Introduction Insight into the characteristics of populations from which research samples are drawn is essential to understanding the generalizability of research findings. This study characterizes ...the membership of Kaiser Permanente and compares members to the population of the communities in which they live. Methods This study is a descriptive comparison of population distributions for Kaiser Permanente members vs the general population within counties in which Kaiser Permanente operates. Kaiser Permanente data on demographics, membership, geographically linked census data, and chronic condition prevalence were compared with community data drawn from the US Census and the Behavioral Risk Factor Surveillance System. Results Overall, Kaiser Permanente members were older (50% aged 40 or older compared to 45.8% of the general population) and more likely to be female (51.8% vs 50.5% of the general population). Distribution by race and ethnicity was similar for all Regions combined but varied somewhat within Regions. Distribution by neighborhood-linked income, education, and social vulnerability was similar between Kaiser Permanente and the community. Prevalence of 6 of 7 chronic conditions was higher in the community than in Kaiser Permanente, with differences ranging from 0.5% for depression to 7.7% for hyperlipidemia. Conclusion The demographic characteristics of Kaiser Permanente members are similar to the general population within each of the Kaiser Permanente Regions. Overall, the size and diversity of the Kaiser Permanente membership offers an effective platform for research. This approach to comparing health system members with the larger community provides valuable context for interpreting real-world evidence, including understanding the generalizability of research and of measures of system performance.
Background
The primary high‐risk human papillomavirus (hrHPV) assays in the United States are the cobas (Roche) and the Aptima (Hologic). The cobas assay detects hrHPV by DNA analysis while the ...Aptima detects messenger RNA (mRNA) oncogenic transcripts. As the Aptima assay identifies oncogenic expression, it should have a lower rate of hrHPV and genotype detection.
Methods
The Kaiser Permanente Regional Reference Laboratory in Denver, Colorado changed its hrHPV assay from the cobas to the Aptima assay. The rates of hrHPV detection and genotyping were compared over successive six‐month periods.
Results
The overall hrHPV detection rates by the two platforms were similar (9.5% versus 9.1%) and not statistically different. For genotyping, the HPV 16 rate by the cobas was 1.6% and by the Aptima it was 1.1%. These differences were statistically different with the Aptima detecting nearly one‐third less HPV 16 infections. With the HPV 18 and HPV 18/45, there was a slightly higher detection rate of HPV 18/45 by the Aptima platform (0.5% versus 0.9%) and this was statistically significant.
Conclusion
While HPV 16 represents a low percentage of hrHPV infections, it was detected significantly less by the Aptima assay compared to the cobas assay. This has been previously reported, although not highlighted. Given the test methodologies, one would expect the Aptima to detect less HPV 16. This difference appears to be mainly due to a significantly increased number of non‐oncogenic HPV 16 infections detected by the cobas test as there were no differences in HPV 16 detection rates in the high‐grade squamous intraepithelial lesions indicating that the two tests have similar sensitivities for oncogenic HPV 16.
Background
The Patient Assessment of Chronic Illness Care (PACIC) has potential for use as a patient-centered measure of the implementation of the Chronic Care Model (CCM), but there is little ...research on the relationship between the PACIC and important behavioral and quality measures for patients with chronic conditions.
Objective
To examine the relationship between PACIC scores and self-management behaviors, patient rating of their health care, and self-reported quality of life.
Design
Cross-sectional survey with a 61% response rate.
Participants
Included in the survey were 4,108 adults with diabetes, chronic pain, heart failure, asthma, or coronary artery disease in the Kaiser Permanente Medical Care program across 7 regions nationally.
Measurements
The PACIC was the main independent variable. Dependent variables included use of self-management resources, self-management behaviors such as regular exercise, self-reported adherence to medications, patient rating of their health care, and quality of life.
Results
PACIC scores were significantly, positively associated with all measures (odds ratio ORs ranging from 1.20 to 2.36) with the exception of self-reported medication adherence.
Conclusions
Use of the PACIC, a practical, patient-level assessment of CCM implementation, could be an important tool for health systems and other stakeholders looking to improve the quality of chronic disease care.
We examined the patient activation measure's (PAM's) association with process and health outcomes among adults with chronic conditions. Patients with high PAM scores were significantly more likely to ...perform self-management behaviors, use self-management services, and report high medication adherence, compared to patients with the lowest PAM scores. This population was 10 times more likely to report high patient-satisfaction scores, 5 times more likely to report high quality-of-life scores, and reported significantly higher physical and mental functional status scores, compared to those with the lowest scores. These results suggest that PAM scores are associated with key process and health outcome measures.
