared to 41% in the controls.
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Affiliation(s)
- Christina Y Chen
- 1 Geriatric Medicine Fellowship, Mayo Clinic , Rochester, Minnesota
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Gharacholou SM, Tashiro T, Cha SS, Scott CG, Takahashi PY, Pellikka PA. Echocardiographic indices associated with frailty in adults ≥65 years. Am J Cardiol 2015; 116:1591-5. [PMID: 26394832 DOI: 10.1016/j.amjcard.2015.08.023] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2015] [Revised: 08/15/2015] [Accepted: 08/15/2015] [Indexed: 11/30/2022]
Abstract
Frailty is prevalent in patients with cardiovascular disease, but few studies have evaluated relations between frailty and echocardiographically determined cardiac indexes. To assess the prevalence of frailty and its association with echocardiographic characteristics, we prospectively measured frailty in 257 patients ≥65 years who underwent echocardiography (transthoracic echocardiography [TTE]) from June 2012 to February 2013. Deficits of weight loss, exhaustion, physical activity, gait speed, and handgrip strength were used to categorize patients as frail (≥3 features), intermediately frail (1 or 2 features), or nonfrail (0 features). Pearson correlation was used to examine bivariate associations between TTE variables and frailty. Kaplan-Meier methods were used to estimate overall survival based on frailty status. A multivariable model was used to examine TTE indexes associated with frailty while accounting for age and baseline cardiac co-morbidities. Of the 257 patients studied, 40 (15.6%) were nonfrail, 167 (65.0%) intermediately frail, and 50 (19.4%) frail. Left atrial volume (r = 0.14; p = 0.03), stroke volume (r = -0.19; p <0.01), E/A ratio (r = 0.26; p <0.001), and pulmonary artery systolic pressure (r = 0.33; p <0.001) correlated with fraility. After age and baseline cardiac comorbidities were accounted for, larger left atrial volumes, lower stroke volumes, and higher pulmonary artery systolic pressures remained independently associated with frailty. Frail patients had worse survival compared with nonfrail and intermediately frail patients (p = 0.016 by log-rank). In conclusion, 1/5 of older patients who underwent clinically indicated TTE were frail, with worse survival and a unique fingerprint of TTE findings distinguishing them from nonfrail patients.
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Affiliation(s)
- S Michael Gharacholou
- Division of Cardiovascular Diseases, Department of Internal Medicine, Mayo Clinic Health System-Franciscan Healthcare, La Crosse, Wisconsin; Division of Cardiovascular Diseases, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota.
| | - Teruko Tashiro
- Division of Cardiovascular Diseases, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota
| | - Stephen S Cha
- Department of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota
| | - Christopher G Scott
- Department of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota
| | - Paul Y Takahashi
- Division of Primary Care Internal Medicine, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota
| | - Patricia A Pellikka
- Division of Cardiovascular Diseases, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota
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Takahashi PY, Ryu E, Hathcock MA, Olson JE, Bielinski SJ, Cerhan JR, Rand-Weaver J, Juhn YJ. A novel housing-based socioeconomic measure predicts hospitalisation and multiple chronic conditions in a community population. J Epidemiol Community Health 2015; 70:286-91. [PMID: 26458399 DOI: 10.1136/jech-2015-205925] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2015] [Accepted: 09/27/2015] [Indexed: 11/04/2022]
Abstract
BACKGROUND Socioeconomic status (SES) is an important predictor for outcomes of chronic diseases. However, it is often unavailable in clinical data. We sought to determine whether an individual housing-based SES index termed HOUSES can influence the likelihood of multiple chronic conditions (MCC) and hospitalisation in a community population. METHODS Participants were residents of Olmsted County, Minnesota, aged >18 years, who were enrolled in Mayo Clinic Biobank on 31 December 2010, with follow-up until 31 December 2011. Primary outcome was all-cause hospitalisation over 1 calendar-year. Secondary outcome was MCC determined through a Minnesota Medical Tiering score. A logistic regression model was used to assess the association of HOUSES with the Minnesota tiering score. With adjustment for age, sex and MCC, the association of HOUSES with hospitalisation risk was tested using the Cox proportional hazards model. RESULTS Eligible patients totalled 6402 persons (median age, 57 years; 25th-75th quartiles, 45-68 years). The lowest quartile of HOUSES was associated with a higher Minnesota tiering score after adjustment for age and sex (OR (95% CI) 2.4 (2.0 to 3.1)) when compared with the highest HOUSES quartile. Patients in the lowest HOUSES quartile had higher risk of all-cause hospitalisation (age, sex, MCC-adjusted HR (95% CI) 1.53 (1.18 to 1.98)) compared with those in the highest quartile. CONCLUSIONS Low SES, as assessed by HOUSES, was associated with increased risk of hospitalisation and greater MCC health burden. HOUSES may be a clinically useful surrogate for SES to assess risk stratification for patient care and clinical research.
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Affiliation(s)
- Paul Y Takahashi
- Division of Primary Care Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Euijung Ryu
- Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota, USA
| | - Matthew A Hathcock
- Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota, USA
| | - Janet E Olson
- Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota, USA
| | - Suzette J Bielinski
- Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota, USA
| | - James R Cerhan
- Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Young J Juhn
- Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, Minnesota, USA
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Veldhuis JD, Olson TP, Takahashi PY, Miles JM, Joyner MJ, Yang RJ, Wigham J. Multipathway modulation of exercise and glucose stress effects upon GH secretion in healthy men. Metabolism 2015; 64:1022-30. [PMID: 26028283 PMCID: PMC4546548 DOI: 10.1016/j.metabol.2015.05.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2014] [Revised: 01/21/2015] [Accepted: 05/12/2015] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Exercise evokes pulsatile GH release followed by autonegative feedback, whereas glucose suppresses GH release followed by rebound-like GH release (feedforward escape). Here we test the hypothesis that age, sex steroids, insulin, body composition and physical power jointly determine these dynamic GH responses. METHODS This was a prospectively randomized glucose-blinded study conducted in the Mayo Center for Advancing Translational Sciences in healthy men ages 19-77 years (N=23). Three conditions, fasting/rest/saline, fasting/exercise/saline and fasting/rest/iv glucose infusions, were used to drive GH dynamics during 10-min blood sampling for 6h. Linear correlation analysis was applied to relate peak/nadir GH dynamics to age, sex steroids, insulin, CT-estimated abdominal fat and physical power (work per unit time). RESULTS Compared with the fasting/rest/saline (control) day, fasting/exercise/saline infusion evoked peak GH within 1h, followed by negative feedback 3-5h later. The dynamic GH excursion was strongly (R(2)=0.634) influenced by (i) insulin negatively (P=0.011), (ii) power positively (P=0.0008), and (iii) E2 positively (P=0.001). Dynamic glucose-modulated GH release was determined by insulin negatively (P=0.0039) and power positively (P=0.0034) (R(2)=0.454). Under rest/saline, power (P=0.031) and total abdominal fat (P=0.012) (R(2)=0.267) were the dominant correlates of GH excursions. CONCLUSION In healthy men, dynamic GH perturbations induced by exercise and glucose are strongly related to physical power, insulin, estradiol, and body composition, thus suggesting a network of regulatory pathways.
