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Stenehjem E, Wallin A, Willis P, Kumar N, Seibert AM, Buckel WR, Stanfield V, Brunisholz KD, Fino N, Samore MH, Srivastava R, Hicks LA, Hersh AL. Implementation of an Antibiotic Stewardship Initiative in a Large Urgent Care Network. JAMA Netw Open 2023; 6:e2313011. [PMID: 37166794 PMCID: PMC10176123 DOI: 10.1001/jamanetworkopen.2023.13011] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [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: 12/23/2022] [Accepted: 03/19/2023] [Indexed: 05/12/2023] Open
Abstract
Importance Urgent Care (UC) encounters result in more inappropriate antibiotic prescriptions than other outpatient setting. Few stewardship interventions have focused on UC. Objective To evaluate the effectiveness of an antibiotic stewardship initiative to reduce antibiotic prescribing for respiratory conditions in a UC network. Design, Setting, and Participants This quality improvement study conducted in a UC network with 38 UC clinics and 1 telemedicine clinic included 493 724 total UC encounters. The study compared the antibiotic prescribing rates of all UC clinicians who encountered respiratory conditions for a 12-month baseline period (July 1, 2018, through June 30, 2019) with an intervention period (July 1, 2019, through June 30, 2020). A sustainability period (July 1, 2020, through June 30, 2021) was added post hoc. Interventions Stewardship interventions included (1) education for clinicians and patients, (2) electronic health record (EHR) tools, (3) a transparent clinician benchmarking dashboard, and (4) media. Occurring independently but concurrent with the interventions, a stewardship measure was introduced by UC leadership into the quality measures, including a financial incentive. Main Outcomes and Measures The primary outcome was the percentage of UC encounters with an antibiotic prescription for a respiratory condition. Secondary outcomes included antibiotic prescribing when antibiotics were not indicated (tier 3 encounters) and first-line antibiotics for acute otitis media, sinusitis, and pharyngitis. Interrupted time series with binomial generalized estimating equations were used to compare periods. Results The baseline period included 207 047 UC encounters for respiratory conditions (56.8% female; mean [SD] age, 30.0 [21.4] years; 92.0% White race); the intervention period included 183 893 UC encounters (56.4% female; mean [SD] age, 30.7 [20.8] years; 91.2% White race). Antibiotic prescribing for respiratory conditions decreased from 47.8% (baseline) to 33.3% (intervention). During the initial intervention month, a 22% reduction in antibiotic prescribing occurred (odds ratio [OR], 0.78; 95% CI, 0.71-0.86). Antibiotic prescriptions decreased by 5% monthly during the intervention (OR, 0.95; 95% CI, 0.94-0.96). Antibiotic prescribing for tier 3 encounters decreased by 47% (OR, 0.53; 95% CI, 0.44-63), and first-line antibiotic prescriptions increased by 18% (OR, 1.18; 95% CI, 1.09-1.29) during the initial intervention month. Antibiotic prescriptions for tier 3 encounters decreased by an additional 4% each month (OR, 0.96; 95% CI, 0.94-0.98), whereas first-line antibiotic prescriptions did not change (OR, 1.00; 95% CI, 0.99-1.01). Antibiotic prescribing for respiratory conditions remained stable in the sustainability period. Conclusions and relevance The findings of this quality improvement study indicated that a UC antibiotic stewardship initiative was associated with decreased antibiotic prescribing for respiratory conditions. This study provides a model for UC antibiotic stewardship.
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Affiliation(s)
- Edward Stenehjem
- Division of Infectious Diseases and Epidemiology, Intermountain Health, Salt Lake City, Utah
| | - Anthony Wallin
- Intermountain Urgent Care, Intermountain Health, Salt Lake City, Utah
| | - Park Willis
- Intermountain Urgent Care, Intermountain Health, Salt Lake City, Utah
| | - Naresh Kumar
- Office of Research, Intermountain Health, Salt Lake City, Utah
| | - Allan M. Seibert
- Division of Infectious Diseases and Epidemiology, Intermountain Health, Salt Lake City, Utah
| | - Whitney R. Buckel
- System Pharmacy Services, Intermountain Health, Salt Lake City, Utah
| | - Valoree Stanfield
- Division of Infectious Diseases and Epidemiology, Intermountain Health, Salt Lake City, Utah
| | | | - Nora Fino
- Department of Internal Medicine, Division of Epidemiology, University of Utah School of Medicine, Salt Lake City
| | - Matthew H. Samore
- Department of Internal Medicine, Division of Epidemiology, University of Utah School of Medicine, Salt Lake City
| | - Rajendu Srivastava
- Intermountain Health Delivery Institute, Intermountain Health, Salt Lake City, Utah
- Department of Pediatrics, Division of Pediatric Inpatient Medicine, University of Utah School of Medicine, Salt Lake City
| | - Lauri A. Hicks
- Office of Antibiotic Stewardship, Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Adam L. Hersh
- Department of Pediatrics, Division of Infectious Diseases, University of Utah School of Medicine, Salt Lake City
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Seibert AM, Matheu MM, Stanfield VK, Gwiazdon M, Kumar N, Brunisholz KD, Willis P, Wallin A, Stenehjem EA. 2212. Improving Sexually Transmitted Infection Co-testing in a Large Urgent Care Network. Open Forum Infect Dis 2022. [PMCID: PMC9752697 DOI: 10.1093/ofid/ofac492.1831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Background Sexually transmitted infections (STIs) remain a serious public health concern. The state of Utah has the lowest percentage of adults 18-64 years-old ever tested for HIV (26.5%) and the lowest percentage tested for HIV in the previous 12 months (6.5%). Increasing HIV testing in Utah is of the utmost importance. Delayed diagnoses and missed testing opportunities for HIV and other STIs exist. Encounters for evaluation of possible gonorrhea (GC) or chlamydia (CT) infection is a critical opportunity to co-test for HIV and syphilis. With continued growth, urgent care (UC) sites are well-positioned to increase STI diagnosis and treatment. We aimed to develop a multi-faceted quality improvement (QI) bundle to increase STI testing in our UC centers. Methods Intermountain Healthcare (IH) is a vertically integrated healthcare network predominantly in Utah and operates a network of 35 UC clinics across the state. In 2020, qualitative interviews to evaluate barriers to STI testing were performed with UC clinicians. Based on these interviews a QI initiative was designed and implemented throughout 2021. The bundle included clinician education, electronic health record (EHR) improvements, and automatic referral for patients with a new diagnosis of HIV to an Infectious Diseases (ID) physician (Methods Image 1). We compared co-testing rates before (July 2018 – December 2020) and after the intervention began (March 2021 – April 2022).
Methods Table 1 ![]() The quality improvement (QI) initiative began in 2021 and consisted of multiple components as detailed below. Results 13,715 and 5,628 UC encounters were associated with GC/CT testing during the pre-intervention and intervention periods, respectively. HIV co-testing was performed in 2,784 (20.3%) GC/CT testing encounters in the pre-intervention period and in 1,674 (29.7%) encounters during the intervention, a relative increase of 37.6%. HIV/syphilis co-testing was performed in 2,304 (16.8%) GC/CT testing encounters and 1,225 (21.8%) encounters during the pre-intervention and intervention phases, respectively. From January 1 2022 – April 1 2022 3 new outpatient HIV diagnoses were identified. The average time from diagnosis to contact with an ID provider was 30.0 hours. Results Image 1
![]() Co-testing rates for GC/CT UC encounters are presented for HIV (blue), syphilis (green), and HIV/syphilis (orange). Testing reagent quality issues in early 2022 lead to an abrupt decline in syphilis co-testing and once these issues were resolved co-testing trends returned to similar rates prior to the reagent quality issue and testing limitation. Conclusion Multi-modal QI initiatives may increase STI testing rates within UC centers of integrated healthcare systems. Further study is needed to optimize STI screening, diagnosis, and care in UC centers. Disclosures Kimberly D. Brunisholz, PhD, MST, Johnson and Johnson: Advisor/Consultant.
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Williams J, Sachdev N, Kirley K, Moin T, Duru OK, Brunisholz KD, Sill K, Joy E, Aquino GC, Brown AR, O'Connell C, Rea B, Craig-Buckholtz H, Witherspoon PW, Bruett C. Implementation of Diabetes Prevention in Health Care Organizations: Best Practice Recommendations. Popul Health Manag 2022; 25:31-38. [PMID: 34161148 PMCID: PMC8861908 DOI: 10.1089/pop.2021.0044] [Citation(s) in RCA: 1] [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] [Indexed: 11/30/2022] Open
Abstract
Approximately 1 in 3 American adults has prediabetes, a condition characterized by blood glucose levels that are above normal, not in the type 2 diabetes ranges, and that increases the risk of developing type 2 diabetes. Evidence-based treatments can be used to prevent or delay type 2 diabetes in adults with prediabetes. The American Medical Association (AMA) has collaborated with health care organizations across the country to build sustainable diabetes prevention strategies. In 2017, the AMA formed the Diabetes Prevention Best Practices Workgroup (DPBP) with representatives from 6 health care organizations actively implementing diabetes prevention. Each organization had a unique strategy, but all included the National Diabetes Prevention Program lifestyle change program as a core evidence-based intervention. DPBP established the goal of disseminating best practices to guide other health care organizations in implementing diabetes prevention and identifying and managing patients with prediabetes. Workgroup members recognized similarities in some of their basic steps and considerations and synthesized their practices to develop best practice recommendations for 3 strategy maturity phases. Recommendations for each maturity phase are classified into 6 categories: (1) organizational support; (2) workforce and funding; (3) promotion and dissemination; (4) clinical integration and support; (5) evaluation and outcomes; (6) and program. As the burden of chronic disease grows, prevention must be prioritized and integrated into health care. These maturity phases and best practice recommendations can be used by any health care organization committed to diabetes prevention. Further research is suggested to assess the impact and adoption of diabetes prevention best practices.