HIV care cascades can evaluate programmatic success over time. However, methodologies for estimating cascade stages vary, and few have evaluated differences by demographic subgroups. We examined ...cascade performance over time and by age, sex, and race/ethnicity in Kaiser Permanente, providing HIV care in eight US states and Washington, DC. We created cascades for HIV+ members' age ≥13 for 2010-2012. We measured "linkage" (a visit/CD4 within 90 days of being diagnosed for new patients; ≥1 medical visit/year if established); "retention" (≥2 medical visits ≥60 days apart); filled ART (filled ≥3 months of combination ART); and viral suppression (HIV RNA <200 copies/mL last measured in year). The cascades were stratified by calendar year, sex, age, and race/ethnicity. We found men had statistically (p < 0.05) higher percent linkage, filled ART, and viral suppression for 2010 and 2011 but not for 2012. Women had significantly greater retention for all years. Annually, older age was associated (p < 0.05) with retention, filled ART, and viral suppression but not linkage. Latinos had greater (p < 0.05) retention than whites or blacks in all years, with similar retention comparing blacks and whites. Filled ART and viral suppression was increased (p < 0.05) for whites compared with all racial/ethnic groups in all years. Cascade methodology requiring success at upstream stages before measuring success at later stages (i.e., "dependent" methodology) underreported performance by up to 20% compared with evaluating each stage separately ("independent"). Thus, care results improved over time, but significant differences exist by patient demographics. Specifically, retention efforts should be targeted toward younger patients and blacks; women, blacks, and Latinos require greater ART prescribing.
We examined the relationship between the patient activation measure (PAM) and future diabetes-related health outcomes through retrospective analysis of secondary data using multivariate logistic ...regression. PAM scores from a 2004 survey on 1180 randomly sampled adults with diabetes and health information from a 2006 diabetes registry were the data sources used. The PAM was predictive for hemoglobin A1c (HgA1c) testing (P < .008), low-density lipoprotein cholesterol (LDL-C) testing (P < .005), HgA1c control (P < .01), and all-cause discharges (P < .03), but not for lipid-lowering drug use, LDL-C control, or acute myocardial infarction discharges. These results suggest that PAM scores can be used to identify patients at risk for poorer health outcomes.
HIV quality performance measurements are critical to evaluating a care program's success in areas of testing, access to and retention in care, care processes and outcomes. Kaiser Permanente (KP) ...provides care to over 8 million Americans and over 19,000 HIV-infected adults. We undertook a quality performance measurement program to assess the care and outcomes for our HIV-positive patient population. We also examined HIV testing practices among our HIV-uninfected patients presenting with a sexually transmitted infection. Our metrics were extracted electronically (encompassing two time periods: July 1, 2005 through June 30, 2006 and the entire calendar year 2007) and did not require any manual data extraction, which was a primary objective of our strategy. For most individual care measures, improvement over time was noted, with 85% or more performance seen on some measures (accessing care and initiating antiretroviral therapy). Opportunities for improvement were identified on other measures, such as diagnosing HIV at an earlier stage of infection, and more consistent Pneumocystis jiroveci pneumonia prophylaxis. Over 90% of our patients on antiretroviral therapy had maximal viral control, along with high median antiretroviral medication adherence. Our results compare favorably to those of other organizations, with a KP HIV mortality rate less than 50% of the overall U.S. rate. These results have implications for improving our care process going forward, as well as for the new U.S. domestic HIV/AIDS Strategy.
We review what is known about the effects of obesity in the Kaiser Permanente (KP) population and discuss outcomes for two nationally available effective online programs, HealthMedia Balance(®) ...(Balance) and 10,000 Steps(®). Obese KP patients often have health problems related to overweight and report difficulties with self-care, yet with the proper support, they can avail themselves of effective treatment to manage both obesity and associated conditions that affect quality of life. Clinicians should be aware of potential problems with functional status and self-care in their obese patients, provide brief assessment and advice, and refer obese patients to effective national and regional weight-management programs.
People with diabetes need to be involved in their care while navigating a health care system unsupportive of an activated patient. Patient activation, or one's knowledge, beliefs, motivation, and ...actions for self care, has its roots in health behavior theories and is a core concept in chronic care models. However, little is known of the relationship between patient activation and future health even though this would be valuable information for health care providers and patients. This study addressed the relationship between patient activation, measured by the patient activation measure (PAM), and the health of people with diabetes. The 22 item PAM assesses one's level of activation, and previous research revealed that individuals with higher PAM scores had better immediate health outcomes. This epidemiological study examined the relationship between the PAM and future health through retrospective analysis of secondary data, including PAM scores from a 2004 survey on 1,180 randomly sampled adults with diabetes and health information from a 2006 diabetes registry. Multivariate logistic regression was used to investigate the relationship between PAM scores and diabetes related clinical health outcomes. The hypothesis for the study was that there would be a positive relationship between PAM scores and future health. This model was supported for HbA1c testing (p<.008), LDL-c testing (p<.005), HbA1c control (p<.01), and all cause discharges (p<.03), but not for lipid lowering drug use, LDL-c control, or AMI discharges. The conclusion was that improved health is not short lived, but is sustained for 18 to 24 months. The social change implications include improving the health and well being of people with diabetes through increased attention to the benefits of supporting an activated, involved patient and reducing the disease's burden and cost for society.
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