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Affiliation(s)
- Johannes D Veldhuis
- Endocrine Research Unit, Mayo Clinic College of Medicine, Center for Translational Science Activities.
| | - Thomas P Olson
- Cardiovascular Research, Mayo Clinic, Rochester, MN 55905
| | - Paul Y Takahashi
- Primary Care Internal Medicine, Mayo Clinic, Rochester, MN 55905
| | - John M Miles
- Endocrine Research Unit, Mayo Clinic College of Medicine, Center for Translational Science Activities
| | | | - Rebecca J Yang
- Endocrine Research Unit, Mayo Clinic College of Medicine, Center for Translational Science Activities
| | - Jean Wigham
- Endocrine Research Unit, Mayo Clinic College of Medicine, Center for Translational Science Activities
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81
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Takahashi PY, Ryu E, Olson JE, Winkler EM, Hathcock MA, Gupta R, Sloan JA, Pathak J, Bielinski SJ, Cerhan JR. Health behaviors and quality of life predictors for risk of hospitalization in an electronic health record-linked biobank. Int J Gen Med 2015; 8:247-54. [PMID: 26316799 PMCID: PMC4540136 DOI: 10.2147/ijgm.s85473] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background Hospital risk stratification models using electronic health records (EHRs) often use age and comorbid health burden. Our primary aim was to determine if quality of life or health behaviors captured in an EHR-linked biobank can predict future risk of hospitalization. Methods Participants in the Mayo Clinic Biobank completed self-administered questionnaires at enrollment that included quality of life and health behaviors. Participants enrolled as of December 31, 2010 were followed for one year to ascertain hospitalization. Data on comorbidities and hospitalization were derived from the Mayo Clinic EHR. Hazard ratios (HR) and 95% confidence interval (CI) were used, adjusted for age and sex. We used gradient boosting machines models to integrate multiple factors. Different models were compared using C-statistic. Results Of the 8,927 eligible Mayo Clinic Biobank participants, 834 (9.3%) were hospitalized. Self-perceived health status and alcohol use had the strongest associations with risk of hospitalization. Compared to participants with excellent self-perceived health, those reporting poor/fair health had higher risk of hospitalization (HR =3.66, 95% CI 2.74–4.88). Alcohol use was inversely associated with hospitalization (HR =0.57 95% CI 0.45–0.72). The gradient boosting machines model estimated self-perceived health as the most influential factor (relative influence =16%). The predictive ability of the model based on comorbidities was slightly higher than the one based on the self-perceived health (C-statistic =0.67 vs 0.65). Conclusion This study demonstrates that self-perceived health may be an important piece of information to add to the EHR. It may be another method to determine hospitalization risk.
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Affiliation(s)
- Paul Y Takahashi
- Division of Primary Care Internal Medicine, Mayo Clinic, Rochester, MN, USA ; Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Euijung Ryu
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | - Janet E Olson
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | - Erin M Winkler
- Center for Individualized Medicine, Mayo Clinic, Rochester, MN, USA
| | | | - Ruchi Gupta
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | - Jeff A Sloan
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | - Jyotishman Pathak
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | | | - James R Cerhan
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
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Bielinski SJ, Pathak J, Carrell DS, Takahashi PY, Olson JE, Larson NB, Liu H, Sohn S, Wells QS, Denny JC, Rasmussen-Torvik LJ, Pacheco JA, Jackson KL, Lesnick TG, Gullerud RE, Decker PA, Pereira NL, Ryu E, Dart RA, Peissig P, Linneman JG, Jarvik GP, Larson EB, Bock JA, Tromp GC, de Andrade M, Roger VL. A Robust e-Epidemiology Tool in Phenotyping Heart Failure with Differentiation for Preserved and Reduced Ejection Fraction: the Electronic Medical Records and Genomics (eMERGE) Network. J Cardiovasc Transl Res 2015. [PMID: 26195183 DOI: 10.1007/s12265-015-9644-2] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Identifying populations of heart failure (HF) patients is paramount to research efforts aimed at developing strategies to effectively reduce the burden of this disease. The use of electronic medical record (EMR) data for this purpose is challenging given the syndromic nature of HF and the need to distinguish HF with preserved or reduced ejection fraction. Using a gold standard cohort of manually abstracted cases, an EMR-driven phenotype algorithm based on structured and unstructured data was developed to identify all the cases. The resulting algorithm was executed in two cohorts from the Electronic Medical Records and Genomics (eMERGE) Network with a positive predictive value of >95 %. The algorithm was expanded to include three hierarchical definitions of HF (i.e., definite, probable, possible) based on the degree of confidence of the classification to capture HF cases in a whole population whereby increasing the algorithm utility for use in e-Epidemiologic research.