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Affiliation(s)
- Janet Williams
- Improving Health Outcomes, American Medical Association, Chicago, Illinois, USA.,Address correspondence to: Janet Williams, MA, Improving Health Outcomes, American Medical Association, 330 N. Wabash Avenue, Chicago, IL 60611, USA
| | - Neha Sachdev
- Improving Health Outcomes, American Medical Association, Chicago, Illinois, USA.,David Geffen School of Medicine, UCLA and VA, Los Angeles, California, USA
| | - Kate Kirley
- Improving Health Outcomes, American Medical Association, Chicago, Illinois, USA.,David Geffen School of Medicine, UCLA, Los Angeles, California, USA
| | - Tannaz Moin
- David Geffen School of Medicine, UCLA and VA, Los Angeles, California, USA
| | - O. Kenrik Duru
- David Geffen School of Medicine, UCLA, Los Angeles, California, USA
| | | | - Kelly Sill
- Improving Health Outcomes, American Medical Association, Chicago, Illinois, USA
| | - Elizabeth Joy
- Wellness and Nutrition, Intermountain Healthcare, Salt Lake City, Utah, USA
| | - Gina C. Aquino
- Henry Ford Macomb Hospital, Clinton Township, Michigan, USA
| | - Ameldia R. Brown
- Faith and Community Health, Henry Ford Health System, Clinton Township, Michigan, USA
| | | | - Brenda Rea
- Department of Family Medicine and Preventive Medicine, Loma Linda University Health, Redlands, California, USA
| | - Holly Craig-Buckholtz
- Diabetes and Outpatient Wound Care Services, Loma Linda University Medical Center, Loma Linda, California, USA
| | | | - Cindy Bruett
- Diabetes Prevention Program, Community Health & Well-Being, Trinity Health, Livonia, Michigan, USA
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Olsen G, Knighton AJ, Belnap T, Brunisholz KD, Gibbons S, Blackburn R, West M, Province W, Pollard M, Woodruff M, Srivastava R. Evaluating a Redesigned Advanced Training Program. Qual Manag Health Care 2021; 30:283-285. [PMID: 34559756 DOI: 10.1097/qmh.0000000000000341] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Griffin Olsen
- Healthcare Delivery Institute, Intermountain Healthcare, Salt Lake City, Utah
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Olsen G, Quam J, Wolfe D, Soria N, West M, Gibbons S, Province W, Brunisholz KD, Belnap T, Knighton AJ, Allen L, Pollard M, Woodruff M, Srivastava R. Quality Improvement Education: Redesigning Intermountain Healthcare's Advanced Training Program for a Value-Based Learning Health Care System. Qual Manag Health Care 2021; 30:209-211. [PMID: 34048376 DOI: 10.1097/qmh.0000000000000327] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Griffin Olsen
- Healthcare Delivery Institute, Intermountain Healthcare, Murray, Utah
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Brunisholz KD, Conroy MB, Belnap T, Joy EA, Srivastava R. Measuring Adherence to U.S. Preventive Services Task Force Diabetes Prevention Guidelines Within Two Healthcare Systems. J Healthc Qual 2021; 43:119-125. [PMID: 32842020 PMCID: PMC7878570 DOI: 10.1097/jhq.0000000000000281] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
ABSTRACT Measuring adherence to the 2015 U.S. Preventive Services Task Force (USPSTF) diabetes prevention guidelines can inform implementation efforts to prevent or delay Type 2 diabetes. A retrospective cohort was used to study patients without a diagnosis of diabetes attributed to primary care clinics within two large healthcare systems in our state to study adherence to the following: (1) screening at-risk patients and (2) referring individuals with confirmed prediabetes to participate in an intensive behavioral counseling intervention, defined as a Center for Disease Control and Prevention (CDC)-recognized Diabetes Prevention Program (DPP). Among 461,866 adults attributed to 79 primary care clinics, 45.7% of patients were screened, yet variability at the level of the clinic ranged from 14.5% to 83.2%. Very few patients participated in a CDC-recognized DPP (0.52%; range 0%-3.53%). These findings support the importance of a systematic implementation strategy to specifically target barriers to diabetes prevention screening and referral to treatment.
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Brunisholz KD, Knighton AJ, Sharma A, Nichols L, Reisig K, Burton J, Scovill D, Tometich C, Foote M, Read S, Whittle S. Trends in Abstinence and Retention Associated with a Medication-Assisted Treatment Program for People with Opioid Use Disorders. Prog Community Health Partnersh 2021; 14:43-54. [PMID: 32280122 DOI: 10.1353/cpr.2020.0007] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Medication-assisted treatment (MAT) is an evidence-based program for patients with opioid use disorders. Yet, within the state of Utah, MAT had not been widely available, promoted, or adopted within the public sector. Recognizing the potential benefit, a collective impact approach was used to promote social change and increase the use of MAT in the community for treatment of opioid use disorders. OBJECTIVE Conduct a retrospective, observational case series study to measure the effect of a community-based, collective impact approach implementing the MAT program to improve the rate of abstinence and retention among individuals identified with an opioid use disorder in three Utah counties. METHODS The study was designed and implemented by the Utah Opioid Community Collaborative (OCC) using a collective impact approach, which included broad sector coordination (public-private collaboration), a common agenda, participation in mutually reinforcing activities, continuous communication, consistent measurement of results, and identification of a backbone organization. The MAT intervention program includes use of medications approved by the U.S. Food and Drug Administration in combination with counseling and behavioral therapies delivered within two community sites. Analysis was performed over time to describe the rate of abstinence and retention associated with participation in the MAT program during 2015 through 2017. RESULTS Of the 339 identified with risk of an opioid use disorders, 228 enrolled in the MAT Program. At MAT enrollment, average age was 32.6 ± 8.2 years old and 58.0% were female. At 365 days after MAT enrollment, 84% of participants were abstinent from opioid substances and 62% from all illicit substances. CONCLUSIONS Use of a collective impact approach provides a successful mobilization framework in Utah for increasing community engagement and expanding patient access to underresourced MAT programs while suggesting a high rate of abstinence from illicit substances at 12 months.
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Knighton AJ, Ranade-Kharkar P, Brunisholz KD, Wolfe D, Allen L, Belnap TW, Moores Todd T, Srivastava R, Kapsandoy S, Ize-Ludlow D, Allen TL. Rapid Implementation of a Complex, Multimodal Technology Response to COVID-19 at an Integrated Community-Based Health Care System. Appl Clin Inform 2020; 11:825-838. [PMID: 33327036 DOI: 10.1055/s-0040-1719179] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND The rapid spread of severe acute respiratory syndrome coronavirus-2 or SARS-CoV-2 necessitated a scaled treatment response to the novel coronavirus disease 2019 (COVID-19). OBJECTIVE This study aimed to characterize the design and rapid implementation of a complex, multimodal, technology response to COVID-19 led by the Intermountain Healthcare's (Intermountain's) Care Transformation Information Systems (CTIS) organization to build pandemic surge capacity. METHODS Intermountain has active community-spread cases of COVID-19 that are increasing. We used the Centers for Disease Control and Prevention Pandemic Intervals Framework (the Framework) to characterize CTIS leadership's multimodal technology response to COVID-19 at Intermountain. We provide results on implementation feasibility and sustainability of health information technology (HIT) interventions as of June 30, 2020, characterize lessons learned and identify persistent barriers to sustained deployment. RESULTS We characterize the CTIS organization's multimodal technology response to COVID-19 in five relevant areas of the Framework enabling (1) incident management, (2) surveillance, (3) laboratory testing, (4) community mitigation, and (5) medical care and countermeasures. We are seeing increased use of traditionally slow-to-adopt technologies that create additional surge capacity while sustaining patient safety and care quality. CTIS leadership recognized early that a multimodal technology intervention could enable additional surge capacity for health care delivery systems with a broad geographic and service scope. A statewide central tracking system to coordinate capacity planning and management response is needed. Order interoperability between health care systems remains a barrier to an integrated response. CONCLUSION The rate of future pandemics is estimated to increase. The pandemic response of health care systems, like Intermountain, offers a blueprint for the leadership role that HIT organizations can play in mainstream care delivery, enabling a nimbler, virtual health care delivery system that is more responsive to current and future needs.
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Affiliation(s)
- Andrew J Knighton
- Healthcare Delivery Institute, Intermountain Healthcare, Murray, Utah, United States
| | - Pallavi Ranade-Kharkar
- Care Transformation Information Systems, Intermountain Healthcare, Salt Lake City, Utah, United States
| | - Kimberly D Brunisholz
- Healthcare Delivery Institute, Intermountain Healthcare, Murray, Utah, United States
| | - Douglas Wolfe
- Healthcare Delivery Institute, Intermountain Healthcare, Murray, Utah, United States
| | - Lauren Allen
- Healthcare Delivery Institute, Intermountain Healthcare, Murray, Utah, United States
| | - Thomas W Belnap
- Healthcare Delivery Institute, Intermountain Healthcare, Murray, Utah, United States
| | - Tamara Moores Todd
- Care Transformation Information Systems, Intermountain Healthcare, Salt Lake City, Utah, United States
| | - Rajendu Srivastava
- Healthcare Delivery Institute, Intermountain Healthcare, Murray, Utah, United States.,Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, Utah, United States
| | - Seraphine Kapsandoy
- Care Transformation Information Systems, Intermountain Healthcare, Salt Lake City, Utah, United States
| | - Diego Ize-Ludlow
- Care Transformation Information Systems, Intermountain Healthcare, Salt Lake City, Utah, United States
| | - Todd L Allen
- Healthcare Delivery Institute, Intermountain Healthcare, Murray, Utah, United States
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Nguyen QC, Keralis JM, Dwivedi P, Ng AE, Javanmardi M, Khanna S, Huang Y, Brunisholz KD, Kumar A, Tasdizen T. Leveraging 31 Million Google Street View Images to Characterize Built Environments and Examine County Health Outcomes. Public Health Rep 2020; 136:201-211. [PMID: 33211991 DOI: 10.1177/0033354920968799] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [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: 11/17/2022] Open
Abstract
OBJECTIVES Built environments can affect health, but data in many geographic areas are limited. We used a big data source to create national indicators of neighborhood quality and assess their associations with health. METHODS We leveraged computer vision and Google Street View images accessed from December 15, 2017, through July 17, 2018, to detect features of the built environment (presence of a crosswalk, non-single-family home, single-lane roads, and visible utility wires) for 2916 US counties. We used multivariate linear regression models to determine associations between features of the built environment and county-level health outcomes (prevalence of adult obesity, prevalence of diabetes, physical inactivity, frequent physical and mental distress, poor or fair self-rated health, and premature death [in years of potential life lost]). RESULTS Compared with counties with the least number of crosswalks, counties with the most crosswalks were associated with decreases of 1.3%, 2.7%, and 1.3% of adult obesity, physical inactivity, and fair or poor self-rated health, respectively, and 477 fewer years of potential life lost before age 75 (per 100 000 population). The presence of non-single-family homes was associated with lower levels of all health outcomes except for premature death. The presence of single-lane roads was associated with an increase in physical inactivity, frequent physical distress, and fair or poor self-rated health. Visible utility wires were associated with increases in adult obesity, diabetes, physical and mental distress, and fair or poor self-rated health. CONCLUSIONS The use of computer vision and big data image sources makes possible national studies of the built environment's effects on health, producing data and results that may inform national and local decision-making.