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Affiliation(s)
- Suzette J Bielinski
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, 55905, USA.
| | - Jyotishman Pathak
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, 55905, USA
| | | | - Paul Y Takahashi
- Department of Medicine, Division of Primary Care Internal Medicine, Mayo Clinic, Rochester, MN, 55905, USA
| | - Janet E Olson
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, 55905, USA
| | - Nicholas B Larson
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, 55905, USA
| | - Hongfang Liu
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, 55905, USA
| | - Sunghwan Sohn
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, 55905, USA
| | - Quinn S Wells
- Department of Medicine, Vanderbilt University, Nashville, TN, 37232, USA
| | - Joshua C Denny
- Departments of Biomedical Informatics and Medicine, Vanderbilt University, Nashville, TN, 37232, USA
| | - Laura J Rasmussen-Torvik
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, 60611, USA
| | - Jennifer Allen Pacheco
- Center for Genetic Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, 60611, USA
| | - Kathryn L Jackson
- Center for Healthcare Studies, Northwestern University Feinberg School of Medicine, Chicago, IL, 60611, USA
| | - Timothy G Lesnick
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, 55905, USA
| | - Rachel E Gullerud
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, 55905, USA
| | - Paul A Decker
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, 55905, USA
| | - Naveen L Pereira
- Division of Cardiovascular Diseases, Mayo Clinic Rochester, Rochester, MN, 55905, USA
| | - Euijung Ryu
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, 55905, USA
| | - Richard A Dart
- Center for Human Genetics, Marshfield Clinic Research Foundation, Marshfield, WI, 54449, USA
| | - Peggy Peissig
- Biomedical Informatics Research Center, Marshfield Clinic Research Foundation, Marshfield, WI, 54449, USA
| | - James G Linneman
- Biomedical Informatics Research Center, Marshfield Clinic Research Foundation, Marshfield, WI, 54449, USA
| | - Gail P Jarvik
- Departments of Medicine (Medical Genetics) and Genome Sciences, University of Washington, Seattle, WA, 98195, USA
| | - Eric B Larson
- Group Health Research Institute, Seattle, WA, 98101, USA
| | - Jonathan A Bock
- The Sigfried and Janet Weis Center for Research, Geisinger Health System, Danville, PA, 17822, USA
| | - Gerard C Tromp
- The Sigfried and Janet Weis Center for Research, Geisinger Health System, Danville, PA, 17822, USA
| | - Mariza de Andrade
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, 55905, USA
| | - Véronique L Roger
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, 55905, USA
- Division of Cardiovascular Diseases, Mayo Clinic Rochester, Rochester, MN, 55905, USA
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Chandra A, Crane SJ, Tung EE, Hanson GJ, North F, Cha SS, Takahashi PY. Patient-reported geriatric symptoms as risk factors for hospitalization and emergency department visits. Aging Dis 2015; 6:188-95. [PMID: 26029477 DOI: 10.14336/ad.2014.0706] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2013] [Accepted: 07/06/2014] [Indexed: 11/01/2022] Open
Abstract
There is an urgent need to identify predictors of adverse outcomes and increased health care utilization in the elderly. The Mayo Ambulatory Geriatric Evaluation (MAGE) is a symptom questionnaire that was completed by patients aged 65 years and older during office visits to Primary Care Internal Medicine at Mayo Clinic in Rochester, MN. It was introduced to improve screening for geriatric conditions. We conducted this study to explore the relationship between self-reported geriatric symptoms and hospitalization and emergency department (ED) visits within 1 year of completing the survey. This was a retrospective cohort study of patients who completed the MAGE from April 2008 to December 2010. The primary outcome was an ED visit or hospitalization within 1 year. Predictors included responses to individual questions in the MAGE. Data were obtained from the electronic medical record and administrative records. Logistic regression analyses were performed from significant univariate factors to determine predictors in a multivariable setting. A weighted scoring system was created based upon the odds ratios derived from a bootstrap process. The sensitivity, specificity, and AUC were calculated using this scoring system. The MAGE survey was completed by 7738 patients. The average age was 76.2 ± 7.68 years and 57% were women. Advanced age, a self-report of worse health, history of 2 or more falls, weight loss, and depressed mood were significantly associated with hospitalization or ED visits within 1 year. A score equal to or greater than 2 had a sensitivity of 0.74 and specificity of 0.45. The calculated AUC was 0.60. The MAGE questionnaire, which was completed by patients at an outpatient visit to screen for common geriatric issues, could also be used to assess risk for ED visits and hospitalization within 1 year.
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Affiliation(s)
- Anupam Chandra
- 1Division of Primary Care Internal Medicine; Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
| | - Sarah J Crane
- 1Division of Primary Care Internal Medicine; Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
| | - Ericka E Tung
- 1Division of Primary Care Internal Medicine; Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
| | - Gregory J Hanson
- 1Division of Primary Care Internal Medicine; Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
| | - Frederick North
- 1Division of Primary Care Internal Medicine; Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
| | - Stephen S Cha
- 2Department of Health Sciences Research; Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
| | - Paul Y Takahashi
- 1Division of Primary Care Internal Medicine; Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
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Njeru JW, St Sauver JL, Jacobson DJ, Ebbert JO, Takahashi PY, Fan C, Wieland ML. Emergency department and inpatient health care utilization among patients who require interpreter services. BMC Health Serv Res 2015; 15:214. [PMID: 26022227 PMCID: PMC4448538 DOI: 10.1186/s12913-015-0874-4] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2014] [Accepted: 05/18/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Limited English proficiency is associated with health disparities and suboptimal health outcomes. Although Limited English proficiency is a barrier to effective health care, its association with inpatient health care utilization is unclear. The aim of this study was to examine the association between patients with limited English proficiency, and emergency department visits and hospital admissions. METHODS We compared emergency department visits and hospitalizations in 2012 between patients requiring interpreter services and age-matched English-proficient patients (who did not require interpreters), in a retrospective cohort study of adult patients actively empanelled to a large primary health care network in a medium-sized United States city (n = 3,784). RESULTS Patients who required interpreter services had significantly more Emergency Department visits (841 vs 620; P ≤ .001) and hospitalizations (408 vs 343; P ≤ .001) than patients who did not require interpreter services. On regression analysis the risk of a first Emergency Department visit was 60% higher for patients requiring interpreter services than those who did not (unadjusted hazard ratio [HR], 1.6; 95% confidence interval (CI), 1.4-1.9; P < .05), while that of a first hospitalization was 50% higher (unadjusted HR, 1.5; 95% CI, 1.2-1.8; P < .05). These findings remained significant after adjusting for age, sex, medical complexity, residency and outpatient health care utilization. CONCLUSIONS Patients who required interpreter services had higher rates of inpatient health care utilization compared with patients who did not require an interpreter. Further research is required to understand factors associated with this utilization and to develop sociolinguistically tailored interventions to facilitate appropriate health care provision for this population.