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Affiliation(s)
- Quynh C Nguyen
- 1068 Department of Epidemiology and Biostatistics, University of Maryland School of Public Health, College Park, MD, USA
| | - Jessica M Keralis
- 1068 Department of Epidemiology and Biostatistics, University of Maryland School of Public Health, College Park, MD, USA
| | - Pallavi Dwivedi
- 1068 Department of Epidemiology and Biostatistics, University of Maryland School of Public Health, College Park, MD, USA
| | - Amanda E Ng
- 1068 Department of Epidemiology and Biostatistics, University of Maryland School of Public Health, College Park, MD, USA
| | - Mehran Javanmardi
- 14434 Department of Electrical and Computer Engineering, Scientific Computing and Imaging Institute, University of Utah, Salt Lake City, UT, USA
| | - Sahil Khanna
- Electrical and Computer Engineering Department and Robert H. Smith School of Business, University of Maryland, College Park, MD, USA
| | - Yuru Huang
- 1068 Department of Epidemiology and Biostatistics, University of Maryland School of Public Health, College Park, MD, USA
| | - Kimberly D Brunisholz
- 7061 Intermountain Healthcare Delivery Institute, Intermountain Healthcare, Murray, UT, USA
| | - Abhinav Kumar
- Department of Computer Science and Engineering, Michigan State University, East Lansing, MI, USA
| | - Tolga Tasdizen
- 14434 Department of Electrical and Computer Engineering, Scientific Computing and Imaging Institute, University of Utah, Salt Lake City, UT, USA
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Nguyen QC, Huang Y, Kumar A, Duan H, Keralis JM, Dwivedi P, Meng HW, Brunisholz KD, Jay J, Javanmardi M, Tasdizen T. Using 164 Million Google Street View Images to Derive Built Environment Predictors of COVID-19 Cases. Int J Environ Res Public Health 2020; 17:E6359. [PMID: 32882867 PMCID: PMC7504319 DOI: 10.3390/ijerph17176359] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 08/24/2020] [Accepted: 08/29/2020] [Indexed: 12/15/2022]
Abstract
The spread of COVID-19 is not evenly distributed. Neighborhood environments may structure risks and resources that produce COVID-19 disparities. Neighborhood built environments that allow greater flow of people into an area or impede social distancing practices may increase residents' risk for contracting the virus. We leveraged Google Street View (GSV) images and computer vision to detect built environment features (presence of a crosswalk, non-single family home, single-lane roads, dilapidated building and visible wires). We utilized Poisson regression models to determine associations of built environment characteristics with COVID-19 cases. Indicators of mixed land use (non-single family home), walkability (sidewalks), and physical disorder (dilapidated buildings and visible wires) were connected with higher COVID-19 cases. Indicators of lower urban development (single lane roads and green streets) were connected with fewer COVID-19 cases. Percent black and percent with less than a high school education were associated with more COVID-19 cases. Our findings suggest that built environment characteristics can help characterize community-level COVID-19 risk. Sociodemographic disparities also highlight differential COVID-19 risk across groups of people. Computer vision and big data image sources make national studies of built environment effects on COVID-19 risk possible, to inform local area decision-making.
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Affiliation(s)
- Quynh C. Nguyen
- Department of Epidemiology and Biostatistics, University of Maryland School of Public Health, College Park, MD 20742, USA; (Y.H.); (J.M.K.); (P.D.); (H.-W.M.)
| | - Yuru Huang
- Department of Epidemiology and Biostatistics, University of Maryland School of Public Health, College Park, MD 20742, USA; (Y.H.); (J.M.K.); (P.D.); (H.-W.M.)
| | - Abhinav Kumar
- School of Computing, Scientific Computing and Imaging Institute, University of Utah, Salt Lake City, UT 84112, USA;
| | - Haoshu Duan
- Department of Sociology, University of Maryland, College Park, MD 20742, USA;
| | - Jessica M. Keralis
- Department of Epidemiology and Biostatistics, University of Maryland School of Public Health, College Park, MD 20742, USA; (Y.H.); (J.M.K.); (P.D.); (H.-W.M.)
| | - Pallavi Dwivedi
- Department of Epidemiology and Biostatistics, University of Maryland School of Public Health, College Park, MD 20742, USA; (Y.H.); (J.M.K.); (P.D.); (H.-W.M.)
| | - Hsien-Wen Meng
- Department of Epidemiology and Biostatistics, University of Maryland School of Public Health, College Park, MD 20742, USA; (Y.H.); (J.M.K.); (P.D.); (H.-W.M.)
| | - Kimberly D. Brunisholz
- Intermountain Healthcare Delivery Institute, Intermountain Healthcare, Murray, UT 84107, USA;
| | - Jonathan Jay
- Department of Community Health Sciences, Boston University School of Public Health, Boston, MA 02118, USA;
| | - Mehran Javanmardi
- Department of Electrical and Computer Engineering, Scientific Computing and Imaging Institute, University of Utah, Salt Lake City, UT 84112, USA; (M.J.); (T.T.)
| | - Tolga Tasdizen
- Department of Electrical and Computer Engineering, Scientific Computing and Imaging Institute, University of Utah, Salt Lake City, UT 84112, USA; (M.J.); (T.T.)
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Phan L, Yu W, Keralis JM, Mukhija K, Dwivedi P, Brunisholz KD, Javanmardi M, Tasdizen T, Nguyen QC. Google Street View Derived Built Environment Indicators and Associations with State-Level Obesity, Physical Activity, and Chronic Disease Mortality in the United States. Int J Environ Res Public Health 2020; 17:ijerph17103659. [PMID: 32456114 PMCID: PMC7277659 DOI: 10.3390/ijerph17103659] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Revised: 05/17/2020] [Accepted: 05/20/2020] [Indexed: 11/21/2022]
Abstract
Previous studies have demonstrated that there is a high possibility that the presence of certain built environment characteristics can influence health outcomes, especially those related to obesity and physical activity. We examined the associations between select neighborhood built environment indicators (crosswalks, non-single family home buildings, single-lane roads, and visible wires), and health outcomes, including obesity, diabetes, cardiovascular disease, and premature mortality, at the state level. We utilized 31,247,167 images collected from Google Street View to create indicators for neighborhood built environment characteristics using deep learning techniques. Adjusted linear regression models were used to estimate the associations between aggregated built environment indicators and state-level health outcomes. Our results indicated that the presence of a crosswalk was associated with reductions in obesity and premature mortality. Visible wires were associated with increased obesity, decreased physical activity, and increases in premature mortality, diabetes mortality, and cardiovascular mortality (however, these results were not significant). Non-single family homes were associated with decreased diabetes and premature mortality, as well as increased physical activity and park and recreational access. Single-lane roads were associated with increased obesity and decreased park access. The findings of our study demonstrated that built environment features may be associated with a variety of adverse health outcomes.
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Affiliation(s)
- Lynn Phan
- Department of Public Health Science, University of Maryland School of Public Health, College Park, MA 20742, USA
- Correspondence: (L.P.); (Q.C.N.)
| | - Weijun Yu
- Department of Epidemiology and Biostatistics, University of Maryland School of Public Health, College Park, MD 20742, USA; (W.Y.); (J.M.K.); (P.D.)
| | - Jessica M. Keralis
- Department of Epidemiology and Biostatistics, University of Maryland School of Public Health, College Park, MD 20742, USA; (W.Y.); (J.M.K.); (P.D.)
| | | | - Pallavi Dwivedi
- Department of Epidemiology and Biostatistics, University of Maryland School of Public Health, College Park, MD 20742, USA; (W.Y.); (J.M.K.); (P.D.)
| | - Kimberly D. Brunisholz
- Intermountain Healthcare Delivery Institute, Intermountain Healthcare, Murray, UT 4107, USA;
| | - Mehran Javanmardi
- Department of Electrical and Computer Engineering, Scientific Computing and Imaging Institute, University of Utah, Salt Lake City, UT 84112, USA; (M.J.); (T.T.)
| | - Tolga Tasdizen
- Department of Electrical and Computer Engineering, Scientific Computing and Imaging Institute, University of Utah, Salt Lake City, UT 84112, USA; (M.J.); (T.T.)
| | - Quynh C. Nguyen
- Department of Epidemiology and Biostatistics, University of Maryland School of Public Health, College Park, MD 20742, USA; (W.Y.); (J.M.K.); (P.D.)
- Correspondence: (L.P.); (Q.C.N.)
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12
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Affiliation(s)
- Andrew J Knighton
- Healthcare Delivery Institute, Intermountain Healthcare, Salt Lake City, Utah (Drs Knighton, Brunisholz, Allen, and Srivastava and Messrs Wolfe and Belnap); and Division of Inpatient Medicine, Department of Pediatrics, Primary Children's Hospital/University of Utah School of Medicine, Salt Lake City (Dr Srivastava)
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Stenehjem E, Wallin A, Fleming-Dutra KE, Buckel WR, Stanfield V, Brunisholz KD, Sorensen J, Samore MH, Srivastava R, Hicks LA, Hersh AL. Antibiotic Prescribing Variability in a Large Urgent Care Network: A New Target for Outpatient Stewardship. Clin Infect Dis 2020; 70:1781-1787. [PMID: 31641768 PMCID: PMC7768670 DOI: 10.1093/cid/ciz910] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Accepted: 09/15/2019] [Indexed: 01/06/2023] Open
Abstract
Improving antibiotic prescribing in outpatient settings is a public health priority. In the United States, urgent care (UC) encounters are increasing and have high rates of inappropriate antibiotic prescribing. Our objective was to characterize antibiotic prescribing practices during UC encounters, with a focus on respiratory tract conditions. This was a retrospective cohort study of UC encounters in the Intermountain Healthcare network. Among 1.16 million UC encounters, antibiotics were prescribed during 34% of UC encounters and respiratory conditions accounted for 61% of all antibiotics prescribed. Of respiratory encounters, 50% resulted in antibiotic prescriptions, yet the variability at the level of the provider ranged from 3% to 94%. Similar variability between providers was observed for respiratory conditions where antibiotics were not indicated and in first-line antibiotic selection for sinusitis, otitis media, and pharyngitis. These findings support the importance of developing antibiotic stewardship interventions specifically targeting UC settings.
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Affiliation(s)
- Edward Stenehjem
- Office of Patient Experience, Intermountain Healthcare, Salt Lake City, Utah, USA
| | - Anthony Wallin
- Intermountain Urgent Care, Intermountain Healthcare, Salt Lake City, Utah, USA
| | - Katherine E Fleming-Dutra
- Office of Antibiotic Stewardship, Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Whitney R Buckel
- System Pharmacy Services, Intermountain Healthcare, Salt Lake City, Utah, USA
| | - Valoree Stanfield
- Office of Patient Experience, Intermountain Healthcare, Salt Lake City, Utah, USA
| | - Kimberly D Brunisholz
- Intermountain Healthcare Delivery Institute, Intermountain Healthcare, Salt Lake City, Utah, USA
| | - Jeff Sorensen
- Office of Research, Intermountain Healthcare, Salt Lake City, Utah, USA
| | - Matthew H Samore
- Department of Internal Medicine, Division of Epidemiology, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Raj Srivastava
- Intermountain Healthcare Delivery Institute, Intermountain Healthcare, Salt Lake City, Utah, USA
- Department of Pediatrics, Division of Pediatric Inpatient Medicine, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Lauri A Hicks
- Office of Antibiotic Stewardship, Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Adam L Hersh
- Department of Pediatrics, Division of Infectious Diseases, University of Utah School of Medicine, Salt Lake City, Utah, USA
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Brunisholz KD, Knighton A, Sharma A, Nichols L, Reisig K, Burton J, Scovill D, Tometich C, Foote M, Read S, Whittle S. Trends in Abstinence and Retention Associated with a Medication-Assisted Treatment Program for People with Opioid Use Disorders. Prog Community Health Partnersh 2020. [DOI: 10.1353/cpr.2020.0002] [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: 11/11/2022]
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Nguyen QC, Khanna S, Dwivedi P, Huang D, Huang Y, Tasdizen T, Brunisholz KD, Li F, Gorman W, Nguyen TT, Jiang C. Using Google Street View to examine associations between built environment characteristics and U.S. health outcomes. Prev Med Rep 2019; 14:100859. [PMID: 31061781 PMCID: PMC6488538 DOI: 10.1016/j.pmedr.2019.100859] [Citation(s) in RCA: 20] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2019] [Accepted: 03/28/2019] [Indexed: 10/28/2022] Open
Abstract
Neighborhood attributes have been shown to influence health, but advances in neighborhood research has been constrained by the lack of neighborhood data for many geographical areas and few neighborhood studies examine features of nonmetropolitan locations. We leveraged a massive source of Google Street View (GSV) images and computer vision to automatically characterize national neighborhood built environments. Using road network data and Google Street View API, from December 15, 2017-May 14, 2018 we retrieved over 16 million GSV images of street intersections across the United States. Computer vision was applied to label each image. We implemented regression models to estimate associations between built environments and county health outcomes, controlling for county-level demographics, economics, and population density. At the county level, greater presence of highways was related to lower chronic diseases and premature mortality. Areas characterized by street view images as 'rural' (having limited infrastructure) had higher obesity, diabetes, fair/poor self-rated health, premature mortality, physical distress, physical inactivity and teen birth rates but lower rates of excessive drinking. Analyses at the census tract level for 500 cities revealed similar adverse associations as was seen at the county level for neighborhood indicators of less urban development. Possible mechanisms include the greater abundance of services and facilities found in more developed areas with roads, enabling access to places and resources for promoting health. GSV images represents an underutilized resource for building national data on neighborhoods and examining the influence of built environments on community health outcomes across the United States.