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Affiliation(s)
- Jane W Njeru
- Division of Primary Care Internal Medicine, Mayo Clinic, 200 First Street, SW, Rochester, MN, 55905, USA.
| | | | - Debra J Jacobson
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, USA.
| | - Jon O Ebbert
- Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Rochester, MN, USA.
| | - Paul Y Takahashi
- Division of Primary Care Internal Medicine, Mayo Clinic, 200 First Street, SW, Rochester, MN, 55905, USA.
| | - Chun Fan
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, USA.
| | - Mark L Wieland
- Division of Primary Care Internal Medicine, Mayo Clinic, 200 First Street, SW, Rochester, MN, 55905, USA.
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85
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North F, Elrashidi MY, Ward WJ, Takahashi PY, Ebbert JO, Ytterberg KL, Tulledge-Scheitel SM. Telemonitoring Blood Pressure by Secure Message on a Patient Portal: Use, Content, and Outcomes. Telemed J E Health 2015; 21:630-6. [PMID: 25885765 DOI: 10.1089/tmj.2014.0179] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION Secure messages on a patient portal allow patients to asynchronously communicate with their healthcare teams. Patients can use this mode of communication to transmit data such as home blood pressure (BP) measurements. MATERIALS AND METHODS In this retrospective study, we examined 52,373 secure messages for content related to home BP monitoring. Text searches of the messages were followed by manual message review to identify BP-related messages. Two physicians independently reviewed a sample of these messages and the provider responses. RESULTS Of 19,545 total message users, there were 4,412 message users with a diagnosis of hypertension and 365 who sent BP-related messages. Of the 52,373 secure messages, 624 messages (1.2%) contained information about home BP. Providers responded to messages with a change in medication dose or a prescription in 17%. When new medications were recommended, providers needed more pharmacy information in 53%. Messages contained a concern about high BP in 27% and concern about low BP in 8.5%. BP data in patient messages only attained American Heart Association-endorsed measurement criteria in 7% of messages. CONCLUSIONS Patient-generated secure messages with BP data often result in message responses from providers for a BP medication dose change or a new prescription. Despite its increasing use, BP management by secure message has significant limitations and might be better served by BP virtual visits (e-visits) containing specific data requirements such as an average BP value from at least 12 readings and a preferred pharmacy for a prescription.
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Affiliation(s)
- Frederick North
- Primary Care Internal Medicine, Mayo Clinic Rochester , Rochester, Minnesota
| | - Muhamad Y Elrashidi
- Primary Care Internal Medicine, Mayo Clinic Rochester , Rochester, Minnesota
| | - William J Ward
- Primary Care Internal Medicine, Mayo Clinic Rochester , Rochester, Minnesota
| | - Paul Y Takahashi
- Primary Care Internal Medicine, Mayo Clinic Rochester , Rochester, Minnesota
| | - Jon O Ebbert
- Primary Care Internal Medicine, Mayo Clinic Rochester , Rochester, Minnesota
| | - Karen L Ytterberg
- Primary Care Internal Medicine, Mayo Clinic Rochester , Rochester, Minnesota
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86
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McKenzie KM, McKenzie KM, Gupta N, Hansen MA, Takahashi PY. Paraneoplastic Pemphigus in a Long-Term Care Resident. J Am Med Dir Assoc 2015. [DOI: 10.1016/j.jamda.2015.01.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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87
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Takahashi PY, St Sauver JL, Finney Rutten LJ, Jacobson RM, Jacobson DJ, McGree ME, Ebbert JO. Health outcomes in diabetics measured with Minnesota Community Measurement quality metrics. Diabetes Metab Syndr Obes 2015; 8:1-8. [PMID: 25565873 PMCID: PMC4274142 DOI: 10.2147/dmso.s71726] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
OBJECTIVE Our objective was to understand the relationship between optimal diabetes control, as defined by Minnesota Community Measurement (MCM), and adverse health outcomes including emergency department (ED) visits, hospitalizations, 30-day rehospitalization, intensive care unit (ICU) stay, and mortality. PATIENTS AND METHODS In 2009, we conducted a retrospective cohort study of empaneled Employee and Community Health patients with diabetes mellitus. We followed patients from 1 September 2009 until 30 June 2011 for hospitalization and until 5 January 2014 for mortality. Optimal control of diabetes mellitus was defined as achieving the following three measures: low-density lipoprotein (LDL) cholesterol <100 mg/mL, blood pressure <140/90 mmHg, and hemoglobin A1c <8%. Using the electronic medical record, we assessed hospitalizations, ED visits, ICU stays, 30-day rehospitalizations, and mortality. The chi-square or Wilcoxon rank-sum tests were used to compare those with and without optimal control. We used Cox proportional hazard models to estimate the associations between optimal diabetes mellitus status and each outcome. RESULTS We identified 5,731 empaneled patients with diabetes mellitus; 2,842 (49.6%) were in the optimal control category. After adjustment, we observed that non-optimally controlled patients had higher risks for hospitalization (hazard ratio [HR] 1.11; 95% confidence interval [CI] 1.00-1.23), ED visits (HR 1.15; 95% CI 1.06-1.25), and mortality (HR 1.29; 95% CI 1.09-1.53) than diabetic patients with optimal control. No differences were observed in ICU stay or 30-day rehospitalization. CONCLUSION Diabetic patients without optimal control had higher risks of adverse health outcomes than those with optimal control. Patients with optimal control defined by the MCM were associated with decreased morbidity and mortality.