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Affiliation(s)
- Quynh C Nguyen
- Department of Epidemiology and Biostatistics, University of Maryland School of Public Health, College Park, MD, United States
| | - Sahil Khanna
- Master's in Telecommunications Program, University of Maryland, College Park, MD, United States
| | - Pallavi Dwivedi
- Department of Epidemiology and Biostatistics, University of Maryland School of Public Health, College Park, MD, United States
| | - Dina Huang
- Department of Epidemiology and Biostatistics, University of Maryland School of Public Health, College Park, MD, United States
| | - Yuru Huang
- Department of Epidemiology and Biostatistics, University of Maryland School of Public Health, College Park, MD, United States
| | - Tolga Tasdizen
- Department of Electrical and Computer Engineering & Scientific Computing and Imaging Institute, University of Utah, Salt Lake City, UT, United States
| | - Kimberly D Brunisholz
- Healthcare Delivery Institute, Intermountain Healthcare, Salt Lake City, UT, United States
| | - Feifei Li
- School of Computing, University of Utah, Salt Lake City, UT, United States
| | | | - Thu T Nguyen
- Department of Epidemiology and Biostatistics, University of California San Francisco School of Medicine, San Francisco, United States
| | - Chengsheng Jiang
- Maryland Institute for Applied Environmental Health (MIAEH), University of Maryland, College Park, MD, United States
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Abstract
PURPOSE OF REVIEW The Diabetes Prevention Program (DPP) is an evidence-based lifestyle change program for prediabetes that is associated with a 58% reduction in 3-year diabetes incidence, and it has been supported by the American Medical Association and the Centers for Disease Control and Prevention. However, 9 in 10 patients are unaware they have the condition. RECENT FINDINGS With the passage of the Affordable Care Act (ACA) and broadened coverage for preventive services, the DPP has emerged as an accessible intervention in patients at risk. In 2018, Medicare began to cover the DPP, making it widely available for the first time to any patient over the age of 65 meeting eligibility criteria. The DPP is an evidence-based, widely available, frequently covered benefit, for lifestyle change for patients with prediabetes. To take advantage of this intervention, providers need to develop prediabetes screening and DPP referral workflows.
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Affiliation(s)
- Carolyn Bradner Jasik
- Omada Health, Inc., 500 Sansome Street, San Francisco, CA, 94111, USA.
- Department of Pediatrics, University of California, San Francisco, CA, USA.
| | - Elizabeth Joy
- Community Health, Intermountain Healthcare, 389 S 900 E, Salt Lake City, UT, 84102, USA
- Family & Preventive Medicine, University of Utah, 389 S 900 E, Salt Lake City, UT, 84102, USA
| | - Kimberly D Brunisholz
- Institute for Healthcare Delivery Research, Intermountain Healthcare, 389 S 900 E, Salt Lake City, UT, 84102, USA
- Division of Epidemiology, University of Utah, 389 S 900 E, Salt Lake City, UT, 84102, USA
| | - Katherine Kirley
- American Medical Association, American Medical Association 330 N Wabash Ave, Chicago, IL, 60611, USA
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Brunisholz KD, Olson J, Anderson JW, Hays E, Tilbury PM, Winter B, Rickard J, Hamilton S, Parkin G. "Pharming out" support: a promising approach to integrating clinical pharmacists into established primary care medical home practices. J Int Med Res 2017; 46:234-248. [PMID: 28789606 PMCID: PMC6011325 DOI: 10.1177/0300060517710885] [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] [Indexed: 11/17/2022] Open
Abstract
Objective Embedding clinical pharmacists into ambulatory care settings needs to be assessed in the context of established medical home models. Methods A retrospective, observational study examined the effectiveness of the Intermountain Healthcare Collaborative Pharmacist Support Services (CPSS) program from 2012–2015 among adult patients diagnosed with diabetes mellitus (DM) and/or high blood pressure (HBP). Patients who attended this program were considered the intervention (CPSS) cohort. These patients were matched using propensity scores with a reference group (no-CPSS cohort) to determine the effect of achieving disease management goals and time to achievement. Results A total of 17,684 patients had an in-person office visit with their provider and 359 received CPSS (the matched no-CPSS cohort included 999 patients). CPSS patients were 93% more likely to achieve a blood pressure goal < 140/90 mmHg, 57% more likely to achieve HbA1c values < 8%, and 87% more likely to achieve both disease management goals compared with the reference group. Time to goal achievement demonstrated increasing separation between the study cohorts across the entire study period (P < .001), and specifically, at 180 days post-intervention (HBP: 48% vs 27% P < .001 and DM: 39% vs 30%, P < .05). Conclusions CPSS participation is associated with significant improvement in achievement of disease management goals, time to achievement, and increased ambulatory encounters compared with the matched no-CPSS cohort.
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Affiliation(s)
| | - Jeff Olson
- 1 Intermountain Healthcare, Salt Lake City, UT, USA
| | | | - Emily Hays
- 1 Intermountain Healthcare, Salt Lake City, UT, USA
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18
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Brunisholz KD, Kim J, Savitz LA, Hashibe M, Gren LH, Hamilton S, Huynh K, Joy EA. A Formative Evaluation of a Diabetes Prevention Program Using the RE-AIM Framework in a Learning Health Care System, Utah, 2013-2015. Prev Chronic Dis 2017; 14:E58. [PMID: 28727546 PMCID: PMC5524524 DOI: 10.5888/pcd14.160556] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Introduction Evaluation of interventions can help to close the gap between research and practice but seldom takes place during implementation. Using the RE-AIM framework, we conducted a formative evaluation of the first year of the Intermountain Healthcare Diabetes Prevention Program (DPP). Methods Adult patients who met the criteria for prediabetes (HbA1c of 5.70%–6.49% or fasting plasma glucose of 100–125 mg/dL) were attributed to a primary care provider from August 1, 2013, through July 31, 2014. Physicians invited eligible patients to participate in the program during an office visit. We evaluated 1) reach, with data on patient eligibility, participation, and representativeness; 2) effectiveness, with data on attaining a 5% weight loss; 3) adoption, with data on providers and clinics that referred patients to the program; and 4) implementation, with data on patient encounters. We did not measure maintenance. Results Of the 6,862 prediabetes patients who had an in-person office visit with their provider, 8.4% of eligible patients enrolled. Likelihood of participation was higher among patients who were female, aged 70 years or older, or overweight; had depression and higher weight at study enrollment; or were prescribed metformin. DPP participants were more likely than nonparticipants to achieve a 5% weight loss (odds ratio, 1.70; 95% confidence interval, 1.29–2.25; P < .001). Providers from 7 of 8 regions referred patients to the DPP; 174 providers at 53 clinics enrolled patients. The mean number of DPP counseling encounters per patient was 2.3 (range, 1–16). Conclusion The RE-AIM framework was useful for estimating the formative impact (ie, reach, effectiveness, adoption, and implementation fidelity) of a DPP-based lifestyle intervention deployed in a learning health care system.
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Affiliation(s)
- Kimberly D Brunisholz
- Institute for Healthcare Delivery Research, Intermountain Healthcare, 36 South State St, Salt Lake City, UT 84111. .,University of Utah, Salt Lake City, Utah
| | | | - Lucy A Savitz
- Intermountain Healthcare, Salt Lake City, Utah.,University of Utah, Salt Lake City, Utah
| | | | | | | | - Kelly Huynh
- Intermountain Healthcare, Salt Lake City, Utah
| | - Elizabeth A Joy
- Intermountain Healthcare, Salt Lake City, Utah.,University of Utah, Salt Lake City, Utah
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May HT, Reiss-Brennan B, Brunisholz KD, Horne BD. Clinically Feasible Stratification of 3-Year Chronic Disease Risk in Primary Care: The Mental Health Integration Risk Score. Psychosomatics 2017; 58:395-405. [DOI: 10.1016/j.psym.2017.03.001] [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] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Revised: 03/02/2017] [Accepted: 03/02/2017] [Indexed: 02/04/2023]
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20
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May HT, Bair TL, Reiss-Brennan B, Knight S, Anderson JL, Horne BD, Brunisholz KD, Muhlestein JB. The association of antidepressant and statin use with death and incident cardiovascular disease varies by depression severity. PSYCHOL HEALTH MED 2017; 22:919-931. [DOI: 10.1080/13548506.2017.1281975] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Heidi T. May
- Intermountain Medical Center, Intermountain Heart Institute, Murray, UT, USA
| | - Tami L. Bair
- Intermountain Medical Center, Intermountain Heart Institute, Murray, UT, USA
| | | | - Stacey Knight
- Intermountain Medical Center, Intermountain Heart Institute, Murray, UT, USA
- Department of Medicine, University of Utah, Salt Lake City, UT, USA
| | - Jeffrey L. Anderson
- Intermountain Medical Center, Intermountain Heart Institute, Murray, UT, USA
- Department of Medicine, University of Utah, Salt Lake City, UT, USA
| | - Benjamin D. Horne
- Intermountain Medical Center, Intermountain Heart Institute, Murray, UT, USA
- Department of Medicine, University of Utah, Salt Lake City, UT, USA
| | | | - Joseph B. Muhlestein
- Intermountain Medical Center, Intermountain Heart Institute, Murray, UT, USA
- Department of Medicine, University of Utah, Salt Lake City, UT, USA
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Reiss-Brennan B, Brunisholz KD, Dredge C, Briot P, Grazier K, Wilcox A, Savitz L, James B. Association of Integrated Team-Based Care With Health Care Quality, Utilization, and Cost. JAMA 2016; 316:826-34. [PMID: 27552616 DOI: 10.1001/jama.2016.11232] [Citation(s) in RCA: 173] [Impact Index Per Article: 21.6] [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] [Indexed: 11/14/2022]
Abstract
IMPORTANCE The value of integrated team delivery models is not firmly established. OBJECTIVE To evaluate the association of receiving primary care in integrated team-based care (TBC) practices vs traditional practice management (TPM) practices (usual care) with patient outcomes, health care utilization, and costs. DESIGN A retrospective, longitudinal, cohort study to assess the association of integrating physical and mental health over time in TBC practices with patient outcomes and costs. SETTING AND PARTICIPANTS Adult patients (aged ≥18 years) who received primary care at 113 unique Intermountain Healthcare Medical Group primary care practices from 2003 through 2005 and had yearly encounters with Intermountain Healthcare through 2013, including some patients who received care in both TBC and TPM practices. EXPOSURES Receipt of primary care in TBC practices compared with TPM practices for patients treated in internal medicine, family practice, and geriatrics practices. MAIN OUTCOMES AND MEASURES Outcomes included 7 quality measures, 6 health care utilization measures, payments to the delivery system, and program investment costs. RESULTS During the study period (January 2010-December 2013), 113,452 unique patients (mean age, 56.1 years; women, 58.9%) accounted for 163,226 person-years of exposure in 27 TBC practices and 171,915 person-years in 75 TPM practices. Patients treated in TBC practices compared with those treated in TPM practices had higher rates of active depression screening (46.1% for TBC vs 24.1% for TPM; odds ratio [OR], 1.91 [95% CI, 1.75 to 2.08), adherence to a diabetes care bundle (24.6% for TBC vs 19.5% for TPM; OR, 1.26 [95% CI, 1.11 to 1.42]), and documentation of self-care plans (48.4% for TBC vs 8.7% for TPM; OR, 5.59 [95% CI, 4.27 to 7.33]), lower proportion of patients with controlled hypertension (<140/90 mm Hg) (85.0% for TBC vs 97.7% for TPM; OR, 0.87 [95% CI, 0.80 to 0.95]), and no significant differences in documentation of advanced directives (9.6% for TBC vs 9.9% for TPM; OR, 0.97 [95% CI, 0.91 to 1.03]). Per 100 person-years, rates of health care utilization were lower for TBC patients compared with TPM patients for emergency department visits (18.1 for TBC vs 23.5 for TPM; incidence rate ratio [IRR], 0.77 [95% CI, 0.74 to 0.80]), hospital admissions (9.5 for TBC vs 10.6 for TPM; IRR, 0.89 [95% CI, 0.85 to 0.94]), ambulatory care sensitive visits and admissions (3.3 for TBC vs 4.3 for TPM; IRR, 0.77 [95% CI, 0.70 to 0.85]), and primary care physician encounters (232.8 for TBC vs 250.4 for TPM; IRR, 0.93 [95% CI, 0.92 to 0.94]), with no significant difference in visits to urgent care facilities (55.7 for TBC vs 56.2 for TPM; IRR, 0.99 [95% CI, 0.97 to 1.02]) and visits to specialty care physicians (213.5 for TBC vs 217.9 for TPM; IRR, 0.98 [95% CI, 0.97 to 0.99], P > .008). Payments to the delivery system were lower in the TBC group vs the TPM group ($3400.62 for TBC vs $3515.71 for TPM; β, -$115.09 [95% CI, -$199.64 to -$30.54]) and were less than investment costs of the TBC program. CONCLUSIONS AND RELEVANCE Among adults enrolled in an integrated health care system, receipt of primary care at TBC practices compared with TPM practices was associated with higher rates of some measures of quality of care, lower rates for some measures of acute care utilization, and lower actual payments received by the delivery system.
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Affiliation(s)
| | | | | | - Pascal Briot
- Intermountain Healthcare, Salt Lake City, Utah2Institut Driot et Sante, Paris, France
| | | | - Adam Wilcox
- Intermountain Healthcare, Salt Lake City, Utah
| | - Lucy Savitz
- Intermountain Healthcare, Salt Lake City, Utah
| | - Brent James
- Intermountain Healthcare, Salt Lake City, Utah
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Brunisholz KD, Joy EA, Hashibe M, Gren LH, Savitz LA, Hamilton S, Cannon W, Kim J. Incidental Risk of Type 2 Diabetes Mellitus among Patients with Confirmed and Unconfirmed Prediabetes. PLoS One 2016; 11:e0157729. [PMID: 27427913 PMCID: PMC4948775 DOI: 10.1371/journal.pone.0157729] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2015] [Accepted: 06/04/2016] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE To determine the risk of type 2 diabetes (T2DM) diagnosis among patients with confirmed and unconfirmed prediabetes (preDM) relative to an at-risk group receiving care from primary care physicians over a 5-year period. STUDY DESIGN Utilizing data from the Intermountain Healthcare (IH) Enterprise Data Warehouse (EDW) from 2006-2013, we performed a prospective analysis using discrete survival analysis to estimate the time to diagnosis of T2DM among groups. POPULATION STUDIED Adult patients who had at least one outpatient visit with a primary care physician during 2006-2008 at an IH clinic and subsequent visits through 2013. Patients were included for the study if they were (a) at-risk for diabetes (BMI ≥ 25 kg/m2 and one additional risk factor: high risk ethnicity, first degree relative with diabetes, elevated triglycerides or blood pressure, low HDL, diagnosis of gestational diabetes or polycystic ovarian syndrome, or birth of a baby weighing >9 lbs); or (b) confirmed preDM (HbA1c ≥ 5.7-6.49% or fasting blood glucose 100-125 mg/dL); or (c) unconfirmed preDM (documented fasting lipid panel and glucose 100-125 mg/dL on the same day). PRINCIPAL FINDINGS Of the 33,838 patients who were eligible for study, 57.0% were considered at-risk, 38.4% had unconfirmed preDM, and 4.6% had confirmed preDM. Those with unconfirmed and confirmed preDM tended to be Caucasian and a greater proportion were obese compared to those at-risk for disease. Patients with unconfirmed and confirmed preDM tended to have more prevalent high blood pressure and depression as compared to the at-risk group. Based on the discrete survival analyses, patients with unconfirmed preDM and confirmed preDM were more likely to develop T2DM when compared to at-risk patients. CONCLUSIONS Unconfirmed and confirmed preDM are strongly associated with the development of T2DM as compared to patients with only risk factors for disease.
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Affiliation(s)
- Kimberly D. Brunisholz
- Institute for Healthcare Delivery Research, Intermountain Healthcare, Salt Lake City, Utah, United States of America
- Division of Public Health, School of Medicine, University of Utah, Salt Lake City, Utah, United States of America
- Primary Care Clinical Program, Intermountain Healthcare, Salt Lake City, Utah, United States of America
- Office of Research, Intermountain Healthcare, Salt Lake City, Utah, United States of America
- * E-mail:
| | - Elizabeth A. Joy
- Office of Research, Intermountain Healthcare, Salt Lake City, Utah, United States of America
| | - Mia Hashibe
- Division of Public Health, School of Medicine, University of Utah, Salt Lake City, Utah, United States of America
| | - Lisa H. Gren
- Division of Public Health, School of Medicine, University of Utah, Salt Lake City, Utah, United States of America
| | - Lucy A. Savitz
- Institute for Healthcare Delivery Research, Intermountain Healthcare, Salt Lake City, Utah, United States of America
| | - Sharon Hamilton
- Primary Care Clinical Program, Intermountain Healthcare, Salt Lake City, Utah, United States of America
| | - Wayne Cannon
- Primary Care Clinical Program, Intermountain Healthcare, Salt Lake City, Utah, United States of America
| | - Jaewhan Kim
- Division of Public Health, School of Medicine, University of Utah, Salt Lake City, Utah, United States of America
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Brunisholz KD, Briot P, Hamilton S, Joy EA, Lomax M, Barton N, Cunningham R, Savitz LA, Cannon W. Diabetes self-management education improves quality of care and clinical outcomes determined by a diabetes bundle measure. J Multidiscip Healthc 2014; 7:533-42. [PMID: 25473293 PMCID: PMC4247143 DOI: 10.2147/jmdh.s69000] [Citation(s) in RCA: 89] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
PURPOSE The purpose of this study was to determine the impact of diabetes self-management education (DSME) in improving processes and outcomes of diabetes care as measured by a five component diabetes bundle and HbA1c, in individuals with type 2 diabetes mellitus (T2DM). METHODS A retrospective analysis was performed for adult T2DM patients who received DSME training in 2011-2012 from an accredited American Diabetes Association center at Intermountain Healthcare (IH) and had an HbA1c measurement within the prior 3 months and 2-6 months after completing their first DSME visit. Control patients were selected from the same clinics as case-patients using random number generator to achieve a 1 to 4 ratio. Case and control patients were included if 1) pre-education HbA1c was between 6.0%-14.0%; 2) their main provider was a primary care physician; 3) they met the national Healthcare Effectiveness Data and Information Set criteria for inclusion in the IH diabetes registry. The IH diabetes bundle includes retinal eye exam, nephropathy screening or prescription of angiotensin converting enzyme or angiotensin receptor blocker; blood pressure <140/90 mmHg, LDL <100 mg/dL, HbA1c <8.0%. RESULTS DSME patients had a significant difference in achievement of the five element IH diabetes bundle and in HbA1c % compared to those without DSME. After adjusting for possible confounders in a multivariate logistic regression model, DSME patients had a 1.5 fold difference in improvement in their diabetes bundle and almost a 3 fold decline in HbA1c compared to the control group. CONCLUSION Standardized DSME taught within an IH American Diabetes Association center is strongly associated with a substantial improvement in patients meeting all five elements of a diabetes bundle and a decline in HbA1c beyond usual care. Given the low operating cost of the DSME program, these results strongly support the value adding benefit of this program in treating T2DM patients.
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Affiliation(s)
- Kimberly D Brunisholz
- Primary Care Clinical Program, Intermountain Healthcare, Salt Lake City, UT, USA ; Institute for Healthcare Delivery, Intermountain Healthcare, Salt Lake City, UT, USA
| | - Pascal Briot
- Primary Care Clinical Program, Intermountain Healthcare, Salt Lake City, UT, USA ; Institute for Healthcare Delivery, Intermountain Healthcare, Salt Lake City, UT, USA
| | - Sharon Hamilton
- Primary Care Clinical Program, Intermountain Healthcare, Salt Lake City, UT, USA
| | - Elizabeth A Joy
- Office of Research, Intermountain Healthcare, Salt Lake City, UT, USA
| | - Michael Lomax
- Institute for Healthcare Delivery, Intermountain Healthcare, Salt Lake City, UT, USA
| | - Nathan Barton
- Institute for Healthcare Delivery, Intermountain Healthcare, Salt Lake City, UT, USA
| | | | - Lucy A Savitz
- Institute for Healthcare Delivery, Intermountain Healthcare, Salt Lake City, UT, USA
| | - Wayne Cannon
- Primary Care Clinical Program, Intermountain Healthcare, Salt Lake City, UT, USA
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Woller SC, Stevens SM, Towner S, Olson J, Christensen P, Hamilton S, Newman L, Mott L, Hu P, Brunisholz KD, Long Y, Lloyd J, Evans RS, Cannon W, Elliott CG. Computerized clinical decision support improves warfarin management and decreases recurrent venous thromboembolism. Clin Appl Thromb Hemost 2014; 21:197-203. [PMID: 25228672 DOI: 10.1177/1076029614550818] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [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: 12/29/2022] Open
Abstract
BACKGROUND An explicit approach to warfarin dose adjustment using computerized clinical decision support (CDS) improves warfarin management. We report metrics of quality for warfarin management before and after implementation of CDS in a large health care system. METHODS A total of 2591 chronically anticoagulated patients were eligible for inclusion. We compared interpatient time in therapeutic range (TTR) and international normalized ratio (INR) variability before and after implementation of CDS. We report outcomes of major bleeding, thrombosis, and health care utilization. RESULTS Implementation of CDS significantly improved TTR (from 63.99% to 65.13%; P = .04) and reduced out-of-range INRs (from 42.39% to 39.97%; P < .001). Venous thromboembolism (relative risk [RR] 0.41; P < .001) emergency department utilization (RR 0.62; P < .001), and hospitalization (RR 0.62; P < .001) were reduced after CDS implementation. Major hemorrhage was more frequent after CDS implementation (RR 1.42; P = .01). CONCLUSION The CDS warfarin management was associated with improved TTR and decreased INR variability in a large cohort of chronically anticoagulated patients. Clinically relevant outcomes were broadly improved, although more bleeding events were observed.