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Affiliation(s)
- Paul Y Takahashi
- Department of Internal Medicine, Division of Primary Care Internal Medicine, Rochester, MN, USA
- Correspondence: Paul Y Takahashi, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA, Tel +1 507 284 2511, Fax +1 507 266 0036, Email
| | - Jennifer L St Sauver
- Department of Health Sciences Research, Mayo Clinic Robert D and Patricia E Kern Center for the Science of Health Care Delivery, Rochester, MN, USA
| | - Lila J Finney Rutten
- Department of Health Sciences Research, Mayo Clinic Robert D and Patricia E Kern Center for the Science of Health Care Delivery, Rochester, MN, USA
| | - Robert M Jacobson
- Department of Pediatric and Adolescent Medicine, Division of Community Pediatrics, Mayo Clinic, Rochester, MN, USA
| | - Debra J Jacobson
- Department of Health Sciences Research, Mayo Clinic Robert D and Patricia E Kern Center for the Science of Health Care Delivery, Rochester, MN, USA
| | - Michaela E McGree
- Department of Health Sciences Research, Mayo Clinic Robert D and Patricia E Kern Center for the Science of Health Care Delivery, Rochester, MN, USA
| | - Jon O Ebbert
- Department of Internal Medicine, Division of Primary Care Internal Medicine, Rochester, MN, USA
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88
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Upatising B, Wood DL, Kremers WK, Christ SL, Yih Y, Hanson GJ, Takahashi PY. Cost comparison between home telemonitoring and usual care of older adults: a randomized trial (Tele-ERA). Telemed J E Health 2014; 21:3-8. [PMID: 25453392 DOI: 10.1089/tmj.2014.0021] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND From 1992 to 2008, older adults in the United States incurred more healthcare expense per capita than any other age group. Home telemonitoring has emerged as a potential solution to reduce these costs, but evidence is mixed. The primary aim of the study was to evaluate whether the mean difference in total direct medical cost consequence between older adults receiving additional home telemonitoring care (TELE) (n=102) and those receiving usual medical care (UC) (n=103) were significant. Inpatient, outpatient, emergency department, decedents, survivors, and 30-day readmission costs were evaluated as secondary aim. MATERIALS AND METHODS Multivariate generalized linear models (GLMs) and parametric bootstrapping method were used to model cost and to determine significance of the cost differences. We also compared the differences in arithmetic mean costs. RESULTS From the conditional GLMs, the estimated mean cost differences (TELE versus UC) for total, inpatient, outpatient, and ED were -$9,537 (p=0.068), -$8,482 (p =0.098), -$1,160 (p=0.177), and $106 (p=0.619), respectively. Mean postenrollment cost was 11% lower than the prior year for TELE versus 22% higher for UC. The ratio of mean cost for decedents to survivors was 2.1:1 (TELE) versus 12.7:1 (UC). CONCLUSIONS There were no significant differences in the mean total cost between the two treatment groups. The TELE group had less variability in cost of care, lower decedents to survivors cost ratio, and lower total 30-day readmission cost than the UC group.
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Affiliation(s)
- Benjavan Upatising
- 1 Regenstrief Center for Healthcare Engineering, Purdue University , West Lafayette, Indiana
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89
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Leibson CL, Petterson TM, Smith CY, Bailey KR, Emerson JA, Ashrani AA, Takahashi PY, Heit JA. Rethinking guidelines for VTE risk among nursing home residents: a population-based study merging medical record detail with standardized nursing home assessments. Chest 2014; 146:412-421. [PMID: 24626961 DOI: 10.1378/chest.13-2652] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Nursing home (NH) residents are at increased risk for both VTE and bleeding from pharmacologic prophylaxis. Construction of prophylaxis guidelines is hampered by NH-specific limitations with VTE case identification and characterization of risk. We addressed these limitations by merging detailed provider-linked Rochester Epidemiology Project (REP) medical records with Centers for Medicare and Medicaid Services Minimum Data Set (MDS) NH assessments. METHODS This population-based nested case-control study identified all Olmsted County, Minnesota, residents with first-lifetime VTE October 1, 1998, through December 31, 2005, while a resident of an NH (N = 91) and one to two age-, sex-, and calendar year-matched NH non-VTE control subjects. For each NH case without hospitalization 3 months before VTE (n = 23), we additionally identified three to four nonhospitalized NH control subjects. REP and MDS records were reviewed before index date (VTE date for cases; respective REP encounter date for control subjects) for numerous characteristics previously associated with VTE in non-NH populations. Data were modeled using conditional logistic regression. RESULTS The multivariate model consisting of all cases and control subjects identified only three characteristics independently associated with VTE: respiratory infection vs no infection (OR, 5.9; 95% CI, 2.6-13.1), extensive or total assistance with walking in room (5.6, 2.5-12.6), and general surgery (3.3, 1.0-10.8). In analyses limited to nonhospitalized cases and control subjects, only nonrespiratory infection vs no infection was independently associated with VTE (8.8, 2.7-29.2). CONCLUSIONS Contrary to previous assumptions, most VTE risk factors identified in non-NH populations do not apply to the NH population. NH residents with infection, substantial mobility limitations, or recent general surgery should be considered potential candidates for VTE prophylaxis.
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Affiliation(s)
- Cynthia L Leibson
- Division of Epidemiology, Department of Internal Medicine, Mayo Clinic, Rochester, MN.