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Affiliation(s)
- Scott C Woller
- Department of Medicine, Intermountain Medical Center, Murray, UT, USA Department of Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Scott M Stevens
- Department of Medicine, Intermountain Medical Center, Murray, UT, USA Department of Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Steven Towner
- Intermountain Healthcare Salt Lake Clinic, Salt Lake City, UT, USA
| | - Jeff Olson
- Department of Pharmacy, Intermountain Medical Center, Murray, UT, USA
| | | | | | | | - Loren Mott
- Intermountain Healthcare, Salt Lake City, UT, USA
| | - Ping Hu
- Intermountain Healthcare Homer Warner Center for Medical Informatics, Murray, UT, USA
| | | | - Yenh Long
- Department of Pharmacy, Intermountain Medical Center, Murray, UT, USA Roseman University of Health Sciences, South Jordan, UT, USA
| | - Jim Lloyd
- Medical Informatics, Intermountain Healthcare, Salt Lake City, UT, USA
| | - R Scott Evans
- Medical Informatics, Intermountain Healthcare, Salt Lake City, UT, USA
| | - Wayne Cannon
- Intermountain Healthcare, Salt Lake City, UT, USA
| | - C Greg Elliott
- Department of Medicine, Intermountain Medical Center, Murray, UT, USA Department of Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA
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Holmes MV, Simon T, Exeter HJ, Folkersen L, Asselbergs FW, Guardiola M, Cooper JA, Palmen J, Hubacek JA, Carruthers KF, Horne BD, Brunisholz KD, Mega JL, van Iperen EPA, Li M, Leusink M, Trompet S, Verschuren JJW, Hovingh GK, Dehghan A, Nelson CP, Kotti S, Danchin N, Scholz M, Haase CL, Rothenbacher D, Swerdlow DI, Kuchenbaecker KB, Staines-Urias E, Goel A, van 't Hooft F, Gertow K, de Faire U, Panayiotou AG, Tremoli E, Baldassarre D, Veglia F, Holdt LM, Beutner F, Gansevoort RT, Navis GJ, Mateo Leach I, Breitling LP, Brenner H, Thiery J, Dallmeier D, Franco-Cereceda A, Boer JMA, Stephens JW, Hofker MH, Tedgui A, Hofman A, Uitterlinden AG, Adamkova V, Pitha J, Onland-Moret NC, Cramer MJ, Nathoe HM, Spiering W, Klungel OH, Kumari M, Whincup PH, Morrow DA, Braund PS, Hall AS, Olsson AG, Doevendans PA, Trip MD, Tobin MD, Hamsten A, Watkins H, Koenig W, Nicolaides AN, Teupser D, Day INM, Carlquist JF, Gaunt TR, Ford I, Sattar N, Tsimikas S, Schwartz GG, Lawlor DA, Morris RW, Sandhu MS, Poledne R, Maitland-van der Zee AH, Khaw KT, Keating BJ, van der Harst P, Price JF, Mehta SR, Yusuf S, Witteman JCM, Franco OH, Jukema JW, de Knijff P, Tybjaerg-Hansen A, Rader DJ, Farrall M, Samani NJ, Kivimaki M, Fox KAA, Humphries SE, Anderson JL, Boekholdt SM, Palmer TM, Eriksson P, Paré G, Hingorani AD, Sabatine MS, Mallat Z, Casas JP, Talmud PJ. Secretory phospholipase A(2)-IIA and cardiovascular disease: a mendelian randomization study. J Am Coll Cardiol 2013; 62:1966-1976. [PMID: 23916927 PMCID: PMC3826105 DOI: 10.1016/j.jacc.2013.06.044] [Citation(s) in RCA: 96] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2013] [Revised: 05/22/2013] [Accepted: 06/27/2013] [Indexed: 11/19/2022]
Abstract
OBJECTIVES This study sought to investigate the role of secretory phospholipase A2 (sPLA2)-IIA in cardiovascular disease. BACKGROUND Higher circulating levels of sPLA2-IIA mass or sPLA2 enzyme activity have been associated with increased risk of cardiovascular events. However, it is not clear if this association is causal. A recent phase III clinical trial of an sPLA2 inhibitor (varespladib) was stopped prematurely for lack of efficacy. METHODS We conducted a Mendelian randomization meta-analysis of 19 general population studies (8,021 incident, 7,513 prevalent major vascular events [MVE] in 74,683 individuals) and 10 acute coronary syndrome (ACS) cohorts (2,520 recurrent MVE in 18,355 individuals) using rs11573156, a variant in PLA2G2A encoding the sPLA2-IIA isoenzyme, as an instrumental variable. RESULTS PLA2G2A rs11573156 C allele associated with lower circulating sPLA2-IIA mass (38% to 44%) and sPLA2 enzyme activity (3% to 23%) per C allele. The odds ratio (OR) for MVE per rs11573156 C allele was 1.02 (95% confidence interval [CI]: 0.98 to 1.06) in general populations and 0.96 (95% CI: 0.90 to 1.03) in ACS cohorts. In the general population studies, the OR derived from the genetic instrumental variable analysis for MVE for a 1-log unit lower sPLA2-IIA mass was 1.04 (95% CI: 0.96 to 1.13), and differed from the non-genetic observational estimate (OR: 0.69; 95% CI: 0.61 to 0.79). In the ACS cohorts, both the genetic instrumental variable and observational ORs showed a null association with MVE. Instrumental variable analysis failed to show associations between sPLA2 enzyme activity and MVE. CONCLUSIONS Reducing sPLA2-IIA mass is unlikely to be a useful therapeutic goal for preventing cardiovascular events.
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Affiliation(s)
- Michael V Holmes
- Faculty of Population Health Sciences, University College London, London, United Kingdom.
| | - Tabassome Simon
- Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Saint-Antoine, Department of Clinical Pharmacology, URC-EST, Paris, France; Université Pierre et Marie Curie, Paris, France; INSERM, U 698, Paris, France
| | - Holly J Exeter
- Centre for Cardiovascular Genetics, Institute of Cardiovascular Science, University College London, London, United Kingdom
| | - Lasse Folkersen
- Atherosclerosis Research Unit, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden; Center for Molecular Medicine, Karolinska University Hospital Solna, Stockholm, Sweden
| | - Folkert W Asselbergs
- Department of Cardiology, Division Heart and Lungs, University Medical Center Utrecht, Utrecht, the Netherlands; Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, the Netherlands; Durrer Center for Cardiogenetic Research, Amsterdam, the Netherlands
| | - Montse Guardiola
- Unitat de Recerca en Lípids i Arteriosclerosi, IISPV, Universitat Rovira i Virgili, CIBERDEM, Reus, Spain
| | - Jackie A Cooper
- Centre for Cardiovascular Genetics, Institute of Cardiovascular Science, University College London, London, United Kingdom
| | - Jutta Palmen
- Centre for Cardiovascular Genetics, Institute of Cardiovascular Science, University College London, London, United Kingdom
| | - Jaroslav A Hubacek
- Center for Experimental Medicine, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Kathryn F Carruthers
- Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, Scotland, United Kingdom
| | - Benjamin D Horne
- Intermountain Heart Institute, Intermountain Medical Center, Salt Lake City, Utah; Department of Medicine, University of Utah School of Medicine, Salt Lake City, Utah
| | | | - Jessica L Mega
- TIMI Study Group, Divison of Cardiovascular Medicine, Brigham and Women's Hospital & Harvard Medical School, Boston, Massachusetts
| | - Erik P A van Iperen
- Durrer Center for Cardiogenetic Research, Amsterdam, the Netherlands; Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Mingyao Li
- Department of Biostatistics & Epidemiology, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
| | - Maarten Leusink
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, the Netherlands
| | - Stella Trompet
- Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands; Department of Gerontology and Geriatrics, Leiden University Medical Center, Leiden, the Netherlands
| | | | - G Kees Hovingh
- Department of Vascular Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Abbas Dehghan
- Department of Epidemiology, Erasmus Medical Center, Rotterdam, the Netherlands; Member of the Netherlands Consortium on Healthy Aging (NCHA), Leiden, the Netherlands
| | - Christopher P Nelson
- Department of Cardiovascular Sciences, University of Leicester, Leicester, United Kingdom; Leicester NIHR Biomedical Research Unit in Cardiovascular Disease, Glenfield Hospital, Leicester, United Kingdom
| | - Salma Kotti
- Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Saint-Antoine, Department of Clinical Pharmacology, URC-EST, Paris, France
| | - Nicolas Danchin
- Assistance Publique Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Department of Cardiology, Paris, France; Université Paris Descartes, Paris V, Paris, France
| | - Markus Scholz
- Institute for Medical Informatics, Statistics and Epidemiology, University of Leipzig, Leipzig, Germany; LIFE: Leipzig Research Center for Civilization Diseases, University of Leipzig, Leipzig, Germany
| | - Christiane L Haase
- Department of Clinical Biochemistry, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Dietrich Rothenbacher
- Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany; Division of Clinical Epidemiology & Aging Research, German Cancer Research Center, Heidelberg, Germany
| | - Daniel I Swerdlow
- Faculty of Population Health Sciences, University College London, London, United Kingdom
| | - Karoline B Kuchenbaecker
- Centre for Cancer Genetic Epidemiology, Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom
| | - Eleonora Staines-Urias
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Anuj Goel
- Wellcome Trust Centre for Human Genetics, University of Oxford, Oxford, United Kingdom; Department of Cardiovascular Medicine, University of Oxford, Oxford, United Kingdom
| | - Ferdinand van 't Hooft
- Atherosclerosis Research Unit, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden; Center for Molecular Medicine, Karolinska University Hospital Solna, Stockholm, Sweden
| | - Karl Gertow
- Atherosclerosis Research Unit, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden; Center for Molecular Medicine, Karolinska University Hospital Solna, Stockholm, Sweden
| | - Ulf de Faire
- Division of Cardiovascular Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Andrie G Panayiotou
- Cyprus Cardiovascular Educational and Research Trust, Nicosia, Cyprus and Cyprus International Institute for Environmental and Public Health in association with the Harvard School of Public Health, Cyprus University of Technology, Limassol, Cyprus
| | - Elena Tremoli
- Dipartimento di Scienze Farmacologiche e Biomolecolari, Universitá di Milano, Milan, Italy; Centro Cardiologico Monzino, IRCCS, Milan, Italy
| | - Damiano Baldassarre
- Dipartimento di Scienze Farmacologiche e Biomolecolari, Universitá di Milano, Milan, Italy; Centro Cardiologico Monzino, IRCCS, Milan, Italy
| | | | - Lesca M Holdt
- LIFE: Leipzig Research Center for Civilization Diseases, University of Leipzig, Leipzig, Germany; Institute of Laboratory Medicine, Clinical Chemistry and Molecular Diagnostics, University Hospital Leipzig, Leipzig, Germany; Institute of Laboratory Medicine, University Hospital Munich (LMU), Ludwig-Maximilians-University Munich, Munich, Germany
| | - Frank Beutner
- LIFE: Leipzig Research Center for Civilization Diseases, University of Leipzig, Leipzig, Germany; Department of Internal Medicine/Cardiology, Heart Center, University of Leipzig, Leipzig, Germany
| | - Ron T Gansevoort