| | - Tanya M Petterson
- Division of Biomedical Statistics and Informatics, Department of Internal Medicine, Mayo Clinic, Rochester, MN
| | - Carin Y Smith
- Division of Biomedical Statistics and Informatics, Department of Internal Medicine, Mayo Clinic, Rochester, MN
| | - Kent R Bailey
- Division of Biomedical Statistics and Informatics, Department of Internal Medicine, Mayo Clinic, Rochester, MN
| | - Jane A Emerson
- Division of Epidemiology, Department of Internal Medicine, Mayo Clinic, Rochester, MN
| | - Aneel A Ashrani
- Department of Health Sciences Research, and the Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, MN
| | - Paul Y Takahashi
- Division of Primary Care, Department of Internal Medicine, Mayo Clinic, Rochester, MN
| | - John A Heit
- Department of Health Sciences Research, and the Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, MN; Division of Cardiovascular Disease, Department of Internal Medicine, Mayo Clinic, Rochester, MN
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90
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Haas LR, Takahashi PY, Shah ND, Stroebel RJ, Bernard ME, Finnie DM, Naessens JM. Simple errors in interpretation and publication can be costly--response. Am J Manag Care 2014; 20:538-540. [PMID: 25434056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
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91
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Takahashi PY, Liu PY, Veldhuis JD. Distinct roles of age and abdominal visceral fat in reducing androgen receptor-dependent negative feedback on LH secretion in healthy men. Andrology 2014; 2:588-95. [PMID: 24782426 DOI: 10.1111/j.2047-2927.2014.00218.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2014] [Revised: 03/10/2014] [Accepted: 03/25/2014] [Indexed: 12/31/2022]
Abstract
Testosterone (T) impacts luteinizing hormone (LH) secretion through negative feedback via the androgen receptor (AR) in the hypothalamo-pituitary system. An untested postulate is that increasing body mass index (BMI), abdominal visceral fat (AVF) or total abdominal fat (TAF) with ageing decreases LH secretion by heightening T negative feedback via AR. This hypothesis was tested in a prospective, randomized double-blind cross-over study of 19 healthy men comparing the effects of flutamide, a selective non-steroidal AR antagonist and placebo administration on basal and pulsatile LH secretion as a function of age and obesity measures. To this end, serum levels of 2-hydroxyflutamide (2-OHF), a major active flutamide metabolite, were measured by mass spectrometry, and AVF/TAF quantified by abdominal computerized tomography. Statistical analysis showed that antiandrogen administration elevated 6-h mean LH concentrations to 5.4 ± 1.3 IU/L compared with 3.3 ± 1.2 IU/L for placebo (p < 10(-3) ), and total T by 35% (p < 10(-4) ). The LH-T concentration product doubled (p < 10(-8) ). According to deconvolution analysis, flutamide exposure increased total LH secretion (p < 10(-3) ) and pulsatile LH secretion (p = 0.0077), along with LH pulse frequency (p = 0.019). Despite feedback inhibition, the LH-T product declined as a linear function of AVF (p = 0.021) and TAF (p = 0.017). This was explained by the fact that higher BMI was associated with lower 2-OHF concentrations (R = -0.562, p = 0.012). In contrast, age was associated with less pulsatile LH secretion (R = -0.567, p = 0.011) even when LH responses were normalized to antiantrogen levels. In conclusion, increased AVF, TAF and BMI predict decreased LH and flutamide blood levels, whereas older age is marked by impaired stimulation of pulsatile LH secretion even when normalized for antiandrogen levels, suggesting different mechanisms of regulation by adiposity and age.
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Affiliation(s)
- P Y Takahashi
- Department of Internal Medicine, Endocrine Research Unit, Mayo Clinic College of Medicine, Center for Translational Science Activities, Mayo Clinic, Rochester, MN, USA
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92
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Olson JE, Bielinski SJ, Ryu E, Winkler EM, Takahashi PY, Pathak J, Cerhan JR. Biobanks and personalized medicine. Clin Genet 2014; 86:50-5. [PMID: 24588254 DOI: 10.1111/cge.12370] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2014] [Revised: 02/27/2014] [Accepted: 02/27/2014] [Indexed: 12/21/2022]
Abstract
We provide a mini-review of how biobanks can support clinical genetics in the era of personalized medicine. We discuss types of biobanks, including disease specific and general biobanks not focused on one disease. We present considerations in setting up a biobank, including consenting and governance, biospecimens, risk factor and related data, informatics, and linkage to electronic health records for phenotyping. We also discuss the uses of biobanks and ongoing considerations, including genotype-driven recruitment, investigations of gene-environment associations, and the re-use of data generated from studies. Finally, we present a brief discussion of some of the unresolved issues, such as return of research results and sustaining biobanks over time. In summary, carefully designed biobanks can provide critical research and infrastructure support for clinical genetics in the era of personalized medicine.
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Affiliation(s)
- J E Olson
- Department of Health Sciences Research, Rochester, MN, USA
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93
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Pagali SR, Pagali SR, Verdoorn BP, Wieland ML, Takahashi PY, Chandra A. Infection Control and Managing Tuberculosis at Long Term Care Facility: A Case Report. J Am Med Dir Assoc 2014. [DOI: 10.1016/j.jamda.2013.12.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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94
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Verdoorn BP, Verdoorn BP, Takahashi PY, Pagali SR, Chandra A. Electroconvulsive Therapy for Depression in a Nursing Home Resident With Frontotemporal Dementia. J Am Med Dir Assoc 2014. [DOI: 10.1016/j.jamda.2013.12.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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95
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North F, Crane SJ, Takahashi PY, Ward WJ, Tulledge-Scheitel SM, Ytterberg K, Tangalos EG, Stroebel RJ. Telemedicine Barriers Associated with Regional Quality Measures. Telemed J E Health 2014; 20:179-81. [DOI: 10.1089/tmj.2013.0167] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Frederick North
- Primary Care Internal Medicine, Mayo Clinic, Rochester, Minnesota
| | - Sarah J. Crane
- Primary Care Internal Medicine, Mayo Clinic, Rochester, Minnesota
| | | | - William J. Ward
- Primary Care Internal Medicine, Mayo Clinic, Rochester, Minnesota
| | | | - Karen Ytterberg
- Community Pediatrics and Adolescent Medicine, Mayo Clinic, Rochester, Minnesota
| | - Eric G. Tangalos
- Primary Care Internal Medicine, Mayo Clinic, Rochester, Minnesota
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96
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Bielinski SJ, Olson JE, Pathak J, Weinshilboum RM, Wang L, Lyke KJ, Ryu E, Targonski PV, Van Norstrand MD, Hathcock MA, Takahashi PY, McCormick JB, Johnson KJ, Maschke KJ, Rohrer Vitek CR, Ellingson MS, Wieben ED, Farrugia G, Morrisette JA, Kruckeberg KJ, Bruflat JK, Peterson LM, Blommel JH, Skierka JM, Ferber MJ, Black JL, Baudhuin LM, Klee EW, Ross JL, Veldhuizen TL, Schultz CG, Caraballo PJ, Freimuth RR, Chute CG, Kullo IJ. Preemptive genotyping for personalized medicine: design of the right drug, right dose, right time-using genomic data to individualize treatment protocol. Mayo Clin Proc 2014; 89:25-33. [PMID: 24388019 PMCID: PMC3932754 DOI: 10.1016/j.mayocp.2013.10.021] [Citation(s) in RCA: 222] [Impact Index Per Article: 22.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2013] [Revised: 10/16/2013] [Accepted: 10/23/2013] [Indexed: 01/08/2023]
Abstract
OBJECTIVE To report the design and implementation of the Right Drug, Right Dose, Right Time-Using Genomic Data to Individualize Treatment protocol that was developed to test the concept that prescribers can deliver genome-guided therapy at the point of care by using preemptive pharmacogenomics (PGx) data and clinical decision support (CDS) integrated into the electronic medical record (EMR). PATIENTS AND METHODS We used a multivariate prediction model to identify patients with a high risk of initiating statin therapy within 3 years. The model was used to target a study cohort most likely to benefit from preemptive PGx testing among the Mayo Clinic Biobank participants, with a recruitment goal of 1000 patients. We used a Cox proportional hazards model with variables selected through the Lasso shrinkage method. An operational CDS model was adapted to implement PGx rules within the EMR. RESULTS The prediction model included age, sex, race, and 6 chronic diseases categorized by the Clinical Classifications Software for International Classification of Diseases, Ninth Revision codes (dyslipidemia, diabetes, peripheral atherosclerosis, disease of the blood-forming organs, coronary atherosclerosis and other heart diseases, and hypertension). Of the 2000 Biobank participants invited, 1013 (51%) provided blood samples, 256 (13%) declined participation, 555 (28%) did not respond, and 176 (9%) consented but did not provide a blood sample within the recruitment window (October 4, 2012, through March 20, 2013). Preemptive PGx testing included CYP2D6 genotyping and targeted sequencing of 84 PGx genes. Synchronous real-time CDS was integrated into the EMR and flagged potential patient-specific drug-gene interactions and provided therapeutic guidance. CONCLUSION This translational project provides an opportunity to begin to evaluate the impact of preemptive sequencing and EMR-driven genome-guided therapy. These interventions will improve understanding and implementation of genomic data in clinical practice.
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Affiliation(s)
| | - Janet E Olson
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN
| | | | - Richard M Weinshilboum
- Department of Molecular Pharmacology and Experimental Therapeutics, Mayo Clinic, Rochester, MN; Center for Individualized Medicine, Mayo Clinic, Rochester, MN
| | - Liewei Wang
- Department of Molecular Pharmacology and Experimental Therapeutics, Mayo Clinic, Rochester, MN
| | - Kelly J Lyke
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN
| | - Euijung Ryu
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN
| | - Paul V Targonski
- Division of Primary Care Internal Medicine, Mayo Clinic, Rochester, MN
| | | | | | - Paul Y Takahashi
- Division of Primary Care Internal Medicine, Mayo Clinic, Rochester, MN
| | - Jennifer B McCormick
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN; Center for Individualized Medicine, Mayo Clinic, Rochester, MN; Division of General Internal Medicine, Mayo Clinic, Rochester, MN
| | - Kiley J Johnson
- Center for Individualized Medicine, Mayo Clinic, Rochester, MN
| | | | | | | | - Eric D Wieben
- Department of Biochemistry and Molecular Biology, Mayo Clinic, Rochester, MN
| | - Gianrico Farrugia
- Center for Individualized Medicine, Mayo Clinic, Rochester, MN; Division of Gastroenterology, Mayo Clinic, Rochester, MN
| | | | - Keri J Kruckeberg
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN
| | - Jamie K Bruflat
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN
| | - Lisa M Peterson
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN
| | - Joseph H Blommel
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN
| | - Jennifer M Skierka
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN
| | - Matthew J Ferber
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN
| | - John L Black
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN
| | - Linnea M Baudhuin
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN
| | - Eric W Klee
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN
| | - Jason L Ross
- Department of Information Technology, Mayo Clinic, Rochester, MN
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Sharma S, Datta S, Gharacholou S, Siddique SK, Cha SS, Takahashi PY. The relationship between Elder Risk Assessment (ERA) scores and cardiac revascularization: a cohort study in Olmsted County, Minnesota, USA. Clin Interv Aging 2013; 8:1209-15. [PMID: 24072966 PMCID: PMC3783541 DOI: 10.2147/cia.s50713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Purpose The aging population is predisposed to cardiovascular disease. Our goal was to determine the relationship between a higher Elder Risk Assessment (ERA) score and coronary artery bypass graft (CABG) or percutaneous coronary intervention (PCI), in adults over 60 years. Methods This was a retrospective cohort study in a primary care internal medicine practice. Patients included community-dwelling individuals aged 60 years or older on January 1, 2005. The primary outcome was a combined outcome of CABG and PCI in 2 years. The secondary outcome was mortality 5 years after CABG or PCI. The primary predictor variable was the score on the ERA Index, an instrument that predicts emergency room visits and hospitalization. The outcomes were obtained using administrative data from electronic medical records. The analysis included logistic regression, with odds ratios for the primary outcome and time-to-event analysis for mortality. Results The records of 12,650 patients were studied. A total of 902 patients (7.1%) had either CABG or PCI, with an average age of 74.5 years (±8.3 years). There were 205 patients (23%) who experienced CABG or PCI in the highest-score group (top 10%) compared with 29 patients (3%) in the lowest score group, for an odds ratio of 15.4; 95% confidence interval, 10.1–23.5. There was a greater association of revascularization events by increasing score group. We noted increased mortality by increasing ERA score, in patients undergoing CABG or PCI. The patients in the highest-scoring group had a 50% 5-year survival rate compared with a 97% 5-year survival rate in the lowest-scoring group (P < 0.001). Conclusion Older adults in the highest-ERA-scoring group had the highest utilization of CABG or PCI. Patients with high ERA scores undergoing coronary revascularization were also at the highest risk of mortality. Providers should be aware that higher ERA scores can potentially predict outcomes in high-risk patients.