- University Medical Center Groningen, University of Groningen, Department of Internal Medicine, Groningen, the Netherlands
| | - Gerjan J Navis
- University Medical Center Groningen, University of Groningen, Department of Internal Medicine, Groningen, the Netherlands
| | - Irene Mateo Leach
- University Medical Center Groningen, University of Groningen, Department of Cardiology, Groningen, the Netherlands
| | - Lutz P Breitling
- Division of Clinical Epidemiology & Aging Research, German Cancer Research Center, Heidelberg, Germany
| | - Hermann Brenner
- Division of Clinical Epidemiology & Aging Research, German Cancer Research Center, Heidelberg, Germany
| | - Joachim Thiery
- LIFE: Leipzig Research Center for Civilization Diseases, University of Leipzig, Leipzig, Germany; Institute of Laboratory Medicine, Clinical Chemistry and Molecular Diagnostics, University Hospital Leipzig, Leipzig, Germany
| | - Dhayana Dallmeier
- Department of Internal Medicine II-Cardiology, University of Ulm Medical Center, Ulm, Germany
| | - Anders Franco-Cereceda
- Cardiothoracic Surgery Unit, Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Jolanda M A Boer
- Department for Nutrition and Health, National Institute for Public Health and the Environment, Bilthoven, the Netherlands
| | - Jeffrey W Stephens
- Diabetes Research Group, Institute of Life Sciences, College of Medicine, Swansea University, Swansea, Wales, United Kingdom
| | - Marten H Hofker
- Department of Pathology and Medical Biology, Medical Biology Section, Molecular Genetics, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Alain Tedgui
- Inserm U970, Paris-Cardiovascular Research Center, Paris, France
| | - Albert Hofman
- Department of Epidemiology, Erasmus Medical Center, Rotterdam, the Netherlands; Member of the Netherlands Consortium on Healthy Aging (NCHA), Leiden, the Netherlands
| | - André G Uitterlinden
- Member of the Netherlands Consortium on Healthy Aging (NCHA), Leiden, the Netherlands; Department of Internal Medicine, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Vera Adamkova
- Center for Experimental Medicine, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Jan Pitha
- Center for Experimental Medicine, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - N Charlotte Onland-Moret
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, the Netherlands
| | - Maarten J Cramer
- Department of Cardiology, Division Heart and Lungs, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Hendrik M Nathoe
- Department of Cardiology, Division Heart and Lungs, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Wilko Spiering
- Department of Vascular Medicine, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Olaf H Klungel
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, the Netherlands
| | - Meena Kumari
- Faculty of Population Health Sciences, University College London, London, United Kingdom
| | - Peter H Whincup
- Division of Population Health Sciences and Education, St George's, University of London, London, United Kingdom
| | - David A Morrow
- TIMI Study Group, Divison of Cardiovascular Medicine, Brigham and Women's Hospital & Harvard Medical School, Boston, Massachusetts
| | - Peter S Braund
- Department of Cardiovascular Sciences, University of Leicester, Leicester, United Kingdom
| | - Alistair S Hall
- Leeds Institute of Genetics, Health and Therapeutics, University of Leeds, Leeds, United Kingdom
| | - Anders G Olsson
- Stockholm Heart Center, Stockholm, and Linköping University, Linkőping, Sweden
| | - Pieter A Doevendans
- Department of Cardiology, Division Heart and Lungs, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Mieke D Trip
- Department of Cardiology, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Martin D Tobin
- Departments of Health Sciences & Genetics, University of Leicester, Leicester, United Kingdom
| | - Anders Hamsten
- Atherosclerosis Research Unit, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden; Center for Molecular Medicine, Karolinska University Hospital Solna, Stockholm, Sweden
| | - Hugh Watkins
- Wellcome Trust Centre for Human Genetics, University of Oxford, Oxford, United Kingdom; Department of Cardiovascular Medicine, University of Oxford, Oxford, United Kingdom
| | - Wolfgang Koenig
- Department of Internal Medicine II-Cardiology, University of Ulm Medical Center, Ulm, Germany
| | - Andrew N Nicolaides
- Department of Vascular Surgery, Imperial College, London, United Kingdom; Cyprus Cardiovascular Educational and Research Trust, Nicosia, Cyprus
| | - Daniel Teupser
- LIFE: Leipzig Research Center for Civilization Diseases, University of Leipzig, Leipzig, Germany; Institute of Laboratory Medicine, Clinical Chemistry and Molecular Diagnostics, University Hospital Leipzig, Leipzig, Germany; Institute of Laboratory Medicine, University Hospital Munich (LMU), Ludwig-Maximilians-University Munich, Munich, Germany
| | - Ian N M Day
- Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Saint-Antoine, Department of Clinical Pharmacology, URC-EST, Paris, France
| | - John F Carlquist
- Intermountain Heart Institute, Intermountain Medical Center, Salt Lake City, Utah; Department of Medicine, University of Utah School of Medicine, Salt Lake City, Utah
| | - Tom R Gaunt
- MRC Centre for Causal Analyses in Translational Epidemiology (CAiTE), and Bristol Genetic Epidemiology Laboratories (BGEL), School of Social and Community Medicine, University of Bristol, Bristol, United Kingdom
| | - Ian Ford
- Robertson Centre for Biostatistics, University of Glasgow, Glasgow, Scotland, United Kingdom
| | - Naveed Sattar
- British Heart Foundation Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, Scotland, United Kingdom
| | - Sotirios Tsimikas
- Division of Cardiovascular Diseases, Department of Medicine, University of California San Diego, La Jolla, California
| | - Gregory G Schwartz
- VA Medical Center and University of Colorado School of Medicine, Denver, Colorado
| | - Debbie A Lawlor
- MRC Centre for Causal Analyses in Translational Epidemiology (CAiTE), and Bristol Genetic Epidemiology Laboratories (BGEL), School of Social and Community Medicine, University of Bristol, Bristol, United Kingdom
| | - Richard W Morris
- Department of Primary Care & Population Health, University College London, Royal Free Campus, London, United Kingdom
| | - Manjinder S Sandhu
- VA Medical Center and University of Colorado School of Medicine, Denver, Colorado
| | - Rudolf Poledne
- Center for Experimental Medicine, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Anke H Maitland-van der Zee
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, the Netherlands
| | - Kay-Tee Khaw
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom
| | - Brendan J Keating
- Center for Applied Genomics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Pim van der Harst
- University Medical Center Groningen, University of Groningen, Department of Cardiology, Groningen, the Netherlands
| | - Jackie F Price
- Centre for Population Health Sciences, University of Edinburgh, United Kingdom
| | - Shamir R Mehta
- Department of Clinical Epidemiology & Biostatistics, McMaster University, Hamilton, Ontario, Canada; Department of Medicine, McMaster University, Hamilton, Ontario, Canada; Interventional Cardiology, McMaster University, Hamilton, Ontario, Canada; Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, Ontario, Canada
| | - Salim Yusuf
- Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, Ontario, Canada
| | - Jaqueline C M Witteman
- Department of Epidemiology, Erasmus Medical Center, Rotterdam, the Netherlands; Member of the Netherlands Consortium on Healthy Aging (NCHA), Leiden, the Netherlands
| | - Oscar H Franco
- Department of Epidemiology, Erasmus Medical Center, Rotterdam, the Netherlands; Member of the Netherlands Consortium on Healthy Aging (NCHA), Leiden, the Netherlands
| | - J Wouter Jukema
- Durrer Center for Cardiogenetic Research, Amsterdam, the Netherlands; Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands; Interuniversity Cardiology Institute of the Netherlands, Utrecht, the Netherlands
| | - Peter de Knijff
- Department of Human Genetics, Leiden University Medical Center, Leiden, the Netherlands
| | - Anne Tybjaerg-Hansen
- Department of Clinical Biochemistry, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Daniel J Rader
- Preventive Cardiovascular Medicine, Penn Heart and Vascular Center, Philadelphia, Pennsylvania
| | - Martin Farrall
- Wellcome Trust Centre for Human Genetics, University of Oxford, Oxford, United Kingdom; Department of Cardiovascular Medicine, University of Oxford, Oxford, United Kingdom
| | - Nilesh J Samani
- Department of Cardiovascular Sciences, University of Leicester, Leicester, United Kingdom; Leicester NIHR Biomedical Research Unit in Cardiovascular Disease, Glenfield Hospital, Leicester, United Kingdom
| | - Mika Kivimaki
- Faculty of Population Health Sciences, University College London, London, United Kingdom
| | - Keith A A Fox
- Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, Scotland, United Kingdom
| | - Steve E Humphries
- Centre for Cardiovascular Genetics, Institute of Cardiovascular Science, University College London, London, United Kingdom
| | - Jeffrey L Anderson
- Intermountain Heart Institute, Intermountain Medical Center, Salt Lake City, Utah; Department of Medicine, University of Utah School of Medicine, Salt Lake City, Utah
| | - S Matthijs Boekholdt
- Department of Cardiology, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Tom M Palmer
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, United Kingdom
| | - Per Eriksson
- Atherosclerosis Research Unit, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden; Center for Molecular Medicine, Karolinska University Hospital Solna, Stockholm, Sweden
| | - Guillaume Paré
- Department of Clinical Epidemiology & Biostatistics, McMaster University, Hamilton, Ontario, Canada; Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, Ontario, Canada; Department of Pathology and Molecular Medicine, McMaster University, Hamilton, Ontario, Canada; Genetic and Molecular Epidemiology Laboratory, McMaster University, Hamilton, Ontario, Canada
| | - Aroon D Hingorani
- Faculty of Population Health Sciences, University College London, London, United Kingdom; Centre for Clinical Pharmacology, Division of Medicine, University College London, London, United Kingdom
| | - Marc S Sabatine
- TIMI Study Group, Divison of Cardiovascular Medicine, Brigham and Women's Hospital & Harvard Medical School, Boston, Massachusetts
| | - Ziad Mallat
- Inserm U970, Paris-Cardiovascular Research Center, Paris, France; Division of Cardiovascular Medicine, University of Cambridge, Addenbrooke's Hospital, Cambridge, United Kingdom
| | - Juan P Casas
- Faculty of Population Health Sciences, University College London, London, United Kingdom; Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, United Kingdom.
| | - Philippa J Talmud
- Centre for Cardiovascular Genetics, Institute of Cardiovascular Science, University College London, London, United Kingdom
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Horne BD, Muhlestein JB, Lappé DL, May HT, Carlquist JF, Galenko O, Brunisholz KD, Anderson JL. Randomized cross-over trial of short-term water-only fasting: metabolic and cardiovascular consequences. Nutr Metab Cardiovasc Dis 2013; 23:1050-1057. [PMID: 23220077 DOI: 10.1016/j.numecd.2012.09.007] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2012] [Revised: 09/27/2012] [Accepted: 09/30/2012] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND AIMS Routine, periodic fasting is associated with a lower prevalence of coronary artery disease (CAD). Animal studies show that fasting may increase longevity and alter biological parameters related to longevity. We evaluated whether fasting initiates acute changes in biomarker expression in humans that may impact short- and long-term health. METHODS AND RESULTS Apparently-healthy volunteers (N = 30) without a recent history of fasting were enrolled in a randomized cross-over trial. A one-day water-only fast was the intervention and changes in biomarkers were the study endpoints. Bonferroni correction required p ≤ 0.00167 for significance (p < 0.05 was a trend that was only suggestively significant). The one-day fasting intervention acutely increased human growth hormone (p = 1.1 × 10⁻⁴), hemoglobin (p = 4.8 × 10⁻⁷), red blood cell count (p = 2.5 × 10⁻⁶), hematocrit (p = 3.0 × 10⁻⁶), total cholesterol (p = 5.8 × 10⁻⁵), and high-density lipoprotein cholesterol (p = 0.0015), and decreased triglycerides (p = 1.3 × 10⁻⁴), bicarbonate (p = 3.9 × 10⁻⁴), and weight (p = 1.0 × 10⁻⁷), compared to a day of usual eating. For those randomized to fast the first day (n = 16), most factors including human growth hormone and cholesterol returned to baseline after the full 48 h, with the exception of weight (p = 2.5 × 10⁻⁴) and (suggestively significant) triglycerides (p = 0.028). CONCLUSION Fasting induced acute changes in biomarkers of metabolic, cardiovascular, and general health. The long-term consequences of these short-term changes are unknown but repeated episodes of periodic short-term fasting should be evaluated as a preventive treatment with the potential to reduce metabolic disease risk. Clinical trial registration (ClinicalTrials.gov): NCT01059760 (Expression of Longevity Genes in Response to Extended Fasting [The Fasting and Expression of Longevity Genes during Food abstinence {FEELGOOD} Trial]).
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Affiliation(s)
- B D Horne
- Intermountain Heart Institute, Intermountain Medical Center, Salt Lake City, UT, USA; Genetic Epidemiology Division, Department of Medicine, University of Utah, Salt Lake City, UT, USA.
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Horne BD, Lappé DL, Muhlestein JB, May HT, Ronnow BS, Brunisholz KD, Kfoury AG, Bunch TJ, Alharethi R, Budge D, Whisenant BK, Bair TL, Jensen KR, Anderson JL. Repeated measurement of the intermountain risk score enhances prognostication for mortality. PLoS One 2013; 8:e69160. [PMID: 23874899 PMCID: PMC3714235 DOI: 10.1371/journal.pone.0069160] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2012] [Accepted: 06/12/2013] [Indexed: 11/24/2022] Open
Abstract
Background The Intermountain Risk Score (IMRS), composed of the complete blood count (CBC) and basic metabolic profile (BMP), predicts mortality and morbidity in medical and general populations. Whether longitudinal repeated measurement of IMRS is useful for prognostication is an important question for its clinical applicability. Methods Females (N = 5,698) and males (N = 5,437) with CBC and BMP panels measured 6 months to 2.0 years apart (mean 1.0 year) had baseline and follow-up IMRS computed. Survival analysis during 4.0±2.5 years (maximum 10 years) evaluated mortality (females: n = 1,255 deaths; males: n = 1,164 deaths) and incident major events (myocardial infarction, heart failure [HF], and stroke). Results Both baseline and follow-up IMRS (categorized as high-risk vs. low-risk) were independently associated with mortality (all p<0.001) in bivariable models. For females, follow-up IMRS had hazard ratio (HR) = 5.23 (95% confidence interval [CI] = 4.11, 6.64) and baseline IMRS had HR = 3.66 (CI = 2.94, 4.55). Among males, follow-up IMRS had HR = 4.28 (CI = 3.51, 5.22) and baseline IMRS had HR = 2.32 (CI = 1.91, 2.82). IMRS components such as RDW, measured at both time points, also predicted mortality. Baseline and follow-up IMRS strongly predicted incident HF in both genders. Conclusions Repeated measurement of IMRS at baseline and at about one year of follow-up were independently prognostic for mortality and incident HF among initially hospitalized patients. RDW and other CBC and BMP values were also predictive of outcomes. Further research should evaluate the utility of IMRS as a tool for clinical risk adjustment.
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Affiliation(s)
- Benjamin D Horne
- Intermountain Heart Institute, Intermountain Medical Center, Salt Lake City, Utah, USA.
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Januzzi JL, Horne BD, Moore SA, Galenko O, Snow GL, Brunisholz KD, Muhlestein JB, Alharethi R, Carlquist JF, Budge D, Rasmussen K, Kfoury AG. Interleukin receptor family member ST2 concentrations in patients following heart transplantation. Biomarkers 2013; 18:250-6. [DOI: 10.3109/1354750x.2013.773081] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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Horne BD, Muhlestein JB, Lappé DL, Brunisholz KD, May HT, Kfoury AG, Carlquist JF, Alharethi R, Budge D, Whisenant BK, Bunch TJ, Ronnow BS, Rasmusson KD, Bair TL, Jensen KR, Anderson JL. The intermountain risk score predicts incremental age-specific long-term survival and life expectancy. Transl Res 2011; 158:307-14. [PMID: 22005271 DOI: 10.1016/j.trsl.2011.06.004] [Citation(s) in RCA: 9] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2011] [Revised: 06/02/2011] [Accepted: 06/05/2011] [Indexed: 10/18/2022]
Abstract
The Intermountain Risk Score (IMRS) encapsulates the mortality risk information from all components of the complete blood count (CBC) and basic metabolic profile (BMP), along with age. To individualize the IMRS more clearly, this study evaluated whether IMRS weightings for 1-year mortality predict age-specific survival over more than a decade of follow-up. Sex-specific 1-year IMRS values were calculated for general medical patients with CBC and BMP laboratory tests drawn during 1999-2005. The population was divided randomly 60% (N = 71,921, examination sample) and 40% (N = 47,458, validation sample). Age-specific risk thresholds were established, and both survival and life expectancy were compared across low-, moderate-, and high-risk IMRS categories. During 7.3 ± 1.8 years of follow-up (range, 4.5-11.1 years), the average IMRS of decedents was higher than censored in all age/sex strata (all P < 0.001). For examination and validation samples, every age stratum had incrementally lower survival for higher risk IMRS, with hazard ratios of 2.5-8.5 (P < 0.001). Life expectancies were also significantly shorter for higher risk IMRS (all P < 0.001): For example, among 50-59 year-olds, life expectancy was 7.5, 6.8, and 5.9 years for women with low-, moderate-, and high-risk IMRS (with mortality in 5.7%, 16.3%, and 37.0% of patients, respectively). In Men, life expectancy was 7.3, 6.8, and 5.4 for low-, moderate-, and high-risk IMRS (with patients having 7.3%, 19.5%, and 40.0% mortality), respectively. IMRS significantly stratified survival and life expectancy within age-defined subgroups during more than a decade of follow-up. IMRS may be used to stratify age-specific risk of mortality in research, clinical/preventive, and quality improvement applications. A web calculator is located at http://intermountainhealthcare.org/IMRS.
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Affiliation(s)
- Benjamin D Horne
- Cardiovascular Department, Intermountain Medical Center, Salt Lake City, Utah, USA.
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Galenko O, Panahi S, Gunter S, Brunisholz KD, Horne BD, Carlquist J, Anderson JL. Circulating microRNA Patterns in Ischemic and Idiopathic Heart Failure. J Card Fail 2011. [DOI: 10.1016/j.cardfail.2011.06.113] [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: 10/17/2022]
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Brunisholz KD, Horne BD, James R, Balling KD, Rasmusson KD, Budge D, Alharethi R, Nelson DP, Tuinei JM, Kfoury AG. The Intermountain Risk Score Stratifies Mortality Risk in Heart Failure Patients Receiving an ICD Based on Pre-Implant Laboratory Values. J Card Fail 2011. [DOI: 10.1016/j.cardfail.2011.06.248] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Horne BD, Rasmusson KD, Alharethi R, Budge D, Brunisholz KD, Metz T, Carlquist JF, Connolly JJ, Porter TF, Lappé DL, Muhlestein JB, Silver R, Stehlik J, Park JJ, May HT, Bair TL, Anderson JL, Renlund DG, Kfoury AG. Genome-wide significance and replication of the chromosome 12p11.22 locus near the PTHLH gene for peripartum cardiomyopathy. ACTA ACUST UNITED AC 2011; 4:359-66. [PMID: 21665988 DOI: 10.1161/circgenetics.110.959205] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.2] [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]
Abstract
BACKGROUND Peripartum (PP) cardiomyopathy (CM) is a rare condition of unknown etiology that occurs in late pregnancy or early postpartum. Initial evidence suggests that genetic factors may influence PPCM. This study evaluated and replicated genome-wide association of single nucleotide polymorphisms with PPCM. METHODS AND RESULTS Genome-wide single nucleotide polymorphisms in women with verified PPCM diagnosis (n=41) were compared separately with local control subjects (n=49 postmenopausal age-discordant women with parity ≥1 and no heart failure) and iControls (n=654 women ages 30 to 84 years with unknown phenotypes). A replication study of independent population samples used new cases (PPCM2, n=30) compared with new age-discordant control subjects (local2, n=124) and with younger control subjects (n=89) and obstetric control subjects (n=90). A third case set of pregnancy-associated CM cases not meeting strict PPCM definitions (n=29) was also studied. In the genome-wide association study, 1 single nucleotide polymorphism (rs258415) met genome-wide significance for PPCM versus local control subjects (P=2.06×10(-8); odds ratio [OR], 5.96). This was verified versus iControls (P=7.92×10(-19); OR, 8.52). In the replication study for PPCM2 cases, rs258415 (ORs are per C allele) replicated at P=0.009 versus local2 control subjects (OR, 2.26). This replication was verified for PPCM2 versus younger control subjects (P=0.029; OR, 2.15) and versus obstetric control subjects (P=0.013; OR, 2.44). In pregnancy-associated cardiomyopathy cases, rs258415 had a similar effect versus local2 control subjects (P=0.06; OR, 1.79), younger control subjects (P=0.14; OR, 1.65), and obstetric control subjects (P=0.038; OR, 1.99). CONCLUSIONS Genome-wide association with PPCM was discovered and replicated for rs258415 at chromosome 12p11.22 near PTHLH. This study indicates a role of genetic factors in PPCM and provides a new locus for further pathophysiological and clinical investigation.
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Affiliation(s)
- Benjamin D Horne
- Cardiovascular Department, Intermountain Medical Center, Genetic Epidemiology Division, University of Utah, USA.
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Horne BD, Rasmusson KD, Alharethi R, Budge D, Brunisholz KD, Carlquist JF, Connolly JJ, Porter TF, Park JJ, Lappe' DL, Muhlestein JB, May HT, Bair TL, Anderson JL, Renlund DG, Kfoury AG. Replication of Genome-Wide Association of the PTHLH-KLHDC5 Locus with Peripartum Cardiomyopathy. J Card Fail 2010. [DOI: 10.1016/j.cardfail.2010.06.133] [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: 11/30/2022]
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