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Affiliation(s)
- Saurabh Sharma
- Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA
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98
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Haas LR, Takahashi PY, Shah ND, Stroebel RJ, Bernard ME, Finnie DM, Naessens JM. Risk-stratification methods for identifying patients for care coordination. Am J Manag Care 2013; 19:725-732. [PMID: 24304255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
BACKGROUND Care coordination is a key component of the patient-centered medical home. However, the mechanism for identifying primary care patients who may benefit the most from this model of care is unclear. OBJECTIVES To evaluate the performance of several risk-adjustment/stratification instruments in predicting healthcare utilization. STUDY DESIGN Retrospective cohort analysis. METHODS All adults empaneled in 2009 and 2010 (n = 83,187) in a primary care practice were studied. We evaluated 6 models: Adjusted Clinical Groups (ACGs), Hierarchical Condition Categories (HCCs), Elder Risk Assessment, Chronic Comorbidity Count, Charlson Comorbidity Index, and Minnesota Health Care Home Tiering. A seventh model combining Minnesota Tiering with ERA score was also assessed. Logistic regression models using demographic characteristics and diagnoses from 2009 were used to predict healthcare utilization and costs for 2010 with binary outcomes (emergency department [ED] visits, hospitalizations, 30-day readmissions, and highcost users in the top 10%), using the C statistic and goodness of fit among the top decile. RESULTS The ACG model outperformed the others in predicting hospitalizations with a C statistic range of 0.67 (CMS-HCC) to 0.73. In predicting ED visits, the C statistic ranged from 0.58 (CMSHCC) to 0.67 (ACG). When predicting the top 10% highest cost users, the performance of the ACG model was good (area under the curve = 0.81) and superior to the others. CONCLUSIONS Although ACG models generally performed better in predicting utilization, use of any of these models will help practices implement care coordination more efficiently.
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Affiliation(s)
- Lindsey R Haas
- Health Care Policy and Research, Mayo Clinic, 200 First St Southwest, Rochester, MN 55905. E-mail:
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Olson JE, Ryu E, Johnson KJ, Koenig BA, Maschke KJ, Morrisette JA, Liebow M, Takahashi PY, Fredericksen ZS, Sharma RG, Anderson KS, Hathcock MA, Carnahan JA, Pathak J, Lindor NM, Beebe TJ, Thibodeau SN, Cerhan JR. The Mayo Clinic Biobank: a building block for individualized medicine. Mayo Clin Proc 2013; 88:952-62. [PMID: 24001487 PMCID: PMC4258707 DOI: 10.1016/j.mayocp.2013.06.006] [Citation(s) in RCA: 157] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2013] [Revised: 05/29/2013] [Accepted: 06/03/2013] [Indexed: 01/22/2023]
Abstract
OBJECTIVE To report the design and implementation of the first 3 years of enrollment of the Mayo Clinic Biobank. PATIENTS AND METHODS Preparations for this biobank began with a 4-day Deliberative Community Engagement with local residents to obtain community input into the design and governance of the biobank. Recruitment, which began in April 2009, is ongoing, with a target goal of 50,000. Any Mayo Clinic patient who is 18 years or older, able to consent, and a US resident is eligible to participate. Each participant completes a health history questionnaire, provides a blood sample, and allows access to existing tissue specimens and all data from their Mayo Clinic electronic medical record. A community advisory board provides ongoing advice and guidance on complex decisions. RESULTS After 3 years of recruitment, 21,736 individuals have enrolled. Fifty-eight percent (12,498) of participants are female and 95% (20,541) of European ancestry. Median participant age is 62 years. Seventy-four percent (16,171) live in Minnesota, with 42% (9157) from Olmsted County, where the Mayo Clinic in Rochester, Minnesota, is located. The 5 most commonly self-reported conditions are hyperlipidemia (8979, 41%), hypertension (8174, 38%), osteoarthritis (6448, 30%), any cancer (6224, 29%), and gastroesophageal reflux disease (5669, 26%). Among patients with self-reported cancer, the 5 most common types are nonmelanoma skin cancer (2950, 14%), prostate cancer (1107, 12% in men), breast cancer (941, 4%), melanoma (692, 3%), and cervical cancer (240, 2% in women). Fifty-six percent (12,115) of participants have at least 15 years of electronic medical record history. To date, more than 60 projects and more than 69,000 samples have been approved for use. CONCLUSION The Mayo Clinic Biobank has quickly been established as a valuable resource for researchers.
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Affiliation(s)
- Janet E Olson
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA.
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Takahashi PY, Ryu E, Olson JE, Anderson KS, Hathcock MA, Haas LR, Naessens JM, Pathak J, Bielinski SJ, Cerhan JR. Hospitalizations and emergency department use in Mayo Clinic Biobank participants within the employee and community health medical home. Mayo Clin Proc 2013; 88:963-9. [PMID: 24001488 PMCID: PMC4151531 DOI: 10.1016/j.mayocp.2013.06.015] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2013] [Revised: 05/31/2013] [Accepted: 06/12/2013] [Indexed: 10/26/2022]
Abstract
OBJECTIVE To evaluate the participants in the Mayo Clinic Biobank for their representativeness to the entire Employee and Community Health program (ECH) primary care population with regard to hospital utilization. PATIENTS AND METHODS Participants enrolled in the Mayo Clinic Biobank from April 1, 2009, to December 31, 2010, were linked to the ECH population. These individuals were categorized into risk tiers (0-4) on the basis of the number of health conditions present as of December 31, 2010. Outcomes were ascertained through December 31, 2011. Hazard ratios (HRs) and 95% CIs for risk of hospitalization, emergency department (ED) visits, and for risk of hospitalization and emergency department (ED) visits were estimated. RESULTS The 8927 Biobank participants were part of ECH (N=84,872). Compared with the entire ECH population, the Biobank-ECH participants were more likely to be female (64.3% vs 54.6%), older (median age, 58 years vs 47 years), and categorized to tier 0 (6.4% vs 24.0%). There were strong positive associations between tier (tier 4 vs combined tiers 0 and 1) and risk of hospitalization (HR, 5.8; 95% CI, 4.6-7.5) and ED visits (HR, 5.4; 95% CI, 4.2-6.8) among Biobank-ECH participants. Similar associations for risk of hospitalization (HR, 8.5; 95% CI, 7.8-9.3) and ED visits (HR, 6.9; 95% CI, 6.4-7.5) were observed for the entire ECH population. CONCLUSION Although the Biobank-ECH participants were older and had more chronic conditions compared with the overall ECH population, the associations of risk tier with utilization outcomes were similar, supporting the use of the Biobank participants to assess biomarkers for health care outcomes in the primary care setting.
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Affiliation(s)
- Paul Y Takahashi
- Division of Primary Care Internal Medicine, Department of Medicine, Mayo Clinic, Rochester, MN 55905, USA.
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